1Waseem Wahood, 2Jacob McPhee, 2Brian Baigorri, 2Martin Radvany
1Dr.Kiran C. Patel College of Allopathic Medicine, 2Aventura Hospital & Medical Center
Patients with abdominal aortic aneurysms who undergo failure of endovascular aneurysm repair and conversion to open aortic repair (EVAR-c) have a higher 30-day mortality than those treated with open repair alone. The purpose of this study was to identify patients at risk for EVAR-c.
Material(s) and Method(s):
The National Surgical Quality Improvement Project Vascular-targeted database was queried from 2011 to 2019 for EVAR patients. Patient demographics were analyzed between EVAR and EVAR-c groups using chi-square and student t-tests. Multivariable logistic regression was conducted for risk factor assessment.
18,387 underwent EVAR and 146 underwent EVAR-c. There was no statistical difference in age (p=0.47), gender (p=0.32), race (p=0.75) or BMI (p=0.61). The average aneurysm diameter was 5.83 cm (SD=1.69) in the EVAR group, and 6.43 cm (SD=1.65) in the EVAR-c group (p<0.001). Aneurysm diameter (OR: 1.07 per 1 cm increase; 95% CI: 1.01 to 1.14; p<0.001), distal extension involving the common iliac (OR: 2.38, 95% CI: 1.43-3.98, p=0.001), and distal extension inferior to the common iliac (OR: 2.40; 95% CI: 1.24-4.63; p=0.009) were associated with higher odds of EVAR-c.
This study suggests that aneurysm morphology plays a dominant and important role when predicting patients who are at risk for failure of endovascular therapy. These results may help guide patient selection for interventional radiologists.