OUTCOMES OF FAMILIAL ABDOMINAL AORTIC ANEURYSM REPAIR IN THE VASCULAR QUALITY INITIATIVE
Yi Zhou, M.D.1, Evan J. Ryer, M.D.1, Robert P. Garvin, M.D.1, Ksenia Orlova, M.D.1, Grace J. Wang, M.D.2, Wen Feng, M.S.1, James R. Elmore, M.D.1.
1Geisinger Medical Center, Danville, PA, USA, 2Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
OBJECTIVES: Recent investigations have reported increased rates of aneurysm related complications after endovascular aneurysm repair (EVAR) in familial abdominal aortic aneurysm (fAAA) patients. The purpose of this study is to evaluate the outcomes of open AAA repair and EVAR in sporadic (spAAA) and fAAA patients in the Vascular Quality Initiative (VQI). METHODS: Retrospective review of all AAA repairs in the VQI from 2002 to 2015. Patient data were summarized and standard statistical analysis performed. Patients with known genetic syndromes and centers with long-term follow-up in fewer than 50% patients were excluded. RESULTS: 1585 fAAA patients underwent repair from 2002 to 2015 and were compared to 12,886 spAAA patients undergoing repair during the same study period. When compared to their spAAA counterparts, fAAA patients were younger (p<0.0001), more likely to be living at home prior to their surgery (p=0.0076) and demonstrated a lower incidence of end stage renal disease (p=.003). Rates of CAD, HTN and smoking did not differ between groups. fAAA patients were also more likely to have aneurysmal degeneration of their iliac arteries (29% vs 25%, p<.0001) and to undergo open AAA repair (29% vs 23%, p<.0001). When examining outcomes following open AAA repair, we found that fAAA patients appear to be at decreased risk for transfusion > 3 units (16 vs 23%, p=0.001), acute changes in renal function (10% vs 16%, p=0.0065) and post-operative stroke (0.4 vs 1%, p=0.007). The incidence of late complications following open repair did not differ between the groups. When examining fAAA patients who underwent EVAR (n=1130), we found no difference in the overall early morbidity (p=0.865), the use of adjunctive procedures or the rate of endoleak (p=0.21). Furthermore, fAAA patients undergoing EVAR did not incur more complications, re-interventions or endoleak at 1-year follow-up. Lastly, the majority of endoleaks seen in fAAA patients undergoing EVAR were type II endoleaks that did not require treatment. CONCLUSIONS: The current study shows that patients with a familial form of AAA do not have increased morbidity following AAA repair and do not develop more short-term aneurysm related complications following EVAR. Our findings suggest that EVAR and open AAA repair are both safe and effective for fAAA patients. Further studies with longer follow-up are needed to best care for this unique patient cohort.
Back to 2017 ePosters
