Fenestrated Endovascular Repair is superior to Open Repair of Abdominal Aortic Aneurysms involving Visceral Vessels
Prateek K. Gupta, MD1, Reshma Brahmbhatt, MD1, Kelly Kempe, MD1, Himani Gupta, MD2, Shaun M. Stickley, MD1, Michael J. Rohrer, MD1.
1University of Tennessee Health Science Center, Memphis, TN, USA, 2Methodist Primary Care Group, Memphis, TN, USA.
Objectives: While few studies have reported outcomes after fenestrated or branched endovascular repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-V), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs.
Methods: Patients who underwent FEVAR (n=535) and OS (n=1207) for elective AAA-Vs were identified from the ACS NSQIP 2008-13 database. All thoracoabdominal aneurysms were excluded. Univariable and multivariable logistic regression analyses were performed.
Results: There were more men (82% vs 72%; P<.0001), diabetics (16% vs 11%; P=.005), patients with dependent functional status (4% vs 2%; P=.002), and non-smokers (70% vs 56%; P<.0001) in the FEVAR group vs OS. There was no difference in rates of COPD, cardiac history, PAD, hypertension, and dialysis (P>.05). FEVAR had less major postoperative pulmonary complications (3.0% vs 19.0%; P<.0001), renal failure needing dialysis (1.9% vs 6.4%; P<.0001), cardiac arrest or myocardial infarction (2.2% vs 5.8%; P= .001), bleeding with major transfusion (17.4% vs 50.2%; P< .0001), return to OR (4.5% vs 9.6%; P<.0001), and death (2.1% vs 5.3%; P=.002). On multivariable analyses, OS was associated with higher risk than FEVAR for 30-day death (OR 2.4; 95%CI 1.2-4.7); pulmonary complications (OR 8.8; 95%CI 5.1-15.0); cardiac complications (OR 3.4; 95% CI 1.8-6.6), renal failure needing dialysis (OR 3.8; 95%CI 1.9-7.7), and return to OR (OR 2.5; 95%CI 1.6-4.0).
Conclusions: FEVAR is associated with lower risk for 30-day mortality and adverse events in comparison to open repair for abdominal aortic aneurysms involving visceral vessels.
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