Novel Risk Score Calculator For Operative Mortality After Evar: Incorporation Of Aortic Neck Anatomy Factors
Asma Mathlouthi, M.D, Hanaa Dakour-Aridi, M.D, Omar Al-Nouri, M.D, Mahmoud B. Malas, M.D, M.H.S.
University of California, San Diego, San Diego, CA, USA.
OBJECTIVES: Hostile proximal aortic neck anatomy has been associated with increased risk of operative mortality after endovascular aneurysm repair (EVAR). However, all available mortality risk prediction models after EVAR lack anatomic predictors. The aim of this study is to develop a preoperative prediction model for operative mortality after EVAR incorporating important anatomic factors
METHODS: Data were obtained from the Vascular Quality Initiative database on all patients who underwent EVAR between January 2015 and December 2018. Stepwise multivariable logistic regression analysis was implemented to identify independent predictors and develop a risk calculator for operative mortality after EVAR. Internal validation was done using bootstrap of 1000 reps.
RESULTS: A total of 26,740 patients were included, of whom 2.4% (N=646) died within 30 days or before discharge. Significant preoperative predictors of operative mortality were age (odds ratio [OR], 1.03; 95% CI, 1.02-1.05; P<0.001), female gender (OR, 1.6; 95% CI, 1.2-2.1; P=0.002), chronic kidney disease (OR, 2.5; 95% CI, 1.9-3.3; P<0.001), chronic obstructive pulmonary disease (OR, 1.3; 95% CI, 1.02-1.8; P=0.03), congestive heart failure (OR, 1.5; 95% CI, 1.04-2, P=0.02), aspirin use (OR, 0.6; 95% CI, 0.5-0.8; P=0.001), statin intake (OR, 0.7; 95% CI, 0.6-0.97; P=0.03), aneurysm diameter ≥ 6.5cm (OR, 5; 95% CI, 3.8-6.6, P<0.001), proximal neck length< 10mm (OR, 1.9; 95% CI, 1.2-3; P=0.006), proximal neck diameter ≥30mm (OR, 1.7; 95% CI, 1.2-2.3; P=0.004) and infrarenal neck angulation >60° (OR, 1.5; 95% CI, 1.003-2.13; P=0.002) (Table1). These predictors were incorporated to build an interactive risk calculator of operative mortality after EVAR (C-statistic=0.798) (Table1; Table2).
CONCLUSIONS: This study provides the first prediction model incorporating anatomic predictors for mortality following EVAR. The risk calculator can be used to weigh risk/benefit ratio when counseling patients preoperatively. Identifying high-operative-risk asymptomatic patients with low rupture risk might guide toward conservative management and follow-up. 
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