Life-altering Events Following Endovascular Aortic Repair In The Society For Vascular Surgery Vascular Quality Initiative
Priya B. Patel, MD MPH, Christina L. Marcaccio, MD MPH, Livia de Guerre, Nicholas Swerdlow, MD, Thomas F.X. O'Donnell, MD, Virendra I. Patel, MD MPH, Sara Zettervall, MD, Marc L. Schermerhorn, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
OBJECTIVES: Endovascular aortic aneurysm repair is associated with improved outcomes compared with open repair. However, endovascular repair still caries risk of postoperative morbidity and mortality. Therefore, we examined the rate of thoracoabdominal aortic aneurysm life-altering events (TALE) after endovascular repair for all aortic aneurysms within the VQI. METHODS: We identified all patients who underwent infrarenal EVAR, complex EVAR, and TEVAR within the VQI registry between 2014-2020. TALE was defined as a composite endpoint of new post-operative dialysis, paralysis, stroke, and/or mortality. Mixed-effects multivariable logistic regression modeling with clustering at center level was used to identify procedural and anatomic factors associated with TALE after endovascular aortic aneurysm repair.
RESULTS: We identified 46246 infrarenal EVARs, 2753 complex EVARs, and 5211 TEVARs. Among elective repairs TALE occurred more frequently following TEVAR (EVAR: 1.2%, complex EVAR:6.0%, TEVAR: 9.6%; P<.001). (Figure) Among infrarenal EVARs, aortic diameter ≥6.5cm at the time of repair was associated with higher odds of TALE (OR: 1.9; 95%CI [1.5-2.4]), as was more proximal extension of disease (OR: 1.4[1.1-1.7]). Among complex EVARs adjuvant left arm access when compared with no arm access was associated with higher odds of TALE (OR: 1.8[1.2-2.7]), as was proximal landing zone at or cephalad to zone 6 (OR: 1.5[1.0-2.2]). Among TEVARs left subclavian artery bypass when compared with no intervention was associated with higher odds of TALE (OR: 1.6[1.0-2.7]). CONCLUSIONS: TALE occurred more frequently following TEVAR and complex EVAR when compared with infrarenal EVAR. Overall, more complex and more proximal repairs, as well as repairs that involve increased wire manipulation in the aortic arch were associated with higher risk of TALE. Aortic anatomy and anticipated procedural characteristics should be considered and factored into clinical decision-making prior to repair. 
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