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Symptomatic Presentation For Complex Aortic Aneurysms Is Associated With Increased Mortality When Compared With Asymptomatic Patients
Rahul Ghosh, MS1, Kirsten D. Dansey, MD, MPH
1, Lily H. Wang, MS
2, Xuehan Ci
2, Thu Vu, MS
2, Thomas FX O’Donnell, MD
3, Grace J. Wang, MD
4, Marc L. Schermerhorn, MD
5, Sara L. Zettervall, MD, MPH
1.
1University of Washington, Seattle, WA, USA,
2Department of Biostatistics, University of Washington, Seattle, WA, USA,
3Columbia University Irving Medical Center, New York City, NY, USA,
4Hospital of the University of Pennsylvania, Philadelphia, PA, USA,
5Beth Israel Deaconess Medical Center, Boston, MA, USA.
OBJECTIVES: Patients treated for symptomatic infrarenal aneurysms have worse outcomes compared to those treated electively, however this has not been quantified in patients with juxtrarenal and thoracoabdominal aneurysms. This study assesses outcomes patients who undergo endovascular repair for symptomatic and asymptomatic complex aortic aneurysms.
METHODS: All patients who underwent complex aortic repairs in the VQI were included. Symptomatic patients presented with non-ruptured aneurysms and underwent repair within 48 hours of pain on presentation. Patient demographics, comorbidities, operative details and outcomes were compared.
RESULTS: Of the 3757 patients, 442 were symptomatic. These patients were younger (71 vs 74 p<0.001) more commonly female (40% vs 24%, p<0.001), less likely to be white (71% vs 84%, p<0.001), and more likely to have a prior aneurysm repair (3.6% vs 2.7%, p<0.001). Symptomatic patients were repaired at larger aneurysm diameters (66 vs 61, p<0.001), more commonly had dissection (8.4% vs 1.1%, p<0.001), and more frequently had a thoracoabdominal aneurysm (vs juxtarenal) (41% vs 21%, p<0.001). Symptomatic patients had higher in-hospital mortality (6% vs 2%, p<0.001), more reinterventions (12% vs 6%, p<0.001), increased dialysis (5.0% vs 1.9%, p<.0001 ), and more spinal cord ischemia (8% vs 3%, p<0.001) which persisted after adjustment (figure 1). The increased mortality rates among symptomatic patients also persisted following adjustment (HR 1.8;95%CI:1.4-2.4).
CONCLUSIONS: Patients who underwent complex endovascular repair for symptomatic aneurysms were had worse long term outcomes including increased mortality even when adjusting for baseline differences. These symptomatic patients were more commonly, women, persons of color and younger patients but presented with more aggressive disease with more thoracoabdominal aneurysms and larger diameters. These results represent an unmet need in the community and may be mitigated by earlier intervention and access to care.
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