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Racial Inequities Exist In Outcomes Following Endovascular Repair Of Complex Aortic Aneurysms
Whitney L. Teagle, BA1, Hanyi Wang, MS
1, Xuehan Ci, MS
1, Thu Vu, MS
1, Marc Schermerhorn, MD
2, Thomas F. O'Donnell, MD
3, Elina Quiroga, MD, MPH
1, Kirsten D. Dansey, MD, MPH
1, Sara L. Zettervall, MD, MPH
1.
1University of Washington, Seattle, WA, USA,
2Beth Israel Deaconess Medical Center, Boston, MA, USA,
3Columbia University, New York, NY, USA.
OBJECTIVES: Prior studies have found disparities in outcomes by race following repair of abdominal aortic aneurysms. However, little is known about the disparities in outcomes following endovascular repair of complex abdominal aortic aneurysms (cAAA), including juxtarenal and thoracoabdominal aneurysms. This study aims to assess differences in presentation and outcomes by race following endovascular repair of cAAA.
METHODS: All patients with cAAA treated in the Vascular Quality Initiative database from 2010-2022 were included. Demographics, comorbidities, and operative details were compared by race. Perioperative outcomes and long-term survival were then assessed using univariable and adjusted analysis.
RESULTS: 4389 patients were treated for cAAA. This included 2% of patients who identified as Asian, 9% Black/African American, 4% Hispanic/Latino, and 85% White. Age, sex, COPD, CHF, diabetes, and baseline creatinine differed by race (all p<0.01). The frequency of patients presenting symptomatic and ruptured differed, as well as the frequency of thoracoabdominal versus juxtarenal aneurysms (all p<0.01). Thirty-day survival differed by race (p=0.008); however, this did not persist after adjustment for comorbidities, symptom status, and aneurysm extent. There were no differences in long-term survival. There were differences in rates of prolonged length of stay, endoleak at case completion, and post-operative dialysis (Table 1). After adjustment, only respiratory complications differed by race. Long-term interventions also differed by race in both univariate and adjusted analysis (Figure 1).
CONCLUSIONS: Thirty-day mortality differs by racial grouping; however, this is driven by higher rates of symptomatic and ruptured presentation, as well as varying aneurysm extent among racial groups at presentation. Efforts to improve screening and access to care may provide an opportunity to address disparity and survival after treatment for cAAA.
Outcomes following endovascular repair of complex aortic aneurysms by race| Outcome | Asian(N = 107) | Black or AA (N = 378) | Hispanic/Latino (N = 174) | White (N = 3730) | P-Value |
| 30-Day Survival | 35 (33%) | 85 (23%) | 51 (29%) | 816 (22%) | 0.008 |
| Cardiac Complication | 9 (8.4%) | 38 (10.1%) | 22 (13%) | 392 (11%) | 0.699 |
| Respiratory Complication | 3 (2.8%) | 15 (4.0%) | 4 (2.3%) | 197 (5.3%) | 0.155 |
| Dialysis | 5 (4.7%) | 12 (3.2%) | 7 (4.0%) | 76 (2.0%) | 0.046 |
| Intestinal Ischemia | 2 (1.9%) | 6 (1.6%) | 3 (1.7%) | 70 (1.9%) | 0.982 |
| No Endoleak at Completion | 58 (54%) | 238 (63%) | 113 (65%) | 2379 (64%) | 0.028 |
| Stroke | 3 (2.8%) | 10 (2.6%) | 4 (2.3%) | 50 (1.3%) | 0.119 |
| Re-Intervention | 13 (12%) | 27 (7.1%) | 15 (8.6%) | 244 (6.5%) | 0.096 |
| Post-Op Length of Stay (> 7 days) | 21 (20%) | 89 (24%) | 28 (16%) | 600 (16%) | 0.002 |
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