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Open Juxta-renal Abdominal Aortic Aneurysm Repair Still Confers Post-Operative Rupture Risk
Lena Chatterjee, MD, Afshin Parsikia, MD, Evan Deutsch, MD, Nadia Awad, MD.
Einstein Medical Center, Philadelphia, PA, USA.
OBJECTIVES: While endovascular approaches to repairing abdominal aortic aneurysm have expanded and both physician-modified and prefabricated devices can address juxta-renal anatomy, open aneurysm repair is still considered the gold-standard. However, these cases are technically more complex and carry higher risk of morbidity and mortality. We sought to evaluate the real-world outcomes of open juxta-renal abdominal aortic aneurysm repair.
METHODS: We utilized the NSQIP vascular-targeted dataset for abdominal aortic aneurysm, merged with the regular NSQIP adult dataset from 2017 to 2020, selecting juxta-renal as the proximal aneurysm extent. Patients that expired peri-operatively were identified and relevant pre-operative, intra-operative, and post-operative features were considered. A bivariate analysis of patients was performed to assess characteristics of patients who did or did not survive the peri-operative period with a multivariate logistic regression performed for those variables with a p-value less than 0.2.
RESULTS: A total of 557 patients underwent open surgery for a juxta-renal abdominal aortic aneurysm, and there were 60 peri-operative deaths. Older age, longer operative time, patients presenting with rupture were all predictors of death. Interestingly, 13 patients were noted to have post-operative aneurysm rupture, nine of which died, accounting for 15% of deaths (OR 11.038, p < 0.001). Additionally, post-operative ischemic colitis conferred significant mortality risk (OR 3.826, p < 0.006).
CONCLUSIONS: Juxta-renal aortic aneurysms can be addressed with both endovascular and open surgical approaches. As expected, older patients, longer cases, and patients presenting with rupture have a higher risk of peri-operative mortality after open repair. However, while open aneurysm repair is still considered the gold-standard approach, review of the NSQIP data reveals that there is still a significant post-operative rupture risk in these patients, which is counter to standard teaching that open aneurysm repair is considered more durable. Further research is needed to determine why such a high post-operative rupture rate has been observed, but this may indicate that the durability of open repair is not as high as perceived.
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