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Abdominal Aortic Aneurysm Anatomic Severity Grading Score Predicts Aortic Branch Vessel Complications, Non-Aortic Adverse Events, and Survival
William B. Best, BS, S Sadie Ahanchi, MD, Kedar S. Lavingia, Chad P. Ammar, MD, Sebastian Larion, MS, Jean M. Panneton, MD, FRCSC.
Eastern Virginia Medical School, Norfolk, VA, USA.

Objectives: Our aim was to examine the predictive value of ASG score on aortic branch vessel complications, non-aortic adverse events, and survival.
Methods: Using 3D reconstruction of preoperative CTA imaging (TeraRecon Aquarius iNtuition Workstation, Foster City, CA), we retrospectively reviewed EVARs from 2009-2012. Two independent patient groups were created based on ASG score: < 14 (low-score group) and ≥ 14 (high-score group). Aortic branch vessel complications, non-aortic adverse events, and survival were collected and analyzed in relation to ASG score.
Results: 218 patients were analyzed: mean age 74 years (range 48-92), 75% male and 83% caucasian, 114 were in the low-score group and 104 were in the high-score group. Excluding age, there were no other differences in demographics between groups. There were 17 patients with 30-day aortic branch vessel complications: claudication or rest pain (50%), renal insufficiency (39%), and spinal or mesenteric ischemia (11%). The incidence of 30-day branch vessel complications was significantly different between the low-score group (n=5, 4%) and the high score group (n=12, 11%), (p=.049). There were 23 patients with 30-day non-aortic adverse events: pulmonary dysfunction (46%), coagulopathy (32%), deep vein thrombosis (DVT) (14%), myocardial infarction (4%), and cerebrovascular accident (CVA) (4%). The incidence of 30-day non-aortic adverse events trended toward statistical significance when analyzing the low-score group (n=8, 7%) versus the high-score group (n=15, 14%), (p=0.075). When we combined 30-day aortic branch vessel complications with 30-day non-aortic adverse events, we found that the low-score group was statistically different from the high-score group (n=10, 9% versus n=23, 22%), (p=0.006). After 30 days, there were 40 patients who had midterm aortic branch complications and 41 patients who had non-aortic adverse events. After Kaplan-Meier Analysis, the freedom from adverse events was statistically different at both 1 year (80% vs 71%) and 2 years (79% vs 65%), (p=.006). Lastly, Kaplan-Meier analysis revealed a significantly longer survival in the low score group (93% and 90% at 1 and 4 years) versus the high score group (88% and 80% at 1 and 4 years), p=.022.
Conclusion: The AAA ASG score can not only be used to predict operative complexity and reinterventions, but also 30-day and midterm aortic branch vessel complications, non-aortic adverse events, and survival.


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