Back to 2025 Display Posters
Incidence And Predictors Of Gastrointestinal Adverse Events After Fenestrated And Branched Endovascular Aortic Repair
Yazen Qumsiyeh, MD
1, Diego V. S. Rodrigues, MD
1, Jesse D. Chait, DO
1, Guilherme B. Lima, MD
1, Randall R. DeMartino, MD
1, Gustavo S. Oderich, MD
2, Bernardo C. Mendes, MD
1.
1Mayo Clinic, Rochester, MN, USA,
2The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
OBJECTIVES: Gastrointestinal adverse events (GIE) are rare after fenestrated-branched endovascular aortic repair (F/B-EVAR). The aim of this study was to describe incidence and predictors of early GIE following F/B-EVAR for complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs).
METHODS: Single-center retrospective review of patients who underwent elective F/B-EVAR for TAAA and CAAAs between 2007-2023 was conducted. All GIE were identified and categorized as ischemic or non-ischemic. Endpoints included incidence of any GIE, need for GI surgical resection, ostomy creation, major adverse events, ICU length of stay (LOS), Hospital LOS, and 30-day mortality.
RESULTS: A total of 676 patients underwent F/B-EVAR (73% male, mean age 74 ± 8). Thirty-two patients (4.7%) experienced GIE including 22 ischemic (3.2%) and 11 non-ischemic complications (1.6%). Ischemic complications involved the colon (n=18), small bowel (n=3), gallbladder (n=3), liver (n=2), stomach (n=1), and pancreas (n=1). Non-ischemic complications included gastrointestinal hemorrhage (n=4), ileus (n=2), Ogilvie’s syndrome (n=2), acute pancreatitis (n=1), small bowel obstruction (n=1), and cecal volvulus (n=1). Patients with GIE were more likely to be female (47% vs 21%, P=.014), have PAD (53% vs 22%; P<.001), or have preoperative hypogastric artery occlusion (12% vs 3.7%, P=.038). Five complications resulted from intraoperative technical complications (SMA dissection n=1, branch vessel partial occlusion n=4). The use of patient-specific manufactured devices (57%), PMEGs (28%), and off-the-shelf devices (15%) was similar between groups. Surgical resection was required in nine patients who had GIE, of whom seven required end colostomy (1%). GIE were associated with longer hospital LOS (15 vs 7 days, P<.001), ICU LOS (4 vs 2 days, P=.001), and intubation time >48 hours (16% vs 2.6%, P=.003). They had higher rates of any major adverse event (78% vs 28%, P<.001), spinal cord ischemia (19% vs 4%, P=.003), permanent paraplegia (12% vs 0.9%, P<.001), new-onset dialysis (9.4% vs 1.4%, P=.016), acute kidney injury (44% vs 12%, P<.001), and 30-day mortality (19% vs 1.1%, P<.001). Similar trends were observed when ischemic only GIE were analyzed.
CONCLUSIONS: The occurrence of GIE is low after F/B-EVAR for CAAAs and TAAAs, nevertheless entails high risk of death, major adverse events, and prolonged hospitalization.
Table I. Risk Factors and Clinical Outcomes | GIE (N=32) | No GIE (N=644) | Total (N=676) | P value |
| Mean Age | 74.4 ± 6.0 | 74.3 ± 7.9 | 74.3 ± 7.9 | .963 |
| Male Sex | 17 (53%) | 476 (79%) | 493 (73%) | .014 |
| Peripheral Vascular Disease | 17 (53%) | 141 (22%) | 158 (23%) | <0.001 |
| Occluded Hypogastric Artery | 4 (12%) | 24 (3.7%) | 28 (4%) | .038 |
| Technical Success | 26 (81%) | 621 (97%) | 647 (96%) | .001 |
| Any Major Adverse Event | 25 (78%) | 181 (28%) | 206 (30%) | <.001 |
| 30-Day Mortality | 6 (19%) | 7 (1.1%) | 13 (1.9%) | <.001 |
| Hospital LOS (days) | 15 ± 11 | 7 ± 8 | 7 ± 8 | <.001 |
| ICU LOS (days) | 4 ± 4 | 2 ± 2 | 2 ± 2 | .001 |
Back to 2025 Display Posters
