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Large Aneurysm Size Is Associated With Increased Short And Long-term Mortality After Fenestrated/Branched Aortic Repair
Norma Elizaga, MD
1, Thomas F. O'Donnell, MD
2, 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.
OBJECTIVES:Large aneurysms have been associated with adverse outcomes following EVAR; however, the impact of aneurysm size on outcomes after fenestrated/branched repair (F/BEVAR) remains unclear.
METHODS:We included patients who underwent F/BEVAR for asymptomatic, intact aortic aneurysms in the Vascular Quality Initiative (VQI) from 2013-2022. Aneurysm size was categorized as small (<5.5cm in males, <5cm in females), medium (5.5-7cm in males, 5-7cm in females), and large (>7cm). Univariate and multivariable analyses were performed. Kaplan-Meier curves were generated and adjusted Cox regression conducted to compare long-term survival.
RESULTS:3,804 patients underwent F/BEVAR (small:n=519, medium:n=2,685, large:n=600) from 2013-2022. Comorbidities were similar regardless of aneurysm size. Anatomic characteristics reflective of aneurysm complexity differed by size including the prevalence of prior aneurysm repair (small: 15%, medium: 20%, large: 39%, p<0.001), aortic dissection (small: 1%, medium: 3%, large: 5%, p-value <0.001), and the rate of thoracoabdominal (vs juxtarenal) aneurysms (small: 38%, medium: 54%, large: 64%, p-value <0.001).When outcomes were compared, both 30-day (small:1%, medium:2%, large:4%, p=0.004) and long-term mortality differed (Figure 1, p<0.001). After adjustment, large aneurysms had the highest 30-day (Large OR 4.3 [95% CI 1.8-12.8]) and long-term mortality (Small [ref], Medium HR 1.5 [95% CI: 1.1-2.2], Large HR 2.6 [95% CI: 1.8-3.9]). Major morbidities were more common among patients with large aneurysms compared to small including any complication (small: 15%, medium: 20%, large: 19%, p=0.02), cardiac complication (small: 7%, medium: 10%, large:10%, p=0.03), stroke (small:0.9%, medium:0.4%, large:2.3%, p=0.003), acute kidney injury (small:8%, medium:11%, large: 14%, p=0.003), completion endoleak (small: 7%, medium: 10%, large: 8%, p=0.04), return to the operating room (small: 6.3% and medium: 2.7%, large: 7.5%, p=0.002), and prolonged length of stay (small: 7%, medium: 13%, large: 18%, p<0.001). However, after adjustment for characteristics reflective of aneurysm complexity, only prolonged length of stay differed by size (Medium: OR 1.5 [1.1-2.2], Large: OR 1.9 [1.3-2.9]).
CONCLUSIONS:Large aneurysm size is associated with increased short and long-term mortality, likely reflecting a greater degree of disease progression and technical complexity of repair. These data should guide preoperative risk stratification and opportunities to mitigate this operative risk considered for patients presenting with large aneurysms.
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