Back to 2025 Abstracts
Contemporary Outcomes Of Open Aortic Reconstruction
Joshua K. Burk, MD, MBA, Ayman Alrazem, Karem Harth, MD, Benjamin Colvard, MD, Jane M. Chung, MD, William Yoon, MD, PhD, Woosup M. Park, MD, Jonathan Kwong, MD, Jae S. Cho, MD.
University Hospitals/Case Western Reserve University, Cleveland, OH, USA.
ObjectivesTo evaluate the contemporary results of open aortic reconstruction (OAR) at a single-center, high-volume institution.
MethodsA retrospective review identified 327 patients who underwent elective OAR from 1/2014 to 3/2023. Ruptured aneurysms, thoracoabdominal aortic aneurysms, perivisceral/aortoiliac endarterectomies, and infectious etiologies were excluded. Demographics, comorbidities, and operative details, including clamp location and need for adjunct procedures, were collected (Table). The primary endpoint was in-hospital mortality and secondary endpoints included major adverse events. Chi-square, Fisher’s exact, Kaplan-Meier, and Cox proportional hazard model were used as appropriate.
ResultsMean age was 65 years, and 190 (66%) were male. 170 patients (55.6%) had aneurysmal disease (AD), and 136 (44.4%) occlusive disease (OD) (Table). 147 (48%) patients required suprarenal or higher aortic control. Concomitant iliofemoral reconstruction was performed in 105 (32.1%) and renal/mesenteric in 52 (15.9%) patients. Composite in-hospital mortality was 5.2% and did not differ between AD (5.9%) and OD (4.4%) (P=0.55), and infrarenal clamp (4.4%) and suprarenal clamp (6.2%) (P=0.48). Concomitant vascular reconstruction showed a trend towards higher in-hospital mortality (HR 2.24, P=0.27). 5-year survival estimates were higher in OD (77.9%) compared to AD (63.5%) (P=0.076). Multivariable regression analysis showed the duration of surgery to be predictive of in-hospital mortality (HR 1.51, CI 1.15-1.98, P=0.03), while statin was protective (HR 0.24, CI 0.058-0.980, P=0.047) against in-hospital mortality. Coronary artery disease (CAD, HR 2.84, CI 1.43-5.65, P=0.003), chronic obstructive pulmonary disease (COPD, HR 2.06, CI 1.12-3.79, P=0.021), and statin (HR 0.35, CI 0.16-0.79, P=0.011) correlated with long-term mortality. COPD correlated with long-term mortality (HR. 4.01, CI 1.17-9.53, P=0.002) in AD, while statin was associated with improved survival (HR 0.27, CI 0.10-0.72, P=0.009). In OD, CAD (HR 8.89, CI 1.44-55.1, P = 0.019) correlated with late mortality.
ConclusionsOAR in the current era exacts high technical expertise often requiring proximal aortic control and extensive concomitant vascular reconstruction, but can be performed safely with acceptable mortality for both AD and OD in a high-volume referral center. Length of surgery serves as a surrogate marker of case complexity influencing perioperative mortality. Baseline cardiac and pulmonary status, coupled with statin use, determine long-term survival.
Table 1: Demographics and Intraoperative Variables | | | | |
| Overall | Aneurysm | Occlusive | P |
| N=306 (%) | N=170 (%) | N=136 (%) |
| Demographics | | | | |
| Age (years, mean ± SD) | 65.2 ± 10.1 | 64.7 ± 9.6 | 65.9 ± 10.7 | 0.33 |
| Sex ( % male) | 66.3% | 61.8% | 70.0% | 0.13 |
| Race | | | | 0.13 |
| Caucasian | 83.7% | 85.9% | 80.9% | |
| African-American | 14.7% | 12.9% | 16.9% | |
| Comorbidities | | | | |
| Smoking History | 91.5% | 88.2% | 95.6% | 0.018 |
| Coronary artery disease | 41.8% | 44.1% | 39.0% | 0.36 |
| Cerebrovascular accident | 13.4% | 12.9% | 14.0% | 0.79 |
| Chronic obstructive pulmonary disease | 26.8% | 28.2% | 25.0% | 0.53 |
| Diabetes mellitus | 14.7% | 10.6% | 19.9% | 0.023 |
| Chronic kidney disease | 13.7% | 16.5% | 10.3% | 0.12 |
| Hypertension | 81.4% | 82.9% | 79.4% | 0.43 |
| Hyperlipidemia | 72.5% | 72.9% | 72.1% | 0.86 |
| Peripheral artery disease | 51.0% | 25.9% | 82.4% | < .001 |
| History of vascular surgery | 39.5% | 38.2% | 41.2% | 0.60 |
| History of prior aortic surgery | 10.5% | 13.5% | 6.6% | 0.047 |
| Operative Details | | | | |
| Aortic clamp position | | | | 0.031 |
| Infrarenal | 52.0% | 46.5% | 58.8% | |
| Supra-renal/-SMA/-celiac | 48.0% | 53.5% | 41.2% | |
| Iliofemoral reconstruction | 32.30% | 22.40% | 49.30% | < .001 |
| Renal/visceral bypass | 17.0% | 25.9% | 5.9% | < .001 |
| Duration of surgery (hours) | 6.3 ± 1.9 | 6.3 ± 1.9 | 6.2 ± 1.8 | 0.43 |
| Intraoperative blood loss (L) | 1.8 ± 2.2 | 2.5 ± 2.5 | 0.95 ± 1.3 | < .001 |
Back to 2025 Abstracts
