The impact of prior aortic surgery on outcomes after multibranched endovascular aortic aneurysm repair

Smita Kaushik, Warren J. Gasper, Bala Ramanan, Shant M. Vartanian, Linda M. Reilly, Timothy A.M. Chuter, Jade S. Hiramoto

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this study was to evaluate the impact of prior aortic surgery on outcomes after multibranched endovascular aneurysm repair (MBEVAR) of thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs). Methods: From July 2005 to October 2016, there were 153 patients who underwent elective endovascular repair of TAAA and PRAA using multibranched stent grafts. Data on demographics, procedural details, and outcomes were collected prospectively. Results: The mean age was 73 ± 8 years, and 113 of 153 (74%) were men. Mean aneurysm diameter was 67 ± 9 mm. Before MBEVAR, 68 of 153 (44%) patients had undergone a prior aortic surgery; 49 of 68 (72%) had prior open aortic surgery, 15 of 68 (22%) had prior endovascular aortic surgery, and 4 of 68 (6%) had both. There were no significant differences in age, sex, preoperative aneurysm diameter, or medical comorbidities (coronary artery disease, lung disease, diabetes mellitus, or hypertension) in patients with previous aortic surgery compared with those without. Patients with previous aortic surgery had higher fluoroscopy times (131 ± 59 vs 118 ± 54 minutes; P = .18) and procedural times (370 ± 101 vs 345 ± 118 minutes; P = .27) during MBEVAR, but these differences did not reach statistical significance. Patients without previous aortic intervention had higher rates of postoperative paraplegia (9/85 [11%]) vs (0/68 [0%]; P = .005) compared with those with previous aortic surgery. Of 153 patients, 3 (2%) had a postoperative stroke, and this was not different between the two groups. Median follow-up time was 2.5 years (interquartile range, 1.0-4.5 years) and did not differ between those with and those without previous aortic surgery. Kaplan-Meier estimated 5-year freedom from aneurysm-related mortality and overall mortality was 90% and 48%, respectively, and did not differ between the two groups. There was also no difference in branch vessel occlusion between the two groups. Conclusions: A high proportion of patients undergoing MBEVAR for TAAA or PRAA have already undergone prior open or endovascular aortic procedures, but this does not appear to increase the complication rate or affect midterm clinical outcomes. Patients with prior aortic surgery who undergo MBEVAR have lower rates of paraplegia compared with those without prior surgery, which may be due to effective recruitment of collateral circulation.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Aortic Aneurysm
Aneurysm
Thoracic Aortic Aneurysm
Paraplegia
Collateral Circulation
Endovascular Procedures
Mortality
Fluoroscopy
Lung Diseases
Stents
Comorbidity
Coronary Artery Disease
Diabetes Mellitus
Stroke
Demography
Hypertension
Transplants

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Kaushik, S., Gasper, W. J., Ramanan, B., Vartanian, S. M., Reilly, L. M., Chuter, T. A. M., & Hiramoto, J. S. (Accepted/In press). The impact of prior aortic surgery on outcomes after multibranched endovascular aortic aneurysm repair. Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2017.11.075

The impact of prior aortic surgery on outcomes after multibranched endovascular aortic aneurysm repair. / Kaushik, Smita; Gasper, Warren J.; Ramanan, Bala; Vartanian, Shant M.; Reilly, Linda M.; Chuter, Timothy A.M.; Hiramoto, Jade S.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Kaushik, Smita ; Gasper, Warren J. ; Ramanan, Bala ; Vartanian, Shant M. ; Reilly, Linda M. ; Chuter, Timothy A.M. ; Hiramoto, Jade S. / The impact of prior aortic surgery on outcomes after multibranched endovascular aortic aneurysm repair. In: Journal of Vascular Surgery. 2018.
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abstract = "Objective: The purpose of this study was to evaluate the impact of prior aortic surgery on outcomes after multibranched endovascular aneurysm repair (MBEVAR) of thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs). Methods: From July 2005 to October 2016, there were 153 patients who underwent elective endovascular repair of TAAA and PRAA using multibranched stent grafts. Data on demographics, procedural details, and outcomes were collected prospectively. Results: The mean age was 73 ± 8 years, and 113 of 153 (74{\%}) were men. Mean aneurysm diameter was 67 ± 9 mm. Before MBEVAR, 68 of 153 (44{\%}) patients had undergone a prior aortic surgery; 49 of 68 (72{\%}) had prior open aortic surgery, 15 of 68 (22{\%}) had prior endovascular aortic surgery, and 4 of 68 (6{\%}) had both. There were no significant differences in age, sex, preoperative aneurysm diameter, or medical comorbidities (coronary artery disease, lung disease, diabetes mellitus, or hypertension) in patients with previous aortic surgery compared with those without. Patients with previous aortic surgery had higher fluoroscopy times (131 ± 59 vs 118 ± 54 minutes; P = .18) and procedural times (370 ± 101 vs 345 ± 118 minutes; P = .27) during MBEVAR, but these differences did not reach statistical significance. Patients without previous aortic intervention had higher rates of postoperative paraplegia (9/85 [11{\%}]) vs (0/68 [0{\%}]; P = .005) compared with those with previous aortic surgery. Of 153 patients, 3 (2{\%}) had a postoperative stroke, and this was not different between the two groups. Median follow-up time was 2.5 years (interquartile range, 1.0-4.5 years) and did not differ between those with and those without previous aortic surgery. Kaplan-Meier estimated 5-year freedom from aneurysm-related mortality and overall mortality was 90{\%} and 48{\%}, respectively, and did not differ between the two groups. There was also no difference in branch vessel occlusion between the two groups. Conclusions: A high proportion of patients undergoing MBEVAR for TAAA or PRAA have already undergone prior open or endovascular aortic procedures, but this does not appear to increase the complication rate or affect midterm clinical outcomes. Patients with prior aortic surgery who undergo MBEVAR have lower rates of paraplegia compared with those without prior surgery, which may be due to effective recruitment of collateral circulation.",
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