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Trends and Outcomes in Endovascular and Open Surgical Treatment of Visceral Aneurysms
Jason A. Chin1, Adele Heib2, Cassius I. Ochoa Chaar1, Jonathan A. Cardella1, Kristine C. Orion1, Timur P. Sarac1.
1Yale New Haven Hospital, New Haven, CT, USA, 2Fordham University, New York, NY, USA.
Visceral artery aneurysms (VAA) are rare but often repaired due to dire consequences of rupture. This is a population-based evaluation of chronologic trends in management, and risk factors and outcomes in endovascular and open therapy.
The 2003-2013 AHRQ-NIS database was reviewed. Cases with primary diagnosis of VAA and undergoing endovascular or open repair were identified. Patients with renal artery, or abdominal or thoracoabdominal aortic disease were excluded. Case numbers of respective techniques were charted over time. Baseline characteristics and in-hospital outcomes were compared for endovascular and open groups using chi-square, Fisher’s exact, or t-test. Predictors of mortality and complications were evaluated with multivariate logistic regression.
There were 9260 interventions for VAAs 2003-2013 including 5166 endovascular and 4094 open. Endovascular repairs increased from 5.3 to 24.7 per 10 million US population (P<.001), surpassing open repairs in 2008 which decreased from 14.3 to 9.2 per 10 million (P<.001) (Figure 1). Endovascular patients were more likely to have non-elective admission (71.1% vs 40.2%; P<.001), renal failure (7.6% vs 4.9%; P=.02), liver disease (11.3% vs 6.6%; P<.001), alcohol abuse (13.1% vs 3.6%; P<.001), chronic blood loss anemia (4.5% vs 1.6%; P<.001), metastatic cancer (2.7% vs 0.8%; P=.003), solid tumor without metastases (3.6% vs 2.0%; P<.037), and weight loss (9.8% vs 5.2%; P<.001). In-hospital mortality (4.1% vs 4.5%; P=.618) and overall complication rates (37.8% vs 38.8%; P=.688) were similar between groups; however, pulmonary complications were decreased for endovascular (10.6% vs 19.7%, P<.001). Endovascular patients had shorter hospital stays (6.5 vs 8.7 days; P<.001). Multivariate adjustment for mortality predictors, including non-elective admission (OR 3.1, CI 1.5-6.4; P=.002), coagulopathy (OR 4.3, CI 2.6-7.4; P<.001), liver disease (OR 2.2, CI 1.2-4.1; P=.007), fluid/electrolyte disorders (OR 2.8, CI 1.7-4.7; P<.001), and solid tumor without metastases (OR 2.8, CI 1.1-7.1; P=.031); showed endovascular treatment was associated with decreased mortality (OR 0.59, CI 0.36-0.97; P=.038). Analysis of overall complications revealed decreased mortality for endovascular treatment (OR 0.56, CI 0.45-0.70; P<.001).
Endovascular VAA repairs are increasing. Despite patients having worse comorbidities and more non-elective admissions, endovascular therapy appears associated with decreased mortality and complications, and shorter hospital stays.
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