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Outcomes After Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms.
Vasc Endovascular Surg. 2017 Aug; 51(6):357-362.VE

Abstract

OBJECTIVES

Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability.

MATERIALS AND METHODS

Patients who underwent EVAR for rAAA (n = 425) using AUI (n = 55; 12.9%) and MUB (n = 370; 87.1%) were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2005-2010) database. Univariable and multivariable logistic regression analyses were performed.

RESULTS

No significant difference (P > .5) was seen in comorbidities between patients who underwent EVAR with AUI or MUB; there was also no change in endoprosthesis use from 2005 to 2010 (P = .7). Patients who underwent EVAR with AUI more commonly had a history of peripheral arterial procedure (10.9% vs 4.6%; P = .053) and preoperative transfusion of >4 U packed red blood cells (18.2% vs 6.8%; P = .004). Use of AUI versus MUB was associated with more 30-day wound complications (16.4% vs 6.2%; P = .01), return to operating room (38.2% vs 20.0%; P = .003), and mortality (34.5% vs 21.4%; P = .03). On multivariable analysis, use of AUI was associated with an increased risk of 30-day mortality (odds ratio: 2.4; 95% confidence interval: 1.1-5.3). On subanalysis of the cohort for only the patients with unstable rAAA (n = 159; AUI = 29 and MUB = 130), 30-day mortality for AUI versus MUB was still higher but not statistically significant (44.8% vs 32.3%; P = .2).

CONCLUSION

Endovascular repair for ruptured AAA using aortouniliac endoprosthesis is associated with higher 30-day mortality than using modular or unibody bifurcated endoprosthesis.

Authors+Show Affiliations

1 Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 2 Methodist Le Bonheur Healthcare, Memphis, TN, USA.1 Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 2 Methodist Le Bonheur Healthcare, Memphis, TN, USA. 3 Regional One Medical Center, Memphis, TN, USA.1 Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 2 Methodist Le Bonheur Healthcare, Memphis, TN, USA.2 Methodist Le Bonheur Healthcare, Memphis, TN, USA.4 Doctors Hospital at Renaissance Health Care System, Edinburg, TX, USA.4 Doctors Hospital at Renaissance Health Care System, Edinburg, TX, USA.1 Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 3 Regional One Medical Center, Memphis, TN, USA.1 Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 2 Methodist Le Bonheur Healthcare, Memphis, TN, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28514895

Citation

Gupta, Prateek K., et al. "Outcomes After Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms." Vascular and Endovascular Surgery, vol. 51, no. 6, 2017, pp. 357-362.
Gupta PK, Kempe K, Brahmbhatt R, et al. Outcomes After Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. Vasc Endovascular Surg. 2017;51(6):357-362.
Gupta, P. K., Kempe, K., Brahmbhatt, R., Gupta, H., Montes, J., Forse, R. A., Stickley, S. M., & Rohrer, M. J. (2017). Outcomes After Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. Vascular and Endovascular Surgery, 51(6), 357-362. https://doi.org/10.1177/1538574417703562
Gupta PK, et al. Outcomes After Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. Vasc Endovascular Surg. 2017;51(6):357-362. PubMed PMID: 28514895.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes After Use of Aortouniiliac Endoprosthesis Versus Modular or Unibody Bifurcated Endoprostheses for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. AU - Gupta,Prateek K, AU - Kempe,Kelly, AU - Brahmbhatt,Reshma, AU - Gupta,Himani, AU - Montes,Jorge, AU - Forse,R Armour, AU - Stickley,Shaun M, AU - Rohrer,Michael J, Y1 - 2017/05/17/ PY - 2017/5/19/pubmed PY - 2017/9/19/medline PY - 2017/5/19/entrez KW - EVAR KW - aneurysm KW - aortouniiliac KW - endograft KW - rupture SP - 357 EP - 362 JF - Vascular and endovascular surgery JO - Vasc Endovascular Surg VL - 51 IS - 6 N2 - OBJECTIVES: Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability. MATERIALS AND METHODS: Patients who underwent EVAR for rAAA (n = 425) using AUI (n = 55; 12.9%) and MUB (n = 370; 87.1%) were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2005-2010) database. Univariable and multivariable logistic regression analyses were performed. RESULTS: No significant difference (P > .5) was seen in comorbidities between patients who underwent EVAR with AUI or MUB; there was also no change in endoprosthesis use from 2005 to 2010 (P = .7). Patients who underwent EVAR with AUI more commonly had a history of peripheral arterial procedure (10.9% vs 4.6%; P = .053) and preoperative transfusion of >4 U packed red blood cells (18.2% vs 6.8%; P = .004). Use of AUI versus MUB was associated with more 30-day wound complications (16.4% vs 6.2%; P = .01), return to operating room (38.2% vs 20.0%; P = .003), and mortality (34.5% vs 21.4%; P = .03). On multivariable analysis, use of AUI was associated with an increased risk of 30-day mortality (odds ratio: 2.4; 95% confidence interval: 1.1-5.3). On subanalysis of the cohort for only the patients with unstable rAAA (n = 159; AUI = 29 and MUB = 130), 30-day mortality for AUI versus MUB was still higher but not statistically significant (44.8% vs 32.3%; P = .2). CONCLUSION: Endovascular repair for ruptured AAA using aortouniliac endoprosthesis is associated with higher 30-day mortality than using modular or unibody bifurcated endoprosthesis. SN - 1938-9116 UR - https://www.unboundmedicine.com/medline/citation/28514895/Outcomes_After_Use_of_Aortouniiliac_Endoprosthesis_Versus_Modular_or_Unibody_Bifurcated_Endoprostheses_for_Endovascular_Repair_of_Ruptured_Abdominal_Aortic_Aneurysms_ L2 - https://journals.sagepub.com/doi/10.1177/1538574417703562?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -