Readmissions after Abdominal Aortic Aneurysm Repair: Differences between Open Repair and Endovascular Aneurysm Repair

Objectives Endovascular treatment of pararenal abdominal aortic aneurysm has gained terrain over the past decade, despite the substantial need for reinterventions during follow-up. However, open repair is still a well-established treatment option. With the current study we report the results of a consecutive series of elective primary open pararenal abdominal aortic aneurysm repair in a tertiary vascular referral centre, combined with an overview of current literature and pooled data analysis of perioperative mortality of open and endovascular pararenal abdominal aortic aneurysm repair. Methods A retrospective analysis of a prospective database of all elective open pararenal abdominal aortic aneurysm repairs in the St. Antonius Hospital between 2005 and 2014 was performed. Primary endpoint was 30-day mortality. Secondary endpoints were 30-day morbidity, new onset dialysis, reintervention free survival, and overall survival during follow-up. Results Between 2005 and 2014, 214 consecutive patients underwent elective open pararenal abdominal aortic aneurysm repair. Mean age was 69.8 (±7.1) years, 82.7% (177/214) were men, and mean abdominal aortic aneurysm diameter was 62 (±11) mm. Thirty-day mortality was 3.4%. Thirty-day morbidity was 27.1%, which predominantly consisted of pneumonia (18.7% (40/214)), cardiac events (3.3% (7/214)), and new onset dialysis (2.8% (6/214)). Estimated five-year overall survival rate was 74.2%. 0.9% (2/214) of patients required abdominal aortic aneurysm-related reintervention, and an additional 2.3% (5/214) required surgical repair of an incisional hernia. Pooled analysis of literature revealed a 30-day mortality of 3.0% for open pararenal repair and 1.9% for fenestrated endovascular repair. Conclusion Open pararenal abdominal aortic aneurysm repair in the era of increasing endovascular options results in acceptable perioperative morbidity and mortality rates. Mid-term reintervention rate is low compared to fenestrated endovascular aneurysm repair. Expertise with open repair still remains essential for treatment of pararenal abdominal aortic aneurysms in the near future, especially for those patients that are declined for endovascular treatment.

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Changing Indications and Outcomes for Open Abdominal Aortic Aneurysm Repair since the Advent of Endovascular Repair

The American Surgeon ◽

10.1177/000313480907500806 ◽

2009 ◽

Vol 75 (8) ◽

pp. 665-670 ◽

Cited By ~ 10

Author(s):

Charles S. Joels ◽

Eugene M. Langan ◽

Charles A Daley ◽

Corey A. Kalbaugh ◽

Anna L. Cass ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Open Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Complication Rates ◽

Aortoiliac Occlusive Disease ◽

Abdominal Aortic ◽

Artery Disease ◽

Aneurysm Repair

The indications for open abdominal aortic aneurysm (AAA) repair have changed with the development of endovascular techniques. The purpose of this study is to clarify the indications and outcomes for open repair since endovascular aneurysm repair (EVAR) and to compare contemporary AAA repair with the pre-EVAR era. Patients undergoing open AAA repair were identified; the demographics, outcomes, and indications for open repair were reviewed. Outcomes were compared based on indication for open repair in the EVAR era and between the pre-EVAR and EVAR eras. Open indications in the EVAR era included: age younger than 65 years with minimal comorbidities (AGE, n = 24 [9.8%]), unfavorable anatomy (ANAT, n = 146 [59.3%]), aortoiliac occlusive disease (AIOD, n = 38 [15.4%]), and miscellaneous (OTHER, n = 38 [15.4%]). Mortality (30-day and 5-year) was affected by indication: AGE = 0 and 0 per cent, ANAT = 4.1 and 49.7 per cent, AIOD = 13.5 and 32.3 per cent, and OTHER = 5.3 and 41.8 per cent. Age, sex, race, coronary artery disease, and peripheral artery disease were similar between the pre-EVAR and EVAR eras. EVAR-era patients had more diabetes mellitus, hypertension, and hyperlipidemia and longer operative time. Mortality was not different, but complication rates were lower in the pre-EVAR era (23.7 vs 43.5%, P = 0.025). Patients undergoing open AAA repair in the EVAR era have more comorbidities, longer operative times, and more complications. Outcomes for EVAR-era patients are affected by the indication for open repair. A preference for open repair in younger patients with minimal comorbidities is justified.

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Improved results in the management of ruptured abdominal aortic aneurysm may not be on the basis of endovascular aneurysm repair alone

Vascular ◽

10.1177/1708538112473974 ◽

2013 ◽

Vol 22 (1) ◽

pp. 51-54 ◽

Cited By ~ 7

Author(s):

Dipankar Mukherjee ◽

Elias Kfoury ◽

Keilla Schmidt ◽

Tarek Waked ◽

Homayoun Hashemi

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Open Repair ◽

Endovascular Aneurysm Repair ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Clinical Series ◽

Hybrid Repair ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Recent improvement in the survival of patients presenting with a ruptured abdominal aortic aneurysm (rAAA) has been credited to endovascular aneurysm repair (EVAR). We present our clinical series in the management of rAAA from 2007 to 2011. A total of 55 consecutive patient charts were reviewed. Thirty-eight patients underwent EVAR, 17 of the 55 patients did not have favorable anatomy for EVAR. Nine of the 17 patients underwent standard open repair. Eight patients underwent a ‘hybrid repair’ defined as suprarenal aortic endovascular balloon control followed by open repair. Overall 30-day mortality for all 55 patients was 22%. Mortality for the patients managed by endovascular aortic aneurysm repair was 26% compared with 22% with open repair. There were no deaths in the eight patients undergoing the hybrid repair. Endovascular balloon control of the aorta followed by open rAAA repair in patients who are not candidates for rEVAR has produced good results in our experience. Improved results being reported in the management of rAAA may not be on the basis of endovascular repair alone.

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Long Term Risk Prediction in Patients Undergoing Abdominal Aortic Aneurysm Repair: The Ultimate Stress Test of Open Repair

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2007.11.012 ◽

2008 ◽

Vol 35 (4) ◽

pp. 420-421 ◽

Cited By ~ 2

Author(s):

T. Winkel ◽

O. Schouten ◽

D. Poldermans

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Risk Prediction ◽

Open Repair ◽

Stress Test ◽

Abdominal Aortic Aneurysm Repair ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Does the diameter of abdominal aortic aneurysm influence late survival following abdominal aortic aneurysm repair? A systematic review and meta-analysis

Vascular ◽

10.1177/1708538116650580 ◽

2016 ◽

Vol 24 (6) ◽

pp. 658-667 ◽

Cited By ~ 6

Author(s):

Manar Khashram ◽

Phil N Hider ◽

Jonathan A Williman ◽

Gregory T Jones ◽

Justin A Roake

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Hazard Ratio ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair ◽

Aneurysm Diameter ◽

Late Survival

Background Studies reporting the influence of preoperative abdominal aortic aneurysm diameter on late survival following abdominal aortic aneurysm repair have not been consistent. Aim: To report the influence of abdominal aortic aneurysm diameter on overall long-term survival following abdominal aortic aneurysm repair. Methods Embase, Medline and the Cochrane electronic databases were searched to identify articles reporting the influence of abdominal aortic aneurysm diameter on late survival following open aneurysm repair and endovascular aneurysm repair published up to April 2015. Data were extracted from multivariate analysis; estimated risks were expressed as hazard ratio. Results A total of 2167 titles/abstracts were retrieved, of which 76 studies were fully assessed; 19 studies reporting on 22,104 patients were included. Preoperative larger abdominal aortic aneurysm size was associated with a worse survival compared to smaller aneurysms with a pooled hazard ratio of 1.14 (95% CI: 1.09–1.18), per 1 cm increase in abdominal aortic aneurysm diameter. Subgroup analysis of the different types of repair was performed and the hazard ratio (95% CI), for open aneurysm repair and endovascular aneurysm repair were 1.08 (1.03–1.12) and 1.20 (1.15–1.25), respectively, per 1 cm increase. There was a significant difference between the groups p < 0.02. Conclusions This meta-analysis suggests that preoperative large abdominal aortic aneurysm independently influences overall late survival following abdominal aortic aneurysm repair, and this association was greater in abdominal aortic aneurysm repaired with endovascular aneurysm repair.

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Prophylactic Abdominal Aortic Aneurysm Repair? Open Repair Brings Early Pain but Later Gain

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2016.07.008 ◽

2016 ◽

Vol 52 (6) ◽

pp. 719-720 ◽

Cited By ~ 5

Author(s):

J.T. Powell

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Open Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Abdominal aortic aneurysm repair: long-term follow-up of endovascular versus open repair

Archives of Medical Science ◽

10.5114/aoms.2014.42579 ◽

2014 ◽

Vol 2 ◽

pp. 273-282 ◽

Cited By ~ 13

Author(s):

Gabriele Piffaretti ◽

Giovanni Mariscalco ◽

Francesca Riva ◽

Federico Fontana ◽

Gianpaolo Carrafiello ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Open Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Abdominal Aortic ◽

Long Term Follow Up ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Systematic review of perioperative outcomes following laparoscopic abdominal aortic aneurysm repair

Vascular ◽

10.1177/1708538114561823 ◽

2014 ◽

Vol 23 (5) ◽

pp. 525-553 ◽

Cited By ~ 2

Author(s):

Maral J Rouhani ◽

Ankur Thapar ◽

Mahiben Maruthappu ◽

Alex B Munster ◽

Alun H Davies ◽

...

Keyword(s):

Systematic Review ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Laparoscopic Repair ◽

Open Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Perioperative Outcomes ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Objective To collate information available in the literature regarding perioperative outcomes following elective laparoscopic abdominal aortic aneurysm repair. Materials and methods Electronic databases were searched and a systematic review was performed. In total, 1256 abstracts were screened, from which 10 studies were included for analysis. Perioperative and technical outcomes were analysed. Results In the totally laparoscopic repair of infra-renal aneurysms ( n = 302), 30-day mortality ranged between 0% and 6% and in the laparoscopic-assisted cases ( n = 547) ranged between 0% and 7%. Of the former group, 5–30% of cases were converted to open repair, with 6% reintervention rate, whereas there was a 5–10% conversion and 3% reintervention rate in the latter group. Conclusions The outcomes from selected patients in selected centres demonstrate that elective laparoscopic repair of aortic aneurysms is feasible and comparable in safety to open repair; it remains unclear, however, whether there are substantial advantages of this method compared with open and endovascular repair.

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