Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel
Journal cover image

Low mortality rates after endovascular aortic repair expand use to high-risk patients.

Publication ,  Journal Article
Adkar, SS; Turner, MC; Leraas, HJ; Gilmore, BF; Nag, U; Turley, RS; Shortell, CK; Mureebe, L
Published in: Journal of vascular surgery
February 2018

The 2010 endovascular aneurysm repair (EVAR) trial 2 (EVAR 2) reported that patients with comorbidity profiles rendering them unfit for open aneurysm repair who underwent EVAR did not experience a survival advantage compared with those who did not undergo intervention. These patients experienced a 30-day mortality of 7.3%, whereas reports from similar cohorts reported far lower mortality rates. The primary objective of our study was to compare the incidence of 30-day mortality in low- and high-risk patients undergoing EVAR in a contemporary data set, using patient risk stratification criteria from EVAR 2. Secondarily, we sought to identify risk factors associated with a disproportionate contribution to 30-day mortality risk.Data were obtained from the 2005 to 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data Files (N = 24,813). Patients were included in the high-risk cohort with the presence of renal, respiratory, or cardiac preoperative criteria alone or in combination. Renal impairment criteria were defined as dialysis and creatinine concentration >2.26 mg/dL. Respiratory impairment criteria included history of chronic obstructive pulmonary disease and preoperative ventilator support. Cardiac impairment criteria included history of myocardial infarction, congestive heart failure, angina, and prior coronary intervention. Patient and procedural characteristics and 30-day postoperative outcomes were compared using Pearson χ2 tests for categorical variables and Wilcoxon rank sum tests for continuous variables.Among 24,813 patients undergoing EVAR, 12,043 (48%) patients were characterized as high risk (at least one impairment criterion); 12,770 (52%) patients were stratified as low risk. The 30-day mortality rate was 1.9% in the high-risk cohort compared with the 7.3% reported by EVAR 2, and it was higher in the high-risk cohort compared with the low-risk cohort (1.9% vs 0.9%; P < .001). Whereas the presence of each comorbidity increased the odds of 30-day mortality (respiratory odds ratio [OR], 1.62; 95% confidence interval [CI], 1.16-2.26; P = .005; cardiac OR, 1.55; 95% CI, 1.14-2.10; P = .005), the presence of renal criteria disproportionately increased the odds of mortality threefold (OR, 3.42; 95% CI, 2.31-5.09; P < .001).Contemporary 30-day mortality after EVAR in high-risk patients is substantially lower than that reported in the EVAR 2 trial. Whereas low- and high-risk stratification by current comorbidity criteria is appropriate, attention needs to be paid to disproportionate risk contribution from renal disease to mortality compared with cardiac and pulmonary comorbidities. Given the lower mortality risk than previously described, patients stratified as high risk should be thoughtfully considered for definitive EVAR.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Journal of vascular surgery

DOI

EISSN

1097-6809

ISSN

0741-5214

Publication Date

February 2018

Volume

67

Issue

2

Start / End Page

424 / 432.e1

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Postoperative Complications
  • Patient Selection
  • Odds Ratio
  • Multivariate Analysis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Adkar, S. S., Turner, M. C., Leraas, H. J., Gilmore, B. F., Nag, U., Turley, R. S., … Mureebe, L. (2018). Low mortality rates after endovascular aortic repair expand use to high-risk patients. Journal of Vascular Surgery, 67(2), 424-432.e1. https://doi.org/10.1016/j.jvs.2017.06.107
Adkar, Shaunak S., Megan C. Turner, Harold J. Leraas, Brian F. Gilmore, Uttara Nag, Ryan S. Turley, Cynthia K. Shortell, and Leila Mureebe. “Low mortality rates after endovascular aortic repair expand use to high-risk patients.Journal of Vascular Surgery 67, no. 2 (February 2018): 424-432.e1. https://doi.org/10.1016/j.jvs.2017.06.107.
Adkar SS, Turner MC, Leraas HJ, Gilmore BF, Nag U, Turley RS, et al. Low mortality rates after endovascular aortic repair expand use to high-risk patients. Journal of vascular surgery. 2018 Feb;67(2):424-432.e1.
Adkar, Shaunak S., et al. “Low mortality rates after endovascular aortic repair expand use to high-risk patients.Journal of Vascular Surgery, vol. 67, no. 2, Feb. 2018, pp. 424-432.e1. Epmc, doi:10.1016/j.jvs.2017.06.107.
Adkar SS, Turner MC, Leraas HJ, Gilmore BF, Nag U, Turley RS, Shortell CK, Mureebe L. Low mortality rates after endovascular aortic repair expand use to high-risk patients. Journal of vascular surgery. 2018 Feb;67(2):424-432.e1.
Journal cover image

Published In

Journal of vascular surgery

DOI

EISSN

1097-6809

ISSN

0741-5214

Publication Date

February 2018

Volume

67

Issue

2

Start / End Page

424 / 432.e1

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Postoperative Complications
  • Patient Selection
  • Odds Ratio
  • Multivariate Analysis