AAN 4. A 14-Year Single-Center Review of Inflammatory Abdominal Aortic Aneurysm Repair

Abstract

The objective of this study was to review our experience with the contemporary management of inflammatory abdominal aortic aneurysms (IAAAs) involving either open surgery (OS) or endovascular aneurysm repair (EVAR). There were 120 consecutive patients (mean age, 70 ± 8 years; 97 male patients) undergoing IAAA repair between 2004 and 2017 included. Primary outcomes were all-cause mortality and AAA-related mortality. Freedom from reintervention, presence of hydronephrosis (HF) caused by perianeurysmal fibrosis, and renal insufficiency (defined as absolute serum creatinine value >2 mg/dL or an increased value >0.5 mg/dL vs the baseline one) before and after repair at the last follow-up were considered secondary end points. EVAR was performed according to the instructions for use of each device. Mean follow-up was 41 (range, 0-168) months; 110 (92%) patients were treated by OS and the remaining 10 (8%) by EVAR. Mean sac diameter was 69 (±14) mm. Twenty-one (17%) patients had a ruptured IAAA. The 30-day mortality was 5.9% (n = 7), with all deaths in the OS group (P = 1). Overall survival was 70%, 59%, and 30% at 1 year, 2 years, and 5 years, respectively. Elective survival was 96%, 93%, and 79% at 1 year, 2 years, and 5 years (EVAR vs OS, P = . 45). Eleven (9%) aneurysm-related deaths occurred, two in the EVAR group and nine in the OS group (P = .23). Freedom from reintervention was 94%, 92%, and 83% at 1 year, 2 years, and 5 years, respectively. Reintervention was more frequent in the EVAR vs the OS group (55.6% vs 4.6%; P < .001). HF occurred in 26 (22%) and 17 (14%) patients before and after repair, respectively. Repair resolved HF in 17 patients, whereas a new HF occurred after repair in another 8 patients. The Table reports results on HF and renal insufficiency before and after repair for both OS and EVAR groups as well as independent predictors of mortality at multivariate analysis. In this 14-year single-center study, a ruptured IAAA showed up in nearly one of five patients with a high mortality rate. EVAR could be a reasonable option to decrease the mortality rate in such complex patients; however, EVAR did not seem to offer any benefits for HF and renal insufficiency vs OS. More patients and long-term data are still needed.TableOutcomes and predictors for mortalityResultsOS (110), No. (%)EVAR (10), No. (%)P valueAAA-related deaths9 (8.2)2 (20).2330-Day mortality7 (6.4)01HF before repair25 (24)2 (22)1HF after repair13 (12)4 (44.4).03Renal insufficiency before repair7 (6.5)1 (11).51Renal insufficiency after repair8 (7.4)3 (33).04Dialysis3 (2.7)01Predictors for mortalityOR95% CIP valueOS3.51.6-4.8.02Age >80 years1.31.1-1.6.001Urgent repair34.911.6-47.8.036HF before repair8.691.3-56.3.025Anticoagulation therapy9.42.6-14.8.036AAAc, Abdominal aortic aneurysm; CI, confidence interval; EVAR, endovascular aneurysm repair; HF, hydronephrosis; OR, odds ratio; OS, open surgery. Open table in a new tab