Effects of Chronic Obstructive Pulmonary Disease on the Outcomes of Fenestrated-Branched Endovascular Aortic Repair

Abstract

Chronic obstructive pulmonary disease (COPD) is a frequent comorbid condition in patients with aortic aneurysms. Severe COPD is associated with an increased risk of aneurysm rupture and perioperative complications. The purpose of this study was to assess the outcomes of patients with COPD after fenestrated-branched endovascular aortic repair F-BEVAR. During a 5-year period, 387 patients (71% male) had undergone F-BEVAR at a single institution. The outcomes were compared between patients with and without COPD. The end points included perioperative mortality, pulmonary complications, and major adverse events. Patient survival and late complications were assessed using life-table and Cox regression analysis. The median age was 72 years (interquartile range [IQR], 68-79 years). Suprarenal (36%), juxtarenal (25%), and thoracoabdominal (39%) aortic aneurysms were treated. Technical success was achieved in 384 patients (99.2%). In-patient or 30-day mortality was 2.8%. History of COPD was identified in 180 patients (46%). No significant differences in demographics, comorbidities, or aneurysm sac size or type were identified between both groups, except for a more frequent history of smoking (91% vs 82%; P = .003). Among patients with COPD, 21% were oxygen dependent and 40% received steroids. The in-patient/30-day mortality was similar between patients with and without COPD (2.9% vs 2.8%; P = .95). Patients with COPD had more frequent pulmonary complications (6.1% vs 2.4%; P = .07) and were more susceptible to be discharged on oxygen (10.7% vs 2%; P = .003). Patients with and without COPD did not have significant differences in intensive care unit length of stay (2 days [1-4]) or hospital length of stay (5 days [3-6] vs 4 days [3-6], respectively; P = .78; Table). The survival rates at 12, 36, and 60 months were lower for patients with COPD than for those without (87%, 73%, and 64% vs 92%, 78%, and 66%, respectively; P = .09; Fig). History of COPD or oxygen-dependent COPD was not an independent predictor of patient survival (P = .28). F-BEVAR is a safe and effective procedure for patients with COPD, even those with oxygen-dependent disease. Patients with COPD had a greater frequency of perioperative pulmonary complications and were more susceptible to be discharged on oxygen. However, their in-patient or 30-day mortality was not affected. Long-term patient survival was slightly reduced in patients with COPD, but COPD itself was not a predictor of long-term survival.TableResultsOutcomeOverall (n = 387)COPD (n = 180)Healthy (n = 207)P valuePulmonary complications12 (3.1)7 (3.8)5 (2.4).0730-Day mortality11 (2.8)5 (2.8)6 (2.8).95Hospital stay, days5 [3-6]5 [3-6]4 [3-6].78Discharge on oxygen23 (6)19 (10.6)4 (2).003COPD, Chronic obstructive pulmonary disease; IQR, interquartile range. Data presented as median [IQR] or number (%). Open table in a new tab