PC172. Visceral Artery Aneurysms—Management and Outcomes

Abstract

Visceral artery aneurysms (VAAs) are rare and can be challenging to manage. The goal of this study was to detail the evolution of management of VAAs and to compare outcomes of open and endovascular repair. Using the Nationwide Inpatient Sample data from 1998 to 2014, all admissions with a diagnosis of VAA and intervention were identified. Patients were stratified by aneurysm type (splenic artery aneurysm or non-splenic VAA [NSVAA]) and by procedure type (open, endovascular, combined). Years studied were then divided between procedures performed before and after January 2005. Primary outcomes included in-hospital mortality, length of stay (LOS), postoperative complications (POCs), and total hospital charges. There were 9363 patients who underwent an intervention for a VAA. There was a significant increase in VAA procedures overall as well as in endovascular procedures during the 14 years studied (P < .001 and P < .001). The Table details the cohort demographic and outcomes studied stratified by time frame (before and after 2005). After 2005, there were significant increases in endovascular treatment, POCs, and total hospital charges. After 2005, there were significant decreases in open repair, elective procedures, LOS, non-home discharge, and in-hospital mortality. Overall, the in-hospital mortality rate was 5.4% (n = 506). Significant predictors of in-hospital mortality included preoperative aneurysm rupture (odds ratio [OR], 4.7; P < .001), increased Charlson comorbidity score (OR, 1.2; P < .001), and open repair (OR, 1.61; P = .005). The average LOS was 9.5 ± 11 days, and the only factor that significantly reduced LOS was having an endovascular procedure (−3.2 days; P < .001). Having an NSVAA, preoperative aneurysm rupture, and teaching hospital status significantly increased LOS (+1.7 days [P < .001], +3.5 days [P < .001], and +1.5 [P < .001], respectively). There were 3880 patients (41%) who had any POC, and significant predictors of POC included open procedure (OR, 1.45; P < .001), NSVAA (OR, 1.3; P = .001), surgery after 2005 (OR, 1.3; P < .001), and preoperative rupture (OR, 1.9; P < .001). Endovascular procedures had significantly reduced total hospital charges (−$22,903; P < .001) compared with open repair. Combined procedures, NSVAAs, and preoperative rupture significantly increased total charges (+$26,226 [P = .014], +$16,558 [P < .001], and +$17,965 [P = .007], respectively). Treatment, particularly endovascular management, of VAAs has significantly increased in contemporary practice. Endovascular interventions have a lower mortality, reduced LOS, fewer POCs, and decreased costs compared with open surgery. These data support an endovascular-first approach to VAAs.TableDemographics and outcomes for the treatment of visceral artery aneurysms (VAAs) before and after 2005Demographic and outcomeBefore 2005After 2005P valueDemographicNo. (%) or average (±SD)No. (%) or average (±SD) Patients30166347 Age, years60 (±16)59 (±16)<.001 Female sex1316 (44)2878 (45).128 Splenic artery aneurysm1230 (41)2545 (40).528 NSVAA1828 (61)3893 (61).501 Splenic and VAA42 (1.4)91 (1.4).875 Ruptured VAA496 (16)1020 (16).645 Open repair1388 (46)1441 (23)<.001 Endovascular repair1200 (40)4588 (72)<.001 Combined open and endovascular repair428 (14)318 (5)<.001 Elective procedure652 (43)2058 (32)<.001Outcome Length of stay10.4 days (±14)9 days (±10)<.001 Any postoperative complication1156 (38)2724 (43)<.001 Nonhome discharge348 (14)82 (9)<.001 Total charges$78,753 (±$105,732)$118,589 (±$150,347)<.001 In-hospital mortality202 (7)304 (5)<.001NSVAA, Non-splenic visceral artery aneurysm; SD, standard deviation.Boldface entries indicate statistical significance. Open table in a new tab