SS8. Contemporary Outcomes of Intact (iVAA) and Ruptured (rVAA) Visceral Artery Aneurysm Repair

Abstract

To review the outcomes of open and endovascular intervention for intact visceral artery aneurysm (iVAA) and ruptured VAA (rVAA). Retrospective review of treated VAA at one institution from 2003 to 2013. We identified 261patients with VAA; of these 155 were repaired (69 ruptured, 86 intact; Table). Pseudoaneurysms were more common in rVAA (80%) vs iVAA (35%; P < .001). rVAA were smaller than iVAA (20.5 vs 27.5 mm; P = .018) at repair, and their most common presentation was abdominal pain; 18% were hemodynamically unstable. Endovascular intervention was the initial treatment for 70% (78% for rVAA, 63% for iVAA). Perioperative complication rate was higher for rVAA (19% vs iVAA 4%; P = .003), as well as 30-day (12% vs 0% iVAA; P = .001), 1-year (26% vs 4% iVAA; P < .001), and 3-year (30% vs 7% iVAA; P < .001) mortality. Lower 30-day mortality was noted with endovascular repair for rVAA (7% vs 28% open; P = .06). Predictors of mortality for rVAA included age (HR, 1.098; P = .006) whereas endovascular repair was protective (HR, 0.231; P = .035). Mean follow up was 26 months, and Kaplan-Meier estimates of survival were higher for iVAA at 3 years (88% vs 62% iVAA, P = .045). The 30-day reintervention rate was higher for rVAA (9% vs 1% iVAA; P = .045), but was similar between open and endovascular repair (8.5% vs 15%, P = NS). rVAAs have significant mortality. Open or endovascular interventions are equally durable, but endovascular interventions for rVAA result in lower morbidity and mortality. Aggressive treatment of pseudoaneurysms is electively recommended at diagnosis, regardless of size.TableRuptured VAA (N = 69)No. (%)Gender (Male)43 (62.3)Age (mean)±SD5S.8 ± 15Smoking16 (23.2)VAA type (pseudoaneurysm)55 (79.7)Mean size (mm) (range)20.5 (3.5-75)Splenic19 (27.5)Celiac6 (8.7)SMA8 (11.6)Hepatic16 (23.2)Renal1 (1.5)Pancreaticoduodenal (PDA)18 (26.1)Comorbidities DM8 (11.6) CRI6 (8.7) ESRD1 (1.4) Hypertension41 (59.4) Hyperlipidemia13 (18.8) CAD4 (5.9) COPD7 (10.1) CVA5 (7.2) Pancreatitis29 (42) Open table in a new tab