Trends and Outcomes in Endovascular and Open Surgical Treatment of Visceral Aneurysms

Abstract

Visceral artery aneurysms (VAAs) are rare but often repaired because of dire consequences of rupture. This is a population-based evaluation of chronologic trends in management, risk factors, and outcomes in endovascular and open therapy. The 2003-2013 Agency for Healthcare Research and Quality National Inpatient Sample database was reviewed. Cases with primary diagnosis of VAA and undergoing endovascular or open repair were identified. Patients with renal artery or abdominal or thoracoabdominal aortic disease were excluded. Case numbers of respective techniques were charted over time. Baseline characteristics and in-hospital outcomes were compared for endovascular and open groups using χ2, Fisher exact, or t-test. Predictors of mortality and complications were evaluated with multivariate logistic regression. There were 9260 interventions for VAAs from 2003 to 2013, including 5166 endovascular and 4094 open. Endovascular repairs increased from 5.3 to 24.7 per 10 million U.S. population (P < .001), surpassing open repairs in 2008, which decreased from 14.3 to 9.2 per 10 million (P < .001; Fig). Endovascular patients were more likely to have nonelective admission (71.1% vs 40.2%; P < .001), renal failure (7.6% vs 4.9%; P = .02), liver disease (11.3% vs 6.6%; P < .001), alcohol abuse (13.1% vs 3.6%; P < .001), chronic blood loss anemia (4.5% vs 1.6%; P < .001), metastatic cancer (2.7% vs 0.8%; P = .003), solid tumor without metastases (3.6% vs 2.0%; P < .037), and weight loss (9.8% vs 5.2%; P < .001). In-hospital mortality (4.1% vs 4.5%; P = .618) and overall complication rates (37.8% vs 38.8%; P = .688) were similar between groups; however, pulmonary complications were decreased for endovascular patients (10.6% vs 19.7%; P < .001). Endovascular patients had shorter hospital stays (6.5 vs 8.7 days; P < .001). Multivariate adjustment for mortality predictors, including nonelective admission (odds ratio [OR], 3.1; confidence interval [CI], 1.5-6.4; P = .002), coagulopathy (OR, 4.3; CI, 2.6-7.4; P < .001), liver disease (OR, 2.2; CI, 1.2-4.1; P = .007), fluid and electrolyte disorders (OR, 2.8; CI, 1.7-4.7; P < .001), and solid tumor without metastases (OR, 2.8; CI, 1.1-7.1; P = .031), showed that endovascular treatment was associated with decreased mortality (OR, 0.59; CI, 0.36-0.97; P = .038). Analysis of overall complications revealed decreased mortality for endovascular treatment (OR, 0.56; CI, 0.45-0.70; P < .001). Endovascular VAA repairs are increasing. Despite patients' having worse comorbidities and more nonelective admissions, endovascular therapy appears to be associated with decreased mortality and complications and shorter hospital stays.