What Factors Predict Wound Complications after Endovascular Aortic Aneurysm Repair?

Abstract

s Accepted for Presentation during the 2015 Southern California Vascular Surgical Society Annual Meeting Endoleak after Modular Bifurcated Stent Versus Unibody Stent Graft for Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm Neha Sheng, Phong Dargon, Jason T. Chiriano, Theodore H. Teruya, Sheela T. Patel, Ahmed M. Abou-Zamzam Jr., and Christian Bianchi Loma Linda, California. Background: The purpose of our study is to report on results of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) and postoperative aneurysm sac diameter change, after repair with modular bifurcated and unibody aortic stent grafts. Methods: We retrospectively reviewed a prospectively maintained database of all endovascular aneurysm repair (EVAR) procedures performed for infrarenal abdominal aortic aneurysms (AAA) at a single VA institution. A total of 113 patients underwent EVAR for infrarenal AAA between October, 2008 and November, 2011. Patients were included if they underwent elective EVAR for asymptomatic infrarenal AAA greater than 5 centimeters in diameter, and if preoperative and postoperative imaging was available for review. Patients were assessed with clinical examination and CT scan at 1, 6, and 12 months and yearly thereafter. Results: Fifty patients underwent EVAR with a modular bifurcated graft: Gore Excluder (n 41, 82%), Medtronic Talent (n8, 16%), Cook Zenith (n1, 2%). Sixty-three patients underwent EVAR with the Endologix unibody design stent graft. Thirty-six patients (72%) in the modular bifurcated group met the criteria for the instructions for use (IFU) of the graft inserted (Mod-IFU), and 14 patients (28%) did not (Mod-non IFU). Fifty-two patients (83%) in the unibody group met the IFU criteria (Uni-IFU), and 11 (17%) did not (Uni-nonIFU). Overall follow-up was 20.1 months. Rate of postoperative endoleak was 27.8% in the Mod-IFU group, 28.6% in the Mod-non IFU group, and in 27.3% in the Uni-non IFU group, and 7.7% in the Uni-IFU group. Conclusions: Overall, fewer endoleaks are noted in patients meeting IFU criteria and undergoing EVAR for infrarenal AAA with unibody stent graft design. http://dx.doi.org/10.1016/j.avsg.2015.03.002 870 What Factors Predict Wound Complications after Endovascular Aortic Aneurysm Repair? Michael F. Amendola, Luke Wolfe, Marcella WoogenFisher and John Pfeifer Hunter Holmes McGuire VA Medical Center, Richmond, VA. Introduction: Endovascular aortic aneurysm repair (EVAR) is becoming thepreferredmethod for treating infrarenal aortic aneurysms. The majority of EVAR procedures require a groin incision to access the common femoral artery. Weset forth to examineourEVARpopulation to discover factors that contribute to wound complications post-operatively. Methods: With Institutional Board Review approval, we retrospectively queried our Veterans Administration Hospital operative database to identify male patients who underwent EVAR from January 1, 2010 to December 31, 2012. Each patient’s groin wound was considered individually and no adjunctive procedures were performed at the time of EVAR. All re-operative groins were excluded. Patients were followed for wound infection, wound breakdown, wound revision, and lymphatic leaks. Patients with wound complications (WC) were compared to patients with no wound complication (NWC). Age, body mass index (BMI), operative times, and CT calculated wound depth (CWD) were recorded. CWD was defined as the perpendicular distance measured in centimeters from the common femoral artery just proximal to the profunda femoris artery to the nearest skin edge. Receiver operator correlations were calculated for BMI as compared to CWD. Age, history of hypertension, history of diabetes, pre-EVAR hypogastric intervention, side of wound, incision type (vertical or horizontal) and operative times were also collected. Results: A total of 142 incisions were followed in 71 male patients. There was a 14.8% total wound complication rate. The WC group had a statistically higher BMI and CWD. Age, operative times, history of hypertension, history of diabetes, pre-EVAR hypogastric intervention, side of wound, incision type (vertical or horizontal), operative times, history of smoking and death rates were not statistically different between the two groups. Spearman Correlation Coefficient of 0.80300 (p 50, history of CHF, paraplegia, prior operation in last 30 days, emergent surgery, unplanned reintubation, and septic shock were independently associated with increased 30-day mortality. (table 2). Conclusion: Overall 30-day mortality was not significantly different between the two surgical techniques. However, older patients with more medical comorbidities underwent TEVAR. Age >50, history of CHF, operation in the previous 30 days, emergency surgery, unplanned re-intubation, and septic shock were independent predictors of 30-day mortality. http://dx.doi.org/10.1016/j.avsg.2015.03.004 Endovascular Repair of Mycotic Aneurysms e An Evolving Paradigm Erin Ward, Erik Owens, John Lane and