Lower Extremity Ischemia after Abdominal Aortic Aneurysm Repair

TY - JOUR

T1 - Lower Extremity Ischemia after Abdominal Aortic Aneurysm Repair

AU - Behrendt, Christian Alexander

AU - Dayama, Anand

AU - Debus, Eike Sebastian

AU - Heidemann, Franziska

AU - Matolo, Nathaniel M.

AU - Kölbel, Tilo

AU - Tsilimparis, Nikolaos

N1 - Publisher Copyright: © 2017 Elsevier Inc.

PY - 2017/11

Y1 - 2017/11

N2 - Background Treatment reality of abdominal aortic aneurysm (AAA) is changing. Up to date, approximately 65% of intact AAA and 30% of ruptured AAA are treated endovascularly. As most comparative studies focus upon mortality and few major complications, some outcomes as lower extremity ischemia (LEI) after invasive AAA repair are often underreported. However, there is evidence for a worse outcome of patients suffering from this kind of complication. Methods Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) vascular surgery targeted module from 2011 to 2014, we identified all patients undergoing endovascular aortic repair (EVAR) and open aortic repair (OAR) for AAA to illuminate the incidence and outcome of LEI after AAA repair. Results In total, 185 patients (1.9%) developed LEI after AAA repair. 1.6% of all patients showed LEI after treatment of asymptomatic or symptomatic intact AAA, compared with 4.8% of ruptured AAA repair (P < 0.001). Operation time, male gender, current smoking, and increased creatinine levels (>1.5 mg/dL) were associated with an increased likelihood of exhibiting LEI. No statistically significant differences between EVAR versus OAR were noted in the multivariate model. If LEI occurred, length of hospital stay (6 vs. 2 days, P < 0.001) and mortality (20.5 vs. 4.6%, P < 0.001) was significantly higher as compared with the patients without LEI. Furthermore, 30-day mortality and most major complications were more common if LEI occurred. Conclusions In this specialized analysis regarding LEI after AAA repair up to 2% develop this severe ischemic complication. Since the occurrence of LEI is associated with significantly worse outcome, future research and strategies to avoid this complication is needed.

AB - Background Treatment reality of abdominal aortic aneurysm (AAA) is changing. Up to date, approximately 65% of intact AAA and 30% of ruptured AAA are treated endovascularly. As most comparative studies focus upon mortality and few major complications, some outcomes as lower extremity ischemia (LEI) after invasive AAA repair are often underreported. However, there is evidence for a worse outcome of patients suffering from this kind of complication. Methods Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) vascular surgery targeted module from 2011 to 2014, we identified all patients undergoing endovascular aortic repair (EVAR) and open aortic repair (OAR) for AAA to illuminate the incidence and outcome of LEI after AAA repair. Results In total, 185 patients (1.9%) developed LEI after AAA repair. 1.6% of all patients showed LEI after treatment of asymptomatic or symptomatic intact AAA, compared with 4.8% of ruptured AAA repair (P < 0.001). Operation time, male gender, current smoking, and increased creatinine levels (>1.5 mg/dL) were associated with an increased likelihood of exhibiting LEI. No statistically significant differences between EVAR versus OAR were noted in the multivariate model. If LEI occurred, length of hospital stay (6 vs. 2 days, P < 0.001) and mortality (20.5 vs. 4.6%, P < 0.001) was significantly higher as compared with the patients without LEI. Furthermore, 30-day mortality and most major complications were more common if LEI occurred. Conclusions In this specialized analysis regarding LEI after AAA repair up to 2% develop this severe ischemic complication. Since the occurrence of LEI is associated with significantly worse outcome, future research and strategies to avoid this complication is needed.

UR - http://www.scopus.com/inward/record.url?scp=85021828387&partnerID=8YFLogxK

U2 - 10.1016/j.avsg.2017.05.037

DO - 10.1016/j.avsg.2017.05.037

M3 - SCORING: Journal article

C2 - 28602897

AN - SCOPUS:85021828387

VL - 45

SP - 206

EP - 212

JO - ANN VASC SURG

JF - ANN VASC SURG

SN - 0890-5096

ER -