This article is more than 5 years old. Information may no longer be current.
Mortality rates reasonable among high-risk EVAR patients
Patients considered high risk for open aneurysm repair had a low mortality rate after endovascular aneurysm repair, despite previously reported results from the EVAR 2 trial.
According to data published in the Journal of Vascular Therapy, high-risk EVAR patients can undergo EVAR with a low rate of 30-day mortality; however, renal dysfunction and other comorbidities increase risk.
“EVAR, considered by some to be the standard of care for infrarenal abdominal aortic aneurysms, provides an alternative, often safer AAA treatment option for high-risk patients unfit for open repair,” Shaunak S. Adkar, from the Duke University School of Medicine, and colleagues wrote. “Whereas randomized controlled trials have demonstrated improved perioperative safety of EVAR compared with open surgery, the utility of EVAR for high-risk patients categorized as unfit for open repair remains controversial.”
To compare the incidence of 30-day mortality among low- and high-risk patients undergoing EVAR, researchers used data from the American College of Surgeons National Surgical Quality Improvement Program collected between 2005 and 2013.
A total of 24,813 patients were included in the study based on the presence of renal, respiratory or cardiac preoperative criteria, including a history of MI, congestive HF, angina and the need for prior coronary intervention.
Chi-square tests were used to compare patient and procedural characteristics and 30-day postoperative outcomes.
Of the patients undergoing EVAR, 48% of patients were characterized as high risk and 52% as low risk.
The 30-day mortality rate in the high-risk cohort was 1.9% compared with the 7.3% reported in EVAR 2 in 2010, and it was higher among patients in the high-risk cohort compared with those at low risk (1.9% vs. 0.9%; P < .001), the researchers wrote.
Thirty-day mortality risk was increased by the presence of each comorbidity (respiratory OR = 1.62; 95% CI, 1.16-2.26; cardiac OR = 1.55; 95% CI, 1.14-2.1), and there was a threefold increase in mortality risk with the presence of renal impairment criteria (OR = 3.42; 95% CI, 2.31-5.09).
“Given the lower mortality risk of contemporary endovascular repair of AAA than previously described, patients stratified as high risk should be considered for definitive EVAR on the basis of the preoperative comorbidity profile,” the researchers wrote. by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.