Outcomes of thoracoabdominal aortic aneurysm repair in patients with and without peripheral arterial disease.

Abstract

Certain comorbid atherosclerotic diseases have known associations with worse outcomes in thoracoabdominal aortic aneurysm (TAAA) repair; however, the association is less clear with peripheral arterial disease (PAD). This study investigates the relationship between PAD and TAAA repair outcomes. This retrospective, single-practice study analyzed data from 3772 patients who underwent TAAA repair between 1990 and 2023, including 891 patients (23.6%) with PAD and 2881 (76.4%) without PAD. Outcomes included adverse events, which comprised operative death (before final hospital discharge or ≤30 days postoperatively) and key events persisting at discharge: stroke, spinal cord deficit (SCD; paraplegia or paraparesis), or renal failure necessitating dialysis. Patients with PAD were older than patients without PAD (median, 69 years [interquartile range (IQR), 64-75 years] versus 66 years [IQR, 56-73 years]; P < .001). Patients with PAD had a lower rate of aortic dissection (21.1% vs 41.2%; P < .001). Patients with PAD more often underwent extent IV repair (30.4% vs 16.8%; P < .001), whereas patients without PAD more often had extent I repair (29.4% vs 16.9%; P < .001). Operative mortality did not differ between patients with PAD and those without PAD (9.2% vs 8.4%; P = .5). However, PAD patients had more SCD (12.3% vs 9.1%; P = .004) and persistent stroke (3.6% vs 2.0%; P = .009); these differences were pronounced in extent II repair (18.6% vs 12.8% [P = .02] and 6.7% vs 3.0% [P = .005], respectively). Our data suggest that PAD is associated with higher rates of SCD and persistent stroke after TAAA repair. This difference may necessitate the development of protective techniques for patients with PAD who undergo TAAA repair.