Large Aneurysm Size is Associated with Increased Short and Long Term Mortality after Branched and Fenestrated Repair for Thoraco-Abdominal and Complex Abdominal Aortic Aneurysms.

Abstract

This study assessed outcomes following fenestrated and branched endovascular aortic repair (FBEVAR) for thoraco-abdominal aortic aneurysms (TAAAs) and complex abdominal aortic aneurysms (cAAAs) based on aneurysm size (small, medium, and large). Patients who underwent elective FBEVAR for TAAAs and cAAAs (only juxtarenal aneurysms) from 2013 - 2022 in the Vascular Quality Initiative database were included. Aneurysm size was categorised as small (< 5.5 cm in men, < 5 cm in women), medium (5.5 - 7 cm in men, 5 - 7 cm in women), and large (≥ 7 cm). Demographics and outcomes were compared. Survival was evaluated using Kaplan-Meier curves and Cox regression. A total of 3 804 patients underwent FBEVAR (small, n = 519; medium, n = 2 685; large, n = 600). Median patient age (small, 73 years; medium, 74 years; large, 76 years; p < .001), previous aortic repair (small, 14.3%; medium, 18.7%; large, 39.0%; p < .001), and treatment for extent II TAAA (small, 2.7%; medium, 8.5%; large, 14.0%; p < .001) statistically significantly differed between patient groups. Peri-operative death (small, 1.0%; medium, 2.3%; large, 4.0%; p = .004), any complication (small, 14.6%; medium, 20.0%; large, 19.3%; p = .018), stroke (small, 0.4%; medium, 0.9%; large, 2.3%; p = .003), and prolonged length of stay (small, 6.7%; medium, 13.3%; large, 17.5%; p < .001) statistically significantly differed by aneurysm size. Both survival at one year (small, 95%; medium, 91%; large, 85%; p < .001) and five years (small, 87%; medium, 80%; large, 65%; p < .001) statistically significantly differed. After adjustment, patients with large aneurysms had increased 30 day mortality (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.3 - 10.1), long term mortality (hazard ratio [HR] 2.4, 95% CI 1.6 - 3.7), and prolonged length of stay (OR 1.87, 95% CI 1.2 - 2.9) compared with those with small aneurysms. Compared with patients with medium aneurysms, those with large aneurysms had increased 30 day mortality (OR 1.85, 95% CI 1.1 - 3.1) and long term mortality (HR 1.71, 95% CI 1.3 - 2.2). Large aneurysm size was associated with increased short and long term mortality rates in patients undergoing FBEVAR. Improved screening may provide an opportunity for earlier identification in order to decrease adverse events following FBEVAR for large TAAAs.