Comparison of Morbidity and Mortality Rates following Endovascular Repair of Complex Abdominal and Thoraco-abdominal Aortic Aneurysms by Self-identified Race and Ethnicity in the Vascular Quality Initiative.

Abstract

Inequities in outcomes after endovascular repair of complex abdominal aortic aneurysms (cAAAs) are poorly described. This study assessed racial and ethnic differences in mortality and peri-operative outcomes after endovascular cAAA and thoraco-abdominal aortic aneurysm (TAAA) repair. This was a retrospective cohort study of patients treated with branched and or fenestrated endovascular grafts from the prospectively collected Vascular Quality Initiative registry. Patients undergoing endovascular treatment for cAAA or TAAA from 2014 to 2022 were included. Demographic, comorbidity, and operative details were compared by race and ethnicity. Peri-operative complications and survival were analysed using unadjusted and adjusted logistic regression. In total, 4 079 patients (2.3% Asian, 7.0% Black, 4.0% Hispanic and Latino, and 86.7% White) were treated for cAAA or TAAA. Age, sex, hypertension, and glomerular filtration rate differed by race and ethnicity (all p < .001). Frequency of symptomatic (Asian 8%, Black 16.0%, Hispanic and Latino 8.6%, and White 8.8%) and ruptured (Asian 5%, Black 3.5%, Hispanic and Latino 2.5%, and White 1.8%) presentation differed, as did thoraco-abdominal vs. complex abdominal aneurysms (TAAA: Asian 36%, Black 36.4%, Hispanic and Latino 25.2%, and White 24.3%) (all p < .001). Unadjusted analyses showed differences in survival (log rank p = .049) and morbidity, including cardiac complications (Asian 4%, Black 10.1%, Hispanic and Latino 15.3%, and White 10.5%; p = .050), endoleak (Asian 35%, Black 24.4%, Hispanic and Latino 30.1%, and White 33.5%; p = .027), and length of stay (mean days: Asian 6.7, Black 8.1, Hispanic and Latino 9.7, and White 6.3; p < .001). After adjustment, race and ethnicity was not independently associated with survival or adverse outcomes. Thoraco-abdominal extent and non-elective presentation predicted the long term mortality rate, respiratory complications, and prolonged hospital stay; extent predicted cardiac complications; presentation predicted the 30 day mortality rate and adverse events including spinal cord injury and renal complications. Morbidity and mortality rates following cAAA and TAAA repair differ by race and ethnicity; however, disparities appear to be driven by higher rates of symptomatic and ruptured aneurysms and thoraco-abdominal extent in non-White patients rather than race. The findings underscore the need for increased awareness, improved screening, and timely access to care to address inequities.