Preoperative risk factors for 1-year mortality in patients undergoing fenestrated endovascular aortic aneurysm repair in the US Aortic Research Consortium

Charles A Banks; Zdenek Novak; Emily L Spangler; Andres Schanzer; Mark A Farber; Matthew P Sweet; Gustavo Oderich; Carlos H Timaran; Anothny Lee; Darren B Schneider; Matthew J Eagleton; Warren Gasper; Adam W Beck

doi:10.1016/j.jvs.2024.04.063

Preoperative risk factors for 1-year mortality in patients undergoing fenestrated endovascular aortic aneurysm repair in the US Aortic Research Consortium

J Vasc Surg. 2024 May 6:S0741-5214(24)01089-9. doi: 10.1016/j.jvs.2024.04.063. Online ahead of print.

Authors

Affiliations

¹ Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL.
² Division of Vascular and Endovascular Surgery, University of Massachusetts Memorial Hospital, Worcester, MA.
³ Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
⁴ Division of Vascular and Endovascular Surgery, University of Washington, Seattle, WA.
⁵ Division of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center, Houston, TX.
⁶ Division of Vascular Surgery, UT Southwestern Medical Center, Dallas, TX.
⁷ Division of Vascular Surgery, Boca Raton Regional Hospital, Boca Raton, FL.
⁸ Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA.
⁹ Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
¹⁰ Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA.
¹¹ Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL. Electronic address: awbeck@uabmc.edu.

PMID: 38718849
DOI: 10.1016/j.jvs.2024.04.063

Abstract

Background: Early survival (1-year) after elective repair of complex abdominal aortic aneurysms (AAA) or thoracoabdominal aortic aneurysms (TAAA) can be used as an indicator of successful repair and provides a reasonable countermeasure to the annual rupture risk based on diameter. We aimed to identify preoperative factors associated with 1-year mortality after fenestrated or branched endovascular aortic repair (F/BEVAR) and develop a predictive model for 1-year mortality based on patient-specific risk profiles.

Methods: The US-Aortic Research Consortium database was queried for all patients undergoing elective F/BEVAR for complex AAA (cAAA) or TAAA from 2005 to 2022. The primary outcome was 1-year survival based on preoperative risk profile. Multivariable Cox regression was used to determine preoperative variables associated with 1-year mortality overall and by extent of aortic pathology. Logistic regression was performed to build a predictive model for 1-year mortality based on number of risk factors present.

Results: A total of 2099 patients met the inclusion criteria for this study (cAAA: n = 709 [34.3%]; type 1-3 TAAA: n = 777 [37.6%]; type 4-5 TAAA: n = 580 [28.1%]). Multivariable Cox regression identified the following significant risk factors associated with 1-year mortality: current smoker, chronic obstructive pulmonary disease, congestive heart failure (CHF), aortic diameter >7 cm, age >75 years, extent 1-3, creatinine >1.7 mg/dL, and hematocrit <36%. When stratified by extent of aortic involvement, multivariable Cox regression revealed risk factors for 1-year mortality in cAAA (CHF maximum aortic diameter >7 cm, hematocrit <36 mg/dL, and current smoking status), type 1-3 TAAA (chronic obstructive pulmonary disease, CHF, and age >75 years), and type 4-5 TAAA (age >75 years, creatinine >1.7 mg/dL, and hematocrit <36 mg/dL). Logistic regression was then used to develop a predictive model for 1-year mortality based on patient risk profile. Appraisal of the model revealed an area under the curve of 0.64 (P < .001), and an observed to expected ratio of 0.85.

Conclusions: This study describes multiple risk factors associated with an increase in 1-year mortality after F/BEVAR. Given that elective repair of cAAA or TAAA is offered to some patients in whom future rupture risk outweighs operative risk, these findings suggest that highly comorbid patients with smaller aneurysms may not benefit from repair. Descriptive and predictive models for 1-year mortality based on patient risk profiles can serve as an adjunct in clinical decision-making when considering elective F/BEVAR.

Keywords: 1-Year mortality; Complex abdominal aortic aneurysm; Fenestrated/branched endovascular aortic aneurysm repair; Thoracoabdominal aortic aneurysm.