Fenestrated EVAR Compared to Open Repair of AAAs Involving Visceral Vessels

November 28, 2017—Findings from a study comparing 30-day outcomes after fenestrated endovascular aneurysm repair (FEVAR) versus open surgery (OS) for abdominal aortic aneurysms involving visceral vessels (AAA-Vs) were published by Prateek K. Gupta, MD, et al in Journal of Vascular Surgery (2017;66:1653–1658).

Using the American College of Surgeons National Surgical Quality Improvement Program 2008–2013 database, the investigators identified patients who underwent FEVAR (n = 535) and OS (n = 1,207) for elective AAA-V treatment. Thoracoabdominal aneurysms were excluded. Univariable and multivariable logistic regression analyses were performed.

As summarized in Journal of Vascular Surgery, there were more men (82% vs 72%; P < .0001), diabetic patients (16% vs 11%; P = .005), patients with dependent functional status (4% vs 2%; P = .002), and nonsmokers (70% vs 56%; P < .0001) in the FEVAR group versus the OS group.

The investigators found that there was no difference in the rates of chronic obstructive pulmonary disease, cardiac history, peripheral artery disease, hypertension, and dialysis (P > .05). FEVAR had fewer major postoperative pulmonary complications (3% vs 19%; P < .0001), less renal failure requiring dialysis (1.9% vs 6.4%; P < .0001), less frequent cardiac arrest or myocardial infarction (2.2% vs 5.8%; P = .001), less bleeding with major transfusion (17.4% vs 50.2%; P < .0001), and decreased incidence of return to the operating room (4.5% vs 9.6%; P < .0001) and death (2.4% vs 4.7%; P = .02). The median length of hospital stay was also significantly shorter for FEVAR (2 days vs 7 days; P < .0001).

On multivariable analyses, OS was associated with higher risk than FEVAR for 30-day death (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3–5.0), pulmonary complications (OR, 8.8; 95% CI, 5.1–15.0), cardiac complications (OR, 3.4; 95% CI, 1.8–6.6), renal failure requiring dialysis (OR, 3.8; 95% CI, 1.9–7.7), and return to the operating room (OR 2.5; 95% CI, 1.6–4.0).

FEVAR is therefore associated with a lower risk for 30-day mortality and adverse events compared with OS for AAA-Vs, concluded the investigators in Journal of Vascular Surgery.