Background
Treatment reality of abdominal aortic aneurysm (AAA) is changing. Up to date, approximately
65% of intact AAA and 30% of ruptured AAA are treated endovascularly. As most comparative
studies focus upon mortality and few major complications, some outcomes as lower extremity
ischemia (LEI) after invasive AAA repair are often underreported. However, there is
evidence for a worse outcome of patients suffering from this kind of complication.
Methods
Using the American College of Surgeons National Surgical Quality Improvement Program
(NSQIP) vascular surgery targeted module from 2011 to 2014, we identified all patients
undergoing endovascular aortic repair (EVAR) and open aortic repair (OAR) for AAA
to illuminate the incidence and outcome of LEI after AAA repair.
Results
In total, 185 patients (1.9%) developed LEI after AAA repair. 1.6% of all patients
showed LEI after treatment of asymptomatic or symptomatic intact AAA, compared with
4.8% of ruptured AAA repair (P < 0.001). Operation time, male gender, current smoking, and increased creatinine
levels (>1.5 mg/dL) were associated with an increased likelihood of exhibiting LEI.
No statistically significant differences between EVAR versus OAR were noted in the
multivariate model. If LEI occurred, length of hospital stay (6 vs. 2 days, P < 0.001) and mortality (20.5 vs. 4.6%, P < 0.001) was significantly higher as compared with the patients without LEI. Furthermore,
30-day mortality and most major complications were more common if LEI occurred.
Conclusions
In this specialized analysis regarding LEI after AAA repair up to 2% develop this
severe ischemic complication. Since the occurrence of LEI is associated with significantly
worse outcome, future research and strategies to avoid this complication is needed.
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Article info
Publication history
Published online: June 07, 2017
Accepted:
May 29,
2017
Received:
March 25,
2017
Footnotes
Conflict of interest: The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
