Clinical Research| Volume 45, P206-212, November 2017

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Lower Extremity Ischemia after Abdominal Aortic Aneurysm Repair


      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.


      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.


      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.


      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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        • Beck A.W.
        • Sedrakyan A.
        • Mao J.
        • et al.
        • International Consortium of Vascular R
        Variations in Abdominal Aortic Aneurysm Care: A Report from the International Consortium of Vascular Registries.
        Circulation. 2016; 134: 1948-1958
        • Soden P.A.
        • Zettervall S.L.
        • Ultee K.H.
        • et al.
        Outcomes for symptomatic abdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program.
        J Vasc Surg. 2016; 64: 297-305
        • Maldonado T.S.
        • Rockman C.B.
        • Riles E.
        • et al.
        Ischemic complications after endovascular abdominal aortic aneurysm repair.
        J Vasc Surg. 2004; 40 (discussion 709-710): 703-709
        • Cochennec F.
        • Becquemin J.P.
        • Desgranges P.
        • et al.
        Limb graft occlusion following EVAR: clinical pattern, outcomes and predictive factors of occurrence.
        Eur J Vasc Endovasc Surg. 2007; 34: 59-65
        • Ultee K.H.
        • Zettervall S.L.
        • Soden P.A.
        • et al.
        • Vascular Study Group of New E
        Incidence of and risk factors for bowel ischemia after abdominal aortic aneurysm repair.
        J Vasc Surg. 2016; 64: 1384-1391
        • Carroccio A.
        • Faries P.L.
        • Morrissey N.J.
        • et al.
        Predicting iliac limb occlusions after bifurcated aortic stent grafting: anatomic and device-related causes.
        J Vasc Surg. 2002; 36: 679-684
        • Faure E.M.
        • Becquemin J.P.
        • Cochennec F.
        • collaborators E
        Predictive factors for limb occlusions after endovascular aneurysm repair.
        J Vasc Surg. 2015; 61: 1138-1145.e2
        • Ali M.M.
        • Flahive J.
        • Schanzer A.
        • et al.
        In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair.
        J Vasc Surg. 2015; 61: 1399-1407
        • Nedeau A.E.
        • Pomposelli F.B.
        • Hamdan A.D.
        • et al.
        Endovascular vs open repair for ruptured abdominal aortic aneurysm.
        J Vasc Surg. 2012; 56: 15-20
        • Investigators I.T.
        Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.
        Eur Heart J. 2015; 36: 2061-2069