Abstract
Objective
Hostile proximal aortic neck anatomy has been associated with increased risk of perioperative
mortality after endovascular aneurysm repair (EVAR). However, all available mortality
risk prediction models after EVAR lack neck anatomic associations. The aim of this
study is to develop a preoperative prediction model for perioperative mortality after
EVAR incorporating important anatomic factors.
Methods
Data were obtained from the Vascular Quality Initiative database on all patients who
underwent elective EVAR between January 2015 and December 2018. Stepwise multivariable
logistic regression analysis was implemented to identify independent predictors and
develop a risk calculator for perioperative mortality after EVAR. Internal validation
was done using bootstrap of 1000 reps.
Results
A total of 25,133 patients were included, of whom 1.1% (N=271) died within 30 days
or before discharge. Significant preoperative predictors of perioperative mortality
were age (odds ratio [OR], 1.053; 95% CI, 1.050-1.056; P<.001), female sex (OR, 1.46;
95% CI, 1.38-1.54; P<.001), chronic kidney disease (OR, 1.65; 95% CI, 1.57-1.73; P<.001),
chronic obstructive pulmonary disease (OR, 1.86; 95% CI, 1.77-1.94; P<.001), congestive
heart failure (OR, 2.02; 95% CI, 1.91-2.13, P<.001), aneurysm diameter ≥ 6.5cm (OR,
2.35; 95% CI, 2.24-2.47, P<.001), proximal neck length< 10mm (OR, 1.96; 95% CI, 1.81-2.12;
P<.001), proximal neck diameter ≥30mm (OR, 1.41; 95% CI, 1.32-1.5; P<.001), infrarenal
neck angulation ≥60° (OR, 1.27; 95% CI, 1.18-1.26; P<.001) and suprarenal neck angulation
≥60° (OR, 1.26; 95% CI, 1.16-1.37; P<.001). Significant protective factors included
aspirin use (OR, 0.89; 95% CI, 0.85-0.93; P<.001) and statin intake (OR, 0.77; 95%
CI, 0.73-0.81; P<.001), These predictors were incorporated to build an interactive
risk calculator of perioperative mortality after EVAR (C-statistic=0.749)
Conclusion
This study provides a prediction model for mortality following EVAR that incorporates
aortic neck features. The risk calculator can be used to weigh risk/benefit ratio
when counseling patients preoperatively. Prospective use of this risk calculator may
show its benefit in long-term prediction of adverse outcomes.
Keywords
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Article info
Publication history
Accepted:
February 22,
2023
Received in revised form:
February 7,
2023
Received:
July 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
