Background
Hostile proximal aortic neck anatomy has been associated with an 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. A 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 1,000 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% confidence interval
[CI], 1.050–1.056; P < 0.001), female sex (OR, 1.46; 95% CI, 1.38–1.54; P < 0.001), chronic kidney disease (OR, 1.65; 95% CI, 1.57–1.73; P < 0.001), chronic obstructive pulmonary disease (OR, 1.86; 95% CI, 1.77–1.94; P < 0.001), congestive heart failure (OR, 2.02; 95% CI, 1.91–2.13, P < 0.001), aneurysm diameter ≥ 6.5 cm (OR, 2.35; 95% CI, 2.24–2.47, P < 0.001), proximal neck length < 10 mm (OR, 1.96; 95% CI, 1.81–2.12; P < 0.001), proximal neck diameter ≥ 30 mm (OR, 1.41; 95% CI, 1.32–1.5; P < 0.001), infrarenal neck angulation ≥ 60° (OR, 1.27; 95% CI, 1.18–1.26; P < 0.001), and suprarenal neck angulation ≥ 60° (OR, 1.26; 95% CI, 1.16–1.37; P < 0.001). Significant protective factors included aspirin use (OR, 0.89; 95% CI,
0.85–0.93; P < 0.001) and statin intake (OR, 0.77; 95% CI, 0.73–0.81; P < 0.001). These predictors were incorporated to build an interactive risk calculator
of perioperative mortality after EVAR (C-statistic = 0.749).
Conclusions
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.
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Article info
Publication history
Published online: February 28, 2023
Accepted:
February 22,
2023
Received:
July 26,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: The authors declare that they have no conflicts of interest relevant to the content of this manuscript.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Poster presentation at the 2020 Society for Clinical Vascular Surgery Annual Meeting (canceled).
Author contributions: A.M., A.A., N.E., G.R., I.N., and M.B.M. contributed to the conceptual framework, methodology, design of the study, interpretation of results, and critical revision. A.M. and I.N. performed the analysis. A.M., A.A., G.R., and N.E. wrote the manuscript.
Identification
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