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PC36. Preoperative Risk Score for the Prediction of Mortality Following Repair of Ruptured Abdominal Aortic Aneurysms
JOURNAL OF VASCULAR SURGERY Volume 61, Number 6S
Abstracts 127S
Nothing to disclose; R. K. Veeraswamy: Cook Inc, Lombard Medical Inc, consulting fee; Medtronic Inc, contracted research; R. L. Motaganahalli: Nothing to disclose; A. P. Sawchuk: Nothing to disclose; Y. Duwayri: Cook Medical, consulting fee.
Author Disclosures: N. T. Tran: Nothing to disclose; E. Quiroga: Nothing to disclose; N. Singh: Nothing to disclose; M. T. Caps: Nothing to disclose; B. W. Starnes: Cook Inc, Endologix, consulting fee; Aortica, receipt of intellectual property rights/patent holder; B. T. Garland: Nothing to disclose; P. J. Danaher: Nothing to disclose.
PC36.
PC38.
Preoperative Risk Score for the Prediction of Mortality Following Repair of Ruptured Abdominal Aortic Aneurysms Nam T. Tran1, Elina Quiroga1, Niten Singh2, Michael T. Caps3, Benjamin W. Starnes4, Brandon T. Garland1, Patrick J. Danaher5. 1University of Washington, Seattle, Wash; 2University of Washington, Mercer Island, Wash; 3 Hawaii Permanente Medical Group, Honolulu, Hawaii; 4Division of Vascular Surgery, University of Washington, Seattle, Wash; 5NanoString Technologies, Seattle, Wash
The Role of EndoAnchors During Complex and Thoracic Endovascular Aortic Repairs: A Feasibility and Early Outcome Study Daniel F. Miller1, Colin T. Brandt2, Sadaf S. Ahanchi1, David J. Dexter1, Jean M. Panneton1. 1Eastern Virginia Medical School, Norfolk, Va; 2Eastern Virginia Medical School, Division of Vascular Surgery, Norfolk, Va
Objectives: Several scoring systems for predicting mortality in patients with ruptured abdominal aortic aneurysms (rAAA) in the endovascular era have been derived. However, all of these scores include intraoperative variables that limit their utility in preoperative planning and patient counseling. The purpose of this study was to develop and validate a practical mortality risk score using only preoperative variables and compare it with other previously published scoring criteria. Methods: Data on all patients with rAAA presenting between January 1, 2002, and October 31, 2013, were collected. Univariate logistic regression was used to identify important predictors of mortality. Multiple logistic regression analysis was used to select a subset of four of these variables and combine their values into a single predictor of rAAA mortality. The predictor’s accuracy was compared with previously published algorithms. Results: A total of 303 patients presented during the study period. Fifteen patients died in the emergency department, en route to surgery, or after choosing comfort care. Overall, 30-day mortality was 54% for patients undergoing open rAAA repair and 22% for those undergoing endovascular rAAA repair. Preoperative variables most predictive of mortality were preoperative systolic blood pressure <70 mm Hg (odds ratio [OR], 2.7; P < .05), pH <7.2 (OR, 2.6; P < .05), age <76 years (OR, 2.1; P < .05), and creatinine >2 (OR, 3.7; P < .05). Patient stratification according to the preoperative rAAA mortality risk score (range, 0-4) accurately predicted mortality and identified those at low-risk and high-risk for death. While the Vascular Study Group of New England score, Glasgow aneurysm score, and Edinburg score were validated in our contemporary data set, our preoperative risk score was most predictive with area under the curve of 0.67. Conclusions: Existing scoring systems predict mortality after rAAA repair in our cohort but rely on intraoperative variables. Our rAAA mortality risk score is based on four variables readily assessed preoperatively, allows accurate prediction of in-hospital mortality after repair of rAAAs in the EVAR-first era, and does so more accurately than those previously described.
Objectives: EndoAnchors were designed to augment endograft fixation during aortic repair. Previous studies have evaluated EndoAnchor use with endovascular aortic repair (EVAR) of infrarenal aortic aneurysms. This experience expands the use of EndoAnchors to complex endovascular aortic aneurysm repair (CEVAR) and thoracic endovascular aortic aneurysm repair (TEVAR). Our goal was to study the applicability of this technology to more complex patients and to assess their outcomes. Methods: We completed a retrospective review of CEVARs and TEVARs utilizing EndoAnchors from 2012 to 2014. Data collected included patient demographics, medical history, procedural details, and outcome data. CEVAR was defined as EVAR requiring revascularization of visceral vessels with branched or fenestrated endografts or with the use of a chimney technique. Prophylactic EndoAnchors were defined as placement when there was no endoleak, and therapeutic EndoAnchors were defined as placement to treat an endoleak after endograft deployment. Primary end points included freedom from migration, type I endoleaks and aortic related reintervention. Results: Fifty-nine patients, 45 male patients (76.0%) with a mean age of 72 6 12 years, met inclusion criteria. Thirty-three of these patients (54.1%) had previous aortic interventions including open repair (8), EVAR (11), FEVAR (3), and TEVAR (11). Sixty-one procedures were performed on these 59 patients using EndoAnchors: 33 CEVARs and 28 TEVARs. The anatomic location of the aneurysm was thoracic (15), thoracoabdominal (28), pararenal (3), juxtarenal (11), and infrarenal (4). Four cases (6.6%) were done as emergencies. Seventy-eight visceral branches were revascularized in patients who underwent CEVAR with a mean of 2.4 6 1 vessels per patient. EndoAnchors were used for prophylactic fixation for 38 cases (62.3%) and for therapeutic indications in 23 (37.7%). For those patients with therapeutic indications, the target endoleak was type I for all cases. An average of 9.5 6 2.6 EndoAnchors were placed per procedure. Zones of EndoAnchor deployment for TEVAR were 1 (n ¼ 9), 2 (n ¼ 8), and other (n ¼ 11). The CEVAR zones were 5 supraceliac (n ¼ 15), 7 adjacent to superior mesenteric artery (n ¼ 10), and other (n ¼ 11). A total of 583 EndoAnchors were placed, with a technical success rate of 99.5%, with three requiring endovascular retrieval. Thirty-day nonaortic adverse events included paraplegia in 2 (3.3%), ischemic bowel in 4 (6.7%), and respiratory failure in 16 (26.2%). Thirty-day mortality was 9.8% (n ¼ 6). After a
Abstracts 127S
Nothing to disclose; R. K. Veeraswamy: Cook Inc, Lombard Medical Inc, consulting fee; Medtronic Inc, contracted research; R. L. Motaganahalli: Nothing to disclose; A. P. Sawchuk: Nothing to disclose; Y. Duwayri: Cook Medical, consulting fee.
Author Disclosures: N. T. Tran: Nothing to disclose; E. Quiroga: Nothing to disclose; N. Singh: Nothing to disclose; M. T. Caps: Nothing to disclose; B. W. Starnes: Cook Inc, Endologix, consulting fee; Aortica, receipt of intellectual property rights/patent holder; B. T. Garland: Nothing to disclose; P. J. Danaher: Nothing to disclose.
PC36.
PC38.
Preoperative Risk Score for the Prediction of Mortality Following Repair of Ruptured Abdominal Aortic Aneurysms Nam T. Tran1, Elina Quiroga1, Niten Singh2, Michael T. Caps3, Benjamin W. Starnes4, Brandon T. Garland1, Patrick J. Danaher5. 1University of Washington, Seattle, Wash; 2University of Washington, Mercer Island, Wash; 3 Hawaii Permanente Medical Group, Honolulu, Hawaii; 4Division of Vascular Surgery, University of Washington, Seattle, Wash; 5NanoString Technologies, Seattle, Wash
The Role of EndoAnchors During Complex and Thoracic Endovascular Aortic Repairs: A Feasibility and Early Outcome Study Daniel F. Miller1, Colin T. Brandt2, Sadaf S. Ahanchi1, David J. Dexter1, Jean M. Panneton1. 1Eastern Virginia Medical School, Norfolk, Va; 2Eastern Virginia Medical School, Division of Vascular Surgery, Norfolk, Va
Objectives: Several scoring systems for predicting mortality in patients with ruptured abdominal aortic aneurysms (rAAA) in the endovascular era have been derived. However, all of these scores include intraoperative variables that limit their utility in preoperative planning and patient counseling. The purpose of this study was to develop and validate a practical mortality risk score using only preoperative variables and compare it with other previously published scoring criteria. Methods: Data on all patients with rAAA presenting between January 1, 2002, and October 31, 2013, were collected. Univariate logistic regression was used to identify important predictors of mortality. Multiple logistic regression analysis was used to select a subset of four of these variables and combine their values into a single predictor of rAAA mortality. The predictor’s accuracy was compared with previously published algorithms. Results: A total of 303 patients presented during the study period. Fifteen patients died in the emergency department, en route to surgery, or after choosing comfort care. Overall, 30-day mortality was 54% for patients undergoing open rAAA repair and 22% for those undergoing endovascular rAAA repair. Preoperative variables most predictive of mortality were preoperative systolic blood pressure <70 mm Hg (odds ratio [OR], 2.7; P < .05), pH <7.2 (OR, 2.6; P < .05), age <76 years (OR, 2.1; P < .05), and creatinine >2 (OR, 3.7; P < .05). Patient stratification according to the preoperative rAAA mortality risk score (range, 0-4) accurately predicted mortality and identified those at low-risk and high-risk for death. While the Vascular Study Group of New England score, Glasgow aneurysm score, and Edinburg score were validated in our contemporary data set, our preoperative risk score was most predictive with area under the curve of 0.67. Conclusions: Existing scoring systems predict mortality after rAAA repair in our cohort but rely on intraoperative variables. Our rAAA mortality risk score is based on four variables readily assessed preoperatively, allows accurate prediction of in-hospital mortality after repair of rAAAs in the EVAR-first era, and does so more accurately than those previously described.
Objectives: EndoAnchors were designed to augment endograft fixation during aortic repair. Previous studies have evaluated EndoAnchor use with endovascular aortic repair (EVAR) of infrarenal aortic aneurysms. This experience expands the use of EndoAnchors to complex endovascular aortic aneurysm repair (CEVAR) and thoracic endovascular aortic aneurysm repair (TEVAR). Our goal was to study the applicability of this technology to more complex patients and to assess their outcomes. Methods: We completed a retrospective review of CEVARs and TEVARs utilizing EndoAnchors from 2012 to 2014. Data collected included patient demographics, medical history, procedural details, and outcome data. CEVAR was defined as EVAR requiring revascularization of visceral vessels with branched or fenestrated endografts or with the use of a chimney technique. Prophylactic EndoAnchors were defined as placement when there was no endoleak, and therapeutic EndoAnchors were defined as placement to treat an endoleak after endograft deployment. Primary end points included freedom from migration, type I endoleaks and aortic related reintervention. Results: Fifty-nine patients, 45 male patients (76.0%) with a mean age of 72 6 12 years, met inclusion criteria. Thirty-three of these patients (54.1%) had previous aortic interventions including open repair (8), EVAR (11), FEVAR (3), and TEVAR (11). Sixty-one procedures were performed on these 59 patients using EndoAnchors: 33 CEVARs and 28 TEVARs. The anatomic location of the aneurysm was thoracic (15), thoracoabdominal (28), pararenal (3), juxtarenal (11), and infrarenal (4). Four cases (6.6%) were done as emergencies. Seventy-eight visceral branches were revascularized in patients who underwent CEVAR with a mean of 2.4 6 1 vessels per patient. EndoAnchors were used for prophylactic fixation for 38 cases (62.3%) and for therapeutic indications in 23 (37.7%). For those patients with therapeutic indications, the target endoleak was type I for all cases. An average of 9.5 6 2.6 EndoAnchors were placed per procedure. Zones of EndoAnchor deployment for TEVAR were 1 (n ¼ 9), 2 (n ¼ 8), and other (n ¼ 11). The CEVAR zones were 5 supraceliac (n ¼ 15), 7 adjacent to superior mesenteric artery (n ¼ 10), and other (n ¼ 11). A total of 583 EndoAnchors were placed, with a technical success rate of 99.5%, with three requiring endovascular retrieval. Thirty-day nonaortic adverse events included paraplegia in 2 (3.3%), ischemic bowel in 4 (6.7%), and respiratory failure in 16 (26.2%). Thirty-day mortality was 9.8% (n ¼ 6). After a