Fenestrated/Branched Endovascular Aortic Repair Patients With Peripheral Artery Disease Have Significantly Lower Long-Term Survival and Higher Incidence of Postoperative Mesenteric Ischemia

The aim of this study was to investigate the outcomes of F/BEVAR patients comparing individuals with and without a prior diagnosis of peripheral arterial disease (PAD) A single-center retrospective analysis was performed, including patients with the diagnosis of complex aortic aneurysms treated with an F/BEVAR procedure, using either an off-the-shelf or a patient-specific device. The diagnosis of PAD was determined by an ankle- brachial index <0.9 or a toe-brachial index <0.7 in non-diabetic and diabetic patients, respectively. No individuals presenting active wounds or foot infection were included; therefore, only the ischemia grade of the WIFi classification was applied to categorize PAD patients into "mild PAD" (grades 0 and 1) and "severe PAD" (grades 2 and 3), and both groups were compared with the non-PAD cases. The primary outcomes were 30-day and long-term mortality. Secondary outcomes included 30-day major adverse events (bowel ischemia, acute kidney injury [AKI], spinal cord ischemia [SCI]), long-term major complications (myocardial infarction [MI], stroke, and kidney function deterioration), and aneurysm-related adverse events. Four hundred one patients (72.3% males; mean age, 71.7 ± 8.9 years) who underwent a F/BEVAR procedure between July/2012 and October/2023 were included in the study, 95 (24%) with a prior diagnosis of PAD (22 mild; 73 severe). In terms of demographics, aneurysm extent, aneurysm maximal diameter, and comorbidities, no significant difference was observed across the three groups, except for the history of tobacco use (P = .033) and prior diagnosis of diabetes (P = .036) that were significantly higher amongst the patients with severe PAD. The 30-day survival (P = .483) and 30-day major adverse events (Table I) such as MI (P = .237), stroke (P = .222), AKI (P = .566), and SCI (P = .183) were similar across the groups. However, when all PAD cases were compared with non-PAD patients, they presented a significantly higher incidence of postoperative mesenteric ischemia (3 cases in PAD group, 1 case in non-PAD group; P = .043). Despite a similar incidence of long-term complications such as MI (P = .330), stroke (P = .353), and kidney function deterioration requiring dialysis (p = .093) observed across the groups, time- to-event analysis demonstrated that patients with severe PAD have a lower long-term survival when compared to the ones without this diagnosis (Fig 1) (Log-rank P = .035). As for aneurysm-related adverse events, there was no significant difference in terms of types I, II, and III endoleaks, access complications, target vessel occlusions, and freedom from secondary interventions across the groups. Significantly lower 5-year survival is observed in the F/BEVAR cases with a preoperative diagnosis of PAD and severe ischemic component. In addition, patients with PAD might require a higher index of suspicion of mesenteric ischemia in the perioperative period.TableOutcomesCounts (percentages)P-valueMild PAD, n = 73 casesSevere PAD, n = 22 casesNon-PAD, n = 30630-day MI2 (2.73)0 (0)1 (0.32).23730-day stroke1 (1.37)2 (9.09)1 (0.32).222Spinal cord ischemia4 (5.47)0 (0)6 (1.96).183Long-term MI5 (6.84)1 (4.54)10 (3.26).330Long-term stroke5 6.84)3 (13.63)18 (5.88).353Long-term renal failure requiring dialysis5 6.84)7 (31.81)0 (0).093Spinal cord ischemia4 (5.47)0 (0)6 (1.96).183Types 1a + 1b endoleaks3 (4.11)0 (0)20 (6.53).519Type 2 endoleak16 (21.92)7 (31.81)108 (35.29).089Type 3 endoleaks12 (16.43)0 (0)30 (9.8).066 Open table in a new tab