Key result
Open surgical repair for juxtarenal abdominal aortic aneurysms was associated with higher odds of major complications compared with complex EVAR (45% vs 21%; OR 3.64; 95% CI 2.25-5.89; P<0.001).
Why the study?
Juxtarenal abdominal aortic aneurysms can be treated with open surgical repair or complex endovascular aneurysm repair, prompting a comparison of short-term mortality and complications in daily practice.
Does open surgical repair compared to complex endovascular aneurysm repair increase short-term mortality and complications in patients with juxtarenal abdominal aortic aneurysms?
Cohort (n=455)
Yes
Does open surgical repair compared to complex endovascular aneurysm repair increase short-term mortality and complications in patients with juxtarenal abdominal aortic aneurysms?
Odds Ratio: 3.64 (95% CI 2.25–5.89)
Absolute Event Rate: 45% vs 21%
p-value: p=<.001
In patients with juxtarenal abdominal aortic aneurysms, open surgical repair is associated with significantly higher short-term mortality and complications compared to complex endovascular repair.
BACKGROUND: Juxtarenal abdominal aortic aneurysms (JRAAAs) can be treated either with open surgical repair (OSR) including suprarenal clamping or by complex endovascular aneurysm repair (cEVAR). In this study, we present the comparison between the short-term mortality and complications of the elective JRAAA treatment modalities from a national database reflecting daily practice in The Netherlands. METHODS: All patients undergoing elective JRAAA open repair or cEVAR (fenestrated EVAR or chimney EVAR) between January 2016 and December 2018 registered in the Dutch Surgical Aneurysm Audit (DSAA) were eligible for inclusion. Descriptive perioperative variables and outcomes were compared between patients treated with open surgery or endovascularly. Adjusted odds ratios for short-term outcomes were calculated by logistic regression analysis. RESULTS: In all, 455 primary treated patients with JRAAAs could be included (258 OSR, 197 cEVAR). Younger patients and female patients were treated more often with OSR vs cEVAR (72 ± 6.1 vs 76 ± 6.0; P < .001 and 22% vs 15%; P = .047, respectively). Patients treated with OSR had significantly more major and minor complications as well as a higher chance of early mortality (OSR vs cEVAR, 45% vs 21%; P < .001; 34% vs 23%; P = .011; and 6.6% vs 2.5%; P = .046, respectively). After logistic regression with adjustment for confounders, patients who were treated with OSR showed an odds ratio of 3.64 (95% confidence interval [CI], 2.25-5.89; P < .001) for major complications compared with patients treated with cEVAR, and for minor complications, the odds ratios were 2.17 (95% CI, 1.34-3.53; P = .002) higher. For early mortality, the odds ratios were 3.79 (95% CI, 1.26-11.34; P = .017) higher after OSR compared with cEVAR. CONCLUSIONS: In this study, after primary elective OSR for JRAAA, the odds for major complications, minor complications, and short-term mortality were significantly higher compared with cEVAR.
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Meijenfeldt et al. (2021) conducted a cohort in Juxtarenal abdominal aortic aneurysms (n=455). Open surgical repair vs. Complex endovascular aneurysm repair (cEVAR) was evaluated on Major complications (OR 3.64, 95% CI 2.25-5.89, p=<.001). Open surgical repair for juxtarenal abdominal aortic aneurysms was associated with higher odds of major complications compared with complex EVAR (45% vs 21%; OR 3.64; 95% CI 2.25-5.89; P<0.001).
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