Pedro G R Teixeira1, Karen Woo2, Ahmed M Abou-Zamzam3, Sara L Zettervall4, Marc L Schermerhorn4, Fred A Weaver5. 1. Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Tex. 2. Division of Vascular Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, Calif. 3. Division of Vascular Surgery, Loma Linda Medical Center, Loma Linda, Calif. 4. Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. 5. Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, Calif. Electronic address: fweaver@med.usc.edu.
Abstract
OBJECTIVE: The objective of this study was to evaluate the impact of exposure technique on perioperative complications in patients undergoing elective open abdominal aortic aneurysm (AAA) repair. METHODS: Using the Society for Vascular Surgery Vascular Quality Initiative database, the study identified patients subjected to open AAA repair from January 2003 to July 2014 and divided them into two aortic exposure groups, retroperitoneal (RP) and transperitoneal (TP). Multivariable analysis was performed to compare the incidence of cardiac events (myocardial infarction, dysrhythmia, heart failure), prolonged intubation, renal dysfunction, and mortality, adjusting for between-group differences identified on univariate analysis. RESULTS: Open AAA repair was performed in 3530 patients, using RP in 26% and TP in 74%. The RP group had a higher rate of suprarenal aortic clamp (60.9% vs 30.2%; P < .001), higher proportion of high-risk patients as stratified by the Vascular Study Group of New England Cardiac Risk Index (25.6% vs 22.2%; P = .038), and lower rate of iliac aneurysms (18.0% vs 31.2%; P < .001). After multivariable analysis, RP was associated with a lower incidence of cardiac events (12.2% vs 16.0%; adjusted odds ratio, 0.60; 95% confidence interval, 0.41-0.88; P = .009) and renal dysfunction (13.3% vs 16.5%; adjusted odds ratio, 0.65; 95% confidence interval, 0.46-0.97; P = .011). No difference in respiratory complications or mortality was identified. CONCLUSIONS: Despite increased utilization of suprarenal aortic clamp during elective open AAA repair, the RP technique was associated with a lower risk-adjusted incidence of cardiac and renal complications compared with the TP technique.
OBJECTIVE: The objective of this study was to evaluate the impact of exposure technique on perioperative complications in patients undergoing elective open abdominal aortic aneurysm (AAA) repair. METHODS: Using the Society for Vascular Surgery Vascular Quality Initiative database, the study identified patients subjected to open AAA repair from January 2003 to July 2014 and divided them into two aortic exposure groups, retroperitoneal (RP) and transperitoneal (TP). Multivariable analysis was performed to compare the incidence of cardiac events (myocardial infarction, dysrhythmia, heart failure), prolonged intubation, renal dysfunction, and mortality, adjusting for between-group differences identified on univariate analysis. RESULTS: Open AAA repair was performed in 3530 patients, using RP in 26% and TP in 74%. The RP group had a higher rate of suprarenal aortic clamp (60.9% vs 30.2%; P < .001), higher proportion of high-risk patients as stratified by the Vascular Study Group of New England Cardiac Risk Index (25.6% vs 22.2%; P = .038), and lower rate of iliac aneurysms (18.0% vs 31.2%; P < .001). After multivariable analysis, RP was associated with a lower incidence of cardiac events (12.2% vs 16.0%; adjusted odds ratio, 0.60; 95% confidence interval, 0.41-0.88; P = .009) and renal dysfunction (13.3% vs 16.5%; adjusted odds ratio, 0.65; 95% confidence interval, 0.46-0.97; P = .011). No difference in respiratory complications or mortality was identified. CONCLUSIONS: Despite increased utilization of suprarenal aortic clamp during elective open AAA repair, the RP technique was associated with a lower risk-adjusted incidence of cardiac and renal complications compared with the TP technique.
Authors: Sarah E Deery; Sara L Zettervall; Thomas F X O'Donnell; Philip P Goodney; Fred A Weaver; Pedro G Teixeira; Virendra I Patel; Marc L Schermerhorn Journal: J Vasc Surg Date: 2019-06-24 Impact factor: 4.268
Authors: Vinamr Rastogi; Nicole H Kim; Christina L Marcaccio; Priya B Patel; Rens R B Varkevisser; Jorg L de Bruin; Hence J M Verhagen; Marc L Schermerhorn Journal: Eur J Vasc Endovasc Surg Date: 2022-05-20 Impact factor: 6.427
Authors: Christopher A Latz; Laura Boitano; Samuel Schwartz; Nicholas Swerdlow; Kirsten Dansey; Rens R B Varkevisser; Virendra Patel; Marc Schermerhorn Journal: J Vasc Surg Date: 2020-04-29 Impact factor: 4.268
Authors: Vinamr Rastogi; Christina L Marcaccio; Priya B Patel; Rens R B Varkevisser; Virendra I Patel; Peter A Soden; Jorg L de Bruin; Hence J M Verhagen; Marc L Schermerhorn Journal: J Vasc Surg Date: 2022-03-08 Impact factor: 4.860