Results from a nationwide prospective registry on open surgical or endovascular repair of juxtarenal abdominal aortic aneurysms

Gerdine C.I. von Meijenfeldt*, Anna J. Alberga, Ron Balm, Anco C. Vahl, Hence J.M. Verhagen, Jan D. Blankensteijn, Clark J. Zeebregts, Maarten J. van der Laan

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.

Original languageEnglish
Pages (from-to)81-89.e5
JournalJournal of Vascular Surgery
Volume75
Issue number1
Early online date28 Jun 2021
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
The authors would like to thank all surgeons (in training), registrars, physician assistants, and administrative nurses who registered all the patients in the DSAA, the Dutch Surgical Aneurysm Audit group, for their time and effort.

Publisher Copyright:
© 2021 The Authors

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