The AAA ASG score can be used to predict patients at risk for midterm implant-related complications, 30-day and midterm systemic complications, and all-cause mortality.

Program targeted AAA database from 2012 to 2014 to identify patients undergoing open AAA repair. The patients with missing information about the intraoperative management and chronically occluded IMA were excluded. Variables, including patient and aneurysm characteristics, operative techniques, and postoperative complications, were selected for univariate analysis. Variables with an association of P < .2 were then tested using multiple logistic regression analysis. Results: Of 1901 patients undergoing open AAA repair from 2012 to 2014, the incidence of ischemic colitis in the emergency cohort was 8.4% (43 of 513) and the elective cohort was 4% (55 of 1388). A total of 770 patients had a confirmed patent IMA and met the study criteria. The mean age was 69.88 6 9.3 years (Table I). The IMA was replanted in 82 patients (10.6%) and ligated in 688 patients (89.4%) intraoperatively. Ischemic colitis developed in eight patients (9.8%) with a replanted IMA and in 38 patients (5.5%) with a ligated IMA. The 30-day mortality was 12 of 82 (14.6%) in the IMA implanted cohort compared with 52 of 688 (7.6%) in the IMA ligated cohort (P ¼ .028). After controlling for preoperative factors and operative technique, ligating vs replanting IMA was not significantly associated with ischemic colitis (Table II). However, in multivariate analysis, ischemic colitis (OR, 4.683; CI, 2.10-10.4; P < .001), emergency surgery (OR, 6.109; CI, 3.41-10.91; P < .001), age (OR, 1.103; CI, 1.06-1.14; P < .001), and operative time (OR, 1.002; CI, 1.00-1.06; P ¼ .031) were independently associated with 30-day mortality (Table II). Conclusions: The IMA replantation during open AAA repair does not prevent or decrease an incidence of colon ischemia, whereas, this procedure increases operative time significantly, which is independently associated with 30-day mortality.

Objectives: Endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) reduces in-hospital mortality compared with open repair (OR) but it is unknown whether EVAR reduces long-term mortality. We hypothesized that EVAR of RAAA would independently reduce long-term mortality compared with OR.Methods: The Vascular Quality Initiative (VQI) database (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) was used to determine Kaplan-Meier 1-year and 5-year mortality after EVAR and OR of RAAA. Multivariate analysis was performed to identify patient and operative characteristics associated with mortality at 1 and 5 years after RAAA repair.Results: Among 590 patients who underwent EVAR and 692 patients who underwent OR of RAAA, the lower mortality seen in-hospital after EVAR (EVAR: 23% vs OR: 35%; P < .001) persisted at 1 year (EVAR: 34% vs OR: 42%; P ¼ .001) and 5 years (EVAR: 50% vs OR: 58%; P ¼ .003; Fig) after repair. After adjusting for patient and operative characteristics, EVAR did not independently reduce mortality at 1 year (hazard ratio [HR], 0.88 [95% confidence interval, 0.7-1.1]) or 5 years (HR, 0.95 [.77-1.2]) compared with OR. Women (HR, 1.3 [1.04-1.6]), age (HR, 1.06 [1.05-1.08] per 5 years), home oxygen use (HR, 1.9 [1.3-2.7]), dialysis-dependence (HR, 3.9 [1.8-8.6]), cardiac ejection fraction <50% (HR, 1.5 [1.03-2.1]), as well as preoperative systolic blood pressure <90 mm Hg (HR, 1.4 [1.1-1.8]), loss of consciousness (HR, 1.7 [1.3-2.2]), and cardiac arrest (HR, 3.4 [2.5-4.5]) on admission predicted mortality at 1 and 5 years after RAAA repair. Type I endoleak (HR, 2.2 [1.2-3.8]) also predicted mortality at 1 year.Conclusions: EVAR does not independently reduce long-term mortality compared with OR. Patient comorbidities and indices of shock on admission are the primary independent determinants of long-term mortality. However, the lower early mortality observed in the VQI for patients selected to undergo EVAR of RAAA compared with patients selected for OR is sustained over time, supporting the use of EVAR for RAAA in appropriate candidates. Better elucidation of the key selection factors, including aneurysm anatomy, is needed to best select patients for EVAR and OR in order to reduce long-term mortality.Objectives: Our aim was to examine the predictive value of the Anatomic Severity Grading (ASG) score on aortic branch vessel complications, nonaortic adverse events, and survival.Methods: Using three-dimensional reconstruction of preoperative computed tomography angiography imaging (TeraRecon; Aquarius iNtuition Workstation, Foster City, Calif), we retrospectively reviewed endovascular aneurysm repairs (EVARs) from 2009 to 2012. Two independent patient groups were created based on ASG score: <14 (low-score group) and $14 (high-score group). Aortic branch vessel complications, nonaortic adverse events, and survival were collected and analyzed in relation to ASG score.Results: We analyzed 218 patients. Mean age was 74 years (range, 48-92), 75% were male and 83% were Caucasian; 114 w...