A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair

Doonan, R.J.; Girsowicz, Elie; Dubois, Luc; Gill, Heather L.

doi:10.1016/j.jvs.2019.04.464

Cited by 52 publications

(14 citation statements)

References 40 publications

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“…14 In addition, the mortality rate of 8.0% following supracoeliac clamping may call for efforts to further implement endovascular techniques such as fenestrated EVAR, as these modalities are associated with lower mortality for juxtarenal and suprarenal AAA repair. 17,18 Renal and visceral artery revascularisations were more common for supracoeliac clamp locations, corresponding to prior studies. 10 Although it was not possible to elucidate the indication for these revascularisations, the adjusted models and even exclusion of renal and visceral revascularisations, demonstrated that supracoeliac clamping was independently associated with worse outcomes.…”

Section: Discussionsupporting

confidence: 58%

The Impact of Proximal Clamp Location on Peri-Operative Outcomes Following Open Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms

Varkevisser

Guerre

Swerdlow

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Previous reports investigating the differences in outcomes between proximal aortic clamp locations for open repair of juxtarenal abdominal aortic aneurysm (AAA) were small single centre studies and were unable to determine the optimal location. In this retrospective analysis of prospectively collected data from a nationwide clinical registry, it was found that for repair of juxtarenal AAA, there is no difference in outcomes between clamp location above one or both renal arteries, while a supracoeliac clamp is associated with significantly higher 30 day mortality and morbidity. These finding suggests that, when feasible, surgeons should avoid a supracoeliac clamp location.Objective: Open surgical repair of juxtarenal abdominal aortic aneurysms (AAA) requires an aortic cross clamp location above at least one renal artery. This study investigated the impact of clamp location on perioperative outcomes using a United States based nationwide clinical registry. Methods: The National Surgical Quality Improvement Program targetted vascular module was used to identify all elective open juxtarenal AAA repairs (2011e2017). Outcomes were compared between clamping above one vs. above both renal arteries, and above one or both renal arteries vs. supracoeliac clamping. The primary outcome was 30 day mortality and secondary outcomes included post-operative renal dysfunction (creatinine increase 177 mmol/L or new dialysis) and unplanned re-operations. Multivariable logistic regression models were constructed to perform risk adjusted analyses. Results: A total of 615 repairs were identified, with a clamp location above one renal artery in 42%, above both renal arteries in 40%, and supracoeliac in 18% of cases. Procedures with a clamp location above one vs. above both renal arteries showed no difference in mortality (3.5% vs. 2.1%, p ¼ .34) or renal dysfunction (6.9% vs. 4.9%, p ¼ .34). In contrast, supracoeliac clamping compared with clamping above one or both renal arteries was associated with a higher mortality rate (8.0% vs. 2.8%, p ¼ .023), renal dysfunction (12% vs. 6.0%, p ¼ .017), and unplanned re-operations (24% vs. 10%, p < .001). In the multivariable adjusted models, outcomes were similar between clamping above both vs. above one renal artery, while supracoeliac clamping vs. clamping above one or both renal arteries was associated with higher mortality (odds ratio [OR]: 3.4; 95% CI: 1.3e8.8; p ¼ .013) and unplanned re-operation (OR: 2.4; 95% CI: 1.4e4.1; p ¼ .002). Conclusion:Although there is no difference between clamping above one vs. both renal arteries during open juxtarenal AAA repair, a supracoeliac clamp location is associated with worse peri-operative outcomes. Surgeons should avoid supracoeliac clamping when clamping above one or both renal arteries is technically possible.

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Section: Discussionsupporting

confidence: 58%

The Impact of Proximal Clamp Location on Peri-Operative Outcomes Following Open Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms

Varkevisser

Guerre

Swerdlow

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…An initial concern with TFA could be the risk of spinal cord ischemia and lower leg ischemia owing to the prolonged placement of large transfemoral introducer sheaths. 2,22 In the present study, we implemented a downsizing technique using a tourniquet on the sutures of the vascular closure device to resume hypogastric and leg perfusion as soon as possible. 23,24 TFA was associated with a lower rate of spinal cord ischemia and no thromboembolic events, lower leg ischemia, or the need for fasciotomy to treat compartment syndrome.…”

Section: Discussionmentioning

confidence: 99%

Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

Eilenberg

Kölbel

Rohlffs

et al. 2021

Journal of Vascular Surgery

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“…A systematic review and metaanalysis of endovascular juxtarenal aortic aneurysm repair also demonstrated lower 30-day mortality, acute renal failure, bowel ischemia, and length of stay but with increased SCI compared with OR. In this analysis the endovascular interventions included short-neck standard EVAR, parallel grafts, and F/BEVAR [247]. Among them, FEVAR should be considered as a first option 1, due to their reported safety and efficacy in the VQI among others [248][249][250].…”

Section: Large Trials Meta-analyses Databases and Registries On Outcomesmentioning

confidence: 99%

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

Nikol

Mathias²,

Olinic

et al. 2020

Vasa

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A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair

Cited by 52 publications

References 40 publications

The Impact of Proximal Clamp Location on Peri-Operative Outcomes Following Open Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms

The Impact of Proximal Clamp Location on Peri-Operative Outcomes Following Open Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms

Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

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