The perioperative effect of concomitant procedures during open infrarenal abdominal aortic aneurysm repair

Abstract

Introduction Open repair of abdominal aortic aneurysms (AAA) is occasionally performed in conjunction with additional procedures. However, it is unclear how these concomitant procedures affect outcome. This study aims to determine the frequency of additional procedures during elective open AAA repair and the impact on perioperative outcomes. Methods Between January 2003 and November 2014, all elective infrarenal open AAA repairs in the Vascular Study Group of New England (VSGNE) were identified. Patients were grouped by concomitant procedures, which included: no concomitant procedure, renal artery bypass, lower extremity bypass, other abdominal procedure or thrombo-embolectomy. Analyses were performed using multivariable logistic regression. Results 1314 patients underwent elective AAA repair, of whom 153 (11.6%) had a concomitant procedure, including renal bypass 27 (2.1%), lower extremity bypass 28 (2.1%), other abdominal procedures 64 (4.9%), and thrombo-embolectomy 48 (3.7%). Independent risk factors for 30-day mortality were renal bypass (OR: 7.2, 95% CI: 1.9 – 27.7), other abdominal procedures (OR: 4.8, 95% CI: 1.6 – 14.1) and thrombo-embolectomy (OR: 8.8, 95% CI: 3.1 – 24.9). Deterioration of renal function was predicted by renal bypass (OR: 5.1, 95% CI: 2.1–12.4) and thrombo-embolectomy (OR: 3.7, 95% CI: 1.8 – 7.6). Lower extremity bypass and thrombo-embolectomy were predictive of postoperative leg ischemia (OR: 8.9, 95% CI: 2.7 – 29.0; OR: 11.2, 95% CI: 4.4 – 28.8, respectively), while thrombo-embolectomy was also predictive of postoperative myocardial infarction (OR: 4.4, 95% CI: 1.6 – 12.0). Conclusions Performing additional procedures during infrarenal open AAA repair is associated with increased morbidity and mortality in the postoperative period. Careful deliberation of both the operative risks and the necessity of the additional interventions are therefore advised during operative planning. This study also highlights the importance of avoiding perioperative thrombo-embolic events.

Effects of Suprarenal Aortic Cross-Clamping and Adjunctive Renal Reconstruction on Outcomes of Open Abdominal Aortic Aneurysm Repair

“…Some studies indicated that performing adjunctive RR during open AAA repair was associated with an increased risk of operative morbidity and mortality. 12) In contrast, others reported the feasibility of simultaneous renal and aortic reconstruction because they found similar outcomes to IR aortic repair. 13) …”

Patient-perceived health-related quality of life before and after laparoscopic aortobifemoral bypass

“…Previously, studies have shown increased morbidity and mortality related to concomitant procedures with open or endovascular repair of abdominal aorta 22,23. However, in patients with advanced atherosclerotic disease, it is sometimes necessary to perform additional procedures, for example, thromboendarterectomy of the groin arteries or even infrainguinal bypass, to ensure postoperative graft patency.…”

“…Previously, studies have shown increased morbidity and mortality related to concomitant procedures with open or endovascular repair of abdominal aorta. 22 , 23 However, in patients with advanced atherosclerotic disease, it is sometimes necessary to perform additional procedures, for example, thromboendarterectomy of the groin arteries or even infrainguinal bypass, to ensure postoperative graft patency. We have previously, in a comparative cohort study design in the same patient population, found a significant relative reduction of the composite events (all-cause mortality, graft occlusion and systemic morbidity) in patients with LABFB as compared to open ABFB, during a median follow-up time period of 4.12 years.…”

Concomitant Treatment of Several Visceral and Renal Artery Pathologies during Open Abdominal Aortic Aneurysm Repair

“…Abdominal aortic aneurysm (AAA) infrequently co-exists with visceral/renal artery pathologies needing concomitant treatment, where a higher technical complexity and a higher risk for morbidity/mortality are anticipated [ 1 , 2 ]. A 77-year-old male patient underwent computed tomography for weight loss and postprandial pain presenting a 65-mm infrarenal AAA, 35-mm right common iliac aneurysm, left internal iliac artery occlusion, 35-mm right renal artery aneurysm (RAA), occluded superior mesenteric artery (SMA), occluded left renal artery and median arcuate ligament syndrome ( Fig.…”