Aortic & peripheral vascular disease
Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study
Main finding · Late aortic ruptureResult — go to the resultHazard ratio 5.85 95% CI 1.31–26.2Authors' conclusion
ARM and aortic rupture are uncommon after elective FB-EVAR of asymptomatic intact TAAAs. Half of the ARMs occurred early, and most of the late deaths were not aortic related.
Study context
- Population
- Patients undergoing elective fenestrated-branched endovascular aortic repair (FB-EVAR) of asymptomatic intact thoracoabdominal aortic aneurysms, 2005–2020
- Participants
- 1,109 patients
- Exposure
- Extent I-III vs Extent IV
- Extent I-IIIn = 589
- Extent IVn = 520reference
- Outcome
- Aortic-related mortality (any early death, or late death from aortic rupture, dissection, malperfusion attributable to aortic disease, or reintervention complications) and aortic rupture
Methodological detailsmulticenter
- Multicenter
Main finding
Late aortic rupture
Hazard ratio
5.85
95% CI 1.31–26.2
P = 0.02
As reported in the abstract
- Early mortality
- 2.7% (n=30)
- Early aortic rupture
- 0.4% (n=4)
- Late aortic-related mortality (ARM): 30 events; 5-year cumulative incidence
- 3.8% (95% CI, 2.6%-5.4%)
- Late aortic ruptures: 14; 5-year cumulative incidence
- 2.7% (95% CI, 1.2%-4.3%)
- Older age and extent I-III thoracoabdominal aortic aneurysms (TAAAs) independently associated with late ARM
- each P<0.05
Observational data: associations, not effects.
Secondary outcomes
Early mortality, predictor · 30 days or in hospital
| OR (95% CI) | P value | ||
|---|---|---|---|
| Congestive heart failureAssociated with early mortality | 3.30 (1.22–8.02) | P = 0.01 | |
| 0.10.31310Odds ratio (log scale) |
Late aortic rupture, predictor
| HR (95% CI) | P value | ||
|---|---|---|---|
| Extent I-III TAAAsAssociated with late aortic rupture | 5.85 (1.31–26.2) | P = 0.02 | |
| 0.050.21520Hazard ratio (log scale) |
Early major adverse events
- Early major adverse events
- 20.4% (n=226)
TAAA life-altering events (death, permanent spinal cord injury, permanent dialysis or stroke) · early
- TAAA life-altering events
- 7.7% (n=85)
All-cause mortality · 5 years
- Five-year all-cause mortality
- 45.7% (95% CI, 41.7%-49.4%)
Secondary intervention · 5 years
- Five-year cumulative incidence of secondary intervention
- 40.3% (95% CI, 35.8%-44.5%)
Safety
Early major adverse events and TAAA life-altering events · early (30 days or in hospital)
- Early major adverse events
- 20.4% (n=226)
- TAAA life-altering events (death, permanent spinal cord injury, permanent dialysis or stroke)
- 7.7% (n=85)
Original publication
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