A. Cha1, V. Dombrovskiy1, N. Nassiri1, R. Shafritz1, S. Rahimi1 1Robert Wood Johnson – UMDNJ,Vascular Surgery,New Brunswick, NJ, USA
Introduction: Endovascular repair of ruptured abdominal aortic aneurysms has shown improved outcomes compared to open repair. Endovascular repair can be accomplished via a bifurcated device or an aorto-uni-iliac device with a femoral-femoral crossover graft. The purpose of this study was to evaluate these two endovascular procedures in the treatment of ruptured abdominal aortic aneurysms in Medicare population.
Methods: Data was queried from the Medicare MedPAR and Carrier files 2005-2009 using appropriate ICD-9-CM and CPT-4 codes. Rates of major postoperative complications, hospital and 30-day mortality, hospital length of stay and cost, and 1 year survival were analyzed and compared. Chi-square and Wilcoxon rank-sum tests, Kaplan-Meier survival curves and Cox proportional hazards modelling were used for statistics.
Results: We identified 914 patients with bifurcated device and 77 with aorto-uni-iliac device. Patients with aorto-uni-iliac device compared to those with bifurcated device had greater rates of various postoperative complications (overall, 74.0% vs 62.8%; P=0.049) including cardiac (22.1% vs 12.9%; P=0.024) and renal (36,4% vs 25.1%; P=0.03) complications, ischemic colitis (6.5% vs 0.6%; P<0.0001). They also tended to greater rates of infectious complications (29.9% vs 20.5%; P=0.052), including sepsis (14.3% vs 8.1%; P=0.06), and embolism and thrombosis of lower extremity arteries (5.2% vs 1.8%; P=0.06). Patients with aorto-uni-iliac device had greater hospital (37.7% vs 23.3%; P=0.005) and 30-day mortality rates (41.6% vs 25.4%; P=0.002), and poorer 1-year survival (P=0.01). They had longer hospital length of stay (median = 7days vs 5 days; P=0.04) and tended to greater cost (median = $117,483 vs $101,074; P=0.07).
Conclusion: Use of aorto-uni-iliac device compared to bifurcated device for endovascular repair of ruptured abdominal aortic aneurysms significantly increases complications rate, mortality, and hospital resource utilization. This is most likely due to the more unstable health conditions and more challenging anatomy in patients undergoing repair with aorto-uni-iliac device. Endovascular repair with a bifurcated endoprosthesis should be performed for ruptured abdominal aortic aneurysms when feasible.