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Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does not Affect Major Morbidity or Mortality

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  1. Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does not Affect Major Morbidity or Mortality Thomas W. Cheng1, M.S., Shelley K. Maithel2, M.D., Nii-Kabu Kabutey2, M.D., Alik Farber1, M.D., Virendra I. Patel3, M.D., Douglas W. Jones1, M.D., Denis Rybin1, Ph.D., Gheorghe Doros1, Ph.D., Jeffrey J. Siracuse1, M.D. 1Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA. 2Division of Vascular and Endovascular Surgery, University of California, Irvine Medical Center, Orange, CA. 3Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, New York.

  2. Disclosures • None

  3. Background • Benefits of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) has been extensively investigated • Access type utilized in EVAR such as percutaneous compared to open surgical access is associated with lower morbidity • Limited data on access type when treating ruptured AAA with EVAR

  4. Objective • To evaluate if access type utilized during EVAR for ruptured AAA affected outcomes

  5. Methods • Vascular Quality Initiative • 2009 to 2018 • Ruptured AAA treated with index EVAR • Excluded iliac access, both percutaneous and open access, and concurrent bypass • Procedures grouped by access type: percutaneous, open, and conversion to open from failed percutaneous • Univariable and multivariable analyses performed for baseline characteristics, procedure details, and outcomes

  6. Results • 1,206 ruptured AAAs identified

  7. Results P<.001 P=.026 P<.001 P=.022

  8. Results P<.001

  9. Results P<.001 188.7±75.1 152.6±74.2 133.4±85.8

  10. Results

  11. Results P<.001

  12. Multivariable analysis Length of Stay Predictors for Conversion to Open From Failed Percutaneous

  13. Limitations • Retrospective study • Limited follow up • Selection bias for access type

  14. Conclusion • Access type for ruptured AAA did not significantly affect major morbidity or mortality • Percutaneous access had the shortest operative time • However, failed percutaneous access had the longest operative time • Access utilized during these emergent procedures should be based on surgeon preference and experience

  15. Thank you

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