Work

Understanding the risks of abdominal aortic endograft explantation with early outcomes from two decades of experience

Year: 2025

Type: article

Abstract: OBJECTIVE: Endovascular aneurysm repair (EVAR) currently comprises more than two-thirds of all abdominal aortic aneurysm repairs in the United States. However, data show that patients are at higher risk for late mortality after EVAR compared with open repair. As the number of aging EVARs grow, so, too, does the number requiring explant. The objective of this work is to highlight perioperative details and outcomes of EVAR explantation to allow physicians to better counsel patients regarding the perioperative risks. METHODS: test, or their non-parametric counterpart when appropriate. Multivariable logistic regression models were developed to evaluate postoperative complications and 30-day mortality rates. Survival was compared using Kaplan-Meier survival analysis. RESULTS: A total of 142 EVAR explants were evaluated, 100 for endoleak and 42 for infection from 2002 to 2024. Patients with infected endografts were more likely than those with endoleaks to have any complications (57.1% vs 32.0%; P = .006) and serious complications (54.8% vs 30.0%; P = .005). Real-world complications were reflected in National Surgical Quality Improvement Program (NSQIP) estimated risks, with infected endograft patients at a higher predicted NSQIP risk than endoleak patients for any complication (44.9% vs 35.6%; P < .001), serious complication (35.7% vs 29.2%; P < .001), and 30-day mortality (19.0% vs 7.0%; P = .03). No differences were seen based on endograft type. Infected endografts were at higher risk for mortality at 30 days (28.6% vs 14.0%; P = .03). That trend persisted to 2 years (38.1% vs 15.0%; P = .007). Most mortality occurred by postoperative day 45. CONCLUSIONS: EVAR explantation, regardless of indication, places patients at high risk for mortality, with infection conferring early mortality risk in this cohort. This work underscores the need for a candid discussion regarding operative risk with patients facing explantation.

Source: Journal of Vascular Surgery

DOI: 10.1016/j.jvs.2025.05.048

Authors: Andrew Huang, Craig Brown, Shipra Arya, Katherine Gallagher, Jonathan Eliason

Institutions: University of Michigan, Michigan Medicine, Stanford Medicine, Stanford University

Language: English

Topic: Aortic aneurysm repair treatments

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,010