The variable impact of aneurysm size on outcomes after open abdominal aortic aneurysm repairs

• Published in: Journal of vascular surgery 2021-08, Vol.74 (2), p.425-432.e3
• Main Authors: Mehta, Ambar, O'Donnell, Thomas F.X., Trestman, Eric, Schutzer, Richard, Bajakian, Danielle, Morrissey, Nicholas, Siracuse, Jeffrey, Garg, Karan, Schermerhorn, Marc, Takayama, Hiroo, Patel, Virendra I.
• Format: Article
• Language: English
• Subjects: Abdominal aortic aneurysms; Aneurysm size; Open repairs; Outcomes
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2020.12.109

Previous studies evaluating the association between abdominal aortic aneurysm (AAA) size with postoperative outcomes after open repairs seldom accounted for renal or visceral artery involvement, proximal clamp site, intraoperative renal ischemia time, and hospital volume. This study examined the association between aneurysm size with outcomes after open repairs. We identified patients who underwent open repairs of infrarenal versus juxtarenal nonruptured AAAs, defined by proximal clamp site, in the 2004-2019 Vascular Quality Initiative. Outcomes included 30-day mortality, postoperative complications, failure to rescue, and 1-year mortality. Multivariable logistic regressions adjusted for patient characteristics, operative factors, hospital volume, and hospital clustering. We identified 8011 patients (54% infrarenal, 46% juxtarenal). The median aneurysm size did not differ between infrarenal versus juxtarenal aneurysms (5.7 cm vs 5.9 cm; P = .12). For infrarenal aneurysms, every 1-cm increase in size increase the adjusted odds ratio (OR) or hazard ratio (HR) of 30-day mortality by 18% (OR, 1.18; 95% CI, 1.06-1.31), failure to rescue by 20% (OR, 1.20; 95% CI, 1.06-1.34), 1-year mortality by 18% (HR, 1.18; 95% CI, 1.10-1.26), but not complications (OR, 1.03; 95% CI, 0.98-1.07). For juxtarenal aneurysm, larger aneurysm sizes were not associated with any outcome. Proximal clamp site, ischemia time, and volume were associated with outcomes. The association between AAA size and outcomes matters less with renal and visceral artery aneurysmal involvement, having important implications for surgical decision-making, operative planning, and patient counseling.