High mortality rates after both open surgical and endovascular thoracic aortic interventions in patients with end-stage renal disease

• Published in: Journal of vascular surgery 2017-10, Vol.66 (4), p.991-996
• Main Authors: Liang, Nathan L., MD, MS, Yuo, Theodore H., MD, MSc, Al-Khoury, Georges E., MD, Hager, Eric S., MD, Makaroun, Michel S., MD, Singh, Michael J., MD
• Format: Article
• Language: English
• Subjects: Aged; Aorta, Thoracic - surgery; Aortic Diseases - complications; Aortic Diseases - diagnosis; Aortic Diseases - mortality; Aortic Diseases - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Databases, Factual; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Humans; Kaplan-Meier Estimate; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Postoperative Complications - mortality; Postoperative Complications - therapy; Proportional Hazards Models; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Time Factors; Treatment Outcome; United States
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.12.144

Abstract Background Morbidity and mortality have improved with the evolution of endovascular techniques (thoracic endovascular aortic repair [TEVAR]) for thoracic aortic disease, but results after aortic intervention in patients with end-stage renal disease (ESRD) remain unclear. The objective of this study was to evaluate outcomes of open and endovascular descending thoracic aortic repair in dialysis-dependent patients. Methods We identified 352 patients with ESRD on dialysis undergoing open repair (n = 136) or TEVAR (n = 216) of the thoracic aorta from 2005 to 2008 using the United States Renal Data System database. Acute presentation was defined as ruptured aneurysm, dissection, or traumatic injury; all other interventions were considered elective. End points were 30-day mortality, overall survival, rates of perioperative complications, and procedural trends over time. Between-group comparisons and survival analysis used standard statistical methods. Logistic regression and Cox regression were performed using multivariate analysis. Results TEVAR subjects were older than those undergoing open repair (68.2 ± 11.5 vs 60.8 ± 13.2 years; P  < .001); no other demographics differed. There were 303 patients who had thoracic or thoracoabdominal aneurysms; 47 (13.4%) were ruptured on presentation. There were 44 patients (12.5%) who had aortic dissection and 5 (1.4%) with aortic trauma. Overall 30-day mortality was 21.3% (n = 75), and it was greater for open repair (n = 41 [30.1%]) than for TEVAR (n = 34 [15.7%]; P  = .002). Elective 30-day mortality for open repair (n = 27 [29.3%]) was also greater than for TEVAR (n = 24 [14.3%]; P  = .005). Those with acute presentation trended toward higher mortality for open repair (n = 14 [31.8%] vs n = 10 [15.7%]; P  = .17). Respiratory failure was higher for open repair (n = 69 [50.7%] vs n = 56 [25.9%]; P  < .001); postoperative stroke was higher with TEVAR (n = 21 [9.7%] vs n < 10 [