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Ilio-femoral calcium score may assist Glasgow Aneurysm Score prediction of long-term survival of low-risk patients after infrarenal EVAR

BACKGROUND

The aim of this study is to evaluate if ilio-femoral calcium score (CS) combined with Glasgow Aneurysm Score (GAS) can improve the prediction of long-term survival after EVAR.

METHODS

All the patients who underwent infrarenal endovascular aortic repair (EVAR) for non-ruptured AAA between January 2004 and December 2012 at a tertiary referral center were retrospectively included if the preoperative imaging was of sufficient quality and they had survived for more than 30 days. Pre-operative non-contrast enhanced CT were used to measure ilio-femoral calcium score using dedicated postprocessing software. GAS was calculated and patients were divided into low or high GAS by a cutoff of 80.

RESULTS

288 out of 500 patients were included in the study with no difference in survival compared to excluded patients (P = .529). Patients were followed-up for a median of 7 (4 - 9) years. GAS correlated positively with ilio-femoral calcium score (r = .123; P = .037). One hundred thirty-five patients (46,9 %) had low GAS, and 153 (53,1 %) had high GAS. Patients with high GAS had lower survival compared to the ones with low GAS (P ≤ .0001). GAS was associated with long-term mortality in a uni- and multivariate regression (P = < .0001 and P = < .0001). Ilio-femoral calcium score was significantly associated with mortality in the group with low GAS (P = .028), but not in the group with high GAS (P = .297). Significance retained in multivariate regression analysis (P = .029). Moreover, in the low GAS group, iliofemoral calcium score was further divided in high and low according to the median. Patients with high calcium score had lower survival compared to the ones with low calcium score ( P = .047).

CONCLUSIONS

Long-term survival in patients who have had infrarenal EVAR can be predicted by the clinically based Glasgow Aneurysm Score. Measuring the ilio-femoral calcium score preoperatively may refine GAS assessment in low-risk patients.

Outcomes of Endovascular Aneurysm Repair with Adjunctive Stenting

OBJECTIVE

Endovascular aneurysm repair is the standard of care for abdominal aortic aneurysm repair, however data regarding adjunctive stenting at the time of endovascular aneurysm repair (EVAR) are limited. The study aims to evaluate outcomes of patients undergoing EVAR with and without adjunctive stenting.

METHODS

Patients undergoing EVAR with stenting (EVAR-S) and without stenting (EVAR) (2008 to 2017) were selected from Cerner HealthFacts® database using ICD-9 diagnosis and procedure codes. Chi-square analysis and multivariable logistic regression were used to evaluate the association of patient characteristics with medical and vascular outcomes.

RESULTS

4,957 patients undergoing EVAR procedures were identified (3,816 EVAR and 1,141 EVAR-S). Demographic analysis revealed that patients who underwent EVAR-S had higher Charlson comorbidity scores (2.35 vs. 2.13, p = .0001). EVAR-S was associated with a greater frequency of vascular complications such as thrombolysis/percutaneous thrombectomy (0.9% vs. 0.2%; p < .0004). There were no differences seen in access complications between EVAR and EVAR-S. Multivariable analysis revealed that EVAR-S was associated with prolonged length of stay (OR 1.37, 95% CI 1.03-1.82), readmission < 30 days (OR 1.36, 95% CI 1.11-1.68), major adverse cardiac events (OR 1.59, 95% CI 1.09-2.32), respiratory complications (OR 1.47, 95% CI 1.16-1.88) and renal failure (OR 1.57, 95% CI 1.16-2.11).

CONCLUSIONS

Endovascular aneurysm repair with adjunctive stenting (EVAR-S) was associated with vascular complications requiring reintervention, although the overall rate was very low. As well, readmission within 30 days, cardiac complications, respiratory problems and renal failure were more likely when compared to standard EVAR. The need for adjunctive stenting acts as a marker for an overall sicker and more complex population, not just in terms of vascular complications but across all medical complications as well. Staging the procedure may be helpful in terms of spreading out the operative risk into smaller portions. Furthermore, consideration of a non-operative strategy should be discussed with the patient if the risk of the procedure outweighs the risk of aneurysm rupture in high-risk groups.