Impact of preoperative risk factors on 5-year survival after fenestrated/branched endovascular aortic repair.

Autor:	Gomes VC; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC., Parodi FE; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC., Browder SE; Department of Biostatistics, University of North Carolina, Chapel Hill, NC., Motta F; Department of Vascular Surgery, University of Oklahoma, Tulsa, OK., Vasan P; University of North Carolina School of Medicine, Chapel Hill, NC., Sun D; University of North Carolina, Chapel Hill, NC., Marston WA; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC., Pascarella L; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC., McGinigle KL; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC., Wood JC; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC., Farber MA; Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC. Electronic address: mark_farber@med.unc.edu.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2024 Nov 12. Date of Electronic Publication: 2024 Nov 12.
DOI:	10.1016/j.jvs.2024.11.002
Abstrakt:	Objective: To investigate which preoperative factors most impact the 5-year survival of patients undergoing fenestrated/branched endovascular aortic repair (F/BEVAR) and to identify modifiable elements that, if time allows, should be actively managed and adequately controlled preoperatively. Methods: Patients treated for aortic aneurysms with complex anatomy using either patient-specific company-manufactured or off-the-shelf F/BEVAR devices were included. The exposure of interest was aneurysm type (group I: type I-III thoracoabdominal aneurysms vs group II: type IV thoracoabdominal aneurysms vs group III: juxtarenal or suprarenal aneurysms), and the primary outcome was 5-year risk of all-cause mortality. Generalized linear models were used to estimate each group's crude 5-year risk of death and the 5-year risk of death across groups. Each preoperative factor was added to the model individually, and a change in estimate was calculated between the new risks and the crude risk. Preoperative factors with a change of estimate of ≥10% were used to create an inverse probability of treatment weights for multivariable analysis. Results: A total of 408 F/BEVAR patients were included, of whom 71.6% were male (mean age: 72.0 ± 7.9 years). Eleven of the 22 preoperative factors analyzed had a change in estimate ≥10%. The greatest changes in estimates were observed for history of congestive heart failure (CHF), arrhythmia, overweight, obesity, and chronic obstructive pulmonary disease. Almost 60% of patients with CHF in group I died within 5 years. Current smoking or overweight at the time of F/BEVAR increases the 5-year risk of death more significantly than having a history of myocardial infarction. After adjustment, patients in group I had a significantly higher risk of 5-year all-cause mortality than those in group III (log-rank, P value = .0082). Conclusions: The present findings suggest that cardiac arrhythmias, CHF, overweight, obesity, chronic obstructive pulmonary disease, and aneurysm diameter above 7 cm are the most relevant preoperative factors that impact the 5-year survival after F/BEVAR. More specifically, CHF and arrhythmias should be used to alter patient selection and identify those individuals more likely to benefit from repair. Moreover, modifiable risk factors such as weight loss and smoking cessation during the surveillance period before the F/BEVAR procedure might improve survival in this population. Considering that, preoperatively, many patients are periodically evaluated by a vascular surgery team until the aneurysm diameter meets criteria for repair, a multidisciplinary approach that could address these modifiable risk factors might be an impactful strategy. Competing Interests: Disclosures F.E.P. has stock options in Centerline Biomedical. W.A.M. is a consultant for InterVene Inc and Molnlycke Inc, and reports research and clinical trial support from InterVene and Reapplix Medical. K.L.M. reports speaker fees from Penumbra Inc and Shockwave Medical, is a consultant for Vascular Technology Inc, and has received research support from NovoNordisk Foundation. M.A.F. is a consultant for WL Gore, Getinge, and ViTTA; received clinical trial support from WL Gore, Cook, ViTTA, and Centerline Biomedical; received research support from Cook; and has stock options in Centerline Biomedical. The remaining authors report no conflicts. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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