Study: Abdominal debrancing with aortic stent grafts linked to high early mortality

The clinical data from 167 patients who underwent abdominal debrancing combined with aortic stent grafts (ADSG) at 12 centers in North America from1999-2010 were released today at the 65th Vascular Annual Meeting® presented by the Society for Vascular Surgery®. According to the principal investigator Gustavo S. Oderich, MD, associate professor of surgery at the Mayo Clinic, the study data was provided from The North American Complex Abdominal Aortic Debranching (NACAAD) Registry and end-points were mortality, morbidity, graft patency, patient survival and stent-graft related complications.

"We found that ADSG is associated with high early mortality," said Dr. Oderich. "The wide variation in mortality rates among large volume centers (0 percent to 24 percent) indicates differences in patient selection, co-morbidities, the extent of aneurysm repair and the use of single vs. two stage approach."

Thirty-day or in-hospital mortality was 16 percent (27 patients). Mortality was higher for TAAA's than for PRAA's (19 percent vs. 10 percent, P<0.05), and ranged from 0 percent to 24 percent in centers with less than10 cases. Four percent of the patients (3) had aneurysm rupture before the second stage. Morbidity rate was 49 percent (83 patients), including pulmonary (32 percent) or gastrointestinal complications (18 percent). Patients also had myocardial ischemia (14 percent), renal insufficiency (14 percent) and spinal cord injury (8 percent).

Factors associated with increased mortality (P<0.05) were advanced age, coronary artery disease, congestive heart failure, renal insufficiency, TAAA extent, more than 3 vessels reconstructed, and single stage procedures. At 1-year, patient survival was 72±8 percent, primary graft patency was 95±4 percent, and freedom from endoleak, secondary intervention and aneurysm-related death was 87±6 percent, 86±6 percent and 82±6 percent, respectively.

"This preliminary data serves as a benchmark for comparison with open surgical and total endovascular techniques to repair complex aortic aneurysms," said Dr. Oderich, "however long-term follow up is needed to evaluate durability of abdominal debranching combined with aortic stent grafts"