Outcomes of Thoracoabdominal Aortic Aneurysm Repair in Patients with and without Peripheral Vascular Disease

P0246 

Abstract Submission 

Alexis Nichols (1), Veronica Glover (1), Lynna Nguyen (1), Ginger Etheridge (1), Susan Green (1), Subhasis Chatterjee (1), Marc Moon (2), Joseph Coselli (3)

(1) Baylor College of Medicine, Houston, TX, (2) Baylor College of Medicine / Texas Heart Institute, Houston, TX, (3) Baylor College of Medicine, Texas Heart Institute, Houston, TX

Alexis Nichols    -  Contact Me
Baylor College of Medicine

Veronica Glover    -  Contact Me
Baylor College of Medicine

Lynna Nguyen    -  Contact Me
Baylor College of Medicine

Ginger Etheridge    -  Contact Me
Baylor College of Medicine

Susan Green    -  Contact Me
Baylor College of Medicine

*Subhasis Chatterjee    -  Contact Me
Baylor College of Medicine

*Marc Moon    -  Contact Me
Baylor College of Medicine / Texas Heart Institute

*Joseph Coselli    -  Contact Me
Baylor College of Medicine, Texas Heart Institute

Alexis Nichols    -  Contact Me
N/A

Outcomes of Thoracoabdominal Aortic Aneurysm Repair in Patients with and without Peripheral Vascular Disease

Authors: Alexis Nichols, Veronica A. Glover, Lynna Nguyen, Ginger Etheridge, Susan Green, Subhasis Chatterjee, Marc Moon, Joseph Coselli

Author Institutions: Baylor College of Medicine/The Texas Heart Institute

Objective: Peripheral vascular disease (PVD) is closely associated with other atherosclerotic diseases that are common in patients with thoracoabdominal aortic aneurysms (TAAA); however, its association with TAAA repair is not well studied. This study aims to investigate the relationship between PVD and TAAA repair; specifically, how patients with and without PVD differ in terms of presentation, extent and details of TAAA repair, and early outcomes.

Methods: This retrospective, single-practice study analyzed 3,772 patients who underwent TAAA repair from 1990-2023. Included were 891 (23.6%) patients with PVD and 2,881 (76.4%) patients without PVD. Preoperative, perioperative, and postoperative factors were compared. Adverse events included operative mortality (within 30 days or final hospital discharge, including transfer) or persistent (ie, present at discharge or at time of death) stroke, paraplegia, paraparesis, or renal failure necessitating dialysis.

Results: The median age of patients who underwent TAAA repair was 69 [64-75, P<.001] in patients with PVD and 66 [56-73, P<.001] in patients without PVD. Patients without PVD had a higher prevalence of heritable aortic disorder (12.9 % vs 4.0%, P<.001). Patients with PVD had a higher prevalence of hypertension (90.8% vs 84.6%, P<.001), hyperlipidemia (42.8% vs 28.1%, P<.001), coronary artery disease (45.7% vs 32.0%, P<.001), cerebrovascular disease (29.3% vs 13.8%, P<.001), chronic kidney disease (49.9% vs 35.4%, P<.001), and chronic obstructive pulmonary disease (42.7% vs 56.5%, P<.001). Patients with PVD were more likely former tobacco users (59.0% vs 46.1%, P<.001), while those without PVD were more likely never tobacco users (22.6% vs 10.3%, P<.001). Patients with PVD underwent extent IV repairs more often (30.4% vs 16.8%, P<.001), while patients without PVD underwent extent I repair more often (29.4% vs 16.9%, P<.001). Management of visceral/renal arteries by endarterectomy, stenting, or bypass was required more often in PVD patients (55.8% vs 40.1%, P<.001). There was no difference in operative mortality between patients with and without PVD (9.2% vs 8.4%, P=.5). Adverse events were increased in PVD patients (17.6% vs 14.4%, P=.02), specifically persistent stroke (3.6% vs 2.0%, P=.009). Spinal cord deficit occurred more often in PVD patients (12.3% vs 9.1%, P=.004); however, much of this was transient with no difference in incidence of persistent paraplegia between patients with and without PVD (3.6% vs 2.7%, P=.2).

Conclusions:
Our data suggest that a history of PVD is associated with significant differences in preoperative, perioperative, and postoperative factors in patients presenting with TAAA. Patients with PVD more often had other comorbid atherosclerotic disease and were more likely to have used tobacco. Patients with PVD more often underwent extent IV repairs, while patients without PVD more often underwent extent I repairs. PVD was associated with higher rates of adverse outcomes after TAAA repair. Patients with PVD may experience higher rates of stroke and of spinal cord deficit, which may necessitate careful monitoring after repair.

Descending/Thoracoabdominal Aorta