TY - JOUR
T1 - Effect of Blood Loss and Transfusion Requirements on Clinical Outcomes of Fenestrated-Branched Endovascular Aortic Repair
AU - Sen, Indrani
AU - Tenorio, Emanuel R.
AU - Mirza, Aleem K.
AU - Kärkkäinen, Jussi M.
AU - Mendes, Bernardo C.
AU - DeMartino, Randall R.
AU - Cha, Stephen
AU - Oderich, Gustavo S.
N1 - Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Objective: The aim of this study was to evaluate the effect of blood loss and transfusion requirements on clinical outcomes of patients treated by fenestrated-branched endovascular aortic repair (F-BEVAR) for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of 370 consecutive patients (277 male, mean age 74 ± 10 years) treated by F-BEVAR between 2007 and 2017. Outcomes were estimated blood loss (EBL), use of intraoperative blood salvage (IOBS), transfusion of packed red blood cells (PRBCs), mortality, and major adverse events (MAEs). Results: There were 189 patients (51%) treated for PRAs and 181 patients (49%) treated for TAAAs. IOBS was used in 194 patients (52%) and transfusion of PRBCs was needed in 137 (37%). Thirty-day mortality was 2.2% (8/370) and MAEs occurred in 123 patients (33%), including 74 patients (20%) who had EBL > 1L. EBL > 1L and transfusion of PRBCs were significantly higher (P < 0.05) in patients treated in the first half of clinical experience and in those with larger aneurysms, iliofemoral conduits, bilateral open surgical femoral access and Extent I–III TAAAs. Use of DrySeal® sheaths (WL Gore, Flagstaff AZ) was associated with significantly lower (P <.05) EBL volume and with less transfusion of PRBCs. On multivariate analysis PRBCs > 1L, male gender and the last half of clinical experience were associated with MAEs/mortality. Conclusions: F-BEVAR was associated with significantly higher volume of blood loss and transfusion requirements in patients treated in the early experience and in those who had iliofemoral conduits, open femoral surgical exposure or Extent I–III TAAAs.
AB - Objective: The aim of this study was to evaluate the effect of blood loss and transfusion requirements on clinical outcomes of patients treated by fenestrated-branched endovascular aortic repair (F-BEVAR) for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of 370 consecutive patients (277 male, mean age 74 ± 10 years) treated by F-BEVAR between 2007 and 2017. Outcomes were estimated blood loss (EBL), use of intraoperative blood salvage (IOBS), transfusion of packed red blood cells (PRBCs), mortality, and major adverse events (MAEs). Results: There were 189 patients (51%) treated for PRAs and 181 patients (49%) treated for TAAAs. IOBS was used in 194 patients (52%) and transfusion of PRBCs was needed in 137 (37%). Thirty-day mortality was 2.2% (8/370) and MAEs occurred in 123 patients (33%), including 74 patients (20%) who had EBL > 1L. EBL > 1L and transfusion of PRBCs were significantly higher (P < 0.05) in patients treated in the first half of clinical experience and in those with larger aneurysms, iliofemoral conduits, bilateral open surgical femoral access and Extent I–III TAAAs. Use of DrySeal® sheaths (WL Gore, Flagstaff AZ) was associated with significantly lower (P <.05) EBL volume and with less transfusion of PRBCs. On multivariate analysis PRBCs > 1L, male gender and the last half of clinical experience were associated with MAEs/mortality. Conclusions: F-BEVAR was associated with significantly higher volume of blood loss and transfusion requirements in patients treated in the early experience and in those who had iliofemoral conduits, open femoral surgical exposure or Extent I–III TAAAs.
KW - Blood loss
KW - Fenestrated-branched endovascular aortic repair
KW - Thoracoabdominal aortic aneurysm
KW - Transfusion requirements
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U2 - 10.1007/s00270-020-02573-8
DO - 10.1007/s00270-020-02573-8
M3 - Article
C2 - 32864718
AN - SCOPUS:85089958341
SN - 0174-1551
VL - 43
SP - 1600
EP - 1607
JO - Cardiovascular and Interventional Radiology
JF - Cardiovascular and Interventional Radiology
IS - 11
ER -