Learning curve of fenestrated and branched endovascular aortic repair for pararenal and thoracoabdominal aneurysms

Aleem K. Mirza, Emanuel R. Tenorio, Jussi M. Kärkkäinen, Jan Hofer, Thanila Macedo, Stephen Cha, Pinar Ozbek, Gustavo S. Oderich

Research output: Contribution to journalArticle

Abstract

Objective: The objective of this study was to review the learning curve for fenestrated-branched endovascular aortic repair (F-BEVAR) of pararenal and thoracoabdominal aortic aneurysms (TAAAs). Methods: We reviewed the clinical data of 334 consecutive patients (255 males, mean age 75 ± 7 years) who underwent F-BEVAR between 2007 and 2016 in a single institution. Outcomes were analyzed in four quartiles of experience (Q1-Q4). Study outcomes included trends in patient characteristics, device design, procedural variables, 30-day mortality, and major adverse events (MAEs). Results: There were 178 patients (53%) treated for pararenal aneurysms and 156 (47%) for TAAAs. During the study period, there was a statistically significant increase in the proportion of TAAAs and in the number of vessels incorporated. Despite this, there was a steady decrease in 30-day mortality (6% in Q1 to 0% in Q4; P <.04) and in the rate of MAEs (60% in Q1 to 29% in Q4; P<.001). By linear regression analysis, there was significant decline in estimated blood loss (1358 ± 1517 mL in Q1 to 486 ± 520 mL in Q4; P <.001), total operating time (325 ± 116 minutes in Q1 to 248 ± 92 minutes in Q4; P <.001), total fluoroscopy time (121 ± 59 minutes in Q1 to 85 ± 39 minutes in Q4; P <.001), contrast volume (201 ± 92 mL in Q1 to 160 ± 61 mL in Q4; P =.002), and radiation dose (4141 ± 2570 mGy in Q2 to 2543 ± 1895 mGy in Q4; P <.001). Independent predictors of MAEs were total operating time (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.8; P <.001), Society for Vascular Surgery total score (OR, 1.1; 95% CI, 1.02-1.2; P =.009), and quartile 1 (OR, 3.0; 95% CI, 1.7-5.2; P <.001). Conclusions: This study demonstrates significant improvement in perioperative mortality, MAEs, procedural variables, and secondary interventions in patients treated by F-BEVAR, despite the increase in complexity of aneurysm pathology during the study period. Also, better patient selection contributed to improve outcomes.

Original languageEnglish (US)
JournalJournal of vascular surgery
DOIs
StateAccepted/In press - Jan 1 2020

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Keywords

  • Cumulative sum analysis
  • Fenestrated and branched endovascular aortic repair
  • Learning curve
  • Thoracoabdominal aortic aneurysm

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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