Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms

• Published in: Journal of vascular surgery Vol. 66; no. 1; pp. 95 - 101
• Main Authors: Farivar, Behzad S., MD, Kalsi, Richa, BS, Drucker, Charles B., MD, Goldstein, Carly B., BA, Sarkar, Rajabrata, MD, PhD, Toursavadkohi, Shahab, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Abdominal - therapy; Arteries - physiopathology; Blood Vessel Prosthesis Implantation - adverse effects; Chi-Square Distribution; Colitis, Ischemic - diagnosis; Colitis, Ischemic - etiology; Colitis, Ischemic - therapy; Databases, Factual; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Endovascular Procedures - adverse effects; Female; Humans; Length of Stay; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Pelvis - blood supply; Regional Blood Flow; Registries; Renal Dialysis; Renal Insufficiency - diagnosis; Renal Insufficiency - etiology; Renal Insufficiency - therapy; Retrospective Studies; Risk Factors; Surgery; Time Factors; Treatment Outcome; United States
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2016.10.124

Abstract Objective Hypogastric artery embolization (HAE) is associated with significant risk of ischemic complications. We assessed the impact of HAE on 30-day outcomes of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms. Methods We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2014 to identify and to compare clinical features, operative details, and 30-day outcomes of EVAR with those of concomitant HAE with EVAR (HAE + EVAR). Multivariate analysis was performed to determine preoperative and intraoperative factors associated with development of significant complications observed in patients with HAE + EVAR. Results In a cohort of 5881 patients, 387 (6.6%) underwent HAE + EVAR. Compared with EVAR, a higher incidence of ischemic colitis (2.6% vs 0.9%; P  = .002), renal failure requiring dialysis (2.8% vs 1%; P  = .001), pneumonia (2.6% vs 1.3%; P  = .039), and perioperative blood transfusion (17% vs 13%; P  = .024) was noted after HAE + EVAR. Thirty-day thromboembolic events, strokes, myocardial infarction, lower extremity ischemia, reoperation, and readmission rates were not significantly different ( P > .05). Mortality at 30 days in HAE + EVAR patients was 4.1% compared with 2.5% with EVAR ( P  = .044). HAE was independently associated with increased risk of colonic ischemia (adjusted odds ratio, 2.98; 95% confidence interval, 1.44-6.14; P  = .003) and renal failure requiring dialysis (adjusted odds ratio, 2.22; 95% confidence interval, 1.09-4.53; P  = .029). However, HAE was not an independent predictor of mortality. Average length of hospital stay was 4 ± 8.5 days after HAE + EVAR vs 3.3 ± 5.9 days after EVAR ( P  = .001). Conclusions Concomitant HAE with EVAR is associated with longer and more complicated hospital stays. Ischemic colitis is a rare complication of EVAR. HAE increases the risk of ischemic colitis and renal failure requiring dialysis. This study highlights the importance of hypogastric artery preservation during EVAR.