Elsevier

Journal of Vascular Surgery

Volume 71, Issue 1, January 2020, Pages 39-45.e1
Journal of Vascular Surgery

Clinical research study
Abdominal aortic and iliac artery aneurysms
Transabdominal open abdominal aortic aneurysm repair is associated with higher rates of late reintervention and readmission compared with the retroperitoneal approach

Presented at the Forty-fourth Annual Meeting of the New England Society for Vascular Surgery, Boston, Mass, September 8-10, 2017.
https://doi.org/10.1016/j.jvs.2019.03.045Get rights and content
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Abstract

Objective

Limited data exist comparing the transabdominal and retroperitoneal approaches to open abdominal aortic aneurysm (AAA) repair, especially late mortality and laparotomy-related reinterventions and readmissions. Therefore, we compared long-term rates of mortality, reintervention, and readmission after open AAA repair through a transabdominal compared with a retroperitoneal approach.

Methods

We identified all patients in the Vascular Quality Initiative (VQI) undergoing open AAA repair from 2003 to 2015. Patients with rupture or supraceliac clamp were excluded. We used the VQI linkage to Medicare to ascertain rates of long-term outcomes, including rates of AAA-related and laparotomy-related (ie, hernia, bowel obstruction) reinterventions and readmissions. We used multivariable Cox regression to account for differences in comorbidities, aneurysm details, and operative characteristics.

Results

We identified 1282 patients in the VQI with linkage to Medicare data, 914 (71%) who underwent a transperitoneal approach and 368 (29%) who underwent a retroperitoneal approach. Patients who underwent a retroperitoneal approach were slightly more likely to have preoperative renal insufficiency but were otherwise similar in terms of demographics and comorbidities. They more often had a clamp above at least one renal artery (61% vs 36%; P < .001) and underwent concomitant renal revascularization (9.5% vs 4.3%; P < .001). Patients who underwent a transabdominal approach more often presented with symptoms (14% vs 9.0%; P < .01) and had a femoral distal anastomosis (15% vs 7.1%; P < .001). There was no difference in 5-year survival (62% vs 61%; log-rank, P = .51). However, patients who underwent a transabdominal approach experienced higher rates of repair-related reinterventions and readmissions (5-year: 42% vs 34%; log-rank, P < .01), even after adjustment for demographic and operative differences (hazard ratio, 1.5; 95% confidence interval, 1.1-1.9; P < .01).

Conclusions

A transabdominal exposure for AAA repair is associated with higher rates of late reintervention and readmission than with the retroperitoneal approach, which should be considered when possible in operative decision-making.

Keywords

Aortic aneurysm
Retroperitoneal
Laparotomy
Reintervention
Readmission

Cited by (0)

S.E.D., S.L.Z., and T.F.X.O. were supported by the Harvard-Longwood Research Training in Vascular Surgery NIH T32 Grant 5T32HL007734-22.

Author conflict of interest: none.

Additional material for this article may be found online at www.jvascsurg.org.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.