Presence of Atherosclerosis in Multiple Arterial Beds is Associated with Increased Mortality in Patients Undergoing Endovascular Aortic Aneurysm Repair

Abstract

Objective: Patients with polyvascular disease are considered high risk for major adverse cardiac events (MACE). This retrospective study used the Vascular Quality Initiative (VQI) database to quantify the effect of polyvascular disease on outcomes after endovascular aneurysm repair (EVAR).

Methods: The VQI database was queried from 2012 - 2022 for elective EVAR. Patients were identified as having peripheral arterial disease, coronary artery disease, or cerebrovascular disease, and then stratified based on the number of arterial beds involved (one to three). Primary outcomes were peri-operative death and MACE. Multivariable analysis was performed to find associations between comorbidities and primary outcomes.

Results: Of the 21 160 patients with arterial disease included in the study, 83.7% were male and the mean age was 73.73 ± 8.57 years. After stratification, 16 892 patients had atherosclerosis in one arterial bed, 3 869 in two arterial beds, and 399 in three arterial beds. Pre-operatively, patients with atherosclerosis in three arterial beds were more likely to have hypertension, diabetes, and renal failure (all p < .001). Post-operatively, patients with disease in three arterial beds were more likely to experience a post-operative complication (11.5% vs. 8.3% vs. 5.4%; p < .001), including MACE (4.3% vs. 2.5% vs. 1.3%; p < .001) and death (2.8% vs. 1.1% vs. 0.5%; p < .001). On multivariable analysis, polyvascular disease was associated with MACE (odds ratio 1.54, 95% confidence interval 1.29 - 1.84; p < .001). Kaplan-Meier analysis estimates showed statistically significant differences in survival at approximately the three year follow up (p < .001).

Conclusion: In this review of patients undergoing elective EVAR, patients with polyvascular disease experienced worse peri-operative outcomes, including death and MACE, the latter of which was confirmed on multivariable analysis. These patients should be considered high risk and managed accordingly.

Keywords: Abdominal aortic aneurysm; Atherosclerosis; Endovascular aneurysm repair; Major adverse cardiac events; Mortality; Polyvascular disease.