IP037. Outcome Differences Between Infrarenal and Suprarenal Fixation for Endografts in the Treatment Abdominal Aortic Aneurysms

Early studies found no differences between infrarenal and suprarenal fixation for endovascular abdominal aortic aneurysm repair (EVAR). However these studies reflect the early experience with EVAR and are predominantly small, single-institution experiences. This study aims to evaluate the differences in patient selection and outcomes for contemporary endografts with infrarenal and suprarenal fixation. All patients undergoing EVAR in the Vascular Study Group of New England from 200 to 2014 were identified. Patients with ruptured aneurysms, concomitant procedures, or infrequent use (<50) stent grafts were excluded. Suprarenal endografts included Talent, Zenith, and Endurant. Infrarenal stent grafts included AneuRx and Excluder. Powerlink was excluded due to its potential for suprarenal or infrarenal position. Renal deterioration was defined as an increase in creatinine >0.5 mg/dL or new hemodialysis. Prolonged hospitalization was defined as >2 days. Patient demographics, comorbidities, operative details, and outcomes were compared. A subgroup analysis was completed to evaluate differences between the early and recent EVAR experience (excluding AneuRx and Talent). Multivariable regression and Cox hazard models were used to account for patient demographics, comorbidities, operative differences, and year. A total of 2992 endografts were identified, including 1510 suprarenal and 1482 infrarenal. There were no differences in patient demographics or comorbidities. Patients treated with infrarenal grafts more commonly underwent general anesthesia (92% vs 86%; P < .01), and less commonly had concurrent iliac aneurysms (20% vs 24%; P = .02). All other operative details, including aneurysm size, were similar. Patients treated with infrarenal grafts had decreased rates of renal deterioration (2% vs 4%; P = .01), type I or III endoleak (2% vs 3%; P = .02), and decreased incidence of prolonged hospitalization (18% vs 27%; P < .01). There were no differences in 30-day mortality (0.8 vs 1%; P = .48) or late mortality (P = .20). Following adjustment, suprarenal stent grafts remained associated with increased renal deterioration (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.5; P < .01), and longer length of stay (OR, 1.8; 95% CI, 1.4-2.2; P < .01). Suprarenal fixation was associated with increased renal deterioration and longer hospital length of stay but did not impact perioperative or long-term survival. However, this along with potential for further renal decline over time needs to be weighed with the possible benefit of decreased graft migration.