Impact of Endovascular Repair on Management of Visceral Artery Aneurysms

Endovascular (EV) repair of visceral artery aneurysms (VAAs) has become more widespread. The purpose of this study was to evaluate the outcomes of EV repair and open repair of VAA. Patients with a primary diagnosis of VAA (splenic and nonsplenic visceral artery aneurysms), excluding those with concomitant aortic disease, were identified from the Nationwide Inpatient Sample between 2003 and 2012. Demographics, comorbidities, complications, and surgical outcomes of patients treated with EV repair (coil or stent) or open repair or ligation were compared and analyzed by χ2 tests of independence and independent samples t-tests using SPSS 24 software (IBM Corp, Armonk, NY). P < .05 was considered statistically significant. We identified 2561 VAA patients (1239 were splenic artery aneurysms). The incidence of VAA steadily rose, and the number of patients treated rose from 62.8% in 2003 to 73.0% in 2012 (P < .05). Of the patients treated, those with EV repair rose from 26.8% in 2003 to 71.4% in 2012 (P < .001); those treated with open repair fell from 73.2% to 28.6% (P < .001). Aside from differences in the incidence of dysrhythmias and chronic renal failure, the patients did not differ in comorbidities between treatment groups. Mortality was not different between EV repair (3.8%) and open repair (4.7%). Patients with open repairs were more likely to experience postoperative complications (13.0%, wound and infections) than those with EV repair (9.7%, vascular complications). Length of stay was shorter for patients with EV repair (6.6 days vs 9.68; P < .001; Table). EV intervention of VAA has increased, whereas open repair is being used less. Mortality rates were similar for EV and open repairs. Patients with EV repairs experienced fewer complications and stayed 2 days shorter in the hospital than those with open repairs, both of which may lead to decreased cost. With the increasing prevalence of VAA, the addition of an EV option may be increasing the number of patients with VAA who can be treated.TableVisceral artery aneurysm (VAA)VAA (N = 2561)EV repair (n = 1001)Open repair (n = 790)P valueVAA (N = 2561)EV repair (n = 1001)Open repair (n = 790)P valueAge, years58.758.759.1NSMortality4.33.84.7NSFemale51.151.150.0NSCardiac complications1.50.92.9<.05Coronary artery disease9.68.89.9NSRespiratory complications1.30.32.8<.001Hypertension42.440.944.7NSPeripheral vascular complications0.40.90.0<.05Dysrhythmia13.312.115.8<.05Wound complications0.30.00.6<.05Atrial fibrillation8.38.48.5NSInfectious complications1.30.82.4<.05Prior myocardial infarction3.02.53.2NSAcute renal failure5.36.65.4NSHeart failure5.05.64.3NSHematologic complications1.01.40.8NSChronic obstructive pulmonary disease7.37.11.1NSAny complication9.99.713.0<.05Chronic renal failure0.91.40.1<.05LOS, days7.096.608.68<.001Cardiovascular disease0.30.30.5NSPeripheral vascular disease1.81.51.9NSEV, Endovascular; LOS, length of stay; NS, not significant.Values are reported as % unless otherwise indicated. Open table in a new tab