Predictors of serious morbidity and mortality after endovascular repair of aortoiliac lesions

Abstract

Background: Endovascular approaches to aortoiliac disease are becoming increasingly frequent due to decreases in recovery time, bleeding, and discomfort. Despite this trend, little is known about the predictors of complications. This study was designed to identify risk factors for major 30-day morbidity and mortality after endovascular repair.

Methods: Data were derived from the 2015-2016 Participant User Files and Procedure Targeted databases of the American College of Surgeons National Surgical Quality Improvement Program. Demographics and comorbidities of patients undergoing repair were assessed. Preoperative risk factors were analyzed using univariate and multivariate analysis.

Results: Twelve hundred and nine patients underwent endovascular aortoiliac repair, including 532 females (44.0%) and 677 males (56.0%). The 30-day mortality rate was 0.7%. Diabetes mellitus requiring medication, chronic steroid use, dialysis, pre-existing open wound, age, and low serum albumin and hematocrit increased mortality. After logistic regression, 30-day mortality was correlated with low serum albumin (survivors = 3.77, nonsurvivors = 2.60; P = .003) and chronic steroid use (P = .020). Multivariate analysis identified high preoperative white blood cell count as a risk factor for amputation. Diabetes, smoking history, and low serum sodium were risk factors for return to the operating room. Female sex and steroid use were risk factors for myocardial infarction and stroke. Open wounds and high platelets were risk factors for the need for an operative bypass after endovascular intervention. Preprocedural statin use was protective against need for a later operative bypass and reintervention.

Conclusions: Open wound, smoking, preprocedural steroid use, diabetes, female sex, high platelet and white blood cell count, and low serum albumin are the most strongly associated risk factors for adverse 30-day postoperative outcomes. Mortality rates remain low after endovascular aortoiliac revascularization.