Lower Extremity Ischemia after Abdominal Aortic Aneurysm Repair

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Research
• Surgical Complications

Background:

• Endovascular aortic repair (EVAR) and open aortic repair (OAR) are common treatments for abdominal aortic aneurysms (AAA).
• Lower extremity ischemia (LEI) is an underreported complication following invasive AAA repair.
• LEI is associated with worse patient outcomes.

Purpose of the Study:

• To determine the incidence and outcomes of LEI after EVAR and OAR for AAA.
• To identify risk factors associated with LEI development.
• To compare LEI rates between EVAR and OAR.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) vascular surgery targeted module (2011-2014).
• Inclusion of patients undergoing EVAR or OAR for AAA.
• Statistical analysis to identify incidence, outcomes, and risk factors for LEI.

Main Results:

• 1.9% of patients developed LEI post-AAA repair; ruptured AAA repair had a higher incidence (4.8%) than intact AAA repair (1.6%).
• Risk factors for LEI included operation time, male gender, current smoking, and elevated creatinine.
• LEI occurrence significantly increased hospital stay (6 vs. 2 days) and mortality (20.5% vs. 4.6%).

Conclusions:

• LEI is a severe complication affecting up to 2% of patients after AAA repair.
• LEI is linked to substantially worse outcomes, including higher mortality and prolonged hospitalization.
• Further research and preventative strategies are necessary to mitigate LEI after AAA repair.