title: Implications of problematic access in transluminal endografting of abdominal aortic aneurysm.
abstract: OBJECTIVE
  Despite careful preoperative assessment, problematic access to the abdominal aorta for transluminal endografting (TE) of abdominal aortic aneurysm (AAA) is sometimes encountered. This study identifies preoperative risk factors predictive of problematic access and determines the impact of problematic access on outcomes.
  
  
  METHODS
  Three hundred twenty-one consecutive TE procedures for AAA were divided into two groups: group A, which had access problems (n = 74), and group B, which had none (n = 247).
  
  
  RESULTS
  Logistic regression analysis of risk factors showed that (i) a pulmonary risk score of 3 (P <.001; odds ratio, 11.2), (ii) a hyperlipidemia score of 3 (P =.004; odds ratio, 2.6), and (iii) a small body (short height with low weight, P =.003; odds ratio, of 4.2) were independent risk factors for problematic access. Outcomes compared included rates of perioperative mortality, aborted procedure, surgical conversion, major complication, limb complication, and endoleak. The perioperative mortality rate was higher in group A (6.8% vs 1.2%; P =.018) and procedures were more likely to be aborted in patients in group A (12.2% vs 0%; P <.001). Rates of surgical conversion, major complication, and limb complication were not different between the two groups. The endoleak rate was higher in group B (10.8% vs 26.7%; P =.004). Logistic regression analysis showed that problematic access was an independent risk factor (P =.004; odds ratio, 12.0) for perioperative mortality.
  
  
  CONCLUSIONS
  Moderate to severe chronic obstructive pulmonary disease and hyperlipidemia, both risk factors for atherosclerosis, were related to problematic access in this series. Small body size was another factor related to problematic access. Problematic access was an independent risk factor for perioperative mortality.
authors.affiliation: Division of Clinical Research and Outcomes, Miami Cardiac and Vascular Institute, Baptist Health Systems of South Florida, 8900 North Kendall Drive, Miami, Florida 33176, USA. mmathison@acrionline.org
authors.forename: Megumi N
authors.initials: MN
authors.lastname: Mathison
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Becker
authors.forename: Barry T
authors.initials: BT
authors.lastname: Katzen
authors.forename: James F
authors.initials: JF
authors.lastname: Benenati
authors.forename: Gerald
authors.initials: G
authors.lastname: Zemel
authors.forename: Alex
authors.initials: A
authors.lastname: Powell
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Lima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors