Comparison of aortomonoiliac endovascular aneurysm repair versus a bifurcated stent-graft: analysis of perioperative morbidity and mortality.
OBJECTIVE
To compare the perioperative morbidity and mortality following endovascular aneurysm repair (EVAR) with a bifurcated stent-graft versus an aortomonoiliac stent-graft combined with a femorofemoral crossover graft.


METHODS
A prospectively maintained database of patients undergoing EVAR over a 7-year period (January 2001 to June 2008) was interrogated retrospectively to identify all patients receiving either a bifurcated or an aortomonoiliac stent-graft. Patients undergoing emergency treatment or renal/mesenteric fenestrated or iliac branched EVAR were excluded. Data retrieval found 210 patients (194 men; mean age 75 years) who had been treated with 41 aortomonoiliac stent-grafts and 169 bifurcated devices. The impact of preoperative and intraoperative variables on postoperative morbidity was assessed by means of univariate and multivariate logistic regression analysis.


RESULTS
Significant postoperative complications occurred in 41% (17/41) of aortomonoiliac stent-graft patients compared to 14% (23/169) of bifurcated stent-graft patients (p = 0.0001). Univariate logistic regression analyses identified patient age, operating time, and implantation of an aortomonoiliac stent-graft as significant predictors of postoperative complications. In a multivariate logistic regression model, only implantation of an aortomonoiliac stent-graft was independently associated with postoperative complications (p = 0.003).


CONCLUSIONS
Compared to EVAR with a bifurcated device, the implantation of an aortomonoiliac stent-graft and crossover bypass is associated with higher patient morbidity similar to rates reported after open repair. These patients comprise a high-risk endovascular group and require careful postoperative management in order to minimize complications.
Noorani
Ayesha
A
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Cooper
David G
DG
Walsh
Stewart R
SR
Sadat
Umar
U
Varty
Kevin
K
Boyle
Jonathan R
JR
Hayes
Paul D
PD
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome