title: Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality.
abstract: OBJECTIVE
  The aim of our study was to examine the predictive value of the anatomic severity grading (ASG) score for abdominal aortic aneurysms (AAAs) on implant-related complications, systemic complications, and mortality at 30-day and midterm, defined as 2 years, follow-up assessments.
  
  
  METHODS
  Patients who underwent endovascular aneurysm repair for infrarenal AAAs between 2009 and 2012 were retrospectively reviewed, and ASG scores were calculated from three-dimensonal computed tomography reconstructions. Two independent patient groups were created: those with a low ASG score (score <14) and those with a high ASG score (score ≥14).
  
  
  RESULTS
  We identified 190 patients (77% male), with a mean age of 73 years, and 84% Caucasian, with 104 patients in the low-score group and 86 in the high-score group. Within 30 days of the index endovascular aneurysm repair, 10 implant-related complications occurred in six patients (3%) and 25 systemic complications in 18 (9%). The incidence of 30-day implant-related complications was not significantly different between the low-score group (2 [2%]) and the high-score group (4 [5%]; P = .41). The incidence of patients with 30-day systemic complications was significantly different between the low-score group (5 [5%]) and the high score group (13 [15%]; P = .023). A composite end point of combined implant-related and systemic complications at 30 days showed there was a statistically significant difference between the low-score (7 [7%]) and high-score group (17 [20%]; P = .007). At a midterm follow up of 26 months (range, 1-64 months), implant-related complications occurred in 21 patients (11%), and systemic complications occurred in 29 (15%). The incidence of implant-related complications was significantly different between the low-score group (7 [7%]) and the high-score group (14 [16%]; P = .037). The incidence of midterm systemic complications was significantly different between the low-score group (11 [11%]) and the high-score group (18 [21%]; P = .048). A composite end point of combined implant-related and systemic complications at midterm follow-up resulted in a statistically significant difference between the low-score group (16 [15%]) and the high-score group (26 [30%]; P = .014). Kaplan-Meier analysis revealed that the low-score group had fewer overall complications (combined implant-related and systemic) at 1 year (14% vs 34%) and 2 years (15% vs 45%) compared with the high-score group (P < .001). The low-scoring group also had significantly higher survival at 1 year (96% vs 86%) and 2 years (88% vs 84%) compared with the high-score group (P = .047).
  
  
  CONCLUSIONS
  The AAA ASG score can be used to predict patients at risk for midterm implant-related complications, 30-day and midterm systemic complications, and all-cause mortality.
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: W Burke
authors.initials: WB
authors.lastname: Best
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va. Electronic address: ahanchi@yahoo.com.
authors.forename: Sadaf S
authors.initials: SS
authors.lastname: Ahanchi
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Larion
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: Chad P
authors.initials: CP
authors.lastname: Ammar
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: Kedar S
authors.initials: KS
authors.lastname: Lavingia
authors.affiliation: Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Panneton
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome