Endovasküler aort onarımı yapılan hastalarda nörolojik sonuçlar ile hastane mortalitesi arasındaki ilişki

Year 2022, Volume: 32 Issue: 1, 102 - 107, 28.02.2022

Levent Altınay , Elif Coşkun Sungur , İlker İnce

https://doi.org/10.54005/geneltip.1022644

Cited By: 1

Abstract

Amaç
Torakoabdominal aort patolojilerinde EVAR/TEVAR sonuçlarımızı ve post-prosedural nörolojik olaylar ile hastane mortalitesi arasındaki ilişkiyi sunmak.
Gereç ve yöntem
Kasım 2016 – Mayıs 2021 arasında EVAR/TEVAR işlemi uygulanmış hastalar bu retrospektif çalışmaya alındı. İşlem öncesi herhangi bir nörolojik olay öyküsü olan hastalar çalışmaya alınmadı. Post-prosedural erken nörolojik komplikasyonların oluşuna göre hastalar iki gruba ayrıldı.
Bulgular
Toplam 60 hasta değerlendirildi. Grup 1 nörolojik komplikasyon olmayan 37 (%78.7) hasta, Grup 2 post-prosedural nörolojik komplikasyon olan 10 (%21.3) hastadan oluştu. Yoğunbakımda kalış süresi Grup 2’de anlamlı derecede uzundu (1.7 ± 2.0 gün Group 1 vs 6.2 ± 5.1 gün Group 2, p=0.021). genel mortalite oranı %19.1 (47 hastada 9) idi. Grup 2 mortalite oranı anlamlı derecede yüksekti (37 hastada 2 (%5.4) Group 1’de vs 10 hastada 7 (%70) Group 2’de, p=0.001). Amerikan Anesteziyolojistler Birliği fiziksel sınıflama skoru Grup 2’de anlamlı derecede yüksekti (3.5 ± 0.6 Group 1 vs 4.1 ± 0.3 Group 2, p=0.016). En sık erken postprosedural nörolojik komplikasyon bilinç olmamasıydı.
Sonuç
Erken postprosedural nörolojik komplikasyon oluşması, TEVAR ve EVAR prosedürlerinin hastane mortalitesini artmasına katkı yapmaktadır.

Keywords

EVAR, TEVAR, nörolojik komplikasyon, hastane mortalitesi

Supporting Institution

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Project Number

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Thanks

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The relation between neurological outcomes and in-hospital mortality rates of endovascular aortic repair patients

Abstract

Aim
To represent our results of EVAR/TEVAR procedures for thoracoabdominal aortic pathologies and the relation between the post-procedural neurological adverse events and in-hospital mortality.
Material and Method
Patients who underwent EVAR/TEVAR procedures between November 2016 and May 2021 included in this retrospective study. Patients with a history of any cerebrovascular event before the intervention were excluded. Patients divided into two groups according to occurrence of any early neurological complications.
Results
A total of 60 patients who underwent EVAR/TEVAR procedures were evaluated. Group 1 included 37 (78.7%) patients who had no neurological complication. Group 2 included 10 (21.3%) patients who had a postoperative neurological complication. The intensive care unit stay time was significantly longer in Group 2 than Group 1 (1.7 ± 2.0 days in Group 1 vs 6.2 ± 5.1 days in Group 2, p=0.021). Overall mortality rate was 19.1% (9 of 47 patients). The mortality rate of the Group 2 was significantly higher than Group 1 (2 of 37 (5.4%) patients in Group 1 vs 7 of 10 patients (70%) in Group 2, p=0.001). American Society of Anesthesiologists physical classification score was significantly higher in Group 2 than Group 1 (3.5 ± 0.6 in Group 1 vs 4.1 ± 0.3 in Group 2, p=0.016). The most common early postoperative neurological complication was lack of recovery of consciousness (no postoperative consciousness).
Conclusion
The occurrence of any postoperative neurological adverse event has an additive effect to the in-hospital mortality rate of TEVAR and EVAR procedures.

Keywords

EVAR, TEVAR, neurological deficit, in-hospital mortality

Project Number

yok

References

• Upchurch GR, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, et al. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021;73:55S-83S.
• Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63:636–46.
• Hu FY, Fang ZB, Leshnower BG, Duwayri Y, Jordan WD, Gillespie TW, et al. Contemporary evaluation of mortality and stroke risk after thoracic endovascular aortic repair. J Vasc Surg. 2017;66:718-727.e5.
• Chung J, Corriere MA, Veeraswamy RK, Kasirajan K, Milner R, Dodson TF, et al. Risk factors for late mortality after endovascular repair of the thoracic aorta. J Vasc Surg. 2010;52:549–55.
• Scali ST, Chang CK, Feezor RJ, Hess PJ, Beaver TM, Martin TD, et al. Preoperative prediction of mortality within 1 year after elective thoracic endovascular aortic aneurysm repair. J Vasc Surg. 2012;56:1266–73.
• Goodney PP, Travis L, Lucas FL, Fillinger MF, Goodman DC, Cronenwett JL, et al. Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation. 2011;124:2661–9.
• Fairman RM, Criado F, Farber M, Kwolek C, Mehta M, White R, et al. Pivotal results of the Medtronic Vascular Talent Thoracic Stent Graft System: the VALOR trial. J Vasc Surg. 2008;48:546–54.
• Malas MB, Freischlag JA. Interpretation of the results of OVER in the context of EVAR trial, DREAM, and the EUROSTAR registry. Semin Vasc Surg. 2010;23:165–9.
• Quinney BE, Parmar GM, Nagre SB, Patterson M, Passman MA, Taylor S, et al. Long-term single institution comparison of endovascular aneurysm repair and open aortic aneurysm repair. J Vasc Surg. 2011;54:1592–7; discussion 1597-8.
• Messé SR, Bavaria JE, Mullen M, Cheung AT, Davis R, Augoustides JG, et al. Neurologic Outcomes from High Risk Descending Thoracic and Thoracoabdominal Aortic Operations in the Era of Endovascular Repair. Neurocrit Care. 2008;9:344–51.
• Buth J, Harris PL, Hobo R, van Eps R, Cuypers P, Duijm L, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) Registry. J Vasc Surg. 2007;46:1103-1111.e2.
• Morales JP, Taylor PR, Bell RE, Chan YC, Sabharwal T, Carrell TWG, et al. Neurological Complications Following Endoluminal Repair of Thoracic Aortic Disease. Cardiovasc Intervent Radiol. 2007;30:833–9.
• Gravereaux EC, Faries PL, Burks JA, Latessa V, Spielvogel D, Hollier LH, et al. Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms. J Vasc Surg. 2001;34:997–1003.
• Drinkwater SL, Goebells A, Haydar A, Bourke P, Brown L, Hamady M, et al. The Incidence of Spinal Cord Ischaemia Following Thoracic and Thoracoabdominal Aortic Endovascular Intervention. Eur J Vasc Endovasc Surg. 2010;40:729–35.
• Chiesa R, Melissano G, Marrocco-Trischitta MM, Civilini E, Setacci F. Spinal cord ischemia after elective stent-graft repair of the thoracic aorta. J Vasc Surg. 2005;42:11–7.
• Matsumura JS, Rizvi AZ. Left subclavian artery revascularization: Society for Vascular Surgery® Practice Guidelines. J Vasc Surg. 2010;52:65S-70S. Feezor RJ, Martin TD, Hess PJ, Daniels MJ, Beaver TM, Klodell CT, et al. Extent of Aortic Coverage and Incidence of Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair. Ann Thorac Surg. 2008;86:1809–14.
• Kawaharada N, Morishita K, Kurimoto Y, Hyodoh H, Ito T, Harada R, et al. Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆. Eur J Cardio-Thoracic Surg. 2007;31:998–1003.
• Brewster DC, Franklin DP, Cambria RP, Darling RC, Moncure AC, Lamuraglia GM, et al. Intestinal ischemia complicating abdominal aortic surgery. Surgery. 1991;109:447–54.
• Järvinen O, Laurikka J, Salenius J-P, Lepäntalo M. Mesenteric Infarction after Aortoiliac Surgery on the Basis of 1752 Operations from the National Vascular Registry. World J Surg. 1999;23:243–7.
• Becquemin J-P, Kelley L, Zubilewicz T, Desgranges P, Lapeyre M, Kobeiter H. Outcomes of secondary interventions after abdominal aortic aneurysm endovascular repair. J Vasc Surg. 2004;39:298–305.
• Carroccio A, Faries PL, Morrissey NJ, Teodorescu V, Burks JA, Gravereaux EC, et al. Predicting iliac limb occlusions after bifurcated aortic stent grafting: anatomic and device-related causes. J Vasc Surg. 2002;36:679–84.
• Maldonado TS, Rockman CB, Riles E, Douglas D, Adelman MA, Jacobowitz GR, et al. Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2004;40:703–10.
• Xue L, Luo S, Ding H, Zhu Y, Liu Y, Huang W, et al. Risk of spinal cord ischemia after thoracic endovascular aortic repair. J Thorac Dis. 2018;10:6088–96.
• Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011;55:111–5.