Morbidity following complex EVAR

Abstract

Objectives: patterns of morbidity are poorly characterized for patients undergoing complex EVAR. Evidence for complex endografts is based on case series and morbidity is often poorly reported. Multi organ dysfunction is described but the pathological events triggering this are uncertain. We hypothesised that early postoperative cardiac morbidity occurs as part of multi-organ dysfunction rather than as an isolated ischaemic event.

Methods: a prospective analysis of 41 patients undergoing complex EVAR was undertaken. Primary endpoint was development of cardiac morbidity, on postoperative day 3.

Results: 8 patients underwent thoracoabdominal, 29 juxtarenal fenestrated and 4 iliac branched graft AAA repair. There were 5 deaths, 3 of which were in emergency cases. The most common postoperative morbidities on day 5 were renal (50% of inpatients), respiratory (44%), gastrointestinal (25%) and cardiac (19%). Occurrence of cardiac morbidity on day 3 was associated with increased total morbidity on days 3, 5, 8 and 15 (P=.04).

Conclusions: complex EVAR patients suffer non-cardiac morbidity in line with major non-vascular surgery. Early postoperative cardiac morbidity is associated with multi-organ dysfunction in this population indicating a more global pathology. This highlights the need for further study into the aetiology of cardiac injury in this group.

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