A population-based analysis of endovascular aortic stent graft therapy in patients with liver cirrhosis.

Abstract

BACKGROUND:

Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatments for high-risk surgical candidates. However, information about the management of EVAR and TEVAR in liver cirrhosis (LC) is lacking. The aim of our study was to evaluate outcomes after EVAR and TEVAR in patients with LC.

METHODS:

Using Taiwan's National Health Insurance Research Database, we retrospectively evaluated patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013.

RESULTS:

A total of 146 patients with LC and 730 matched patients without LC were eligible for analysis after propensity score matching. In-hospital mortality and perioperative complications were not statistically significantly different between the two cohorts, although the LC group had an increased volume of blood transfusion and a trend toward a lower survival rate (P of stratified Cox = .092). However, patients with LC had a higher adjusted hazard ratio for death (1.66; 95% confidence interval, 1.31-2.12; P < .001) in the sensitivity analysis by traditional multivariable adjustment. The LC cohort had a higher risk of liver-related death (4.1% vs 0.7%; P = .001) and liver-related readmission (6.2% vs 0.3%; P < .001). As expected, the advanced LC group had a higher mortality rate than the early LC group (P = .022). The risk for reintervention, redo open aortic surgery (P = .859), and redo stent graft therapy (P = .179) was not statistically significantly different between the two cohorts.

CONCLUSIONS:

Short-term results after EVAR and TEVAR are promising in patients with LC, despite poor long-term outcomes, because of the nature of LC. Innovations in endovascular therapy for aortic disease have improved surgical outcomes, even in high-risk patients with LC.

• Authors: An-Hsun Chou, Ching-Chang Chen, Yu-Sheng Lin, Ming-Shyan Lin, Victor Chien-Chia Wu, Pei-Chi Ting, Shao-Wei Chen
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 69 Issue 5 Pg. 1395-1404.e4 (05 2019) ISSN: 1097-6809 [Electronic] United States
• PMID: 30528408 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Aorta, Thoracic (drug effects, surgery)
• Aortic Diseases (diagnostic imaging, epidemiology, mortality, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation, mortality)
• Databases, Factual
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Female
• Hospital Mortality
• Humans
• Liver Cirrhosis (diagnosis, epidemiology, mortality)
• Male
• Middle Aged
• Patient Readmission
• Postoperative Complications (mortality, therapy)
• Retrospective Studies
• Risk Factors
• Stents
• Taiwan (epidemiology)
• Time Factors
• Treatment Outcome