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PVSS18. Therapy Of Renal Artery Aneurysms In New York State: Identifying Patients Undergoing Endovascular Or Open Repair At Risk Of Death Or In Need Of Future Supportive Care

Sean J. Hislop, Peter L. Abt, Siddharth A Patel, Karl A Illig.
University of Rochester, Rochester, N.Y.  

OBJECTIVES: The purpose of this study was to evaluate determinants of outcomes among patients with a renal artery aneurysm (RAA) undergoing surgical or endovascular repair in New York State (NYS).

METHODS: A retrospective cohort study of patients who underwent therapy for RAA in NYS from 2000-2006 was identified from the Statewide Planning and Research Cooperative System (SPARCS) database. International Classification of Diseases - 9th revision (ICD-9) coding was used to identify renal artery aneurysm (442.1) repair as surgical (38.46, 39.52, 39.24, 55.51, 38.36, 38.66, 55.61, and 39.55) or endovascular (39.79). Regression models which included hospital and patient characteristics were created to identify predictors of untoward events.

RESULTS: There were 91 endovascular and 131 surgical repairs of RAAs between 2000 and 2006 in the State of New York. During this time, there was a significant increase in the proportion of repairs performed endovascularly (p< 0.001), with the total number of surgical repairs remaining stable and the number of endovascular repairs increasing. Patients undergoing endovascular repair were more likely to be diabetic (15.4% vs. 6.9%, p=0.041), chronically anemic (5.5% vs. 0.8%, p=0.033) and emergently admitted (48.4% vs. 28.2%, p=0.002).). Endovascularly treated patients also had a lower median length of stay (4 vs. 7 days, p=0.008), in-hospital mortality (1.1% vs. 7.6%, p=0.028) and were more likely to return home without the need for nursing services (80.2% vs. 55.7%, p=0.001). In multivariate analysis, predictors of death included concomitant aneurysmal disease (odds ratio (OR)=40.7, p=0.003), emergent admission status (OR=30.5, p=0.006), chronic pulmonary disease (OR=10.1, P=0.016) and coagulopathy (OR=9.2, p=0.032). Repair of additional aneurysms was not associated with mortality (p=0.40). Predictors of need for further nursing care after discharge included open repair (OR 3.0, p=0.001), concomitant aneurysmal disease (OR=2.0, p=0.043) and age (OR=1.03, p=0.014).

CONCLUSIONS: These data suggest that endovascular management has resulted in an increase in renal artery aneurysms treated. Whether this is a true increase in RAAs requiring management or an extension of indications caused by the availability endovascular repair is unknown. In-hospital mortality of endovascular repair is significantly lower and endovascular patients are more likely to be discharged sooner and to return home without the need for further services despite a higher percentage of emergent admissions. Predictors of further care requirements after discharge include receiving an open repair, concomitant aneurysmal disease and age. Predictors of in-hospital mortality are concomitant aneurysmal disease, chronic pulmonary disease, coagulopathy and emergent admission status.