Peripheral Artery Disease Diagnosis is an Independent Predictor Factor for Reduced Long-Term Survival after Fenestrated/Branched Endovascular Aortic Repair.

BACKGROUND: This study aimed to investigate the outcomes of fenestrated/branched endovascular aortic repair (F/BEVAR) patients comparing individuals with and without a prior diagnosis of peripheral artery disease (PAD).

METHODS: A single-center retrospective analysis was performed, including patients with the diagnosis of complex aortic aneurysms treated with an F/BEVAR procedure. The diagnosis of PAD was determined by an ankle-brachial index <0.9 or a toe-brachial index <0.7 in nondiabetic and diabetic patients, respectively. The ischemia grade of the WIFi classification was applied to categorize patients with PAD into "mild PAD" (grades 0 and 1) and "severe PAD" (grades 2 and 3), and both groups were compared with the non-PAD cases. The primary outcomes were 30-day and 5-year survival. The secondary outcomes included 30-day major adverse events (ischemic colitis, acute kidney injury [AKI], spinal cord ischemia [SCI]), long-term major complications such as myocardial infarction [MI], stroke, and kidney function deterioration, and aneurysm-related adverse events.

RESULTS: Four hundred one patients (72.3% males; mean age, 71.7 ± 8.9 years) who underwent an F/BEVAR procedure between July 2012 and October 2023 were included in the study, 95 of whom (24%) presented a prior diagnosis of PAD (73 mild; 22 severe). In terms of demographics, aneurysm extent, aneurysm maximal diameter, and comorbidities, no significant difference was observed across the 3 groups, except for the history of tobacco use (P = 0.033) and prior diagnosis of diabetes (P = 0.036), which were significantly higher among the patients with severe PAD. The 30-day survival (P = 0.483) and 30-day major adverse events such as MI (P = 0.237), stroke (P = 0.222), AKI (P = 0. 566), and SCI(P = 0.183) were not significantly different across the groups. Ischemic colitis seemed to be more frequent among mild patients with PAD (P = 0.036), but the etiology might be multifactorial. Time-to-event analysis demonstrated that patients with severe PAD have a lower long-term survival when compared to the ones without this diagnosis (Log-rank P = 0.035). Cox regression analysis demonstrated that a prior diagnosis of severe PAD is associated with a significant increase in the probability of death at 5 years post-F/BEVAR (HR:2.15, P = 0.04). As for the aneurysm-related adverse events, there was no significant difference in terms of types I, II, and III endoleaks, access complications, target vessel occlusions, and freedom from secondary interventions across the groups.

CONCLUSION: Significantly lower 5-year survival is observed in the F/BEVAR cases with a preoperative diagnosis of PAD and severe ischemic component. In addition, patients with PAD might present higher incidence of ischemic colitis post-F/BEVAR, but the origin of this adverse event might be multifactorial.