Outcomes of thoracoabdominal aortic aneurysm repair in patients with and without peripheral arterial disease.

Abstract

Objective: Certain comorbid atherosclerotic diseases have known associations with worse outcomes in thoracoabdominal aortic aneurysm (TAAA) repair; however, the association is less clear with peripheral arterial disease (PAD). This study investigates the relationship between PAD and TAAA repair outcomes.

Methods: This retrospective, single-practice study analyzed data from 3772 patients who, from 1990-2023, underwent TAAA repair: 891 (23.6%) patients with PAD and 2881 (76.4%) patients without PAD. Outcomes included adverse event, which comprised operative death (before final hospital discharge or ≤30 days postoperatively) and key events persisting at discharge: stroke, spinal cord deficit (paraplegia or paraparesis), or renal failure necessitating dialysis.

Results: Patients with PAD were older than patients without PAD (69 y [64-75] vs 66 y [56-73], P<.001). Patients with PAD had a lower rate of aortic dissection (21.1% vs 41.2%, P<.001). Patients with PAD more often underwent extent IV repair (30.4% vs 16.8%, P<.001), whereas patients without PAD more often had extent I repair (29.4% vs 16.9%, P<.001). Operative mortality did not differ between patients with and without PAD (9.2% vs 8.4%, P=.5). However, PAD patients had more spinal cord deficits (12.3% vs 9.1%, P=.004) and persistent stroke (3.6% vs 2.0%, P=.009); these differences were pronounced in extent II repair (18.6% vs 12.8% [P=.02] and 6.7% vs 3.0% [P=.005], respectively).

Conclusions: Our data suggest that PAD is associated with higher rates of spinal cord deficit and persistent stroke after TAAA repair. This difference may necessitate the development of protective techniques for patients with PAD who undergo TAAA repair.