Effect of Blood Loss and Transfusion Requirements on Clinical Outcomes of Fenestrated-Branched Endovascular Aortic Repai
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CLINICAL INVESTIGATION
ARTERIAL INTERVENTIONS
Effect of Blood Loss and Transfusion Requirements on Clinical Outcomes of Fenestrated-Branched Endovascular Aortic Repair Indrani Sen1 • Emanuel R. Tenorio2 • Aleem K. Mirza1 • Jussi M. Ka¨rkka¨inen1 • Bernardo C. Mendes1 • Randall R. DeMartino1 • Stephen Cha1 • Gustavo S. Oderich2,3
Received: 7 February 2020 / Accepted: 22 June 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Objective The aim of this study was to evaluate the effect of blood loss and transfusion requirements on clinical outcomes of patients treated by fenestrated-branched endovascular aortic repair (F-BEVAR) for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAAs). Methods We reviewed the clinical data of 370 consecutive patients (277 male, mean age 74 ± 10 years) treated by F-BEVAR between 2007 and 2017. Outcomes were estimated blood loss (EBL), use of intraoperative blood salvage (IOBS), transfusion of packed red blood cells (PRBCs), mortality, and major adverse events (MAEs). Results There were 189 patients (51%) treated for PRAs and 181 patients (49%) treated for TAAAs. IOBS was used in 194 patients (52%) and transfusion of PRBCs was needed in 137 (37%). Thirty-day mortality was 2.2% (8/370) and MAEs occurred in 123 patients (33%), including 74 patients (20%) who had EBL [ 1L. EBL [ 1L and
transfusion of PRBCs were significantly higher (P \ 0.05) in patients treated in the first half of clinical experience and in those with larger aneurysms, iliofemoral conduits, bilateral open surgical femoral access and Extent I–III TAAAs. Use of DrySeal sheaths (WL Gore, Flagstaff AZ) was associated with significantly lower (P \ .05) EBL volume and with less transfusion of PRBCs. On multivariate analysis PRBCs [ 1L, male gender and the last half of clinical experience were associated with MAEs/mortality. Conclusions F-BEVAR was associated with significantly higher volume of blood loss and transfusion requirements in patients treated in the early experience and in those who had iliofemoral conduits, open femoral surgical exposure or Extent I–III TAAAs. Keywords Blood loss Transfusion requirements Fenestrated-branched endovascular aortic repair Thoracoabdominal aortic aneurysm
Presented at Society for Clinical Vascular Surgery Annual Meeting, Las Vegas, NV, March 21st, 2018.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02573-8) contains supplementary material, which is available to authorized users. & Gustavo S. Oderich [email protected] 1
Advanced Endovascular Aortic Research Program, Mayo Clinic, Rochester, MN, USA
2
Advanced Aortic Research Program, University of Texas Health Science at Houston, McGoven Medical School, Houston, TX, USA
3
Memorial Hermann Medical Plaza, University of Texas Health Science, Houston, TX, USA
Introduction Blood loss and transfusion requirements have been associated with m
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