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Effect of Blood Loss and Transfusion Requirements on Clinical Outcomes of Fenestrated-Branched Endovascular Aortic Repair

CardioVascular and Interventional Radiology volume 43, pages 1600–1607 (2020)Cite this article

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.

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Funding

This study was not supported by any funding.

Author information

Affiliations

  1. Advanced Endovascular Aortic Research Program, Mayo Clinic, Rochester, MN, USA

    Indrani Sen, Aleem K. Mirza, Jussi M. Kärkkäinen, Bernardo C. Mendes, Randall R. DeMartino & Stephen Cha

  2. Advanced Aortic Research Program, University of Texas Health Science at Houston, McGoven Medical School, Houston, TX, USA

    Emanuel R. Tenorio & Gustavo S. Oderich

  3. Memorial Hermann Medical Plaza, University of Texas Health Science, Houston, TX, USA

    Gustavo S. Oderich

Authors
  1. Indrani Sen
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  2. Emanuel R. Tenorio
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  3. Aleem K. Mirza
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  4. Jussi M. Kärkkäinen
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  5. Bernardo C. Mendes
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  6. Randall R. DeMartino
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  7. Stephen Cha
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  8. Gustavo S. Oderich
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Corresponding author

Correspondence to Gustavo S. Oderich.

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Conflict of interest

GSO has received consulting fees and grants from Cook Medical, W. L. Gore, and GE Healthcare (all paid to Mayo Clinic with no personal income); Other co-authors: no conflict of interest.

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Consent for publication was obtained for every individual person’s data included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sen, I., Tenorio, E.R., Mirza, A.K. et al. Effect of Blood Loss and Transfusion Requirements on Clinical Outcomes of Fenestrated-Branched Endovascular Aortic Repair. Cardiovasc Intervent Radiol 43, 1600–1607 (2020). https://doi.org/10.1007/s00270-020-02573-8

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  • DOI: https://doi.org/10.1007/s00270-020-02573-8

Keywords

  • Blood loss
  • Transfusion requirements
  • Fenestrated-branched endovascular aortic repair
  • Thoracoabdominal aortic aneurysm