Skip to main content

Advertisement

SpringerLink
Log in

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

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Obi AT, Park YJ, Bove P, Cuff R, Kazmers A, Gurm HS, et al. The association of perioperative transfusion with 30-day morbidity and mortality in patients undergoing major vascular surgery. J Vasc Surg. 2015;61(4):1000–9.

    Article  PubMed  Google Scholar 

  2. Venkataraman R. Vascular surgery critical care: perioperative cardiac optimization to improve survival. Crit Care Med. 2006;34(9):S200–7.

    Article  PubMed  Google Scholar 

  3. Wu W-C, Smith TS, Henderson WG, Eaton CB, Poses RM, Uttley G, et al. Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery. Ann Surg. 2010;252(1):11–7.

    Article  PubMed  Google Scholar 

  4. Bursi F, Barbieri A, Politi L, Di Girolamo A, Malagoli A, Grimaldi T, et al. Perioperative red blood cell transfusion and outcome in stable patients after elective major vascular surgery. Eur J Vasc Endovasc Surg. 2009;37(3):311–8.

    Article  CAS  PubMed  Google Scholar 

  5. Bernard AC, Davenport DL, Chang PK, Vaughan TB, Zwischenberger JB. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg. 2009;208(5):931–7.

    Article  PubMed  Google Scholar 

  6. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation. 2011;123(23):2736–47.

    Article  PubMed  Google Scholar 

  7. Behrendt C-A, Debus ES, Schwaneberg T, Rieß HC, Dankhoff M, Makaloski V, et al. Predictors of bleeding or anemia requiring transfusion in complex endovascular aortic repair and its impact on outcomes in health insurance claims. J Vasc Surg. 2020;71(2):382–9.

    Article  PubMed  Google Scholar 

  8. Banga PV, Oderich GS, Reis de Souza L, Hofer J, Cazares Gonzalez ML, Pulido JN, et al. Neuromonitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits to minimize risk of spinal cord injury during complex endovascular aortic repair. J Endovasc Ther. 2016;23(1):139–49.

    Article  PubMed  Google Scholar 

  9. Dijkstra ML, Vainas T, Zeebregts CJ, Hooft L, van der Laan MJ. Spinal cord ischaemia in endovascular thoracic and thoraco-abdominal aortic repair: review of preventive strategies. Eur J Vasc Endovasc Surg. 2018.

  10. Scali ST, Kim M, Kubilis P, Feezor RJ, Giles KA, Miller B, et al. Implementation of a bundled protocol significantly reduces risk of spinal cord ischemia after branched or fenestrated endovascular aortic repair. J Vasc Surg. 2018;67(2):409–23.

    Article  PubMed  Google Scholar 

  11. Carson JL, Stanworth SJ, Alexander JH, Roubinian N, Fergusson DA, Triulzi DJ, et al. Clinical trials evaluating red blood cell transfusion thresholds: an updated systematic review and with additional focus on patients with cardiovascular disease. Am Heart J. 2018;200:96–101.

    Article  PubMed  Google Scholar 

  12. Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion. 1985;25(6):573–7.

    Article  CAS  PubMed  Google Scholar 

  13. Oderich GS, Fatima J, Gloviczki P. Stent graft modification with mini-cuff reinforced fenestrations for urgent repair of thoracoabdominal aortic aneurysms. J Vasc Surg. 2011;54(5):1522–6.

    Article  PubMed  Google Scholar 

  14. Oderich GS, Ribeiro M, Reis de Souza L, Hofer J, Wigham J, Cha S. Endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched endografts. J Thorac Cardiovasc Surg. 2017;153(2):S32–41.

    Article  PubMed  Google Scholar 

  15. Fillinger MF, Greenberg RK, McKinsey JF, Chaikof EL. Society for vascular surgery ad hoc committee on TRS. Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg. 2010;52(4):1022–33.

    Article  PubMed  Google Scholar 

  16. Chaikof EL, Blankensteijn JD, Harris PL, White GH, Zarins CK, Bernhard VM, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2002;35(5):1048–60.

    Article  PubMed  Google Scholar 

  17. Rana MA, Oderich GS, Pochettino A. Techniques and results of aortic arch hybrid repair. Endovascular aortic repair. Berlin: Springer; 2017. p. 555–66.

    Book  Google Scholar 

  18. Timaran DE, Soto M, Knowles M, Modrall JG, Rectenwald JE, Timaran CH. Safety and effectiveness of total percutaneous access for fenestrated endovascular aortic aneurysm repair. J Vasc Surg. 2016;64(4):896–901.

    Article  PubMed  Google Scholar 

  19. Siracuse JJ, Farber A, Kalish JA, Jones DW, Rybin D, Doros G, et al. Comparison of access type on perioperative outcomes after endovascular aortic aneurysm repair. J Vasc Surg. 2018.

  20. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM, EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366–74.

    Article  PubMed  Google Scholar 

  21. Brown LC, Powell JT, Thompson SG, Epstein DM, Sculpher MJ, Greenhalgh RM. The UK EndoVascular Aneurysm Repair (EVAR) trials: randomised trials of EVAR versus standard therapy. Health technology assessment (Winchester, England). 2012;16(9):1–218.

  22. Chong T, Nguyen L, Owens CD, Conte MS, Belkin M. Suprarenal aortic cross-clamp position: a reappraisal of its effects on outcomes for open abdominal aortic aneurysm repair. J Vasc Surg. 2009;49(4):873–80.

    Article  PubMed  Google Scholar 

  23. Bertoglio L, Mascia D, Cambiaghi T, Kahlberg A, Tshomba Y, Gomez JC, et al. Management of visceral aortic patch aneurysms after thoracoabdominal repair with open, hybrid, or endovascular approach. J Vasc Surg. 2018;67(5):1360–71.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and 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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuel R. Tenorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aleem K. Mirza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jussi M. Kärkkäinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernardo C. Mendes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Randall R. DeMartino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephen Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gustavo S. Oderich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gustavo S. Oderich.

Ethics declarations

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.

Consent for Publication

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.

Informed Consent

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Search

Navigation