PMID- 19059754 OWN - NLM STAT- MEDLINE DCOM- 20090514 LR - 20220419 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 23 IP - 2 DP - 2009 Mar TI - Therapy of renal artery aneurysms in New York State: outcomes of patients undergoing open and endovascular repair. PG - 194-200 LID - 10.1016/j.avsg.2008.10.002 [doi] AB - The purpose of this study was to evaluate changing trends in therapy and determinants of outcomes among patients with a renal artery aneurysm (RAA) undergoing surgical or endovascular repair in New York State (NYS). A retrospective cohort study of patients who underwent therapy for RAA in NYS from October 1, 2000, to December 31, 2006, was identified from the Statewide Planning and Research Cooperative System database. Regression models which included hospital and patient characteristics were created to identify predictors of untoward events following surgical or endovascular intervention. Over this time period 215 patients with RAA repairs were analyzed. In multivariate analysis, preoperative predictors of death included diabetes (adjusted odds ratio [OR]=57.8, 95% confidence interval [CI] 2.3-1,430.1, p=0.013), the presence of other aneurysms (adjusted OR=18.5, CI 1.5-234.4, p=0.024), and coagulopathy (adjusted OR=16.9, CI 3.4-393.1, p=0.03) but not repair type. Perioperative cardiac (adjusted OR=16.7, CI 1.4-197.1, p=0.026) and vascular device-related (adjusted OR=11.1, CI 1.003-123.0, p=0.049) complications were predictive of mortality. When patients with other aneurysms were excluded from analysis (n=153), there were no significant predictors of death. Ninety-one endovascular and 124 open surgical repairs were performed with a significant increase in the proportion of endovascular repairs performed over time (p<0.001), although since 2003 the proportion of both has been roughly equal. Diabetes (15.4% vs. 5.6%, p=0.018), chronic anemia (5.5% vs. 0.8%, p=0.04), and emergent admission (48.4% vs. 24.2%, p<0.001) were more prevalent among those with endovascular repair. Endovascular therapy was associated with a lower incidence of complications, lower median length of stay (4 vs. 7 days, p<0.001), and lower rates of discharge to skilled nursing facilities (18.9% vs. 39.2%, p=0.001). There has been an increasing number of treated RAAs in NYS since 2000, with the increase being primarily in those treated by endovascular techniques. Whether this represents a true increase in RAA incidence requiring management or an extension of indications is unknown. Outcomes after endovascular repair were better than those after conventional surgery, although whether this was due to the technique of repair itself or preprocedural selection bias cannot be determined. FAU - Hislop, Sean J AU - Hislop SJ AD - Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA. FAU - Patel, Siddharth A AU - Patel SA FAU - Abt, Peter L AU - Abt PL FAU - Singh, Michael J AU - Singh MJ FAU - Illig, Karl A AU - Illig KA LA - eng PT - Journal Article DEP - 20081206 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 SB - IM MH - Aged MH - Aneurysm/*surgery MH - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation/mortality MH - Databases as Topic MH - Female MH - Hospital Mortality MH - Humans MH - Male MH - Middle Aged MH - New York/epidemiology MH - Odds Ratio MH - Renal Artery/*surgery MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - *Vascular Surgical Procedures/adverse effects/instrumentation/mortality EDAT- 2008/12/09 09:00 MHDA- 2009/05/15 09:00 CRDT- 2008/12/09 09:00 PHST- 2008/07/09 00:00 [received] PHST- 2008/10/13 00:00 [revised] PHST- 2008/10/16 00:00 [accepted] PHST- 2008/12/09 09:00 [pubmed] PHST- 2009/05/15 09:00 [medline] PHST- 2008/12/09 09:00 [entrez] AID - S0890-5096(08)00371-3 [pii] AID - 10.1016/j.avsg.2008.10.002 [doi] PST - ppublish SO - Ann Vasc Surg. 2009 Mar;23(2):194-200. doi: 10.1016/j.avsg.2008.10.002. Epub 2008 Dec 6.