The Protective Effects of Diabetes Mellitus on Post-EVAR AAA Growth and Reinterventions

Chien Yi M Png; Rami O Tadros; Ming Kang; William E Beckerman; Melissa L Tardiff; Ageliki G Vouyouka; Michael L Marin; Peter L Faries

doi:10.1016/j.avsg.2016.10.059

The Protective Effects of Diabetes Mellitus on Post-EVAR AAA Growth and Reinterventions

Ann Vasc Surg. 2017 Aug:43:65-72. doi: 10.1016/j.avsg.2016.10.059. Epub 2017 Mar 14.

Authors

Chien Yi M Png¹, Rami O Tadros², Ming Kang¹, William E Beckerman¹, Melissa L Tardiff¹, Ageliki G Vouyouka¹, Michael L Marin¹, Peter L Faries¹

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
² Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: [email protected].

PMID: 28302476
DOI: 10.1016/j.avsg.2016.10.059

Abstract

Background: This study aims to investigate the effect of diabetes on post-endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs).

Methods: A total of 1,479 consecutive patients who underwent AAA EVAR were reviewed. The cohorts were divided based on their diabetes status and compared. Preoperative demographic and comorbidity data were analyzed using the t-test and chi-squared test, whereas post-EVAR outcomes were analyzed using Probit multivariate model, followed by Kaplan-Meier survival curve and Cox regression.

Results: Of our 1,479 patients, 993 met inclusion criteria. One hundred eighty-three were diabetics (18.4%) compared with 810 nondiabetics (81.6%). Coronary artery disease (CAD; diabetics: 70.49%, nondiabetics: 60.76%, P = 0.014) and hypertension (HTN; diabetics: 90.16%, nondiabetics: 79.46%, P = 0.0008) were the only comorbidities analyzed, including follow-up length, which had any significant differences between the diabetic and nondiabetic groups. Probit multivariate analysis using a combined cohort follow-up mean of 51 months showed a significant decrease in aneurysm sac enlargement in diabetic patients (diabetics: 13.11%, nondiabetics: 19.43%, model estimate: 0.3058; 95% confidence interval [CI]: 0.0486-0.5629, Pr > ChiSq = 0.0198) and trended toward significantly fewer reinterventions (diabetics: 23.50%, nondiabetics: 28.41%, model estimate: 0.1990; 95% CI: -0.0262 to 0.4243, Pr > ChiSq = 0.0833). In the Cox regressions, diabetes had a significant protective factor on reinterventions (hazard ratio [HR]: 0.697, Pr > ChiSq = 0.0151), and was trending toward significance for aneurysm sac enlargement (HR: 0.750, Pr > ChiSq = 0.1961). There was no significant difference across diabetic status in any other outcomes, including mortality and endoleak occurrence.

Conclusions: Although a higher proportion of diabetic patients present with HTN and CAD, they have decreased long-term rates of aneurysm sac enlargement after EVAR. As a result, this cohort trends toward a lower need for reintervention after EVAR.

MeSH terms

Aged
Aortic Aneurysm, Abdominal / diagnostic imaging
Aortic Aneurysm, Abdominal / mortality
Aortic Aneurysm, Abdominal / surgery*
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / mortality
Chi-Square Distribution
Comorbidity
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / mortality
Endovascular Procedures* / adverse effects
Endovascular Procedures* / mortality
Female
Humans
Kaplan-Meier Estimate
Male
Multivariate Analysis
Postoperative Complications / etiology
Postoperative Complications / mortality
Postoperative Complications / prevention & control*
Proportional Hazards Models
Protective Factors
Retreatment
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome