Aorto-Uniliac Vs Bifurcated Endovascular Aortic Repair: Technical Success, Secondary Intervention Rate and Quality-adjusted cost analysis.

Our endeavour was to contrast clinical and technical outcome of BIF vs AUI in high risk EVAR patients.
From 2002 to 2007, 82 high-risk patients underwent elective EVAR (BIF, n=52 [63.4%]; AUI, n=30[36.6%]). Mean Age 74yrs (BIF vs AUI, p=0.835), Male% (BIF vs AUI, 86.5%vs76.7%, p=0.260) and Mean Aneurysm Diameter (BIF vs AUI: 5.4cmvs5.3cm, p=0.514).
The predicted probability of receiving AUI was tabulated for all patients by using multiple logistic regressions to control for SVS co-morbidity and anatomical severity scores. We used propensity scoring to adjust for baseline characteristics and selection bias by matching co-variables, creating a pseudo-randomized control design. Primary endpoints were 30-day mortality, 4-year survival and 4-year intervention free survival.
Mean Proximal Endograft diameter was significantly lower with BIF (29.3 vs 30.9, p=0.031). Mean number of devices used was similar (3.0vs3.4, p=0.165)
BIF and AUI had similar 30-day mortality (1.9%vs0%, p=0.453), 4-year all-cause survival (72.1%vs74.0%, p=0.882, h=0.92 [95%CI=0.30-2.78]) and 4-yr Aneurysm-related Survival (98.1%vs100%, p=0.448). There was no graft migration or structural failure. There was no intervention required for Type II (23.1%vs36.7%, p=0.191). 4-yr Limb thrombosis Rate (7.6% vs 10%, p=0.723) and 4-yr Intervention-free survival (BIF 89.8% vs AUI 85.9%, p=0.612, h=0.71 [95%CI=0.18-2.76]) were similar. 4 year Fem-Fem cross over patency rate is 92.6% [95%CI=75.6%-98.6%].
There were no significant differences in procedure time, mean blood units and change in estimated glomerular filtration rate between groups (p>0.05). Length of Stay/HDU (4.2 vs. 7.4 p=0.021/ 0.87 vs. 1.2days, p=0.656) were similarly low, with the majority of patients discharged directly home (BIF vs AUI: 92%vs80%, p=0.103)
By using propensity scoring for the primary endpoints, the proportions of AUI patients were equal to BIF for all levels of probability and were unchanged as the probability of AUI increased.
We established at 4 years that clinical and technical outcomes were not compromised with AUI compared to BIF in this high-risk cohort.