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Duong W, Grigorian A, Yuen S, Nahmias J, Kabutey NK, Farzaneh C, Donayre C, Fujitani RM. Increased Mortality in Octogenarians Undergoing Endovascular Aortic Aneurysm Repair for Smaller Aneurysms Warrants Caution. Ann Vasc Surg 2024; 99:175-185. [PMID: 37827211 DOI: 10.1016/j.avsg.2023.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Geriatric patients constitute a growing portion of the general population, with particular increase in the prevalence of octogenarians. The incidence and prevalence of abdominal aortic aneurysms (AAAs) have been clearly shown to be associated with advancing age. The effect of advanced age in outcomes from endovascular aneurysm repair (EVAR) is unclear. We study the effect of advanced age, as an independent risk factor for mortality in octogenarian geriatric patients (OGPs) compared to nonoctogenarian geriatric patients (NOGPs) undergoing EVAR. METHODS The 2011-2017 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Procedure-Targeted Vascular database was queried for geriatric patients (>65 years) undergoing EVAR for symptomatic and asymptomatic indications. A multivariable logistic regression analysis was performed comparing outcomes between OGPs and NOGPs. RESULTS Of the 10,490 geriatric patients who underwent EVAR, 7,508 (71.6%) were NOGPs and 2,982 (28.4%) were OGPs. Octogenarians were more often female (82.3% vs. 76.7%). In comparison to NOGPs, fewer OGPs were treated for AAA <5.5 cm (46.7% vs. 54.9%, P < 0.001) and AAA <5.0 cm (19.2% vs. 24.0%, P < 0.001). Nearly 90% of male and over 80% of female NOGPs and OGPs treated for AAA <5.0 cm were asymptomatic. Octogenarian geriatric patients (OGPs) had less dyspnea (15.3% vs. 17.3%, P = 0.01), chronic obstructive pulmonary disease (16.1% vs. 20.5%, P < 0.001), diabetes (12.7% vs. 17.8%, P < 0.001), and smoking (13.2% vs. 36.3%, P < 0.001) compared to NOGPs. Octogenarian geriatric patients (OGPs) were found to have a greater length of stay (2 days vs. 1 day, P < 0.001), as well as rate of mortality (3.4% vs. 1.7%, P < 0.001). Both symptomatic and asymptomatic OGPs had a higher rate of mortality than their NOGP counterparts (symptomatic 16% vs. 9.5%, P < 0.001; asymptomatic 1.3% vs. 0.5%, P < 0.001). Multivariate logistic regression analysis showed OGPs to have increased overall associated risk of mortality compared to NOGPs (odds ratio (OR) 1.88, confidence interval (CI) 1.39-2.54, P < 0.001), as well as in the symptomatic (OR 1.54, CI 1.06-2.23, P < 0.001) and asymptomatic cohorts (OR 2.66, CI 1.59-4.45, P < 0.001). CONCLUSIONS Octogenarian geriatric patients (OGPs) accounted for over a quarter of geriatric patients undergoing EVAR. This elderly group was associated with an increased rate and risk of mortality compared to NOGPs, even when controlling for known risk factors for mortality. Given this increased risk of mortality in OGPs undergoing EVAR, elective treatment of AAAs in this advanced age group should be performed with caution, particularly in those with diameters in which the risk of rupture may not warrant repair.
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Affiliation(s)
- William Duong
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Areg Grigorian
- Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Sarah Yuen
- Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA.
| | - Jeffry Nahmias
- Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Nii-Kabu Kabutey
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Cyrus Farzaneh
- Division of Trauma, Department of Surgery, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA
| | - Carlos Donayre
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
| | - Roy M Fujitani
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine, Orange, CA
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Hafeez MS, Habib SG, Semaan DB, Abdul-Malak O, Liang NL, Madigan MC, Siracuse JJ, Eslami MH. Outcomes of octogenarians receiving aortic repair. J Vasc Surg 2024; 79:34-43.e3. [PMID: 37714501 DOI: 10.1016/j.jvs.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm in men and 5 cm in women. Because AAA is more common among the elderly, we sought to evaluate contemporary practices of elective AAA repair and 2-year postoperative outcomes in octogenarians. METHODS We identified octogenarians undergoing elective AAA repair in the Vascular Quality Initiative from 2012 to 2019. We included patients undergoing endovascular (EVAR) and open (OAR) aortic repair. Demographics and comorbid conditions were compared between patient groups. Frailty was calculated using previously published methods. Patients with frailty scores above the 75th percentile of the operative cohort were considered high frailty. The primary outcome was 1- and 2-year mortality. Secondary outcomes included postoperative complications. Standard statistical methods were utilized. Cox proportional hazard models were used to identify factors that affect mortality. RESULTS The frequency of AAA repair in octogenarians has remained stable. Of all aortic operations, 21.4% were performed on octogenarians; 9735 (23.3% of 41,712) EVAR and 755 (10.3% of 7325) OARs. Among octogenarian patients, 42.0% of EVARs were under size thresholds: 48.3% males ≤5.5 cm diameter and 21.5% females ≤5.0 cm diameter compared with 18.8% OARs: 23.4% males and 10.7% females. Additionally, 25.6% had high frailty scores. Among octogenarians, 1- and 2-year mortality was 9.3% ± 0.3% and 14.8% ± 0.4% for EVAR and 15.2% ± 1.3% and 18.9% ± 1.5% for OAR patients, respectively (P < .01). In-hospital mortality rate was higher after OAR (0.87% EVAR vs 7.55% OAR; P < .01) and differed with frailty (EVAR, low frailty 0.2% vs high frailty 1.7%; OAR, low frailty 2.3% vs high frailty 15.6%). For EVAR, patient factors associated with mortality included heart failure (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.06-1.25; P = .001) and dialysis (HR, 1.71; 95% CI, 1.13-2.59; P = .012). For OAR, coronary artery disease (HR, 1.55; 95% CI, 0.98-2.44; P = .062) was associated with mortality. Statin use was protective of mortality for all patients (EVAR: HR, 0.68; 95% CI, 0.60-0.78; P < .01): OAR: HR, 0.58; 95% CI, 0.37-0.92; P = .020). Among octogenarians, high frailty was independently associated with 2-year mortality (EVAR: HR, 3.36; 95% CI, 2.62-4.31; P < .01 and OAR: HR, 2.35; 95% CI, 1.09-5.10; P = .030). CONCLUSIONS Nationally, a large portion of elective AAA repair in octogenarians is performed below recommended size thresholds, one-quarter of whom are frail with poor long-term 2-year mortality rates. High 2-year mortality following AAA repair in this age group exceeds the published risk of rupture for 5- to 5.5-cm AAA, suggesting that increase in the size threshold of elective repair among octogenarians should be explored.
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Affiliation(s)
| | - Salim G Habib
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Dana B Semaan
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Nathan L Liang
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Michael C Madigan
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Mohammad H Eslami
- Division of Vascular and Endovascular Surgery, Charleston Area Medical Center, Charleston, WV.
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Gwon JG, Jeong S, Jin H, Ko GY, Cho YP, Kwon TW. Similar long-term outcomes between endovascular aneurysm repair and open surgical repair for abdominal aortic aneurysms in octogenarian patients: a single-center study. Ann Surg Treat Res 2022; 103:372-377. [PMID: 36601339 PMCID: PMC9763780 DOI: 10.4174/astr.2022.103.6.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Endovascular aneurysm repair (EVAR) has lower perioperative mortality and morbidity rates and shorter hospital stays when compared to open surgical repair (OSR) in octogenarian patients. However, its long-term results remain unclear. Hence, we aimed to analyze and compare the long-term outcomes of OSR and EVAR in this aging population. Methods This single-center, retrospective, observational study analyzed the data of patients older than 80 years who underwent primary repair of an abdominal aortic aneurysm (AAA) between 2011 and 2016 in our hospital. The primary outcomes were in-hospital complications and 30-day mortality, while the secondary outcomes included all-cause mortality and reintervention rate. Results Among the 48 patients with elective AAA repair, 13 underwent OSR and 35 underwent EVAR. In-hospital complications occurred in 10 patients (20.8%), 5 for OSR (38.5%) and 5 for EVAR (14.3%) with no significant difference between the groups (P = 0.067). In the OSR group, pulmonary complications were the most common events; in the EVAR group, 2 patients had ischemic colitis diagnosed with sigmoidoscopy and recovered by conservative treatment. The 1- and 5-year survival rates were 77.8% and 55.6% in the OSR group, and 66.0% and 54.9% in the EVAR group, respectively. The reintervention rate was 8.6% for the EVAR group; none of the OSR group were readmitted. Conclusion The difference in procedures did not affect patient survival. Therefore, OSR does not necessarily have a worse prognosis than EVAR. Individual risk stratification must be preceded before the selection of an appropriate treatment method.
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Affiliation(s)
- Jun Gyo Gwon
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seonjeong Jeong
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hana Jin
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Marcos Garcia L, Calsina Juscafresa L, Velescu A, Casajuana Urgell E, Galarza Tapia A, Llort Pont C, Clarà Velasco A. Outcome of elective endovascular repair of abdominal aortic aneurysms in octogenarians. Geriatr Gerontol Int 2021; 21:392-397. [PMID: 33754472 DOI: 10.1111/ggi.14148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
AIM The need to adjust the indications of elective abdominal aortic aneurysm (AAA) repair among patients with a limited life-span deserves a specific evaluation for octogenarians. The aim of this study was to compare the postoperative results and the long-term survival after endovascular repair of abdominal aortic and/or iliac aneurysms (EVAR) in octogenarians compared with patients under 80 years of age. METHODS Retrospective analysis of 241 consecutive patients who underwent an elective EVAR between 2000 and 2017. EVAR was not considered among patients with clear life-limiting conditions. Patients receiving other than commercially standard infra-renal endoprostheses were excluded. RESULTS Seventy patients (29.0%) were octogenarians. They had a lower rate of active smoking (10.0% vs. 30.4%, P < 0.001) and a higher prevalence of previous cerebrovascular disease (21.4% vs. 11.7%, P = 0.055) than younger patients. Thirty-day/in-hospital complication and mortality rates were not significantly higher among octogenarians when compared with younger patients (24.3% vs. 16.9% and 2.9% vs. 2.4%, respectively). Octogenarians had a lower long-term survival at 1, 3 and 5 years (92.6% vs. 93.3%, 67.7% vs. 78.0% and 39.3% vs. 60.6%, P = 0.039) in the bivariate analysis. However, an age ≥ 80 years per se was not an independent predictor of survival after adjustment for confounding factors. CONCLUSION An age above 80 years was not associated with an increased risk of postoperative complications or long-term mortality. Our results suggest that EVAR can be considered in elderly patients without a clear life-limiting condition and with a suitable aneurysm anatomy. Geriatr Gerontol Int 2021; 21: 392-397.
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Affiliation(s)
| | - Laura Calsina Juscafresa
- Vascular Surgery, Hospital del Mar, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alina Velescu
- Vascular Surgery, Hospital del Mar, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER CV, Institut Municipal de Investigacions Mèdiques, Barcelona, Spain
| | | | | | | | - Albert Clarà Velasco
- Vascular Surgery, Hospital del Mar, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER CV, Institut Municipal de Investigacions Mèdiques, Barcelona, Spain
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5
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Bellamkonda KS, Kim T, Rosenthal R, Dardik A, Nassiri N. Endovascular abdominal aortic aneurysm repair in a centenarian. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:361-364. [PMID: 32715172 PMCID: PMC7371717 DOI: 10.1016/j.jvscit.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/14/2020] [Indexed: 11/18/2022]
Abstract
As the general population ages, there will be an increasing number of vascular patients in their 90s and older. However, geriatric patients have historically been turned down for abdominal aortic aneurysm repair despite high aneurysm-related mortality in the unrepaired. Herein, we describe the perioperative considerations and the successful, uncomplicated operative course of a 100-year-old woman who underwent an elective endovascular aortic aneurysm repair for an expanding 5.3-cm abdominal aortic aneurysm. Given a suitable patient, there is acceptable risk profile of an endovascular approach, even in centenarians.
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Affiliation(s)
- Kirthi S Bellamkonda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Tanner Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | | | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
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Mwipatayi BP, Oshin OA, Faraj J, Varcoe RL, Wong J, Becquemin JP, Riambau V, Böckler D, Verhagen HJ. Analysis of Midterm Outcomes of Endovascular Aneurysm Repair in Octogenarians From the ENGAGE Registry. J Endovasc Ther 2020; 27:836-844. [PMID: 32436808 DOI: 10.1177/1526602820923827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess periprocedural results and secondary endovascular procedure outcomes over 5 years in patients aged ≥80 vs <80 years undergoing endovascular aneurysm repair (EVAR). MATERIALS AND METHODS Data from the Endurant Stent Graft Natural Selection Global post-market registry (ENGAGE) were used for the analyses. A total of 1263 consecutive patients were enrolled in the prospective, observational, single-arm registry and divided into 2 groups according to age: ≥80 years (290, 22.9%) and <80 years (973, 77.1%). Baseline patient characteristics, risk scores according to the Society for Vascular Surgery (SVS) reporting standards, American Society of Anesthesiologists (ASA) classification, quality of life assessments [EuroQol 5 (EQ5D) index], and treatment outcomes, including all-cause mortality, aneurysm-related mortality, major adverse events, secondary endovascular procedures, and endoleaks were compared between groups. RESULTS Octogenarians were classified into the highest category of the SVS risk stratification system; however, this did not result in a significant difference in the 30-day mortality [1.4% (4/290) vs 1.2% (12/973) for controls; p=0.85] or major adverse event rates [5.2% (15/290) vs 3.6% (35/973), p=0.23]. Multivariable analysis confirmed that age ≥80 years, pulmonary disease, large aneurysm diameter, and renal insufficiency were significantly associated with all-cause mortality, whereas diameter was the only parameter associated with increased aneurysm-related mortality. The differences in freedom from secondary endovascular procedures over 5 years between octogenarians and controls did not reach statistical significance (88.5% vs 83.2%, p=0.07). CONCLUSION EVAR can be performed in individuals aged ≥80 years with no statistically significant difference in midterm aneurysm-related deaths compared with younger patients. The findings in this elderly patient cohort show that EVAR can be safely performed with acceptable morbidity rates in octogenarians.
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Affiliation(s)
- Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Olufemi A Oshin
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Joseph Faraj
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital and the University of New South Wales, Sydney, Australia
| | - Jackie Wong
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Vincente Riambau
- Division of Vascular Surgery, Thorax Institute, Hospital Clinic, University of Barcelona, Spain
| | - Dittmar Böckler
- Division of Vascular Surgery, University Hospital Heidelberg, Germany
| | - Hence J Verhagen
- Division of Vascular and Endovascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Rueda-Ochoa OL, van Bakel P, Hoeks SE, Verhagen H, Deckers J, Rizopoulos D, Ikram MA, Rouwet E, Ultee K, Ten Raa S, Franco OH, Kavousi M, Josee van Rijn M. Survival After Uncomplicated EVAR in Octogenarians is Similar to the General Population of Octogenarians Without an Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2020; 59:740-747. [PMID: 32115359 DOI: 10.1016/j.ejvs.2020.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/04/2020] [Accepted: 01/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Long term survival after endovascular aortic aneurysm repair (EVAR) in octogenarians remains unclear. This was evaluated by comparing octogenarians after EVAR with a matched group of octogenarians without an abdominal aortic aneurysm (AAA) from the Rotterdam Study (RS). The influence of complications after EVAR on survival was also studied with the aim of identifying risk factors for the development of complications in octogenarians. METHODS Using propensity score matching (PSM), 83 EVAR octogenarians were matched for comorbidities with 83 octogenarians from the RS, and survival was compared between these two groups using Cox proportional hazard analysis. Then, complications were studied, defined as cardiac or pulmonary, renal deterioration, access site bleeding, acute limb ischaemia or bowel ischaemia, within 30 days of surgery between 83 EVAR octogenarians and 475 EVAR non-octogenarians. Also, the difference in baseline characteristics between the octogenarians with and without complications after EVAR were studied, and survival was compared between the RS controls and the complicated and uncomplicated EVAR octogenarians separately. RESULTS The total EVAR octogenarian population did not show an increased mortality risk compared with RS octogenarian controls (hazard ratio [HR] 1.28, 95% confidence interval [CI] 0.84-1.97). Post-operative complications occurred in 22 octogenarians (27%) and 59 non-octogenarians (12.4%, p < .001), mainly cardiac, pulmonary, and bleeding complications. All baseline characteristics were similar in the complicated EVAR octogenarians compared with the uncomplicated EVAR octogenarians. After uncomplicated EVAR, octogenarians had a similar survival compared with the RS controls (HR 1.09, 95% CI 0.68-1.77), but after complicated EVAR their mortality risk increased significantly (HR 1.93, 95% CI 1.06-3.54). CONCLUSION After standard EVAR, the life expectancy of octogenarians is the same as that of a matched group from the general population without an AAA, provided they do not develop early post-operative complications. Patient selection and meticulous peri-operative care are key.
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Affiliation(s)
- Oscar L Rueda-Ochoa
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; School of Medicine, Faculty of Health, Universidad Industrial de Santander UIS, Bucaramanga, Colombia.
| | - Pieter van Bakel
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sanne E Hoeks
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hence Verhagen
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jaap Deckers
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mohammad A Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ellen Rouwet
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Klaas Ultee
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sander Ten Raa
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Marie Josee van Rijn
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
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Henstra L, Yazar O, de Niet A, Tielliu IF, Schurink GW, Zeebregts CJ. Outcome of Fenestrated Endovascular Aneurysm Repair in Octogenarians: A Retrospective Multicentre Analysis. Eur J Vasc Endovasc Surg 2020; 59:24-30. [DOI: 10.1016/j.ejvs.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/04/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
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9
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Law Y, Chan Y, Cheng S. Predictors of early operative mortality and long-term survival in octogenarians undergoing open and endovascular repair of abdominal aortic aneurysm. Asian J Surg 2018; 41:490-497. [DOI: 10.1016/j.asjsur.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/17/2017] [Accepted: 09/07/2017] [Indexed: 11/15/2022] Open
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10
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Hye RJ, Janarious AU, Chan PH, Cafri G, Chang RW, Rehring TF, Nelken NA, Hill BB. Survival and Reintervention Risk by Patient Age and Preoperative Abdominal Aortic Aneurysm Diameter after Endovascular Aneurysm Repair. Ann Vasc Surg 2018; 54:215-225. [PMID: 30081171 DOI: 10.1016/j.avsg.2018.05.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) has become the standard of care for abdominal aortic aneurysm (AAA), but questions remain regarding the benefit in high-risk and elderly patients. The purpose of this study was to examine the effect of age, preoperative AAA diameter, and their interaction on survival and reintervention rates after EVAR. METHODS Our integrated health system's AAA endograft registry was used to identify patients who underwent elective EVAR between 2010 and 2014. Of interest was the effect of patient age at the time of surgery (≤80 vs. >80 years old), preoperative AAA diameter (≤5.5 cm vs. >5.5 cm), and their interaction. Primary endpoints were all-cause mortality and reintervention. Between-within mixed-effects Cox models with propensity score weights were fit. RESULTS Of 1,967 patients undergoing EVAR, unadjusted rates for survival at 4 years after EVAR was 76.1%, and reintervention-free rate was 86.0%. For mortality, there was insufficient evidence for an interaction between age and AAA size (P = 0.309). Patient age >80 years was associated with 2.53-fold higher mortality risk (hazard ratios [HR] = 2.53; 95% confidence intervals [CI], 1.73-3.70; P < 0.001), whereas AAA > 5.5 cm was associated with 1.75-fold higher mortality risk (HR = 1.75; 95% CI, 1.26-2.45; P = 0.001). For reintervention risk, there were no significant interactions or main effects for age or AAA diameter. CONCLUSIONS Age and AAA diameter are independent predictors of reduced survival after EVAR, but the effect is not amplified when both are present. Age >80 years or AAA size >5.5 cm did not increase the risk of reintervention. No specific AAA size, patient age, or combination thereof was identified that would contraindicate AAA repair.
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Affiliation(s)
- Robert J Hye
- Department of Surgery, Southern California Permanente Medical Group, San Diego, CA
| | - Afra U Janarious
- Department of Surgery, Southern California Permanente Medical Group, San Diego, CA
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Guy Cafri
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Robert W Chang
- Department of Surgery, The Permanente Medical Group, South San Francisco, CA
| | - Thomas F Rehring
- Department of Vascular Surgery, Colorado Permanente Medical Group, Denver, CO
| | - Nicolas A Nelken
- Department of Vascular Therapy, Hawaii Permanente Group, Honolulu, HI
| | - Bradley B Hill
- Department of Vascular Surgery, The Permanente Medical Group, Santa Clara, CA.
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11
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Prospective cohort 20 years after endovascular treatment for abdominal aortic aneurysm. J Vasc Surg 2017; 67:1102-1109. [PMID: 29074113 DOI: 10.1016/j.jvs.2017.08.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the factors associated with survival 20 years after endovascular treatment of an abdominal aortic aneurysm (AAA) in a single center. METHODS Prospective cohort of asymptomatic patients with an infrarenal aortic aneurysm treated with a bifurcated endovascular graft (Talent) between June 1997 and August 2008. Cox proportional hazard multivariable regression was used for analysis of independent risk factors for survival. Kaplan-Meier curves were done with the long-rank test. P < .05 was considered significant. RESULTS We followed 229 patients, 184 without an endoleak and 45 with an endoleak. Ages ranged between 52 and 89 years, and the mean diameter of the aneurysm was 59.51 ± 14.6 mm. Implantation of the endovascular graft was possible in 99% of the patients. The 30-day mortality rate was 3.4%. In the Cox regression, age <73 years (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.27-0.64), aneurysm size ≤55 mm (HR, 0.62; 95% CI, 0.40-0.95), male sex (HR, 0.17; 95% CI, 0.05-0.52), American Society of Anesthesiologists surgical risk category I and II vs III and IV (HR, 0.51; 95% CI, 0.34-0.75), and aneurysm size reduction ≤3 mm after treatment (HR, 2.23; 95% CI, 1.11-4.51) were significantly correlated with the survival of the patients followed in this long-term case series. CONCLUSIONS This 20-year prospective cohort included patients with an AAA treated with a bifurcated endovascular graft (Talent) at a university hospital in Brazil. This study supports that sex, age, aneurysm size, aneurysm size reduction, and American Society of Anesthesiologists surgical risk category are significantly correlated with patient survival after endovascular treatment of the AAA.
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Majd P, Ahmad W, Becker I, Brunkwall JS. Ten-Year Single-Center Results of Abdominal Aortic Aneurysm Treatment: Endovascular versus Open Repair. Ann Vasc Surg 2017; 44:113-118. [DOI: 10.1016/j.avsg.2017.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
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Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians: Meta-analysis and Systematic Review. Eur J Vasc Endovasc Surg 2017; 54:454-463. [DOI: 10.1016/j.ejvs.2017.06.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/25/2017] [Indexed: 12/13/2022]
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14
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Fenestrated endovascular aneurysm repair among octogenarians at high and standard risk for open repair. J Vasc Surg 2017; 66:354-359. [DOI: 10.1016/j.jvs.2016.11.064] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022]
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Tan TW, Eslami M, Rybin D, Doros G, Zhang WW, Farber A. Outcomes of endovascular and open surgical repair of ruptured abdominal aortic aneurysms in elderly patients. J Vasc Surg 2017; 66:64-70. [PMID: 28216354 DOI: 10.1016/j.jvs.2016.10.119] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/24/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is becoming the preferred treatment modality for patients with a ruptured abdominal aortic aneurysm (rAAA). Although the survival advantage of EVAR over open aortic repair (OAR) has been shown in some studies, it is unclear whether this benefit extends to elderly patients. We sought to evaluate the outcomes of rAAA repair in octogenarians. METHODS We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data set (2005-2014) to identify patients older than 80 years who were treated with EVAR and OAR for rAAA. Procedural trends were evaluated during the course of the study period. Perioperative outcomes including mortality, morbidity, and hospital length of stay (LOS) were compared. Multivariable regression models were used to identify predictors of perioperative mortality and morbidity. RESULTS Among 1048 elderly patients who underwent rAAA repair, 450 (43%) and 598 (57%) were treated with EVAR and OAR, respectively. The use of EVAR to treat rAAA had increased significantly in this population of patients (0% in 2005 vs 56% in 2014; P < .001). The overall 30-day mortality rate among octogenarians was 41%. The mortality rate was significantly higher among those treated with OAR compared with EVAR (47% vs 33%; P < .001). Pneumonia (21% vs 10%; P < .001), reintubation (14% vs 9%; P < .001), and >48-hour ventilator dependence (43% vs 21%; P < .001) were significantly higher in patients undergoing OAR. Hospital LOS (13 vs 10 days; P < .001) was also longer in the OAR cohort. Compared with EVAR, OAR was independently predictive of 30-day mortality (adjusted odds ratio [AOR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .001), pneumonia (AOR, 2.4; 95% CI, 1.7-3.6; P < .001), >48-hour ventilator dependence (AOR, 2.5; 95% CI, 1.8-3.3; P < .001), and longer LOS (adjusted mean ratio, 1.4; 95% CI, 1.2-1.6; P < .001). CONCLUSIONS Elderly patients have significant but acceptable perioperative mortality and morbidity after rAAA repair. Use of endovascular repair in the elderly population has increased and is associated with better perioperative survival and 30-day outcomes compared with traditional open repair in this study.
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Affiliation(s)
- Tze-Woei Tan
- Division of Vascular Surgery, University of Arizona, Tucson, Ariz.
| | - Mohammad Eslami
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Wayne W Zhang
- Division of Vascular Surgery, Louisiana State University Health Sciences Center, Shreveport, La
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass
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Dohi S, Yokoyama Y, Yamamoto T, Kuwaki K, Hariya A, Kajimoto K, Yamaoka H, Shimada A, Tsuruta R, Amano A. Push-Up Technique and Anatomical Deployment With the Endurant Stent-Graft System for Severely Angulated Aneurysm Necks. J Endovasc Ther 2017; 24:435-439. [PMID: 28205450 DOI: 10.1177/1526602817692790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a technique suitable for treating severely angulated (>75°) necks during endovascular aneurysm repair using the Endurant stent-graft. TECHNIQUE In the push-up technique, the suprarenal stent is released early to fix the proximal stent-graft in place so that each stent in the neck can be deployed individually without displacing the device upward. It is important to push the delivery system up after each stent deployment to allow the fabric between the stents to fold up circumferentially. By doing so, there is minimal upward force applied to the suprarenal stent. Because the stents expand along the angulated neck while catching blood flow, this anatomical deployment is feasible, with hardly any change to the proximal neck shape after stent-graft implantation. CONCLUSION The push-up technique and anatomical deployment with the Endurant stent-graft system are effective and safe methods for treating aneurysms with severely angulated necks.
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Affiliation(s)
- Shizuyuki Dohi
- 1 Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Yasutaka Yokoyama
- 1 Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Taira Yamamoto
- 1 Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Kenji Kuwaki
- 1 Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Akifusa Hariya
- 2 Department of Cardiovascular Surgery, Kobari General Hospital, Chiba, Japan
| | - Kan Kajimoto
- 1 Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Hironobu Yamaoka
- 3 Department of Cardiovascular Surgery, Edogawa Hospital, Tokyo, Japan
| | - Akie Shimada
- 1 Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Ryo Tsuruta
- 4 Department of Cardiovascular Surgery, Kamagaya General Hospital, Chiba, Japan
| | - Atsushi Amano
- 1 Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan
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Aitken SJ, Naganathan V, Blyth FM. Aortic aneurysm trials in octogenarians: Are we really measuring the outcomes that matter? Vascular 2016. [DOI: 10.1177/1708538115597079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose This study is a systematic review to determine the types of outcomes reported in abdominal aortic aneurysm (AAA) studies of patients aged 80 and over. Specifically, it determines the types of patient-centered outcomes reported. Method MEDLINE and EMBASE were searched from 2000 to 2014 for studies on AAA surgery with outcome data on patients aged 80 and over. Outcomes were categorized according to Donabedian’s framework for health quality indicators, with further classification as procedural, complication, resource or patient-centered outcome indicators. Findings Forty studies were reviewed. Patient-centered outcomes were infrequently reported (13%, n=5), with limited outcomes specifically relevant to older patients. No studies reported physical function, activities of daily living or cognition using validated assessment methods. Short-term mortality (95%, n=38) and complications (85%, n=34) were reported most frequently. Conclusion Reporting of aortic surgery outcomes in patients aged 80 and over requires a focus upon outcomes of primary importance to people of this age.
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Affiliation(s)
- SJ Aitken
- Concord Clinical School, Professorial Surgery Unit, Department of Vascular Surgery, New South Wales, Australia
| | - V Naganathan
- Concord Clinical School, Centre for Education and Research on Ageing, Concord, Sydney, New South Wales, Australia
| | - FM Blyth
- Concord Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Silveira D, Pitoulias G, Torsello G, Donas KP. Outcomes of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians. J Vasc Surg 2016; 63:909-14. [DOI: 10.1016/j.jvs.2015.10.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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Lippmann M, Kakazu C, Karnwal A, Kopchok G, Paullin C, Donayre C, White R. An alternative anaesthetic technique on nonagenerians undergoing endovascular aortic surgery and long term outcomes. Br J Anaesth 2015; 115:937-8. [DOI: 10.1093/bja/aev387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wigley J, Shantikumar S, Hameed W, Griffin K, Handa A, Scott DJA. Endovascular Aneurysm Repair in Nonagenarians: A Systematic Review. Ann Vasc Surg 2015; 29:385-91. [DOI: 10.1016/j.avsg.2014.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 11/24/2022]
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Elective EVAR in Nonagenarians Is Safe in Carefully Selected Patients. Ann Vasc Surg 2014; 28:1402-8. [DOI: 10.1016/j.avsg.2014.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 11/22/2022]
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Hertault A, Sobocinski J, Kristmundsson T, Maurel B, Dias NV, Azzaoui R, Sonesson B, Resch T, Haulon S. Results of F-EVAR in Octogenarians. Ann Vasc Surg 2014; 28:1396-401. [DOI: 10.1016/j.avsg.2014.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 01/06/2014] [Accepted: 02/04/2014] [Indexed: 11/16/2022]
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Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians. J Vasc Surg 2014; 60:308-17. [DOI: 10.1016/j.jvs.2014.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/21/2022]
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Piffaretti G, Mariscalco G, Riva F, Fontana F, Carrafiello G, Castelli P. Abdominal aortic aneurysm repair: long-term follow-up of endovascular versus open repair. Arch Med Sci 2014; 10:273-82. [PMID: 24904660 PMCID: PMC4042047 DOI: 10.5114/aoms.2014.42579] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 01/17/2013] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION To compare early and long-term outcomes of endovascular abdominal aortic aneurysm repair (EVAR) versus open repair (OPEN). DESIGN Prospective observational, per protocol, non-randomized, with retrospective analyses. MATERIAL AND METHODS Between 2000 and 2005, a total of 311 patients having EVAR or OPEN repair of infrarenal abdominal aortic aneurysms were identified and included in this prospective single-center observational study. A propensity score-based optimal-matching algorithm was employed, and 138 patients undergoing EVAR procedures were matched (1: 1) to OPEN repair. RESULTS Open repair showed higher hospital mortality (17% vs. 6%, p = 0.004), respiratory failure (p < 0.026), transfusion requirement (p < 0.001), and intensive care unit admission (27% vs. 7%, p < 0.001), and longer hospitalization (p < 0.001). Median follow-up was 70 months (25(th) to 75(th) percentile, 24 to 101). Actuarial survival estimates at 1, 5 and 10 years were 93%, 74%, 49% for the OPEN group compared to 89%, 69%, 59% for the EVAR group (p = 0.465). A significant difference between groups was observed in younger patients (< 75 years) only (p < 0.044). Late complication and re-intervention rates were significantly higher in EVAR patients (p < 0.001 and p = 0.002, respectively). Freedom from late complications at 1, 5 and 10 years was 96%, 92%, 86%, and 84%, 70%, 64% for OPEN and EVAR procedures, respectively. CONCLUSIONS Our experience confirms the excellent results of the EVAR procedures, offering excellent early and long-term results in terms of safety and reduction of mortality. Patients < 75 years seem to benefit from EVAR not only in the immediate postoperative period but even in a long-term perspective.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Giovanni Mariscalco
- Cardiac Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | | | - Federico Fontana
- Interventional Radiology, Department of Radiology Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology, Department of Radiology Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Patrizio Castelli
- Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
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Elective Endovascular Aneurysm Repair in the Elderly: Trends and Outcomes From the Nationwide Inpatient Sample. Ann Vasc Surg 2014; 28:798-807. [DOI: 10.1016/j.avsg.2013.07.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/11/2013] [Accepted: 07/25/2013] [Indexed: 11/21/2022]
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Visser L, Pol RA, Tielliu IFJ, van den Dungen JJAM, Zeebregts CJ. A limited and customized follow-up seems justified after endovascular abdominal aneurysm repair in octogenarians. J Vasc Surg 2014; 59:1232-40. [PMID: 24440677 DOI: 10.1016/j.jvs.2013.11.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/23/2013] [Accepted: 11/17/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether long-term follow-up after endovascular aneurysm repair (EVAR) is justified in octogenarians. METHODS Between September 1996 and October 2011, all patients, including octogenarians, treated for an abdominal aortic aneurysm (AAA) by EVAR were included in a prospective database. Patients older than 80 years and with a nonruptured infrarenal aneurysm treated electively or urgently were included in the study (study group [SG]). Patients with ruptured aneurysms and patients who died during surgery or within the first postoperative month were excluded from further analysis. The control group (CG) consisted of patients younger than 80 years, matched for gender and AAA diameter. All patients were evaluated 4 to 8 weeks after EVAR and then annually thereafter. Follow-up data were complemented by review of the computerized hospital registry and charts and by contact of the patient's general practitioner or referring hospital. Primary outcomes were stent- or aneurysm-related complications and interventions. Secondary outcomes were additional surgical complications and patient survival. RESULTS A total number of 193 patients (SG, n = 97; CG, n = 96) were included for analysis. Median age was 80 years, and 88.6% were male. Median follow-up time was 33.6 months (interquartile range [IQR], 12.9-68.3). Stent- and procedure-related postoperative complications were comparable between groups (SG, 41.2%; CG, 39.6%; P = .82). Median time to complication was 2.3 months (IQR, 0.2-19.4) in the SG compared with 18.1 months (IQR, 6.8-50.5) in the CG. The 2-year complication-free survival rates were 58% (SG) and 60% (CG). Interventions were performed significantly less frequently in octogenarians (SG, 8.2%; CG, 19.8%; P < .05). Median time to intervention was 11.1 months (IQR, 2.0-31.0) in the SG compared with 54.3 months (IQR, 15.0-93.2) in the CG. The 2-year intervention-free survival rates were 90% (SG) and 92% (CG). During follow-up, 98 patients died (SG, n = 54; CG, n = 44); median time to death was 31.8 months (IQR, 13.3-66.0) in the SG compared with 44.4 months (IQR, 15.0-77.7) in the CG. One aneurysm-related death occurred in the CG. The 2- and 5-year survival rates were 71% and 32% for the SG compared with 77% and 66% for the CG (P < .05). CONCLUSIONS Because of the low incidence of secondary procedures and AAA-related deaths in octogenarians, long-term and frequent follow-up after EVAR seems questionable. An adapted and shortened follow-up seems warranted in this patient group.
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Affiliation(s)
- Linda Visser
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ignace F J Tielliu
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan J A M van den Dungen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Thirty-day outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians based on the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE). J Vasc Surg 2012; 56:27-35. [DOI: 10.1016/j.jvs.2011.12.080] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 11/22/2011] [Accepted: 12/15/2011] [Indexed: 12/22/2022]
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Geisbüsch P, Katzen BT, Tsoukas AI, Arango D, Peña CS, Benenati JF. Endovascular repair of infrarenal aortic aneurysms in octogenarians and nonagenarians. J Vasc Surg 2011; 54:1605-13. [DOI: 10.1016/j.jvs.2011.06.096] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/24/2011] [Accepted: 06/24/2011] [Indexed: 12/01/2022]
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O’Brien G, Martin Z, Haider N, Colgan M, O’Neill S, Moore D, Madhavan P. An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy. Ir J Med Sci 2011; 181:73-6. [DOI: 10.1007/s11845-011-0779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
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Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model. J Vasc Surg 2011; 54:644-53. [DOI: 10.1016/j.jvs.2011.03.217] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/04/2011] [Accepted: 03/04/2011] [Indexed: 11/19/2022]
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Gómez Palonés F, Vaquero Puerta C, Gesto Castromil R, Serrano Hernando F, Maeso Lebrun J, Vila Coll R, Clará Velasco A, Escudero Román J, Riambau Alonso V. Tratamiento endovascular del aneurisma de aorta abdominal. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Biancari F, Catania A, D'Andrea V. Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2011; 42:571-6. [PMID: 21820922 DOI: 10.1016/j.ejvs.2011.07.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/12/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Endovascular treatment (EVAR) of abdominal aortic aneurysm (AAA) is thought to be of benefit, particularly in patients aged ≥80 years. This issue was investigated in the present meta-analysis. DESIGN The study design involved a systematic review of the literature and meta-analysis. METHODS Systematic review of the literature and meta-analysis of data on elective EVAR vs. open repair of AAA in patients aged ≥80 years were performed. RESULTS Six observational studies reporting on 13,419 patients were included in the present analysis. Pooled analysis showed higher immediate postoperative mortality after open repair compared with EVAR (risk ratio 3.87, 95% confidence interval (CI) 3.19-4.68; risk difference, 6.2%, 95%CI 5.4-7.0%). The pooled immediate mortality rate after open repair was 8.6%, whereas it was 2.3% after EVAR. Open repair was associated with a significantly higher risk of postoperative cardiac, pulmonary and renal complications. Pooled analysis of three studies showed similar overall survival at 3 years after EVAR and open repair (risk ratio 1.10, 95%CI 0.77-1.57). CONCLUSIONS The results of this meta-analysis suggest that elective EVAR in patients aged ≥80 years is associated with significantly lower immediate postoperative mortality and morbidity than open repair and should be considered the treatment of choice in these fragile patients. These results indicate also that, when EVAR is not feasible, open repair can be performed with acceptable immediate and late survival in patients at high risk of aneurysm rupture.
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Affiliation(s)
- F Biancari
- Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu 90029, Finland.
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Outcome of elective endovascular abdominal aortic aneurysm repair in nonagenarians. J Vasc Surg 2011; 54:287-94. [DOI: 10.1016/j.jvs.2010.12.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 09/29/2010] [Accepted: 12/16/2010] [Indexed: 11/22/2022]
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Martínez-Mira C, Alonso-Argüeso G, Fernández-Samos R, Ortega-Martín J, Peña-Cortes R, Vaquero-Morillo F. Tratamiento endovascular de aneurismas de aorta abdominal en octogenarios: 10 años de experiencia. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Woo EY, Ullery BW, Carpenter JP, Wang GJ, Fairman RM, Jackson BM. Open abdominal aortic aneurysm repair is feasible and can be done with excellent results in octogenarians. J Vasc Surg 2011; 53:278-84. [DOI: 10.1016/j.jvs.2010.08.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 08/19/2010] [Accepted: 08/19/2010] [Indexed: 11/28/2022]
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Scheer MLJ, Pol RA, Haveman JW, Tielliu IFJ, Verhoeven ELG, Van Den Dungen JJAM, Nijsten MW, Zeebregts CJ. Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm. J Vasc Surg 2011; 53:918-25. [PMID: 21211933 DOI: 10.1016/j.jvs.2010.10.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether advanced age may be a reason to refrain from treatment in patients with an acute abdominal aortic aneurysm (AAAA). METHODS This was a retrospective cohort study that took place in a tertiary care university hospital with a 45-bed intensive care unit. Two hundred seventy-one patients with manifest AAAA, admitted and treated between January 2000 and February 2008, were included. Six patients died during operation and were included in the final analysis to ensure an intention-to-treat protocol, resulting in 234 men and 37 women with a mean age of 72 ± 7.8 years (range, 54-88 years). Forty-six patients (17%) were 80 years or older. Interventions involved open or endovascular AAAA repair. RESULTS Mean follow-up was 33 ± 30.4 months (including early deaths). Mean hospital length of stay was 16.9 ± 20 days for patients younger than 80 and 13 ± 16.7 days for patients older than 80 years of age. Kaplan-Meier survival analysis revealed a significantly better survival for the younger patients (P < .05). Stratification based on urgency or type of treatment did not change the difference. Two-year actuarial survival was 70% for patients younger than 80 and 52% for those older than 80. At 5-year follow-up, these figures were 62% and 29%, respectively. Mean survival in patients older than 80 was 39.8 ± 6.8 months versus 64.5 ± 3.0 months in those younger than 80. CONCLUSIONS For octogenarians, our liberal strategy of treating patients with AAAA was associated with satisfactory short- and long-term outcome, with no difference with regard to disease- or procedure-related morbidity between the younger and older group. Assuming an integrated system for managing AAAA is in place, advanced age is not a reason to deny patients surgery.
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Affiliation(s)
- Margot L J Scheer
- Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands
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Ghouri MA, Dougherty KG, Krajcer Z. Technical Tips for Endovascular Treatment of Abdominal Aortic Aneurysms With Challenging Infrarenal Neck Anatomy Using the Excluder Endoprosthesis. J Endovasc Ther 2010; 17:705-11. [DOI: 10.1583/10-3170.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Walker TG, Kalva SP, Yeddula K, Wicky S, Kundu S, Drescher P, d'Othee BJ, Rose SC, Cardella JF. Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:1632-55. [DOI: 10.1016/j.jvir.2010.07.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/24/2010] [Accepted: 07/11/2010] [Indexed: 12/17/2022] Open
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Lomazzi C, Mariscalco G, Piffaretti G, Bacuzzi A, Tozzi M, Carrafiello G, Castelli P. Endovascular treatment of elective abdominal aortic aneurysms: independent predictors of early and late mortality. Ann Vasc Surg 2010; 25:299-305. [PMID: 20926237 DOI: 10.1016/j.avsg.2010.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 04/08/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this study was to review our personal experience with patients who underwent elective endovascular repair of abdominal aortic aneurysms so as to detect the predictors of early and late mortality. METHODS Between November 2000 and June 2008, a total of 235 consecutive patients (218 men; mean age: 71.9 ± 8.0 years, range: 48-95 years) underwent endovascular repair of abdominal aortic aneurysms. Comorbidities were defined by using the Society for Vascular score grading system and the preoperative risk grade on the basis of the classification of the American Society of Anesthesiologists (ASA). Physical examination and spiral computed tomography were planned at 1, 4, and 12 months after the procedure, and on a yearly basis thereafter. Contrast-enhanced ultrasonography and plain X-rays were also performed. RESULTS Primary technical success rate was 97% (228 of 235 cases). The overall hospital mortality was 2.1% (n = 5), ranging from 1.2% and 2.8% for patients with an ASA of score 2 and 3, respectively, to 7.7% for patients with an ASA score of 4. Multivariable analysis confirmed chronic renal failure (OR: 12.12, 95% CI: 1.83-80.17, p = 0.010) and transrenal endograft (OR: 9.61, 95% CI: 1.01-91.57, p = 0.049) as the only independent predictors of early mortality. Follow-up was completed for all 230 patients who were discharged, with a mean follow-up period of 26.3 ± 22.7 months (maximum: 92 months). Kaplan-Meier analysis revealed a reduced survival rate for older patients (p < 0.001) and patients with a larger aneurysm (p < 0.001). A reduced survival rate was also demonstrated for women and patients with higher ASA scores (p = 0.007, and p = 0.003, respectively). In multivariate Cox analysis, ASA score, age, diameter of the aneurysm, and being female independently affected long-term survival. CONCLUSION On the basis of our experience, it was concluded that chronic renal failure and the endograft configuration were independent predictors of early mortality. Also, older patients, women, and patients with larger aneurysms and higher ASA scores had the poorest late survival rates.
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Affiliation(s)
- Chiara Lomazzi
- Division of Vascular Surgery, Department of Surgical Sciences, Varese University Hospital, University of Insubria, Via Guicciardini 9, Varese, Italy
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Fonseca R, Rockman C, Pitti A, Cayne N, Maldonado TS, Lamparello PJ, Riles T, Adelman M. Intermediate-term EVAR outcomes in octogenarians. J Vasc Surg 2010; 52:556-60; discussion 560-1. [PMID: 20620011 DOI: 10.1016/j.jvs.2010.03.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 03/23/2010] [Accepted: 03/23/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The utilization of endovascular abdominal aortic aneurysm repair (EVAR) in suitable patients has resulted in decreased perioperative morbidity and mortality. Octogenarians as a subgroup have been more readily offered EVAR, as it is less invasive, and therefore presumably better tolerated than conventional open aortic repair. The purpose of this study is to investigate periprocedural and late EVAR outcomes in octogenarians compared with patients less than 80 years of age. METHODS From January 2003 to May 2008, 322 patients underwent EVAR. A total of 117 octogenarians were compared with 205 patients less than 80 years of age. A retrospective review of the demographic data, aneurysm details, perioperative morbidity, mortality, and late outcomes were analyzed. RESULTS Octogenarians were significantly more likely to have a history of diabetes mellitus (51% vs 23%; P < .001), coronary artery disease (45% vs 32%; P = .0165), chronic obstructive pulmonary disease (44% vs 30%; P = .0113), and renal insufficiency (57% vs 31%; P < .0001). There were no significant differences in the rates of perioperative myocardial infarction, stroke, death, intestinal, or arterial ischemic complications between the two groups. Octogenarians had a significant higher rate of pulmonary complications (5.1% vs 1%; P < .03) and access-site hematomas (12% vs 2.4%; P = .001) than younger patients. When all significant perioperative morbidity was combined, octogenarians were twice as likely to develop complications following EVAR than younger patients (27.4% vs 11.7%; P = .001). At 5-year follow-up, younger patients were twice as likely to develop type II endoleaks. CONCLUSIONS EVAR can be performed safely and effectively in octogenarians, and the incidence of major complications including myocardial infarction, stroke, and death is unchanged compared with younger patients. However, there is a significantly increased rate of access-site hematomas, pulmonary, and perioperative complications in octogenarians as a whole. Our findings suggest EVAR remains a suitable form of therapy in the elderly group provided there is an appropriate preoperative evaluation and perioperative monitoring following repair.
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Prenner SB, Turnbull IC, Malik R, Salloum A, Ellozy SH, Vouyouka AG, Marin ML, Faries PL. Outcome of elective endovascular abdominal aortic aneurysm repair in octogenarians and nonagenarians. J Vasc Surg 2010; 51:1354-9. [DOI: 10.1016/j.jvs.2010.01.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/08/2010] [Accepted: 01/10/2010] [Indexed: 10/19/2022]
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Jim J, Sanchez LA, Sicard GA, Curci JA, Choi ET, Geraghty PJ, Flye MW, Rubin BG. Acceptable Risk but Small Benefit of Endovascular Aneurysm Repair in Nonagenarians. Ann Vasc Surg 2010; 24:441-6. [DOI: 10.1016/j.avsg.2009.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 10/09/2009] [Accepted: 10/19/2009] [Indexed: 10/20/2022]
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Bakoyiannis CN, Tsekouras NS, Georgopoulos SE, Skrapari IC, Economopoulos KP, Tsigris C, Bastounis EA. Minilaparotomy abdominal aortic aneurysm repair in the era of minimally invasive vascular surgery: preliminary results. ANZ J Surg 2010; 79:829-35. [PMID: 20078535 DOI: 10.1111/j.1445-2197.2009.05111.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the early post-operative clinical impact of minimal incision aortic surgery (MIAS) for infrarenal abdominal aortic aneurysm (AAA) repair in comparison with the standard open repair. METHODS A case-control study was conducted. Patients of groups A (19 patients) and B (18 patients) were treated with the MIAS technique and the standard open method, respectively. RESULTS There were significant differences between the two groups in fluid resuscitation during the operation. Post-operatively, there were significant differences between groups A and B in the time until starting liquid diet (2 +/- 0.74 versus 3.55 +/- 0.85 post-operative days (PD), respectively; P < 0.05), the time until starting the solid diet (3.05 +/- 0.77 versus 5.11 +/- 0.75 PD, respectively; P < 0.05), the time of ambulation (2 +/- 0.74 versus 3.4 +/- 0.98 PD, respectively; P < 0.05) and in the hospital length of stay (4 +/- 0.81 versus 9.7 +/- 2.66 days, respectively; P < 0.05). CONCLUSIONS The MIAS technique, for repair of infrarenal aortic aneurysms, is a safe and feasible procedure that combines the early advantages of endovascular repair with the long-term advantages of the traditional open repair.
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Affiliation(s)
- Chris N Bakoyiannis
- First Department of Surgery, Vascular Department, University of Athens Medical School, 'Laiko' General Hospital, Athens, Greece.
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Preston SD, Southall ARD, Nel M, Das SK. Geriatric surgery is about disease, not age. J R Soc Med 2009; 101:409-15. [PMID: 18687864 DOI: 10.1258/jrsm.2008.080035] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Maintaining life span and quality of life remains a valid aim of surgery in elderly people. Surgery can be an effective way of restoring both length and quality of life to older people. Minimally invasive techniques and surgery under local anaesthesia make fewer demands on geriatric physiology; given that co-morbidity is a stronger predictor of outcome from surgery than age, this is a significant consideration.
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Affiliation(s)
- Stephen D Preston
- Cellular Pathology, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, UK
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Pitoulias GA, Schulte S, Donas KP, Horsch S. Secondary Endovascular and Conversion Procedures for Failed Endovascular Abdominal Aortic Aneurysm Repair: Can We Still Be Optimistic? Vascular 2009; 17:15-22. [PMID: 19344578 DOI: 10.2310/6670.2009.00004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate the incidence, etiology, and outcome of secondary endovascular and “open” conversion procedures after failed endovascular abdominal aortic aneurysm repair (EVAR). From January 1997 until December 2005, 625 patients with an infrarenal abdominal aortic aneurysm were treated by elective EVAR, with 98.7% ( n = 617) primary EVAR success. The mean follow-up of the 617 patients was 46.7 ± 11.2 months. One hundred of these patients (16.2%) required secondary endovascular or peripheral procedures, and 39 (6.3%) patients underwent a secondary abdominal conversion. There were 5 acute conversions (0.8%) and 34 elective conversions (5.5%). The pre-EVAR anatomic suitability data, the main cause of the secondary procedure, and stent graft type were compared between patients with primary EVAR success, patients in need of a secondary endovascular or peripheral procedure, and patients with abdominal conversion. The overall main causes for reinterventions were proximal migration ( n = 60; 9.7%), progressive kinking of the stent graft ( n = 59; 9.6%), and late type III endoleak ( n = 12; 1.9%). Multivariate logistic regression analysis showed that factors significantly correlated with secondary procedures were the abdominal aortic aneurysm's maximum diameter, the proximal neck's width and length, and particularly the commercial withdrawal of the stent graft ( p < .001). The morbidity and mortality rates of secondary endovascular or peripheral interventions were 0%. The mortality rate of acute secondary conversions was 20% ( n = 1) and of elective secondary conversions was 8.8% ( n = 3). The morbidity rates for acute and elective conversions were 0% and 65%, respectively. The aneurysm-related mortality rate in our series was below 1%. Abdominal conversion surgery still carries a high mortality rate, but the overall EVAR-related mortality rate remains low. Early pitfall detection and proper reintervention are crucial to long-term EVAR success.
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Affiliation(s)
- Georgios A. Pitoulias
- *Hospital Porz am Rhein, Center for Vascular Surgery, Academic Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Stefan Schulte
- *Hospital Porz am Rhein, Center for Vascular Surgery, Academic Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Konstantinos P. Donas
- *Hospital Porz am Rhein, Center for Vascular Surgery, Academic Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Svante Horsch
- *Hospital Porz am Rhein, Center for Vascular Surgery, Academic Teaching Hospital of the University of Cologne, Cologne, Germany
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Endofugas tipo II tras tratamiento endovascular de los aneurismas de aorta abdominal: incidencia, factores predisponentes, pruebas diagnósticas, indicaciones y alternativas terapéuticas. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)14003-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schlösser F, Gusberg R, Dardik A, Lin P, Verhagen H, Moll F, Muhs B. Aneurysm Rupture after EVAR: Can the Ultimate Failure be Predicted? Eur J Vasc Endovasc Surg 2009; 37:15-22. [PMID: 19008129 DOI: 10.1016/j.ejvs.2008.10.011] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
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Abbruzzese TA, Kwolek CJ, Brewster DC, Chung TK, Kang J, Conrad MF, LaMuraglia GM, Cambria RP. Outcomes following endovascular abdominal aortic aneurysm repair (EVAR): An anatomic and device-specific analysis. J Vasc Surg 2008; 48:19-28. [PMID: 18440182 DOI: 10.1016/j.jvs.2008.02.003] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Revised: 01/31/2008] [Accepted: 02/02/2008] [Indexed: 11/27/2022]
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