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Warren AS, Dansey K, Starnes BW, Hemingway J, Quiroga E, Singh N, Tran N, Zettervall SL. Modified Harborview Risk Score accurately predicts mortality for patients with ruptured abdominal aortic aneurysm. J Vasc Surg 2024; 79:555-561. [PMID: 37967587 DOI: 10.1016/j.jvs.2023.11.013] [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: 09/23/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE The modified Harborview Risk Score (HRS) is a simple measure initially derived from a single institutional dataset used to predict ruptured abdominal aortic aneurysm (rAAA) repair survival preoperatively using basic labs and vital signs collected upon presentation. However, validation of this widely applicable scoring system has not been performed. This study aims to validate this scoring system using a large multi-institutional database. METHODS All patients who underwent repair of an rAAA from 2011 to 2018 in the National Surgical Quality Improvement Program (NSQIP) and at a single academic medical center were included. The modified HRS was calculated by assigning 1 point for each of the following: age >76 years, creatinine >2 mg/dL, international normalized ratio >1.8, and any systolic blood pressure less than 70 mmHg. Assessment of the prediction model was then completed. Using a primary outcome measure of 30-day mortality, the receiver operating characteristic area under the curve was calculated. The discrimination between datasets was compared using a Delong test. Mortality rates for each score were compared between datasets using the Pearson χ2 test. Comparative analysis for patients with a score of 4 was limited due to a small sample size. RESULTS A total of 1536 patients were identified using NSQIP, and 163 patients were assessed in the institutional dataset. There were 518 patients with a score of 0 (455 NSQIP, 63 institutional), 676 patients with a score of 1 (617 NSQIP, 59 institutional), 391 patients with a score of 2 (364 NSQIP, 27 institutional), 106 with a score of 3 (93 NSQIP, 13 institutional), and 8 patients with a score of 4 (7 NSQIP, 1 institutional). No difference was found in the receiver operating characteristic area under the curves between datasets (P = .78). Thirty-day mortality was 10% NSQIP vs 22% institutional for a score of 0; 28% NSQIP vs 36% institutional for a score of 1; 41% NSQIP vs 44% institutional for a score of 2; 45% NSQIP vs 69% institutional for a score of 3; and 57% NSQIP vs 100% institutional for a score of 4. Score 0 was the only score with a significant mortality rate difference between datasets (P = .01). CONCLUSIONS The modified HRS is confirmed to be broadly applicable as a clinical decision-making tool for patients presenting with rAAAs. Therefore, this easily applicable model should be applied for all patients presenting with rAAAs to assist with provider and patient decision-making prior to proceeding with repair.
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Affiliation(s)
- Andrew S Warren
- Division of Vascular Surgery, University of Washington, Seattle, WA; Pacific Northwest University of Health Sciences, Yakima, WA
| | - Kirsten Dansey
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | | | - Jake Hemingway
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Elina Quiroga
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Niten Singh
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Nam Tran
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Sara L Zettervall
- Division of Vascular Surgery, University of Washington, Seattle, WA.
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2
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Pumares-García L, Paredes-Mariñas E, Calsina-Juscafresa L, Subirana-Cachinero I, Miralles-Hernández M, Clarà-Velasco A. Association of polypharmacy scores with the long-term survival of patients with intact aortoiliac aneurysms and indication for repair. J Vasc Surg 2024; 79:540-546.e2. [PMID: 37923020 DOI: 10.1016/j.jvs.2023.10.051] [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: 07/30/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE/BACKGROUND Our study analyzed the relationship between two polypharmacy scores (addition of chronic prescribed drugs [ACPDs] and Rx-Risk Comorbidity Index) and survival in patients with an intact abdominal aortic and/or common iliac aneurysm (AAA). METHODS Consecutive retrospective, single-center cohort of patients attended for an intact AAA with indication for repair from 2008 to 2021. Demographic data, Charlson Comorbidity Index, AAA treatment, ACPD, and Rx-Risk polypharmacy scores were recorded at baseline. Main outcomes were the 5-year and long-term survival rates. The statistical analysis included Cox regression, area under the curve, and continuous net reclassification index. RESULTS A total of 424 patients with AAA were evaluated (median age: 76 years; 92.2% male, median Charlson index 2), of whom 314 (74.1%) underwent intervention (80% endovascular and 20% open) and 110 (25.9%) did not. During follow-up (mean 4.6 years), 245 patients (57.8%) died, with 1-month, 1-year, and 5-year survival rates of 98.1%, 86.3%, and 52.7%, respectively. ACPD and Rx-Risk indices (median [interquartile range]: 6 [4-9] and 3 [0-5], respectively) were significantly and linearly associated (P < .001) with survival, with the best cutoff points at 5 and 0, respectively. An ACPD >5 (patients with >5 chronically prescribed drugs at baseline) and an Rx-Risk >0 were associated with a 45.2% (P = .038) and 102% (P = .002) increase in 5-year mortality, respectively, after adjustment for age, sex, Charlson index, and type of AAA treatment. Both polypharmacy indices improved significantly the discriminative power of the Charlson Comorbidity Index in predicting survival. CONCLUSIONS Both ACPD and Rx-Risk polypharmacy scores are independently related to survival among patients with an intact AAA and indication for repair. Their behavior is similar, so the simple ACPD >5 appears to be sufficient to identify patients with lower survival rates.
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Affiliation(s)
| | - Ezequiel Paredes-Mariñas
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Calsina-Juscafresa
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain; Department of Medicine and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Isaac Subirana-Cachinero
- Hospital del Mar Research Institute, Barcelona, Spain; CIBER Cardiovascular, IMIM-Parc de Salut Mar, Barcelona, Spain
| | | | - Albert Clarà-Velasco
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain; Department of Medicine and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Cardiovascular, IMIM-Parc de Salut Mar, Barcelona, Spain.
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3
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Akintoye OO. Pre-operative Aortic Anatomic Features as Predictors of Clinical Outcomes Following Endovascular Repair of Abdominal Aortic Aneurysm: A Retrospective Cohort Study. Cureus 2023; 15:e46983. [PMID: 38022100 PMCID: PMC10640889 DOI: 10.7759/cureus.46983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
ARTICLE REMOVED.
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Cardiel-Pérez A, Paredes-Mariñas E, Nieto-Fernández L, Abadal-Jou M, Mellado-Joan M, Clarà-Velasco A. Comparative performance of three comorbidity scores in predicting survival after the elective repair of abdominal aortic aneurysms. INT ANGIOL 2023; 42:73-79. [PMID: 36744425 DOI: 10.23736/s0392-9590.22.04974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to study the discriminative power of 3 comorbidity scores for predicting 5-year survival after the elective repair of aorto-iliac aneurysms (AAA). METHODS 444 patients with AAA undergoing elective repair (33% open and 67% endovascular) between 2000 and 2020 were reviewed. The Charlson Comorbidity Index (CCI) and subsequent adjustments by Schneeweiss, Quan and Armitage, the Modified Frailty Index (MFI) and the American Society of Anesthesiologists Score (ASA) were calculated from preoperative data. Their association with 5-year survival was analyzed using Cox regression models and their discriminative power and its changes with C statistics and Net Reclassification Index (NRI). RESULTS All comorbidity scores were associated with survival after adjusting by age, sex and type of surgical repair: original CCI HR=1.24, P<0.001; Schneeweiss CCI HR=1.23, P<0.001; Quan CCI HR=1.27, P<0.001, Armitage CCI HR=1.46, P<0.001, MFI HR=1.39, P<0.001 and ASA HR=1.68 (P=0.04) and 2.86 (P=0.01) for classes III and IV, respectively. Associated C statistics were of 0.64, 0.65, 0.65, 0.64, 0.61 and 0.59, respectively. Compared with the original CCI, models based on Schneeweiss CCI and Armitage CCI provided minor improvements in NRI (0.32 and 0.23), and the model based on ASA showed lower C statistics (P=0.014) and NRI (-0.30). CONCLUSIONS Established comorbidity scores, such as CCI, MFI or ASA, are all associated with 5-year survival after the elective repair of AAAs, being ASA the worst of them. However, their predictive power is in no case sufficient to identify, by themselves, those patients who may not be eligible for intervention on the basis of life expectancy.
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Affiliation(s)
- Ada Cardiel-Pérez
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain
| | - Ezequiel Paredes-Mariñas
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain - .,Department of Surgery, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Mar Abadal-Jou
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain
| | | | - Albert Clarà-Velasco
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Barcelona, Spain.,CIBER Cardiovascular, Institut Hospital del Mar d'Investigacions Mèdiques, Hospital del Mar, Barcelona, Spain.,Department of Medicine and Surgery, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
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Mirzamidinov D, Karauzum K, Kahraman N, Cakir O, Karauzum I, Ural E, Sahin T. A successful endovascular treatment of a patient with extended-spectrum beta-lactamase positive Escherichia coli related emphysematous distal abdominal aortitis rapidly progressing to a saccular aneursym. J Cardiol Cases 2023; 27:215-217. [PMID: 37180213 PMCID: PMC10173396 DOI: 10.1016/j.jccase.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 01/13/2023] [Indexed: 02/16/2023] Open
Abstract
Infectious aortitis is a rare disease and associated with adverse clinical outcomes. A 66-year-old man was admitted to the emergency department with abdominal and lower back pain, fever, chills, and anorexia continuing for a week. A contrast-enhanced computed tomography (CT) scan of the abdomen showed multiple periaortic enlarged lymphatic nodes, mural wall thickening, and gas collections in the infrarenal aorta and proximal segment of right common iliac artery. The patient was hospitalized with the diagnosis of acute emphysematous aortitis. During hospitalization, extended-spectrum beta-lactamase-positive Escherichia coli was grown in all blood and urine cultures. Despite sensitive antibiotherapy, abdominal and back pain, inflammation biomarkers, and fever of the patient were not improved. Control CT demonstrated a newly developed mycotic aneurysm, increased intramural gas collection, and periaortic soft-tissue thickening. Urgent vascular surgery was recommended to the patient by the heart team, but the patient rejected surgery due to the high perioperative risk. Alternatively, an endovascular rifampin-impregnated stent-graft was successfully implanted and antibiotics were completed at 8 weeks. After procedure, inflammatory indicators were normalized and clinical symptoms of the patient were resolved. No microorganism grew on control blood and urine cultures. The patient was discharged with a good health. Learning objective Aortitis should be suspected in patients who present with fever, abdominal and back pain, especially in the presence of predisposing risk factors. Infectious aortitis (IA) accounts for a small part of all aortitis cases and the most common causative microorganism is Salmonella. The mainstay treatment of IA is sensitive antibiotherapy. Surgery may be required in patients who are unresponsive to antibiotics or develop aneurysm. Alternatively, endovascular treatment can be performed in selected cases.
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Blair R, Harkin D, Johnston D, Lim A, McFetridge L, Mitchell H. Open Surgery for Abdominal Aortic Aneurysm: 980 Consecutive Patient Outcomes from a High-Volume Centre in the United Kingdom. Vasc Endovascular Surg 2023:15385744221149585. [PMID: 36714998 DOI: 10.1177/15385744221149585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy persists regarding the optimal treatment for large abdominal aortic aneurysm (AAA), highlighted by the publication of the National Institute for Health and Care Excellence (NICE) guideline (NG156) on March 2020. The pendulum of opinion swings once more from endovascular to open surgical treatment. We report our experience over the last 15 years in treating consecutive AAA by open surgery. METHODS A retrospective review of a prospectively collected vascular database of all patients undergoing infra-renal open abdominal aortic aneurysm repair (OR) repair from 2004 to 2019 at the largest aneurysm centre in the United Kingdom. OR for elective and emergency (ruptured and symptomatic) outcomes included early morbidity and 30-day mortality, and long-term survival. RESULTS 1017 patients underwent OR between 2004-2019, on application of our inclusion-criteria 994 patients formed our cohort for analysis (81.2% male) with a mean age 73.6 ± 7.8 years treated by OR for AAA. In that group 672 were elective and 308 were emergency (for ruptured or symptomatic). Overall 30 day mortality was 11.3%, elective 30 day mortality was 2.5%, and emergency 30 day mortality was 29.9%. 30 day re-intervention rate was 9.5%, (elective 7.0%, emergency 15.9%). Survival at 1000 days for elective repair was 72 v 46.7% for emergency and at 2000 days was 43.4% for elective v 25% for emergency. CONCLUSION Our data confirm that open surgery for AAA can be performed in large volume centres quite safely. Elective and Emergency surgery does affect early 30 day mortality but does not influence long-term outcome.
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Affiliation(s)
- Robert Blair
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Denis Harkin
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK.,Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Dorothy Johnston
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Adrian Lim
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Lisa McFetridge
- Mathematical Sciences Research Centre, 227990Queen's University Belfast, Belfast, UK
| | - Hannah Mitchell
- Mathematical Sciences Research Centre, 227990Queen's University Belfast, Belfast, UK
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Meuli L, Zimmermann A, Menges AL, Stefanikova S, Reutersberg B, Makaloski V. Prognostic model for survival of patients with abdominal aortic aneurysms treated with endovascular aneurysm repair. Sci Rep 2022; 12:19540. [PMID: 36380101 PMCID: PMC9666454 DOI: 10.1038/s41598-022-24060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
The role of endovascular aneurysm repair (EVAR) in patients with asymptomatic abdominal aortic aneurysm (AAA) who are unfit for open surgical repair has been questioned. The impending risk of aneurysm rupture, the risk of elective repair, and the life expectancy must be balanced when considering elective AAA repair. This retrospective observational cohort study included all consecutive patients treated with standard EVAR for AAA at a referral centre between 2001 and 2020. A previously published predictive model for survival after EVAR in patients treated between 2001 and 2012 was temporally validated using patients treated at the same institution between 2013 and 2020 and updated using the overall cohort. 558 patients (91.2% males, mean age 74.9 years) were included. Older age, lower eGFR, and COPD were independent predictors for impaired survival. A risk score showed good discrimination between four risk groups (Harrel's C = 0.70). The 5-years survival probabilities were only 40% in "high-risk" patients, 68% in "moderate-to-high-risk" patients, 83% in "low-to-moderate-risk", and 89% in "low-risk" patients. Low-risk patients with a favourable life expectancy are likely to benefit from EVAR, while high-risk patients with a short life expectancy may not benefit from EVAR at the current diameter threshold.
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Affiliation(s)
- Lorenz Meuli
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Zimmermann
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Anna-Leonie Menges
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sandra Stefanikova
- grid.411656.10000 0004 0479 0855Department for Vascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Benedikt Reutersberg
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Vladimir Makaloski
- grid.411656.10000 0004 0479 0855Department for Vascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
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8
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Vaccarino R, Wachtmeister M, Sun J, Bornè Y, Resch T, Sonesson B, Dias NV. Ilio-femoral calcium score may assist Glasgow Aneurysm Score prediction of long-term survival of low-risk patients after infrarenal EVAR. INT ANGIOL 2022; 41:285-291. [PMID: 35583456 DOI: 10.23736/s0392-9590.22.04883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to evaluate if ilio-femoral calcium score (CS) combined with Glasgow Aneurysm Score (GAS) can improve the prediction of long-term survival after EVAR. METHODS All the patients who underwent infrarenal endovascular aortic repair (EVAR) for non-ruptured AAA between January 2004 and December 2012 at a tertiary referral center were retrospectively included if the preoperative imaging was of sufficient quality and they had survived for more than 30 days. Pre-operative non-contrast enhanced CT were used to measure ilio-femoral calcium score using dedicated postprocessing software. GAS was calculated and patients were divided into low or high GAS by a cutoff of 80. RESULTS 288 out of 500 patients were included in the study with no difference in survival compared to excluded patients (P = .529). Patients were followed-up for a median of 7 (4 - 9) years. GAS correlated positively with ilio-femoral calcium score (r = .123; P = .037). One hundred thirty-five patients (46,9 %) had low GAS, and 153 (53,1 %) had high GAS. Patients with high GAS had lower survival compared to the ones with low GAS (P ≤ .0001). GAS was associated with long-term mortality in a uni- and multivariate regression (P = < .0001 and P = < .0001). Ilio-femoral calcium score was significantly associated with mortality in the group with low GAS (P = .028), but not in the group with high GAS (P = .297). Significance retained in multivariate regression analysis (P = .029). Moreover, in the low GAS group, iliofemoral calcium score was further divided in high and low according to the median. Patients with high calcium score had lower survival compared to the ones with low calcium score ( P = .047). CONCLUSIONS Long-term survival in patients who have had infrarenal EVAR can be predicted by the clinically based Glasgow Aneurysm Score. Measuring the ilio-femoral calcium score preoperatively may refine GAS assessment in low-risk patients.
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Affiliation(s)
- Roberta Vaccarino
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skane University Hospital, Malmö, Sweden - .,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden -
| | | | - Jianming Sun
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Yan Bornè
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Timothy Resch
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Björn Sonesson
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skane University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nuno V Dias
- Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skane University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Open Abdominal Aortic Aneurysm Surgery and Renal Dysfunction; Association of Demographic and Clinical Variables with Proximal Clamp Location. Ann Vasc Surg 2022; 84:239-249. [PMID: 35247532 DOI: 10.1016/j.avsg.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND While cross-clamp site is a known risk factor for postoperative acute and chronic renal dysfunction following open abdominal aortic aneurysm surgery (AAA), the additive impact of patient demographic and clinical factors is lacking. In this study, we investigated the impact of body mass index (BMI), surgical duration and aneurysm diameter on the association between proximal cross-clamp location and postoperative renal dysfunction. METHODS In this study, we conducted a retrospective analysis of 4,197 patients undergoing open AAA surgery between 2011 and 2018 using data housed in the American College of Surgeons National Safety Quality Improvement Program (ACS-NSQIP) database. The primary outcome was renal dysfunction, which was defined as patients requiring dialysis within 30 days or patients with ≥2 mg/dL rise in creatinine from baseline. We assessed the incidence of renal dysfunction with regard to clamp location and subsequently used multivariable logistic regression to assess clinical and demographic factors associated with renal dysfunction. We used a regression model to plot the association of BMI, surgical duration, and aneurysm diameter with an adjusted probability of postoperative acute and chronic renal dysfunction for individual cross-clamp locations. RESULTS Of the 4,197 patients analyzed, 405 patients (9.6%) developed renal dysfunction within 30 days with 287 patients requiring dialysis. Patients with supraceliac clamp location had the highest incidence of renal dysfunction (20.4%). Our data showed a significant association of renal dysfunction with higher BMI patients [OR 1.04 (1.02, 1.07), P = 0.001], longer operative times [OR1.01 (1.01, 1.02), P < 0.001], clamp location between the superior mesenteric artery (SMA) and renal artery [OR 1.80 (1.17, 2.78), P = 0.007] and supraceliac clamp location [OR 2.47 (1.62, 3.76), P < 0.001]. CONCLUSIONS The incidence of renal dysfunction increases with suprarenal clamps. Patients with higher BMI, longer operative times, and increasing aneurysm diameter, and a suprarenal clamp have a significantly increased risk of renal dysfunction compared to those who also had a suprarenal clamp but lower BMI, shorter operative times and smaller aneurysm diameter.
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Hahl T, Kurumaa T, Uurto I, Protto S, Väärämäki S, Suominen V. The effect of suprarenal graft fixation during EVAR on short- and long-term renal function. J Vasc Surg 2022; 76:96-103.e1. [PMID: 35074412 DOI: 10.1016/j.jvs.2021.12.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The effect of suprarenal fixation (SR) compared to infrarenal fixation (IR) on renal function during endovascular aneurysm repair (EVAR) remains controversial. This study aims to compare the renal outcomes between fixation types in short- and long-term follow-up. METHODS Patients undergoing EVAR for infrarenal abdominal aortic aneurysm between 2005 and 2013 were included. Estimated glomerular filtration rate (eGFR) was measured at baseline and during a follow-up of 5 years. A decline in renal function was defined as a ≥ 20% decrease in eGFR. Changes in eGFR were compared between SR and IR groups at 1-7 days, 30 days, and 1-5 years postoperatively. Preoperative renal insufficiency was defined as eGFR < 60mL/min/1.73m2, and those patients were included in the subanalyses. RESULTS A total of 358 patients were included. Among these, 267 (74.6%) had SR and 91 (25.4%) had IR fixation. A decline in renal function occurred more commonly after SR than after IR in 1-7 days postoperatively (p = .009), but no difference was noticed at 30 days and 1-5 years. Regardless of the fixation method, renal function steadily decreased steadily over time after EVAR (estimate -3.13 per a year, 95% confidence interval -3.40- -2.85, p < .001). Patients with pre-existing renal insufficiency were included in subgroup analyses, and those with SR were more often found to have a decline in eGFR 5 years postoperatively than their counterparts with IR (59.5% vs 20.0%, p = .036). CONCLUSION An immediate postoperative decline in renal function was seen more often after SR fixation than IR fixation but this difference was transient. SR fixation is a safe method for patients with normal renal function. Long-term results seems to favor IR over SR in patients with pre-existing renal insufficiency.
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Affiliation(s)
- Tilda Hahl
- Centre for vascular surgery and interventional radiology, Tampere University Hospital, Central hospital, P.O. BOX 2000, FI-33521 Tampere, Finland.
| | - Tiiu Kurumaa
- Tampere University, FI-33014 Tampere University, Tampere, Finland
| | - Ilkka Uurto
- Centre for vascular surgery and interventional radiology, Tampere University Hospital, Central hospital, P.O. BOX 2000, FI-33521 Tampere, Finland; Tampere University, FI-33014 Tampere University, Tampere, Finland
| | - Sara Protto
- Centre for vascular surgery and interventional radiology, Tampere University Hospital, Central hospital, P.O. BOX 2000, FI-33521 Tampere, Finland
| | - Suvi Väärämäki
- Centre for vascular surgery and interventional radiology, Tampere University Hospital, Central hospital, P.O. BOX 2000, FI-33521 Tampere, Finland
| | - Velipekka Suominen
- Centre for vascular surgery and interventional radiology, Tampere University Hospital, Central hospital, P.O. BOX 2000, FI-33521 Tampere, Finland; Tampere University, FI-33014 Tampere University, Tampere, Finland
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11
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Özen A, Yılmaz M, Yiğit G, Civelek İ, Türkçü MA, Çetinkaya F, Ünal EU, İşcan HZ. Glasgow Aneurysm Score: a predictor of long-term mortality following endovascular repair of abdominal aortic aneurysm? BMC Cardiovasc Disord 2021; 21:551. [PMID: 34798809 PMCID: PMC8603579 DOI: 10.1186/s12872-021-02366-y] [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: 07/29/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the value of Glasgow Aneurysm Score (GAS) in predicting long-term mortality and survival in patients who have undergone endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). METHODS A retrospective single-center study of 257 patients with non-ruptured AAA undergoing EVAR between January 2013 and 2021. GAS scores were compared between the survivors (group 1) and the long-term mortality (group 2) groups. Cox regression analysis was used to determine independent predictors of late mortality. Receiver operating characteristic curve (ROC) analysis was used to determine the optimum cut-off values of GAS values to determine the effect on late-mortality. Survival analysis was conducted using Kaplan-Meier. RESULTS The study included 257 patients with a mean age of 69.75 ± 7.75 (46-92), who underwent EVAR due to AAA. Average follow up period was 18.98 ± 22.84 months (0-88). Fourty-five (17.8%) mortalities occured during long-term follow-up. A past medical history of cancer resulted in a 2.5 fold increase in risk of long-term mortality (OR: 2.52, 95% CI 1.10-5.76; p = 0.029). GAS values were higher in group 2 compared to group 1 (81.02 ± 10.33 vs. 73.73 ± 10.46; p < 0.001). The area under the ROC curve for GAS was 0.682 and the GAS cut-off value was 77.5 (specificity 64%, p < 0.001). The mortality rates in patients with GAS < 77.5 and GAS > 77.5 were: 12.8% and 24.8% respectively (p = 0.014). Every 10 point increase in GAS resulted in approximately a 2 fold increase in risk of long-term mortality (OR: 1.8, 95% CI 1.3-2.5; p < 0.001). Five year survival rates in patients with GAS < 77.5 and > 77.5 were 75.7% and 61.7%, respectively (p = 0.013). CONCLUSIONS The findings of our study suggests that an increase in GAS score may predict long-term mortality. In addition, the mortality rates in patients above the GAS cut-off value almost doubled compared to those below. Furthermore, the presence of a past history of cancer resulted in a 2.5 fold increase in long-term mortality risk. Addition of cancer to the GAS scoring system may be considered in future studies. Further studies are necessary to consolidate these findings.
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Affiliation(s)
- Anıl Özen
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Metin Yılmaz
- Department of Cardiovascular Surgery, VM Medicalpark Hospital, Ankara, Turkey
| | - Görkem Yiğit
- Department of Cardiovascular Surgery, Yozgat City Hospital, Yozgat, Turkey
| | - İsa Civelek
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Ali Türkçü
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ferit Çetinkaya
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ertekin Utku Ünal
- Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Hakkı Zafer İşcan
- Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
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Mylonas S, Behrens A, Dorweiler B. [Pro Endo: No Need for Open Any More... Surveillance is All Important]. Zentralbl Chir 2021; 146:464-469. [PMID: 34666361 DOI: 10.1055/a-1618-6913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Since its first report in 1991, endovascular aneurysm repair (EVAR) has become an established and preferred treatment modality for many patients. Several randomised controlled trials comparing EVAR and open repair have shown an early survival benefit, lower perioperative morbidity and shorter hospital stay with EVAR. As a result, EVAR has become the most common method of elective repair of BAAs in most vascular centres. Despite its widespread use, there are still subgroups of the patient population for whom the benefit of EVAR has not been clearly demonstrated. The most frequently discussed subgroup in this context is the patient with few risk factors - due to concerns about the durability and need of reinterventions. EVAR can provide durability and long-term survival similar to open repair in these younger patients, as long as the aneurysm anatomy and instructions for use are followed. The evidence on the effects of follow-up on patient survival is currently controversial. With increasing knowledge about the behavior of endoprostheses and factors that influence the complications of the endograft, changes in follow-up protocols have been made. A more patient-specific follow-up strategy and less compliance with a rigorous follow up scheme are required.
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Affiliation(s)
- Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
| | - Amelie Behrens
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
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Long J, Xie X, Xu D, Huang C, Liu Y, Meng X, Cai X, Fang X. Association Between Red Blood Cell Distribution Width-to-Albumin Ratio and Prognosis of Patients with Aortic Aneurysms. Int J Gen Med 2021; 14:6287-6294. [PMID: 34621131 PMCID: PMC8491781 DOI: 10.2147/ijgm.s328035] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Red blood cell distribution width (RDW) is a predictor of adverse outcomes in aortic aneurysms. Recent recommendations suggest that combining RDW with other biomarkers could yield better results. We, therefore, propose evaluating the biomarker of vascular aging, albumin with RDW to predict the risk of aortic aneurysms. This study aims to explore whether the combination of RDW with albumin can effectively predict the prognosis of aortic aneurysm patients. Methods This retrospective cohort study was conducted among adults (age >18) with aortic aneurysms in the Medical Information Mart for Intensive Care Database III V1.4 (MIMIC-III). RAR was measured according to the red blood cell distribution width and albumin. The primary outcome was the 30-day mortality rate, and the secondary outcome was the 90-day and one-year mortality rates. Estimation of hazard ratios (HR) was obtained from Cox regression models for all-cause mortality related to red cell distribution width-to-albumin ratio (RAR) values. Results In total, 312 patients were involved, with an average age of 74.9 ± 10.9 years and an average RAR value of 5.4 ± 1.6 mL/g. In 30 days for all-cause mortality, the HR (95% CI) in the highest RAR group (>5.8 mL/g) in tertiles was 2.54 (1.25, 5.14) in the unadjusted model, with a significant difference compared with the reference group (P < 0.05). After adjusting for race, gender and age, there was still a correlation (P < 0.05), and the HR (95% CI) was 2.51 (1.23, 5.10). Further adjustment of possible covariates showed similar correlation in model 3 (P < 0.05), and HR (95% CI) was 2.66 (1.17, 6.01). Multivariable logistic regression shows that RAR is an independent risk factor for the outcome of aortic aneurysms after adjusting the covariates. In the subgroup analysis, we analyzed the patient’s complications, and no significant interaction was observed. Conclusion RAR is a risk factor for patients with aortic aneurysms. However, more in-depth research is warranted to further analyze and substantiate our findings on the role of RAR in aortic aneurysm patients.
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Affiliation(s)
- Jianyun Long
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Xupin Xie
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Dong Xu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Changpin Huang
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Yongchang Liu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Xiaohu Meng
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Xuchao Cai
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Xin Fang
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, ZheJiang University School of Medicine, Hangzhou, Zhejiang, 310014, People's Republic of China
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Tsolakis IA, Kakkos SK, Papageorgopoulou CP, Papadoulas S, Lampropoulos G, Fligou F, Nikolakopoulos KM, Ntouvas I, Kouri A. Predictors of Operative Mortality of 928 Intact Aortoiliac Aneurysms. Ann Vasc Surg 2020; 71:370-380. [PMID: 32890639 DOI: 10.1016/j.avsg.2020.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study is to identify preoperative and intraoperative factors associated with in-hospital mortality of intact abdominal aortoiliac aneurysm repair. METHODS In this observational study, prospectively collected information included demographics, risk factors, comorbidities, aneurysm characteristics (including special aneurysm presentation, i.e., inflammatory, mycotic/infected, aortocaval fistula), investigations, and operative variables. Receiver operating characteristic) curve analysis of the Glasgow aneurysm score (GAS) and the Vascular Study Group of New England (VSGNE) score was performed in the subgroup of bland aneurysms undergoing isolated elective repair. RESULTS A total of 928 cases with intact aortoiliac aneurysms had an elective (n = 882) or urgent (n = 46) repair, associated with an in-hospital mortality of 1.7% and 8.7%, respectively (P = 0.01). Open repair (n = 514) was a predictor of higher mortality (3.3% vs. 0.5% for endovascular aneurysm repair [EVAR], n = 414, odds ratio [OR] 7.1, P = 0.003), and so was the pre-EVAR era (4.8% vs. 1.3% in the EVAR era, OR 4.0, P = 0.004). Other significant predictors included the presence of abdominal/back pain (7.5% vs. 1.3%, OR = 6.0, P = 0.001), preoperative angiography (7% vs. 1.6%, OR = 4.5, P = 0.01), special aneurysm presentation (10.9% vs. 1.5%, OR = 8.1, P < 0.001), concomitant major procedures (19% vs. 1.7%, OR = 14.0, P < 0.001), serious intraoperative complications (9.1% vs. 1.5%, OR = 6.6, P = 0.001), median number of transfused units of blood intraoperatively (2 and 0 for cases with and without mortality, respectively, P < 0.001), and procedure duration (270 and 150 min for cases with and without mortality, respectively, P < 0.001). Open repair (OR = 4.5, P = 0.05), special aneurysm presentation (OR = 6.58, P = 0.001), and concomitant major procedures (OR = 14.3, P < 0.001) were independent predictors of higher mortality. ROC curve analysis for the GAS (P = 0.87) and VSGNE score (P = 0.10) failed to demonstrate statistical significance in the subgroup of bland aneurysms undergoing isolated elective repair. CONCLUSIONS Our study has demonstrated independent risk factors for mortality, which should be considered when contemplating aortoiliac aneurysm repair. We failed to externally validate the GAS and VSGNE score.
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Affiliation(s)
- Ioannis A Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | | | - Spyros Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Lampropoulos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras Medical School, Patras, Greece
| | | | - Ioannis Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Anastasia Kouri
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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Wanken ZJ, Barnes JA, Trooboff SW, Columbo JA, Jella TK, Kim DJ, Khoshgowari A, Riblet NB, Goodney PP. A systematic review and meta-analysis of long-term reintervention after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2020; 72:1122-1131. [DOI: 10.1016/j.jvs.2020.02.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/03/2020] [Indexed: 01/12/2023]
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16
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Yanquez FJ, Peterson A, Weinkauf C, Goshima KR, Zhou W, Mohler J, Ehsani H, Toosizadeh N. Sensor-Based Upper-Extremity Frailty Assessment for the Vascular Surgery Risk Stratification. J Surg Res 2020; 246:403-410. [DOI: 10.1016/j.jss.2019.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/14/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023]
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CÓDIGO ANEURISMA ¿UNA REALIDAD NECESARIA? ANGIOLOGIA 2019. [DOI: 10.20960/angiologia.00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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18
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Khashram M, Kvizhinadze G, Khashram Z, Williman JA, Jones GT, Roake JA. Development and Validation of a Predictive Model to Aid in the Management of Intact Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2018; 56:48-56. [DOI: 10.1016/j.ejvs.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/10/2018] [Indexed: 11/30/2022]
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Garland BT, Danaher PJ, Desikan S, Tran NT, Quiroga E, Singh N, Starnes BW. Preoperative risk score for the prediction of mortality after repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2018; 68:991-997. [PMID: 29753581 DOI: 10.1016/j.jvs.2017.12.075] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/22/2017] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Even in the ruptured endovascular aneurysm repair first era, there are still patients who will not survive their ruptured abdominal aortic aneurysm (rAAA). All previously published mortality risk scores include intraoperative variables and are not helpful with the decision to operate or in providing preoperative patient and family counseling. The purpose of this study was to develop a practical preoperative risk score to predict mortality after repair of rAAA. METHODS Data of all patients with rAAA presenting between January 1, 2002, and October 31, 2013, were collected. Logistic regression was used to evaluate predictive variables both univariately and jointly, and the results of multivariate models guided the definition of the final simplified scoring algorithm. RESULTS There were 303 patients who presented during the study period. Sixteen patients died in the emergency department, en route to surgery, or after choosing comfort care. Preoperative variables most predictive of mortality were age >76 years (odds ratio [OR], 2.11; confidence interval [CI], 1.47-4.97; P = .011), creatinine concentration >2.0 mg/dL (OR, 3.66; CI, 1.85-7.24; P < .001), pH <7.2 (OR, 2.58; CI, 1.27-5.24; P = .009), and systolic blood pressure ever <70 mm Hg (OR, 2.70; CI, 1.46-4.97; P = .002). Assigning 1 point for each variable, patients were stratified according to the preoperative rAAA mortality risk score (range, 0-4). For all repairs, at 30 days, patients with 1 point suffered 22% mortality; 2 points, 69% mortality; and 3 points, 80% mortality. All patients with 4 points died. There was a mortality benefit for ruptured endovascular aneurysm repair across all categories. CONCLUSIONS Our rAAA mortality risk score is based on four variables readily assessed in the emergency department and allows accurate prediction of 30-day mortality after repair of rAAAs. It also has a direct impact on clinical decision-making by adding prognostic information to the decision to transfer patients to tertiary care centers and aiding in preoperative discussions with patients and their families.
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Affiliation(s)
| | - Patrick J Danaher
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, Wash
| | - Sarasi Desikan
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, Wash
| | - Nam T Tran
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, Wash
| | - Elina Quiroga
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, Wash
| | - Niten Singh
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, Wash
| | - Benjamin W Starnes
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, Wash
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Schnitzbauer M, Güntner O, Wohlgemuth WA, Zeman F, Haimerl M, Stroszczynski C, Müller-Wille R. CT after Endovascular Repair of Abdominal Aortic Aneurysms: Diagnostic Accuracy of Diameter Measurements for the Detection of Aneurysm Sac Enlargement. J Vasc Interv Radiol 2018; 29:178-187.e3. [DOI: 10.1016/j.jvir.2017.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 11/26/2022] Open
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Low total psoas area as scored in the clinic setting independently predicts midterm mortality after endovascular aneurysm repair in male patients. J Vasc Surg 2018; 67:460-467. [DOI: 10.1016/j.jvs.2017.06.085] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 06/04/2017] [Indexed: 01/06/2023]
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22
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Neilson M, Healey C, Clark D, Nolan B. External Validation of a Rapid Ruptured Abdominal Aortic Aneurysm Score. Ann Vasc Surg 2017; 46:162-167. [PMID: 28887244 DOI: 10.1016/j.avsg.2017.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/15/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Rapid Ruptured Abdominal Aortic Aneurysm Score (RrAAAS) was developed from Vascular Study Group of New England (VSGNE) data (649 ruptured abdominal aortic aneurysm (rAAA) patients, repaired both open and endovascularly), using preoperative age, creatinine, and blood pressure. This study validates that model using the larger National Vascular Quality Initiative (VQI) data set and compares its performance to previous models. METHODS The VQI registry was queried for patients undergoing rAAA repair from 2006 to 2016. The performance of our original model, RrAAAS, was tested on this data set excluding VSGNE patients (VQI minus VSGNE), and its performance was then compared to the performance of the Glasgow Aneurysm Score (GAS) and Edinburgh Ruptured Aneurysm Score (ERAS). RESULTS VQI contained 2,704 eligible patients, of which 715 had been contributed by VSGNE. The discrimination of RrAAAS was similar to GAS or ERAS (area under a receiver operator characteristic curve = 0.66). Neither GAS nor ERAS provides a direct prediction of mortality; observed mortality in the VQI minus VSGNE cohort tended to be somewhat lower than predictions of the original RrAAAS. A recalibrated equation predicting the percent mortality was Mortality (%) = 16 + 12*(age > 76) + 8*(creatinine > 1.5) + 20*(systolic blood pressure < 70). CONCLUSIONS The previously described RrAAAS has similar discrimination as the GAS and ERAS, is easier to obtain in an emergency setting, and has been recalibrated to reflect the experience of a large national sample. The RrAAAS could be useful for clinicians caring for these patients and could be used for risk adjustment when comparing regional differences in mortality associated with rAAA repair.
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Kaladji A, Daoudal A, Duménil A, Göksu C, Cardon A, Clochard E, Lucas A, Lalys F. Predictive Models of Complications after Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2016; 40:19-27. [PMID: 27903486 DOI: 10.1016/j.avsg.2016.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The risk of long-term complications after endovascular aneurysm repair (EVAR) is still higher than open surgery and is a critical issue. This study aims to make available reliable statistical predictive models of complications after EVAR. METHODS Two hundred and thirteen patients who underwent EVAR between 2002 and 2012 were included in this study. The preoperative computed tomography scans were analyzed with a dedicated workstation to provide spatially correct 3-dimensional data. Age, gender, operation-related factors, and 21 morphologic variables were measured and included in the analyses. Five postoperative outcomes were studied. After an initial selection of predictors based on univariate analysis, binomial logistic regression models were proposed for each outcome. The ability to predict each outcome was assessed with receiver operating characteristic curves considering that an area under the curve (AUC) > 0.70 is generally considered sufficiently accurate. RESULTS The mean age was 74.8 ± 8.6 years with a mean follow-up of 43.8 ± 22.1 months. Respectively, rates and risk factors of each outcome were 25.3% (n = 51) for abdominal aortic aneurysm (AAA) enlargement (age, number of patent sac branches, iliac calcifications and tortuosity, aneurysmal thrombus), 7% (n = 15) for type IA endoleak (neck calcification and AAA diameter), 3.7% (n = 8) for type IB endoleak (iliac tortuosity, AAA diameter, neck thrombus), 19.8% (n = 40) for type II endoleak (female, number of patent sac branches), and 25.9% (n = 55) for reintervention from any cause (neck calcification). The risk associated to each outcome can be calculated with a combination of these different preoperative variables. AUC for each outcome were 79.6% for AAA enlargement, 70.4% for reintervention, 81.3% for type IA endoleak, 92.3% for type IB endoleak, 70.6% for type II endoleak. CONCLUSIONS This study shows that an exhaustive description of the preoperative anatomy before EVAR is a powerful and reliable tool to predict the risk of developing the most common complications after EVAR.
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Affiliation(s)
- Adrien Kaladji
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France; INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France.
| | - Anne Daoudal
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France; INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
| | - Aurélien Duménil
- INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
| | | | - Alain Cardon
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France
| | - Elodie Clochard
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France
| | - Antoine Lucas
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France; INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
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Buijs RVC, Zeebregts CJ, Willems TP, Vainas T, Tielliu IFJ. Endograft Sizing for Endovascular Aortic Repair and Incidence of Endoleak Type 1A. PLoS One 2016; 11:e0158042. [PMID: 27359115 PMCID: PMC4928836 DOI: 10.1371/journal.pone.0158042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/09/2016] [Indexed: 11/18/2022] Open
Abstract
Objective In endovascular aortic aneurysm repair (EVAR), proximal type 1A endoleaks can occur as a result of hostile neck anatomy or over- or undersizing of the endograft. As the current standard is based on the diameter or average of the short and long axes in a central lumen reconstruction image, it can falter in irregularly shaped aortic necks. An alternative method is circumference-based, therefore minimizing the measurement error. In this study we aimed to assess the degree of discrepancy between both methods and the association of this discrepancy with the occurrence of endoleak type 1A. Methods All patients with early (<30 days post-operative) endoleak type 1A after elective EVAR at our center between 2004 and 2016 were identified for a retrospective case-control study. Control patients were matched based on hostile neck anatomy, such as calcification, thrombus, reverse taper, and β-angulation. The aortic neck diameter was measured using the traditional, diameter-based method as well as an alternative method, based on the circumference of the aortic neck. Results In 482 EVAR patients, 18 early endoleak type 1A cases were found (3.9%). After exclusion, 12 cases remained and 48 matching controls were found. No significant differences were found between the two measuring methods at any level below the renal arteries. The inter-observer variability was significant for the D(mean) (0.4 ± 1.69 mm, P = .02) and was larger than the D(circ) method (-0.1 ± 1.03 mm, P = .35). In only four out of 12 cases the endograft size was 10–20% larger than the D(mean) and D(circ) measurements. The differences between the diameter of the D(mean) and D(circ) and the chosen endograft were smaller for the case group (-8 ± 25.6% and -7 ± 24%) than for the control group. (-12.4 ± 12.4% and -11 ± 10.7%). Conclusion The difference between the D(mean) and D(circ) methods for aortic neck measurement was not large enough to play a significant role in the incidence of endoleak type 1A. Inadequate oversizing and considerable β-angulation of the aortic neck may have been the cause of endoleak type 1A in this population. Robust and well-investigated sizing methods are paramount for accurate endograft sizing and prevention of endoleak type 1A. Therefore the lack of studies in this field and a sizeable inter-observer variability do not justify the widespread reliance on the traditional diameter-based methods for endograft sizing.
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Affiliation(s)
- Ruben V. C. Buijs
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Tineke P. Willems
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tryfon Vainas
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Ignace F. J. Tielliu
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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Kolh P, De Hert S, De Rango P. The Concept of Risk Assessment and Being Unfit for Surgery. Eur J Vasc Endovasc Surg 2016; 51:857-66. [PMID: 27053098 DOI: 10.1016/j.ejvs.2016.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
The concept of risk assessment and the identification of surgical unfitness for vascular intervention is a particularly controversial issue today as the minimally invasive surgical population has increased not only in volume but also in complexity (comorbidity profile) and age, requiring an improved pre-operative selection and definition of high risk. A practical step by step (three steps, two points for each) approach for surgical risk assessment is suggested in this review. As a general rule, the identification of a "high risk" patient for vascular surgery follows a step by step process where the risk is clearly defined, quantified (when too "high"?), and thereby stratified based on the procedure, the patient, and the hospital, with the aid of predictive risk scores. However, there is no standardized, updated, and objective definition for surgical unfitness today. The major gap in the current literature on the definition of high risk in vascular patients explains the lack of sound validated predictive systems and limited generalizability of risk scores in vascular surgery. In addition, the concept of fitness is an evolving tool and many traditional high risk criteria and definitions are no longer valid. Given the preventive purpose of most vascular procedures performed in elderly asymptomatic patients, the decision to pursue or withhold surgery requires realistic estimates not only regarding individual peri-operative mortality, but also life expectancy, healthcare priorities, and the patient's primary goals, such as prolongation of life versus maintenance of independence or symptom relief. The overall "frailty" and geriatric risk burden, such as cognitive, functional, social, and nutritional status, are variables that should be also included in the analyses for stratification of surgical risk in elderly vascular patients.
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Affiliation(s)
- P Kolh
- Cardiovascular Surgery Department, University Hospital (CHU, ULg) of Liège, Belgium.
| | - S De Hert
- Department of Anesthesiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - P De Rango
- Unit of Vascular Surgery, Hospital S.M. Misericordia, Perugia, Italy
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Majd P, Mylonas S, Gawenda M, Brunkwall J. External Validation of Risk Stratification Models Predicting the Immediate Mortality After Open Repair of Ruptured AAA. World J Surg 2016; 40:1771-7. [PMID: 26913734 DOI: 10.1007/s00268-016-3461-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preoperative risk stratification of the immediate postoperative death after surgery may be helpful for the decision-making for patients with ruptured AAAs (rAAs). The purpose of this study was to apply and validate the Glasgow aneurysm score (GAS) and the Hardman Index (HI) in predicting 30-day/in-hospital mortality in open surgical repair (OSR) and endovascular repair (rEVAR) of rAAAs. METHODS We conducted a retrospective review of a prospectively created database including all patients with a rAAA referred to our Institution between August 1998 and December 2014. Primary outcome was 30-day/in-hospital mortality. Multivariate logistic regression analysis was used to identify independent risk factors. The receiver-operator characteristic curve was used to determine the value of the HI and GAS in predicting 30-day/in-hospital death. RESULTS A total of 150 patients (130 patients received OSR, 20 patients rEVAR) were included in our analysis. The 30-day/in-hospital mortality was 34.0 % for the entire cohort: 36.15 % for OSR group and 20.0 % for rEVAR group (p 0.210). A multivariate analysis in the OSR group evidenced that unconsciousness was a statistically significant [adjusted odds ratio (OR) 8.00] predictor of 30-day/in-hospital mortality. The mean GAS was 86.9 ± 16.1 for the OSR group and 88.1 ± 11.2 for the rEVAR group (p 0.773). The AUC for GAS was 0.805 among OSR patients and 0.975 among rEVAR patients. The mean HI in the OSR group was 1.11 ± 1.0 and the AUC for HI was 0.82. CONCLUSIONS Surgical repair of rAAAs is still associated with a considerable mortality rate. We confirmed the great discriminative ability of GAS in patients with rAAAs treated with OSR. With regard to HI, this scoring system could accurately predict early mortality after OSR in our cohort but failed to identify patients at highest risk for postoperative mortality.
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Affiliation(s)
- Payman Majd
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Michael Gawenda
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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Hale AL, Twomey K, Ewing JA, Langan EM, Cull DL, Gray BH. Impact of sarcopenia on long-term mortality following endovascular aneurysm repair. Vasc Med 2016; 21:217-22. [DOI: 10.1177/1358863x15624025] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sarcopenia, also known as a reduction of skeletal muscle mass, is a patient-specific risk factor for vascular and cancer patients. However, there are no data on abdominal aortic aneurysm (AAA) patients treated with endovascular aneurysm repair (EVAR) who have sarcopenia. To determine the impact of sarcopenia on mortality following EVAR, we retrospectively reviewed 200 patients treated with EVAR by estimating muscle mass on abdominal computed tomography (CT) scans. Mortality was analyzed according to its presence ( n=25) or absence ( n=175). Sarcopenia was more common in women than men (32.0% vs 9.7%; p=0.005). Patients with sarcopenia had an increased risk of mortality compared to those without (76% vs 48%; p=0.016). Of note, the overall mortality rate was 51% with a median follow up of 8.4 years (interquartile range, 5.3–11.7). In conclusion, the presence of sarcopenia on a CT scan is an important predictor of long-term mortality in patients treated for AAA with EVAR. Pending further study, these data suggest that sarcopenia may aid in pre-procedural long-term survival assessment of patients undergoing EVAR.
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Affiliation(s)
- Allyson L Hale
- Department of Surgery, Vascular Medicine Division, Greenville Health System, Greenville, SC, USA
| | - Kayla Twomey
- Department of Surgery, Vascular Medicine Division, Greenville Health System, Greenville, SC, USA
| | - Joseph A Ewing
- Department of Surgery, Vascular Medicine Division, Greenville Health System, Greenville, SC, USA
| | - Eugene M Langan
- Department of Surgery, Vascular Medicine Division, Greenville Health System, Greenville, SC, USA
| | - David L Cull
- Department of Surgery, Vascular Medicine Division, Greenville Health System, Greenville, SC, USA
| | - Bruce H Gray
- Department of Surgery, Vascular Medicine Division, Greenville Health System, Greenville, SC, USA
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Hinchliffe RJ, Earnshaw JJ. Vascular interventions in the elderly. Br J Surg 2016; 103:e16-8. [DOI: 10.1002/bjs.10043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/08/2022]
Abstract
Overused?
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Affiliation(s)
- R J Hinchliffe
- St George's Vascular Institute, St George's Hospital, London
| | - J J Earnshaw
- Department of Vascular Surgery, Cheltenham General Hospital, Sandford Road, Cheltenham GL53 7AN, UK (e-mail: )
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Dover M, Tawfick W, Hynes N, Sultan S. Evaluation of illness severity scoring systems and risk prediction in vascular intensive care admissions. Vascular 2015; 24:390-403. [PMID: 26482428 DOI: 10.1177/1708538115604089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study examines the predictive value of intensive care unit (ICU) scoring systems in a vascular ICU population. METHODS From April 2005 to September 2011, we examined 363 consecutive ICU admissions. Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE IV, Multiple Organ Dysfunction Score (MODS), organ dysfunctions and/or infection (ODIN), mortality prediction model (MPM) and physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM) were calculated. The Glasgow Aneurysm Score (GAS) was calculated for patients with aneurysm-related admissions. RESULTS Overall mortality for complex vascular intervention was 11.6%. At admission, the areas under the receiver operating characteristic curve (AUCs) was 0.884 for SAPS II, 0.894 for APACHE II, 0.895 for APACHE IV, 0.902 for MODS, 0.891 for ODIN and 0.903 for MPM. At 24 h, model discrimination was best for POSSUM (AUC = 0.906) and MPM (AUC = 0.912). CONCLUSION The good discrimination of these scoring systems indicates their value as an adjunct to clinical assessment but should not be used on an individual basis as a clinical decision-making tool.
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Affiliation(s)
- M Dover
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, National University of Ireland, Galway, Republic of Ireland
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, Galway Clinic, Galway, Republic of Ireland
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, National University of Ireland, Galway, Republic of Ireland Department of Vascular and Endovascular Surgery, Galway Clinic, Galway, Republic of Ireland
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Kim JT, Kim MJ, Han Y, Choi JY, Ko GY, Kwon TW, Cho YP. A new risk-scoring model for predicting 30-day mortality after repair of abdominal aortic aneurysms in the era of endovascular procedures. Ann Surg Treat Res 2015; 90:95-100. [PMID: 26878017 PMCID: PMC4751151 DOI: 10.4174/astr.2016.90.2.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/16/2015] [Accepted: 09/30/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To propose a new, multivariable risk-scoring model for predicting 30-day mortality in individuals underwent repair of abdominal aortic aneurysms (AAA). Methods Four hundred eighty-five consecutive patients who underwent AAA repair from January 2000 to December 2010 were included in the study. Univariate and multivariate analyses were performed to evaluate the risk factors, and a risk-scoring model was developed. Results Multivariate analysis identified three independent preoperative risk factors associated with mortality, and a risk-scoring model was created by assigning an equal value to each factor. The independent predictors were location of the AAA, rupture of AAA, and preoperative pulmonary dysfunction. The multivariable regression model demonstrated moderate discrimination (c statistic, 0.811) and calibration (Hosmer-Lemeshow test, P = 0.793). The observed mortality rate did not differ significantly from that predicted by our risk-scoring model. Conclusion Our risk-scoring model has excellent ability to predict 30-day mortality after AAA repair, and awaits validation in further studies.
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Affiliation(s)
- Jihoon T Kim
- Department of Trauma and Vascular Surgery, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Min-Ju Kim
- Biostatistics Collaboration Unit, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngjin Han
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yoon Choi
- 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
| | - Tae-Won Kwon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Pil Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Blanes Ortí P, Miralles Hernández M, Merino Mairal O, Barjau Urrea E, Leiva Hernando L, Gálvez Núñez L. Comparación de modelos de riesgo para reparación endovascular y abierta por rotura de aneurisma aórtico abdominal. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Knops A, Goossens A, Ubbink D, Balm R, Koelemay M, Vahl A, de Nie A, van den Akker P, Willems M, Koedam N, de Haes J, Bossuyt P, Legemate D. A Decision Aid Regarding Treatment Options for Patients with an Asymptomatic Abdominal Aortic Aneurysm: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg 2014; 48:276-83. [DOI: 10.1016/j.ejvs.2014.04.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/15/2014] [Indexed: 01/27/2023]
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Moulakakis KG, Dalainas I, Kakisis J, Mylonas S, Liapis CD. Endovascular Treatment versus Open Repair for Abdominal Aortic Aneurysms: The Influence of Fitness in Decision Making. Int J Angiol 2014; 22:9-12. [PMID: 24436578 DOI: 10.1055/s-0033-1333868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Two methods of repair are currently available for an abdominal aortic aneurysm (AAA), open aneurysm repair and endovascular aneurysm repair (EVAR). The decision making depends on the balance of risks and benefits. The treating physician must take into account the patient's life expectancy, the patient's fitness, the anatomic suitability that makes endovascular repair possible, and finally the patient's preference. The patient's fitness is an important variable predicting the outcome of AAA surgical reconstruction. The hypothesis is that the impact of risk factors upon perioperative mortality might differ between patients undergoing open repair and endovascular repair. The purpose of this review article is to investigate whether fitter patients with a large AAA benefit more from having endovascular rather than open repair. According to the available data, there is emerging evidence that patients at high medical risk for open repair may benefit from EVAR while in low risk patients with suitable anatomy for EVAR, both techniques have similar effects. There is rising evidence that a patient with ruptured AAA would benefit more from an endovascular procedure if eligible, and thus fitness in such emergencies is not the first priority but anatomical suitability for EVAR.
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Affiliation(s)
| | - Ilias Dalainas
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
| | - Spyridon Mylonas
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
| | - Christos D Liapis
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
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Tadros RO, Faries PL, Ellozy SH, Lookstein RA, Vouyouka AG, Schrier R, Kim J, Marin ML. The impact of stent graft evolution on the results of endovascular abdominal aortic aneurysm repair. J Vasc Surg 2014; 59:1518-27. [DOI: 10.1016/j.jvs.2014.01.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/03/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
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Paravastu SCV, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev 2014; 2014:CD004178. [PMID: 24453068 PMCID: PMC10749584 DOI: 10.1002/14651858.cd004178.pub2] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND An abnormal dilatation of the abdominal aorta is referred to as an abdominal aortic aneurysm (AAA). Due to the risk of rupture, surgical repair is offered electively to individuals with aneurysms greater than 5.5 cm in size. Traditionally, conventional open surgical repair (OSR) was considered the first choice approach. However, over the past two decades endovascular aneurysm repair (EVAR) has gained popularity as a treatment option. This article intends to review the role of EVAR in the management of elective AAA. OBJECTIVES To assess the effectiveness of EVAR versus conventional OSR in individuals with AAA considered fit for surgery, and EVAR versus best medical care in those considered unfit for surgery. This was determined by the effect on short, intermediate and long-term mortality, endograft related complications, re-intervention rates and major complications. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (January 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12). The TSC also searched trial databases for details of ongoing or unpublished studies. SELECTION CRITERIA Prospective randomised controlled trials (RCTs) comparing EVAR with OSR in individuals with AAA considered fit for surgery. and comparing EVAR with best medical care in individuals considered unfit for surgery. We excluded studies with inadequate data or using an inadequate randomisation technique. DATA COLLECTION AND ANALYSIS Three reviewers independently evaluated trials for appropriateness for inclusion and extracted data using pro forma designed by the Cochrane PVD Group. We assessed the quality of trials using The Cochrane Collaboration's 'Risk of bias' tool. We entered collected data in to Review Manager (version 5.2.3) for analysis. Where direct comparisons could be made, we determined odds ratios (OR). We tested studies for heterogeneity and, when present, we used a random-effects model; otherwise we used a fixed-effect model. We tabulated data that could not be collated. MAIN RESULTS Four high-quality trials comparing EVAR with OSR (n = 2790) and one high-quality trial comparing EVAR with no intervention (n = 404) fulfilled the inclusion criteria. In individuals considered fit for surgery, a pooled analysis, including 1362 individuals randomised to EVAR and 1361 randomised to OSR, found short-term mortality (including 30-day or inhospital mortality, excluding deaths prior to intervention) with EVAR to be significantly lower than with OSR (1.4% versus 4.2%, OR 0.33, 95% confidence interval (CI) 0.20 to 0.55; P < 0.0001). Using intention-to-treat analysis (ITT) there was no significant difference in mortality at intermediate follow-up (up to four years from randomisation), with 221 (15.8%) and 237 (17%) deaths in the EVAR (n = 1393) and OSR (n = 1390) groups, respectively (OR 0.92, 95% CI 0.75 to 1.12; P = 0.40). There was also no significant difference in long-term mortality (beyond four years), with 464 (37.3%) deaths in the EVAR and 470 (37.8%) deaths in the OSR group (OR 0.98, 95% CI 0.83 to 1.15; P = 0.78). Similarly, there was no significant difference in aneurysm-related mortality between groups, either at the intermediate- or long-term follow up.Studies showed that both EVAR and OSR were associated with similar incidences of cardiac deaths (OR 1.14, 95% CI 0.86 to 1.52; P = 0.36) and fatal stroke rate (OR 0.81, 95% CI 0.42 to 1.55; P = 0.52). The long-term reintervention rate was significantly higher in the EVAR group than in the OSR group (OR 1.98, 95% CI 1.12 to 3.51; P = 0.02; I(2) = 85%). Results of the reintervention analysis should be interpreted with caution due to significant heterogeneity. Operative complications, health-related quality of life and sexual dysfunction were generally comparable between the EVAR and OSR groups. However, there was a slightly higher incidence of pulmonary complications in the OSR group compared with the EVAR group (OR 0.36, 95% CI 0.17 to 0.75; P = 0.006).In individuals considered unfit for conventional OSR, the one included trial found no difference between the EVAR and no-intervention groups with regard to all-cause mortality at final follow up, with 21.0 deaths per 100 person-years in the EVAR group and 22.1 deaths per 100 person years in the no-intervention group (adjusted hazard ratio (HR) with EVAR 0.99, 95% CI 0.78 to 1.27; P = 0.97). Aneurysm-related deaths were, however, significantly higher in the no-intervention group than in the EVAR group (adjusted HR 0.53, 95% CI 0.32 to 0.89; P = 0.02). There was no difference in myocardial events (HR 1.07, 95% CI 0.60 to 1.91) between the groups in this study. AUTHORS' CONCLUSIONS In individuals considered fit for conventional surgery, EVAR was associated with lower short-term mortality than OSR. However, this benefit from EVAR did not persist at the intermediate- and long-term follow ups. Individuals undergoing EVAR had a higher reintervention rate than those undergoing OSR. Most of the reinterventions undertaken following EVAR, however, were catheter-based interventions associated with low mortality. Operative complications, health-related quality of life and sexual dysfunction were generally comparable between EVAR and OSR. However, there was a slightly higher incidence of pulmonary complications in the OSR group than in the EVAR group.In individuals considered unfit for open surgery, the results of a single trial found no overall short- or long-term benefits of EVAR over no intervention with regard to all-cause mortality, but individuals may differ and individual preferences should always be taken into account.
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Affiliation(s)
| | - Rubaraj Jayarajasingam
- Northern General HospitalDepartment of Clinical RadiologyHerries RoadSheffieldSouth YorkshireUKS5 7AU
| | - Rachel Cottam
- Sheffield Teaching Hospital NHS Foundation TrustVascular AngiographyHerries RoadSheffieldSouth YorkshireUKS5 7AU
| | - Simon J Palfreyman
- Sheffield Teaching Hospitals NHS Foundation TrustTissue ViabilityNorthern General HospitalSheffieldUKS5 7AU
| | - Jonathan A Michaels
- University of Sheffield, ScHARRSchool of Health and Related ResearchRegent Court, Regent StreetSheffieldUKS1 4DA
| | - Steven M Thomas
- Northern General HospitalSheffield Vascular InstituteHerries RoadSheffieldUKS5 7AU
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Nessvi S, Gottsäter A, Acosta S. Comparable mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and endovascular aneurysm repair for abdominal aortic aneurysm. SAGE Open Med 2014; 2:2050312113519986. [PMID: 26770700 PMCID: PMC4607194 DOI: 10.1177/2050312113519986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/04/2013] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate mid-term survival in patients undergoing elective fenestrated
endovascular aneurysm repair and standard endovascular aneurysm repair for
abdominal aortic aneurysm. Methods: Consecutive patients treated from 2007 to 2011 with elective fenestrated
endovascular aneurysm repair (n = 81) and endovascular aneurysm repair (n =
201) were evaluated concerning age, cardiovascular medication,
comorbidities, and mid-term mortality. Results: Patients in the elective fenestrated endovascular aneurysm repair group were
younger than the endovascular aneurysm repair group (p = 0.006). In
comparison with the endovascular aneurysm repair group, a lower proportion
of patients in the elective fenestrated endovascular aneurysm repair group
had diabetes (p = 0.013) and anemia (p = 0.003), and a higher proportion had
arterial hypertension (p = 0.009). When entering age, endovascular aneurysm
repair or fenestrated endovascular aneurysm repair operation, diabetes,
anemia, and hypertension in a Cox regression model, only age (hazard ratio:
1.07; 95% confidence interval: 1.03–1.11; p < 0.001) was a
risk factor for mid-term mortality. Conclusion: Careful patient selection and medical optimization resulted in comparable
mid-term survival in patients undergoing elective fenestrated endovascular
aneurysm repair and endovascular aneurysm repair.
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Affiliation(s)
- Sofia Nessvi
- Vascular Center Malmö-Lund, Skåne
University Hospital, Malmö, Sweden
| | - Anders Gottsäter
- Vascular Center Malmö-Lund, Skåne
University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Vascular Center Malmö-Lund, Skåne
University Hospital, Malmö, Sweden
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van Beek SC, Blankensteijn JD, Balm R. Validation of three models predicting in-hospital death in patients with an abdominal aortic aneurysm eligible for both endovascular and open repair. J Vasc Surg 2013; 58:1452-1457.e1. [DOI: 10.1016/j.jvs.2013.05.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/17/2013] [Accepted: 05/24/2013] [Indexed: 11/15/2022]
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de Bruin JL, Vervloet MG, Buimer MG, Baas AF, Prinssen M, Blankensteijn JD. Renal function 5 years after open and endovascular aortic aneurysm repair from a randomized trial. Br J Surg 2013; 100:1465-70. [DOI: 10.1002/bjs.9280] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Deterioration of renal function after major vascular surgery is an important complication, and may vary between patients undergoing endovascular (EVAR) or open surgical (OR) repair of an abdominal aortic aneurysm (AAA). The objective was to determine the impact of OR and EVAR on renal function after 5 years.
Methods
This was a post hoc analysis of data collected prospectively from the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial. Five years after surgery, creatinine levels were available for 189 patients (94 after OR and 95 after EVAR). The severity of renal disease was staged using the chronic kidney disease classification of the US National Kidney Foundation clinical guidelines.
Results
Using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the estimated glomerular filtration rate (eGFR) for the entire group declined over time, with a mean(s.d.) preoperative value of 80·0(7·6) ml per min per 1·73 m2 compared with 75·7(9·7) ml per min per 1·73 m2 after 5 years (mean difference 4·2 (95 per cent confidence interval 3·2 to 5·3) ml per min per 1·73 m2; P < 0·001). Five years after surgery, the mean eGFR (CKD-EPI equation) was not significantly different between the OR and EVAR groups: 76·3(9·3) versus 75·1(10·0) ml per min per 1·73 m2 (mean difference 1·2 (−1·6 to 3·9) ml per min per 1·73 m2; P = 0·410).
Conclusion
Renal function 5 years after OR and EVAR for AAA was similar. Neither surgical procedure accelerated the loss of renal function. Registration number: NCT00421330 (http://www.clinicaltrials.gov).
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Affiliation(s)
| | - J L de Bruin
- Division of Vascular Surgery, Department of Surgery, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
| | - M G Vervloet
- Department of Nephrology, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
| | - M G Buimer
- Division of Vascular Surgery, Department of Surgery, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
| | - A F Baas
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Prinssen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J D Blankensteijn
- Division of Vascular Surgery, Department of Surgery, VU University Medical Centre, Amsterdam, Utrecht, The Netherlands
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García F, Marchena J, Cabrera V, Hermida M, Sotgiu E. Evaluation of four risk-scoring methods to predict long-term outcomes in patients undergoing aorto-bifemoral bypass for aorto-iliac occlusive disease. Int J Angiol 2013; 21:19-28. [PMID: 23450270 DOI: 10.1055/s-0032-1302434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This study was done to determine the usefulness of the American Society of Anesthesiologists (ASA) classification, the comorbidity Charlson index unadjusted (CCIu),the comorbidity Charlson index adjusted by age (CCIa), and the Glasgow aneurysm score (GAS) for postoperative morbimortality and survival in patients treated with aorto-bifemoral bypass (AFB) for aorto-iliac occlusive disease (AIOD). A series of 278 patients who underwent AFB were restrospectively studied. For the CCIu, CCIa, ASA, and GAS, receiver operating characteristics curve analysis for prediction of morbidity showed area under the curves of 0.61 (p = 0.004), 0.59 (p = 0.026), 0.569 (p = 0.087), and 0.63 (p = 0.001), respectively. Additionally, univariate analysis showed that CCIa (p = 0.016) and GAS (p = 0.006) were associated significantly with an increased risk of developing complications. Furthermore, CCIa (p < 0.001) and GAS (p = 0.001) showed a significant association with survival. Finally, the variable age was related to morbidity (p = 0.004), mortality (p = 0.038), and survival (p < 0.001). The comorbididity and the age should be taken in account in clinical treatment decisions for patients with AIOD. The CCIa and GAS may play a role as predictive factors for postoperative morbidity and survival after AFB.
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Affiliation(s)
- Francisca García
- Department of Vascular Surgery, University Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Bryce G, Payne C, Gibson S, Kingsmore D, Byrne D, Delles C. Risk Stratification Scores in Elective Open Abdominal Aortic Aneurysm Repair: Are They Suitable for Preoperative Decision Making? Eur J Vasc Endovasc Surg 2012; 44:55-61. [DOI: 10.1016/j.ejvs.2012.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Álvarez Salgado A, Vaquero Lorenzo F, Vicente Santiago M, Ramos Gallo M, Vallina Vázquez Victorero M, Álvarez Fernández L. Escalas de riesgo preoperatorio para el tratamiento endovascular de aneurismas aórticos. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bailey MA, Sohrabi S, Flood K, Griffin KJ, Rashid ST, Johnson AB, Baxter PD, Patel JV, Scott DJA. Calcium channel blockers enhance sac shrinkage after endovascular aneurysm repair. J Vasc Surg 2012; 55:1593-9. [DOI: 10.1016/j.jvs.2011.12.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 12/22/2011] [Accepted: 12/27/2011] [Indexed: 12/11/2022]
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Ohrlander T, Dencker M, Acosta S. Preoperative Spirometry Results as a Determinant for Long-term Mortality after EVAR for AAA. Eur J Vasc Endovasc Surg 2012; 43:43-7. [DOI: 10.1016/j.ejvs.2011.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 09/29/2011] [Indexed: 11/30/2022]
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Evaluation of the perioperative risk factors in patients with the abdominal aorta aneurysm--literature review. POLISH JOURNAL OF SURGERY 2011; 83:571-8. [PMID: 22189286 DOI: 10.2478/v10035-011-0091-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Menezes FH, Gomes de Souza VM. Physiologic component of the estimation of physiologic ability and surgical stress scoring system as a predictor of immediate outcome after elective open abdominal aortic aneurysm repair. Ann Vasc Surg 2011; 25:485-95. [PMID: 21549917 DOI: 10.1016/j.avsg.2010.12.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/27/2010] [Accepted: 12/09/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies have shown a good predictive power of the risk scoring method, Estimation of Physiologic Ability and Surgical Stress, in predicting mortality after open elective aortic aneurysm repair. The aim of the present study was to evaluate the physiologic component of this method to assess mortality risk in a different geographic population from previously published reports. METHODS Operative, morbidity and mortality data were collected retrospectively from charts of patients submitted to elective open repair of an abdominal aortic aneurysm over an 8-year period. There were 214 patients, the median age was 70 (range: 48-91) years; 179 (83.6%) patients were men. The Preoperative Physiologic Risk Score (PRS), Surgical Stress Score, and Comprehensive Risk Score (CRS) values were categorized and compared with morbidity and mortality rates. RESULTS There were 27 deaths (12.6%), and 81 (37.9%) patients experienced a postoperative complication that required medical intervention. There was a significant statistical difference for the values of PRS and CRS for patients who survived (0.53/0.63, respectively) and for those who died (0.88/1.02, respectively), p < 0.0001 for both values. There is a strong correlation between PRS and CRS values and development of complications (p < 0.0001). Surgical Stress Score did not correlate as strongly to development of complications (p = 0.0028). For PRS, the area under the receiver-operator characteristic curve was 0.844 (95% confidence interval: 0.747-0.941) for mortality and 0.725 (95% confidence interval: 0.650-0.799) for morbidity. For CRS, the area under the curve was 0.812 (95% confidence interval: 0.734-0.891) for mortality and 0.719 (95% confidence interval: 0.645-0.792) for morbidity. There was also a significant positive correlation between length of hospital stay and PRS and CRS scores (p < 0.0001). In this study, it was found that renal impairment has a significant positive correlation with mortality (p = 0.0008), with an odds ratio of 4.3. In a multivariate regression analysis, renal impairment failed to increase the accuracy of the model when associated with the other parameters considered in PRS. CONCLUSION This study corroborates with the previous findings that the Estimation of Physiologic Ability and Surgical Stress model seems to be a promising method of predicting death and postoperative complications in patients undergoing open abdominal aortic aneurysm repair.
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Affiliation(s)
- Fábio Hüsemann Menezes
- Division of Vascular Surgery, Department of Surgery, University of Campinas, Campinas, SP Brazil.
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The Glasgow Aneurysm Score does not predict mortality after open abdominal aortic aneurysm in the era of endovascular aneurysm repair. J Vasc Surg 2011; 54:353-7. [PMID: 21458200 DOI: 10.1016/j.jvs.2011.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/04/2011] [Accepted: 01/04/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Endovascular aneurysm repair (EVAR) has reduced early adverse outcomes from abdominal aortic aneurysm (AAA) repair. Preferential use of EVAR may have altered the profile of patients who undergo open repair. The validity of scoring systems such as the Glasgow Aneurysm Score (GAS), devised when open surgery was the only treatment, required reappraisal. METHODS Patients were identified from a database of patients undergoing elective infrarenal aneurysm repair at seven United Kingdom centers, and the GAS was calculated for each patient. Discrimination and calibration were calculated to determine the performance of the model in this setting using the C statistic, tertile analysis, and the χ(2) test. Univariate analysis was performed to determine if a new iteration of the GAS could be produced. RESULTS We identified 330 patients who met the inclusion criteria. There were 18 deaths ≤30 days of surgery (5.4%). The average (standard deviation) GAS was 78.6 (8.8) for the survivors and 81.9 (10.4) for nonsurvivors (P = .122). The C statistic was 0.625 (95% confidence interval, 0.481-0.769; P = .75) suggesting a discriminatory ability not much better than chance alone. Despite this, calibration of the model was good. There was no significant difference in the comorbidities of either group, so no recalibration of the GAS could be performed. CONCLUSION The GAS did not discriminate between survivors and nonsurvivors after open AAA repair in this cohort. In the era of EVAR, it is possible that the GAS does not predict the outcome of open AAA repair. An alternative explanation is that patients with risk factors for poor outcomes from EVAR, such as adverse AAA morphology, are being selected out for open repair.
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Becquemin JP, Pillet JC, Lescalie F, Sapoval M, Goueffic Y, Lermusiaux P, Steinmetz E, Marzelle J. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients. J Vasc Surg 2011; 53:1167-1173.e1. [PMID: 21276681 DOI: 10.1016/j.jvs.2010.10.124] [Citation(s) in RCA: 339] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of reinterventions. Thus, the role of EVAR, most notably in low-risk patients, remains debated. METHODS The ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery. A total of 316 patients with >5 cm aneurysms were randomized in institutions with proven expertise for both treatments: 299 patients were available for analysis, and 149 were assigned to OSR and 150 to EVAR. Patients were monitored for 5 years after treatment. Statistical analysis was by intention to treat. RESULTS With a median follow-up of 3 years (range, 0-4.8 years), there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR: 95.9% ± 1.6% vs 93.2% ± 2.1% at 1 year and 85.1% ± 4.5% vs 82.4% ± 3.7% at 3 years, respectively (P = .09). In-hospital mortality (0.6% vs 1.3%; P = 1.0), survival, and the percentage of minor complications were not statistically different. In the EVAR group, however, the crude percentage of reintervention was higher (2.4% vs 16%, P < .0001), with a trend toward a higher aneurysm-related mortality (0.7% vs 4%; P = .12). CONCLUSIONS In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option.
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Affiliation(s)
- Jean-Pierre Becquemin
- Department of Vascular Surgery, Hopital Henri Mondor, University Paris XII, Creteil, France.
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Existing risk prediction methods for elective abdominal aortic aneurysm repair do not predict short-term outcome following endovascular repair. J Vasc Surg 2010; 52:25-30. [DOI: 10.1016/j.jvs.2010.01.084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 01/26/2010] [Accepted: 01/26/2010] [Indexed: 11/24/2022]
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Defining high risk in endovascular aneurysm repair. J Vasc Surg 2010; 51:1088-1095.e1. [DOI: 10.1016/j.jvs.2009.12.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/20/2009] [Accepted: 12/08/2009] [Indexed: 11/18/2022]
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Nevala T, Biancari F, Perälä J, Manninen H, Aho PS, Matsi P, Mäkinen K, Roth WD, Ylönen K, Lepäntalo M. Risk prediction in patients undergoing elective endovascular repair of an abdominal aortic aneurysm. SCAND CARDIOVASC J 2009; 44:125-8. [DOI: 10.3109/14017430903420590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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