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Vaughan-Burleigh S, Leung YYR, Khan F, Lintott P, Howard DPJ. The Safety and Outcomes of Elective Endovascular Aneurysm Repair in the Elderly: A Systemic Review and Meta-Analysis. J Endovasc Ther 2024:15266028241283669. [PMID: 39323301 DOI: 10.1177/15266028241283669] [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: 09/27/2024]
Abstract
PURPOSE Prevalence of abdominal aortic aneurysms (AAAs) increases with age. Previous trials confirm that elective endovascular aneurysm repair (EVAR) is an effective intervention for AAA. However, few elderly patients were recruited into randomized trials, whereas in contemporary clinical practice, elective repair is commonly performed on octogenarians. We evaluated the safety and outcome of elective EVAR in elderly patients to inform clinical practice and vascular service provision. METHODS A systematic review and meta-analysis of studies reporting risk of complications and death in patients undergoing elective EVAR was performed (PROSPERO CRD: 42022308423). Observational studies and interventional arms of randomized trials were included if the outcome rates or raw data were provided. Primary outcome was 30-day mortality. Secondary outcomes were longer-term mortality, 30-day major adverse events, and aneurysm-related mortality. Primary and secondary outcomes were compared between octogenarians and non-octogenarians. Exclusion criteria were emergency procedures, non-infrarenal aneurysms, and lack of octogenarian data. RESULTS A total of 41 studies were eligible from 10 099 citations, including 10 national and 5 international registries, 26 retrospective studies, and our own prospective cohort. The analysis included 208 997 non-octogenarians (mean age=70.19 [SD=0.62]) and 106 188 octogenarians (mean age=83.75 [SD=0.35]). The 30-day mortality post-elective EVAR was higher in octogenarians (1.08% in non-octogenarians, 2.31% in octogenarians, odds ratio [OR]=2.27 [2.08-2.47], p<0.0001). Linear regression demonstrated a 0.83% increase in 30-day mortality for every 10-year age increase above 60 years old. Mortality for octogenarians increased significantly during follow-up: 11.35% (OR=1.87 [1.65-2.13], p<0.001), 22.80% (OR=1.89 [1.52-2.35], p<0.001), 32.00% (OR=1.98 [1.66-2.37], p<0.001), 47.53%, and 51.08% (OR=2.40 [1.90-3.03], p<0.001) at 1-through-5-year follow-up, respectively. The 30-day major adverse events after elective EVAR were higher in octogenarians (OR=1.75-2.83, p<0.001). CONCLUSIONS Octogenarians experience higher but acceptable peri-operative morbidity and mortality compared with younger patients. However, 3-year to 5-year survival is very low among octogenarians. Our findings challenge the notion of routine intervention in elderly patients and support very careful selection for elective EVAR. Many octogenarians with peri-threshold (<6 cm) AAAs may derive no benefit from EVAR due to limited 3-year to 5-year overall survival and low risk of aneurysm rupture with conservative management. An adjusted threshold for intervention in octogenarians may be warranted. CLINICAL IMPACT Octogenarians with infra-renal AAA are increasingly managed with elective EVAR. Previous studies have demonstrated that EVAR is safer than open repair for octogenarians, with lower peri-operative mortality and major adverse events. However, randomised trials, on which much of contemporary evidence is based, recruited a relatively younger population of participants. This systematic review and meta-analysis provides a contemporary synthesis of the literature comparing outcomes in octogenarians to younger patients. The results of this analysis, together with low rupture rates amongst octogenarians in existing literature, question the benefit of routine elective intervention for peri-threshold aneurysms and an adjusted threshold for intervention in octogenarians may be warranted.
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Affiliation(s)
| | - Ya Yuan Rachel Leung
- Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Faaraz Khan
- Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Patrick Lintott
- Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Dominic P J Howard
- Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Merenda M, Earnest A, Ruseckaite R, Tse WC, Elder E, Hopper I, Ahern S. Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review. Aesthet Surg J Open Forum 2024; 6:ojae015. [PMID: 38650972 PMCID: PMC11033681 DOI: 10.1093/asjof/ojae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Little is known about the methods and outcomes of patient-reported outcome measure (PROM) use among high-risk medical device registries. The objective of this scoping review was to assess the utility and predictive ability of PROMs in high-risk medical device registries. We searched Ovid Medline, Embase, APA PsychINFO, Cochrane Library, and Scopus databases for published literature. After searching, 4323 titles and abstracts were screened, and 262 full texts were assessed for their eligibility. Seventy-six papers from across orthopedic (n = 64), cardiac (n = 10), penile (n = 1), and hernia mesh (n = 1) device registries were identified. Studies predominantly used PROMs as an outcome measure when comparing cohorts or surgical approaches (n = 45) or to compare time points (n = 13) including pre- and postintervention. Fifteen papers considered the predictive ability of PROMs. Of these, 8 treated PROMs as an outcome, 5 treated PROMs as a risk factor through regression analysis, and 2 papers treated PROMs as both a risk factor and as an outcome. One paper described PROMs to study implant survival. To advance methods of PROM integration into clinical decision-making for medical devices, an understanding of their use in high-risk device registries is needed. This scoping review found that there is a paucity of studies using PROMs to predict long-term patient and clinical outcomes in high-risk medical device registries. Determination as to why PROMs are rarely used for predictive purposes in long-term data collection is needed if PROM data are to be considered suitable as real-world evidence for high-risk device regulatory purposes, as well as to support clinical decision-making. Level of Evidence 4
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Affiliation(s)
- Michelle Merenda
- Corresponding Author: Mrs Michelle Merenda, Level 3, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia. E-mail:
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Powell JT. Great vascular surgeons needed for great aneurysms. J Vasc Surg 2021; 74:1161-1162. [PMID: 34598755 DOI: 10.1016/j.jvs.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Janet T Powell
- Imperial College London, Department of Surgery & Cancer, Charing Cross Hospital, London, UK
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Machin M, Ulug P, Pandirajan K, Bown MJ, Powell JT. Towards a Core Outcome Set for Abdominal Aortic Aneurysm: Systematic Review of Outcomes Reported Following Intact and Ruptured Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2021; 61:909-918. [PMID: 33741209 DOI: 10.1016/j.ejvs.2021.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/07/2020] [Accepted: 02/04/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To encompass the needs of all stakeholders and allow effective data synthesis from trials, registries, and other studies; a core outcome set for infrarenal abdominal aortic aneurysm (AAA) repair is needed. In this first stage, the aim was to report the range, frequency, and time of pre-specified outcomes reported following AAA repair. DATA SOURCES Medline, Embase, and CENTRAL databases 2010 - 2019 were searched using ProQuest Dialog™. REVIEW METHODS The systematic review was reported to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA), PROSPERO registration CRD42019130119. Outcomes were coded using Core Outcome Measures in Effectiveness Trials (COMET) taxonomy and presented separately for intact and rupture repairs, endovascular aneurysm repair (EVAR) and open repair, and time from repair (acute < 90 days vs. ≥ 1 year) (COMET Initiative 1582). RESULTS For intact AAA and rupture repair, a total of 231 and 70 reports with 589 255 and 177 465 patients respectively were included: only 98 and 19 respectively provided ≥ 1 year outcomes. Most studies were retrospective, with 13 randomised trials of intact AAA repair and five randomised trials of ruptured AAA repair. For intact AAA, the most common pre-specified COMET taxonomy outcomes were mortality (181), vascular complications (137), and re-intervention (52). EVAR studies dominated the vascular outcomes in acute and later time periods: excluding 47 reports from device registries, reduced vascular outcomes to 83. For ruptured AAA, the three most common outcomes were mortality (64), vascular (11), and hospital stay (10). The range of outcomes reported was wide with functioning outcomes reported from most randomised trials but few retrospective studies. CONCLUSION This review identifies the paucity of long term data and the disproportionate attention paid to vascular complications vs. patient functioning outcomes, this skew being accentuated by reporting from EVAR device registries. These data will inform focus groups, prior to a pan-European Delphi consensus, involving clinicians, patients, carers and providers, for developing core outcomes for repair of intact and ruptured AAA.
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Affiliation(s)
- Matthew Machin
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Pinar Ulug
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Kamashi Pandirajan
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Matthew J Bown
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Janet T Powell
- Department of Surgery & Cancer, Imperial College London, London, UK.
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Pouwels S, Sanches EE, Cagiltay E, Severin R, Philips SA. Perioperative Exercise Therapy in Bariatric Surgery: Improving Patient Outcomes. Diabetes Metab Syndr Obes 2020; 13:1813-1823. [PMID: 32547143 PMCID: PMC7261659 DOI: 10.2147/dmso.s215157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
Nowadays, obesity and related comorbidities like type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea syndrome are considered one of the medical challenges of the 21st century. Even with the rise of bariatric and metabolic surgery, obesity and metabolic syndrome are reaching endemic proportions. Even in 2020, obesity is still a growing problem. There is increasing evidence that next to bariatric surgery, exercise interventions in the perioperative period could give extra beneficial effects. In this regard, effects on anthropometrics, cardiovascular risk factors and physical fitness. The aim of this review is to summarise effects of preoperative and postoperative exercise, tools for screening and directions for future research and implementations.
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Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
- Correspondence: Sjaak Pouwels Department of Surgery, Haaglanden Medical Center, P.O. Box 432, 2501 CK, The Hague, the Netherlands Email
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Eylem Cagiltay
- University of Health Sciences Turkey, Sultan Abdulhamid Han Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, Istanbul, Uskudar, 34668, Turkey
| | - Rich Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Shane A Philips
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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The usefulness of preoperative exercise therapy in patients scheduled for lung cancer surgery; a survey among Dutch pulmonologists and cardiothoracic surgeons. Support Care Cancer 2019; 28:1983-1989. [DOI: 10.1007/s00520-019-05014-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022]
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Teijink JA, Power AH, Böckler D, Peeters P, van Sterkenburg S, Bouwman LH, Verhagen HJ, Bosiers M, Riambau V, Becquemin JP, Cuypers P, van Sambeek M. Editor's Choice – Five Year Outcomes of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair in the ENGAGE Registry. Eur J Vasc Endovasc Surg 2019; 58:175-181. [DOI: 10.1016/j.ejvs.2019.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/05/2019] [Indexed: 10/26/2022]
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Preece R, Shaw S, Wiltshire J, Stenson K, Budge J, De Bruin J, Loftus I, Holt P, Patterson B. Development of novel patient selection criteria for a short stay endovascular aneurysm repair pathway: Improving patient selection for short stay endovascular aneurysm repair. Vascular 2019; 28:59-67. [PMID: 31354107 DOI: 10.1177/1708538119867523] [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: 11/16/2022]
Abstract
Objectives A short-stay endovascular aneurysm repair (SS-EVAR) pathway for infrarenal abdominal aortic aneurysms offers the potential to improve service efficiency and patient satisfaction by reducing the hospital length of stay. This study aimed to determine whether the implementation of a novel set of patient selection criteria for a theoretical SS-EVAR pathway could facilitate an expansion of the proportion of suitable patients, whilst maintaining patient safety and limiting unplanned emergency readmissions. Methods Two SS-EVAR selection criteria (low and high risk) were generated based upon patient pre-operative comorbidities. The low risk criteria essentially selected fit and healthy individuals, whereas the high risk criteria included patients with a range of comorbidities that could still theoretically enable enrolment onto a SS-EVAR pathway. A retrospective analysis, whereby both criteria were applied to all elective EVARs recorded in the National Vascular Registry between 2013 and 2016 at a single tertiary vascular unit was performed. Rates and timings of postoperative complications, reinterventions and unplanned readmissions for patients meeting each criteria were assessed. Results In total, 188 patients were included (92% male, mean age 75.4 ± 7.2 years). Twenty-nine patients (15%) met the low risk criteria. Two (7%) of these experienced an inpatient complication which were both detected within 24 h of operation (including one who required reintervention), and no patients in this group had an unplanned readmission within 30 days. One-hundred and ten patients (59%) met our high risk criteria and 19 (17%) experienced an inpatient complication, with 4 (4%) of these occurring beyond 24 h post-EVAR (three urinary problems and one acute on chronic kidney injury). Six (6%) of these patients required a reintervention; however, all of these complications were detected within 24 h. Two (2%) high risk cohort patients required unplanned readmission within 30 days for a femoral pseudoaneurysm and musculoskeletal back pain. Conclusions With high risk patient selection criteria and appropriate post-operative safeguards, up to 60% of infrarenal abdominal aortic aneurysms patients could be safely enrolled onto a next-day discharge SS-EVAR pathway with minimal readmissions, thus allowing more effective resource utilisation.
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Affiliation(s)
- Ryan Preece
- St George's Vascular Institute, St George's Hospital, London, UK
| | - Sarah Shaw
- St George's Vascular Institute, St George's Hospital, London, UK
| | - Joseph Wiltshire
- St George's Vascular Institute, St George's Hospital, London, UK
| | | | - James Budge
- St George's Vascular Institute, St George's Hospital, London, UK
| | - Jorg De Bruin
- St George's Vascular Institute, St George's Hospital, London, UK
| | - Ian Loftus
- St George's Vascular Institute, St George's Hospital, London, UK
| | - Peter Holt
- St George's Vascular Institute, St George's Hospital, London, UK
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Topal B, Smelt HJ, Van Helden EV, Celik A, Verseveld M, Smeenk F, Pouwels S. Utility of preoperative exercise therapy in reducing postoperative morbidity after surgery; a clinical overview of current evidence. Expert Rev Cardiovasc Ther 2019; 17:395-412. [DOI: 10.1080/14779072.2019.1625771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Esmee V. Van Helden
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Alper Celik
- Department of Metabolic Surgery, Metabolic Surgery Clinic, Sisli, Istanbul, Turkey
| | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - Frank Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
- SHE School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Sjaak Pouwels
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
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10
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Pini R, Gallitto E, Faggioli G, Mascoli C, Vacirca A, Fenelli C, Gargiulo M, Stella A. Predictors of perioperative and late survival in octogenarians undergoing elective endovascular abdominal aortic repair. J Vasc Surg 2019; 69:1405-1411. [DOI: 10.1016/j.jvs.2018.07.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/09/2018] [Indexed: 02/04/2023]
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Shan L, Saxena A, Goh D, Robinson D. A systematic review on the quality of life and functional status after abdominal aortic aneurysm repair in elderly patients with an average age older than 75 years. J Vasc Surg 2019; 69:1268-1281. [DOI: 10.1016/j.jvs.2018.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
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Hye RJ, Janarious AU, Chan PH, Cafri G, Chang RW, Rehring TF, Nelken NA, Hill BB. Survival and Reintervention Risk by Patient Age and Preoperative Abdominal Aortic Aneurysm Diameter after Endovascular Aneurysm Repair. Ann Vasc Surg 2018; 54:215-225. [PMID: 30081171 DOI: 10.1016/j.avsg.2018.05.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) has become the standard of care for abdominal aortic aneurysm (AAA), but questions remain regarding the benefit in high-risk and elderly patients. The purpose of this study was to examine the effect of age, preoperative AAA diameter, and their interaction on survival and reintervention rates after EVAR. METHODS Our integrated health system's AAA endograft registry was used to identify patients who underwent elective EVAR between 2010 and 2014. Of interest was the effect of patient age at the time of surgery (≤80 vs. >80 years old), preoperative AAA diameter (≤5.5 cm vs. >5.5 cm), and their interaction. Primary endpoints were all-cause mortality and reintervention. Between-within mixed-effects Cox models with propensity score weights were fit. RESULTS Of 1,967 patients undergoing EVAR, unadjusted rates for survival at 4 years after EVAR was 76.1%, and reintervention-free rate was 86.0%. For mortality, there was insufficient evidence for an interaction between age and AAA size (P = 0.309). Patient age >80 years was associated with 2.53-fold higher mortality risk (hazard ratios [HR] = 2.53; 95% confidence intervals [CI], 1.73-3.70; P < 0.001), whereas AAA > 5.5 cm was associated with 1.75-fold higher mortality risk (HR = 1.75; 95% CI, 1.26-2.45; P = 0.001). For reintervention risk, there were no significant interactions or main effects for age or AAA diameter. CONCLUSIONS Age and AAA diameter are independent predictors of reduced survival after EVAR, but the effect is not amplified when both are present. Age >80 years or AAA size >5.5 cm did not increase the risk of reintervention. No specific AAA size, patient age, or combination thereof was identified that would contraindicate AAA repair.
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Affiliation(s)
- Robert J Hye
- Department of Surgery, Southern California Permanente Medical Group, San Diego, CA
| | - Afra U Janarious
- Department of Surgery, Southern California Permanente Medical Group, San Diego, CA
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Guy Cafri
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Robert W Chang
- Department of Surgery, The Permanente Medical Group, South San Francisco, CA
| | - Thomas F Rehring
- Department of Vascular Surgery, Colorado Permanente Medical Group, Denver, CO
| | - Nicolas A Nelken
- Department of Vascular Therapy, Hawaii Permanente Group, Honolulu, HI
| | - Bradley B Hill
- Department of Vascular Surgery, The Permanente Medical Group, Santa Clara, CA.
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Tzani A, Doulamis IP, Katsaros I, Martinou E, Schizas D, Economopoulos KP. Mortality after endovascular treatment of infrarenal abdominal aortic aneurysms – the newer the better? VASA 2018; 47:187-196. [PMID: 29334334 DOI: 10.1024/0301-1526/a000685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract. Although endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) presents a delicate alternative treatment for abdominal aortic aneurysms (AAA) with lower perioperative mortality, its long-term efficacy remains a matter of concern. The purpose of this study was to evaluate the currently reported mortality evidence after EVAR and to examine the possible effect of aneurysm status and the study period on mortality rates. The PubMed and Cochrane bibliographical databases were thoroughly searched for studies reporting on more than 1 000 patients with non-ruptured or ruptured infrarenal AAA, treated with EVAR from August 1991 to September 2016. A total of 10 910 titles/abstracts were retrieved and 121 studies were deemed relevant. Twenty-six studies met the inclusion criteria and reported on 354 500 patients with a mean age of 74.6 years. Almost all of the studies referred to elective EVAR and the mean aneurysm size was 5.58 cm. The most common early complication for elective EVAR was perioperative bleeding (1.9 %), whereas hospital-acquired pneumonia was a major concern in urgent EVAR (28.5 %). Conversion rate to open surgery was 1.2 %. The 30-day all-cause mortality rate was 4.84 % (1.7 % for non- ruptured aneurysms, 33.8 % for ruptured aneurysms).The overall all-cause late mortality in a mean follow-up period of 23.8 months was 19.1 %. The aneurysm-related late mortality rate was 3.4 %. With respect to the time period of patient enrollment, studies reporting on patients recruited before 2006 were found to face more secondary complications and higher late mortality rates than patients enrolled after 2005.The endovascular treatment of large and anatomically suitable infrarenal AAA in selected patients remains a safe alternative to open repair. Our findings demonstrate that newer studies show better long-term outcomes than the older ones, proposing a possible improvement of EVAR techniques and perioperative care and providing encouraging evidence for a wider application of EVAR.
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Affiliation(s)
- Aspasia Tzani
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Ioannis Katsaros
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Eirini Martinou
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Dimitrios Schizas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos P. Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians: Meta-analysis and Systematic Review. Eur J Vasc Endovasc Surg 2017; 54:454-463. [DOI: 10.1016/j.ejvs.2017.06.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/25/2017] [Indexed: 12/13/2022]
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Kulig P, Lewandowski K, Ziaja D, Zaniewski M, Kulig J. Endovascular Aneurysm Repair or Open Aneurysm Repair for the Treatment of Abdominal Aortic Aneurysm - The Latest Update. POLISH JOURNAL OF SURGERY 2017; 88:166-74. [PMID: 27428840 DOI: 10.1515/pjs-2016-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 11/15/2022]
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Preoperative exercise therapy in surgical care: a scoping review. J Clin Anesth 2016; 33:476-90. [DOI: 10.1016/j.jclinane.2016.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
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Aitken SJ, Naganathan V, Blyth FM. Aortic aneurysm trials in octogenarians: Are we really measuring the outcomes that matter? Vascular 2016. [DOI: 10.1177/1708538115597079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose This study is a systematic review to determine the types of outcomes reported in abdominal aortic aneurysm (AAA) studies of patients aged 80 and over. Specifically, it determines the types of patient-centered outcomes reported. Method MEDLINE and EMBASE were searched from 2000 to 2014 for studies on AAA surgery with outcome data on patients aged 80 and over. Outcomes were categorized according to Donabedian’s framework for health quality indicators, with further classification as procedural, complication, resource or patient-centered outcome indicators. Findings Forty studies were reviewed. Patient-centered outcomes were infrequently reported (13%, n=5), with limited outcomes specifically relevant to older patients. No studies reported physical function, activities of daily living or cognition using validated assessment methods. Short-term mortality (95%, n=38) and complications (85%, n=34) were reported most frequently. Conclusion Reporting of aortic surgery outcomes in patients aged 80 and over requires a focus upon outcomes of primary importance to people of this age.
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Affiliation(s)
- SJ Aitken
- Concord Clinical School, Professorial Surgery Unit, Department of Vascular Surgery, New South Wales, Australia
| | - V Naganathan
- Concord Clinical School, Centre for Education and Research on Ageing, Concord, Sydney, New South Wales, Australia
| | - FM Blyth
- Concord Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Ehlert BA, Abularrage CJ. Fenestrated endovascular repair of abdominal aortic aneurysms: a less invasive option for the treatment of juxtarenal aortic aneurysms. Future Cardiol 2016; 12:317-26. [PMID: 27092859 DOI: 10.2217/fca.16.2] [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: 11/21/2022] Open
Abstract
Endovascular aortic aneurysm repair has become the predominant surgical therapy for abdominal aortic aneurysms. Whereas anatomical limitations had become the major contraindication to endovascular treatment, fenestrated stent grafts were developed to overcome such obstacles. Fenestrated endovascular aortic aneurysm repair now provides an additional treatment option for patients felt to be unsuitable for an invasive open repair whose anatomy is not compatible with more traditional stent grafts. We review the evolution of fenestrated endovascular aortic aneurysm repair and compare its safety and efficacy to other endovascular options.
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Affiliation(s)
- Bryan A Ehlert
- Division of Vascular Surgery & Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, MD 21287, USA
| | - Christopher J Abularrage
- Division of Vascular Surgery & Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, MD 21287, USA
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Abstract
Patient-reported outcomes (PROs) after vascular surgery are becoming increasingly important in the current era of health care reform. Although a number of general quality of life instruments exist, vascular disease-specific instruments may provide more targeted data on how patients feel after specific interventions. Here we provide a review of both generic and disease-specific instruments focused on arterial conditions, including peripheral arterial disease, carotid arterial disease, and aortic disease, which have been described in the literature. While many different tools currently exist, there is a paucity of well-validated, specific instruments that accurately reflect functional and objective measures of patients' arterial disease burden. A full understanding of the existing tools available to assess patients' perceived lifestyle impact of their disease and its treatments is essential for both research and clinical purposes, and to highlight the need for additional work on this topic.
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Affiliation(s)
- Caitlin W Hicks
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Ying Wei Lum
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287.
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Howard DPJ, Banerjee A, Fairhead JF, Handa A, Silver LE, Rothwell PM. Population-Based Study of Incidence of Acute Abdominal Aortic Aneurysms With Projected Impact of Screening Strategy. J Am Heart Assoc 2015; 4:e001926. [PMID: 26289347 PMCID: PMC4599457 DOI: 10.1161/jaha.115.001926] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/24/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Current abdominal aortic aneurysm (AAA) screening in men age 65 might have limited impact on overall AAA death rates if incidence is moving to older ages. Up-to-date population-based studies of age-specific incidence, risk factors, and outcome of acute AAA are needed to inform screening policy. METHODS AND RESULTS In a prospective, population-based study (Oxfordshire, UK, 2002-2014), the incidence and outcome of acute AAA events were determined. Based on population projections and current incidence trends, the impact of screening strategies in the UK was estimated. Over the 12-year period, 103 incident acute AAA events occurred in the study population of 92 728. Incidence/100 000/year was 55 in men ages 65 to 74 years, but increased to 112 at 75 to 85 and 298 at ≥85, with 66.0% of all events occurring at age ≥75 years. Incidence at ages 65 to 74 was highest in male smokers (274), with 96.4% of events in men <75 years occurring in ever-smokers. Extrapolating rates to the UK population, using trial evidence of screening efficacy, the current UK screening program would prevent 5.6% of aneurysm-related deaths (315 200 scans/year: 1426/death prevented, 121/year-of-life saved). Screening only male smokers age 65 and then all men at age 75 would prevent 21.1% of deaths (247 900 scans/year; 297/death prevented, 34/year-of-life saved). By 2030, 91.0% of deaths will occur at age ≥75, 61.6% at ≥85, and 28.6% in women. CONCLUSIONS Given that two thirds of acute AAA occurred at ≥75 years of age, screening older age groups should be considered. Screening nonsmokers at age 65 is likely to have very little impact on AAA event rates.
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Affiliation(s)
- Dominic P J Howard
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of OxfordUnited Kingdom
| | - Amitava Banerjee
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of OxfordUnited Kingdom
- Center for Cardiovascular Sciences, University of BirminghamBirmingham, United Kingdom
| | - Jack F Fairhead
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of OxfordUnited Kingdom
- Department of Vascular Surgery, Oxford University Hospitals NHS TrustOxford, United Kingdom
| | - Ashok Handa
- Department of Vascular Surgery, Oxford University Hospitals NHS TrustOxford, United Kingdom
| | - Louise E Silver
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of OxfordUnited Kingdom
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of OxfordUnited Kingdom
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21
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Visser L, Pol RA. The pivotal role of endovascular repair in treating octogenarians suffering from abdominal aortic aneurysm. Int J Surg 2015; 22:1-2. [PMID: 26254998 DOI: 10.1016/j.ijsu.2015.07.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/18/2015] [Indexed: 11/24/2022]
Affiliation(s)
- L Visser
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - R A Pol
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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23
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de Leur K, Flu HC, Ho GH, de Groot HG, Veen EJ, van der Laan L. Outcome of elective treatment of abdominal aortic aneurysm in elderly patients. Int J Surg 2015; 15:117-23. [DOI: 10.1016/j.ijsu.2015.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 11/30/2022]
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24
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Pouwels S, Willigendael E, van Sambeek M, Nienhuijs S, Cuypers P, Teijink J. Beneficial Effects of Pre-operative Exercise Therapy in Patients with an Abdominal Aortic Aneurysm: A Systematic Review. Eur J Vasc Endovasc Surg 2015; 49:66-76. [DOI: 10.1016/j.ejvs.2014.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/14/2014] [Indexed: 01/17/2023]
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25
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Troisi N, Torsello G, Weiss K, Donas KP, Michelagnoli S, Austermann M. Midterm Results of Endovascular Aneurysm Repair Using the Endurant Stent-Graft According to the Instructions for Use vs. Off-Label Conditions. J Endovasc Ther 2014; 21:841-7. [DOI: 10.1583/14-4795mr.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians. J Vasc Surg 2014; 60:308-17. [DOI: 10.1016/j.jvs.2014.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/21/2022]
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27
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de Beaufort H, Zandvoort HJ, Moll FL, Van Herwaarden JA. The Endurant stent graft for endovascular aneurysm repair. Expert Rev Med Devices 2014; 11:331-40. [DOI: 10.1586/17434440.2014.916206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Elective Endovascular Aneurysm Repair in the Elderly: Trends and Outcomes From the Nationwide Inpatient Sample. Ann Vasc Surg 2014; 28:798-807. [DOI: 10.1016/j.avsg.2013.07.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/11/2013] [Accepted: 07/25/2013] [Indexed: 11/21/2022]
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29
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Defining "The Elderly" Undergoing Major Gastrointestinal Resections: Receiver Operating Characteristic Analysis of a Large ACS-NSQIP Cohort. Ann Surg 2014; 262:e59. [PMID: 24441799 DOI: 10.1097/sla.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Visser L, Pol RA, Tielliu IFJ, van den Dungen JJAM, Zeebregts CJ. A limited and customized follow-up seems justified after endovascular abdominal aneurysm repair in octogenarians. J Vasc Surg 2014; 59:1232-40. [PMID: 24440677 DOI: 10.1016/j.jvs.2013.11.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/23/2013] [Accepted: 11/17/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether long-term follow-up after endovascular aneurysm repair (EVAR) is justified in octogenarians. METHODS Between September 1996 and October 2011, all patients, including octogenarians, treated for an abdominal aortic aneurysm (AAA) by EVAR were included in a prospective database. Patients older than 80 years and with a nonruptured infrarenal aneurysm treated electively or urgently were included in the study (study group [SG]). Patients with ruptured aneurysms and patients who died during surgery or within the first postoperative month were excluded from further analysis. The control group (CG) consisted of patients younger than 80 years, matched for gender and AAA diameter. All patients were evaluated 4 to 8 weeks after EVAR and then annually thereafter. Follow-up data were complemented by review of the computerized hospital registry and charts and by contact of the patient's general practitioner or referring hospital. Primary outcomes were stent- or aneurysm-related complications and interventions. Secondary outcomes were additional surgical complications and patient survival. RESULTS A total number of 193 patients (SG, n = 97; CG, n = 96) were included for analysis. Median age was 80 years, and 88.6% were male. Median follow-up time was 33.6 months (interquartile range [IQR], 12.9-68.3). Stent- and procedure-related postoperative complications were comparable between groups (SG, 41.2%; CG, 39.6%; P = .82). Median time to complication was 2.3 months (IQR, 0.2-19.4) in the SG compared with 18.1 months (IQR, 6.8-50.5) in the CG. The 2-year complication-free survival rates were 58% (SG) and 60% (CG). Interventions were performed significantly less frequently in octogenarians (SG, 8.2%; CG, 19.8%; P < .05). Median time to intervention was 11.1 months (IQR, 2.0-31.0) in the SG compared with 54.3 months (IQR, 15.0-93.2) in the CG. The 2-year intervention-free survival rates were 90% (SG) and 92% (CG). During follow-up, 98 patients died (SG, n = 54; CG, n = 44); median time to death was 31.8 months (IQR, 13.3-66.0) in the SG compared with 44.4 months (IQR, 15.0-77.7) in the CG. One aneurysm-related death occurred in the CG. The 2- and 5-year survival rates were 71% and 32% for the SG compared with 77% and 66% for the CG (P < .05). CONCLUSIONS Because of the low incidence of secondary procedures and AAA-related deaths in octogenarians, long-term and frequent follow-up after EVAR seems questionable. An adapted and shortened follow-up seems warranted in this patient group.
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Affiliation(s)
- Linda Visser
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ignace F J Tielliu
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan J A M van den Dungen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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de Blic R, Alsac JM, Julia P, El Batti S, Mirault T, Di Primio M, Sapoval M, Messas E, Fabiani JN. Elective treatment of abdominal aortic aneurysm is reasonable in patients >85 years of age. Ann Vasc Surg 2013; 28:209-16. [PMID: 24084274 DOI: 10.1016/j.avsg.2013.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 12/03/2012] [Accepted: 01/12/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The numbers of patients >85 years of age referred for abdominal aortic aneurysm (AAA) repair have increased in recent decades. With the population aging, increased screening of AAA, and introduction of less invasive surgical techniques, vascular surgeons will be treating more elderly patients. Few data are available for estimating the risks and benefits of prophylactic repair among those with such an advanced age. The aim of this single-center study was to evaluate the short-term to midterm results after AAA repair in patients >85 years of age. METHODS Between 2004 and 2012, data of patients >85 years old who required an elective AAA repair at our institution were collected prospectively. According to the current guidelines, patients underwent endovascular aneurysm repair (EVAR) each time the aortic anatomy was suitable. Open repair (OR) was performed in those patients with hostile proximal neck anatomy and/or severe iliac tortuosity. Type of repair (EVAR or OR) and perioperative and midterm outcomes were analyzed. Primary end points were 30-day mortality and midterm survival. RESULTS Among 1016 patients undergoing elective AAA repair during the study period, 59 (5.8%) were ≥85 years of age (54 men, mean age 87 ± 2 years), with a mean aneurysm diameter of 61.5 ± 20.3 mm. Thirty-three patients (56%) underwent EVAR and 26 (44%) had an OR. Thirty-day mortality was 6.7% (6% with EVAR and 7.6% with OR, P <0.05). Mean follow-up was 24.7 ± 18 months. Kaplan‒Meier analyses for survival were 85.5%, 64.5%, and 50% at 1, 3, and 5 years, respectively. No aneurysm-related death was observed during follow-up. CONCLUSION Elective repair may be proposed in patients >85 years of age in cases of threatening AAA, showing acceptable perioperative mortality and reasonable midterm survival results. Even if EVAR did not seem to offer significant benefits in perioperative mortality in our study, it appears reasonable to suggest this less invasive technique as first-line treatment in cases of suitable anatomy in such an advanced-age population.
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Affiliation(s)
- Romain de Blic
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Jean-Marc Alsac
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
| | - Pierre Julia
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Salma El Batti
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Tristan Mirault
- Department of Vascular Medecine, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Maximiliano Di Primio
- Department of Interventional Radiology, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Marc Sapoval
- Department of Interventional Radiology, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Emmanuel Messas
- Department of Vascular Medecine, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Jean-Noël Fabiani
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
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Mwipatayi BP, Picardo A, Wong J, Thomas SD, Vijayan V. Endovascular Repair of Abdominal Aortic Aneurysms With Reverse Taper Neck Anatomy Using the Endurant Stent-Graft: Analysis of Stent-Graft Oversizing. J Endovasc Ther 2013; 20:514-22. [DOI: 10.1583/13-4321.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pol RA, van Leeuwen BL. Outcomes in older patients requiring comprehensive allied health care prior to discharge from the emergency department: Reply. Emerg Med Australas 2013; 25:284. [DOI: 10.1111/1742-6723.12077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Robert A Pol
- Department of Surgery; University Medical Center Groningen; Groningen; The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery; University Medical Center Groningen; Groningen; The Netherlands
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Saratzis A, Mohamed S. Endovascular abdominal aortic aneurysm repair in the geriatric population. J Geriatr Cardiol 2012; 9:285-91. [PMID: 23097659 PMCID: PMC3470028 DOI: 10.3724/sp.j.1263.2012.06271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/06/2012] [Accepted: 08/13/2012] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.
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Affiliation(s)
- Athanasios Saratzis
- Warwickshire Vascular and Endovascular Unit, University Hospital Coventry & Warwickshire, Coventry CV22DX, United Kingdom
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