A prospective survey of patients presenting with abdominal aortic aneurysm

Magee, T.R.; Galland, R. B.; Collin, J.; McPherson, G. A. D.; Orr, M.M.; Ratliff, David; Rutter, P; McWhinnie, Douglas

doi:10.1016/s1078-5884(97)80084-6

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…35 Szilagyi et al 36 reported 11% of patients unfit for open repair rupture within one year of presentation, and studies have supported the considerable incidence of death from AAA rupture in high risk cohorts that are treated conservatively. 21, 37, 38 Thus, a significant portion of the AAA population will likely die from rupture if they are excluded from endovascular repair.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative risk stratification for noncardiac vascular surgery has been investigated by others and validated, using mathematical models to derive scoring systems and predict mortality. 10, 30–32, 35–37 Analysis of the large Medicare dataset provided sufficient statistical power to accurately identify specific individual criteria predictive of 30-day mortality for EVAR. Our scoring system allows a comparison of the impact of individual factors on mortality, and importantly, a summation of their combined effects.…”

Section: Discussionmentioning

confidence: 99%

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Defining high-risk patients for endovascular aneurysm repair

Egorova

Giacovelli

Gelijns

et al. 2009

Journal of Vascular Surgery

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Background Endovascular aneurysm repair (EVAR) is commonly used as a minimally invasive technique for repairing infrarenal aortic aneurysms. There have been recent concerns that a subset of high-risk patients experience unfavorable outcomes with this intervention. To determine whether such a high-risk cohort exists and to identify the characteristics of these patients, we analyzed the outcomes of Medicare patients treated with EVAR from 2000–2006. Methods and Results We identified 66,943 patients who underwent EVAR from Inpatient Medicare database. The overall 30-day mortality was 1.6%. A risk model for perioperative mortality was developed by randomly selecting 44,630 patients; the other 1/3 of the dataset was used to validate the model. The model was deemed reliable (Hosmer-Lemeshow statistics was p=0.25 for the development, p=0.24 for the validation model) and accurate (c=0.735 and c=0.731 for the development and the validation model, respectively). In our scoring system, where scores ranged between 1 and 7, the following were identified as significant baseline factors that predict mortality: renal failure with dialysis (score=7), renal failure without dialysis (score=3), clinically significant lower extremity ischemia (score=5), patient age ≥85 (score=3), 75–84 (score=2), 70–74 (score=1), heart failure (score=3), chronic liver disease (score=3), female gender (score=2), neurological disorders (score=2), , chronic pulmonary disease (score=2), surgeon experience in EVAR<3 procedures (score=1) and hospital annual volume in EVAR <7 procedures (score=1). The majority of Medicare patients who were treated (96.6%, n=64,651) had a score of 9 or less, which correlated with a mortality < 5%. Only 3.4% of patients had a mortality ≥ 5% and 0.8% of patients (n=509) had a score of 13 or higher, which correlated with a mortality >10%. Conclusion We conclude that there is a high-risk cohort of patients that should not be treated with EVAR; however, this cohort is small. Our scoring system, which is based on patient and institutional factors, provides criteria that can be easily used by clinicians to quantify perioperative risk for EVAR candidates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Defining high-risk patients for endovascular aneurysm repair

Egorova

Giacovelli

Gelijns

et al. 2009

Journal of Vascular Surgery

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“…1 With 60% of patients dying before ever reaching the hospital, those who ''arrive alive'' have a greater than 50% operative mortality. 2,3 This is in contrast to an elective repair mortality rate of 1% to 5%. 1,4 Mortality is directly related to the timeliness of diagnosis before rupture and definitive repair.…”

mentioning

confidence: 88%

Prospective Study of Accuracy and Outcome of Emergency Ultrasound for Abdominal Aortic Aneurysm over Two Years

Tayal

2003

Academic Emergency Medicine

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“…These observations may not be isolated because others have noted sample populations presenting with AAA in which a substantial proportion did not meet conditions for operations. 3 Although most of the patients with ''true'' AAA did not go to the operating room, the potential end point of operative repair may not be the gold criterion for evaluating the merit of EUS-AA. As contrasted with trauma ultrasound, therapeutic laparotomy may be a more subjective and unrealistic goal regarding the individual patient with AAA.…”

Section: Discussionmentioning

confidence: 99%

Section: Prospective Study Of Accuracy and Outcome Of Emergency Ultramentioning

confidence: 90%