Endoluminal Graft Repair for Abdominal Aortic Aneurysms in High-Risk Patients and Octogenarians

Sicard, Gregorio A.; Rubin, Brian G.; Sánchez, Luis A.; Keller, Christine A.; Flye, M. Wayne; Picus, Daniel; Hovsepian, David M.; Choi, Eric T.; Geraghty, Patrick J.; Thompson, Robert W.

doi:10.1097/00000658-200110000-00002

Cited by 87 publications

(75 citation statements)

References 48 publications

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“…10,27 The low operative mortality of 1% observed in this study, despite the patient population and the inclusion of open procedures, may be partly because approximately 70% of the patients underwent less invasive endovascular surgery; however, it is still lower than the reported operative mortality of 1.9-4.0% for endovascular surgery. 16,18,28 In the present study, perioperative risk stratification was undertaken using pharmacologic stress SPECT, which was performed safely in all patients. Although clinical features such as previous MI, DM and renal insufficiency are regarded as having a high predictive value for cardiac events, 10,27 the SPECT finding of a SSS ≥14 was the best predictor in the present study.…”

Section: Discussionmentioning

confidence: 99%

Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Harafuji

Chikamori

Kawaguchi

et al. 2005

Circ J

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valuating the risk of perioperative cardiac events related to noncardiac surgery is important. [1][2][3][4][5][6][7][8][9] Preoperative myocardial perfusion imaging is useful for further stratification of the risk in moderate-and highrisk patients 3,4 because the redistribution findings can be used as predictive factors for cardiac events, and the technique has a high negative predictive value. [5][6][7][8] Moreover, recent studies suggest that the likelihood of cardiac events increases with the severity of the defect score on images evaluated semi-quantitatively 4,6-9 and guidelines for the perioperative cardiovascular evaluation of noncardiac surgery patients were recently published by the ACC/AHA, providing a framework for weighting the cardiac risk of noncardiac surgery based on patients' risk profiles and the type of operation. 10 Of the procedures, aortic surgery is claimed to be high-risk (the reported cardiac risk is often ≥5%), not only because it is highly invasiveness surgery but also because of the high prevalence of coronary artery disease in patients with aortic diseases. 10-12 However, there are few studies regarding preoperative risk stratification in Japanese patients who undergo aortic surgery. 13,14 Thus, the present study evaluated whether perioperative cardiac events related to aortic surgery can be predicted by preoperative pharmacologic stress myocardial perfusion imaging. Methods SubjectsThe subjects of this study were 302 consecutive patients who underwent elective aortic surgery after pharmacologic stress single-photon emission computed tomography (SPECT) between January 1998 and August 2003. SPECT study was performed in all patients unless contraindications such as bronchial asthma and advanced heart block were present. There were 261 men and 41 women, aged 71±10 years (35-86 years); 128 of them (42%) were aged 75 years or older. Medical history of angina pectoris was noted in 19 patients, myocardial infarction (MI) in 26, and heart failure in 5; 19 of them had undergone coronary revascularization. Hypertension was found in 217 patients, hypercholesterolemia in 73, diabetes mellitus (DM) in 55, and renal insufficiency defined as serum creatinine level ≥2.0 mg/dl in 20.The etiologies of the aortic diseases were type B aortic dissection in 56 patients, thoracic aortic aneurysm in 124, and abdominal aortic aneurysm in 122. The indication for aortic surgery was decided by cardiovascular surgeons based on the anatomical and pathological indications. [15][16][17][18] The type of surgery was conventional open surgery in 75 patients and endovascular surgery with stent -graft placement in 227. Aortic surgery including stent -graft placement was performed under general anesthesia. Approval to perform the endovascular surgery was obtained from the Ethical Committee of Tokyo Medical University. Written informed consent was obtained from all of the patients. Stress Myocardial ScintigraphyPharmacologic stress SPECT was performed ≥15 h after Background Aortic surgery is an invasive, high-risk noncard...

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Section: Discussionmentioning

confidence: 99%

Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Harafuji

Chikamori

Kawaguchi

et al. 2005

Circ J

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“…Dicha técnica, en uso en nuestro medio desde 1997 18,19 , en un estudio comparativo retrospectivo con la cirugía convencional en pacientes octogenarios, no mostró diferencia en la mortalidad operatoria, sin embargo tuvo un impacto significativo en la morbilidad perioperatoria y, por ende, en la recuperación de la calidad de vida de los pacientes 20 . Esta técnica resulta especialmente atractiva en pacientes de alto riesgo con anatomía favorable.…”

Section: Discussionunclassified

Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos

Sch

et al. 2003

Rev. méd. Chile

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“…5,6,9,27 Similarly, Kaplan-Meier estimates without risk stratification revealed no clinical relevant differences in midterm survival rates. 34 Only parameters of morbidity such as less blood loss, reduced need for blood replacement, and decreased length of stay in the intensive care unit and the hospital could be proved. 5,6,34 In reconsideration of other clinical investigations, the inability to find statistically different mortality rates or the lack of proof of any difference might be caused by the absence of statistical power due to the small clinical effects in insufficient numbers of patients; ie, Ϸ2% difference in overall mortality rate may be expected, which would require the recruitment of Ͼ1500 patients in each treatment group to achieve sufficient statistical power.…”

Section: Teufelsbauer Et Al Endovascular Stent Grafting Vs Open Surgementioning

confidence: 99%

“…5,6,34 In reconsideration of other clinical investigations, the inability to find statistically different mortality rates or the lack of proof of any difference might be caused by the absence of statistical power due to the small clinical effects in insufficient numbers of patients; ie, Ϸ2% difference in overall mortality rate may be expected, which would require the recruitment of Ͼ1500 patients in each treatment group to achieve sufficient statistical power. Similarly, Sicard et al 34 recently compared TEAM with open surgery in 470 patients. All patients and, as a subgroup, those Ն80 years of age were investigated without evaluation of individual risk profiles.…”

Section: Teufelsbauer Et Al Endovascular Stent Grafting Vs Open Surgementioning

confidence: 99%

Endovascular Stent Grafting Versus Open Surgical Operation in Patients With Infrarenal Aortic Aneurysms

et al. 2002

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Background— Although transfemoral endovascular aneurysm management (TEAM) of infrarenal abdominal aortic aneurysms (AAA) is widely performed, open graft replacement is still considered the standard of care. The aim of this study was to investigate whether clear indications for TEAM can be established in patients with significant comorbidities without investigating differences in relative procedure efficacy or durability. Methods and Results— A propensity score–based analysis of 454 consecutive patients treated electively for AAA from January 1995 through December 2000 was performed. Of those 454 patients, 248 received open surgery and 206 received TEAM. In-hospital mortality rates (MRs) were compared. After adjusting for propensity scores, a Cox proportional hazard model (COX) was employed to test the influence of the respective treatment on postoperative 900-day survival estimates (SEs). Several potential preoperative risk factors were used as covariates. The MR of all patients was 3.7%. Explorative analysis demonstrated that patients treated by TEAM presented with significantly more risk factors. In American Society of Anesthesiologists class IV patients, a significant difference in MR was detected (4.7% for TEAM versus 19.2% for open surgery; P <0.02). After adjusting for the propensity to receive TEAM or open surgery, a regression analysis of survival based on COX revealed predictive influences of impaired kidney ( P <0.047) or pulmonary function ( P <0.001), increased age ( P <0.05), and selection of treatment modality ( P <0.002) on SE. Conclusions— TEAM represents a less invasive procedure for AAA therapy in patients with significant preoperative risk factors. Especially in geriatric patients with multiple morbidities, TEAM offers a method of therapy with acceptable MRs and SEs, making active treatment possible in otherwise incurable patients.

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Endoluminal Graft Repair for Abdominal Aortic Aneurysms in High-Risk Patients and Octogenarians

Cited by 87 publications

References 48 publications

Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery

Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos

Endovascular Stent Grafting Versus Open Surgical Operation in Patients With Infrarenal Aortic Aneurysms

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