Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Huang, Ying; Gloviczki, Péter; Duncan, Audra A.; Kalra, Manju; Oderich, Gustavo S.; Fleming, Mark D.; Harmsen, William S.; Bower, Thomas C.

doi:10.1016/j.jvs.2016.10.093

Cited by 24 publications

(20 citation statements)

References 40 publications

(56 reference statements)

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“…Like other studies, 19 we found that large aneurysms (>75 mm) were a highly independent predictor of late all-cause mortality, regardless of AAA complexity. Likewise, chronic baseline renal insufficiency (estimated glomerular filtration rate of <60) was found to also be a significant predictor of late all-cause mortality in this study.…”

Section: Discussionsupporting

confidence: 85%

Complex endovascular aneurysm repair is associated with higher perioperative mortality but not late mortality compared with infrarenal endovascular aneurysm repair among octogenarians

Tran

Lee

McFarland

et al. 2019

Journal of Vascular Surgery

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Complex EVAR is associated with greater perioperative mortality compared with infrarenal EVAR among octogenarians. However, late outcomes, including the need for reintervention and all-cause mortality, are not significantly different. Larger aneurysms and chronic kidney disease portends greater risk of late death after EVAR, regardless of AAA complexity. These patient-related factors should be considered when offering endovascular treatment to older patients.

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Section: Discussionsupporting

confidence: 85%

Complex endovascular aneurysm repair is associated with higher perioperative mortality but not late mortality compared with infrarenal endovascular aneurysm repair among octogenarians

Tran

Lee

McFarland

et al. 2019

Journal of Vascular Surgery

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“…Previous analyses investigating size effect reported that AAA size ≥6 cm is associated with increased long-term mortality. 11,13 In an unbiased approach to identify a cutoff for AAA size, receiver operating curve (ROC) analysis was first conducted to explore whether there was an optimal cut point of AAA size that increased morality risk. Outcomes included in this study were 3-and 5-year (mid-term) all-cause mortality and 10-year (long-term) allcause mortality.…”

Section: Definitions and Endpointsmentioning

confidence: 99%

Effects of Abdominal Aortic Aneurysm Size on Mid- and Long-term Mortality After Endovascular Aneurysm Repair

et al. 2019

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Purpose: To investigate the effect of abdominal aortic aneurysm (AAA) size on mid- and long-term survival after endovascular aneurysm repair (EVAR). Materials and Methods: Retrospective data were collected from 325 consecutive patients (mean age 69.7 ± 8.5 years; 323 men) who underwent EVAR for intact AAA at a single institution between January 2003 and December 2013. The primary endpoint was death at 3, 5, and 10 years after EVAR. Optimal cutoff points for AAA size and age were determined using receiver operating characteristics (ROC) curves. Time to event analyses (Kaplan-Meier curves and Cox proportional hazard models) were employed to determine any differences in all-cause mortality outcomes between AAA size groups. Cox models were adjusted for age and other comorbidities (hypertension, hyperlipidemia, coronary artery disease, smoking status, symptomatic status, and creatinine); the outcomes are reported as the hazard ratio (HR) with 95% confidence interval (CI). Results: The cohort was dichotomized according to the ROC analysis, which defined an optimal cutoff point of 5.6 cm for AAA size and >70 years for age. The mean follow-up period post EVAR was 45.5±29.2 months. In total, 134 (41.2%) patients died during the 10-year follow-up. Thirty-day mortality was 1.1% (2/184) in the patients with AAA <5.6 cm and 2.1% (3/141) in patients with AAA ≥5.6 cm (p=0.45). All-cause mortality was not significantly affected by comorbidities. However, AAA size ≥5.6 cm was associated with increased 3-year mortality risk (HR 1.59, 95% CI 1.001 to 2.52, p<0.049) but not 5-year (HR 1.44, 95% CI 0.98 to 2.10, p=0.062) or 10-year mortality (HR 1.28, 95% CI 0.91 to 1.80, p=0.149). After adjusting for comorbidities, AAA size ≥5.6 cm was no longer significantly associated with morality at any time point. Using a larger size cutoff (AAA size ≥6.0 cm) resulted in improved statistical significance in the unadjusted model. In the adjusted Cox model, AAA size ≥6.0 cm was significantly associated with increased risk of mortality at 3 years (HR 1.67, 95% CI 1.01 to 2.77, p<0.047), but not at longer time points. Conclusion: Our study demonstrates that midterm survival after EVAR is significantly and independently associated with AAA size even after correcting for comorbidities. However, in the long term, preoperative AAA size is not an independent predictor of mortality.

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“…14 Results from the PIVOTAL and CAESAR randomised trials confirm no benefit in treating patients with smaller AAA, and there remains no conclusive evidence to justify a reduction in guidelines for treatment threshold. Large registry analyses have demonstrated greater operative morbidity with very large (>6.0 cm) AAAs, 15 but no benefit from treating if <5.5 cm in diameter. A recent cost-effectiveness simulation analysis by Tomee et al found that reduction of the treatment threshold to 5.0 cm could result in significantly more surgical procedures, including re-interventions and subsequent operative mortality, at the cost of an estimated US$1 million per rupture-related death prevented.…”

Section: Objectivesmentioning

confidence: 99%

Abdominal aortic aneurysm: An update

Chuen¹,

Theivendran²

2018

Aust J Gen Pract

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THE TREATMENT OF abdominal aortic aneurysm (AAA) has progressed significantly from the early days of open aneurysmorrhaphy and cellophane wrapping. The experiences of Albert Einstein and Rudolph Nissen now exist only in the annals of history, and the staple management of AAA disease includes targeted screening studies, patient education on detection, risk factor and medical management, screening for associated conditions, monitoring and surveillance until surgical treatment is warranted, and open repair or endovascular surgery followed by targeted postoperative surveillance. This article outlines current medical and surgical treatment strategies, for the appreciation of practitioners managing patients with AAA. It is assumed that readers are familiar with the basic concepts described in our previous papers on aortic and non-aortic aneurysms. 1,2

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Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Cited by 24 publications

References 40 publications

Complex endovascular aneurysm repair is associated with higher perioperative mortality but not late mortality compared with infrarenal endovascular aneurysm repair among octogenarians

Complex endovascular aneurysm repair is associated with higher perioperative mortality but not late mortality compared with infrarenal endovascular aneurysm repair among octogenarians

Effects of Abdominal Aortic Aneurysm Size on Mid- and Long-term Mortality After Endovascular Aneurysm Repair

Abdominal aortic aneurysm: An update

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