Operative mortality and long-term relative survival of patients operated on for asymptomatic abdominal aortic aneurysm

Aune, Steinar; Amundsen, S; Evjensvold, Jens; Trippestad, Arne

doi:10.1016/s1078-5884(05)80133-9

Cited by 49 publications

(22 citation statements)

References 18 publications

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“…25) Since cerebral and cardiovascular diseases are responsible for approximately two-thirds of late deaths in patients receiving AAA repair, decrease in the cardiovascular events by adequate control of lipid levels may contribute to improvement of prognosis and late survival in these patients. [17][18][19][20][21][22] Regarding the relationship between the statin treatment and later cardiovascular events occurrence, the statin treatment itself did not reduce the prevalence of later cardiovascular events in this study. As statins would be given to those with dyslipidemia exhibiting a high serum level of LDL-C or low level of HDL-C, there would be many patients at high risk for developing cardiovascular events in the patient group receiving statins.…”

Section: Discussionmentioning

confidence: 86%

“…7,19) Of these, cerebral and cardiovascular diseases are responsible for approximately two-thirds of late deaths, thus appropriate management of these conditions would be essential to ameliorating long-term survival. [17][18][19][20][21][22] The importance of adequate control of dyslipidemia has been emphasized recently for the primary prevention of atherosclerotic disease, [9][10][11] but the evidence for the role of lipids in the development and management of AAA remains to be controversial. Some recent reports, however, described the significant association between lipid levels and AAA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lowered Postoperative Ldl-C/Hdl-C Ratio Reduces Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Kanaoka

Takahashi

Wakamatsu

et al. 2012

Annals of Vascular Diseases

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Lowered Postoperative Ldl-C/Hdl-C Ratio Reduces Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Kanaoka

Takahashi

Wakamatsu

et al. 2012

Annals of Vascular Diseases

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“…This was presumably a consequence of patients with more significant underlying ischaemic heart disease dying in the early postoperative period. 118,119,121,122 Our finding that statins and antiplatelet therapy improve long-term survival emphasises the importance of these medications in the prevention of late cardiovascular events. 123 That statin use is associated with improved long-term survival is in keeping with previously published reports.…”

Section: Survival Modellingmentioning

confidence: 96%

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Grant

Sperrin

Carlson

et al. 2015

Health Technology Assessment

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BackgroundAbdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities.ObjectiveTo develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice.Data sourcesThe UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases.MethodsA combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit.ResultsThe analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty.LimitationsLack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation.ConclusionsThe ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Many investigators [13][14][15][16] have reported the outcomes of standard open AAA repair and their mortality rates are 3-7%, caused by specific complications such as cardiac and respiratory complications, hemorrhage, renal failure and infection, related to the surgical invasiveness of the procedure. Therefore, a less invasive procedure for AAA repair is desirable.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy-Assisted Abdominal Aortic Aneurysm Repair. First Case Reports From Japan.

Matsumoto

Nishimori

Yamada

et al. 2003

Circ J

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Operative mortality and long-term relative survival of patients operated on for asymptomatic abdominal aortic aneurysm

Abstract: Further studies are needed to define subgroups unsuitable for elective surgery.

Cited by 49 publications

References 18 publications

Lowered Postoperative Ldl-C/Hdl-C Ratio Reduces Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Lowered Postoperative Ldl-C/Hdl-C Ratio Reduces Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Laparoscopy-Assisted Abdominal Aortic Aneurysm Repair. First Case Reports From Japan.

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