Outcome after Turndown for Elective Abdominal Aortic Aneurysm Surgery

Whittaker, Joshua D.; Meecham, Lewis; Summerour, Virginia; Khalil, Sheirin; Layton, Georgia R.; Yousif, Marianne; Jennings, Adrian; Wall, Micheal; Newman, Jeremy

doi:10.1016/j.ejvs.2017.07.023

Cited by 16 publications

(8 citation statements)

References 21 publications

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“…Our search and evaluation of non-intervention rates ( appendix ) yielded four publications, all from the UK, including two papers 21 , 22 and two abstracts 23 , 24 (both with additional information provided by the authors). All four studies were retrospective, with a total of 1365 men and 247 women; the studies were assessed as of fair quality ( appendix ).…”

Section: Resultsmentioning

confidence: 99%

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

et al. 2017

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SummaryBackgroundPrognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000.MethodsIn these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the Newcastle–Ottawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227.FindingsFive studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0·44, 95% CI 0·32–0·62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2·27, 95% CI 1·21–4·23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2·3%) than in men (1·4%; OR 1·67, 95% CI 1·38–2·04). The overall estimate for open repair also was higher in women (5·4%) than in men (2·8%; OR 1·76, 95% CI 1·35–2·30).InterpretationCompared with men, a smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative mortality is much higher in women for both EVAR and open repair. The management of abdominal aortic aneurysm in women needs improvement.FundingNational Institute for Health Research (UK).

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Section: Resultsmentioning

confidence: 99%

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

et al. 2017

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“…Ruptured AAA was the cause of death in only 11 (36.7%) of 30 patients. 15 In other words, the majority of this group of frail patients with an AAA who were turned down for elective repair because of their comorbidities did not die of a ruptured AAA, but as a result of their comorbidities.…”

Section: Controversial Issues Regarding Aaa Screening Programsmentioning

confidence: 97%

“…In a recent report, 112 patients with AAA turned down for elective repair were followed up for a minimum of 2 years. 15 Within 2 years, 64 (57.1%) of 112 had died. Of these, 30 of 64 had a recorded cause of death.…”

Section: Controversial Issues Regarding Aaa Screening Programsmentioning

confidence: 99%

Screening Programs for Abdominal Aortic Aneurysms: Luxury or Necessity?

et al. 2018

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“…3 Three studies demonstrate that the decision to offer AAA repair should be individualized for different patients depending on their general fitness and their individual perioperative risk. In the first report, 8 112 AAA patients who were turned down for elective repair (median AAA diameter at turndown: 63 mm) were followed up for a minimum of 2 years. Within 2 years, 64 (57.1%) of 112 patients had died.…”

Section: Recommendations Of International Guidelinesmentioning

confidence: 99%