Shared Decision Making and the Management of Intact Abdominal Aortic Aneurysm: A Scoping Review of the Literature

Machin, Matthew; Herzeele, Isabelle Van; Ubbink, Dirk T.; Powell, J.T.

doi:10.1016/j.ejvs.2023.01.036

Cited by 13 publications

(2 citation statements)

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“…With more AAA patients living longer and improvement in cardiovascular risk factor managementa careful shared clinical decision making process between clinicians and patients is required. [30][31][32] Several prediction models developed to estimate operative risk for open AAA repair and EVAR hold the promise of better informing patients of their individual risk of perioperative mortality and provide surgeons a useful tool to ensure an informed discussion with patients and their families. Potentially predictive survival short and long term models that adjusts for patients risk factors, AAA diameter and estimated life expectancy might assist in AAA management.…”

Section: Discussionmentioning

confidence: 99%

“…Decision making related to AAA repair can be complex. With more AAA patients living longer and improvement in cardiovascular risk factor management – a careful shared clinical decision making process between clinicians and patients is required 30–32 . Several prediction models developed to estimate operative risk for open AAA repair and EVAR hold the promise of better informing patients of their individual risk of perioperative mortality and provide surgeons a useful tool to ensure an informed discussion with patients and their families.…”

Section: Discussionmentioning

confidence: 99%

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Propensity score analysis demonstrates no long term survival benefit from contemporary endovascular aneurysm repair compared to open in Aotearoa New Zealand

Gormley,

Bernau,

et al. 2023

ANZ Journal of Surgery

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BackgroundCurrent guidelines for AAA management are based on landmark trials comparing EVAR and open aneurysm repair (OAR) conducted more than 20 years ago. Important advancements have been made in peri‐operative care but the impact of EVAR and OAR on long‐term patient survival has not been well reported using contemporary data. The objective of this study was to compare the short and long‐term outcomes of OAR and EVAR in the recent era.MethodsThis retrospective observational study included all patients undergoing intact AAA repair in NZ from 1st of January 2011 until 31st of December 2019. Data was collected from national administrative and clinical vascular databases and matched using unique identifiers. Time‐to‐event survival analyses was conducted using cox proportional hazard models to adjust for confounders and propensity score matching were used.ResultsTwo thousand two hundred and ninety‐seven patients had an intact AAA repair with a median (IQR) age of 75 (69–80) years; 494 (21.2%) patients were females and 1206 (53%) underwent EVAR. The 30‐day mortality for OAR and EVAR was 4.8% and 1.2%. The median (IQR) follow up was 5.2 (2.3–9.2) years. After propensity matching for co‐variates, the study cohort consisted of 835 patients in each matched group. Patients undergoing EVAR had a higher overall mortality (HR 1.48 (95% CI: 1.26–1.74) after adjusting for confounders compared to OAR.ConclusionAnalysis of survival following EVAR and OAR in the current era demonstrates that patients that underwent EVAR had a lower 30‐day mortality. However, in the long‐term after adjusting for confounders OAR had a better overall survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%