Systematic Review and Meta-analysis of Long-term survival After Elective Infrarenal Abdominal Aortic Aneurysm Repair 1969–2011: 5 Year Survival Remains Poor Despite Advances in Medical Care and Treatment Strategies

Abstract

BackgroundImproved critical care, pre-operative optimization, and the advent of endovascular surgery (EVAR) have improved 30 day mortality for elective abdominal aortic aneurysm (AAA) repair. It remains unknown whether this has translated into improvements in long-term survival, particularly because these factors have also encouraged the treatment of older patients with greater comorbidity. The aim of this study was to quantify how 5 year survival after elective AAA repair has changed over time.MethodsA systematic review was performed identifying studies reporting 5 year survival after elective infrarenal AAA repair. An electronic search of the Embase and Medline databases was conducted to January 2014. Thirty-six studies, 60 study arms, and 107,814 patients were identified. Meta-analyses were conducted to determine 5 year survival and to report whether 5 year survival changed over time.ResultsFive-year survival was 69% (95% CI 67 to 71%, I2 = 87%). Meta-regression on study midpoint showed no improvement in 5 year survival over the period 1969–2011 (log OR −0.001, 95% CI −0.014–0.012). Larger average aneurysm diameter was associated with poorer 5 year survival (adjusted log OR −0.058, 95% CI −0.095 to −0.021, I2 = 85%). Older average patient age at surgery was associated with poorer 5 year survival (adjusted log OR −0.118, 95% CI −0.142 to −0.094, I2 = 70%). After adjusting for average patient age, an improvement in 5 year survival over the period that these data spanned was obtained (adjusted log OR 0.027, 95% CI 0.012 to 0.042).ConclusionFive-year survival remains poor after elective AAA repair despite advances in short-term outcomes and is associated with AAA diameter and patient age at the time of surgery. Age-adjusted survival appears to have improved; however, this cohort as a whole continues to have poor long-term survival. Research in this field should attempt to improve the life expectancy of patients with repaired AAA and to optimise patient selection.

Temporary Abdominal Closure After Abdominal Aortic Aneurysm Repair: A Systematic Review of Contemporary Observational Studies

“…If identified early, intra-abdominal hypertension and ACS can be managed conservatively with epidural analgesia, neuromuscular blockade, and diuretics; if identified late or when the intra-abdominal pressure reaches 30 mmHg, decompression laparotomy is necessary. 4 Of note, these elderly patients with AAA often have co-existent comorbidities and compromised physiological functions such as cardiac, pulmonary, and renal insufficiency, 5 leading to a relative therapeutic resistance to reduce the fluid overload. Thus, the duration of open abdomen therapy is often prolonged before abdominal closure is possible.…”

Type II Endoleak after Endovascular Aneurysm Repair: Natural History and Treatment Outcomes

“…There was no statistically significant difference in survival between those with and without type II endoleaks Age and smoking were found to be significantly associated with decreased survival in this patient sample. Age has already been reported as a factor associated with poorer long-term (5-year) survival in patients following EVAR in other studies 17,18 . Smoking has not been reported as a predictive factor for survival following EVAR to date.…”

Editor's Choice – Calcification of Thoracic and Abdominal Aneurysms is Associated with Mortality and Morbidity

“… 12 However, such short-term benefits have encouraged the treatment of older patients with greater comorbidity. 13 Pre-operative assessment and risk stratification is key in these patients; the ability to be build a robust operative risk tool, perhaps with the inclusion of calcium score, could help identify patients at higher risk of post-operative complications.…”