Long-Term Outcome After Open (OR) and Endovascular Repairs (EVAR) of Abdominal Aortic Aneurysms (AAAs) in Matched Cohorts Using Propensity Score Modeling

Management of abdominal aortic aneurysms has been the subject of rigorous scientific scrutiny. Prevalence studies have directed the formation of screening programmes, and observational studies and randomised controlled trials have defined aneurysm growth and treatment thresholds. Pre-emptive intervention with traditional open surgical repair has been the bedrock of improving long-term outcome and survival in patients with abdominal aortic aneurysms but it is associated with a significant procedural morbidity and mortality. Endovascular aneurysm repair (EVAR) has substantially reduced these early complications and has been associated with promising results in both elective and emergency aneurysm repair. However, the technique has brought its own unique complications, endoleaks. An endoleak is the presence of blood flow within the aneurysm sac but outside the EVAR graft. Although in randomised control trials EVAR was associated with a reduced early mortality compared with open repair, its longer-term morbidity and mortality was higher because endoleak development is associated with a higher risk of rupture. These endoleak complications have necessitated the development of postoperative imaging surveillance and re-intervention. These contrasting benefits and risks inform the selection of the mode of repair and are heavily influenced by individual patient factors. An improved strategy to predict endoleak development could further help direct treatment choice for patients and improve both early and late outcomes. This article reviews current EVAR practice, recent updates in clinical practice guidelines and the potential future developments to facilitate the selection of mode of aneurysm repair.Trial registration number: ClinicalTrials.gov NCT04577716.

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Wrapping in Ascending Aortic Aneurysms as an Alternative for Replacement: Is It Beneficial?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1700530 ◽

2019 ◽

Vol 68 (04) ◽

pp. 322-327

Author(s):

Roya Ostovar ◽

Magdalena L. Laux ◽

Christian Braun ◽

Martin Hartrumpf ◽

Thomas Claus ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Left Ventricular ◽

Aortic Aneurysms ◽

Inhospital Mortality ◽

Prosthetic Replacement ◽

Term Outcome ◽

Long Term Outcome ◽

Phone Calls

Abstract Background Prosthetic replacement of aneurysms of the ascending aorta is the gold standard in terms of long-term stability. Wrapping seems to be a less invasive procedure. It has not yet been shown if it is as safe in terms of long-term outcome. Methods We present a single-center analysis of our experience over 13 years. We retrospectively analyzed data from patients who received either aortic prosthetic wrapping (AW) or aortic prosthetic replacement (AR) with or without aortic valve replacement and assessed them through phone calls. We used propensity score matching to adjust the baseline of the groups. Results Before propensity matching, 144 patients received AW and 91 patients underwent AR. Mean age was 64 ± 11.8 years. After propensity score matching and adjusting for significant differences in age, gender, body mass index, logistic EuroSCORE I, and left ventricular function, 69 patients in each group remained for further analysis. Rate of early reoperation due to tamponade, inhospital mortality, and survival rates did not differ. In both groups, the surgically treated aortic segment did not show enlargement, whereas the nontreated aortic arch showed comparable aneurysmatical progression. Conclusions AW is safe and feasible and can be used in elderly or frail patients in order to avoid an AR. Progression of the remaining native aortic segments occurs, thus requiring strict life-long follow-up to ensure an elective and thus safe approach for appropriate consecutive surgical measures, if required.

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Perioperative, Postoperative, and Long-Term Outcomes Following Open Surgical Repair of Ruptured Abdominal Aortic Aneurysm

Angiology ◽

10.1177/0003319720911578 ◽

2020 ◽

Vol 71 (7) ◽

pp. 626-632 ◽

Cited By ~ 1

Author(s):

Hashem M. Barakat ◽

Yousef Shahin ◽

Waqas Din ◽

Bankole Akomolafe ◽

Brian F. Johnson ◽

...

Keyword(s):

Hospital Mortality ◽

Surgical Repair ◽

Aortic Aneurysms ◽

Long Term Outcomes ◽

Open Surgical Repair ◽

Term Outcome ◽

Long Term Outcome ◽

Abdominal Aortic ◽

Postoperative Myocardial Infarction

We investigated factors that affected perioperative, postoperative, and long-term outcomes of patients who underwent open emergency surgical repair of ruptured abdominal aortic aneurysms (RAAA). All patients who underwent open emergency surgical repair from 1990 to 2011 were included (463 patients; 374 [81%] male; mean age 74.7 ± 8.7years). Logistic and Cox regression analyses were performed to explore the association of variables with outcomes. Preoperatively, median (interquartile range) hemoglobin was 11.2 (9.5-12.8) g/dL, and median creatinine level was 140 (112-177) µmol/L. Intraoperatively, the median operative time was 2.25 (2-3) hours, and median estimated blood loss was 1.5 (0.5-3) L; 250 (54%) patients required intraoperative inotropes, and a median of 6 (4-8) units of blood was transfused. Median length of hospital stay was 11 (7-20) days. In-hospital mortality rate was 35.6%, and 5-year mortality was 48%. Age, distance traveled, operation duration, postoperative myocardial infarction (MI), and multi-organ failure (MOF) were predictors of in-hospital mortality and long-term outcome. Additionally, postoperative acute renal failure predicted in-hospital mortality. In patients with RAAA undergoing open surgical repair, the strongest predictors of in-hospital mortality and long-term outcome were postoperative MOF and MI and operative duration.

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Early and long-term results of open repair of inflammatory abdominal aortic aneurysms: Comparison with a propensity score-matched cohort

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.11.040 ◽

2020 ◽

Vol 72 (3) ◽

pp. 910-917 ◽

Cited By ~ 1

Author(s):

Slobodan Cvetkovic ◽

Igor Koncar ◽

Stefan Ducic ◽

Petar Zlatanovic ◽

Perica Mutavdzic ◽

...

Keyword(s):

Propensity Score ◽

Open Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Results ◽

Matched Cohort ◽

Abdominal Aortic

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Endoluminal Repair of Abdominal Aortic Aneurysms: Strengths and Weaknesses of Various Prostheses Observed in a 4.5-Year Experience

Journal of Endovascular Therapy ◽

10.1177/152660289700400206 ◽

1997 ◽

Vol 4 (2) ◽

pp. 147-151 ◽

Cited By ~ 10

Author(s):

James May ◽

Geoffrey H. White ◽

Weiyun Yu ◽

Richard Waugh ◽

Michael S. Stephen ◽

...

Keyword(s):

Vascular Complications ◽

Aortic Aneurysms ◽

Term Outcome ◽

Long Term Outcome ◽

Endoluminal Repair ◽

Abdominal Aortic ◽

Contrast Enhanced ◽

Fluoroscopic Control ◽

Enhanced Computed Tomography

Purpose: To summarize the results of endovascular abdominal aortic aneurysm (AAA) treatment using several endograft designs over a 4.5-year experience and offer comparisons on the various devices. Methods: From May 1992 to August 1996, 121 AAA patients meeting the criteria for an endoluminal repair were treated with 1 of 5 endograft designs in three configurations. The endografts were implanted in the operating room under fluoroscopic control. Follow-up included contrast-enhanced computed tomography within 10 days of operation, 6 months postoperatively, and annually thereafter. Results: Endografts were successfully deployed in 106 patients (88%). Fifteen cases were converted to open repair. Six procedure-related deaths occurred within 30 days owing to myocardial infarction (3), combined renal failure and septicemia (2), and multisystem failure (1). There were 36 local/vascular complications (30%) and 18 systemic/remote complications (15%). Of the 121 patients undergoing endoluminal AAA repair, 93 (77%) are currently alive and well with their AAAs excluded from the circulation. Conclusions: Trends in endoluminal AAA repair and prosthetic design point toward simpler devices and earlier treatment of smaller aneurysms once the long-term outcome of aortic endografting has been determined.

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Long-term Comparison of Endovascular and Open Repair of Abdominal Aortic Aneurysms: Retrospective Analysis of Matched Cohorts with Propensity Score

Annals of Vascular Surgery ◽

10.1016/j.avsg.2017.01.011 ◽

2017 ◽

Vol 43 ◽

pp. 96-103 ◽

Cited By ~ 12

Author(s):

Masayuki Sugimoto ◽

Akio Koyama ◽

Kiyoaki Niimi ◽

Akio Kodama ◽

Hiroshi Banno ◽

...

Keyword(s):

Propensity Score ◽

Retrospective Analysis ◽

Open Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic

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Stents for the Treatment of Aortic Aneurysms

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615578 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 171-175 ◽

Cited By ~ 1

Author(s):

D. Ebert ◽

M. Langer ◽

P. Uhrmeister

Keyword(s):

Endovascular Treatment ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Imaging Modalities ◽

Exclusion Criteria ◽

Multicenter Studies ◽

Abdominal Aortic ◽

First Results

SummaryThe endovascular treatment of abdominal aortic aneurysms has generated a great deal of interest since the early 1990s, and many different devices are currently available. The procedure of endovascular repair has been evaluated in many institutions and the different devices are compared. The first results were encouraging, but complications like endoleak, dislocation or thrombosis of the graft occurred. By the available devices the stent application is only promising, if the known exclusion criteria are strictly respected. Therefore a careful preinterventional assessment of the patient by different imaging modalities is necessary. As the available results up to now are preliminary and the durability of the devices has to be controlled, multicenter studies are required to improve the devices and observe their long- term success in the exclusion of abdominal aortic aneurysms.

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