Abstract 41: Designation as “Unfit For Open Repair” is Associated with Poor Outcomes Following Endovascular Aneurysm Repair

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Randall R De Martino ◽  
Benjamin J Brooke ◽  
William P Robinson ◽  
Brian W Nolan ◽  
Jack L Cronenwett ◽  
...  
Keyword(s):  
New England ◽  
Open Repair ◽  
Endovascular Aneurysm Repair ◽  
Cox Proportional Hazards ◽  
Aortic Aneurysms ◽  
Cardiac Complications ◽  
Risk Of Rupture ◽  
Short And Long Term ◽  
Aneurysm Repair

Objective: Endovascular aneurysm repair (EVAR) is a minimally invasive method of repair for abdominal aortic aneurysms (AAA) with a lower perioperative morbidity and mortality compared to open repair (oAAA). In many cases, EVAR is offered to patients who otherwise are not candidates for oAAA. This study attempts to describe the short and long term outcomes of patients undergoing EVAR who are consideredunfit for oAAA with moderate sized aneurysms (<6..5cm diameter). Methods: We analyzed 1,653 elective EVARs within the Vascular Study Group of New England (2003-2011), a regional quality improvement collaborative across 21 hospitals and 87 surgeons in New England. Endpoints included in-hospitalmajor adverse events (MAEs) and one, three, and five-year mortality. Logistic regression was used to develop a prediction model for being deem unfit for open repair. Multivariate predictors of survival were determined using Cox Proportional Hazards. Results: Of 1,653 EVARs, 309 (18.7%) were performed in patients deemed unfit for open repair. These patients were more likely to be over 80 years of age, have advanced cardiac disease,COPD, and a larger aneurysms. Patients deemed unfit for open repair had andhigher rates of cardiac complications (7.8% vs 3.1%, p<0.01) and pulmonary complications (3.6 vs. 1.6, p<0..01). Patients unfit for open repair had poorer survival rates at 1 (93% vs.. 96%), 3 (73% vs. 89%) and 5 years (61% vs. 80%) compared to those appropriate for open repair (logrank p<0.01). The effect of "unfit for open" designation remained significant (HR 1.6, 96% CI 1.2-2.2, p<0.01), even when adjusted for patient characteristics and aneurysm size. Conclusions: Clinical provider assessment provides insight into both short and long-term efficacy of EVAR, even when adjusting for age and comorbidities. Patients in whom open repair is felt to be too "high-risk" may not benefit from EVAR unless their risk of rupture is very high.

scholarly journals PS26. Long Term Quality of Life after Endovascular Aneurysm Repair, Compared to Open Repair in Patients with Abdominal Aortic Aneurysms

2011 ◽  
Vol 53 (6) ◽  
pp. 36S-37S
Author(s):  
Niels J. Ravensbergen ◽  
Mirjam H. Mastenbroek ◽  
Michiel T. Voûte ◽  
Sanne E. Hoeks ◽  
Don Poldermans
Keyword(s):  
Quality Of Life ◽  
Open Repair ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Repair of Infrarenal Abdominal Aortic Aneurysms

2017 ◽  
Author(s):  
James Sampson ◽  
William D Jordan Jr
Keyword(s):  
Tobacco Use ◽  
Endovascular Aneurysm Repair ◽  
Careful Consideration ◽  
Aortic Aneurysms ◽  
Optimal Outcomes ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Aneurysm Detection ◽  
Aneurysm Repair

Aneurysms are localized arterial dilations with a propensity toward expansion and rupture. The abdominal aorta is the most common site of aneurysmal disease and shares risk factors with atherosclerosis, including advanced age, male sex, and tobacco use. Rupture is unpredictable, typically unheralded, and most often fatal. The risk of rupture is related to aneurysm size and continued tobacco use. There is no established medical treatment; therefore, prevention of aneurysm-related death relies on aneurysm detection through screening followed by intervention on appropriately selected and prepared individuals. Intervention is typically warranted when the aneurysm has reached a size of 5.5 cm. Treatment is possible through open surgical repair or through endovascular exclusion of the aneurysm. Optimal outcomes rely on careful consideration of the patient’s comorbid disease and life expectancy and the anatomic features of the aneurysm to determine the most appropriate timing and approach to repair. Continued surveillance after intervention is critical to optimizing long-term benefits of repair, especially for those treated through endovascular means. This review contains 33 figures, and 37 references. Key words: abdominal aortic aneurysm, aneurysm, endovascular, endovascular aneurysm repair, repair, rupture, screening

Repair of Infrarenal Abdominal Aortic Aneurysms

2017 ◽  
Author(s):  
James Sampson ◽  
William D Jordan Jr
Keyword(s):  
Tobacco Use ◽  
Endovascular Aneurysm Repair ◽  
Careful Consideration ◽  
Aortic Aneurysms ◽  
Optimal Outcomes ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Aneurysm Detection ◽  
Aneurysm Repair

Aneurysms are localized arterial dilations with a propensity toward expansion and rupture. The abdominal aorta is the most common site of aneurysmal disease and shares risk factors with atherosclerosis, including advanced age, male sex, and tobacco use. Rupture is unpredictable, typically unheralded, and most often fatal. The risk of rupture is related to aneurysm size and continued tobacco use. There is no established medical treatment; therefore, prevention of aneurysm-related death relies on aneurysm detection through screening followed by intervention on appropriately selected and prepared individuals. Intervention is typically warranted when the aneurysm has reached a size of 5.5 cm. Treatment is possible through open surgical repair or through endovascular exclusion of the aneurysm. Optimal outcomes rely on careful consideration of the patient’s comorbid disease and life expectancy and the anatomic features of the aneurysm to determine the most appropriate timing and approach to repair. Continued surveillance after intervention is critical to optimizing long-term benefits of repair, especially for those treated through endovascular means. This review contains 33 figures, and 37 references. Key words: abdominal aortic aneurysm, aneurysm, endovascular, endovascular aneurysm repair, repair, rupture, screening

Endovascular abdominal aortic aneurysm repair in patients with Marfan syndrome

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 48-52
Author(s):  
Allan Marc Conway ◽  
Khalil Qato ◽  
Gautam Anand ◽  
Laurie Mondry ◽  
Gary Giangola ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Open Repair ◽  
Aortic Surgery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Femoral Access ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed.

scholarly journals Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 573-581 ◽  
Author(s):  
Wan Chin Hsieh ◽  
Chung Dann Kan ◽  
Chong Chao Hsieh ◽  
Mohamed Omara ◽  
Brandon Michael Henry ◽  
...  
Keyword(s):  
Open Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Younger Patients ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Short And Long Term ◽  
Long Term Mortality

Objectives Abdominal aortic aneurysms are conventionally treated by open repair surgery. While endovascular aortic repair improves survival in high-risk patients, younger patients (40–65 years) potentially at lower risk with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair usually have poorer post-operative outcomes and require longer term follow-up. In this study, clinical data on younger patients were analyzed to investigate whether endovascular aortic repair leads to poorer short- and long-term outcomes. Methods This was a systematic review and meta-analysis of articles comparing clinical outcomes in patients aged 40–65 years undergoing open repair or endovascular aortic repair and published between 2000 and 2017. In-hospital mortality, long-term mortality, and post-operative complication data were retrieved from eligible studies and clinical outcomes were compared. Twenty-one retrospective cohort analyses were included, accounting for 250,837 patients (149,051 endovascular aortic repair; 101,786 open repair). Risk ratios were pooled using the DerSimonian and Laird random effects model. All statistical analyses were performed in Review Manager 5.3. Results Younger patients with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair had a significantly reduced 30-day mortality (odds ratio (OR) = 0.40, 95% confidence intervals (CI) 0.28–0.57; p < 0.00001), long-term mortality (OR = 0.37, 95% CI 0.17–0.82; p = 0.01), incidence of reintervention (OR = 0.47, 95% CI 0.34–0.66; p < 0.0001), and incidence of renal failure (OR = 1.58, 95% CI 1.37–1.82; p < 0.00001). Conclusions Endovascular aortic repair may improve short- and long-term survival and reduce post-operative complications in younger patients with asymptomatic abdominal aortic aneurysms.

Endovascular Aneurysm Repair Increases Aortic Arterial Stiffness When Compared to Open Repair of Abdominal Aortic Aneurysms

2016 ◽  
Vol 50 (5) ◽  
pp. 317-320 ◽  
Author(s):  
Cleona Gray ◽  
Patrick Goodman ◽  
Stephen A. Badger ◽  
M. Kevin O’Malley ◽  
Martin K. O’Donohoe ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Open Repair ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Elective endovascular vs. open repair for abdominal aortic aneurysm in octogenarians

Vascular ◽  
2016 ◽  
Vol 24 (4) ◽  
pp. 348-354 ◽  
Author(s):  
Koichi Morisaki ◽  
Takuya Matsumoto ◽  
Yutaka Matsubara ◽  
Kentaro Inoue ◽  
Yukihiko Aoyagi ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Operative Mortality ◽  
Open Repair ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Elective Repair ◽  
Aneurysm Repair ◽  
Repair Group

Purpose The purpose of this study was to investigate the operative mortality and short-term and midterm outcomes of treatment of abdominal aortic aneurysm in Japanese patients over 80 years of age. Methods Between January 2007 and December 2011, 207 patients underwent elective repair of infrarenal abdominal aortic aneurysms. Comorbidities, operative morbidity and mortality, midterm outcomes were analyzed retrospectively. Results The average age (endovascular aneurysm repair, 84.4 ± 0.3; open, 82.8 ± 0.3, P < 0.01) and the percentage of hostile abdomen (endovascular aneurysm repair, 22.2%; open repair, 11.1%, P < 0.05) were higher in the endovascular aneurysm repair group. Percentage of outside IFU was higher in open repair (endovascular aneurysm repair, 38.5%; open repair, 63.3%, P < 0.01). The cardiac complication (endovascular aneurysm repair, 0%; open repair, 5.6%, P < 0.01) and length of postoperative hospital stay (endovascular aneurysm repair, 10.3 ± 0.8 days; open, 18.6 ± 1.6 days, P < 0.05) were significantly lower in the endovascular aneurysm repair group. There were no differences in operative mortality (endovascular aneurysm repair, 0%; open, 1.1%, P = 0.43) and the aneurysm-related death was not observed. The rate of secondary interventions (EVAR, 5.1%; open repair, 0%, P < 0.01) and midterm mortality rate were much higher in the endovascular aneurysm repair group. Conclusions Endovascular aneurysm repair is less invasive than open repair and useful for treating abdominal aortic aneurysm in octogenarians; however, open repair can be acceptable treatment in the inappropriate case treated by endovascular aneurysm repair.

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