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Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age.

Raats JW, Flu HC, Ho GH, Veen EJ, Vos LD, Steyerberg EW, van der Laan L - Clin Interv Aging (2014)

Bottom Line: Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition.There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035).The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Amphia Hospital, Breda, the Netherlands.

ABSTRACT

Background: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA.

Methods: We conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital.

Results: Twelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P<0.001). Advancing age was associated with increasing mortality (hazard ratio 1.05 [95% confidence interval 1.01-1.09]) per year for patients who received operative repair, with a 67%, 76%, and 100% 5-year mortality rate in the 34 patients aged <70 years, 59 patients aged 70-79 years, and 12 octogenarians, respectively; 30-day rAAA-related mortality was also associated with increasing age (21%, 30%, and 61%, respectively; P=0.008).

Conclusion: The 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.

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Related in: MedlinePlus

Patient flow through identification and selection process.Abbreviations: AAA, abdominal aortic aneurysm; eEVAR, emergency endovascular aneurysm repair; OPEN, conservative open repair.
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f1-cia-9-1721: Patient flow through identification and selection process.Abbreviations: AAA, abdominal aortic aneurysm; eEVAR, emergency endovascular aneurysm repair; OPEN, conservative open repair.

Mentions: Between January 2005 and December 2011, 157 patients were admitted to our hospital with a diagnosis of rAAA or symptomatic AAA (Figure 1). Thirty-seven patients were excluded due to diagnosis of a symptomatic non-ruptured AAA. Twelve patients (mean age 87±4.6 years) did not undergo surgical intervention and were treated conservatively for several different reasons, as listed in Table 2. One patient died after 15 months, and in this case a diagnosis of rAAA was confirmed by uncontrasted CT due to significant renal impairment. The remaining eleven patients died within 48 hours (median mortality at 27 hours). Three patients died in the emergency room and were excluded. Of the 105 patients included, 82 (78%) underwent OPEN and 23 (22%) received eEVAR.


Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age.

Raats JW, Flu HC, Ho GH, Veen EJ, Vos LD, Steyerberg EW, van der Laan L - Clin Interv Aging (2014)

Patient flow through identification and selection process.Abbreviations: AAA, abdominal aortic aneurysm; eEVAR, emergency endovascular aneurysm repair; OPEN, conservative open repair.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4206251&req=5

f1-cia-9-1721: Patient flow through identification and selection process.Abbreviations: AAA, abdominal aortic aneurysm; eEVAR, emergency endovascular aneurysm repair; OPEN, conservative open repair.
Mentions: Between January 2005 and December 2011, 157 patients were admitted to our hospital with a diagnosis of rAAA or symptomatic AAA (Figure 1). Thirty-seven patients were excluded due to diagnosis of a symptomatic non-ruptured AAA. Twelve patients (mean age 87±4.6 years) did not undergo surgical intervention and were treated conservatively for several different reasons, as listed in Table 2. One patient died after 15 months, and in this case a diagnosis of rAAA was confirmed by uncontrasted CT due to significant renal impairment. The remaining eleven patients died within 48 hours (median mortality at 27 hours). Three patients died in the emergency room and were excluded. Of the 105 patients included, 82 (78%) underwent OPEN and 23 (22%) received eEVAR.

Bottom Line: Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition.There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035).The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Amphia Hospital, Breda, the Netherlands.

ABSTRACT

Background: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA.

Methods: We conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital.

Results: Twelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P<0.001). Advancing age was associated with increasing mortality (hazard ratio 1.05 [95% confidence interval 1.01-1.09]) per year for patients who received operative repair, with a 67%, 76%, and 100% 5-year mortality rate in the 34 patients aged <70 years, 59 patients aged 70-79 years, and 12 octogenarians, respectively; 30-day rAAA-related mortality was also associated with increasing age (21%, 30%, and 61%, respectively; P=0.008).

Conclusion: The 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.

Show MeSH
Related in: MedlinePlus