University of Massachusetts Medical School Faculty Publications

Title

Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy

UMMS Affiliation

Department of Surgery, Division of Vascular and Endovascular Surgery

Date

9-2013

Document Type

Article

Medical Subject Headings

Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Rupture; Chi-Square Distribution; *Decision Support Techniques; Elective Surgical Procedures; *Endovascular Procedures; Female; Humans; *Life Expectancy; Male; Middle Aged; Multivariate Analysis; New England; *Patient Selection; Proportional Hazards Models; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; *Vascular Surgical Procedures

Disciplines

Surgery | Surgical Procedures, Operative

Abstract

OBJECTIVE: Elective abdominal aortic aneurysm (AAA) repair is beneficial when rupture is likely during a patient's expected lifetime. The purpose of this study was to identify predictors of long-term mortality after elective AAA repair for moderately sized AAAs ( < 6.5-cm diameter) to identify patients unlikely to benefit from surgery.

METHODS: We analyzed 2367 elective infrarenal AAA ( < 6.5 cm) repairs across 21 centers in New England from 2003 to 2011. Our main outcome measure was 5-year life-table survival. Cox proportional hazards analysis was used to describe associations between patient characteristics and 5-year survival.

RESULTS: During the study period, 1653 endovascular AAA repairs and 714 open AAA repairs were performed. Overall, 5-year survival rates were similar by procedure type (75% endovascular repair, 80% open repair; P = .14). Advanced age greater than or equal to 75 years (hazard ratio [HR], 2.0; P < .01) and age > 80 years (HR, 2.6; P < .01), coronary artery disease (HR, 1.4; P < .04), unstable angina or recent myocardial infarction (HR, 4.6; P < .01), oxygen-dependent chronic obstructive pulmonary disease (HR, 2.7; P < .01), and estimated glomerular filtration rate < 30 mL/min/1.73 m(2) (HR, 2.8; P < .01) were associated with poor survival. Aspirin (HR, 0.8; P < .03) and statin (HR, 0.7; P < .01) use were associated with improved survival. We used these risk factors to develop risk strata for low-risk, medium-risk, and high-risk groups with survival, respectively, of 85%, 69%, and 43% at 5 years (P < .001).

CONCLUSIONS: More than 75% of patients with moderately sized AAAs who underwent elective repair in our region survived 5 years, but 4% were at high risk for 5-year mortality. Patients with multiple risk factors, especially age > 80 years, unstable angina, oxygen-dependent chronic obstructive pulmonary disease, and estimated glomerular filtration rate < 30 mL/min/1.73 m(2), are unlikely to achieve sufficient long-term survival to benefit from surgery, unless their AAA rupture risk is very high.

Rights and Permissions

Citation: J Vasc Surg. 2013 Sep;58(3):589-95. doi: 10.1016/j.jvs.2013.03.010. Epub 2013 May 1. Link to article on publisher's site

Related Resources

Link to Article in PubMed