Outcomes of symptomatic abdominal aortic aneurysm repair
Department of Surgery
Medical Subject Headings
Abdominal Pain; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Rupture; Back Pain; Chi-Square Distribution; Databases as Topic; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; New England; Prospective Studies; Risk Assessment; Risk Factors; Surgical Procedures, Elective; Time Factors; Treatment Outcome; *Vascular Surgical Procedures
OBJECTIVE: Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (Sx-AAA) repair has been reported at 6% to 30% during the past 25 years. We used a multicenter regional database to describe the contemporary outcomes of patients undergoing repair of Sx-AAA.
METHODS: All patients undergoing infrarenal AAA repair in 11 hospitals comprising the Vascular Study Group of Northern New England (VSGNNE) between 2003 and 2009 were studied. Sx-AAA was prospectively defined as an AAA accompanied by abdominal or back pain or tenderness, but without rupture. The primary study end point was in-hospital mortality. Secondary end points included in-hospital postoperative major adverse events (MAE) and late survival. These outcomes were compared between symptomatic patients and contemporary VSGNNE cohorts of elective (E-AAA) and ruptured AAAs (R-AAAs) treated within the same study period.
RESULTS: During the study period, 2386 AAA repairs were performed, comprising 1959 (82%) E-AAAs, 156 (7%) Sx-AAAs, and 271 (11%) R-AAAs. Repair was endovascular in 945 (48%) E-AAAs, 60 (38%) Sx-AAAs, and 33 (12%) R-AAAs. Hospital mortality was 1.7% for E-AAA repair and 1.3% for Sx-AAA repair, but was 34.7% for R-AAA repair (P < .001). The MAE rates were 20%, 35%, and 63%, respectively, for E-AAA, Sx-AAA, and R-AAA repairs (P < .001). The mean Glasgow Aneurysm Score (GAS) for Sx-AAA patients who survived was 79 +/- 12. Those who died had an average score of 92 +/- 7, and 83% of all Sx-AAA and R-AAA patients who died had a GAS >85. Kaplan-Meier analysis demonstrated that at 1 and 4 years, Sx-AAA repair was associated with intermediate survival (83% and 68%) compared with E-AAA repair (89% and 73%) and R-AAA repair (49% and 35%; P < .001).
CONCLUSION: The operative mortality of patients with Sx-AAA in contemporary practice appears better than that previously reported in the literature. Despite low operative mortality, MAE and late survival are intermediate compared with E-AAA and R-AAA repair. Review of previous series shows a trend for lower operative mortality after Sx-AAA repair in more recent series, which likely reflects improved perioperative care and more use of endovascular aneurysm repair. All rights reserved.
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Citation: J Vasc Surg. 2010 Jul;52(1):5-12.e1. Epub 2010 May 14. Link to article on publisher's site
De Martino, Randall R.; Nolan, Brian W.; Goodney, Philip P.; Chang, Catherine K.; Schanzer, Andres; Cambria, Robert; Bertges, Daniel J.; Cronenwett, Jack L.; and Vascular Study Group of Northern New England, "Outcomes of symptomatic abdominal aortic aneurysm repair" (2010). Surgery Publications and Presentations. Paper 3.