Document Detail


Endovascular treatment of elective abdominal aortic aneurysms: independent predictors of early and late mortality.
MedLine Citation:
PMID:  20926237     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this study was to review our personal experience with patients who underwent elective endovascular repair of abdominal aortic aneurysms so as to detect the predictors of early and late mortality.
METHODS: Between November 2000 and June 2008, a total of 235 consecutive patients (218 men; mean age: 71.9 ± 8.0 years, range: 48-95 years) underwent endovascular repair of abdominal aortic aneurysms. Comorbidities were defined by using the Society for Vascular score grading system and the preoperative risk grade on the basis of the classification of the American Society of Anesthesiologists (ASA). Physical examination and spiral computed tomography were planned at 1, 4, and 12 months after the procedure, and on a yearly basis thereafter. Contrast-enhanced ultrasonography and plain X-rays were also performed.
RESULTS: Primary technical success rate was 97% (228 of 235 cases). The overall hospital mortality was 2.1% (n = 5), ranging from 1.2% and 2.8% for patients with an ASA of score 2 and 3, respectively, to 7.7% for patients with an ASA score of 4. Multivariable analysis confirmed chronic renal failure (OR: 12.12, 95% CI: 1.83-80.17, p = 0.010) and transrenal endograft (OR: 9.61, 95% CI: 1.01-91.57, p = 0.049) as the only independent predictors of early mortality. Follow-up was completed for all 230 patients who were discharged, with a mean follow-up period of 26.3 ± 22.7 months (maximum: 92 months). Kaplan-Meier analysis revealed a reduced survival rate for older patients (p < 0.001) and patients with a larger aneurysm (p < 0.001). A reduced survival rate was also demonstrated for women and patients with higher ASA scores (p = 0.007, and p = 0.003, respectively). In multivariate Cox analysis, ASA score, age, diameter of the aneurysm, and being female independently affected long-term survival.
CONCLUSION: On the basis of our experience, it was concluded that chronic renal failure and the endograft configuration were independent predictors of early mortality. Also, older patients, women, and patients with larger aneurysms and higher ASA scores had the poorest late survival rates.
Authors:
Chiara Lomazzi; Giovanni Mariscalco; Gabriele Piffaretti; Alessandro Bacuzzi; Matteo Tozzi; Gianpaolo Carrafiello; Patrizio Castelli
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Publication Detail:
Type:  Journal Article     Date:  2010-10-06
Journal Detail:
Title:  Annals of vascular surgery     Volume:  25     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  299-305     Citation Subset:  IM    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Affiliation:
Division of Vascular Surgery, Department of Surgical Sciences, Varese University Hospital, University of Insubria, Varese, Italy.
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