Abdominal aortic aneurysm in Scotland

Abstract

In the 12-year period to December 1991, 5338 new cases of abdominal aortic aneurysm (AAA) were recorded in the Scottish Morbidity Record (SMR) 1. Data from this source were analysed for accuracy; information from 489 of 500 randomly examined case records matched the SMR 1 data, giving an accuracy of 97.8 per cent. There was a steady yearly increase in the number of reported cases, from 283 in 1980 to 612 in 1991; the male to female ratio was 2.5:1. The mean age was 73.1 years, higher in women (73.4 years for intact and 77.2 years for ruptured aneurysm) than in men (69.8 and 71.8 years respectively). The proportion of patients aged over 75 years increased from 29.0 per cent in 1980 to 38.2 per cent in 1991. Rupture occurred in 36.4 per cent of the aneurysms, and 75.0 per cent of these were in men. The increase in numbers occurred in both intact and ruptured cases, particularly the former. The hospital mortality rate for Scotland was 10.5 per cent for intact AAA (including urgent non-ruptured cases) and 54.7 per cent for ruptured aneurysm (including those not operated on), but these figures varied markedly between health boards.

Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?

“…A Hardman Index and a Glasgow Aneurysm Score were calculated retrospectively based on criteria set down in the original description of these statistical models. 16,17 Individual scores were related to postoperative mortality and other clinical outcomes.…”

“…Points were awarded for age, shock, myocardial disease, cerebrovascular disease and renal impairment using the formula: Glasgow Aneurysm Score = age (in years) + 17 for shock + 7 for myocardial disease + 10 for cerebrovascular disease + 14 for renal disease. 17 A Glasgow Aneurysm Score of greater than 95 was considered to indicate a patient at high risk of surgical mortality since this has been associated with a mortality of 80% or more. 19 For purposes of this paper, rAAA was defined as the presence of intraperitoneal or retroperitoneal blood in the presence of an abdominal aortic aneurysm.…”

“…8,9 With the continued emphasis on efficiency of service provision and cost-containment, the possibility of withholding repair from some patients if their death was predictable has been entertained by some authors. [10][11][12][13][14][15][16][17] A number of scoring systems have been developed with the aim of identifying patients less likely to survive surgery based on a number of pre-operative factors. Two such statistical models are the Hardman Index 16 and the Glasgow Aneurysm Score.…”

“…Two such statistical models are the Hardman Index 16 and the Glasgow Aneurysm Score. 17 The aim of this report was to assess the value of these two scoring systems in predicting postoperative mortality in patients with rAAA.…”

‘Real World’ Experience with EVAR - A Retrospective Cohort study of 239 Endoluminal Grafts in a Scottish Vascular Centre

“…Despite this, EVAR remains the current preferred method of operative repair by patients with threshold aneurysms compared to open surgery [3]. Clear survival benefit has been shown in elective AAA repair thanks to advances in surgical technique and intensive care, being shown to have a mortality of 10.7% as recently as 1994 [4], dropping to ~5% in the small aneurysm trial in 1998 [5].The recent advances in EVAR mean that perioperative mortality may be as low as 1.7% in randomized series [1]. EVAR is well studied and understood in a controlled trial population and from registry data.…”