Comparison of Survival Rates for Abdominal Aortic Aneurysm Treatment Methods

Hinterseher, Irene; Kuffner, H D; Koch, Rainer; Gäbel, Gábor; Saeger, H. D.; Smelser, Diane T.

doi:10.1007/s00268-012-1477-4

Cited by 7 publications

(9 citation statements)

References 40 publications

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“…Twenty-four studies, consisting of 40 study arms, provided mean age data and were included in this analysis. 3,5,12,13,15–17,21,23,24,26,27,29,31,32,35,37–42,44,45 This comprised 103,021 patients with a mean age range of 63 years to 78.5 years, from data covering the period 1978–2011 (Table 5).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Long-term survival After Elective Infrarenal Abdominal Aortic Aneurysm Repair 1969–2011: 5 Year Survival Remains Poor Despite Advances in Medical Care and Treatment Strategies

Bahia¹,

Holt²,

Jackson

et al. 2015

European Journal of Vascular and Endovascular Surgery

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BackgroundImproved critical care, pre-operative optimization, and the advent of endovascular surgery (EVAR) have improved 30 day mortality for elective abdominal aortic aneurysm (AAA) repair. It remains unknown whether this has translated into improvements in long-term survival, particularly because these factors have also encouraged the treatment of older patients with greater comorbidity. The aim of this study was to quantify how 5 year survival after elective AAA repair has changed over time.MethodsA systematic review was performed identifying studies reporting 5 year survival after elective infrarenal AAA repair. An electronic search of the Embase and Medline databases was conducted to January 2014. Thirty-six studies, 60 study arms, and 107,814 patients were identified. Meta-analyses were conducted to determine 5 year survival and to report whether 5 year survival changed over time.ResultsFive-year survival was 69% (95% CI 67 to 71%, I2 = 87%). Meta-regression on study midpoint showed no improvement in 5 year survival over the period 1969–2011 (log OR −0.001, 95% CI −0.014–0.012). Larger average aneurysm diameter was associated with poorer 5 year survival (adjusted log OR −0.058, 95% CI −0.095 to −0.021, I2 = 85%). Older average patient age at surgery was associated with poorer 5 year survival (adjusted log OR −0.118, 95% CI −0.142 to −0.094, I2 = 70%). After adjusting for average patient age, an improvement in 5 year survival over the period that these data spanned was obtained (adjusted log OR 0.027, 95% CI 0.012 to 0.042).ConclusionFive-year survival remains poor after elective AAA repair despite advances in short-term outcomes and is associated with AAA diameter and patient age at the time of surgery. Age-adjusted survival appears to have improved; however, this cohort as a whole continues to have poor long-term survival. Research in this field should attempt to improve the life expectancy of patients with repaired AAA and to optimise patient selection.

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Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Long-term survival After Elective Infrarenal Abdominal Aortic Aneurysm Repair 1969–2011: 5 Year Survival Remains Poor Despite Advances in Medical Care and Treatment Strategies

Bahia¹,

Holt²,

Jackson

et al. 2015

European Journal of Vascular and Endovascular Surgery

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“…In general, many of the current devices used according to instructions for use are equivalent regarding postoperative complications, migration, and aneurysm-related mortality [25]. In addition to device design, we have an active interest in studying the outcomes following AAA repair [26]. Recently, we compared the relative survival rates of patients after various operative treatments for AAA to those of the general population.…”

Section: Clinical Studies On Aaamentioning

confidence: 99%

“…Kaplan-Meier curves were generated with the indicated numbers of patients at risk. Reproduced with permission from [26]. …”

Section: Figurementioning

confidence: 99%

Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

et al. 2014

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An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta with a diameter of at least 3.0 cm. AAAs are often asymptomatic and are discovered as incidental findings in imaging studies or when the AAA ruptures leading to a medical emergency. AAAs are more common in males than females, in individuals of European ancestry, and in those over 65 years of age. Smoking is the most important environmental risk factor. In addition, a positive family history of AAA increases the person's risk for AAA. Interestingly, diabetes has been shown to be a protective factor for AAA in many large studies. Hallmarks of AAA pathogenesis include inflammation, vascular smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. Autoimmunity may also play a role in AAA development and progression. In this Outlook paper, we summarize our recent studies on AAA including clinical studies related to surgical repair of AAA and genetic risk factor and large-scale gene expression studies. We conclude with a discussion on our research projects using large data sets available through electronic medical records and biobanks.

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“…Recent studies have shown 1-year survival rates of 57-89.1 % for patients treated with chimney technique and of 85-93 % for patients treated with fenestrated endografts, and 5-year survival rates of 60 % for patients treated with fenestrated endografts [21][22][23]. For elective open aneurysm repair, reported survival rates at 1 year are 73-89 % and at 5-6 years 69.9-84.5 % [2, [24][25][26]. In our study, we only included patients who had follow-up imaging after 6 months or more; however, in a previous study our group assessed mortality rate in patients electively treated with VORTEC as part of the hybrid procedure, which has shown to be 8.6 % in 30 days and 25.8 % during a mean follow-up of 22.1 months.…”

Section: Discussionmentioning

confidence: 99%