Complex endovascular aneurysm repair is associated with higher perioperative mortality but not late mortality compared with infrarenal endovascular aneurysm repair among octogenarians

Tran, Kenneth; Lee, Andy M.; McFarland, Graeme E.; Sgroi, Michael D.; Lee, Jason T.

doi:10.1016/j.jvs.2018.04.064

Cited by 16 publications

(16 citation statements)

References 21 publications

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“…By including all 82 consecutive patients that underwent complex EVAR, it was attempted to present an unselected “real-world” patient group, commensurate with patients seen in a daily clinical practice. The 30-day mortality rate found in the current study (7.3%) is higher compared with the mortality rate found by Van Calster et al 32 (4.9%) and lower compared with the 30-day mortality rates mentioned by Oderich et al 6 (8.2%) and Tran et al 7 (8.6%). The difference with Van Calster et al 32 could be explained by different procedures being included.…”

Section: Discussioncontrasting

confidence: 79%

“…Thirty-day mortality rates ranging from 3.4% up to 8.6% have been reported in complex EVAR, compared with an average of 1.2% in conventional EVAR. [6][7][8][9] Besides morbidity and mortality, patients undergoing complex EVAR are at risk of decline in functional performance. Living independently of care and maintaining quality of life are highly valued outcomes, especially in older patients.…”

Section: Introductionmentioning

confidence: 99%

“…Thirty-day mortality rates ranging from 3.4% up to 8.6% have been reported in complex EVAR, compared with an average of 1.2% in conventional EVAR. 6 – 9 …”

Section: Introductionmentioning

confidence: 99%

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Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

et al. 2021

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Purpose Complex endovascular aortic repair (EVAR) procedures provide a treatment option for patients with aortic aneurysms involving visceral branches. Good technical results and short-term outcomes have been reported. Whether complex EVAR provides acceptable functional outcomes is not clear. The current study aims to describe postoperative functional outcomes in complex EVAR patients—an older and relatively frail patient group. Materials and Methods A single-center retrospective cohort study was performed, using data from a computerized database of consecutive patients who underwent complex EVAR in the Leiden University Medical Center (LUMC, The Netherlands) between July 2013 and September 2020. As of May 2017, patients scheduled for complex EVAR were referred to a geriatric care pathway to determine (Instrumental) Activities of Daily Living ((I)ADL) scores at baseline and, if informed consent was given, after 12 months. For the total patient group, adverse functional performance outcomes were: discharge to a nursing home and 12-month mortality. For the patients included in geriatric follow-up, the additional outcome was the incidence of functional decline (defined by a ≥2 point increase in (I)ADL-score) at 12-month follow-up Results Eighty-two patients underwent complex EVAR, of which 68 (82.9%) were male. Mean age was 73.3 years (SD=6.3). Within 30 days postsurgery, 6 patients (7.3%) died. Mortality within 12 months for the total patient group was 14.6% (n=12). After surgery, no patients had to be discharged to a nursing home. Fifteen patients (18.3%) were discharged to a rehabilitation center. Twenty-three patients gave informed consent and were included in geriatric follow-up. Five patients (21.7%) presented functional decline 12 months postsurgery and 4 patients had died (17.4%) by that time. This means that 39.1% of the patients in the care pathway suffered an adverse outcome. Conclusion To our knowledge, this is the only study that examined functional performance after complex EVAR, using a prospectively maintained database. No patients were newly discharged to a nursing home and functional performance results at 12 months are promising. Future multidisciplinary research should focus on determining which patients are most prone to deterioration of function, so that efforts can be directed toward preventing postoperative functional decline.

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Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

et al. 2021

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“…Henstra et al analysed 272 pts of whom had a median age of 82 years and demonstrated that age itself is not a reason to withhold fenestrated endovascular aortic aneurysm repair (FEVAR) in the elderly, and choice of treatment should be based on the pt's comorbidities and preferences [126]. Yet, perioperative mortality is increased, whereas late mortality is not [127].…”

Section: Predicting Complications and Patient Selection: Anatomic Criteria Age Frailty Obesity And Familial Aortoiliac Aneurysm Or Dissecmentioning

confidence: 99%

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

Nikol

Mathias²,

Olinic

et al. 2020

Vasa

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“…Complex endovascular repair is reported to offer superior perioperative mortality rates when compared with conventional open repair of complex aneuryms 4 , 5 . The safety profile of F/B-EVAR has resulted in an increase in older patients being offered complex endovascular repair 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis

Bradley

Roxburgh

Guthrie

2022

Sci Rep

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Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67–4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66–5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.

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Complex endovascular aneurysm repair is associated with higher perioperative mortality but not late mortality compared with infrarenal endovascular aneurysm repair among octogenarians

Cited by 16 publications

References 21 publications

Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis

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