Contribution of Abdominal Aortic Aneurysmectomy to Prolongation of Life

Szilagyi, D. Emerick; Smith, Riley; DeRUSSO, Franklin J.; Elliott, Janice; Sherrin, F W

doi:10.1097/00000658-196610000-00014

Cited by 461 publications

(129 citation statements)

References 7 publications

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“…Intensive population based studies have provided detailed guidelines for intervention that rely on factors associated with risk of rupture that include maximal transverse diameter, growth rate, aneurysm morphology, and symptoms (1). While these efforts have had a significant impact in decreasing complications from rupture, assessing mid-and long-term outcomes post AAA repair has largely been ignored (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Kays

Liang

Zimmers

et al. 2018

JCSM Clinical Reports

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Aims Repair of abdominal aortic aneurysms (AAA) decreases the incidence of rupture and death. In cancer patients, sarcopenia has been associated with increased surgical complications and mortality. The impact of sarcopenia on survival after AAA repair has yet to be described. Methods and ResultsPatient demographic, laboratory, body composition measurements and survival data were obtained from patients undergoing AAA repair at the Indiana University medical campus over a 5-year period. Univariate and multivariate analyses were performed to identify factors associated with overall survival. Overall, 58.2% presented with sarcopenia. Sarcopenic patients were older (71.88.3 versus 66.88.1 years; p<0.001), had lower body mass index (BMI) (26.35.2 versus 31.55.9 kg/m 2 ; p<0.001), higher rates of myosteatosis (84.4% versus 52.%; p<0.001), greater AAA diameter (60.614.0 versus 57.811.7 mm; p=0.016), higher Charlson Comorbidity Index (CCI) (32.3% versus 25.1% 6; p=0.034), and increased rates of rupture (8.2% versus 3.8%; p=0.047). Sarcopenic and nonsarcopenic patients had no difference in 30-day morbidity (8.5% versus 8.5%; p=0.991) or mortality (3.7% versus 0.9%; p=0.07). Univariate analysis demonstrated age, sarcopenia, myosteatosis, CCI, and BMI to be associated with long-term survival. There was no correlation between BMI and sarcopenia. Both sarcopenia and myosteatosis resulted in decreased one-, three-, and five-year survivals compared to their counterparts. On multivariate analysis sarcopenia is independently associated with survival, conferring a 1.6-fold increase in death (p=0.04). The combination of sarcopenia plus myosteatosis doubled the risk of death compared to sarcopenia alone.Conclusions This is the first study to demonstrate that over half of all patients undergoing AAA repair are sarcopenic, a condition associated with increased mortality. Sarcopenia with myosteatosis is associated with double the mortality of sarcopenia alone. CT scan, but not BMI, accurately identifies sarcopenia and myosteatosis. Defining the mechanisms through which sarcopenia contributes to late death after AAA repair is critical to developing novel interventions that may improve survival in this high risk population.

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Section: Introductionmentioning

confidence: 99%

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Kays

Liang

Zimmers

et al. 2018

JCSM Clinical Reports

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“…The medical literature abounds with data on the frequency with which intact AAAs progress to rupture (Schatz et al 1962, Klippel & Butcher 1966, Szilagyi et al 1966, Bernstein et al 1967. These studies are difficult to compare because of differences in the criteria for the diagnosis of AAA, in the duration of follow up, and in the methods of calculating and presenting the results.…”

Section: Discussionmentioning

confidence: 99%

“…Attempts to evaluate the benefits of surgery in prolonging the lives of certain patients with AAA have been the major concern of several previous studies (Szilagyi et al 1966, Bernstein et al 1967, Foster et al 1969). The present study illustrates that at least part of the difficulty in this evaluation can be attributed to the longevity of patients with AAA not treated surgically.…”

Section: Discussionmentioning

confidence: 99%

Aneurysms of the Abdominal Aorta: A 20-Year Study

Bowers

Cave

1985

J R Soc Med

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Summary: One hundred and eighty-eight patients in whom the diagnosis of aneurysm of the abdominal aorta (AAA) was established after 1 January 1960 were followed until their deaths or to 31 December 1979. By the actuarial method, the cumulative 5-year risk of an intact aneurysm progressing to rupture was 35%; the observed 5-year survival rate for patients who had medical management for intact AAA was 33%, for patients who had elective surgery for AAA 74%, for patients who had emergency surgery for ruptured AAA 35%, and for those who did not have surgery for ruptured AAA 0%.Comparison of the non-operated and electively-operated groups of patients showed that the former was disproportionately weighted with older higher-risk patients, suggesting that the difference in survival rates for the two groups might be a reflection of patient selection rather than of surgical intervention. Comparison of the cumulative 5-year risk of rupture of an intact AAA with the cumulative 5-.year mortality rate associated with elective surgery for intact AAA showed that elective surgery for intact AAA might be expected to result in a reduction in the cumulative 5-year mortality rates of patients with intact AAA.

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“…The results were 19% and 0%, respectively. Szilagyi et al in 1966 published a study of both surgical and nonsurgical groups (15). They found that surgical repair of AAA nearly doubled life expectancy.…”

Section: (A)mentioning

confidence: 99%

Abdominal Aortic Aneurysm

1993

N Engl J Med

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MD: A 68-year-old retired draftsman with chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, and systemic hypertension presented to a hospital emergency department with a 5-day history of worsening dyspnea and abdominal distention and a 1-day history of a nonproductive cough and wheezing. One week earlier he had been discharged from the hospital with a diagnosis of COPD exacerbation, and his prednisone dose had been gradually decreased. His current dyspnea occurred at rest and worsened with minimal exertion. He denied chest pain, abdominal pain, fever, chills, nausea, and vomiting. The patient's father had died of COPD. The patient had an 80-pack/year history of cigarette smoking, drank alcohol occasionally, and denied using illicit drugs. Medications included prednisone (2 mg a day orally), fluticasone propionate, salmeterol xinafoate, ciprofloxacin, guaifenesin, triamterene and hydrochlorothiazide, glipizide, carisoprodol, and home O 2 per nasal canula at 2 L/min. The patient's blood pressure was 137/89 mm Hg; heart rate, 120 beats per minute; and temperature, 36.6°C (97.8°F). He was obese, alert, and oriented and was in moderate respiratory distress, using his accessory respiratory muscles. His extraocular muscles were intact, and his pupils were equal, round, and reactive. His fundi were normal. His oral pharynx contained a whitish plaque on the soft palate. His neck was supple, with no jugular venous distention, lymphopathy, or bruits. He was barrel chested with bilateral wheezing and poor air movement. He had distant heart sounds, without murmur. His abdomen was soft, nontender, and mildly distended. His bowel sounds were normal. A reducible umbilical hernia was present. Neither the liver nor the spleen was enlarged. No abdominal masses were palpated. His extremities were devoid of cyanosis, clubbing, or edema. The pulses were 2+/4+ throughout. Diffuse ecchymoses were present on all extremities. Neurological examination disclosed no abnormalities.His blood glucose was 290 mg/dL, and his leukocyte count was 17 × 10 3 /µL with 82% segmented neutrophils, 3% bands, 8% lymphocytes, and 6% monocytes. His hematocrit was 42%. Room air arterial blood gas showed a pH of 7.31; PCO 2 , 59; PO 2 , 69 (93% saturation); and CO 2 , 29.Electrocardiogram showed sinus tachycardia (105 beats per minute) and low voltage. Chest radiograph showed hyperinflation and chronic changes consistent with COPD, bilateral scarring of the lung bases, some blunting of the left costophrenic angle, and no acute process.

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Contribution of Abdominal Aortic Aneurysmectomy to Prolongation of Life

Cited by 461 publications

References 7 publications

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Aneurysms of the Abdominal Aorta: A 20-Year Study

Abdominal Aortic Aneurysm

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