Improved Long-Term Survival After Abdominal Aortic Aneurysm Repair

Mani, Kevin; Björck, Martin; Lundkvist, Jonas; Wanhainen, Anders

doi:10.1161/circulationaha.108.832774

Cited by 147 publications

(108 citation statements)

References 39 publications

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“…In a Swedish study of 946 patients with noninfected abdominal aortic aneurysm treated with EVAR 1987 to 2005, the 5-year crude survival was 65% after intact abdominal aortic aneurysm and 54% after ruptured abdominal aortic aneurysm, with a mean age of 74 and 75 years, respectively. 20 In a U.S. Medicare study of 2732 patients with descending thoracic aortic aneurysm treated with thoracic endovascular aortic repair from 1998 to 2007, the corresponding survival rates were 62% and 23%, with a mean age of 76 and 78 years. 21 However, an important difference between patients with a primary infected aneurysm and patients with a degenerative noninfected aneurysm is that the former are considerably younger (mean 69 years versus 74-78 years), and also probably have less comorbidities related to peripheral vascular disease and atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Mycotic Aortic Aneurysms

et al. 2014

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Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infectionrelated complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonellapositive culture as predictors for late infection-related death. Conclusions-Endovascular

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Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Mycotic Aortic Aneurysms

et al. 2014

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“…The introduction of endovascular repair (EVAR) was associated with an increasing incidence of intact AAA repair and improvement in operative mortality; a greater number of patients with AAA may receive postoperative long-term follow-up. 25) Since cerebral and cardiovascular diseases are responsible for approximately two-thirds of late deaths in patients receiving AAA repair, decrease in the cardiovascular events by adequate control of lipid levels may contribute to improvement of prognosis and late survival in these patients. [17][18][19][20][21][22] Regarding the relationship between the statin treatment and later cardiovascular events occurrence, the statin treatment itself did not reduce the prevalence of later cardiovascular events in this study.…”

Section: Discussionmentioning

confidence: 99%

Lowered Postoperative Ldl-C/Hdl-C Ratio Reduces Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

Kanaoka

Takahashi

Wakamatsu

et al. 2012

Annals of Vascular Diseases

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“…The pooled survival estimate reported is identical to registry data reported from the Swedvasc prospectively maintained registry covering the periods 1987e 2005. 46 Although there was an improvement in age adjusted survival, long-term mortality remains concerning for this cohort despite improvements in cardiovascular risk 16.0e82.9 40.5e72.6 14.8e69.1 a Ischaemic heart disease was reported variously from "previous myocardial infarction" to "previous coronary artery intervention" to "known ischaemic heart disease." prevention strategies, peri-operative and post-operative management of aortic surgery, and vastly improved perioperative mortality rates, especially since the advent and implementation of EVAR.…”

Section: Discussionmentioning

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,

Jackson³

et al. 2015

Journal of Vascular Surgery

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WHAT THIS PAPER ADDSThe key findings of this study are that 5 year survival after elective infrarenal AAA repair is 69% and that this value has not improved over the period 1969e2011. A larger aneurysm diameter at the time of surgery was associated with poorer 5 year survival. This 5 year survival figure is disappointingly poor; patients diagnosed with a Dukes B colorectal cancer can expect better 5 year survival. More needs to be done to address the shortfall in survival to ensure that patients who can now reasonably expect to survive major aortic surgery live long enough to justify what remains a significant intervention.Background: Improved 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. Methods: A 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. Results: Five-year survival was 69% (95% CI 67 to 71%, I 2 ¼ 87%). Meta-regression on study midpoint showed no improvement in 5 year survival over the period 1969e2011 (log OR À0.001, 95% CI À0.014e0.012). Larger average aneurysm diameter was associated with poorer 5 year survival (adjusted log OR À0.058, 95% CI À0.095 to À0.021, I 2 ¼ 85%). Older average patient age at surgery was associated with poorer 5 year survival (adjusted log OR À0.118, 95% CI À0.142 to À0.094, I 2 ¼ 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). Conclusion: Five-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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Improved Long-Term Survival After Abdominal Aortic Aneurysm Repair

Abstract: Background-Treatment of abdominal aortic aneurysm (AAA) has changed significantly over the past 2 decades. In this perspective, time trends in long-term survival were studied. Methods and Results

Cited by 147 publications

References 39 publications

Endovascular Treatment of Mycotic Aortic Aneurysms

Endovascular Treatment of Mycotic Aortic Aneurysms

Lowered Postoperative Ldl-C/Hdl-C Ratio Reduces Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery

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

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