Long-term Prognosis After Elective Abdominal Aortic Aneurysm Repair is Poor in Women and Men

Abstract

Objective: To evaluate the impact of changes in elective Abdominal Aortic Aneurysm (AAA) management on life-expectancy of AAA patients. Background: Over the past decades AAA repair underwent substantial changes, that is, the introduction of EVAR and implementation of intensified cardiovascular risk management. The question rises to what extent these changes improved longevity of AAA patients. Methods: National evaluation including all 12.907 (82.7% male) patients who underwent elective AAA repair between 2001 and 2015 in Sweden. The impact of changes in AAA management was established by a time-resolved analysis based on 3 timeframes: open repair dominated period (2001–2004, n = 2483), transition period (2005–2011, n = 6230), and EVAR-first strategy period (2012–2015, n = 4194). Relative survival was used to quantify AAA-associated mortality, and to adjust for changes in life-expectancy. Results: Relative survival of electively treated AAA patients was stable and persistently compromised [4-year relative survival and 95% confidence interval: 0.87 (0.85–0.89), 0.87 (0.86–0.88), 0.89 (0.86–0.91) for the 3 periods, respectively]. Particularly alarming is the severely compromised survival of female patients (4-year relative survival females 0.78, 0.80, 0.70 vs males 0.89, 0.89, 0.91, respectively). Cardiovascular mortality remained the main cause of death (51.0%, 47.2%, 47.9%) and the proportion cardiovascular disease over non-cardiovascular disease death was stable over time. Conclusions: Changes in elective AAA management reduced short-term mortality, but failed to improve the profound long-term survival disadvantage of AAA patients. The persistent high (cardiovascular) mortality calls for further intensification of cardiovascular risk management, and a critical appraisal of the basis for the excess mortality of AAA patients.

Prognostic impact of depressive symptoms on all-cause mortality in individuals with abdominal aortic aneurysm and in the general population: a population-based prospective HUNT study in Norway

“…The finding of a substantially higher mortality in individuals with vs without AAA is consistent with a recent study reporting markedly lower overall long-term survival in patients undergoing successful AAA repair as compared with age-adjusted and sex-adjusted mortality rates in the general population. 27 An unfavourable comorbidity profile commonly seen in AAA patients, including other CVDs, as well as smoking, is probably a contributing factor to the high crude mortality rates in individuals with AAA. 28 In our study, however, the relative risk estimate remained high also after adjusting for factors associated with both AAA and increased mortality, such as sex, CHD, diabetes and smoking.…”

“…Most previous studies have almost exclusively been restricted to patients that have undergone surgery for AAA or patients deemed unfit for surgery. 27 29–31 This study included both surgically untreated and treated AAA patients, but we did not distinguish between these subgroups in the analyses due to lack of information on this issue.…”

Differences in Comorbidities Between Women and Men Treated with Elective Repair for Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis

“…Another aspect to take into consideration is the introduction of EVAR which has influenced the patient cohorts for both type of repairs. (58) This change in AAA management could have altered the risk profile and perioperative outcomes of patients undergoing OSR or EVAR over the years following EVAR implementation, which can be of interest for future research.…”

Towards Patient Centred Outcomes for Elective Abdominal Aortic Aneurysm Repair: A Scoping Review of Quality of Life Scales

“…3,4 In the context of AAA, improvements in peri-operative care, patient selection, and surgical techniques (such as the introduction of EVAR) led to marked reductions in procedural complications and death. 62 As a result, traditional (surgical) outcome measures such as peri-operative mortality and/or complication rates became less discriminatory parameters, especially in the case of EVAR, to evaluate patient care, and patient derived outcomes gained in importance. 63 So far, most studies that have addressed the patient's perspective in the context of elective AAA repair have relied on generic quantitative QoL questionnaires.…”