Outcome after emergency repair of symptomatic, unruptured abdominal aortic aneurysm: Results in 42 patients and review of the literature

E, Leo; Biancari, Fausto; Kechagias, Aristotelis; Ylönen, Kari; Rainio, Pekka; Romsi, Pekka; Juvonen, Tatu

doi:10.1080/14017430410016422

Cited by 28 publications

(36 citation statements)

References 7 publications

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“…This is similar to that observed by Leo et al, 3 who reported a median GAS of 76 for survivors and 87 for those who died. Their receiver operating characteristic analysis concluded that a score of 85 was the best cutoff score to predict death.…”

Section: Discussionsupporting

confidence: 91%

“…3–5,10,13,14,18 Our incidence is near the low end of the reported spectrum, similar to the 2008 report of Nevala et al 2 who reported a 6% frequency of Sx-AAA. It is unclear if these more contemporary cohorts have a lower frequency of Sx-AAAs based on increased surveillance or elective repair, or if this is related to other, unknown factors.…”

Section: Discussionsupporting

confidence: 86%

“…3,4,7,9,10,13–15,18 These earlier reports represent almost entirely open repairs compared with only 62% open repairs in the present study (Table IV). Several reports of EVAR to treat Sx-AAA have shown reduced mortality rates compared with historical series using open repair.…”

Section: Discussionsupporting

confidence: 48%

“…Nearly all of our patients required urgent operation ≤24 hours of presentation, which is consistent with other reports, 4,5,11 although few reports have specified this definition. 2,3,6,7,9,10,12–15,18–20 Also, our definition of Sx-AAA could include inflammatory aneurysms; however, we did not track this as a separate category, so we cannot comment about treatment specific to inflammatory aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, concern about impending rupture argues for rapid repair. 3,7,9,11,12 At present, such decision making is difficult because the causes for worse outcomes of Sx-AAAs are not certain, given that these patients do not experience rupture and its physiologic sequelae.…”

mentioning

confidence: 99%

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Outcomes of symptomatic abdominal aortic aneurysm repair

Martino

Nolan

Goodney

et al. 2010

Journal of Vascular Surgery

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Objective Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (Sx-AAA) repair has been reported at 6% to 30% during the past 25 years. We used a multicenter regional database to describe the contemporary outcomes of patients undergoing repair of Sx-AAA. Methods All patients undergoing infrarenal AAA repair in 11 hospitals comprising the Vascular Study Group of Northern New England (VSGNNE) between 2003 and 2009 were studied. Sx-AAA was prospectively defined as an AAA accompanied by abdominal or back pain or tenderness, but without rupture. The primary study end point was in-hospital mortality. Secondary end points included in-hospital postoperative major adverse events (MAE) and late survival. These outcomes were compared between symptomatic patients and contemporary VSGNNE cohorts of elective (E-AAA) and ruptured AAAs (R-AAAs) treated within the same study period. Results During the study period, 2386 AAA repairs were performed, comprising 1959 (82%) E-AAAs, 156 (7%) Sx-AAAs, and 271 (11%) R-AAAs. Repair was endovascular in 945 (48%) E-AAAs, 60 (38%) Sx-AAAs, and 33 (12%) R-AAAs. Hospital mortality was 1.7% for E-AAA repair and 1.3% for Sx-AAA repair, but was 34.7% for R-AAA repair (P < .001). The MAE rates were 20%, 35%, and 63%, respectively, for E-AAA, Sx-AAA, and R-AAA repairs (P < .001). The mean Glasgow Aneurysm Score (GAS) for Sx-AAA patients who survived was 79 ± 12. Those who died had an average score of 92 ± 7, and 83% of all Sx-AAA and R-AAA patients who died had a GAS >85. Kaplan-Meier analysis demonstrated that at 1 and 4 years, Sx-AAA repair was associated with intermediate survival (83% and 68%) compared with E-AAA repair (89% and 73%) and R-AAA repair (49% and 35%; P < .001). Conclusion The operative mortality of patients with Sx-AAA in contemporary practice appears better than that previously reported in the literature. Despite low operative mortality, MAE and late survival are intermediate compared with E-AAA and R-AAA repair. Review of previous series shows a trend for lower operative mortality after Sx-AAA repair in more recent series, which likely reflects improved perioperative care and more use of endovascular aneurysm repair.

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Section: Discussionsupporting

confidence: 91%