Palliation of Abdominal Aortic Aneurysms in the Endovascular Era

Abstract

Under half the deaths in our comorbid cohort were due to rupture. However, decision to palliate may be revisited as risk-benefit ratio changes with aneurysm expansion.

Rupture rates of untreated large abdominal aortic aneurysms in patients unfit for elective repair

“…In all results reported by Kaplan-Meier curves, rupture rates showed linear 17,19,23 or exponential decay. 20,24,25 Different AAA size groupings led to some study data not being used in the meta-analysis. 9,17,23 Autopsy was not routine in any study to confirm cause of death; however, six studies 3,9,19,23,25 used the office of national statistics or an equivalent organization.…”

“…Six prospective cohort studies, three retrospective trials, and one randomized trial were included (Table I). [17][18][19][20][21][22][23][24][25] All but the randomized controlled trial retrieved data post hoc from prospectively maintained databases and are therefore grouped as observational. All but two 17,18 were published after the year 2000.…”

Late Survival in Nonoperated Patients with Infrarenal Abdominal Aortic Aneurysm

“…5 It is likely that patients survive longer than previously observed, possibly because of advances in comorbidity management.…”

“…A 2013 audit of survival rates in 72 patients with AAAs who had been turned down for elective repair reported median survival times of 44 months in patients with an aneurysm diameter of 5.1e6 cm, 26 months for AAAs up to 7 cm in diameter, and only 6 months for those with AAAs > 7 cm. 5 Importantly, however, endovascular aneurysm repair (EVAR) was not offered to any of these patients.…”

Outcome in Men with a Screen-detected Abdominal Aortic Aneurysm Who are not Fit for Intervention

“…8 No initial nonintervention rates for a screened population of AAA exist in the published literature. Conway et al reported on 106 patients turned down for AAA repair over 10 years, 9 and Western et al 10 described the outcomes in 72 patients, but neither paper reported on the denominator treated, or how many screened patients were assessed in total. A questionnaire survey conducted by the VSGBI suggested that the initial nonintervention rate for elective AAA surgery is around 26% in the UK.…”