Risk Stratification and Outcomes of Transluminal Endografting for Abdominal Aortic Aneurysm: 7-Year Experience and Long-term Follow-up

Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms

“…The use of risk stratification to analyze outcomes clearly indicates that survival for those at low to minimal risk is excellent over 10 years; those at highest risk succumb to cardiac disease or cancer, and for those patients, survival is poorest. 27 EVAR has shown a reduction in 30-day mortality relative to that achieved with open repair (1.2% versus 4.6%). Further study is required to determine whether there is a long-term survival advantage.…”

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…Intermediate-term survival rates after endovascular aortic aneurysm repair primarily are influenced by antecedent risk factors, being lowest in series for which high surgical risk was a criterion for patient selection (1164,1170). Again using their scoring system (0 to 3) for stratifying incremental risk, Becker et al (1141) calculated actuarial 1-year survival rates of 98%, 94%, 87%, and 81%, respectively. On the basis of EUROSTAR data, Buth et al found that the cumulative 3-year survival rate was significantly lower for patients who had been deemed unfit for open repair or for general anesthesia than for the remainder of the registry population (68% vs. 83%, p equals 0.0001) (1166).…”

“…Considering all of these criteria, Carpenter et al reported that a disproportionate number of women were excluded from endograft repair because of anatomic limitations (60% of women vs. 30% of men; p equals 0.0009) (1140). Becker et al (1141) also found that significantly fewer women qualified for endovascular aneurysm repair (26% of women vs. 41% of men), and Mathison et al (1142) were forced to abandon more attempted endograft procedures in women (17%) than in men (2.1%; p less than 0.01). Wolf et al described comparable eligibility rates for endograft repair in women (49%) and in men (57%), but the women in that series had a higher incidence of intraoperative complications than men (31% vs. 13%, p less than 0.05) and required more adjunctive arterial reconstructions (42% vs. 21%, p less than 0.05) to correct those complications (1143).…”

Impact of gender and body surface area on outcome after abdominal aortic aneurysm repair

“…Specific to AAA disease, factors that have been implicated for the higher morbidity and mortality in women include a lower aortic tensile strength, greater heart rate variation, less suitable anatomy for repair, and a faster rate of aneurysm growth. 8,18,[22][23][24][25][26] Additionally, postmenopausal women have been found to have a stiffer aorta, increased pulse pressure, and elevated inflammatory markers. 13,17,27,28 Eventually, the higher risk of rupture and acknowledgement of increased prevalence of AAA in women led to the recommendations of ultrasound screening and a lower threshold aneurysm size for surgery (5.0 to 5.4 cm) in high-risk women by the Society of Vascular Surgery (SVS) and the European Society of Vascular Surgery (ESVS).…”