What factors counteract the mid-term survival following endovascular repair of abdominal aortic aneurysms?

Abstract

Background.Endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used and become the standard treatment option for AAA. The aim of the current study was to evaluate the outcomes and predictors of survival of endovascular treatment of AAA at the short and medium-term. Methods.A total of 222 patients having endovascular AAA repair between January 2013 and December 2019 by the same surgical team were included in the study. Patient demographics, perioperative and follow-up data including mortality,complications and need for secondary intervention were collected.Primary endpoint was all-cause mortality.Kaplan-Meier analysis was conducted for survival and Cox regression models were assessed for predictors of survival. Results. Median age was 70 years with male predominance(202 patients,91%). Thirty-day mortality was 1.8%. Median follow-up to the primary endpoint was 20 months(range,1 to 80 months). Survival rates at one, three and five years were 93.5%,81.4% and 62.2% respectively. Freedom from secondary intervention rates were 95.5% at one year,88.7% at three years and 82.1% at five years. Cox proportional hazard models showed that preoperative creatinine levels ≥1.8 mg/dl(hazard ratio (HR) 2.68, 95%CI1.21-6.42, p=0.027), hemoglobin levels <10 gr/dl (HR 3.38 95%CI 1.16-9.90,p=0.026), ejection fraction < 30% (HR 5.67,95%CI1.29-24.86,p=0.021)and AAA diamete≥6.0 cm(HR 2.20,95%CI1.01-4.81,p=0.049)were independently associated with mid-term survival. Conclusion.EVAR is a safe procedure with low postoperative morbidity and mortality. This study confirms that the mid-term survival and results are favorable.However, the analyzed factors in this study that predict reduced survival(high preoperative creatinine,ow hemoglobin,low ejection fraction and larger aneurysms) should be judged when planning EVAR.