Durability of thoracoabdominal aortic aneurysm repair in patients with connective tissue disorders

Objective: Thoracoabdominal aortic aneurysm (TAAA) repair is a durable procedure performed with reasonable perioperative mortality and morbidity in patients with atherosclerotic aortic disease. However, the long-term outcome and durability of TAAA repair performed in patients with a connective tissu...

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Veröffentlicht in:Journal of vascular surgery 2002-10, Vol.36 (4), p.696-703
Hauptverfasser: Dardik, Alan, Krosnick, Teresa, Perler, Bruce A., Roseborough, Glen S., Williams, G.Melville
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Sprache:eng
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Zusammenfassung:Objective: Thoracoabdominal aortic aneurysm (TAAA) repair is a durable procedure performed with reasonable perioperative mortality and morbidity in patients with atherosclerotic aortic disease. However, the long-term outcome and durability of TAAA repair performed in patients with a connective tissue disorder (CTD) is not well known. Methods: The records of 257 patients who underwent TAAA repair at the Johns Hopkins Hospital between January 1992 and December 2001 were reviewed. Survival analysis was performed with Kaplan-Meier analysis, and subgroups were compared with the log-rank test. Multivariable analysis was performed with the Cox proportional hazards model and logistic regression. Results: Patients with CTD (n = 31) were seen earlier (mean age, 48.6 ± 2.9 years) than patients without CTD (mean age, 69.1 ± 0.6 years; P < .0001, Mann-Whitney U test) and had a greater incidence rate of aortic dissection (52% versus 19%; P < .0001, χ 2 test) and extent I or II aneurysm (77% versus 64%; P = .04). The perioperative (30-day) mortality rate was 6.5% in patients with CTD, which was similar to the rest of the cohort ( P = .39, Fisher exact test). The incidence rate of paraparesis/paraplegia was 12.9%/6.5% in patients with CTD, and CTD was the only factor predictive of paraparesis ( P = .03; odds ratio, 9.3; logistic regression). The cumulative survival rate among the entire cohort was 53.4% ± 4.4% at 5 years (Kaplan-Meier), and no difference was seen among patients with or without CTD ( P = .16, log-rank test) or among different Crawford extents ( P = .29). Of the two late (>6 months) deaths in patients with CTD, none were from aortic rupture or dissection, compared with two of 31 late deaths in patients without CTD. Multivariable analysis confirmed that postoperative renal failure ( P = .03) predicted mortality but neither CTD ( P = .93), nor Crawford extent ( P = .21, Cox regression) predicted mortality. Among survivors, no mean difference was found in largest aortic diameter on follow-up imaging in patients with or without CTD (4.7 ± 0.3 cm versus 4.4 ± 0.3 cm; P = .47, Mann-Whitney U test). The cumulative graft patency rate, representing long-term graft stability and with death, rupture, dissection, or recurrent aneurysm as endpoints, was 47.5% ± 4.6% at 5 years (Kaplan-Meier) and was similar in patients with or without CTD ( P = .10, log-rank test). Conclusion: TAAA repair appears to be a durable operation, with a reasonable 5-year patient survival rate
ISSN:0741-5214
1097-6809
DOI:10.1067/mva.2002.128310