Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients
Objective Although the endovascular aneurysm repair trial 2 (EVAR-2) demonstrated no benefit of EVAR in high-risk (HR) patients, EVAR is still performed widely in this patient cohort. This study compares the midterm outcomes after EVAR in HR patients with those in normal-risk (NR) patients. In turn,...
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| Veröffentlicht in: | Journal of vascular surgery 2015-04, Vol.61 (4), p.862-868 |
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| creator | Lim, Sungho, MD Halandras, Pegge M., MD Park, Taeyoung, PhD Lee, Youngeun, BA Crisostomo, Paul, MD Hershberger, Richard, MD Aulivola, Bernadette, MD Cho, Jae S., MD |
| description | Objective Although the endovascular aneurysm repair trial 2 (EVAR-2) demonstrated no benefit of EVAR in high-risk (HR) patients, EVAR is still performed widely in this patient cohort. This study compares the midterm outcomes after EVAR in HR patients with those in normal-risk (NR) patients. In turn, these data are compared with the EVAR-2 data. Methods A retrospective review from January 2006 to December 2013 identified 247 patients (75 HR [30.4%], 172 NR [69.6%]) who underwent elective EVAR for infrarenal aortic aneurysm in an academic tertiary institution and its affiliated Veterans Administration hospital. The same HR criteria used in the EVAR-2 trial were employed. Overall survival, graft-related complications, and reintervention rates were estimated by the Kaplan-Meier method. HR group outcomes were compared with the EVAR-2 data. Results HR patients had a larger abdominal aortic aneurysm size and had a higher prevalence of cardiac disease ( P < .01), chronic obstructive pulmonary disease ( P = .02), renal insufficiency ( P < .01), and cancer ( P < .01). Use of aspirin (63% HR vs 66% NR; P = .6), statin (83% HR vs 72% NR; P = .2), and beta-blockers (71% HR vs 60% NR; P = .2) was similar; in the EVAR-2 trial, the corresponding use of these medications was 58%, 42%, and not available, respectively. Perioperative mortality (0% HR vs 1.2% NR; P = 1.0) and early complication rates (4% HR vs 6% NR; P = .8) were similar. In contrast, perioperative mortality in the EVAR-2 trial was 9%. At a mean follow-up of 3 years, the incidence rates of delayed secondary interventions for aneurysm- or graft-related complications were 7% for HR patients and 10% for NR patients ( P = .5). The 1-, 2-, and 4-year survival rates in HR patients (85%, 77%, 65%) were lower than those in NR patients (97%, 97%, 93%; P < .001), but this was more favorable compared with a 36% 4-year survival in the EVAR-2 trial. No difference was seen in long-term reintervention-free survival in HR and NR patients ( P = .8). Backward stepwise logistic regression analysis identified five prognostic indicators for post-EVAR death: age, chronic kidney disease stages 4 and 5, congestive heart failure, home oxygen use, and current cancer therapy. Conclusions EVAR can be performed in patients unfit for open surgical repair with excellent early survival and long-term durability. These outcomes in the HR group compare more favorably to the EVAR-2 trial data. However, not all HR patients for open su |
| doi_str_mv | 10.1016/j.jvs.2014.11.081 |
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This study compares the midterm outcomes after EVAR in HR patients with those in normal-risk (NR) patients. In turn, these data are compared with the EVAR-2 data. Methods A retrospective review from January 2006 to December 2013 identified 247 patients (75 HR [30.4%], 172 NR [69.6%]) who underwent elective EVAR for infrarenal aortic aneurysm in an academic tertiary institution and its affiliated Veterans Administration hospital. The same HR criteria used in the EVAR-2 trial were employed. Overall survival, graft-related complications, and reintervention rates were estimated by the Kaplan-Meier method. HR group outcomes were compared with the EVAR-2 data. Results HR patients had a larger abdominal aortic aneurysm size and had a higher prevalence of cardiac disease ( P < .01), chronic obstructive pulmonary disease ( P = .02), renal insufficiency ( P < .01), and cancer ( P < .01). Use of aspirin (63% HR vs 66% NR; P = .6), statin (83% HR vs 72% NR; P = .2), and beta-blockers (71% HR vs 60% NR; P = .2) was similar; in the EVAR-2 trial, the corresponding use of these medications was 58%, 42%, and not available, respectively. Perioperative mortality (0% HR vs 1.2% NR; P = 1.0) and early complication rates (4% HR vs 6% NR; P = .8) were similar. In contrast, perioperative mortality in the EVAR-2 trial was 9%. At a mean follow-up of 3 years, the incidence rates of delayed secondary interventions for aneurysm- or graft-related complications were 7% for HR patients and 10% for NR patients ( P = .5). The 1-, 2-, and 4-year survival rates in HR patients (85%, 77%, 65%) were lower than those in NR patients (97%, 97%, 93%; P < .001), but this was more favorable compared with a 36% 4-year survival in the EVAR-2 trial. No difference was seen in long-term reintervention-free survival in HR and NR patients ( P = .8). Backward stepwise logistic regression analysis identified five prognostic indicators for post-EVAR death: age, chronic kidney disease stages 4 and 5, congestive heart failure, home oxygen use, and current cancer therapy. Conclusions EVAR can be performed in patients unfit for open surgical repair with excellent early survival and long-term durability. These outcomes in the HR group compare more favorably to the EVAR-2 trial data. However, not all HR patients for open surgical repair derive the benefit from EVAR. The decision to proceed with EVAR in HR patients should be individualized, depending on the number and severity of risk factors.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2014.11.081</identifier><identifier>PMID: 25704411</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Academic Medical Centers ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - diagnosis ; Aortic Aneurysm, Abdominal - mortality ; Aortic Aneurysm, Abdominal - surgery ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - mortality ; Chi-Square Distribution ; Comorbidity ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Female ; Humans ; Illinois ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Patient Selection ; Postoperative Complications - mortality ; Postoperative Complications - therapy ; Proportional Hazards Models ; Retreatment ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Surgery ; Tertiary Care Centers ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of vascular surgery, 2015-04, Vol.61 (4), p.862-868</ispartof><rights>Society for Vascular Surgery</rights><rights>2015 Society for Vascular Surgery</rights><rights>Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-7046dd0bf0bcd3541173a9c2cdcaa10ffd7cb64ff5afcf1c5054fe5cc6beefb13</citedby><cites>FETCH-LOGICAL-c451t-7046dd0bf0bcd3541173a9c2cdcaa10ffd7cb64ff5afcf1c5054fe5cc6beefb13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521414022307$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25704411$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lim, Sungho, MD</creatorcontrib><creatorcontrib>Halandras, Pegge M., MD</creatorcontrib><creatorcontrib>Park, Taeyoung, PhD</creatorcontrib><creatorcontrib>Lee, Youngeun, BA</creatorcontrib><creatorcontrib>Crisostomo, Paul, MD</creatorcontrib><creatorcontrib>Hershberger, Richard, MD</creatorcontrib><creatorcontrib>Aulivola, Bernadette, MD</creatorcontrib><creatorcontrib>Cho, Jae S., MD</creatorcontrib><title>Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objective Although the endovascular aneurysm repair trial 2 (EVAR-2) demonstrated no benefit of EVAR in high-risk (HR) patients, EVAR is still performed widely in this patient cohort. This study compares the midterm outcomes after EVAR in HR patients with those in normal-risk (NR) patients. In turn, these data are compared with the EVAR-2 data. Methods A retrospective review from January 2006 to December 2013 identified 247 patients (75 HR [30.4%], 172 NR [69.6%]) who underwent elective EVAR for infrarenal aortic aneurysm in an academic tertiary institution and its affiliated Veterans Administration hospital. The same HR criteria used in the EVAR-2 trial were employed. Overall survival, graft-related complications, and reintervention rates were estimated by the Kaplan-Meier method. HR group outcomes were compared with the EVAR-2 data. Results HR patients had a larger abdominal aortic aneurysm size and had a higher prevalence of cardiac disease ( P < .01), chronic obstructive pulmonary disease ( P = .02), renal insufficiency ( P < .01), and cancer ( P < .01). Use of aspirin (63% HR vs 66% NR; P = .6), statin (83% HR vs 72% NR; P = .2), and beta-blockers (71% HR vs 60% NR; P = .2) was similar; in the EVAR-2 trial, the corresponding use of these medications was 58%, 42%, and not available, respectively. Perioperative mortality (0% HR vs 1.2% NR; P = 1.0) and early complication rates (4% HR vs 6% NR; P = .8) were similar. In contrast, perioperative mortality in the EVAR-2 trial was 9%. At a mean follow-up of 3 years, the incidence rates of delayed secondary interventions for aneurysm- or graft-related complications were 7% for HR patients and 10% for NR patients ( P = .5). The 1-, 2-, and 4-year survival rates in HR patients (85%, 77%, 65%) were lower than those in NR patients (97%, 97%, 93%; P < .001), but this was more favorable compared with a 36% 4-year survival in the EVAR-2 trial. No difference was seen in long-term reintervention-free survival in HR and NR patients ( P = .8). Backward stepwise logistic regression analysis identified five prognostic indicators for post-EVAR death: age, chronic kidney disease stages 4 and 5, congestive heart failure, home oxygen use, and current cancer therapy. Conclusions EVAR can be performed in patients unfit for open surgical repair with excellent early survival and long-term durability. These outcomes in the HR group compare more favorably to the EVAR-2 trial data. However, not all HR patients for open surgical repair derive the benefit from EVAR. The decision to proceed with EVAR in HR patients should be individualized, depending on the number and severity of risk factors.</description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - diagnosis</subject><subject>Aortic Aneurysm, Abdominal - mortality</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Chi-Square Distribution</subject><subject>Comorbidity</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Illinois</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Patient Selection</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - therapy</subject><subject>Proportional Hazards Models</subject><subject>Retreatment</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Tertiary Care Centers</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kT-P1DAQxS0E4paDD0CDUtIkzCR2siskJHTin3TSFkBtOeMx51wSL3ay0n7782oPCgqqad57M_N7QrxGqBCwfTdUwzFVNaCsECvY4hOxQdh1ZbuF3VOxgU5iqWqUV-JFSgMAotp2z8VVrTqQEnEj9vt1oTBxKoIreLbhaBKto4mF6W2Y_GzGwoS4eCrMzGs8pamIfDA-Fn4u7vyvuzL6dF8czOJ5XtJL8cyZMfGrx3ktfn7-9OPma3m7__Lt5uNtSVLhUub1rbXQO-jJNiqf0jVmRzVZMgbBOdtR30rnlHHkkBQo6VgRtT2z67G5Fm8vuYcYfq-cFj35RDyO-cqwJo1t2zVSql2bpXiRUgwpRXb6EP1k4kkj6DNHPejMUZ85akSdOWbPm8f4tZ_Y_nX8AZcF7y8Czk8ePUedKAMgtj4yLdoG_9_4D_-4afSzJzPe84nTENaYwecvdKo16O_nIs89ooS6bqBrHgBn9Zpf</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Lim, Sungho, MD</creator><creator>Halandras, Pegge M., MD</creator><creator>Park, Taeyoung, PhD</creator><creator>Lee, Youngeun, BA</creator><creator>Crisostomo, Paul, MD</creator><creator>Hershberger, Richard, MD</creator><creator>Aulivola, Bernadette, MD</creator><creator>Cho, Jae S., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients</title><author>Lim, Sungho, MD ; Halandras, Pegge M., MD ; Park, Taeyoung, PhD ; Lee, Youngeun, BA ; Crisostomo, Paul, MD ; Hershberger, Richard, MD ; Aulivola, Bernadette, MD ; Cho, Jae S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-7046dd0bf0bcd3541173a9c2cdcaa10ffd7cb64ff5afcf1c5054fe5cc6beefb13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - diagnosis</topic><topic>Aortic Aneurysm, Abdominal - mortality</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Chi-Square Distribution</topic><topic>Comorbidity</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Illinois</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Patient Selection</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - therapy</topic><topic>Proportional Hazards Models</topic><topic>Retreatment</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Tertiary Care Centers</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lim, Sungho, MD</creatorcontrib><creatorcontrib>Halandras, Pegge M., MD</creatorcontrib><creatorcontrib>Park, Taeyoung, PhD</creatorcontrib><creatorcontrib>Lee, Youngeun, BA</creatorcontrib><creatorcontrib>Crisostomo, Paul, MD</creatorcontrib><creatorcontrib>Hershberger, Richard, MD</creatorcontrib><creatorcontrib>Aulivola, Bernadette, MD</creatorcontrib><creatorcontrib>Cho, Jae S., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lim, Sungho, MD</au><au>Halandras, Pegge M., MD</au><au>Park, Taeyoung, PhD</au><au>Lee, Youngeun, BA</au><au>Crisostomo, Paul, MD</au><au>Hershberger, Richard, MD</au><au>Aulivola, Bernadette, MD</au><au>Cho, Jae S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>61</volume><issue>4</issue><spage>862</spage><epage>868</epage><pages>862-868</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Objective Although the endovascular aneurysm repair trial 2 (EVAR-2) demonstrated no benefit of EVAR in high-risk (HR) patients, EVAR is still performed widely in this patient cohort. This study compares the midterm outcomes after EVAR in HR patients with those in normal-risk (NR) patients. In turn, these data are compared with the EVAR-2 data. Methods A retrospective review from January 2006 to December 2013 identified 247 patients (75 HR [30.4%], 172 NR [69.6%]) who underwent elective EVAR for infrarenal aortic aneurysm in an academic tertiary institution and its affiliated Veterans Administration hospital. The same HR criteria used in the EVAR-2 trial were employed. Overall survival, graft-related complications, and reintervention rates were estimated by the Kaplan-Meier method. HR group outcomes were compared with the EVAR-2 data. Results HR patients had a larger abdominal aortic aneurysm size and had a higher prevalence of cardiac disease ( P < .01), chronic obstructive pulmonary disease ( P = .02), renal insufficiency ( P < .01), and cancer ( P < .01). Use of aspirin (63% HR vs 66% NR; P = .6), statin (83% HR vs 72% NR; P = .2), and beta-blockers (71% HR vs 60% NR; P = .2) was similar; in the EVAR-2 trial, the corresponding use of these medications was 58%, 42%, and not available, respectively. Perioperative mortality (0% HR vs 1.2% NR; P = 1.0) and early complication rates (4% HR vs 6% NR; P = .8) were similar. In contrast, perioperative mortality in the EVAR-2 trial was 9%. At a mean follow-up of 3 years, the incidence rates of delayed secondary interventions for aneurysm- or graft-related complications were 7% for HR patients and 10% for NR patients ( P = .5). The 1-, 2-, and 4-year survival rates in HR patients (85%, 77%, 65%) were lower than those in NR patients (97%, 97%, 93%; P < .001), but this was more favorable compared with a 36% 4-year survival in the EVAR-2 trial. No difference was seen in long-term reintervention-free survival in HR and NR patients ( P = .8). Backward stepwise logistic regression analysis identified five prognostic indicators for post-EVAR death: age, chronic kidney disease stages 4 and 5, congestive heart failure, home oxygen use, and current cancer therapy. Conclusions EVAR can be performed in patients unfit for open surgical repair with excellent early survival and long-term durability. These outcomes in the HR group compare more favorably to the EVAR-2 trial data. However, not all HR patients for open surgical repair derive the benefit from EVAR. The decision to proceed with EVAR in HR patients should be individualized, depending on the number and severity of risk factors.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25704411</pmid><doi>10.1016/j.jvs.2014.11.081</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Academic Medical Centers Aged Aged, 80 and over Aortic Aneurysm, Abdominal - diagnosis Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - mortality Chi-Square Distribution Comorbidity Endovascular Procedures - adverse effects Endovascular Procedures - mortality Female Humans Illinois Kaplan-Meier Estimate Logistic Models Male Patient Selection Postoperative Complications - mortality Postoperative Complications - therapy Proportional Hazards Models Retreatment Retrospective Studies Risk Assessment Risk Factors Surgery Tertiary Care Centers Time Factors Treatment Outcome |
| title | Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients |
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