Influence of Age, Aneurysm Size, and Patient Fitness on Suitability for Endovascular Aortic Aneurysm Repair
Prior to approval by the U.S. Food and Drug Administration of larger endografts (main body diameters up to 36 mm), small abdominal aortic aneurysms (AAAs,
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| Veröffentlicht in: | Annals of vascular surgery 2008-11, Vol.22 (6), p.730-735 |
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| container_title | Annals of vascular surgery |
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| creator | Timaran, Carlos H Rosero, Eric B Smith, Stephen T Modrall, J. Gregory Valentine, R. James Clagett, G. Patrick |
| description | Prior to approval by the U.S. Food and Drug Administration of larger endografts (main body diameters up to 36 mm), small abdominal aortic aneurysms (AAAs, |
| doi_str_mv | 10.1016/j.avsg.2008.08.034 |
| format | Article |
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Gregory ; Valentine, R. James ; Clagett, G. Patrick</creator><creatorcontrib>Timaran, Carlos H ; Rosero, Eric B ; Smith, Stephen T ; Modrall, J. Gregory ; Valentine, R. James ; Clagett, G. Patrick</creatorcontrib><description>Prior to approval by the U.S. Food and Drug Administration of larger endografts (main body diameters up to 36 mm), small abdominal aortic aneurysms (AAAs, <5.5 cm) were shown to be more suitable for endovascular repair (EVAR) than large AAAs (≥5.5 cm). The purpose of this study was to assess changes in EVAR suitability with the potential use of larger endografts in unselected consecutive patients. The influence of age, aneurysm size, and patient fitness on EVAR suitability was also assessed. We studied 186 male patients referred for evaluation of nonruptured AAAs who underwent contrast-enhanced computed tomographic scans with three-dimensional reconstructions. Morphologicall AAA features and neck characteristics were measured according to Society for Vascular Surgery reporting standards to determine EVAR suitability. Patient fitness for repair was assessed using the customized probability index, a validated fitness score for vascular surgery procedures. Suitability for EVAR was determined by neck anatomy, iliac artery morphology, and total aortic aneurysm angulation and tortuosity according to the clinicians' experience and current practice. The median age of the study cohort was 72 years (interquartile range [IQR] 65-79 years). The median maximum AAA diameter was 5.4 cm (IQR 4.1-5.9). Median fitness score was +7 (IQR -7 to +14). EVAR suitability for large AAAs significantly increased with larger endografts (35-63%, p < 0.001). Changes in EVAR suitability for small AAAs were not significant (69-75%, p = 0.06). Maximum AAA diameter was not an independent predictor for EVAR suitability with larger endografts after adjusting for neck anatomy. Aortic neck length (odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.1-1.2) and diameter (OR = 0.78, 95% CI 0.63-0.96) were the only independent predictors for EVAR suitability with larger endografts. Age, AAA size, and fitness did not differ between patients suitable and unsuitable for EVAR with larger endografts. In conclusion, introduction of larger endografts (up to 36 mm in main body diameter) in the United States has resulted in significantly increased anatomic suitability for EVAR for large AAAs. Conversely, suitability has not significantly changed for small AAAs. Overall, EVAR suitability is not influenced by age, aneurysm size, or patient fitness.</description><identifier>ISSN: 0890-5096</identifier><identifier>EISSN: 1615-5947</identifier><identifier>DOI: 10.1016/j.avsg.2008.08.034</identifier><identifier>PMID: 18834703</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Aortic Aneurysm - diagnostic imaging ; Aortic Aneurysm - physiopathology ; Aortic Aneurysm - surgery ; Aortography - methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Humans ; Iliac Artery - diagnostic imaging ; Male ; Odds Ratio ; Patient Selection ; Physical Fitness ; Prosthesis Design ; Risk Assessment ; Surgery ; Tomography, Spiral Computed ; Treatment Outcome</subject><ispartof>Annals of vascular surgery, 2008-11, Vol.22 (6), p.730-735</ispartof><rights>Annals of Vascular Surgery Inc.</rights><rights>2008 Annals of Vascular Surgery Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-350427cf445c4b5bfe7bf14a139ef8b3326e362dd98d20afe79621032aa0f47c3</citedby><cites>FETCH-LOGICAL-c409t-350427cf445c4b5bfe7bf14a139ef8b3326e362dd98d20afe79621032aa0f47c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.avsg.2008.08.034$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18834703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Timaran, Carlos H</creatorcontrib><creatorcontrib>Rosero, Eric B</creatorcontrib><creatorcontrib>Smith, Stephen T</creatorcontrib><creatorcontrib>Modrall, J. Gregory</creatorcontrib><creatorcontrib>Valentine, R. James</creatorcontrib><creatorcontrib>Clagett, G. Patrick</creatorcontrib><title>Influence of Age, Aneurysm Size, and Patient Fitness on Suitability for Endovascular Aortic Aneurysm Repair</title><title>Annals of vascular surgery</title><addtitle>Ann Vasc Surg</addtitle><description>Prior to approval by the U.S. Food and Drug Administration of larger endografts (main body diameters up to 36 mm), small abdominal aortic aneurysms (AAAs, <5.5 cm) were shown to be more suitable for endovascular repair (EVAR) than large AAAs (≥5.5 cm). The purpose of this study was to assess changes in EVAR suitability with the potential use of larger endografts in unselected consecutive patients. The influence of age, aneurysm size, and patient fitness on EVAR suitability was also assessed. We studied 186 male patients referred for evaluation of nonruptured AAAs who underwent contrast-enhanced computed tomographic scans with three-dimensional reconstructions. Morphologicall AAA features and neck characteristics were measured according to Society for Vascular Surgery reporting standards to determine EVAR suitability. Patient fitness for repair was assessed using the customized probability index, a validated fitness score for vascular surgery procedures. Suitability for EVAR was determined by neck anatomy, iliac artery morphology, and total aortic aneurysm angulation and tortuosity according to the clinicians' experience and current practice. The median age of the study cohort was 72 years (interquartile range [IQR] 65-79 years). The median maximum AAA diameter was 5.4 cm (IQR 4.1-5.9). Median fitness score was +7 (IQR -7 to +14). EVAR suitability for large AAAs significantly increased with larger endografts (35-63%, p < 0.001). Changes in EVAR suitability for small AAAs were not significant (69-75%, p = 0.06). Maximum AAA diameter was not an independent predictor for EVAR suitability with larger endografts after adjusting for neck anatomy. Aortic neck length (odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.1-1.2) and diameter (OR = 0.78, 95% CI 0.63-0.96) were the only independent predictors for EVAR suitability with larger endografts. Age, AAA size, and fitness did not differ between patients suitable and unsuitable for EVAR with larger endografts. In conclusion, introduction of larger endografts (up to 36 mm in main body diameter) in the United States has resulted in significantly increased anatomic suitability for EVAR for large AAAs. Conversely, suitability has not significantly changed for small AAAs. Overall, EVAR suitability is not influenced by age, aneurysm size, or patient fitness.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aortic Aneurysm - diagnostic imaging</subject><subject>Aortic Aneurysm - physiopathology</subject><subject>Aortic Aneurysm - surgery</subject><subject>Aortography - methods</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Humans</subject><subject>Iliac Artery - diagnostic imaging</subject><subject>Male</subject><subject>Odds Ratio</subject><subject>Patient Selection</subject><subject>Physical Fitness</subject><subject>Prosthesis Design</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Tomography, Spiral Computed</subject><subject>Treatment Outcome</subject><issn>0890-5096</issn><issn>1615-5947</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVtrGzEQhUVpady0f6APRU99yjqjy96gFExI2kCgpW4gb0KrHQU5a8mVtAb313cXGwJ9CAwMg845g74h5CODJQNWXW6Wep8elxygWc4l5CuyYBUri7KV9WuygKaFooS2OiPvUtoAMN7I5i05Y00jZA1iQZ5uvR1G9AZpsHT1iBd05XGMh7Sla_d3GrXv6U-dHfpMb1z2mBINnq5Hl3XnBpcP1IZIr30f9jqZcdCRrkLMzjwn_cKddvE9eWP1kPDDqZ-T-5vr31ffi7sf326vVneFkdDmQpQgeW2slKWRXdlZrDvLpGaiRdt0QvAKRcX7vm16Dnp6bivOQHCtwcraiHPy-Zi7i-HPiCmrrUsGh0F7DGNSVVuXLRf1JORHoYkhpYhW7aLb6nhQDNSMWG3UjFjNiNVcQk6mT6f0sdti_2w5MZ0EX44CnP64dxhVMm4m3LuIJqs-uJfzv_5nN4PzzujhCQ-YNmGMfqKnmEpcgVrPR55vDA1My8sH8Q84Z6KP</recordid><startdate>20081101</startdate><enddate>20081101</enddate><creator>Timaran, Carlos H</creator><creator>Rosero, Eric B</creator><creator>Smith, Stephen T</creator><creator>Modrall, J. Gregory</creator><creator>Valentine, R. James</creator><creator>Clagett, G. Patrick</creator><general>Elsevier Inc</general><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>20081101</creationdate><title>Influence of Age, Aneurysm Size, and Patient Fitness on Suitability for Endovascular Aortic Aneurysm Repair</title><author>Timaran, Carlos H ; Rosero, Eric B ; Smith, Stephen T ; Modrall, J. Gregory ; Valentine, R. James ; Clagett, G. Patrick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-350427cf445c4b5bfe7bf14a139ef8b3326e362dd98d20afe79621032aa0f47c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aortic Aneurysm - diagnostic imaging</topic><topic>Aortic Aneurysm - physiopathology</topic><topic>Aortic Aneurysm - surgery</topic><topic>Aortography - methods</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Humans</topic><topic>Iliac Artery - diagnostic imaging</topic><topic>Male</topic><topic>Odds Ratio</topic><topic>Patient Selection</topic><topic>Physical Fitness</topic><topic>Prosthesis Design</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Tomography, Spiral Computed</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Timaran, Carlos H</creatorcontrib><creatorcontrib>Rosero, Eric B</creatorcontrib><creatorcontrib>Smith, Stephen T</creatorcontrib><creatorcontrib>Modrall, J. 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Patrick</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of Age, Aneurysm Size, and Patient Fitness on Suitability for Endovascular Aortic Aneurysm Repair</atitle><jtitle>Annals of vascular surgery</jtitle><addtitle>Ann Vasc Surg</addtitle><date>2008-11-01</date><risdate>2008</risdate><volume>22</volume><issue>6</issue><spage>730</spage><epage>735</epage><pages>730-735</pages><issn>0890-5096</issn><eissn>1615-5947</eissn><abstract>Prior to approval by the U.S. Food and Drug Administration of larger endografts (main body diameters up to 36 mm), small abdominal aortic aneurysms (AAAs, <5.5 cm) were shown to be more suitable for endovascular repair (EVAR) than large AAAs (≥5.5 cm). The purpose of this study was to assess changes in EVAR suitability with the potential use of larger endografts in unselected consecutive patients. The influence of age, aneurysm size, and patient fitness on EVAR suitability was also assessed. We studied 186 male patients referred for evaluation of nonruptured AAAs who underwent contrast-enhanced computed tomographic scans with three-dimensional reconstructions. Morphologicall AAA features and neck characteristics were measured according to Society for Vascular Surgery reporting standards to determine EVAR suitability. Patient fitness for repair was assessed using the customized probability index, a validated fitness score for vascular surgery procedures. Suitability for EVAR was determined by neck anatomy, iliac artery morphology, and total aortic aneurysm angulation and tortuosity according to the clinicians' experience and current practice. The median age of the study cohort was 72 years (interquartile range [IQR] 65-79 years). The median maximum AAA diameter was 5.4 cm (IQR 4.1-5.9). Median fitness score was +7 (IQR -7 to +14). EVAR suitability for large AAAs significantly increased with larger endografts (35-63%, p < 0.001). Changes in EVAR suitability for small AAAs were not significant (69-75%, p = 0.06). Maximum AAA diameter was not an independent predictor for EVAR suitability with larger endografts after adjusting for neck anatomy. Aortic neck length (odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.1-1.2) and diameter (OR = 0.78, 95% CI 0.63-0.96) were the only independent predictors for EVAR suitability with larger endografts. Age, AAA size, and fitness did not differ between patients suitable and unsuitable for EVAR with larger endografts. In conclusion, introduction of larger endografts (up to 36 mm in main body diameter) in the United States has resulted in significantly increased anatomic suitability for EVAR for large AAAs. Conversely, suitability has not significantly changed for small AAAs. Overall, EVAR suitability is not influenced by age, aneurysm size, or patient fitness.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>18834703</pmid><doi>10.1016/j.avsg.2008.08.034</doi><tpages>6</tpages></addata></record> |
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| ispartof | Annals of vascular surgery, 2008-11, Vol.22 (6), p.730-735 |
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| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Age Factors Aged Aortic Aneurysm - diagnostic imaging Aortic Aneurysm - physiopathology Aortic Aneurysm - surgery Aortography - methods Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Humans Iliac Artery - diagnostic imaging Male Odds Ratio Patient Selection Physical Fitness Prosthesis Design Risk Assessment Surgery Tomography, Spiral Computed Treatment Outcome |
| title | Influence of Age, Aneurysm Size, and Patient Fitness on Suitability for Endovascular Aortic Aneurysm Repair |
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