Randall R. De Martino1, Philip P. Goodney1, Brian W. Nolan1, William P. Robinson2, Alik Farber3, Jens Eldrup-Jorgensen4, Robert Cambria5, David H. Stone1, Jack L. Cronenwett1, For the Vascular Study Group of New England1
1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; 2University of Massachusetts Memorial Medical Center, Worcester, MA; 3Boston Medical Center, Boston, MA; 4Maine Medical Center, Portland, ME; 5Eastern Maine Medical Center, Bangor, ME.
OBJECTIVES: Elective abdominal aortic aneurysm (AAA) repair is beneficial when rupture is likely during a patient's expected lifetime. The purpose of this study was to identify predictors of long term mortality following elective AAA repair for moderately sized AAAs (<6.5cm dia) to identify patients unlikely to benefit from surgery.
METHODS: We analyzed 2,367 elective infrarenal (<6.5cm) AAA repairs across 21 centers in New England from 2003-2011. Our main outcome measure was 5-year survival. Cox proportional hazards analysis were used to describe associations between patient characteristics and 5-year survival.
RESULTS: During the study period 1,653 EVAR and 714 open (o) AAA repairs were performed. Overall, 5-year survival rates were similar by procedure type (EVAR 75%, oAAA 80%, p=0.14). Age ≥75 (HR 1.9, p<0.01), severe CAD (HR 1.4, p<0.04), O2-dependent COPD (HR 2.7, p<0.01), and eGFR <30 (HR 2.8, p<0.01), were associated with poor survival, while pre-operative aspirin (HR 0.8, p<0.03) and statin (HR 0.7, p<0.01) use were associated with improved survival. Based on risk strata (Figure), survival for low, medium, and high risk groups were 85%, 71% and 40% at five years (p<0.001).
CONCLUSIONS: Nearly 80% of patients with moderately sized AAA selected for elective repair survived 5 years, demonstrating appropriate patient selection in our region. However, patients with multiple risk factors are unlikely to achieve sufficient long-term survival to benefit from surgery unless their rupture risk is very high.
AUTHOR DISCLOSURES: R. Cambria, Nothing to disclose; J. L. Cronenwett, Nothing to disclose; R. R. De Martino, Nothing to disclose; J. Eldrup-Jorgensen, Nothing to disclose; A. Farber, Nothing to disclose; P. P. Goodney, Nothing to disclose; B. W. Nolan, Nothing to disclose; W. P. Robinson, Nothing to disclose; D. H. Stone, Nothing to disclose.
Posted April 2012