Koen M. van de Luijtgaarden1, Frederico Bastos Goncalves1, Sanne E. Hoeks2, Ellen V. Rouwet1, Danielle Majoor-Krakauer3, Robert J. Stolker2, Hence J. Verhagen1
1Erasmus MC - Department of Vascular Surgery, Rotterdam, Netherlands; 2Erasmus MC - Department of Anesthesiology, Rotterdam, Netherlands; 3Erasmus MC - Department of Clinical Genetics, Rotterdam, Netherlands.
OBJECTIVES: To investigate the risk of postoperative adverse events (PAE) in patients with familial AAA (fAAA) versus sporadic AAA (spAAA).
METHODS: Patients were derived from a prospective database for EVAR. Family history was obtained by written questionnaire (93% response rate). fAAA patients were defined as having ≥1affected 1st-degree relative, and excluding connective tissue disorders. Cardiovascular risk factors, AAA morphology (neck, sac and iliac), and follow-up (FU) information were scored. PAE was defined as a composite of secondary intervention, sac growth (>5mm), and Type I/III endoleak. PAE estimates were obtained from Kaplan-Meier plots and multivariable Cox-regression was used to explore the risk associated with fAAA.
RESULTS: Two hundred seven patients were included (90% men; age 71±8; FU 4.5±3yrs), with 46(22%) classified as fAAA. Patients with fAAA were younger (68 vs. 72 years, p=0.003) and less likely smokers (p=0.056). No difference was observed in AAA morphology. After EVAR, fAAA patients had significantly more PAE (Figure), with a 2-fold increase in risk (adjusted HR 2.0, 95%CI 1.1-3.8). Sac growth was observed in 20% of fAAA vs 9% of spAAA (p=0.005), unrelated to presence of endoleak. There were no further differences in individual components of PAE, nor in overall survival.
CONCLUSIONS: Despite similar morphology, patients with fAAA had more PAE, mainly due to sac growth. Until the underlying cause is identified, patients with fAAA may need closer surveillance.
AUTHOR DISCLOSURES: F. Bastos Goncalves: Nothing to disclose; S. E. Hoeks: Nothing to disclose; D. Majoor-Krakauer: Nothing to disclose; E. V. Rouwet: Nothing to disclose; R. J. Stolker: Nothing to disclose; K. M. van de Luijtgaarden: Lijf & Leven Foundation, Rotterdam, The Netherlands, Research grants; H. J. Verhagen: Nothing to disclose.
Posted April 2013