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Anatomic Predictors for Late Mortality after Standard Endovascular Aneurysm Repair

2019Journal article Open access
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dc.contributor.authorOliveira, N
dc.contributor.authorUltee, K
dc.contributor.authorvan Rijn, MJ
dc.contributor.authorPinto, JP
dc.contributor.authorRaa, S
dc.contributor.authorBastos Gonçalves, F
dc.contributor.authorHoeks, S
dc.contributor.authorVerhagen, H
dc.date.accessioned2021-04-13T15:23:20Z
dc.date.available2021-04-13T15:23:20Z
dc.date.issued2019
dc.description.abstractObjective: Abdominal aortic aneurysm (AAA) management involves a decision process that takes into account anatomic characteristics, surgical risks, patients' preferences, and expected survival. Whereas larger AAA diameter has been associated with increased mortality after both standard endovascular aneurysm repair (EVAR) and open repair, it is unclear whether survival after EVAR is influenced by other anatomic characteristics. The purpose of this study was to determine the importance of baseline anatomic features on survival after EVAR. Methods: All patients treated at a tertiary teaching center with EVAR for intact standard infrarenal AAA from 2000 to 2014 were included. The civil data registry was queried to determine survival status; causes of death were obtained from death certificates. The primary study end point was to determine the impact of baseline morphologic features on all-cause and cardiovascular mortality after EVAR. Results: This study included 404 EVAR patients (12.1% women; mean age, 73 years) with a median follow-up of 5.8 years (interquartile range, 3.1-7.4 years). The 5- and 10-year overall survival rates for the entire population after EVAR were 70% (95% confidence interval [CI], 66%-75%) and 43% (95% CI, 37%-50%), respectively. Only AAA diameter >70 mm (hazard ratio [HR], 1.75; 95% CI, 1.20-3.56) was identified as an independent anatomic predictor of all-cause mortality. Death due to cardiovascular causes occurred in 60 (38.5%) patients. Aneurysm-related mortality was responsible for six of the cardiovascular-related deaths. In multivariable analysis, both neck diameter ≥30 mm (HR, 2.16; 95% CI, 1.05-4.43) and AAA diameter >70 mm (HR, 2.45; 95% CI, 1.34-4.46) were identified as independent morphologic risk factors for cardiovascular mortality, whereas >25% circumferential neck thrombus (HR, 0.32; 95% CI, 0.13-0.77) was protective. Conclusions: This study suggests that patients with AAA diameters >70 mm are at increased risk of all-cause and cardiovascular mortality. In addition, patients with infrarenal neck diameters ≥30 mm have a greater risk of cardiovascular mortality, although AAA-related deaths were not more frequent in this group of patients. Consequently, a more aggressive management of cardiovascular medical comorbidities may be warranted to improve survival after standard EVAR in these patients.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Vasc Surg. 2019 May;69(5):1444-1451.pt_PT
dc.identifier.doi10.1016/j.jvs.2018.07.082pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3640
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectAgedpt_PT
dc.subjectAged, 80 and overpt_PT
dc.subjectAortic Aneurysm, Abdominalpt_PT
dc.subjectAortographypt_PT
dc.subjectBlood Vessel Prosthesis Implantationpt_PT
dc.subjectCardiovascular Diseasespt_PT
dc.subjectCause of Deathpt_PT
dc.subjectComorbiditypt_PT
dc.subjectEndovascular Procedurespt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectMalept_PT
dc.subjectNeoplasmspt_PT
dc.subjectPredictive Value of Testspt_PT
dc.subjectRegistriespt_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectRisk Assessmentpt_PT
dc.subjectRisk Factorspt_PT
dc.subjectTime Factorspt_PT
dc.subjectTreatment Outcomept_PT
dc.subjectComputed Tomography Angiographypt_PT
dc.subjectHSM CIR VASCpt_PT
dc.titleAnatomic Predictors for Late Mortality after Standard Endovascular Aneurysm Repairpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1451pt_PT
oaire.citation.issue5pt_PT
oaire.citation.startPage1444pt_PT
oaire.citation.titleJournal of Vascular Surgerypt_PT
oaire.citation.volume69pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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