scholarly journals A Significant Proportion of Current U.S Endovascular Aneurysm Repair Practice Fails to Meet Society for Vascular Surgery Clinical Practice Guideline-Recommended Abdominal Aortic Aneurysm Diameter Treatment Thresholds

2020 ◽  
Vol 72 (3) ◽  
pp. e277-e278
Author(s):  
Salvatore T. Scali ◽  
Bjoern D. Suckow ◽  
Philip P. Goodney ◽  
Thomas S. Huber ◽  
Gilbert R. Upchurch ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Clinical Practice ◽  
Aortic Aneurysm ◽  
Vascular Surgery ◽  
Significant Proportion ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic ◽  
Treatment Thresholds ◽  
Aneurysm Repair ◽  
Aneurysm Diameter

Perioperative Outcomes for Abdominal Aortic Aneurysm Repair Based on Aneurysm Diameter

2020 ◽  
Vol 54 (4) ◽  
pp. 341-347
Author(s):  
Christopher Ramos ◽  
Amit Pujari ◽  
Ravi R. Rajani ◽  
Guillermo A. Escobar ◽  
Brian G. Rubin ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Asymptomatic Patients ◽  
Abdominal Aortic ◽  
Elective Repair ◽  
Aneurysm Repair ◽  
Aneurysm Diameter

Background: Guidelines from the Society for Vascular Surgery recommend elective repair in asymptomatic patients with an abdominal aortic aneurysm (AAA) only if their diameter is greater than or equal to 5.5 cm, yet smaller ones are routinely repaired. This study aims to evaluate perioperative outcomes based on aneurysm size at the time of repair. Methods: Male patients who underwent elective endovascular aneurysm repair (EVAR) or open abdominal aneurysm repair (OAAR) repair of an infrarenal AAA were abstracted from 2011 to 2015 Targeted National Surgical Quality Improvement Program (NSQIP) database. Patients with symptoms or with aneurysmal extension into the visceral or iliac vessels were excluded. Outcomes of open versus endovascular repair were reported, with multivariate analyses to identify factors associated with the decision to repair AAA ≤5.4 cm. Results: A total of 2115 (90.9%) patients underwent EVAR, while 213 (9.1%) underwent OAAR. The mean diameter in patients who underwent OAAR was 6.1 cm (interquartile range [IQR]: 5.2-6.1 cm) versus 5.7 cm (IQR: 5.2-6.0 cm) for EVAR. However, in 42.5% of EVAR and 32.8% of OAAR patients, the diameter of the AAA was 5.4 cm or less. The group undergoing repair of AAA ≤5.4 cm was younger compared to the larger AAA group (71.9 vs 73.9 years; P < .0001). Patients older than 80 years were less likely to have a repair of AAA measuring ≤5.4 cm (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.30-0.65). Additionally, patients who underwent EVAR were more likely to have AAA measuring ≤5.4 cm repaired compared to those who underwent OAAR (OR = 1.62, 95% CI = 1.19-2.21). There were no differences in perioperative morbidity or mortality between the groups. Conclusion: There were no differences in perioperative outcomes after AAA repair, independent of aneurysm diameter. We found a higher likelihood of repairing AAA ≤5.4 cm in younger patients who were more likely to have been repaired with EVAR. Patients older than 80 years were less likely to undergo small AAA repair.

Does the diameter of abdominal aortic aneurysm influence late survival following abdominal aortic aneurysm repair? A systematic review and meta-analysis

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 658-667 ◽  
Author(s):  
Manar Khashram ◽  
Phil N Hider ◽  
Jonathan A Williman ◽  
Gregory T Jones ◽  
Justin A Roake
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysm Repair ◽  
Hazard Ratio ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Aneurysm Diameter ◽  
Late Survival

Background Studies reporting the influence of preoperative abdominal aortic aneurysm diameter on late survival following abdominal aortic aneurysm repair have not been consistent. Aim: To report the influence of abdominal aortic aneurysm diameter on overall long-term survival following abdominal aortic aneurysm repair. Methods Embase, Medline and the Cochrane electronic databases were searched to identify articles reporting the influence of abdominal aortic aneurysm diameter on late survival following open aneurysm repair and endovascular aneurysm repair published up to April 2015. Data were extracted from multivariate analysis; estimated risks were expressed as hazard ratio. Results A total of 2167 titles/abstracts were retrieved, of which 76 studies were fully assessed; 19 studies reporting on 22,104 patients were included. Preoperative larger abdominal aortic aneurysm size was associated with a worse survival compared to smaller aneurysms with a pooled hazard ratio of 1.14 (95% CI: 1.09–1.18), per 1 cm increase in abdominal aortic aneurysm diameter. Subgroup analysis of the different types of repair was performed and the hazard ratio (95% CI), for open aneurysm repair and endovascular aneurysm repair were 1.08 (1.03–1.12) and 1.20 (1.15–1.25), respectively, per 1 cm increase. There was a significant difference between the groups p < 0.02. Conclusions This meta-analysis suggests that preoperative large abdominal aortic aneurysm independently influences overall late survival following abdominal aortic aneurysm repair, and this association was greater in abdominal aortic aneurysm repaired with endovascular aneurysm repair.

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