Designation as "unfit for open repair" is associated with poor outcomes after endovascular aortic aneurysm repair

Randall R De Martino, Benjamin S. Brooke, William Robinson, Andres Schanzer, Jeffrey E. Indes, Jessica B. Wallaert, Brian W. Nolan, Jack L. Cronenwett, Philip P. Goodney

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background-Endovascular aortic aneurysm repair (EVAR) is often offered to patients with abdominal aortic aneurysms (AAAs) considered preoperatively to be unfit for open AAA repair (oAAA). This study describes the short- and long-term outcomes of patients undergoing EVAR with AAAs <6.5 cm who are considered unfit for oAAA. Methods and Results-We analyzed elective EVARs for AAAs <6.5 cm diameter in the Vascular Study Group of New England (2003-2011). Patients were designated as fit or unfit for oAAA by the treating surgeon. End points included inhospital major adverse events and long-term mortality. We identified patient characteristics associated with being unfit for open repair and predictors of survival using multivariable analyses. Of 1653 EVARs, 309 (18.7%) patients were deemed unfit for oAAA. These patients were more likely to have advanced age, cardiac disease, chronic obstructive pulmonary disease, and larger aneurysms at the time of repair (54 versus 56 mm, P=0.001). Patients unfit for oAAA had higher rates of cardiac (7.8% versus 3.1%, P<0.01) and pulmonary (3.6 versus 1.6, P<0.01) complications and worse survival rates at 5 years (61% versus 80%; log rank P<0.01) compared with those deemed fit for oAAA. Finally, patients designated as unfit for oAAA had worse survival, even adjusting for patient characteristics and aneurysm size (hazard ratio, 1.6; 95% confidence interval, 1.2-2.2; P<0.01). Conclusions-In patients with AAAs <6.5 cm, designation by the operating surgeon as unfit for oAAA provides insight into both short- and long-term efficacy of EVAR. Patients unable to tolerate oAAA may not benefit from EVAR unless their risk of AAA rupture is very high.

Original languageEnglish (US)
Pages (from-to)575-581
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume6
Issue number5
DOIs
StatePublished - Sep 2013
Externally publishedYes

Fingerprint

Aortic Aneurysm
Abdominal Aortic Aneurysm
Aneurysm
Aortic Rupture
New England
Survival
Chronic Obstructive Pulmonary Disease
Blood Vessels
Heart Diseases
Survival Rate
Confidence Intervals

Keywords

  • Aneurysm
  • Complications
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Designation as "unfit for open repair" is associated with poor outcomes after endovascular aortic aneurysm repair. / De Martino, Randall R; Brooke, Benjamin S.; Robinson, William; Schanzer, Andres; Indes, Jeffrey E.; Wallaert, Jessica B.; Nolan, Brian W.; Cronenwett, Jack L.; Goodney, Philip P.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 6, No. 5, 09.2013, p. 575-581.

Research output: Contribution to journalArticle

De Martino, Randall R ; Brooke, Benjamin S. ; Robinson, William ; Schanzer, Andres ; Indes, Jeffrey E. ; Wallaert, Jessica B. ; Nolan, Brian W. ; Cronenwett, Jack L. ; Goodney, Philip P. / Designation as "unfit for open repair" is associated with poor outcomes after endovascular aortic aneurysm repair. In: Circulation: Cardiovascular Quality and Outcomes. 2013 ; Vol. 6, No. 5. pp. 575-581.
@article{ce5766e2a5ad4365a22011394280cce8,
title = "Designation as {"}unfit for open repair{"} is associated with poor outcomes after endovascular aortic aneurysm repair",
abstract = "Background-Endovascular aortic aneurysm repair (EVAR) is often offered to patients with abdominal aortic aneurysms (AAAs) considered preoperatively to be unfit for open AAA repair (oAAA). This study describes the short- and long-term outcomes of patients undergoing EVAR with AAAs <6.5 cm who are considered unfit for oAAA. Methods and Results-We analyzed elective EVARs for AAAs <6.5 cm diameter in the Vascular Study Group of New England (2003-2011). Patients were designated as fit or unfit for oAAA by the treating surgeon. End points included inhospital major adverse events and long-term mortality. We identified patient characteristics associated with being unfit for open repair and predictors of survival using multivariable analyses. Of 1653 EVARs, 309 (18.7{\%}) patients were deemed unfit for oAAA. These patients were more likely to have advanced age, cardiac disease, chronic obstructive pulmonary disease, and larger aneurysms at the time of repair (54 versus 56 mm, P=0.001). Patients unfit for oAAA had higher rates of cardiac (7.8{\%} versus 3.1{\%}, P<0.01) and pulmonary (3.6 versus 1.6, P<0.01) complications and worse survival rates at 5 years (61{\%} versus 80{\%}; log rank P<0.01) compared with those deemed fit for oAAA. Finally, patients designated as unfit for oAAA had worse survival, even adjusting for patient characteristics and aneurysm size (hazard ratio, 1.6; 95{\%} confidence interval, 1.2-2.2; P<0.01). Conclusions-In patients with AAAs <6.5 cm, designation by the operating surgeon as unfit for oAAA provides insight into both short- and long-term efficacy of EVAR. Patients unable to tolerate oAAA may not benefit from EVAR unless their risk of AAA rupture is very high.",
keywords = "Aneurysm, Complications, Mortality",
author = "{De Martino}, {Randall R} and Brooke, {Benjamin S.} and William Robinson and Andres Schanzer and Indes, {Jeffrey E.} and Wallaert, {Jessica B.} and Nolan, {Brian W.} and Cronenwett, {Jack L.} and Goodney, {Philip P.}",
year = "2013",
month = "9",
doi = "10.1161/CIRCOUTCOMES.113.000095",
language = "English (US)",
volume = "6",
pages = "575--581",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Designation as "unfit for open repair" is associated with poor outcomes after endovascular aortic aneurysm repair

AU - De Martino, Randall R

AU - Brooke, Benjamin S.

AU - Robinson, William

AU - Schanzer, Andres

AU - Indes, Jeffrey E.

AU - Wallaert, Jessica B.

AU - Nolan, Brian W.

AU - Cronenwett, Jack L.

AU - Goodney, Philip P.

PY - 2013/9

Y1 - 2013/9

N2 - Background-Endovascular aortic aneurysm repair (EVAR) is often offered to patients with abdominal aortic aneurysms (AAAs) considered preoperatively to be unfit for open AAA repair (oAAA). This study describes the short- and long-term outcomes of patients undergoing EVAR with AAAs <6.5 cm who are considered unfit for oAAA. Methods and Results-We analyzed elective EVARs for AAAs <6.5 cm diameter in the Vascular Study Group of New England (2003-2011). Patients were designated as fit or unfit for oAAA by the treating surgeon. End points included inhospital major adverse events and long-term mortality. We identified patient characteristics associated with being unfit for open repair and predictors of survival using multivariable analyses. Of 1653 EVARs, 309 (18.7%) patients were deemed unfit for oAAA. These patients were more likely to have advanced age, cardiac disease, chronic obstructive pulmonary disease, and larger aneurysms at the time of repair (54 versus 56 mm, P=0.001). Patients unfit for oAAA had higher rates of cardiac (7.8% versus 3.1%, P<0.01) and pulmonary (3.6 versus 1.6, P<0.01) complications and worse survival rates at 5 years (61% versus 80%; log rank P<0.01) compared with those deemed fit for oAAA. Finally, patients designated as unfit for oAAA had worse survival, even adjusting for patient characteristics and aneurysm size (hazard ratio, 1.6; 95% confidence interval, 1.2-2.2; P<0.01). Conclusions-In patients with AAAs <6.5 cm, designation by the operating surgeon as unfit for oAAA provides insight into both short- and long-term efficacy of EVAR. Patients unable to tolerate oAAA may not benefit from EVAR unless their risk of AAA rupture is very high.

AB - Background-Endovascular aortic aneurysm repair (EVAR) is often offered to patients with abdominal aortic aneurysms (AAAs) considered preoperatively to be unfit for open AAA repair (oAAA). This study describes the short- and long-term outcomes of patients undergoing EVAR with AAAs <6.5 cm who are considered unfit for oAAA. Methods and Results-We analyzed elective EVARs for AAAs <6.5 cm diameter in the Vascular Study Group of New England (2003-2011). Patients were designated as fit or unfit for oAAA by the treating surgeon. End points included inhospital major adverse events and long-term mortality. We identified patient characteristics associated with being unfit for open repair and predictors of survival using multivariable analyses. Of 1653 EVARs, 309 (18.7%) patients were deemed unfit for oAAA. These patients were more likely to have advanced age, cardiac disease, chronic obstructive pulmonary disease, and larger aneurysms at the time of repair (54 versus 56 mm, P=0.001). Patients unfit for oAAA had higher rates of cardiac (7.8% versus 3.1%, P<0.01) and pulmonary (3.6 versus 1.6, P<0.01) complications and worse survival rates at 5 years (61% versus 80%; log rank P<0.01) compared with those deemed fit for oAAA. Finally, patients designated as unfit for oAAA had worse survival, even adjusting for patient characteristics and aneurysm size (hazard ratio, 1.6; 95% confidence interval, 1.2-2.2; P<0.01). Conclusions-In patients with AAAs <6.5 cm, designation by the operating surgeon as unfit for oAAA provides insight into both short- and long-term efficacy of EVAR. Patients unable to tolerate oAAA may not benefit from EVAR unless their risk of AAA rupture is very high.

KW - Aneurysm

KW - Complications

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=84884483649&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884483649&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.113.000095

DO - 10.1161/CIRCOUTCOMES.113.000095

M3 - Article

C2 - 24046399

AN - SCOPUS:84884483649

VL - 6

SP - 575

EP - 581

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 5

ER -