Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy

Randall R De Martino, Philip P. Goodney, Brian W. Nolan, William P. Robinson, Alik Farber, Virendra I. Patel, David H. Stone, Jack L. Cronewett

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Objective: 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 after elective AAA repair for moderately sized AAAs (<6.5-cm diameter) to identify patients unlikely to benefit from surgery. Methods: We analyzed 2367 elective infrarenal AAA (<6.5 cm) repairs across 21 centers in New England from 2003 to 2011. Our main outcome measure was 5-year life-table survival. Cox proportional hazards analysis was used to describe associations between patient characteristics and 5-year survival. Results: During the study period, 1653 endovascular AAA repairs and 714 open AAA repairs were performed. Overall, 5-year survival rates were similar by procedure type (75% endovascular repair, 80% open repair; P =.14). Advanced age ≥75 years (hazard ratio [HR], 2.0; P <.01) and age >80 years (HR, 2.6; P <.01), coronary artery disease (HR, 1.4; P <.04), unstable angina or recent myocardial infarction (HR, 4.6; P <.01), oxygen-dependent chronic obstructive pulmonary disease (HR, 2.7; P <.01), and estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR, 2.8; P <.01) were associated with poor survival. Aspirin (HR, 0.8; P <.03) and statin (HR, 0.7; P <.01) use were associated with improved survival. We used these risk factors to develop risk strata for low-risk, medium-risk, and high-risk groups with survival, respectively, of 85%, 69%, and 43% at 5 years (P <.001). Conclusions: More than 75% of patients with moderately sized AAAs who underwent elective repair in our region survived 5 years, but 4% were at high risk for 5-year mortality. Patients with multiple risk factors, especially age >80 years, unstable angina, oxygen-dependent chronic obstructive pulmonary disease, and estimated glomerular filtration rate <30 mL/min/1.73 m2, are unlikely to achieve sufficient long-term survival to benefit from surgery, unless their AAA rupture risk is very high.

Original languageEnglish (US)
Pages (from-to)589-595
Number of pages7
JournalJournal of Vascular Surgery
Volume58
Issue number3
DOIs
StatePublished - Sep 2013
Externally publishedYes

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

De Martino, R. R., Goodney, P. P., Nolan, B. W., Robinson, W. P., Farber, A., Patel, V. I., Stone, D. H., & Cronewett, J. L. (2013). Optimal selection of patients for elective abdominal aortic aneurysm repair based on life expectancy. Journal of Vascular Surgery, 58(3), 589-595. https://doi.org/10.1016/j.jvs.2013.03.010