دورية أكاديمية
Assessment of fitness for open repair in patients with infrarenal abdominal aortic aneurysms.
العنوان: | Assessment of fitness for open repair in patients with infrarenal abdominal aortic aneurysms. |
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المؤلفون: | Khoury MK; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: mitri.khoury@gmail.com., Thornton MA; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA., Eagleton MJ; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA., Srivastava SD; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA., Zacharias N; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA., Dua A; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA., Mohapatra A; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA. |
المصدر: | Journal of vascular surgery [J Vasc Surg] 2024 Aug; Vol. 80 (2), pp. 389-396.e2. Date of Electronic Publication: 2024 Apr 11. |
نوع المنشور: | Journal Article; Comparative Study |
اللغة: | English |
بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE |
أسماء مطبوعة: | Publication: <2008-> : New York, NY : Elsevier Original Publication: St. Louis, Mo. : Mosby, [c1984- |
مواضيع طبية MeSH: | Aortic Aneurysm, Abdominal*/surgery , Aortic Aneurysm, Abdominal*/mortality , Aortic Aneurysm, Abdominal*/diagnostic imaging , Endovascular Procedures*/adverse effects , Endovascular Procedures*/mortality , Blood Vessel Prosthesis Implantation*/adverse effects , Blood Vessel Prosthesis Implantation*/mortality , Postoperative Complications*/etiology , Postoperative Complications*/mortality, Humans ; Male ; Female ; Aged ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Outcome ; Time Factors ; Aged, 80 and over ; Patient Selection ; Databases, Factual |
مستخلص: | Objective: Endovascular aortic repair (EVAR) was originally designed as a treatment modality for patients with abdominal aortic aneurysms (AAAs) deemed unfit for open repair. However, the definition of "unfit for open repair" is largely subjective and heterogenous. The purpose of this study was to compare patients deemed unfit for open repair who underwent EVAR to a matched cohort who underwent open repair for infrarenal AAAs. Methods: The Vascular Quality Initiative of the Society for Vascular Surgery was queried for patients who underwent EVAR and open infrarenal AAA repair from 2003 to 2022. Patients that underwent EVAR were included if they were deemed unfit for open repair by the operating surgeon. EVAR patients deemed unfit because of a hostile abdomen were excluded. Patients in both the open and EVAR datasets were excluded if their repair was deemed non-elective or if they had prior aortic surgery. EVAR patients were matched to a cohort of open patients. The primary outcome for this study was 1-year mortality. Secondary outcomes included 30-day mortality, major adverse cardiac events, pulmonary complications, non-home discharge, reinterventions, and 5-year survival. Results: A total of 5310 EVAR patients were identified who were deemed unfit for open repair. Of those, 3028 EVAR patients (57.0%) were able to be matched 1:1 to a cohort of open patients. Open patients had higher rates of major adverse cardiac events (20.2% vs 4.4%; P < .001), pulmonary complications (12.8% vs 1.6%; P < .001), non-home discharges (28.5% vs 7.9%; P < .001), and 30-day mortality (4.5% vs 1.4%; P < .001). There were no differences in early survival, but open repair had better middle and late survival compared with EVAR over the course of 5 years. A total of 74 EVAR patients (2.4%) had reinterventions during the study period. EVAR patients that required interventions had higher 1-year (40.5% vs 7.3%; P < .001) and 5-year mortality (43.2% vs 14.1%; P < .001) compared with those that did not require reinterventions. EVAR patients who had reinterventions had higher 1-year (40.5% vs 6.3%; P < .001) and 5-year (43.2% vs 20.3%; P = .006) mortality compared with their matched open cohort. Conclusions: Patients undergoing EVAR for AAAs who are deemed unfit for open repair have better perioperative morbidity and mortality compared with open repair. However, patients who had an open repair had better middle and late survival over the course of 5 years. The categorization of unfitness for open surgery may be inaccurate and re-evaluation of this terminology/concept should be undertaken. Competing Interests: Disclosures None. (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.) |
فهرسة مساهمة: | Keywords: Aortic aneurysm; Endovascular; Open surgery; Unfit |
تواريخ الأحداث: | Date Created: 20240413 Date Completed: 20240720 Latest Revision: 20240720 |
رمز التحديث: | 20240722 |
DOI: | 10.1016/j.jvs.2024.04.020 |
PMID: | 38614140 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1097-6809 |
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DOI: | 10.1016/j.jvs.2024.04.020 |