What factors counteract the mid-term survival following endovascular
repair of abdominal aortic aneurysms?
Abstract
Background.Endovascular aortic aneurysm repair (EVAR) for abdominal
aortic aneurysm (AAA) is increasingly used and become the standard
treatment option for AAA. The aim of the current study was to evaluate
the outcomes and predictors of survival of endovascular treatment of AAA
at the short and medium-term. Methods.A total of 222 patients having
endovascular AAA repair between January 2013 and December 2019 by the
same surgical team were included in the study. Patient demographics,
perioperative and follow-up data including mortality,complications and
need for secondary intervention were collected.Primary endpoint was
all-cause mortality.Kaplan-Meier analysis was conducted for survival and
Cox regression models were assessed for predictors of survival. Results.
Median age was 70 years with male predominance(202 patients,91%).
Thirty-day mortality was 1.8%. Median follow-up to the primary endpoint
was 20 months(range,1 to 80 months). Survival rates at one, three and
five years were 93.5%,81.4% and 62.2% respectively. Freedom from
secondary intervention rates were 95.5% at one year,88.7% at three
years and 82.1% at five years. Cox proportional hazard models showed
that preoperative creatinine levels ≥1.8 mg/dl(hazard ratio (HR) 2.68,
95%CI1.21-6.42, p=0.027), hemoglobin levels <10 gr/dl (HR
3.38 95%CI 1.16-9.90,p=0.026), ejection fraction < 30% (HR
5.67,95%CI1.29-24.86,p=0.021)and AAA diamete≥6.0 cm(HR
2.20,95%CI1.01-4.81,p=0.049)were independently associated with mid-term
survival. Conclusion.EVAR is a safe procedure with low postoperative
morbidity and mortality. This study confirms that the mid-term survival
and results are favorable.However, the analyzed factors in this study
that predict reduced survival(high preoperative creatinine,ow
hemoglobin,low ejection fraction and larger aneurysms) should be judged
when planning EVAR.