Study Finds Higher 30-Day Mortality After EVAR in Patients With Familial AAA
August 9, 2017—A study to determine the influence that a positive family history for abdominal aortic aneurysm (AAA) may have on clinical success and mortality after endovascular aneurysm repair (EVAR) showed a higher 30-day mortality rate after EVAR in patients with familial AAA. Koen M. van de Luijtgaarden, MD, et al published the study in European Journal of Vascular and Endovascular Surgery (EJVES; 2017;54:142–149).
The study was composed of 1,262 patients with AAAs treated by EVAR who were enrolled from 2009 to 2011 in the prospective, industry-sponsored, global, prospective ENGAGE clinical registry evaluating the Endurant II stent graft system (Medtronic). Patients were classified into familial and sporadic AAA patients according to baseline clinical reports. Clinical characteristics, aneurysm morphology, and follow-up were registered.
As summarized in EJVES, the primary endpoint was clinical success after EVAR, a composite of technical success and freedom from the following complications: AAA size increase > 5 mm, type I and III endoleak, rupture, conversion, secondary procedures, migration, and occlusion. Secondary endpoints were the individual components of clinical success, 30-day mortality, and aneurysm-related and all-cause mortality.
Of the 1,262 AAA patients (89.5% men; mean age, 73.1 years), 86 patients (6.8%) reported a positive family history and were classified has having familial AAA. The duration of follow-up was 4.4 ± 1.7 years.
The investigators found that patients with familial AAA were more often women (18.6% vs 9.9%; P = .012). No difference was observed in aneurysm morphology. There was no significant difference in clinical success between patients with familial and sporadic AAAs (72.1% vs 79.3%; P =.116).
The study showed that familial AAA patients had a higher 30-day mortality after EVAR (4.7% vs 1.0%; adjusted hazard ratio [HR] 5.7; 95% confidence interval [CI], 1.8–17.9; P = .003) as well as aneurysm-related mortality (5.8% vs 1.3%; adjusted HR 5.4; 95% CI, 1.9–14.9; P = .001), while no difference was observed in all-cause mortality (19.8% vs 24.3%; adjusted HR 0.8; 95% CI, 0.5–1.4; P = .501).
Future studies should determine the role of family history in AAA treatment, suitability for endovascular or open repair, and on adaptation of postoperative surveillance. For the time being, patients with familial forms of AAA should be considered at higher risk for EVAR and warrant extra vigilance, advised the investigators in EJVES.