October 27, 2015
Study Identifies and Quantifies Risk Factors Influencing Late Survival After AAA Repair
October 28, 2015—Manar Khashram, MD, et al conducted a systematic review and meta-analysis of factors influencing survival after abdominal aortic aneurysm (AAA) repair and published their findings online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES). The results of this meta-analysis summarize and quantify nonmodifiable risk factors that influence late survival after AAA repair from the best available published evidence. The presence of these factors might assist in clinical decision making during discussion with patients regarding repair, concluded the investigators in EJVES.
Noting that predicting long-term survival after repair is essential to clinical decision making when offering AAA treatment, the investigators performed a systematic review and a meta-analysis of preoperative nonmodifiable prognostic risk factors influencing patient survival after elective open AAA repair (OAR) and endovascular aneurysm repair (EVAR).
As summarized in EJVES, the investigators searched MEDLINE, Embase, and Cochrane electronic databases to identify all relevant articles published up to April 2015 that reported risk factors influencing long-term survival ( ≥ 1 year) after OAR and EVAR. A total of 5,749 study titles/abstracts were retrieved and 304 studies were deemed relevant. The systematic review included 51 articles and the meta-analysis included 45 articles. They excluded studies with less than 100 patients and those involving primarily ruptured AAA, complex repairs (supra celiac/renal clamp), and high-risk patients. The primary risk factors were increasing age, sex, American Society of Anesthesiologist (ASA) score, and comorbidities, such as ischemic heart disease (IHD), cardiac failure, hypertension, chronic obstructive pulmonary disease (COPD), renal impairment, cerebrovascular disease, peripheral vascular disease (PVD), and diabetes. The estimated risks were expressed as hazard ratio (HR).
The investigators reported that end-stage renal disease and COPD requiring supplementary oxygen had the worst long-term survival (HR 3.15; 95% confidence interval [CI], 2.45–4.04; and HR 3.05; 95% CI, 1.93–4.8, respectively). Every 1-year increase in age was associated with HR of 1.05 (95% CI, 1.04–1.06) and females had a lower survival rate than men (HR, 1.15; 95% CI, 1.07–1.27). An increase in ASA score and the presence of IHD, cardiac failure, hypertension, COPD, renal impairment, cerebrovascular disease, PVD, and diabetes were also factors associated with poor long-term survival, reported the investigators in EJVES.