O-114 - PREOPERATIVE FACTORS AFFECTING LONG-TERM MORTALITY IN PATIENTS SURVIVED TO RUPTURED ABDOMINAL AORTIC ANEURYSM REPAIR

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Troisi N. (University of Pisa, Vascular Surgery Unit ~ Pisa ~ Italy) , Isernia G. (University of Perugia, Vascular Surgery Unit ~ Perugia ~ Italy) , Bertagna G. (University of Pisa, Vascular Surgery Unit ~ Pisa ~ Italy) , Adami D. (University of Pisa, Vascular Surgery Unit ~ Pisa ~ Italy) , Baccani L. (University of Perugia, Vascular Surgery Unit ~ Perugia ~ Italy) , Parlani G. (University of Perugia, Vascular Surgery Unit ~ Perugia ~ Italy) , Berchiolli R. (University of Pisa, Vascular Surgery Unit ~ Pisa ~ Italy) , Simonte G. (University of Perugia, Vascular Surgery Unit ~ Perugia ~ Italy)
Introduction:
Several indexes have been established to predict early mortality in patients with ruptured abdominal aortic aneurysms (rAAAs) through the analysis of preoperative factors including clinical status and laboratory parameters. The debate concerning late survival after rAAA treatment with endovascular aortic repair (EVAR) vs. open surgical repair (OSR) is still open. Some perioperative factors seem to affect long-term survival, such as female gender and age. The aim of this study was to retrospectively evaluate the preoperative factors affecting long-term mortality in patients treated in two tertiary referral centers and survived to OSR or EVAR for rAAAs.
Methods:
From January 2007 to December 2021, 444 patients have been treated for symptomatic or ruptured aortoiliac aneurysms in two tertiary referral centers. Only 405 with diagnosis of rAAA at computed tomography were included in the present study. Initial outcome measures were assessed at 30 and 90 days post-treatment. Estimated 10-year survival of patients survived after 90 days from the index procedure was evaluated with Kaplan-Meier test. Univariate analysis of the preoperative factors affecting 10-year survival in the survivor patients was performed by means of log-rank. All parameters were then included in a multivariate Cox-regression model.
Results:
The procedure was performed by endovascular means in 94 cases (23.2%). EVAR was performed in more elderly population (age >80 years 67% vs. 43.1%; p < .001). Intra-operative death occurred in 29 patients (7.2%). Overall in-hospital death occurred in 97 cases (23.9%). The overall rate of 90-day mortality was 32.6%. No differences were found between OSR and EVAR in terms of intra-operative, in-hospital, and 90-day mortality rates. In survivors estimated survival rates at 1, 5, and 10 years were 84.2%, 58.2%, and 33.3%, respectively (Fig. 1). Type of treatment (OSR vs. EVAR) did not affect long-term freedom from AAA-related death. In survivor patients, multivariate analysis confirmed the association between late survival and female sex (HR 4.7, 95% CI 3.8 to 5.9, p = .03), age > 80 years (HR 28.5, 95% CI 25.1 to 32.3, p < .001), and chronic obstructive pulmonary disease (HR 5.2, 95% CI 4.3 to 6.3, p = .02).
Conclusion:
In our series OSR and EVAR offered similar 90-day mortality rate in patients undergoing repair for rAAAs. One third of patients survived to the index procedure are alive at 10 years. In these patients, female gender, age >80 years at intervention, and chronic obstructive pulmonary disease were predictors of poor long-term survival.
References:
1. Patterson BO, O'Donnell TFX, Kolh P, Holt PJE, Schermerhorn M. Improved outcomes for ruptured abdominal aortic aneurysm through centralisation. Eur J Vasc Endovasc Surg 2018; 56: 159-160. 2. Karthikesalingam A, Wanhainen A, Holt PJ, Vidal-Diez A, Brownrigg JR, Shpitser I, et al. Comparison of long-term mortality after ruptured abdominal aortic aneurysm in England and Sweden. Br J Surg 2016; 103: 199-206. 3. De Rango P, Simonte G, Manzone A, Cieri E, Parlani G, Farchioni L, et al. Arbitrary palliation of ruptured abdominal aortic aneurysms in the elderly is no longer warranted. Eur J Vasc Endovasc Surg 2016; 51: 802-809.
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