Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age

Jelle W Raats,1 Hans C Flu,1 Gwan H Ho,1 Eelco J Veen,1 Louwerens D Vos,2 Ewout W Steyerberg,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Radiology, Amphia Hospital, Breda, 3Department of Public Health, Erasmus MC, Rotterdam, the Netherlands Background: Desp...

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Autores principales:	Raats JW, Flu HC, Ho GH, Veen EJ, Vos LD, Steyerberg EW, van der Laan L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ruptured AAA treatment outcome elderly clinical disicion making Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/8c1af9602e8841b6b85ba7906ccf1a23
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spelling	oai:doaj.org-article:8c1af9602e8841b6b85ba7906ccf1a232021-12-02T00:05:46ZLong-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age1178-1998https://doaj.org/article/8c1af9602e8841b6b85ba7906ccf1a232014-10-01T00:00:00Zhttps://www.dovepress.com/long-term-outcome-of-ruptured-abdominal-aortic-aneurysm-impact-of-trea-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Jelle W Raats,1 Hans C Flu,1 Gwan H Ho,1 Eelco J Veen,1 Louwerens D Vos,2 Ewout W Steyerberg,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Radiology, Amphia Hospital, Breda, 3Department of Public Health, Erasmus MC, Rotterdam, the Netherlands Background: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA.Methods: We conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital.Results: Twelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P<0.001). Advancing age was associated with increasing mortality (hazard ratio 1.05 [95% confidence interval 1.01–1.09]) per year for patients who received operative repair, with a 67%, 76%, and 100% 5-year mortality rate in the 34 patients aged <70 years, 59 patients aged 70–79 years, and 12 octogenarians, respectively; 30-day rAAA-related mortality was also associated with increasing age (21%, 30%, and 61%, respectively; P=0.008). Conclusion: The 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.Keywords: ruptured abdominal aneurysm repair, clinical decision-making, emergency endovascular aneurysm repair, open repairRaats JWFlu HCHo GHVeen EJVos LDSteyerberg EWvan der Laan LDove Medical PressarticleRuptured AAAtreatment outcomeelderlyclinical disicion makingGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 1721-1732 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ruptured AAA treatment outcome elderly clinical disicion making Geriatrics RC952-954.6
spellingShingle	Ruptured AAA treatment outcome elderly clinical disicion making Geriatrics RC952-954.6 Raats JW Flu HC Ho GH Veen EJ Vos LD Steyerberg EW van der Laan L Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age
description	Jelle W Raats,1 Hans C Flu,1 Gwan H Ho,1 Eelco J Veen,1 Louwerens D Vos,2 Ewout W Steyerberg,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Radiology, Amphia Hospital, Breda, 3Department of Public Health, Erasmus MC, Rotterdam, the Netherlands Background: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA.Methods: We conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital.Results: Twelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P<0.001). Advancing age was associated with increasing mortality (hazard ratio 1.05 [95% confidence interval 1.01–1.09]) per year for patients who received operative repair, with a 67%, 76%, and 100% 5-year mortality rate in the 34 patients aged <70 years, 59 patients aged 70–79 years, and 12 octogenarians, respectively; 30-day rAAA-related mortality was also associated with increasing age (21%, 30%, and 61%, respectively; P=0.008). Conclusion: The 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.Keywords: ruptured abdominal aneurysm repair, clinical decision-making, emergency endovascular aneurysm repair, open repair
format	article
author	Raats JW Flu HC Ho GH Veen EJ Vos LD Steyerberg EW van der Laan L
author_facet	Raats JW Flu HC Ho GH Veen EJ Vos LD Steyerberg EW van der Laan L
author_sort	Raats JW
title	Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age
title_short	Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age
title_full	Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age
title_fullStr	Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age
title_full_unstemmed	Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age
title_sort	long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/8c1af9602e8841b6b85ba7906ccf1a23
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Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age

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