COPD, Renal Insufficiency Predict Survival in Open AAA Repair



LAKE BUENA VISTA, FLA. – Several factors were shown to predict decreased survival following open abdominal aortic aneurysm repair, according to a retrospective study of 408 patients.

For example, the clamp site – which was infrarenal in 33.6% of patients, suprarenal in 23.8% of patients, and supraceliac in 42.6% of patients – was found on multivariate analysis to be a statistically significant predictor of 5-year survival, Dr. Derek P. Nathan reported at the annual meeting of the Society for Clinical Vascular Surgery.

The 5-year survival was 74% with infrarenal site, compared with 65% for suprarenal site and 53% for supraceliac site, said Dr. Nathan of the Hospital of the University of Pennsylvania, Philadelphia.

Other factors that were found to significantly predict survival in this study were chronic obstructive pulmonary disease, renal insufficiency, and nonelective repair, all of which were significant predictors of both 30-day and 5-year survival. Cardiovascular disease, renal complications, and pulmonary complications were significant predictors of 5-year survival.

The 30-day survival rates were 92% in patients with COPD vs. 97% in those without; 92% in patients with renal insufficiency vs. 98% in those without; and 90% in patients undergoing nonelective repair vs. 97% in those having elective repair.

The 5-year survival rates were 56% in patients with COPD vs. 68% in those without; 52% in those with renal insufficiency vs. 73% in those without; 43% in patients undergoing nonelective repair vs. 68% in those having elective repair; 47% in patients with cardiovascular disease vs. 68% in those without; 41% in patients who sustained renal complications vs. 72% in those who did not; and 46% in patients who sustained pulmonary complications vs. 66% in those who did not, Dr. Nathan said.

Coronary artery disease was not found to predict either 30-day or 5-year survival, COPD did not predict 30-day survival, and cardiac complications did not predict 5-year survival, he noted.

Overall survival in this study of 289 men and 119 women (mean age, 72 years) who underwent open abdominal aortic aneurysm repair during the era of stent grafting was 96% at 30 days, 90% at 1 year, and 64% at 5 years.

Coronary artery disease was present in 56% of patients, renal insufficiency was present in 43%, COPD was present in 30%, and cerebrovascular disease was present in 18%. The mean aneurysm maximal diameter was 6.3 cm, and 67% of patients underwent nonelective repair.

Renal, cardiac, and pulmonary complications occurred in 19%, 17%, and 11% of patients, respectively.

Although the findings show that open AAA repair can be accomplished with low mortality, they underscore the need for careful patient selection, as well as diligent intraoperative technique and postoperative care, for optimizing results, Dr. Nathan concluded.

Dr. Nathan had no disclosures.

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