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Does the late mortality rate justify EVAR in high risk abdominal aortic aneurysm patients?
Objectives: The development of endovascular aneurysm repair (EVAR) has enabled treatment of more elderly, high-risk patients with abdominal aortic aneurysms who could not tolerate open surgery. We sought to quantify the impact of comorbid conditions on the late mortality of patients who underwent EVAR at our institution in order to assess whether this procedure is warranted in these more high-risk patients.
Methods: Through a retrospective review of the electronic medical records of 105 consecutive patients who underwent EVAR, we calculated the incidence of new diagnoses in prospective surveillance for renal, cardiovascular, cerebrovascular, pulmonary, and neoplastic disease as well as all-cause mortality.
Results: At an average age of 72 at operation, the most frequent condition to arise postoperatively was renal disease at 28.5%, defined as an increase to stage III or worse chronic kidney disease. Only two patients, however, required dialysis. Cancer, including skin cancer, occurred in 19%. Pulmonary disease leading to hospital admission or death occurred in 17%. Cardiovascular disease, defined as the incidence of myocardial infarction, hospital admission for worsening heart failure, or catheterization with intervention, had an incidence of 11.4%. Cerebrovascular accident occurred in 2.8%. The all-cause mortality rate was 30.5% over an average follow up of 39 months. By comparison, aneurysm or graft-related complications, primarily type II endoleak, occurred in 22% with 11 (10.5%) requiring intervention. We found no confirmed aneurysm-related mortality.
Conclusions: Our data demonstrate that EVAR is warranted in high risk, elderly patients and highlight the importance of management of chronic pulmonary disease and surveillance for malignancy in order to maximize survival after EVAR.