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Association Of Diabetic Status And Aneurysm Diameter At Time Of Rupture Repair In The VQI
Camila R. Guetter, MD MPH
1, Jeremy Darling, MD
1, Jorge L. Gomez-Mayorga, MD
1, Isa Van Galen, MD
1, Jemin Park, MD
1, Elisa Caron, MD
1, Ruby C. Lo, MD
2, Sarah Deery, MD
3, Peter A. Soden, MD
4, Christiane J. Ferran, MD PhD
1, Marc L. Schermerhorn, MD
1.
1Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,
2Surgical Associates of Monterey Bay, Santa Cruz, CA, USA,
3Division of Vascular Surgery, Maine Medical Center, Portland, ME, USA,
4Department of Surgery, Division of Vascular Surgery, Brown University, Providence, RI, USA.
OBJECTIVES: Prior studies have reported associations between diabetes and lower risk of both abdominal aortic aneurysm (AAA) rupture, as well as mortality post-rupture. We therefore investigated the impact of diabetic status on aneurysm diameter at time of repair for AAA rupture amongst patients in the Vascular Quality Initiative (VQI) registry.
METHODS: All patients from the VQI undergoing AAA repair between 2003-2024 were examined. Patients not undergoing repair for rupture were excluded. Univariate analysis was performed using parametric and non-parametric tests, as appropriate. Cumulative distribution graphs of rupture repair as a function of aortic diameter were developed and stratified by both diabetic status (none, diet-controlled, medication-controlled, insulin-controlled) and sex.
RESULTS: Of the 92,058 patients analyzed, 7,371 (8.0%) underwent repair for rupture. Amongst ruptured patients, 2,984 (40.5%) underwent open repair, and 4,387 (59.5%) endovascular. Rupture was more predominant amongst women as compared to men (8.8% vs. 7.8%, p<.001). After stratifying by diabetes status (none: 84.4%; diet-controlled: 4.3%; medication-controlled: 8.5%; insulin-controlled: 2.8%), Non diabetic patients, as compared to other diabetic groups were more often White, less likely to have hypertension, CHF, COPD, dialysis requirement, or CAD (all p<.001). Between groups, age was statistically, but not clinically, different (range of group means: 72.1-73.8 years). Mean aneurysm size at time of repair was similar across groups (75.1 +/- 20.7 mm, p=0.143). Ultimately, no association was observed between diabetes status and the cumulative incidence of repair as a function of aortic diameter (p=0.079). Similarly, no association was seen when examining the cumulative incidence amongst men only (p= 0.126) or women only (p=0.420).
CONCLUSIONS: AAA size at time of rupture repair was not associated with diabetes status in the overall study sample, nor when stratified between men and women. These findings suggest the importance of scrupulous analyses that further assess hypothesis around the relationship between diabetes diagnosis, medications, and markers of diabetes control level such as A1C levels, to further elucidate this matter.
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