DR. SIN, KAI CHEUK; DEPARTMENT OF INTENSIVE CARE UNIT; QUEEN ELIZABETH HOSPITAL
Background
Patients with open repair of abdominal aortic aneurysms (AAAs) are generally considered as high risk for significant peri-operative morbidity and mortality. With the introduction of endovascular repair (EVAR) technique, the clinical practice is changing. EVAR has been shown to have peri-operative survival benefit and reduction in complications in previous trials; while these advantages are not sustained in the long-term. Studies comparing the post-operative events and the long-term outcomes of EVAR and open repair of AAAs in local intensive care units are, however, lacking.
Method
This is a retrospective study. Clinical outcomes in terms of peri-operative complications, mortality, 1-year survival and reterinvention rates were compared among propensity-score-matched patients after elective EVAR and open repair during 2007 – 2011 period in Queen Elizabeth Hospital. Epidemiological data of patients with emergency AAA repair were also reviewed.
Results
74 and 40 patients received elective EVAR and open repair of AAAs, respectively. 35 patients from each group were selected to create the propensity-matched cohorts. The average age of the patients was 72.4 years, with mean aneurysm diameter of 61.7 mm. The operative mortality was lower after EVAR than open repair (0% versus 5.7%, P = 0.151). EVAR was associated with reduction in renal complication (2.9% versus 22.9%, P = 0.012) with OR of 0.09 (95% CI, 0.01 – 0.80); and cardiac complication (14.3% versus 31.4%, P = 0.088) with OR of 0.29 (95% CI, 0.08 – 1.01). Early survival advantage of EVAR was lost beyond 8 months, resulting in similar 1-year survival rate among the two groups at 91.4%.
46 patients underwent emergency AAA repair with average age of 77.9 years and mean aneurysm diameter of 70.0 mm. The 30-day operative mortality rate was 23.9% (32.4% after adjustment for rupture aneurysm repair). Peri-operative complications were common (cardiac: 60.9%, pulmonary: 45.7%, and renal: 56.5%). The 1-year survival rate was 52.2%.
Conclusions
The findings confirm the peri-operative advantages of endovascular over open approach for elective AAA repair in the patients in this local centre. The survival curves convergence on subsequent follow-up was likely due to the “catch-up” of cardiovascular events among patients with EVAR. Peri-operative medical therapy optimization and post-operative close monitoring may lead to longer sustainment of the early benefits of EVAR. After all, long-term data are necessary to evaluate the relative merits of both procedures in this locality.
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