INTRODUCTION: The basic premise in managing patients with abdominal aortic aneurysms (AAA) must be to reduce overall mortality from the disease. Operative mortality is widely reported, but data on patients deemed unsuitable for repair are scarce. The purpose of the present study was to report the fate of patients referred with AAA, to define the proportion deemed unsuitable for surgery and to investigate the reasons for conservative treatment. METHODS: All patients who were referred to a regional vascular centre with large (>5.5 cm) infra-renal AAA between 1st January 2008 and 31st December 2009 were included. Patients were classified into two groups; those managed non-operatively, or those offered elective repair. Survival was reported by Kaplan-Meier analysis. Multivariate analysis investigated factors leading to non-operative management. RESULTS: 251 patients with a mean (s.d.) age of 75(8) years were assessed. Thirty-two (13%) patients were deemed unsuitable for repair, mostly because of medical co-morbidity (16/32). 219/251 (87%) patients underwent repair (25/251 (10%) open repair 194/251 (77%) EVAR) with 1/219 (0.5%) 30-day mortality. AAA repair was associated with significantly greater survival (p < 0.001, log-rank test) at 2 years. In multivariate analysis Glasgow Aneurysm Score, female gender and respiratory disease were significant predictors of the decision to treat patients conservatively (p < 0.001). CONCLUSION: Most patients were suitable for surgical intervention with low perioperative mortality. Data on "turndown" rates should be routinely reported to quantify the denominator for operative success.
INTRODUCTION: The basic premise in managing patients with abdominal aortic aneurysms (AAA) must be to reduce overall mortality from the disease. Operative mortality is widely reported, but data on patients deemed unsuitable for repair are scarce. The purpose of the present study was to report the fate of patients referred with AAA, to define the proportion deemed unsuitable for surgery and to investigate the reasons for conservative treatment. METHODS: All patients who were referred to a regional vascular centre with large (>5.5 cm) infra-renal AAA between 1st January 2008 and 31st December 2009 were included. Patients were classified into two groups; those managed non-operatively, or those offered elective repair. Survival was reported by Kaplan-Meier analysis. Multivariate analysis investigated factors leading to non-operative management. RESULTS: 251 patients with a mean (s.d.) age of 75(8) years were assessed. Thirty-two (13%) patients were deemed unsuitable for repair, mostly because of medical co-morbidity (16/32). 219/251 (87%) patients underwent repair (25/251 (10%) open repair 194/251 (77%) EVAR) with 1/219 (0.5%) 30-day mortality. AAA repair was associated with significantly greater survival (p < 0.001, log-rank test) at 2 years. In multivariate analysis Glasgow Aneurysm Score, female gender and respiratory disease were significant predictors of the decision to treat patients conservatively (p < 0.001). CONCLUSION: Most patients were suitable for surgical intervention with low perioperative mortality. Data on "turndown" rates should be routinely reported to quantify the denominator for operative success.
Authors: A Saratzis; A Thatcher; M F Bath; D A Sidloff; M J Bown; J Shakespeare; R D Sayers; C Imray Journal: Ann R Coll Surg Engl Date: 2017-01-10 Impact factor: 1.891
Authors: Alan Karthikesalingam; Sandeep S Bahia; Shaneel R Patel; Bilal Azhar; Dan Jackson; Lynne Cresswell; Robert J Hinchliffe; Peter J E Holt; Matt M Thompson Journal: Kidney Int Date: 2014-08-20 Impact factor: 10.612
Authors: Jorg L de Bruin; Jack R W Brownrigg; Alan Karthikesalingam; Benjamin O Patterson; Peter J E Holt; Robert J Hinchliffe; Robert A Morgan; Ian M Loftus; Matthew M Thompson Journal: J Endovasc Ther Date: 2015-04-22 Impact factor: 3.487
Authors: D A Sidloff; A Saratzis; M J Sweeting; J Michaels; J T Powell; S G Thompson; M J Bown Journal: Br J Surg Date: 2017-07-26 Impact factor: 6.939