TY - JOUR
T1 - Effect of Abdominal Aortic Aneurysm Size on Mid-Term Mortality After Endovascular Repair
AU - Kim, Sooyeon
AU - Jeon-Slaughter, Haekyung
AU - Chen, Xiaofei
AU - Ramanan, Bala
AU - Kirkwood, Melissa L.
AU - Timaran, Carlos H.
AU - Modrall, J. Gregory
AU - Tsai, Shirling
N1 - Funding Information:
Sooyeon Kim: Conceptualization, Data curation, Formal analysis, Validation, Writing ? original draft, Writing ? review & editing. Haekyung Jeon-Slaughter: Data curation, Formal analysis, Validation, Writing ? review & editing. Xiaofei Chen: Data curation, Formal analysis, validation, Writing ? review & editing. Bala Ramanan: Formal analysis, Writing ? review & editing. Melissa L. Kirkwood: Formal analysis, Writing ? review & editing. Carlos H. Timaran: Formal analysis, Writing ? review & editing. J Gregory Modrall: Formal analysis, Writing ? review & editing, and Shirling Tsai: Conceptualization, Formal analysis, Validation, Supervision, Writing ? review & editing. This material is the result of work supported with resources and the use of facilities at the VA North Texas Health Care Systems. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. C.H.T has been a consultant and proctor for Cook Medical, Inc and Gore Medical and has received research funding from Cook Medical, Inc and Gore Medical.
Publisher Copyright:
© 2021
PY - 2021/11
Y1 - 2021/11
N2 - Background: Previous studies have suggested that large preoperative AAA size may impact late survival after elective EVAR. It is unclear, however, whether this association applies to patients with smaller AAA between 5.0-5.5 cm, who constitute a substantial portion of patients undergoing elective EVAR. The purpose of this study was to delineate the effect of AAA size between 5.0 and 5.5 cm on mid-term mortality after EVAR by analyzing a large national cohort, the Vascular Quality Initiative (VQI) database. Methods: Using the Vascular Quality Initiative (VQI) national database, patients who underwent EVAR for intact AAA between 2003 and 2018 were identified and stratified based on maximal AAA diameter into 3 groups: Group 1 (4.0 cm ≤ AAA <5.0 cm); Group 2 (5.0 cm ≤ AAA < 5.5 cm); and Group 3 (AAA ≥ 5.5 cm). Cox proportional hazard model and propensity score matching method were used to estimate AAA size effect on all-cause mortality at 1, 3, and 5 years after EVAR while adjusting for potential confounders. Results: The study included 32,398 patients, of whom 81% were men with a mean age of 74. The most common group who underwent EVAR was Group 2 (5.0 cm ≤ AAA < 5.5 cm). Larger AAA size was associated with male sex (75% versus 79% versus 84%, for Groups 1, 2, and 3 respectively; P < 0.0001) and with coronary artery disease (27% versus 29% versus 31%, for Groups 1, 2, and 3 respectively, P< 0.0001); but was negatively associated with active smoking (33% versus 31% versus 30%, for Groups 1, 2, and 3, respectively, P< 0.001). While 10% of the largest and smallest AAA groups (Groups 3 and 1, respectively) were symptomatic, only 5% of patients in Group 2 were symptomatic (P < 0.01). Adjusted Cox proportional hazard modeling revealed that patients in Group 2 were at significantly lower risk of 5-year mortality when compared to patients in Group 3 (HR 0.66, 95% CI 0.61-0.72, P< 0.01), while similar in risk when compared to patients in Group 1 (HR 1.11, 95% CI 0.93-1.32, P= 0.26). Conclusion: Our analysis found that over 40% of EVAR in the national VQI cohort were performed for AAA < 5.5 cm, with the greatest number of patients undergoing EVAR at AAA size 5.0-5.5cm. Patients with AAA size 5.0-5.5 cm had better 5-year survival outcomes than patients with AAA ≥ 5.5 cm, and similar survival to patients with small AAA between 4.0-5.0 cm.
AB - Background: Previous studies have suggested that large preoperative AAA size may impact late survival after elective EVAR. It is unclear, however, whether this association applies to patients with smaller AAA between 5.0-5.5 cm, who constitute a substantial portion of patients undergoing elective EVAR. The purpose of this study was to delineate the effect of AAA size between 5.0 and 5.5 cm on mid-term mortality after EVAR by analyzing a large national cohort, the Vascular Quality Initiative (VQI) database. Methods: Using the Vascular Quality Initiative (VQI) national database, patients who underwent EVAR for intact AAA between 2003 and 2018 were identified and stratified based on maximal AAA diameter into 3 groups: Group 1 (4.0 cm ≤ AAA <5.0 cm); Group 2 (5.0 cm ≤ AAA < 5.5 cm); and Group 3 (AAA ≥ 5.5 cm). Cox proportional hazard model and propensity score matching method were used to estimate AAA size effect on all-cause mortality at 1, 3, and 5 years after EVAR while adjusting for potential confounders. Results: The study included 32,398 patients, of whom 81% were men with a mean age of 74. The most common group who underwent EVAR was Group 2 (5.0 cm ≤ AAA < 5.5 cm). Larger AAA size was associated with male sex (75% versus 79% versus 84%, for Groups 1, 2, and 3 respectively; P < 0.0001) and with coronary artery disease (27% versus 29% versus 31%, for Groups 1, 2, and 3 respectively, P< 0.0001); but was negatively associated with active smoking (33% versus 31% versus 30%, for Groups 1, 2, and 3, respectively, P< 0.001). While 10% of the largest and smallest AAA groups (Groups 3 and 1, respectively) were symptomatic, only 5% of patients in Group 2 were symptomatic (P < 0.01). Adjusted Cox proportional hazard modeling revealed that patients in Group 2 were at significantly lower risk of 5-year mortality when compared to patients in Group 3 (HR 0.66, 95% CI 0.61-0.72, P< 0.01), while similar in risk when compared to patients in Group 1 (HR 1.11, 95% CI 0.93-1.32, P= 0.26). Conclusion: Our analysis found that over 40% of EVAR in the national VQI cohort were performed for AAA < 5.5 cm, with the greatest number of patients undergoing EVAR at AAA size 5.0-5.5cm. Patients with AAA size 5.0-5.5 cm had better 5-year survival outcomes than patients with AAA ≥ 5.5 cm, and similar survival to patients with small AAA between 4.0-5.0 cm.
KW - Abdominal aortic aneurysm
KW - Evar
KW - Mortality
KW - Preoperative aneurysm size
KW - Vascular quality initiative
UR - http://www.scopus.com/inward/record.url?scp=85109089946&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85109089946&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2021.06.001
DO - 10.1016/j.jss.2021.06.001
M3 - Article
C2 - 34237629
AN - SCOPUS:85109089946
SN - 0022-4804
VL - 267
SP - 443
EP - 451
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -