Key result
A 1 cm increase in preoperative abdominal aortic aneurysm diameter was associated with worse overall late survival following repair (HR 1.14; 95% CI 1.09-1.18), with a greater effect seen in EVAR.
Why the study?
Does larger preoperative abdominal aortic aneurysm diameter reduce overall long-term survival in patients undergoing abdominal aortic aneurysm repair?
Meta-Analysis (n=22,104)
Does larger preoperative abdominal aortic aneurysm diameter reduce overall long-term survival in patients undergoing abdominal aortic aneurysm repair?
Larger preoperative abdominal aortic aneurysm diameter independently predicts worse long-term survival after repair, with a more pronounced negative effect observed in patients undergoing endovascular repair.
Answers are grounded in this paper and cite their sources.
Preoperative AAA size should not yet alter repair thresholds or modality; leaves open whether diameter-stratified trials can refine long-term risk reduction.
BACKGROUND: Studies reporting the influence of preoperative abdominal aortic aneurysm diameter on late survival following abdominal aortic aneurysm repair have not been consistent. AIM: To report the influence of abdominal aortic aneurysm diameter on overall long-term survival following abdominal aortic aneurysm repair. METHODS: Embase, Medline and the Cochrane electronic databases were searched to identify articles reporting the influence of abdominal aortic aneurysm diameter on late survival following open aneurysm repair and endovascular aneurysm repair published up to April 2015. Data were extracted from multivariate analysis; estimated risks were expressed as hazard ratio. RESULTS: A total of 2167 titles/abstracts were retrieved, of which 76 studies were fully assessed; 19 studies reporting on 22,104 patients were included. Preoperative larger abdominal aortic aneurysm size was associated with a worse survival compared to smaller aneurysms with a pooled hazard ratio of 1.14 (95% CI: 1.09-1.18), per 1 cm increase in abdominal aortic aneurysm diameter. Subgroup analysis of the different types of repair was performed and the hazard ratio (95% CI), for open aneurysm repair and endovascular aneurysm repair were 1.08 (1.03-1.12) and 1.20 (1.15-1.25), respectively, per 1 cm increase. There was a significant difference between the groups p < 0.02. CONCLUSIONS: This meta-analysis suggests that preoperative large abdominal aortic aneurysm independently influences overall late survival following abdominal aortic aneurysm repair, and this association was greater in abdominal aortic aneurysm repaired with endovascular aneurysm repair.
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Khashram et al. (2016) conducted a meta-analysis in Abdominal aortic aneurysm (n=22,104). 1 cm increase in abdominal aortic aneurysm diameter vs. Smaller aneurysms was evaluated on Overall late survival (HR 1.14, 95% CI 1.09-1.18). A 1 cm increase in preoperative abdominal aortic aneurysm diameter was associated with worse overall late survival following repair (HR 1.14; 95% CI 1.09-1.18), with a greater effect seen in EVAR.
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