Key result
Impaired pulmonary status and diabetes mellitus did not significantly influence the rates of aortic neck dilatation (30.6% vs 38.0% for IPS vs normal, p>0.05) after endovascular aneurysm repair.
Why the study?
Do impaired pulmonary status and diabetes mellitus influence clinical outcomes and aortic neck dilatation following elective EVAR in patients with abdominal aortic aneurysms?
Cohort (n=6,383)
Yes
Do impaired pulmonary status and diabetes mellitus influence clinical outcomes and aortic neck dilatation following elective EVAR in patients with abdominal aortic aneurysms?
Neither impaired pulmonary status nor diabetes mellitus significantly influences the incidence of aortic neck dilatation or major clinical endpoints after elective EVAR.
May not warrant modified EVAR surveillance by pulmonary status or diabetes; leaves open confirmation in larger prospective cohorts.
PURPOSE: To elucidate the association of impaired pulmonary status (IPS) and diabetes mellitus (DM) with clinical outcome and the incidences of aortic neck dilatation and type I endoleak after elective endovascular infrarenal aortic aneurysm repair (EVAR). METHODS: In 164 European institutions participating in the EUROSTAR registry, 6383 patients (5985 men; mean age 72.4+/-7.6 years) underwent EVAR. Patients were divided into patients without versus with IPS or with/without DM. Clinical assessment and contrast-enhanced computed tomography (CT) were performed at 1, 3, 6, 12, 18, and 24 months and annually thereafter. Cumulative endpoint analysis comprised death, aortic rupture, type I endoleak, endovascular reintervention, and surgical conversion. RESULTS: Prevalence of IPS was 2733/6383 (43%) and prevalence of DM was 810/6383 (13%). Mean follow-up was 21.1+/-18.4 months. Thirty-day mortality, AAA rupture, and conversion rates did not differ between patients with versus without IPS and between patients with versus without DM. All-cause and AAA-related mortality, respectively, were significantly higher in patients with IPS compared to patients with normal pulmonary status (31.0% versus 19.0%, p<0.0001 and 6.8% versus 3.3%, p = 0.0057) throughout follow-up. In multivariate analysis adjusted for smoking, age, gender, comorbidities, fitness for open repair, co-existing common iliac aneurysm, neck and aneurysm size, arterial angulations, aneurysm classification, endograft oversizing >or=15%, and type of stent-graft, the presence of IPS was not associated with significantly higher rates of aortic neck dilatation (30.6% versus 38.0%, p>0.05) and did not influence cumulative rates of type I endoleak, endovascular reintervention, or conversion to open surgery (p>0.05). Similarly, the presence of DM did not influence the above-mentioned study endpoints. CONCLUSION: In contrast to observations regarding the natural course of AAAs, impaired pulmonary status does not negatively influence aortic neck dilatation, while the presence of diabetes does not protect from these dismal events after EVAR.
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Diehm et al. (2007) conducted a cohort in Abdominal Aortic Aneurysms (n=6,383). Impaired pulmonary status (IPS) and diabetes mellitus (DM) vs. Normal pulmonary status and absence of diabetes mellitus was evaluated on aortic neck dilatation (p=>0.05). Impaired pulmonary status and diabetes mellitus did not significantly influence the rates of aortic neck dilatation (30.6% vs 38.0% for IPS vs normal, p>0.05) after endovascular aneurysm repair.
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