Key result
Elective aneurysm repair was performed in half of referred AAA patients with a 5-year mortality of 23.7%, while most patients with AAA >5.5 cm not undergoing elective repair died of rupture.
Why the study?
What are the long-term mortality outcomes and causes of death for patients referred for abdominal aortic aneurysm based on their management strategy?
Cohort (n=194)
What are the long-term mortality outcomes and causes of death for patients referred for abdominal aortic aneurysm based on their management strategy?
Elective repair of abdominal aortic aneurysms is associated with lower long-term mortality, whereas patients with large aneurysms who do not undergo surgery face a very high risk of death from rupture.
Elective repair linked to lower mortality in referred AAA; leaves open whether broader access or thresholds would reduce rupture deaths in real-world cohorts.
BACKGROUND: The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture, without exposing other cases to major surgery. The purpose here was to analyse retrospectively the management of AAA in a well-defined geographical region in the 1990's. METHODS: 194 new vascular surgical outpatient consultations due to AAA were done to the regional vascular centre during the years 1990, 1992, 1994, 1996 and 1998. Data were collected from case records. Statistics Finland provided causes and dates of death. RESULTS: The mean observed annual AAA incidence was 9.0 per 100 000 inhabitants and it rose significantly (33.3%) during the study period. The duration of follow-up varied between 0 and 129 months. The 5/8-year cumulative mortality was 37.3/50.7%. The most common causes of death were AAA-related (31.7%), cardiac (29.1%) or malignancy (19.0%). Twenty-five patients with small AAA were referred to primary health care sector for further follow-up. There were no RAAA (ruptured AAA) deaths in this group. The cumulative 5/8-year mortality was 43.2/49.9%. One hundred patients underwent an elective aneurysm repair with in-hospital mortality of 7.0%. The cumulative 5/8-year mortality was 23.7/35.4%. Twelve patients refused elective treatment. The cumulative 5/8-year mortality was 45.1/ 63.4% and 5/7 deaths were due to RAAA. Twenty-three patients were unfit for elective repair. The cumulative 5/8-year mortality was 87.0%/100% and 5/20 deaths were caused by RAAA. The cumulative 5/8-year RAAA-rate in the patients with AAA more than 5.0 cm in diameter and outside elective aneurysm-repair (n = 23) was 51.9%/100.0%. CONCLUSION: The observed incidence of AAA increased during the 1990's. Half of the patients underwent an elective procedure. Patients unfit for surgery died mainly for other reasons than RAAA. Most patients with AAA over 5.5 cm not subjected to elective procedure, died of rupture.
No takes yet. Share an insight, caveat, or question.
Heikkinen et al. (2002) conducted a cohort in Abdominal aortic aneurysms (AAA) (n=194). Elective aneurysm repair vs. No elective repair (small AAA, unfit, or refused) was evaluated on 5-year cumulative mortality. Elective aneurysm repair was performed in half of referred AAA patients with a 5-year mortality of 23.7%, while most patients with AAA >5.5 cm not undergoing elective repair died of rupture.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: