FT12. Higher 30-Day Mortality in Patients With Familial Abdominal Aortic Aneurysm After EVAR

Abstract

The aim of this study was to determine the influence of a positive family history for aneurysms on the clinical success and mortality after endovascular aneurysm repair (EVAR). From 2009 to 2011, 1262 patients with abdominal aortic aneurysms (AAAs) treated with EVAR were enrolled in a prospective, industry-sponsored clinical registry. Patients were classified into familial and sporadic AAA patients according to baseline clinical reports. Clinical characteristics, aneurysm morphology, and follow-up were registered. The primary end point was long-term clinical success after EVAR, a composite of technical success and freedom from the following complications: AAA increase >5 mm, endoleak type I to III, rupture, conversion, secondary procedures, migration, and occlusion. Secondary end points were the individual components of clinical success, 30-day mortality, and long-term aneurysm-related and all-cause mortality. Of the 1262 AAA patients (89.5% male; mean age, 73.1 years), 86 patients (6.8%) reported a positive family history and were classified as familial AAA. Duration of follow-up was 4.4 ± 1.7 years. Patients with familial AAA were more often female (18.6% vs 9.9%; P = .012). No difference in aneurysm morphology was observed. There was no significant difference in clinical success between patients with familial and sporadic AAA (72.1% vs 79.3%; P = .116, Table). Familial AAA patients had a higher 30-day mortality after EVAR (4.7% vs 1.0%; adjusted hazard ratio [HR], 5.7 [1.8-17.9]; P = .003) as well as long-term aneurysm-related mortality (5.8% vs 1.3%; adjusted HR, 5.4 [1.9-14.9]; P = .001, Fig 1), while no difference in long-term all-cause mortality was observed (19.8% vs 24.3%; adjusted HR, 0.8 [0.5-1.4]; P = .501). The current study shows a higher 30-day mortality after EVAR in familial AAA patients. Future studies should determine the role of family history in both the suitability for EVAR as well as the need for adaptation of postoperative surveillance. For the time being, patients with familial forms of AAA should be considered at higher risk for EVAR and warrant extra vigilance.TableClinical success through 4 years of follow-upVariableaFamilial AAA (n = 86)Sporadic AAA (n = 1144)P valueClinical success72.1 (62/86)79.3 (907/1144).116Technical success98.8 (85/86)99.0 (1133/1144).855AAA increase >5 mm15.7 (23/83)10.4 (115/1106).136Endoleak type I and III2.4 (2/85)1.8 (20/1126).701Aneurysm rupture1.2 (1/86)0.9 (10/1144).784Conversion1.2 (1/86)1.0 (12/1144).921Secondary procedures16.3 (14/86)10.9 (25/1144).131Migration1.2 (1/85)0.4 (4/1126).255Occlusion8.2 (7/85)3.8 (43/1126).048AAA, Abdominal aortic aneurysm.aData are shown as percentage, and the number of patients available for analysis is presented between parenthesis. Open table in a new tab