In-Hospital Outcomes of Patients with Thoracic and Abdominal Aortic Aneurysm Who Underwent Surgical, Endovascular and Conservative Medical Management

Abstract

Background: Aortic aneurysm is a life-threatening condition related to its catastrophic complications of rupture and dissection that warrants consideration of early surgical repair. The decision to intervene for aortic disease remains a challenging decision because of the concomitant high-risk factors and comorbid illnesses as well as increased morbidity and mortality related to it. Methods: We performed a retrospective cohort study that included 275 patients with thoracic and abdominal aortic aneurysms with indication/s for intervention seen at January 2012 to December 2015. The population was divided into three groups, namely, surgical, endovascular or hybrid and medical management groups, respectively. Outcome measured included in-hospital mortality, cardiovascular, cerebrovascular, pulmonary and renal complications, embolic events and infection. Results: Seventy-six percent of the patients underwent surgical repair, 16% underwent endovascular or hybrid strategy and 8% received conservative medical management. The overall mortality rate was 16.36%, with a significant higher in-hospital mortality in the medical group (p=0.001). Infection rate was highest in the surgical group (54.07%, p=0.001). The rates of cardiovascular events (p=0.069), neurologic complications (p=0.094), renal failure (p=0.082), respiratory failure (p=0.908), and embolic events (p=0.381) were similar between the groups. Multivariate logistic regression analysis for in-hospital mortality showed that strategies of endovascular repair were not associated with significant survival benefit (adjusted OR 0.987; 95% CI 0.22 – 4.44; p=0.986). Conclusion: Prompt evaluation for early aortic aneurysm intervention either by open surgery or endovascular procedure is needed because of high mortality related to medical management of large aortic aneurysms. A strategy of endovascular and/or hybrid repair was not associated with significant reduction in in-hospital mortality when compared to open surgery, but evaluation of intermediate and long-term outcomes is warranted. The use of endovascular or hybrid technique can be considered a feasible alternative to surgical repair especially in high-risk patients. Keywords: open surgical repair, endovascular, medical management, thoracic aortic aneurysm, abdominal aortic aneurysm, 30-day mortality.