Outcome Appraisal of Abdominal Aortic Aneurysm Repair

Abstract

of the lower EVAR mortality. 3,4 Both aneurysm size and peri-operative mortality were higher among patients with GAS >82, as expected for complex AAAs and high risk patients, respectively. Despite the increased surgical risks in the latter group of patients, 8.4% of the male and 20.8% of the female patients underwent repair of small AAAs (<5.5 cm in size). The authors concluded that the variations in peri-operative mortality are partially explained by the regional differences in patient selection, and suggested that further audit is needed to assess the underlying reasons for the regional variation in case mix. How can these findings be reconciled? Firstly, the results should be interpreted with some caution as < 19% of the 31,427 intact AAA repairs in the Vascunet database were assessed, because the analysis was focused on the rate of small aneurysms (<5.5 cm) operated on in different regions, and the role of AAA maximum diameter on perioperative outcome. AAA size and other types of data were missing in the vast majority of patients, which raises a concern for a source of bias, as indicated in Table 6 of the article. 9 Secondly, the indication for AAA repair might vary between countries, with small AAAs being operated on more or less often if perceived to be “symptomatic”, having demonstrated a fast growth, or having presented as infected or inflammatory AAAs. The European Society for Vascular Surgery clinical practice guidelines on AAA man