Patients With Chronic Obstructive Pulmonary Disease Have Shorter Survival but Superior Endovascular Outcomes After Endovascular Aneurysm Repair

Abstract

This study was conducted to determine the effect of pulmonary disease on outcomes after endovascular abdominal (EVAR) and thoracoabdominal (eTAAA) aneurysm repair. A prospective study of high-risk patients undergoing EVAR and eTAAA repair between 1998 and 2009 was used to contrast clinical and endovascular outcomes between chronic obstructive pulmonary disease (COPD; group 1) and non-COPD patients (group 2). COPD patients were classified in accordance with the severity of their pulmonary disease using the criteria. Survival, morphologic changes, and complications were assessed using Cox models and life-table analyses. The cause and timing of deaths between the groups was compared. A total of 905 patients were analyzed, of which 289 (32%) had COPD. EVAR was performed in 334 patients (37%), whereas fenestrated/branched devices were used in the remaining 571 (63%). Group 1 patients were younger (73.5 ± 6.7 vs 75.6 ± 8.2 years), had a better glomerular filtration rate (67.8 ± 25.8 vs 61.0 ± 23.3 mL/min/1.73 m2), had higher hematocrits (41.6 ± 5.0 vs 40.5 ± 4.6), and had more extensive aneurysms. Mean follow-up was 39.5 ± 30.9 months. Early (3% vs 3%) and late (2% vs 1%) aneurysm-related deaths were similar between the two groups. Survival in group 1 was lower than that in group 2 (P < .0001; Fig 1). Furthermore, survival in group 1 was dependent upon the severity of disease, with Global Initiative for Chronic Obstructive Lung Disease classification I and II similar to group 2, and classifications III and IV demonstrating lower survival rates (P < .0001; Fig 2). Relevant pulmonary function test variables included a lower forced expiratory volume in 1 second and forced expiratory flow 25%-75%, which were associated with decreased survival. Surrogate endovascular outcome analyses demonstrated that group 1 patients had fewer endoleaks (20% vs 25%, P = .05) and more rapid sac shrinkage rate (1.66 mm/y difference, P < .001). The perioperative risk of mortality between COPD and non-COPD patients is eliminated when endovascular techniques are used. Long-term survival in COPD patients is most strongly related to the severity of their disease, and forced expiratory volume in 1 second and forced expiratory flow 25%-75%, are reasonable indicators of poor long term outcomes. Morphologic changes following EVAR and eTAAA repair are more favorable in COPD patients, with a lower endoleak rate and faster sac shrinkage.