Predictors of Five-Year Survival after EVAR: 10-Year Experience of Single-Center Cohort Study

Abstract

Endovascular abdominal aortic repair (EVAR) is the main therapeutic option for repairing abdominal aortic aneurysms (AAA). We aimed to determine the long-term outcomes of patients who underwent EVAR at our center. In this retrospective cohort study, patients who underwent EVAR for intact isolated AAA at Tehran Heart Center between 2007 and 2017 were included. Clinical outcomes and frequency of mortality were analyzed for follow-up periods. We calculated the five-year survival rate and its predictors for our patients using Kaplan-Meier estimation. We included the data of all patients (154 patients, mean age = 70.7 [±8.0] years, 96.1% men) who successfully underwent EVAR at our center. The most common risk factors were coronary artery disease (70.1%), hypertension (68.2%), smoking (64.9%), and dyslipidemia (39.6%). There was no mortality during the procedure. The median follow-up was 65.5 months. An average decrease of 9.07 mm (95% CI: 6.9-11.2) occurred in the size of the AAA. During follow-up, 12 patients developed some complications, 49 died, and seven did not complete the follow-up. The 5-year survival was 75% (3.9%). The independent predictors for five-year survival were age (HR=1.06, P=0.002) and anemia (HR=1.91, P=0.029). Despite not being statically significant, dyslipidemia (HR=0.573, P=0.078) and long ICU/CCU stay (HR=1.08, P=0.070) were borderline mortality predictors. This study depicted an acceptable survival rate for patients who underwent EVAR at our center. age and anemia, two modifiable predictors of five-year survival, can probably prolong the survival rate of patients, which requires evaluation later.