The association between co-morbidity and mortality after abdominal aortic aneurysm endografting in patients ineligible for elective open surgery.

Abstract

To investigate whether co-morbidity affects mortality after endovascular stenting in patients who are fit and unfit for open surgery. Data were obtained from the EUROSTAR registry. The association between co-morbidity and mortality was examined by Cox proportional hazards models. Between 1994 and July 2000, 2862 patients underwent aneurysm stenting; 381 were unfit for open surgery. The early/late mortality rates for patients fit for surgery, patients unfit for surgery and patients unfit for anaesthesia were 2.7/5.2%, 5.1/11.4% (p=0.035/p<0.0001) and 3.7/11.0% (NS/p=0.016), respectively. The survival curves among patients with poor medical condition were significantly worse than in those patients with a good medical condition (p=0.001). The presence or absence of co-existing diseases did not affect the mortality rate in patients unfit for open surgery. The age-adjusted mortality risks of patients fit for open surgery and pulmonary disease or diabetes mellitus were 1.41 (1.02-1.95) and 1.75 (1.12-2.74), respectively. Patients with co-morbidity had a significantly higher mortality after aortic endografting compared with patients fit for open surgery. Co-morbidity did not increase mortality after endovascular abdominal repair in patients unfit for open surgery. Endovascular repair of abdominal aortic aneurysm seems to have a limited benefit in patients unfit for open surgery.