Abdominal Aortic Aneurysm Death Research Articles

Clinical and financial impact of a machine learning powered screening program for abdominal aortic aneurysms

ObjectiveOur health system recently implemented a machine learning (ML)-enhanced abdominal aortic aneurysm (AAA) screening program to identify and screen high-risk individuals. This program, which uses clinical data to identify the top 150 high-risk patients monthly, increased the number of AAA screening ultrasound examinations and positive diagnoses. The aim of this study was to quantify the clinical and financial impacts of a ML-enhanced AAA screening program in terms of lives saved, costs incurred, payments received, and incremental cost-effectiveness ratio. MethodsWe compared 900 high-risk individuals identified from February to July 2023 (intervention cohort) with 900 individuals from February to July 2022 (comparison cohort), assessing screening rates, positive diagnoses, and outcomes using both internal electronic health record data and external research statistics for long-term estimates. ResultsThis analysis demonstrated a 590% increase in AAA screening within the intervention cohort and a 238% increase in positive AAA diagnoses. The program decreased expected AAA deaths by 36%, primarily by increasing elective surgeries and decreasing emergency repairs. Financial analysis revealed an increase in costs and payments, improving hospital net income and return on investment. The incremental cost-effectiveness ratio of $5222 per quality-adjusted life year) compares favorably with other well-accepted screening initiatives. ConclusionsOverall, an ML-enhanced AAA screening program improves clinical outcomes and financial performance, demonstrating cost effectiveness and feasibility. Future research will refine these estimates and explore similar ML-based risk stratification programs for other conditions.

Optimizing Surveillance and Re-intervention Strategy Following Elective Endovascular Repair of Abdominal Aortic Aneurysms.

EVAR for abdominal aortic aneurysm has an initial survival advantage over OR, but more frequent complications increase costs and long-term aneurysm-related mortality. Randomized controlled trials of EVAR versus OR have shown EVAR is not cost-effective over a patient's lifetime. However, in the EVAR-1 trial, postoperative surveillance may have been sub-optimal, as the importance of sac growth as a predictor of graft failure was overlooked. Real-world data informed a discrete event simulation model of postoperative outcomes following EVAR. Outcomes observed EVAR-1 were compared with those from 5 alternative postoperative surveillance and re-intervention strategies. Key events, quality-adjusted life years and costs were predicted. The impact of using complication and rupture rates from more recent devices, imaging and re-intervention methods was also explored. Compared with observed EVAR-1 outcomes, modeling full adherence to the EVAR-1 scan protocol reduced abdominal aortic aneurysm (AAA) deaths by 3% and increased elective re-interventions by 44%. European Society re-intervention guidelines provided the most clinically effective strategy, with an 8% reduction in AAA deaths, but a 52% increase in elective re-interventions. The cheapest and most cost-effective strategy used lifetime annual ultrasound in primary care with confirmatory computed tomography if necessary, and reduced AAA-related deaths by 5%. Using contemporary rates for complications and rupture did not alter these conclusions. All alternative strategies improved clinical benefits compared with the EVAR-1 trial. Further work is needed regarding the cost and accuracy of primary care ultrasound, and the potential impact of these strategies in the comparison with OR.

Retrospective review of abdominal aortic aneurysm deaths in New Zealand: what proportion of deaths is potentially preventable by a screening programme in the contemporary setting?

ObjectivesTo describe the proportions of people dying from abdominal aortic aneurysm (AAA) who might have benefited from a formal screening programme for AAA.DesignRetrospective cross-sectional review of deaths.Setting and study populationsAll...

Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings.

Population screening for abdominal aortic aneurysm (AAA) in 65‐year‐old men has been shown to be cost‐effective. A risk group with higher prevalence is siblings of patients with an AAA. This health economic model‐based study evaluated the potential cost‐effectiveness of targeted AAA screening of siblings. A Markov model validated against other screening programmes was used. Two methods of identifying siblings were analysed: direct questioning of patients with an AAA (method A), and employing a national multigeneration register (method B). The prevalence was based on observed ultrasound data on AAAs in siblings. Additional parameters were extracted from RCTs, vascular registers, literature and ongoing screening. The outcome was cost‐effectiveness, probability of cost‐effectiveness at different willingness‐to‐pay (WTP) thresholds, reduction in AAA death, quality‐adjusted life‐years (QALYs) gained and total costs on a national scale. Methods A and B were estimated to reduce mortality from AAA, at incremental cost‐effectiveness ratios of €7800 (95 per cent c.i. 4627 to 12 982) and €7666 (5000 to 13 373) per QALY respectively. The probability of cost‐effectiveness was 99 per cent at a WTP of €23 000. The absolute risk reduction in AAA deaths was five per 1000 invited. QALYs gained were 27 per 1000 invited. In a population of ten million, methods A and B were estimated to prevent 12 and 17 AAA deaths, among 2418 and 3572 siblings identified annually, at total costs of €499 500 and €728 700 respectively. The analysis indicates that aneurysm‐related mortality could be decreased cost‐effectively by applying a targeted screening method for siblings of patients with an AAA.

Population-Based Study of Incidence of Acute Abdominal Aortic Aneurysms With Projected Impact of Screening Strategy.

BackgroundCurrent abdominal aortic aneurysm (AAA) screening in men age 65 might have limited impact on overall AAA death rates if incidence is moving to older ages. Up-to-date population-based studies of age-specific incidence, risk factors, and outcome of acute AAA are needed to inform screening policy.Methods and ResultsIn a prospective, population-based study (Oxfordshire, UK, 2002–2014), the incidence and outcome of acute AAA events were determined. Based on population projections and current incidence trends, the impact of screening strategies in the UK was estimated. Over the 12-year period, 103 incident acute AAA events occurred in the study population of 92 728. Incidence/100 000/year was 55 in men ages 65 to 74 years, but increased to 112 at 75 to 85 and 298 at ≥85, with 66.0% of all events occurring at age ≥75 years. Incidence at ages 65 to 74 was highest in male smokers (274), with 96.4% of events in men <75 years occurring in ever-smokers. Extrapolating rates to the UK population, using trial evidence of screening efficacy, the current UK screening program would prevent 5.6% of aneurysm-related deaths (315 200 scans/year: 1426/death prevented, 121/year-of-life saved). Screening only male smokers age 65 and then all men at age 75 would prevent 21.1% of deaths (247 900 scans/year; 297/death prevented, 34/year-of-life saved). By 2030, 91.0% of deaths will occur at age ≥75, 61.6% at ≥85, and 28.6% in women.ConclusionsGiven that two thirds of acute AAA occurred at ≥75 years of age, screening older age groups should be considered. Screening nonsmokers at age 65 is likely to have very little impact on AAA event rates.

Shifting abdominal aortic aneurysm mortality trends in The Netherlands

Mortality from abdominal aortic aneurysm (AAA) in developed countries has decreased since the late 1990s. Our objective was to get an insight of mortality trends in The Netherlands for AAA disease. Data of all AAA deaths (1980 to 2010) were collected from the Dutch cause of death register. Cause of death was divided in two groups: with the mention of rupture and without the mention of rupture. Data were standardized and divided into three age groups (55-69, 70-84, and ≥85 years). Mortality rates per 100,000 were analyzed for both sexes and for each age group. Significant points of change were identified using joinpoint regression analysis. Total standardized AAA mortality increased from 1980 (1062 deaths) until 1995 (1728 deaths), followed by a decline until 2010 (930 deaths). This decline was most prominent in men. Deaths without mention of rupture showed an increase from 1980 until 2010. The age of AAA death was higher in women (79.2 in 1980 and 82.1 in 2010) than in men. This difference declined as the age of death from AAA increased from 72.1 in 1980 to 77.9 years in 2010 in men. Decline in AAA mortality was first seen in the young age group (55-69 years) and then seen consecutively older age groups. Mortality from AAA is declining due to a reduction in deaths from ruptured AAAs. This was first observed in the young age groups. Men died more often and at a lower age.

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.

Background It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation.Methods Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997–2010. Individuals were drawn from linked electronic health records in England, covering primary care, hospitalizations, myocardial infarction (MI) registry and cause-specific mortality (the CALIBER programme).Results During 11.6 million person-years of follow-up, 114 859 people had an initial non-fatal or fatal CVD presentation. By age 90 years, current vs never smokers’ lifetime risks varied from 0.4% vs 0.2% for subarachnoid haemorrhage (SAH), to 8.9% vs 2.6% for peripheral arterial disease (PAD). Current smoking showed no association with cardiac arrest or sudden cardiac death [hazard ratio (HR) = 1.04, 95% confidence interval (CI) 0.91–1.19).The strength of association differed markedly according to disease type: stable angina (HR = 1.08, 95% CI 1.01–1.15),transient ischaemic attack (HR = 1.41, 95% CI 1.28-1.55), unstable angina (HR = 1.54, 95% CI 1.38–1.72), intracerebral haemorrhage (HR = 1.61, 95% CI 1.37–1.89), heart failure (HR = 1.62, 95% CI 1.47–1.79), ischaemic stroke (HR = 1.90, 95% CI 1.72–2.10), MI (HR = 2.32, 95% CI 2.20–2.45), SAH (HR = 2.70, 95% CI 2.27–3.21), PAD (HR = 5.16, 95% CI 4.80–5.54) and abdominal aortic aneurysm (AAA) (HR = 5.18, 95% CI 4.61–5.82). Population-attributable fractions were lower for women than men for unheralded coronary death, ischaemic stroke, PAD and AAA. Ten years after quitting smoking, the risks of PAD, AAA (in men) and unheralded coronary death remained increased (HR = 1.36, 1.47 and 2.74, respectively).Conclusions The heterogeneous associations of smoking with different CVD presentations suggests different underlying mechanisms and have important implications for research, clinical screening and risk prediction.

Metabolomic study of plasma of patients with abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is an important health problem, both because of AAA rupture and death and because of increased cardiovascular mortality. Identification of new biomarkers of AAA may suggest novel pathological mechanisms and targets for new medical treatments to slow AAA progression. Metabolic changes in AAA patients were mainly related to carbohydrate and lipid metabolism and many of these changes can be associated with a situation of insulin resistance (which can be related to metabolic syndrome) together with altered amino acid metabolism. For the first time, metabolites that can be associated with differential metabolism by the gut microflora of AAA patients have also been found. Moreover, aminomalonic acid in plasma has been shown to be the metabolite with the biggest difference between patients suffering from large aneurysm (>5 cm) and controls.

Changing Epidemiology of Abdominal Aortic Aneurysms in England and Wales

Background— Recent studies from Australia, New Zealand, and Sweden have reported declines in abdominal aortic aneurysm (AAA) incidence, prevalence, and mortality. This finding may have important implications for screening programs. This study determined trends in AAA incidence and mortality in England and Wales. Methods and Results— Cause-specific mortality data for England and Wales were obtained from UK Office for National Statistics, and hospital admissions and procedures data for England were obtained from Hospital Episode Statistics from 2001 to 2009. Poisson regression models were constructed to estimate the relative change over time. Age-standardized rates for AAA mortality in England and Wales fell significantly by 35.7% from 2001 to 2009, which was largely due to a 35.3% drop in age-standardized ruptured AAA deaths. During the same period, ruptured AAA admissions and emergency AAA repairs in England declined by 29.3% and 35.5%, respectively. In contrast, nonruptured AAA admissions remained static, and nonemergency AAA repairs increased by 17.2%. The average ages for hospital admissions for nonruptured AAAs and ruptured AAAs increased by 0.19 years of age per annum ( P &lt;0.001) and 0.09 years of age per annum ( P &lt;0.001), respectively. Nonruptured AAA admissions increased by 21.4% in age band 75 years or more but declined by 11.7% in ages &lt;75 years. Conclusions— AAA mortality, ruptured AAA admission, and emergency AAA repair have declined in England and Wales. However, nonruptured AAA admission has remained steady, with an increasing rate in older population offsetting a decreasing rate in younger population. This suggests a shift in AAA presentation to the older population. Present screening strategies may need reassessment to include consideration for increasing the age at which to screen men for AAAs.

An analysis of drug modulation of abdominal aortic aneurysm growth through 25 years of surveillance

A modest (41%) reduction in abdominal aortic aneurysm (AAA) growth rate is likely to delay AAA-related events (surgery or rupture) by 5 years, making the notion of AAA medical treatment very appealing. Randomized controlled trials of commonly used existing medications are expensive and ethically questionable. This study reviewed the independent associations of commonly used medications and AAA growth during a 25-year period of AAA surveillance. The study included all patients monitored through an AAA screening and surveillance program. Records of AAA size, risk factors, outcomes, death, and medications were entered into a continually updated database. AAA growth rates were calculated using a flexible hierarchical model. A multivariate model was used to test for associations independent of confounders. The study comprised 1269 patients (94.1% men) who had a mean age of 67 years. The median starting diameter was 35 mm, the end diameter was 44 mm, and follow-up was 3.4 years. Drugs used in the treatment of diabetes were associated with a 56% reduction in AAA growth rate (P = .01) independent of confounding factors, including other therapeutic agents (P = .003). Angiotensin-receptor blockers and potassium-sparing diuretics were also associated with slower AAA growth rates, although these effects were not independent of all confounders. Diabetes or its medications, or both, have a negative effect on AAA growth. Because of polypharmacy, demonstrating the independent effects of individual drugs affecting the renin-angiotensin system was not possible. In light of this analysis, however, strong associations between angiotensin-receptor blockers and aldosterone-receptor blockers and slowed AAA progression are credible.

Trends in hospital abdominal aortic aneurysm deaths in Scotland over 10 years, 1996–2005

Trends in hospital abdominal aortic aneurysm deaths in Scotland over 10 years, 1996–2005

Preliminary Ten Year Results from a Randomised Single Centre Mass Screening Trial for Abdominal Aortic Aneurysm

At present, several regions and countries are considering screening for abdominal aortic aneurysm (AAA). However, The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA. We therefore supplement previously published data with a preliminary analysis of the ten-year mortality from AAA, based upon population-based data until 2002 (7 years) and incomplete hospital-based information on deaths until 2005 (10 years). In 1994 we started a randomised screening trial of 12,639 64-73 year-old males; 6,306 were controls, and 6,333 were invited to an abdominal ultrasound scan at their district hospital. Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration. Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31.12.2001, and supplemented with AAA deaths known to the Danish National Patient Registry until 15.3.2005. Operations were obtained from the Danish National Vascular Registry from 1.4.1994 to 15.3.2005. Death certificates and medical records were reviewed by two independent assessors. The analyses were based on "intention to treat" from the date of randomisation. The attendance rate was 76.6% and 191 (4.0%) had an AAA. The median observation time was 9.58 years. In the invited group 13 subjects were acutely operated on compared to 40 in the control group (Risk ratio: 0.32 (95% C.I. 0.17-0.60, P<0.001)), and 14 died due to AAA compared to 51 in the control group (Hazard ratio: 0.27 (95% C.I.: 0.15-0.49, P<0.001). Over ten years, screening reduced mortality from AAA by 73%, and the frequency of emergency operations by 68%.

Intrinsic eNOS dysfunction causes vascular remodeling and abdominal aortic aneurysm

We recently showed that angiotensin II uncouples eNOS via NAD(P)H oxidase-dependent production of hydrogen peroxide, resulting in accumulation of reactive oxygen species (PNAS, 2005). We sought to determine whether intrinsic eNOS dysfunction affects vascular function when challenged with angiotensin II. Mice deficient in GTP cyclohydrolase I (HPH-1) have reduced tetrahydrobiopterin levels and markedly increased aortic superoxide production. The latter was abolished by L-NAME, implicating uncoupling of eNOS. Aortic hydrogen peroxide production was also increased in HPH-1 mice. WT (n=15) and HPH-1 mice (n=12) were infused with angiotensin II (100 nmol/L) for 14 days. Mean blood pressure (MBP) was increased in both genotypes (WT: from 119±1 to 164±7; HPH-1: from 117±1 to 160±3 mmHg) till day 10. MBP however started to drop since day 11 in HPH-1 mice to 138±9 whereas in WT it continued to go up to 179±4 mmHg on day 14. 21% of HPH-1 mice, both males and females, started to die suddenly. Immediate dissection and H&E staining revealed severe abdominal aortic aneurysm (AAA). None of the WT mice had AAA or sudden death during the 14-day of angiotensin II infusion. Furthermore, zymography assay indicated that HPH-1 mice had much higher aortic metalloproteinase 2 (MMP-2) activities in response to angiotensin II, suggesting that hydrogen peroxide-dependent pre-activation of MMPs may underlie accelerated matrix degradation. These data for the first time demonstrated that intrinsic eNOS dysfunction can cause vascular remodeling, resulting in lethal aneurysm. This work is supported by American Heart Association and American Diabetes Association Grants 0435189N and 7-04-RA-16, and NIH Grants HL077440 and HL081571 (all to H Cai).

Selective management of abdominal aortic aneurysms smaller than 5.0 cm in a prospective sizing program with gender-specific analysis.

We present extended follow-up findings of the Kingston prospective sizing program for patients with abdominal aortic aneurysm (AAA) smaller than 5.0 cm in diameter, with gender-specific analysis. From 1976 to 2001, 895 patients (688 men, 207 women) with AAA smaller than 5.0 cm were entered, regardless of fitness, in a prospective sizing program in which computed tomography scans were obtained every 6 months. Operations were performed in fit patients with an increase in AAA size to 5 cm (n = 190), AAA expansion greater than 0.5 cm in 6 months (n = 27), or for other reasons (n = 33). Follow-up continued until AAA rupture, surgery, death, or removal from the program. No AAA smaller than 5.0 cm ruptured during prospective follow-up. There was a statistically significant increase in expansion rate relative to size at entry, with the highest mean expansion rate of 0.52 cm/y for AAA 4.5 to 4.9 cm in diameter. There was no significant difference in AAA expansion rate between men and women. The frequency of surgery was inversely related to age at entry, but was positively related to AAA size at entry, with patients with AAA 4.5 to 4.9 cm at entry 6.8 times more likely (95% confidence interval, 4.3-10.7) to undergo surgery than those with AAA 3.0 to 3.4 cm at entry. Women were older than men at entry, and age at entry in those undergoing surgery was significantly greater in women. The study confirms the results of the United Kingdom Small Aneurysm Trial and the Aneurysm Detection and Management Study, that is, that risk for rupture is extremely unlikely with AAA smaller than 5.0 cm, which enables safe follow-up surveillance programs in both men and women with AAA smaller than 5.0 cm.

What are the 1-year mortality rates for carotid endarterectomy (CEA) and abdominal aortic aneurysm (AAA) repair?

Introduction: Most quality of care studies that have analyzed administrative databases have only been able to examine inpatient mortality—which may be a limitation for procedures whose inpatient mortality rates are low. In response, some researchers have examined longer term mortality outcomes (e.g. 30-day), but the available databases only pertain to non-representative segments of the population (i.e. Medicare patients, or Veterans), or cancer registries. In this study, we use a newly developed database to examine the 1-year mortality rates for two vascular surgery procedures. Importantly, the data is population-based, and therefore generalizable. Methods: The OSHPD database (1995–1999), which reports all California inpatient discharges, was linked to the State Death File in order to study mortality outcomes beyond hospital discharge. CEA and AAA procedures were identified by ICD-9 codes and the rates of inpatient and 1-year mortality were assessed. Analyses were performed for each procedure, as well as for elective and emergent cases. Results: For all CEA procedures (n = 44601), the inpatient and 1-year mortality rates were 0.8% and 5.8%, respectively. For emergent cases, the inpatient and 1-year mortality rates were 1.57% and 9.19% (which represents a 5.8-fold increase), while that for elective cases were 0.5% and 5.4% (a 9.7-fold increase). Finally, the CEA inpatient mortality rate for all patients accounts for only 14% of all CEA deaths at 1 year. For all AAA procedures, (n = 16114), the inpatient and 1-year mortality rates were 12.8% and 18.8%. The inpatient and 1-year mortality rates for emergent cases were 28% and 37.1% (a 1.3-fold increase), while for elective cases, they were 4.5% and 9.7%, respectively (a 2.15-fold increase). Contrary to CEA procedures, the AAA inpatient mortality rate for all-comers accounts for 68% of the AAA deaths at 1 year. Conclusions: Our study uses a novel database linkage and reports inpatient and 1-year mortality rates for two common vascular surgical procedures (i.e. CEA and AAA). This analysis provides meaningful data because of the ability to examine outcomes beyond hospital discharge. Future studies will examine the longer-term mortality rates of other common surgical procedures.

Risk Stratification and Outcomes of Transluminal Endografting for Abdominal Aortic Aneurysm: 7-Year Experience and Long-term Follow-up

To determine early and late outcomes of transluminal endografting (TE) in patients with abdominal aortic aneurysm (AAA), stratified by predicted risk of procedure-related mortality with conventional operation. A retrospective study was conducted in consecutive risk-stratified AAA patients undergoing TE at a not-for-profit cardiovascular referral center from March 1994 through November 2000 with follow-up through February 2001. With use of conventional risk strata (0 = low, 1 = minimal, 2 = moderate, and 3 = high), predicted procedure-related mortalities were 0%-1% in stratum 0 (n = 40), 1%-3% in stratum 1 (n = 118), 3%-8% in stratum 2 (n = 116), and 8%-30% in stratum 3 (n = 31). Main outcome measures were: (i) TE procedural success, (ii) procedure-related mortality, (iii) major nonfatal complications, (iv) composite adverse outcome (ii + iii), (v) length of stay (LOS), (vi) freedom from AAA rupture, (vii) late survival, (viii) late complications, and (ix) endoleaks and their classification and management. Women were significantly less likely than men to qualify for and undergo endografting: 24 of 91 (26.4%) women underwent TE, compared to 281 of 684 (41.1%) men. Of 305 attempted TE procedures, 291 (95.4%) were successful, four (1.3%) were urgently converted to open repair, and 10 (3.3%) were aborted. Procedure-related mortalities occurred in eight cases (2.6%) overall and one of 40 (2.5%), one of 118 (0.8%), four of 116 (3.4%), and two of 31 (6.5%) cases for risk strata 0-3, respectively. Perioperative survivors were significantly younger than nonsurvivors (74.3 y +/- 9 vs 81.6 y +/- 5.1; P =.0087). Forty-six patients (15.1%) had major complications. Composite adverse outcome was worse for patients in stratum 3 than those in stratum 1 (P =.0296) and those in strata 0, 1, and 2 combined (P =.026). Procedure-related mortality declined with institutional experience, from 4% among the first 100 patients undergoing TE to 1% among the last 105. For strata 0-3, median LOS were 2, 3, 3, and 4 days, respectively. Seventy patients (22.9%) had 75 endoleaks, of which 30 necessitated additional procedures, 17 self-resolved, and 22 were untreated as of March 1, 2001. Five patients with endoleak died of unrelated causes. One late-onset type IA endoleak (26 mo) resulted in the only AAA rupture and death in the follow-up period among the 291 patients who underwent successful transluminal endograft implantation. Actuarial survival rates at 1 year after TE were 90.3% +/- 1.9% for the overall study group and 97.5% +/- 2.5%, 94% +/- 2.5%, 86.9% +/- 3.3%, and 81.3% +/- 7.7% for risk strata 0-3, respectively. At 5 years, overall actuarial survival was 69.6% +/- 6.1%. Thirty-eight late deaths were attributable to post-TE AAA rupture (n = 1), AAA rupture late after failed TE with no further treatment (n = 1), other cardiovascular disorders (n = 7), cancer (n = 15), other causes (n = 10), and unknown causes (n = 4). Late deaths occurred in risk strata 0-3 at the following rates: two of 40 (5%), 10 of 118 (8.5%), 16 of 116 (13.8%), and 10 of 31 (32.3%), respectively (stratum 0 vs stratum 3, P =.0017; stratum 1 vs stratum 3, P =.003). TE is safe and confers durable protection against AAA rupture in treated populations. Still, protection is not absolute in patients with endoleaks, because late AAA enlargement and even rupture can occur. Given current knowledge, technology, and practice, careful patient selection and close surveillance of patients after implantation of transluminal endografts is essential.

Nonresective therapy for aortic aneurysm: Results of a survey

We reviewed the experience of 120 vascular surgeons with nonresective therapy for abdominal aortic aneurysm (AAA) in medically unstable patients. Of a total pool of 206 patients, 88 underwent iliac artery ligation, which was combined with angiographic attempts at intrasaccular thrombosis in 80% of cases. The remaining 118 patients had ligation of the aneurysm proximally and distally. In all cases distal perfusion was restored, usually by axillofemoral bypass. Our study demonstrated a significantly higher risk of postoperative AAA rupture (20% vs. 3.3%, p < 0.0001) and death (34% vs. 5.1%, p < 0.000001) among patients treated by ligation distal to the AAA alone, whether intrasaccular thrombosis occurred or not. These results support the contention that if nonresective therapy is chosen for the occasional patient deemed too ill to undergo standard AAA resection, AAA exclusion by proximal and distal ligation should be performed.

Nonresective therapy for aortic aneurysm: results of a survey.

We reviewed the experience of 120 vascular surgeons with nonresective therapy for abdominal aortic aneurysm (AAA) in medically unstable patients. Of a total pool of 206 patients, 88 underwent iliac artery ligation, which was combined with angiographic attempts at intrasaccular thrombosis in 80% of cases. The remaining 118 patients had ligation of the aneurysm proximally and distally. In all cases distal perfusion was restored, usually by axillofemoral bypass. Our study demonstrated a significantly higher risk of postoperative AAA rupture (20% vs. 3.3%, p less than 0.0001) and death (34% vs. 5.1%, p less than 0.000001) among patients treated by ligation distal to the AAA alone, whether intrasaccular thrombosis occurred or not. These results support the contention that if nonresective therapy is chosen for the occasional patient deemed too ill to undergo standard AAA resection, AAA exclusion by proximal and distal ligation should be performed.