Show simple item record

dc.contributor.authorDe Martino, Randall R.
dc.contributor.authorBrooke, Benjamin S.
dc.contributor.authorRobinson, William P. III
dc.contributor.authorSchanzer, Andres
dc.contributor.authorIndes, Jeffrey E.
dc.contributor.authorWallaert, Jessica B.
dc.contributor.authorNolan, Brian W.
dc.contributor.authorCronenwett, Jack L.
dc.contributor.authorGoodney, Philip P.
dc.date2022-08-11T08:10:58.000
dc.date.accessioned2022-08-23T17:26:44Z
dc.date.available2022-08-23T17:26:44Z
dc.date.issued2013-09-01
dc.date.submitted2014-02-12
dc.identifier.citation<p>De Martino RR, Brooke BS, Robinson W, Schanzer A, Indes JE, Wallaert JB, Nolan BW, Cronenwett JL, Goodney PP. Designation as "unfit for open repair" is associated with poor outcomes after endovascular aortic aneurysm repair. Circ Cardiovasc Qual Outcomes. 2013 Sep 1;6(5):575-81. doi: 10.1161/CIRCOUTCOMES.113.000095. <a href="http://dx.doi.org/10.1161/CIRCOUTCOMES.113.000095" target="_blank">Link to article on publisher's site</a></p>
dc.identifier.issn1941-7713 (Linking)
dc.identifier.doi10.1161/CIRCOUTCOMES.113.000095
dc.identifier.pmid24046399
dc.identifier.urihttp://hdl.handle.net/20.500.14038/49705
dc.description.abstractBACKGROUND: Endovascular aortic aneurysm repair (EVAR) is often offered to patients with abdominal aortic aneurysms (AAAs) considered preoperatively to be unfit for open AAA repair (oAAA). This study describes the short- and long-term outcomes of patients undergoing EVAR with AAAs <6.5 cm who are considered unfit for oAAA. METHODS AND RESULTS: We analyzed elective EVARs for AAAs <6.5 cm diameter in the Vascular Study Group of New England (2003-2011). Patients were designated as fit or unfit for oAAA by the treating surgeon. End points included in-hospital major adverse events and long-term mortality. We identified patient characteristics associated with being unfit for open repair and predictors of survival using multivariable analyses. Of 1653 EVARs, 309 (18.7%) patients were deemed unfit for oAAA. These patients were more likely to have advanced age, cardiac disease, chronic obstructive pulmonary disease, and larger aneurysms at the time of repair (54 versus 56 mm, P=0.001). Patients unfit for oAAA had higher rates of cardiac (7.8% versus 3.1%, P<0.01) and pulmonary (3.6 versus 1.6, P<0.01) complications and worse survival rates at 5 years (61% versus 80%; log rank P<0.01) compared with those deemed fit for oAAA. Finally, patients designated as unfit for oAAA had worse survival, even adjusting for patient characteristics and aneurysm size (hazard ratio, 1.6; 95% confidence interval, 1.2-2.2; P<0.01). CONCLUSIONS: In patients with AAAs <6.5 cm, designation by the operating surgeon as unfit for oAAA provides insight into both short- and long-term efficacy of EVAR. Patients unable to tolerate oAAA may not benefit from EVAR unless their risk of AAA rupture is very high.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=24046399&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1161/CIRCOUTCOMES.113.000095
dc.subjectaneurysm
dc.subjectcomplications
dc.subjectmortality
dc.subjectCardiovascular Diseases
dc.subjectSurgery
dc.titleDesignation as "unfit for open repair" is associated with poor outcomes after endovascular aortic aneurysm repair
dc.typeJournal Article
dc.source.journaltitleCirculation. Cardiovascular quality and outcomes
dc.source.volume6
dc.source.issue5
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/surgery_pp/132
dc.identifier.contextkey5111949
html.description.abstract<p>BACKGROUND: Endovascular aortic aneurysm repair (EVAR) is often offered to patients with abdominal aortic aneurysms (AAAs) considered preoperatively to be unfit for open AAA repair (oAAA). This study describes the short- and long-term outcomes of patients undergoing EVAR with AAAs <6.5 cm who are considered unfit for oAAA.</p> <p>METHODS AND RESULTS: We analyzed elective EVARs for AAAs <6.5 cm diameter in the Vascular Study Group of New England (2003-2011). Patients were designated as fit or unfit for oAAA by the treating surgeon. End points included in-hospital major adverse events and long-term mortality. We identified patient characteristics associated with being unfit for open repair and predictors of survival using multivariable analyses. Of 1653 EVARs, 309 (18.7%) patients were deemed unfit for oAAA. These patients were more likely to have advanced age, cardiac disease, chronic obstructive pulmonary disease, and larger aneurysms at the time of repair (54 versus 56 mm, P=0.001). Patients unfit for oAAA had higher rates of cardiac (7.8% versus 3.1%, P<0.01) and pulmonary (3.6 versus 1.6, P<0.01) complications and worse survival rates at 5 years (61% versus 80%; log rank P<0.01) compared with those deemed fit for oAAA. Finally, patients designated as unfit for oAAA had worse survival, even adjusting for patient characteristics and aneurysm size (hazard ratio, 1.6; 95% confidence interval, 1.2-2.2; P<0.01).</p> <p>CONCLUSIONS: In patients with AAAs <6.5 cm, designation by the operating surgeon as unfit for oAAA provides insight into both short- and long-term efficacy of EVAR. Patients unable to tolerate oAAA may not benefit from EVAR unless their risk of AAA rupture is very high.</p>
dc.identifier.submissionpathsurgery_pp/132
dc.contributor.departmentDepartment of Surgery
dc.source.pages575-81


This item appears in the following Collection(s)

Show simple item record