The fate of patients with large abdominal aortic aneurysms referred for consideration for elective repair.

The Journal of Cardiovascular Surgery
Claire DawkinsReza Mofidi

Abstract

The premise of the Vascular Services Quality Improvement Programme (VSQIP) in management of patients with asymptomatic large abdominal aortic aneurysms (AAA) is reducing mortality from ruptured AAA in a sustainable way without introducing excessive procedure related mortality. Inevitably a proportion of patients are deemed unfit for elective repair. The aim of this study was to report outcomes of patients who were referred with large asymptomatic AAAs including those turned down for elective repair and identify independent risk factors for being turned down for elective open or endovascular repair of AAA. Consecutive patients referred to a regional vascular center with a large AAA (greater than 55 mm) between 1st January 2008 and 31st March 2018 were included. All patients underwent the nationally agreed VSQIP pathway which included preoperative cardio-pulmonary exercise testing and contrast enhanced CT scan of aorta. The decision to repair and the modality of repair were made through a Multi-Disciplinary Team MDT process on each patient. Patients were classified into two groups; those managed non-operatively and those offered elective repair. Survival was assessed using Kaplan-Meier analysis. Factors associated with non-operat...Continue Reading

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