39.05 AAA Size is Associated with Long-term Survival After EVAR

Posted on January 25, 2017

S. Tsai1,2, H. Jeon-Slaughter3, H. Krishnamoorthi1, D. Timaran1,2, A. Wall2, S. Banerjee3,4, C. H. Timaran1,2, J. G. Modrall1,2  1University Of Texas Southwestern Medical Center,Vascular Surgery,Dallas, TX, USA 2Dallas Veterans Affairs Medical Center,Vascular Surgery,Dallas, TX, USA 3Dallas Veterans Affairs Medical Center,Cardiology,Dallas, TX, USA 4University Of Texas Southwestern Medical Center,Cardiology,Dallas, TX, USA

Introduction:  The long-term durability of EVAR has been demonstrated previously, but few studies have investigated risk factors for long-term survival after EVAR.  The purpose of this study was to identify factors associated with late mortality after elective EVAR.

Methods:  Retrospective data were collected from 288 consecutive patients who underwent elective EVAR at a single institution between January 2003 and December 2012.  The primary end-point was death within 10 years from EVAR.  Abdominal aortic aneurysm (AAA) size and age variables were dichotomized, and optimal cut-off points (AAA size ≥ 56mm and age ≥ 70) were determined using Receiver Operating Characteristics (ROC) curves.  A Cox proportional hazard model was used to conduct time to event analysis.

Results: The mean age of patients was 69.4±8.7 years, and 99% were male.  Mean follow-up was 49.3 ± 29.1 months.  In total, 133 patients (46%) died during follow-up.  Thirty day mortality was 1.3% (2/159) in the patients with AAA < 56mm and 2.3% (3/129) in patients with AAA ≥ 56mm (p=0.48).  All-cause mortality was not significantly affected by hypertension, hyperlipidemia, coronary artery disease, smoking status, or estimated GFR.  However, AAA size ≥ 56mm was associated with significantly increased 10-year mortality (Hazard ratio (HR) 1.63, 95% Confidence Interval (CI) 1.16-2.29, p=0.005).  In an adjusted Cox model (Figure) with covariates of age ≥70 and COPD, AAA size ≥ 56mm still increased mortality risk (HR 1.48, 95% CI 1.04-2.10, p=0.027). Both age ≥70 (HR 2.16, 95% CI 1.52-3.09, p<0.0001) and presence of COPD (HR 1.51, 95% CI 1.05-2.17, p=0.026) were also significantly associated with increased 10-year mortality rate.

 

Conclusion: Despite elective AAA repair, larger AAA size is associated with increased 10-year all-cause mortality after EVAR.