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Tsolakis IA, Kakkos SK, Papageorgopoulou CP, Papadoulas S, Lampropoulos G, Fligou F, Nikolakopoulos KM, Ntouvas I, Kouri A. Predictors of Operative Mortality of 928 Intact Aortoiliac Aneurysms. Ann Vasc Surg 2020; 71:370-380. [PMID: 32890639 DOI: 10.1016/j.avsg.2020.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study is to identify preoperative and intraoperative factors associated with in-hospital mortality of intact abdominal aortoiliac aneurysm repair. METHODS In this observational study, prospectively collected information included demographics, risk factors, comorbidities, aneurysm characteristics (including special aneurysm presentation, i.e., inflammatory, mycotic/infected, aortocaval fistula), investigations, and operative variables. Receiver operating characteristic) curve analysis of the Glasgow aneurysm score (GAS) and the Vascular Study Group of New England (VSGNE) score was performed in the subgroup of bland aneurysms undergoing isolated elective repair. RESULTS A total of 928 cases with intact aortoiliac aneurysms had an elective (n = 882) or urgent (n = 46) repair, associated with an in-hospital mortality of 1.7% and 8.7%, respectively (P = 0.01). Open repair (n = 514) was a predictor of higher mortality (3.3% vs. 0.5% for endovascular aneurysm repair [EVAR], n = 414, odds ratio [OR] 7.1, P = 0.003), and so was the pre-EVAR era (4.8% vs. 1.3% in the EVAR era, OR 4.0, P = 0.004). Other significant predictors included the presence of abdominal/back pain (7.5% vs. 1.3%, OR = 6.0, P = 0.001), preoperative angiography (7% vs. 1.6%, OR = 4.5, P = 0.01), special aneurysm presentation (10.9% vs. 1.5%, OR = 8.1, P < 0.001), concomitant major procedures (19% vs. 1.7%, OR = 14.0, P < 0.001), serious intraoperative complications (9.1% vs. 1.5%, OR = 6.6, P = 0.001), median number of transfused units of blood intraoperatively (2 and 0 for cases with and without mortality, respectively, P < 0.001), and procedure duration (270 and 150 min for cases with and without mortality, respectively, P < 0.001). Open repair (OR = 4.5, P = 0.05), special aneurysm presentation (OR = 6.58, P = 0.001), and concomitant major procedures (OR = 14.3, P < 0.001) were independent predictors of higher mortality. ROC curve analysis for the GAS (P = 0.87) and VSGNE score (P = 0.10) failed to demonstrate statistical significance in the subgroup of bland aneurysms undergoing isolated elective repair. CONCLUSIONS Our study has demonstrated independent risk factors for mortality, which should be considered when contemplating aortoiliac aneurysm repair. We failed to externally validate the GAS and VSGNE score.
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Affiliation(s)
- Ioannis A Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | | | - Spyros Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Lampropoulos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras Medical School, Patras, Greece
| | | | - Ioannis Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Anastasia Kouri
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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Long-term outcomes after repair of symptomatic abdominal aortic aneurysms. J Vasc Surg 2018; 68:1360-1366. [DOI: 10.1016/j.jvs.2018.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/20/2018] [Indexed: 11/20/2022]
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3
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Long B, Koyfman A. Vascular Causes of Syncope: An Emergency Medicine Review. J Emerg Med 2017; 53:322-332. [PMID: 28662832 DOI: 10.1016/j.jemermed.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/05/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly. OBJECTIVE This review evaluates vascular causes of syncope and their evaluation and management in the ED. DISCUSSION Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention. Causes include cardiac, vasovagal, orthostatic, neurologic, medication-related, and idiopathic, and most cases of syncope will not receive a specific diagnosis pertaining to the cause. Emergency physicians are most concerned with life-threatening causes such as dysrhythmia and obstruction, and electrocardiogram is a primary means of evaluation. However, vascular etiologies can result in patient morbidity and mortality. These conditions include pulmonary embolism, subclavian steal, aortic dissection, cerebrovascular disease, intracerebral hemorrhage, carotid/vertebral dissection, and abdominal aortic aneurysm. A focused history and physical examination can assist emergency physicians in determining the need for further testing and management. CONCLUSIONS Syncope is common and may be the result of a deadly condition. The emergency physician, through history and physical examination, can determine the need for further evaluation and resuscitation of these patients, with consideration of vascular etiologies of syncope.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Chandra V, Trang K, Virgin-Downey W, Tran K, Harris EJ, Dalman RL, Lee JT, Mell MW. Management and outcomes of symptomatic abdominal aortic aneurysms during the past 20 years. J Vasc Surg 2017; 66:1679-1685. [PMID: 28619644 DOI: 10.1016/j.jvs.2017.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/02/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We compared the management of patients with symptomatic, unruptured abdominal aortic aneurysms (AAAs) treated at a tertiary care center between two decades. This 20-year period encapsulated a shift in surgical approach to aortic aneurysms from primarily open to primarily endovascular, and we sought to determine the effect of this shift in the evaluation, treatment, and clinical outcomes of patients with symptomatic AAA. METHODS We reviewed 1429 consecutive patients with unruptured AAAs treated at a tertiary care hospital by six staff surgeons between 1995 and 2004 (era 1) and between 2005 and 2014 (era 2). Of those patients, 160 (11%) were symptomatic from their aneurysm and were included in our study. Patient demographics, operative approach, and outcomes were analyzed and compared for each period. RESULTS Era 1 included 75 patients (71% men; average age, 73.1 ± 10.0 years) treated for symptomatic AAA (91.9% infrarenal, 4.0% juxtarenal, and 4.0% pararenal); of these, 68% were treated with open repair and 32.0% were treated with an endovascular repair. Perioperative mortality during this period was 5.3% (7.8% for the open cohort and 0% for the endovascular cohort). Era 2 included 85 patients (72.9% men; average age 72.0 ± 9.5 years) treated for symptomatic AAA (90.1% infrarenal, 7.5% juxtarenal, and 2.4% pararenal); of these, 29% were treated open and 71% underwent endovascular repair. Perioperative mortality was 5.9% (8.0% for the open cohort and 5.0% for the endovascular cohort). Era 2 had a significantly higher rate of endovascular repair compared with era 1 (71% vs 32%; P < .0001) and a trend toward decreased long-term mortality. The length of stay for era 2 was significantly reduced compared with era 1 (4 days vs 6 days; P = .005). CONCLUSIONS To our knowledge, this is the largest single-institution cohort of symptomatic AAAs, which comprise 10% to 11% of overall aneurysms. As expected, we found a significant shift over time in the approach to these patients from a primarily open to a primarily endovascular technique. The modern era was also associated with decreased lengths of stay and fewer gastrointestinal and wound complications but no significant differences in overall perioperative mortality.
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Affiliation(s)
- Venita Chandra
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, Calif.
| | - Karen Trang
- School of Medicine, Stanford University, Stanford, Calif
| | | | - Ken Tran
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, Calif
| | - E John Harris
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, Calif
| | - Ronald L Dalman
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, Calif
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, Calif
| | - Matthew W Mell
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, Calif
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Lijftogt N, Vahl AC, Wilschut ED, Elsman BHP, Amodio S, van Zwet EW, Leijdekkers VJ, Wouters MWJM, Hamming JF. Adjusted Hospital Outcomes of Abdominal Aortic Aneurysm Surgery Reported in the Dutch Surgical Aneurysm Audit. Eur J Vasc Endovasc Surg 2017; 53:520-532. [PMID: 28256396 DOI: 10.1016/j.ejvs.2016.12.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/25/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE/BACKGROUND The Dutch Surgical Aneurysm Audit (DSAA) is mandatory for all patients with primary abdominal aortic aneurysms (AAAs) in the Netherlands. The aims are to present the observed outcomes of AAA surgery against the predicted outcomes by means of V-POSSUM (Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity). Adjusted mortality was calculated by the original and re-estimated V(physiology)-POSSUM for hospital comparisons. METHODS All patients operated on from January 2013 to December 2014 were included for analysis. Calibration and discrimination of V-POSSUM and V(p)-POSSUM was analysed. Mortality was benchmarked by means of the original V(p)-POSSUM formula and risk-adjusted by the re-estimated V(p)-POSSUM on the DSAA. RESULTS In total, 5898 patients were included for analysis: 4579 with elective AAA (EAAA) and 1319 with acute abdominal aortic aneurysm (AAAA), acute symptomatic (SAAA; n = 371) or ruptured (RAAA; n = 948). The percentage of endovascular aneurysm repair (EVAR) varied between hospitals but showed no relation to hospital volume (EAAA: p = .12; AAAA: p = .07). EAAA, SAAA, and RAAA mortality was, respectively, 1.9%, 7.5%, and 28.7%. Elective mortality was 0.9% after EVAR and 5.0% after open surgical repair versus 15.6% and 27.4%, respectively, after AAAA. V-POSSUM overestimated mortality in most EAAA risk groups (p < .01). The discriminative ability of V-POSSUM in EAAA was moderate (C-statistic: .719) and poor for V(p)-POSSUM (C-statistic: .665). V-POSSUM in AAAA repair overestimated in high risk groups, and underestimated in low risk groups (p < .01). The discriminative ability in AAAA of V-POSSUM was moderate (.713) and of V(p)-POSSUM poor (.688). Risk adjustment by the re-estimated V(p)-POSSUM did not have any effect on hospital variation in EAAA but did in AAAA. CONCLUSION Mortality in the DSAA was in line with the literature but is not discriminative for hospital comparisons in EAAA. Adjusting for V(p)-POSSUM, revealed no association between hospital volume and treatment or outcome. Risk adjustment for case mix by V(p)-POSSUM in patients with AAAA has been shown to be important.
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Affiliation(s)
- N Lijftogt
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - A C Vahl
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - E D Wilschut
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - B H P Elsman
- Department of Vascular Surgery, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands
| | - S Amodio
- Department of Medical Statistics, Leiden University, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - E W van Zwet
- Department of Medical Statistics, Leiden University, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - V J Leijdekkers
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - M W J M Wouters
- Department of Surgery, Dutch Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
| | - J F Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Guo B, Dong Z, Fu W, Guo D, Xu X, Chen B, Jiang J, Shi Z. Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysms in a Chinese Population. Ann Vasc Surg 2016; 36:74-84. [DOI: 10.1016/j.avsg.2016.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/26/2016] [Accepted: 03/06/2016] [Indexed: 11/27/2022]
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Soden PA, Zettervall SL, Ultee KH, Darling JD, Buck DB, Hile CN, Hamdan AD, Schermerhorn ML. Outcomes for symptomatic abdominal aortic aneurysms in the American College of Surgeons National Surgical Quality Improvement Program. J Vasc Surg 2016; 64:297-305. [DOI: 10.1016/j.jvs.2016.02.055] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
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Bryce G, Payne C, Gibson S, Kingsmore D, Byrne D, Delles C. Risk Stratification Scores in Elective Open Abdominal Aortic Aneurysm Repair: Are They Suitable for Preoperative Decision Making? Eur J Vasc Endovasc Surg 2012; 44:55-61. [DOI: 10.1016/j.ejvs.2012.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Evaluation of the perioperative risk factors in patients with the abdominal aorta aneurysm--literature review. POLISH JOURNAL OF SURGERY 2011; 83:571-8. [PMID: 22189286 DOI: 10.2478/v10035-011-0091-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Outcomes of symptomatic abdominal aortic aneurysm repair. J Vasc Surg 2010; 52:5-12.e1. [PMID: 20471771 DOI: 10.1016/j.jvs.2010.01.095] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/28/2010] [Accepted: 01/29/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (Sx-AAA) repair has been reported at 6% to 30% during the past 25 years. We used a multicenter regional database to describe the contemporary outcomes of patients undergoing repair of Sx-AAA. METHODS All patients undergoing infrarenal AAA repair in 11 hospitals comprising the Vascular Study Group of Northern New England (VSGNNE) between 2003 and 2009 were studied. Sx-AAA was prospectively defined as an AAA accompanied by abdominal or back pain or tenderness, but without rupture. The primary study end point was in-hospital mortality. Secondary end points included in-hospital postoperative major adverse events (MAE) and late survival. These outcomes were compared between symptomatic patients and contemporary VSGNNE cohorts of elective (E-AAA) and ruptured AAAs (R-AAAs) treated within the same study period. RESULTS During the study period, 2386 AAA repairs were performed, comprising 1959 (82%) E-AAAs, 156 (7%) Sx-AAAs, and 271 (11%) R-AAAs. Repair was endovascular in 945 (48%) E-AAAs, 60 (38%) Sx-AAAs, and 33 (12%) R-AAAs. Hospital mortality was 1.7% for E-AAA repair and 1.3% for Sx-AAA repair, but was 34.7% for R-AAA repair (P < .001). The MAE rates were 20%, 35%, and 63%, respectively, for E-AAA, Sx-AAA, and R-AAA repairs (P < .001). The mean Glasgow Aneurysm Score (GAS) for Sx-AAA patients who survived was 79 +/- 12. Those who died had an average score of 92 +/- 7, and 83% of all Sx-AAA and R-AAA patients who died had a GAS >85. Kaplan-Meier analysis demonstrated that at 1 and 4 years, Sx-AAA repair was associated with intermediate survival (83% and 68%) compared with E-AAA repair (89% and 73%) and R-AAA repair (49% and 35%; P < .001). CONCLUSION The operative mortality of patients with Sx-AAA in contemporary practice appears better than that previously reported in the literature. Despite low operative mortality, MAE and late survival are intermediate compared with E-AAA and R-AAA repair. Review of previous series shows a trend for lower operative mortality after Sx-AAA repair in more recent series, which likely reflects improved perioperative care and more use of endovascular aneurysm repair.
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Huddle MG, Schlösser FJ, Dewan MC, Indes J, Muhs BE. Can Laboratory Tests Predict the Prognosis of Patients after Endovascular Aneurysm Repair? Current Status and Future Directions. Vascular 2009; 17:129-37. [DOI: 10.2310/6670.2009.00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine what laboratory values predict the prognosis of patients after endovascular aneurysm repair (EVAR). MEDLINE and Cochrane Library databases were searched. This resulted in 13 relevant articles. Data were pooled, and meta-analyses were performed. A meta-analysis including 5,655 patients showed that preoperative serum creatinine > 1.5 mg/dL was a significant risk indicator for increased 30-day mortality (relative risk 3.0, 95% confidence interval 2.3–4.1, p < .0001). Four other studies showed that other cutoff values of creatinine or glomerular filtration rate can predict mortality and complications following EVAR. One study suggested that reduced preoperative hemoglobin is a risk indicator for reduced long-term survival. Increased serum creatinine, reduced glomerular filtration rate, and reduced hemoglobin are significant and strong predictors of mortality and complications after EVAR. Current evidence remains limited, and further research is needed to determine conclusively additional laboratory values that may predict the outcome of patients following EVAR.
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Affiliation(s)
- Matthew G. Huddle
- *Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT; †Department of Chemistry, Illinois Wesleyan University, Bloomington, IL
| | - Felix J.V. Schlösser
- *Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT; †Department of Chemistry, Illinois Wesleyan University, Bloomington, IL
| | - Michael C. Dewan
- *Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT; †Department of Chemistry, Illinois Wesleyan University, Bloomington, IL
| | - Jeffrey Indes
- *Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT; †Department of Chemistry, Illinois Wesleyan University, Bloomington, IL
| | - Bart E. Muhs
- *Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT; †Department of Chemistry, Illinois Wesleyan University, Bloomington, IL
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Predicting Risk in Elective Abdominal Aortic Aneurysm Repair: A Systematic Review of Current Evidence. Eur J Vasc Endovasc Surg 2008; 36:637-45. [DOI: 10.1016/j.ejvs.2008.08.016] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 08/27/2008] [Indexed: 11/21/2022]
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Nevala T, Perälä J, Aho P, Matsi P, Ylönen K, Roth WD, Manninen H, Mäkinen K, Lepäntalo M, Biancari F. Outcome of symptomatic, unruptured abdominal aortic aneurysms after endovascular repair with the Zenith stent-graft system. SCAND CARDIOVASC J 2008; 42:178-81. [PMID: 18569949 DOI: 10.1080/14017430701819105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Symptomatic abdominal aortic aneurysms (AAA) account for up to 20% of patients with unruptured AAA undergoing open repair. This condition is associated with an average postoperative mortality rate after open repair of about 16%. The aim of this study was to evaluate the outcome of a consecutive series of patients who underwent endovascular repair for symptomatic, unruptured AAA. MATERIAL AND METHODS From January 2000 to October 2006, 14 patients underwent endovascular repair of intact AAA within 15 days since admission for AAA-related symptoms. In these patients, a Zenith stent-graft (Cook Incorporated, Bloomington, IN, USA) was deployed at the Oulu University Hospital, Kuopio University Hospital and Helsinki University Hospital, Finland. RESULTS Stent-grafting was not successful in one patient because of access failure. The procedure was immediately converted to open repair and an aortobifemoral bypass with a Dacron prosthesis was performed. In the remaining 13 patients, bifurcated Zenith stent-grafts were deployed. After the procedure, type II endoleak was observed in three patients. The mean follow-up time was 1.9+/-1.4 years. The 2-year survival rate was 69%. The survival freedom from secondary procedure was 71% as one patient underwent stent-grafting for a distal type I endoleak 5 months after the procedure. Another patient underwent femoro-femoral cross-over bypass surgery because of right limb graft thrombosis which occurred 9 months after the procedure. CONCLUSIONS These preliminary results suggest that endovascular repair of symptomatic, unruptured AAA is feasible and can be associated with a favourable outcome despite a very high operative risk.
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Affiliation(s)
- Terhi Nevala
- Department of Radiology, Oulu University Hospital, Oulu, Finland.
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Antonello M, Frigatti P, Maturi C, Lepidi S, Noventa F, Pittoni G, Deriu GP, Grego F. Open repair for ruptured abdominal aortic aneurysm: is it possible to predict survival? Ann Vasc Surg 2008; 23:159-66. [PMID: 18834704 DOI: 10.1016/j.avsg.2008.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 04/04/2008] [Accepted: 05/08/2008] [Indexed: 11/26/2022]
Abstract
The aim of the study was to determine variables that could be used to predict survival in patients with ruptured abdominal aortic aneurysm (RAAA) and to assess the accuracy of the Glasgow Aneurysm Score (GAS) and the Acute Physiology Chronic Health Evaluation II (APACHE-II). From January 1998 to July 2006, 103 patients underwent operations for RAAA. For each patient, 44 variables were retrospectively recorded in a database. Data were analyzed with univariate and multivariate methods. In the univariate analysis significant predictors of death were hypotension (p=0.001), preexisting peripheral vascular disease (p<0.001), renal insufficiency (p=0.037), chronic obstructive pulmonary disease (p=0.028), level of HCO(3)(-) (p<0.001), intraperitoneal rupture (p=0.001), blood transfused (p<0.001), cardiac complications (p<0.001), and APACHE-II score (p=0.001). Multivariate analysis confirmed statistical significance for coexisting peripheral vascular disease (p<0.001), diastolic blood pressure at admission <60 mm Hg (p=0.039), APACHE-II score >18.5 (p=0.025), HCO(3)(-) <21 mg/dL (p<0.001), and intraperitoneal rupture of the aneurysm (p=0.011) as predictors of death. Results of the study suggested that different factors can be helpful in identifying those patients whose operative risk is prohibitive. APACHE-II, contrary to GAS, is an accurate system to predict postoperative death after repair for RAAA.
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Affiliation(s)
- M Antonello
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy.
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Merino-Mairal O, Riera-Vázquez R, Lara-Hernández R, Sena-Ruiz F, Juliá-Montoya J, Rimbau-Muñoz, E, Lozano-Vilardell P. Valor pronóstico de la escala de Glasgow en aneurismas de aorta abdominal infrarrenal rotos. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)02005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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