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Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification
OBJECTIVES: Abdominal aortic aneurysms are conventionally treated by open repair surgery. While endovascular aortic repair improves survival in high-risk patients, younger patients (40–65 years) potentially at lower risk with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic rep...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909194/ https://www.ncbi.nlm.nih.gov/pubmed/31081493 http://dx.doi.org/10.1177/1708538119843420 |
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author | Hsieh, Wan Chin Kan, Chung Dann Hsieh, Chong Chao Omara, Mohamed Henry, Brandon Michael Davidovic, Lazar B |
author_facet | Hsieh, Wan Chin Kan, Chung Dann Hsieh, Chong Chao Omara, Mohamed Henry, Brandon Michael Davidovic, Lazar B |
author_sort | Hsieh, Wan Chin |
collection | PubMed |
description | OBJECTIVES: Abdominal aortic aneurysms are conventionally treated by open repair surgery. While endovascular aortic repair improves survival in high-risk patients, younger patients (40–65 years) potentially at lower risk with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair usually have poorer post-operative outcomes and require longer term follow-up. In this study, clinical data on younger patients were analyzed to investigate whether endovascular aortic repair leads to poorer short- and long-term outcomes. METHODS: This was a systematic review and meta-analysis of articles comparing clinical outcomes in patients aged 40–65 years undergoing open repair or endovascular aortic repair and published between 2000 and 2017. In-hospital mortality, long-term mortality, and post-operative complication data were retrieved from eligible studies and clinical outcomes were compared. Twenty-one retrospective cohort analyses were included, accounting for 250,837 patients (149,051 endovascular aortic repair; 101,786 open repair). Risk ratios were pooled using the DerSimonian and Laird random effects model. All statistical analyses were performed in Review Manager 5.3. RESULTS: Younger patients with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair had a significantly reduced 30-day mortality (odds ratio (OR) = 0.40, 95% confidence intervals (CI) 0.28–0.57; p < 0.00001), long-term mortality (OR = 0.37, 95% CI 0.17–0.82; p = 0.01), incidence of reintervention (OR = 0.47, 95% CI 0.34–0.66; p < 0.0001), and incidence of renal failure (OR = 1.58, 95% CI 1.37–1.82; p < 0.00001). CONCLUSIONS: Endovascular aortic repair may improve short- and long-term survival and reduce post-operative complications in younger patients with asymptomatic abdominal aortic aneurysms. |
format | Online Article Text |
id | pubmed-6909194 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-69091942019-12-24 Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification Hsieh, Wan Chin Kan, Chung Dann Hsieh, Chong Chao Omara, Mohamed Henry, Brandon Michael Davidovic, Lazar B Vascular Original Article OBJECTIVES: Abdominal aortic aneurysms are conventionally treated by open repair surgery. While endovascular aortic repair improves survival in high-risk patients, younger patients (40–65 years) potentially at lower risk with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair usually have poorer post-operative outcomes and require longer term follow-up. In this study, clinical data on younger patients were analyzed to investigate whether endovascular aortic repair leads to poorer short- and long-term outcomes. METHODS: This was a systematic review and meta-analysis of articles comparing clinical outcomes in patients aged 40–65 years undergoing open repair or endovascular aortic repair and published between 2000 and 2017. In-hospital mortality, long-term mortality, and post-operative complication data were retrieved from eligible studies and clinical outcomes were compared. Twenty-one retrospective cohort analyses were included, accounting for 250,837 patients (149,051 endovascular aortic repair; 101,786 open repair). Risk ratios were pooled using the DerSimonian and Laird random effects model. All statistical analyses were performed in Review Manager 5.3. RESULTS: Younger patients with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair had a significantly reduced 30-day mortality (odds ratio (OR) = 0.40, 95% confidence intervals (CI) 0.28–0.57; p < 0.00001), long-term mortality (OR = 0.37, 95% CI 0.17–0.82; p = 0.01), incidence of reintervention (OR = 0.47, 95% CI 0.34–0.66; p < 0.0001), and incidence of renal failure (OR = 1.58, 95% CI 1.37–1.82; p < 0.00001). CONCLUSIONS: Endovascular aortic repair may improve short- and long-term survival and reduce post-operative complications in younger patients with asymptomatic abdominal aortic aneurysms. SAGE Publications 2019-05-12 2019-12 /pmc/articles/PMC6909194/ /pubmed/31081493 http://dx.doi.org/10.1177/1708538119843420 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc/4.0/ Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Article Hsieh, Wan Chin Kan, Chung Dann Hsieh, Chong Chao Omara, Mohamed Henry, Brandon Michael Davidovic, Lazar B Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification |
title | Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification |
title_full | Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification |
title_fullStr | Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification |
title_full_unstemmed | Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification |
title_short | Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification |
title_sort | improved outcomes from endovascular aortic repair in younger patients: towards improved risk stratification |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909194/ https://www.ncbi.nlm.nih.gov/pubmed/31081493 http://dx.doi.org/10.1177/1708538119843420 |
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