TY - JOUR
T1 - Higher 30 Day Mortality in Patients with Familial Abdominal Aortic Aneurysm after EVAR
AU - van de Luijtgaarden, K.M.
AU - Bastos Gonçalves, F.
AU - Hoeks, S.E.
AU - Blankensteijn, J.D.
AU - Böckler, D.
AU - Stolker, R.J.
AU - Verhagen, H.J.M.
N1 - Export Date: 28 December 2017
CODEN: EJVSF
Correspondence Address: Verhagen, H.J.M.; Erasmus University Medical Centre, Department of Vascular Surgery, Suite H-810, PO Box 2040, Netherlands; email: [email protected]
References: Rossaak, J.I., Hill, T.M., Jones, G.T., Phillips, L.V., Harris, E.L., van Rij, A.M., Familial abdominal aortic aneurysms in the Otago region of New Zealand (2001) Cardiovasc Surg, 9 (3), pp. 241-248; Kuivaniemi, H., Kyo, Y., Lenk, G., Tromp, G., Genome-wide approach to finding abdominal aortic aneurysm susceptibility genes in humans (2006) Ann N Y Acad Sci, 1085, pp. 270-281; van de Luijtgaarden, K.M., Bastos Goncalves, F., Hoeks, S.E., Valentijn, T.M., Stolker, R.J., Majoor-Krakauer, D., Lower atherosclerotic burden in familial abdominal aortic aneurysm (2014) J Vasc Surg, 59 (3), pp. 589-593; van de Luijtgaarden, K.M., Bastos Goncalves, F., Hoeks, S.E., Majoor-Krakauer, D., Rouwet, E.V., Stolker, R.J., Familial abdominal aortic aneurysm is associated with more complications after endovascular aneurysm repair (2014) J Vasc Surg, 59 (2), pp. 275-282; Ryer, E.J., Garvin, R.P., Thomas, B., Kuivaniemi, H., Franklin, D.P., Elmore, J.R., Patients with familial abdominal aortic aneurysms are at increased risk for endoleak and secondary intervention following elective endovascular aneurysm repair (2015) J Vasc Surg, 62 (5), pp. 1119-1124. , e9; Bockler, D., Fitridge, R., Wolf, Y., Hayes, P., Silveira, P.G., Numan, F., Rationale and design of the endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE): interim analysis at 30 days of the first 180 patients enrolled (2010) J Cardiovasc Surg (Torino), 51 (4), pp. 481-491; Wolters, U., Wolf, T., Stutzer, H., Schroder, T., ASA classification and perioperative variables as predictors of postoperative outcome (1996) Br J Anaesth, 77 (2), pp. 217-222; Chaikof, E.L., Blankensteijn, J.D., Harris, P.L., White, G.H., Zarins, C.K., Bernhard, V.M., Reporting standards for endovascular aortic aneurysm repair (2002) J Vasc Surg, 35 (5), pp. 1048-1060; Ramnath, N.W., van de Luijtgaarden, K.M., van der Pluijm, I., van Nimwegen, M., van Heijningen, P.M., Swagemakers, S.M., Extracellular matrix defects in aneurysmal Fibulin-4 mice predispose to lung emphysema (2014) PLoS One, 9 (9), p. e106054; Pepin, M., Schwarze, U., Superti-Furga, A., Byers, P.H., Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type (2000) N Engl J Med, 342 (10), pp. 673-680; McPhee, J.T., Hill, J.S., Eslami, M.H., The impact of gender on presentation, therapy, and mortality of abdominal aortic aneurysm in the United States, 2001-2004 (2007) J Vasc Surg, 45 (5), pp. 891-899; Abedi, N.N., Davenport, D.L., Xenos, E., Sorial, E., Minion, D.J., Endean, E.D., Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset (2009) J Vasc Surg, 50 (3), pp. 486-491. , 91 e1–4; Mehta, M., Byrne, W.J., Robinson, H., Roddy, S.P., Paty, P.S., Kreienberg, P.B., Women derive less benefit from elective endovascular aneurysm repair than men (2012) J Vasc Surg, 55 (4), pp. 906-913; Bendermacher, B.L., Grootenboer, N., Cuypers, P.W., Teijink, J.A., Van Sambeek, M.R., Influence of gender on EVAR outcomes with new low-profile devices (2013) J Cardiovasc Surg (Torino), 54 (5), pp. 589-593; Brewster, D.C., Jones, J.E., Chung, T.K., Lamuraglia, G.M., Kwolek, C.J., Watkins, M.T., Long-term outcomes after endovascular abdominal aortic aneurysm repair: the first decade (2006) Ann Surg, 244 (3), pp. 426-438; Verloes, A., Sakalihasan, N., Koulischer, L., Limet, R., Aneurysms of the abdominal aorta: familial and genetic aspects in three hundred thirteen pedigrees (1995) J Vasc Surg, 21 (4), pp. 646-655; Darling, R.C., 3rd, Brewster, D.C., Darling, R.C., LaMuraglia, G.M., Moncure, A.C., Cambria, R.P., Are familial abdominal aortic aneurysms different? (1989) J Vasc Surg, 10 (1), pp. 39-43; Sakalihasan, N., Defraigne, J.O., Kerstenne, M.A., Cheramy-Bien, J.P., Smelser, D.T., Tromp, G., Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liege AAA Family Study (2014) Ann Vasc Surg, 28 (4), pp. 787-797
PY - 2017/8
Y1 - 2017/8
N2 - Objectives To determine the influence of a positive family history for aneurysms on clinical success and mortality after endovascular aneurysm repair (EVAR). Methods From 2009 to 2011, 1262 patients with abdominal aortic aneurysms (AAA) treated by EVAR were enrolled in a prospective, industry sponsored clinical registry ENGAGE. Patients were classified into familial and sporadic AAA patients according to baseline clinical reports. Clinical characteristics, aneurysm morphology, and follow-up were registered. The primary endpoint was clinical success after EVAR, a composite of technical success and freedom from the following complications: AAA increase >5 mm, type I and III endoleak, rupture, conversion, secondary procedures, migration, and occlusion. Secondary endpoints were the individual components of clinical success, 30 day mortality, and aneurysm related and all cause mortality. Results Of the 1262 AAA patients (89.5% male and mean age 73.1 years), 86 patients (6.8%) reported a positive family history and were classified as familial AAA. Duration of follow-up was 4.4 ± 1.7 years. Patients with familial AAA were more often female (18.6% vs. 9.9%, p =.012). No difference was observed in aneurysm morphology. There was no significant difference in clinical success between patients with familial and sporadic AAA (72.1% vs. 79.3%, p=.116). Familial AAA patients had a higher 30 day mortality after EVAR (4.7% vs. 1.0%, adjusted HR 5.7, 1.8–17.9, p =.003) as well as aneurysm related mortality (5.8% vs. 1.3%, adjusted HR 5.4, 1.9–14.9, p =.001), while no difference was observed in all cause mortality (19.8% vs. 24.3%, adjusted HR 0.8, 0.5–1.4, p =.501). Conclusions The current study shows a higher 30 day mortality after EVAR in familial AAA patients. Future studies should determine the role of family history in AAA treatment, suitability for endovascular or open repair, and on adaptation of post-operative surveillance. For the time being, patients with familial forms of AAA should be considered at higher risk for EVAR and warrant extra vigilance. © 2017 European Society for Vascular Surgery
AB - Objectives To determine the influence of a positive family history for aneurysms on clinical success and mortality after endovascular aneurysm repair (EVAR). Methods From 2009 to 2011, 1262 patients with abdominal aortic aneurysms (AAA) treated by EVAR were enrolled in a prospective, industry sponsored clinical registry ENGAGE. Patients were classified into familial and sporadic AAA patients according to baseline clinical reports. Clinical characteristics, aneurysm morphology, and follow-up were registered. The primary endpoint was clinical success after EVAR, a composite of technical success and freedom from the following complications: AAA increase >5 mm, type I and III endoleak, rupture, conversion, secondary procedures, migration, and occlusion. Secondary endpoints were the individual components of clinical success, 30 day mortality, and aneurysm related and all cause mortality. Results Of the 1262 AAA patients (89.5% male and mean age 73.1 years), 86 patients (6.8%) reported a positive family history and were classified as familial AAA. Duration of follow-up was 4.4 ± 1.7 years. Patients with familial AAA were more often female (18.6% vs. 9.9%, p =.012). No difference was observed in aneurysm morphology. There was no significant difference in clinical success between patients with familial and sporadic AAA (72.1% vs. 79.3%, p=.116). Familial AAA patients had a higher 30 day mortality after EVAR (4.7% vs. 1.0%, adjusted HR 5.7, 1.8–17.9, p =.003) as well as aneurysm related mortality (5.8% vs. 1.3%, adjusted HR 5.4, 1.9–14.9, p =.001), while no difference was observed in all cause mortality (19.8% vs. 24.3%, adjusted HR 0.8, 0.5–1.4, p =.501). Conclusions The current study shows a higher 30 day mortality after EVAR in familial AAA patients. Future studies should determine the role of family history in AAA treatment, suitability for endovascular or open repair, and on adaptation of post-operative surveillance. For the time being, patients with familial forms of AAA should be considered at higher risk for EVAR and warrant extra vigilance. © 2017 European Society for Vascular Surgery
KW - Abdominal aortic aneurysm
KW - Familial abdominal aortic aneurysm
KW - Post-operative mortality
KW - abdominal aortic aneurysm
KW - aged
KW - aneurysm rupture
KW - Article
KW - clinical feature
KW - device migration
KW - endoleak
KW - endovascular aneurysm repair
KW - familial disease
KW - family history
KW - female
KW - follow up
KW - graft occlusion
KW - human
KW - kidney failure
KW - major clinical study
KW - male
KW - morphology
KW - mortality
KW - postoperative complication
KW - priority journal
KW - register
KW - stent graft
KW - systolic blood pressure
U2 - 10.1016/j.ejvs.2017.04.018
DO - 10.1016/j.ejvs.2017.04.018
M3 - Article
C2 - 28579278
SN - 1078-5884
VL - 54
SP - 142
EP - 149
JO - European Journal of Vascular And Endovascular Surgery
JF - European Journal of Vascular And Endovascular Surgery
IS - 2
ER -
