Outcomes of Small Incidental Abdominal Aortic Aneurysms in Octogenarian and Nonagenarian Patients in Northern Spain.

OBJECTIVE: Greater population life expectancy and consistent improvement in diagnostic techniques have increased the diagnosis of abdominal aortic aneurysms (AAAs) in the elderly population. The aim was to study the natural history of small (< 55 mm) incidental AAAs in octogenarian and nonagenarian patients to assess the need for follow up and/or invasive treatment. METHODS: This was a retrospective analysis of a prospective registry. Patients ≥ 80 years old at the time of diagnosis of a < 55 mm AAA in 1988-2018 were selected. Clinical and anatomical characteristics were registered. Patients were divided in three groups: 30 - 39 mm, 40 - 49 mm, and 50 - 54 mm AAA. The outcome variables were aorto-iliac rupture, AAA reaching a surgical threshold (≥ 55 mm), and death. A descriptive statistical analysis was performed and life tables, Kaplan-Meier curves, and uni- and multivariable Cox regression were used. RESULTS: Three hundred and ten patients were included, 256 (82.6%) men, with mean index age of 84.5 years (standard deviation [SD] 3.5), and median follow up of 37.9 months (interquartile range [IQR] 18.2 - 65.4). Eighteen (5.8%) AAAs ruptured; four of these patients were operated on and only one survived. Sixty-two (20%) AAA reached a surgical size; eight were repaired electively, with 0% early mortality. The survival rates were 81%, 70%, and 38% at one, two, and five years. The rupture rates were 1%, 2%, and 6% and the AAAs reaching surgical threshold were 1%, 4%, and 19% for the same time periods. AAA size < 40 mm was an independent protective factor from rupture (0.13; 95% confidence interval [CI] 0.03 - 0.48), reaching surgical threshold (0.08; 95% CI 0.04 - 0.16) and death (0.63; 95% CI 0.42 - 0.95). CONCLUSION: The risk of late rupture of small incidental AAA diagnosed in octogenarian and nonagenarian patients is very small, especially when the AAA is < 40 mm in diameter. In contrast, global mortality is high. Conservative management seems sensible, with strict selection of the patients who would benefit from follow up and eventual repair.

Pseudoaneurisma poplíteo como complicación tardía de angioplastia transluminal percutánea / Popliteal pseudoaneurysm as a late complication of percutaneous transluminal angioplasty

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Pronóstico tardío de pacientes supervivientes tras la reparación quirúrgica abierta de un aneurisma de aorta abdominal roto / Late prognosis of surviving patients after open surgical repair of a ruptured abdominal aortic aneurysm

INTRODUCCIÓN Y OBJETIVOS: existen múltiples estudios sobre el pronóstico tardío de pacientes tras la reparación electiva de un aneurisma de aorta abdominal (AAA), pero escasos datos sobre aquellos que sobreviven a un AAA roto. El objetivo del presente estudio es analizar la supervivencia y los eventos cardiovasculares (eCV) que presentan estos pacientes a largo plazo. MATERIAL Y MÉTODOS: realizamos un análisis retrospectivo de una cohorte de pacientes supervivientes tras la reparación quirúrgica abierta de un AAA roto entre 1988 y 2014. Se incluyeron aquellos que habían sobrevivido al menos 3 meses tras la intervención y de los que teníamos un seguimiento clínico mínimo de un año. Se registraron los datos demográficos, los factores de riesgo cardiovascular, la comorbilidad, algunos detalles quirúrgicos, las muertes tardías y sus causas, los eCV y las complicaciones relacionadas con el injerto. Se analizaron las tasas de supervivencia y el tiempo libre de eventos cardiovasculares (TLECV), utilizando Kaplan-Meier y Mantel-Cox. RESULTADOS: se estudiaron 45 pacientes (42 hombres), con una edad media de 70 años (DS 8,3; rango 54-89) en el momento de la cirugía. El diámetro máximo medio de los AAA rotos era de 80,1 mm (DS 21,3; rango 51-135). El seguimiento medio fue de 7 años (DS 5,8; rango 0,3-21,5). 25 pacientes (55,6%) presentaron eCV tardíos: 13 cardiológicos (28,9%), 5 neurológicos (11,1%) y 8 vasculares periféricos (17,8%), con una tasa de 0,3 eventos/paciente-año (DS 1,7; rango 0-3,5). 26 pacientes (57,8%) fallecieron durante el seguimiento; los eCV fueron la causa más frecuente (n = 9; 20%). Las complicaciones relacionadas con el injerto fueron 3 (6,7%), con 2 muertes relacionadas (4,4%). La supervivencia de la cohorte a 2, 5 y 10 años fue de 86%, 66% y 53%, respectivamente, con tasas de TLECV de 79%, 65% y 40% para los mismos periodos. La edad y la cardiopatía aumentaron el riesgo de mortalidad y eCV, respectivamente (p ≤ 0,01). CONCLUSIONES: la supervivencia tardía tras superar la rotura de un aneurisma de aorta abdominal es buena, pero estos pacientes presentan una incidencia aumentada de eventos cardiovasculares a lo largo de su vida. Las complicaciones relacionadas con el injerto son poco frecuentes

INTRODUCTION AND OBJECTIVES: several studies have looked into the late prognosis of patients after elective abdominal aortic aneurysm (AAA) repair, but there is little data regarding those who survive a ruptured AAA. Our aim is to analyze the late survival and incidence of cardiovascular events in these patients. MATERIAL AND METHODS: we performed a retrospective analysis of a prospective cohort of patients who had survived the open repair of a ruptured AAA between 1988 and 2014. We included the patients who had survived at least 3 months after the procedure and of whom we had clinical follow-up of at least a year. We registered demographic data, cardiovascular risk factors, comorbidity, some surgical details, late deaths and their causes, cardiovascular events and graft-related complications. We analyzed the survival and freedom from cardiovascular event rates using Kaplan-Meier curves and Mantel-Cox regression. RESULTS: we studied 45 patients (42 men), with a mean age of 70 years (SD 8.3; range 54-89) at the time of the surgical repair. The maximum mean diameter of the ruptured AAA was 80.1 mm (SD 21.3; range 51-135). Mean follow-up was 7 years (SD 5.8; range 0.3-21.5). 25 patients (55,6%) suffered from late cardiovascular events: 13 cardiological (28.9%), 5 neurological (11.1%), and 8 peripheral vascular events (17.8%), with a rate of 0,3 events/ patient-year (SD 1.7; range 0-3.5). 26 patients (57.8%) died during follow-up, with cardiovascular events as the main cause (n = 9; 20%). There were 3 graft-related complications (6.7%), and 2 graft-related deaths (4.4%). The cohort's survival rates were 86%, 66% and 53% at 2, 5 and 10 years respectively, with freedom from cardiovascular evento rates of 79%, 65% and 40% for the same time periods. Age and cardiac disease increased the risk of late death and cardiovascular events respectively (p ≤ 0,01). CONCLUSIONS: late survival after successful open repair of a ruptured AAA is good, but these patients suffer an increased incidence of cardiovascular events throughout their lives. Graft-related complications are rare