From the Guidelines
Advanced age, pre-existing renal insufficiency, COPD, and previous stroke are significant factors that increase morbidity from abdominal aortic aneurysm (AAA) repair, as evidenced by the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. When considering the factors that increase morbidity from AAA repair, it is essential to take into account the patient's characteristics, anatomical characteristics of the aneurysm, and procedural factors.
- Patient-specific factors such as advanced age, with odds ratios of 1.8 and 2.6 for patients aged 65-74 and ≥75 years, respectively, contribute to increased perioperative morbidity and mortality 1.
- Pre-existing renal insufficiency, COPD, and previous stroke are also significant risk factors, as they can lead to complications during and after the repair procedure 1.
- The anatomical characteristics of the aneurysm, such as its size and extent, can also impact the morbidity of the repair, with larger aneurysms and more extensive aortic involvement carrying higher risks.
- Procedural factors, including the type of repair (open or endovascular), can also influence morbidity, with endovascular repair generally associated with lower perioperative mortality but higher risk of re-intervention in the long term 1. It is crucial to carefully evaluate these factors and consider the most recent and highest-quality evidence when making decisions about AAA repair to minimize complications and optimize patient outcomes.
- The choice between open surgical repair and endovascular repair depends on various factors, including the patient's anatomy, overall health, and the extent of the aneurysm, as outlined in the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1.
- Understanding these risk factors and considering the latest evidence allows for better patient selection, preoperative optimization, and appropriate surgical approach selection to minimize complications and improve quality of life.
From the Research
Factors Increasing Morbidity from Abdominal Aortic Aneurysm (AAA) Repair
- Chronic kidney disease is associated with increased risk of perioperative morbidity and mortality in patients undergoing endovascular aneurysm repair (EVAR) 2
- Peripheral artery disease is a factor that increases the risk of perioperative morbidity and mortality in patients undergoing EVAR 2, 3
- The existence of three or more co-morbidities is associated with increased risk of perioperative morbidity and mortality in patients undergoing EVAR 2
- Suprarenal clamping, operative time, and low postoperative temperature are independent predictors of morbidity in patients undergoing open abdominal aortic aneurysm repair (OAR) 4
- Advanced age and operative time are multivariate predictors of 30-day mortality in patients undergoing OAR 4
- Age over 85 years and intensive care unit (ICU) stay are predictive of decreased survival in patients undergoing endovascular AAA repair 5
- Older age, peripheral artery disease, hypertension, congestive heart failure, and urgent procedures are risk factors associated with mortality during follow-up in patients undergoing thoracoabdominal aortic aneurysm repair 3
- Older age, chronic kidney disease, congestive heart failure, and urgent procedures are associated with a higher rate of thoracoabdominal aortic aneurysm life-altering events (TALE) 3