Early and long-term results of open repair of inflammatory abdominal aortic aneurysms: Comparison with a propensity score-matched cohort

Slobodan Cvetkovic; Igor Koncar; Stefan Ducic; Petar Zlatanovic; Perica Mutavdzic; Dejan Maksimovic; Biljana Kukic; Dragan Markovic; Lazar Davidovic

doi:10.1016/j.jvs.2019.11.040

Early and long-term results of open repair of inflammatory abdominal aortic aneurysms: Comparison with a propensity score-matched cohort

J Vasc Surg. 2020 Sep;72(3):910-917. doi: 10.1016/j.jvs.2019.11.040. Epub 2020 Mar 2.

Authors

Slobodan Cvetkovic¹, Igor Koncar², Stefan Ducic³, Petar Zlatanovic³, Perica Mutavdzic³, Dejan Maksimovic⁴, Biljana Kukic⁵, Dragan Markovic¹, Lazar Davidovic¹

Affiliations

¹ Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
² Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. Electronic address: dr.koncar@gmail.com.
³ Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
⁴ Department of General Surgery, Sabac County Hospital, Sabac, Serbia.
⁵ Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia.

PMID: 32139307
DOI: 10.1016/j.jvs.2019.11.040

Abstract

Objective: The aim of our study was to compare early and long-term results of open repair of patients with inflammatory abdominal aortic aneurysm (IAAA) with matched cohort of patients with abdominal aortic aneurysm (AAA).

Methods: This retrospective single-center cohort study used prospectively collected data from an institutional registry from 1786 patients between 2009 and 2015. Patients with IAAA and AAA were matched by propensity score analysis controlling for demographics, baseline comorbidities, and AAA parameters in a 1:2 ratio. Patients were followed for 5 years.

Results: There were 76 patients with IAAA and 152 patients with AAA. Patients with IAAA had more common intraoperative lesion of intraabdominal organs (P = .04), longer in-hospital (P = .035) and intensive care (P = .048) stays and a higher in-hospital mortality rate (P = .012). There were four patients (5.26%) with in-hospital lethal outcome in IAAA there were no deaths in the AAA group. During the follow-up, there was no difference in survival (χ² = 0.07; DF = 1; P = .80) and overall aortic related complications (χ² = 1.25; DF = 1; P = .26); however, aortic graft infection was more frequent in IAAA group (P = .04).

Conclusions: Open repair of IAAA is challenging and comparing to AAA carries a higher perioperative risk and long-term infection rate, even in high-volume centers. The main causes of complications are intraoperative injury of adjacent organs, bleeding, and coronary events. Patients with AAA in a matched cohort showed equal long-term survival, which should be assessed in bigger registries.

Keywords: EVAR; IAAA; Matched cohort; Open repair; Outcome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aortic Aneurysm, Abdominal / diagnostic imaging
Aortic Aneurysm, Abdominal / mortality
Aortic Aneurysm, Abdominal / surgery*
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / mortality
Female
Hospital Mortality
Humans
Inflammation / diagnostic imaging
Inflammation / mortality
Inflammation / surgery*
Length of Stay
Male
Middle Aged
Postoperative Complications / mortality
Postoperative Complications / therapy
Propensity Score
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome