The Futility of Surveillance for Old and Small Aneurysms

Slides:

Advertisements

Similar presentations

James M. Prentis, MBBS, Michael I. Trenell, PhD, Dave J

Advertisements

The Agency for Healthcare Research and Quality Inpatient Quality Indicator #11 overall mortality rate does not accurately assess mortality risk after.

Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder George A. Antoniou, MD, George S. Georgiadis, MD,

Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk Anai N. Kothari, MD, Pegge M. Halandras,

The prevalence of abdominal aortic aneurysm is consistently high among patients with coronary artery disease Jussi A. Hernesniemi, MD, PhD, Ville Vänni,

Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model Brendan Wisniowski,

Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population Samuel T. Edwards, MD,

Rupture rates of untreated large abdominal aortic aneurysms in patients unfit for elective repair Fran Parkinson, MB BCh, Stuart Ferguson, MB BChir,

Robert A. Meguid, MD, MPH, Benjamin S. Brooke, MD, Bruce A

Deep venous thrombosis after repair of nonruptured abdominal aneurysm

Long-term incidence of myocardial infarct, stroke, and mortality in patients operated on for abdominal aortic aneurysms Nikolaj Eldrup, MD, PhD, Jacob.

Randall R. De Martino, MD, MS, Philip P. Goodney, MD, MS, Brian W

Endovascular repair of abdominal aortic aneurysm in octogenarians: An analysis based on EUROSTAR data Conrad Lange, MD, Lina J. Leurs, MSc, Jaap Buth,

George N. Kouvelos, MD, PhD, Nikolaos Patelis, MD, George A

A decade of change in abdominal aortic aneurysm repair in the United States: Have we improved outcomes equally between men and women? Ellen D. Dillavou,

The prevalence of abdominal aortic aneurysm is consistently high among patients with coronary artery disease Jussi A. Hernesniemi, MD, PhD, Ville Vänni,

Variation in Center-Level Frailty Burden and Its Impact on Long-Term Survival in Patients Undergoing Repair for Abdominal Aortic Aneurysms Elizabeth.

Impaired renal function is associated with mortality and morbidity after endovascular abdominal aortic aneurysm repair Athanasios Saratzis, MBBS, MRCS,

Frederico Bastos Gonçalves, MD, PhD, Klaas H. J. Ultee, BSc, Sanne E

Clinical presentation, comorbidities, and age but not female gender predict survival after endovascular repair of abdominal aortic aneurysm Peter Gloviczki,

Effect of lipid-modifying drug therapy on survival after abdominal aortic aneurysm repair Gaurav M. Parmar, MD, MPH, Bruce Lowman, MD, Bart R. Combs,

Long-term durability of open abdominal aortic aneurysm repair

Journal of Vascular Surgery

Endovascular abdominal aortic aneurysm repair: Long-term outcome measures in patients at high-risk for open surgery Gregorio A. Sicard, MD, Robert M.

One-year pivotal trial outcomes of the Nellix system for endovascular aneurysm sealing Jeffrey P. Carpenter, MD, Robert Cuff, MD, Clifford Buckley, MD,

Jonathan Misskey, MD, Meric Osman, MSc, David Kopriva, MDCM, FRCS(C)

Durability and survival are similar after elective endovascular and open repair of abdominal aortic aneurysms in younger patients Kevin Lee, MD, Elaine.

James M. Prentis, MBBS, Michael I. Trenell, PhD, Dave J

The natural history of type II endoleaks after endovascular aneurysm repair for ruptured abdominal aortic aneurysm Anna E. Boniakowski, MD, Randall R.

The impact of endovascular aneurysm repair on mortality for elective abdominal aortic aneurysm repair in England and the United States Alan Karthikesalingam,

Is abdominal aortic aneurysm repair appropriate in oxygen-dependent chronic obstructive pulmonary disease patients? Christopher N. Compton, MD, Ellen.

The Agency for Healthcare Research and Quality Inpatient Quality Indicator #11 overall mortality rate does not accurately assess mortality risk after.

Contemporary results of open repair of ruptured abdominal aortoiliac aneurysms: Effect of surgeon volume on mortality Jae-Sung Cho, MD, Jang Yong Kim,

The influence of incidental abdominal aortic aneurysm monitoring on patient outcomes Carl van Walraven, MD, MSc, FRCPC, Jenna Wong, MSc, Kareem Morant,

A limited and customized follow-up seems justified after endovascular abdominal aneurysm repair in octogenarians Linda Visser, MD, Robert A. Pol, MD,

Nicholas H. Osborne, MD, Gilbert R. Upchurch, MD, Amit K

Current accepted hemodynamic criteria for critical limb ischemia do not accurately stratify patients at high risk for limb loss Raghuveer Vallabhaneni,

Type II endoleak with or without intervention after endovascular aortic aneurysm repair does not change aneurysm-related outcomes despite sac growth

Kenneth Ouriel, MD, Daniel G. Clair, MD, K

Effects of diabetes on small aortic aneurysms under surveillance according to a subgroup analysis from a randomized trial Paola De Rango, MD, PhD, Piergiorgio.

National trends in utilization, mortality, and survival after repair of type B aortic dissection in the Medicare population Douglas W. Jones, MD, Philip.

Meta-analysis and systematic review of the relationship between surgeon annual caseload and mortality for elective open abdominal aortic aneurysm repairs

Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario Prasad Jetty, MD, MSc, FRCSC,

A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms

Increasing Mortality Trends for Open Infrarenal and Thoracoabdominal Aneurysm Repairs in the Endovascular Era Brendan M. Levac, S. Nagpal, George Hajjar,

Cost-effectiveness of intensive smoking cessation therapy among patients with small abdominal aortic aneurysms Kevin Mani, MD, PhD, Anders Wanhainen,

Karthikeshwar Kasirajan, MD, Mark D. Morasch, MD, Michel S

Simple renal cyst and abdominal aortic aneurysm

Andres Schanzer, MD, Louis M

Regarding “Endovascular repair of ruptured abdominal aortic aneurysms”

Adam W. Beck, MD, Philip P. Goodney, MD, Brian W. Nolan, MD, Donald S

Effect of gender on long-term survival after abdominal aortic aneurysm repair based on results from the Medicare national database Natalia N. Egorova,

Survival and Reintervention Risk by Patient Age and Preoperative Abdominal Aortic Aneurysm (AAA) Diameter Following Endovascular Aneurysm Repair (EVAR)

Endovascular treatment of ruptured abdominal aortic aneurysms in the United States ( ): A significant survival benefit over open repair is independently.

Ruptured abdominal aortic aneurysm: A population-based study

Franklin S. Yau, MD, Eric B. Rosero, MD, G. Patrick Clagett, MD, R

Regarding “Lunar cycles and abdominal aortic aneurysm rupture”

Journal of Vascular Surgery

Incidence, follow-up, and outcomes of incidental abdominal aortic aneurysms Carl van Walraven, MD, MSc, FRCPC, Jenna Wong, BSc, Kareem Morant, MD, Alison.

Predictors of decreased short- and long-term survival following open abdominal aortic aneurysm repair Derek P. Nathan, MD, Clayton J. Brinster, MD, Benjamin.

Stuart B. Prenner, BS, Irene C

Midterm outcomes of the Zenith Renu AAA Ancillary Graft

Thoracic aortic endovascular repair for mycotic aneurysms and fistulas

Francisco Alcocer, MD, Marjan Mujib, MD, Bruce Lowman, MD, Mark A

Patients started on hemodialysis with tunneled dialysis catheter have similar survival after arteriovenous fistula and arteriovenous graft creation Theodore.

Contemporary outcomes of open complex abdominal aortic aneurysm repair

Deep venous thrombosis after repair of nonruptured abdominal aneurysm

Sheela T. Patel, MD, Peter Korn, MD, Paul B. Haser, MD, Harry L

Reconsidering gender relative to risk of rupture in the contemporary management of abdominal aortic aneurysms Afshin A. Skibba, MD, James R. Evans, MD,

Endovascular vs open repair for ruptured abdominal aortic aneurysm

Presentation transcript:

The Futility of Surveillance for Old and Small Aneurysms Mark Rockley, MD, Dominic Leblanc, MD, Prasad Jetty, MD Journal of Vascular Surgery Volume 68, Issue 3, (September 2018) DOI: 10.1016/j.jvs.2018.06.154 Copyright © 2018 Terms and Conditions

Fig 1 Kaplan-Meier curves and hazard ratios (HRs) demonstrating freedom from reaching (A) sex-specific threshold-sized aneurysm and (B) aortic event (AE; threshold-sized aneurysm, elective abdominal aortic aneurysm [AAA] repair, or ruptured AAA repair). The overall HR of the young cohort (<80 years old), compared with the octogenarian cohort, of reaching a threshold-sized aneurysm or aortic event is 1.98 (95% confidence interval [CI], 1.46-2.68) and 1.93 (95% CI, 1.54-2.41), respectively. The HRs stratified for each enrollment AAA size are also presented (threshold-sized AAA: HR = 2.75 [95% CI, 0.61-12.27] if enrollment AAA was 3-3.9 cm and HR = 1.94 [95% CI, 1.42-2.65] if enrollment AAA was 4-4.9 cm; aortic event: HR = 3.11 [95% CI, 1.21-7.94] if enrollment AAA was 3-3.9 cm and HR = 1.86 [95% CI, 1.48-2.34] if enrollment AAA was 4-4.9 cm). Cox proportional hazards modeling adjusted for sex because female sex was significantly associated with an increased hazard of reaching threshold-sized aneurysm (HR, 2.91; 95% CI, 2.17-3.89) and aortic event (HR, 1.99; 95% CI, 1.59- 2.49). Journal of Vascular Surgery 2018 68, DOI: (10.1016/j.jvs.2018.06.154) Copyright © 2018 Terms and Conditions

Fig 2 Incidence of abdominal aortic aneurysm (AAA) repair and resulting cost-effectiveness analysis. Groups are stratified by enrollment age and size of AAA at time of enrollment. A, When a threshold-sized AAA was reached, octogenarians were less likely to undergo elective AAA repair than their younger counterparts (overall relative risk, 0.52; 95% confidence interval, 0.45-0.59). B, Repair of ruptured AAA for patients in the surveillance program was rare, and differences were not statistically significant. C, Cost-effectiveness analysis incorporates a base cost of $89.20 for each surveillance ultrasound (Ontario Health Insurance Plan: code H 2, $57.00 technical cost; code P J202, $32.20 professional cost). D, Whereas the cost of surveillance to identify threshold-sized AAA was comparable between age cohorts, there was substantially more discrepancy in the cost of surveillance to prompt elective AAA repair. Journal of Vascular Surgery 2018 68, DOI: (10.1016/j.jvs.2018.06.154) Copyright © 2018 Terms and Conditions