Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.17/1943
Título: Familial Abdominal Aortic Aneurysm Is Associated With More Complications After Endovascular Aneurysm Repair
Autor: Luijtgaarden, K
Bastos Gonçalves, F
Hoeks, S
Majoor-Krakauer, D
Rouwet, E
Stolker, R
Verhagen, H
Palavras-chave: HSM CIR VASC
Academic Medical Centers
Aortic Aneurysm, Abdominal/diagnosis
Aortic Aneurysm, Abdominal/genetics
Aortic Aneurysm, Abdominal/mortality
Aortic Aneurysm, Abdominal/surgery
Blood Vessels Prosthesis Implantation/adverse effects
Blood Vessels Prosthesis Implantation/mortality
Chi-Square Distribution
Endovascular Procedures/adverse effects
Endovascular Procedures/mortality
Genetic Predisposition to Disease
Kaplan-Meier Estimate
Multivariate Analysis
Postoperative Complications/etiology
Postoperative Complications/mortality
Postoperative Complications/surgery
Proportional Hazards Models
Risk Factors
Time Factors
Treatment Outcome
Data: 2014
Editora: Elsevier
Citação: J Vasc Surg. 2014 Feb;59(2):275-82
Resumo: OBJECTIVE: A familial predisposition to abdominal aortic aneurysms (AAAs) is present in approximately one-fifth of patients. Nevertheless, the clinical implications of a positive family history are not known. We investigated the risk of aneurysm-related complications after endovascular aneurysm repair (EVAR) for patients with and without a positive family history of AAA. METHODS: Patients treated with EVAR for intact AAAs in the Erasmus University Medical Center between 2000 and 2012 were included in the study. Family history was obtained by written questionnaire. Familial AAA (fAAA) was defined as patients having at least one first-degree relative affected with aortic aneurysm. The remaining patients were considered sporadic AAA. Cardiovascular risk factors, aneurysm morphology (aneurysm neck, aneurysm sac, and iliac measurements), and follow-up were obtained prospectively. The primary end point was complications after EVAR, a composite of endoleaks, need for secondary interventions, aneurysm sac growth, acute limb ischemia, and postimplantation rupture. Secondary end points were specific components of the primary end point (presence of endoleak, need for secondary intervention, and aneurysm sac growth), aneurysm neck growth, and overall survival. Kaplan-Meier estimates for the primary end point were calculated and compared using log-rank (Mantel-Cox) test of equality. A Cox-regression model was used to calculate the independent risk of complications associated with fAAA. RESULTS: A total of 255 patients were included in the study (88.6% men; age 72 ± 7 years, median follow-up 3.3 years; interquartile range, 2.2-6.1). A total of 51 patients (20.0%) were classified as fAAA. Patients with fAAA were younger (69 vs 72 years; P = .015) and were less likely to have ever smoked (58.8% vs 73.5%; P = .039). Preoperative aneurysm morphology was similar in both groups. Patients with fAAA had significantly more complications after EVAR (35.3% vs 19.1%; P = .013), with a twofold increased risk (adjusted hazard ratio, 2.1; 95% confidence interval, 1.2-3.7). Secondary interventions (39.2% vs 20.1%; P = .004) and aneurysm sac growth (20.8% vs 9.5%; P = .030) were the most important elements accounting for the difference. Furthermore, a trend toward more type I endoleaks during follow-up was observed (15.6% vs 7.4%; P = .063) and no difference in overall survival. CONCLUSIONS: The current study shows that patients with a familial form of AAA develop more aneurysm-related complications after EVAR, despite similar AAA morphology at baseline. These findings suggest that patients with fAAA form a specific subpopulation and create awareness for a possible increase in the risk of complications after EVAR.
Peer review: yes
URI: http://hdl.handle.net/10400.17/1943
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