title: Outcome of abdominal aortic endografting in high-risk patients: a 4-year single-center study.
abstract: OBJECTIVE
  To evaluate feasibility, safety, and effectiveness of endovascular abdominal aortic aneurysm (AAA) repair in patients whose fitness for surgery is questionable.
  
  
  METHODS
  Between April 1997 and December 2001, 389 consecutive patients underwent endovascular AAA repair. Of these, 51 (13.1%) were ASA grade IV. The perioperative and late outcomes of this group were compared to the remaining 338 patients with ASA grades <IV. Failure of AAA exclusion was defined as late conversion to open repair, AAA rupture, increased aneurysm diameter, or persisting graft-related endoleak. Gender, age, ASA grade IV, EUROSTAR class E, and AAA diameter were examined by logistic regression analysis for their influence on perioperative death, survival, and failure of AAA exclusion.
  
  
  RESULTS
  Four (7.8%) perioperative deaths occurred in the ASA IV group compared to 1 (0.3%) in the ASA <IV group (p=0.001). Median follow-up was 22 months (range 1-56). Failure of AAA exclusion occurred in 3 (5.9%) patients in ASA IV group and in 25 (7.4%) in ASA <IV group (p>0.05). Actuarial survival at 30 months was 62.9% in ASA IV group and 88.0% in ASA <IV group (p=0.001, log-rank test). There were no independent predictors for failure of AAA exclusion; ASA IV was independently associated with perioperative mortality (HR 17.8; 95% CI 1.6 to 188; p=0.016).
  
  
  CONCLUSIONS
  Endovascular AAA repair in ASA IV patients is feasible and effective in preventing AAA rupture in the mid term. High-risk patients experience a worse prognosis than their good-risk counterparts. An individualized approach in selecting high-risk patients for endoluminal repair is mandatory.
authors.affiliation: Unit of Vascular Surgery, Policlinico Monteluce, Perugia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Verzini
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Cao
authors.forename: Simona
authors.initials: S
authors.lastname: Zannetti
authors.forename: Gianbattista
authors.initials: G
authors.lastname: Parlani
authors.forename: Paola
authors.initials: P
authors.lastname: De Rango
authors.forename: Agostino
authors.initials: A
authors.lastname: Maselli
authors.forename: Luciano
authors.initials: L
authors.lastname: Lupattelli
authors.forename: Basso
authors.initials: B
authors.lastname: Parente
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures