A comparison of physiology scores and morphology in a group of patients evaluated for endovascular repair of infrarenal aneurysms.
OBJECTIVE
Endovascular repair (EVR) of abdominal aortic aneurysms (AAA) is an accepted alternative to open repair (OR). Anatomical suitability for EVR of 196 consecutive AAA referrals is analysed, according to aneurysm size and relative physiological fitness for OR.


METHODS
Patients were evaluated for suitability according to 2 sets of arbitrary EVR anatomical criteria: flexible criteria (FC), and a subgroup, rigid criteria (RC) with few technical risks. Suitability was related to aneurysm size and operative risk (POSSUM).


RESULTS
Eighty-eight patients (45%) were suitable by FC, 33 (17%) by RC, and 108 (55%) were unsuitable for EVR. Inadequate neck length (56%) and angulation (26%), were principle reasons for unsuitability. Mean AAA diameter was 60.5 mm for the whole group, 58.4 mm for those suitable by FC, 56.5 mm for those suitable by RC and 62.1 mm in those unsuitable (p<0.01). Median physiology scores (interquartile ranges) were 19 (17-21) overall, 18 (17-21) in those suitable FC, 18 (17-19) in those suitable by RC and 19 (18-21) for unsuitable patients (NS). High risk patients with large aneurysms. There were 133 larger aneurysms (=/>55 mm in diameter), of which there were 56 patients with physiology scores =/>20. Of these 16 (29%) and 4 (7%) were suitable by FC and RC, respectively. By comparison, of the remaining 77 with physiology scores of =/<19.35 (45%) were suitable for FC and 15 (19%) for RC (p<0.05).


CONCLUSIONS
Unfit patients with significantly sized aneurysm; ironically those most likely to benefit, tend to be less suitable for EVR.
Butcher
W
W
Department of Surgery, The Royal Bournemouth Hospital, Bournemouth, UK. William.butcher@rbch-trust.nhs.uk
Darke
S G
SG
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D018570:Risk Assessment