title: Patients with abdominal aortic aneurysm and chronic obstructive pulmonary disease have improved outcomes with endovascular aneurysm repair compared with open repair.
abstract: The purpose of our study was to evaluate outcomes in abdominal aortic aneurysm (AAA) patients with chronic obstructive pulmonary disease (COPD) undergoing open or endovascular abdominal aortic aneurysm repair (EVAR). We retrospectively examined the records of consecutive patients with AAA and COPD who underwent either open repair or EVAR between 2001 and 2008. In-hospital and follow-up outcomes were compared between open repair and EVAR using SPSS (SPSS Inc, Chicago, IL). Sixty-nine patients were included for analysis (mean age 71 +/- 1.0 years; 93% [n = 64] male). Open surgery was performed in 63% (n = 43). In-hospital mortality was 4%. All-cause mortality did not differ significantly between the open repair and EVAR groups during 3 years of follow-up (p = .491). In-hospital death and major complications occurred in 30% (n = 13) after open repair compared with 12% (n = 3) after EVAR (p = .075). Pneumonia occurred in 19% (n = 8) after open repair and in 0% after EVAR (p = .019); pneumonia was associated with increased mortality during the first year after AAA repair (log-rank test p = .003). Hospital length of stay was increased in the open repair group compared with the EVAR group (16 vs 5 days, p < .001), as was intensive care unit length of stay (11 vs 2 days, p < .001) and need for ventilation (61% vs 12%, p < .001). Patients with COPD and anatomically suitable AAAs should be preferentially offered EVAR.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Frederik H W
authors.initials: FH
authors.lastname: Jonker
authors.forename: Felix J V
authors.initials: FJ
authors.lastname: Schlösser
authors.forename: Michael
authors.initials: M
authors.lastname: Dewan
authors.forename: Matthew
authors.initials: M
authors.lastname: Huddle
authors.forename: Michael
authors.initials: M
authors.lastname: Sergi
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.forename: Bart E
authors.initials: BE
authors.lastname: Muhs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D011014:Pneumonia / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome