title: The fate of patients referred to a specialist vascular unit with large infra-renal abdominal aortic aneurysms over a two-year period.
abstract: BACKGROUND
  The basic premise in managing patients with abdominal aortic aneurysms (AAA) must be to reduce overall mortality from the disease. Operative mortality is widely reported, but data on patients deemed unsuitable for repair are scarce. The purpose of the present study was to report the fate of patients referred with AAA, to define the proportion deemed unsuitable for surgery and to investigate the reasons for conservative treatment.
  
  
  METHODS
  All patients who were referred to a regional vascular centre with large (>5.5 cm) infra-renal AAA between 1st January 2008 and 31st December 2009 were included. Patients were classified into two groups; those managed non-operatively, or those offered elective repair. Survival was reported by Kaplan-Meier analysis. Multivariate analysis investigated factors leading to non-operative management.
  
  
  RESULTS
  251 patients with a mean (s.d.) age of 75(8) years were assessed. Thirty-two (13%) patients were deemed unsuitable for repair, mostly because of medical co-morbidity (16/32). 219/251 (87%) patients underwent repair (25/251 (10%) open repair 194/251 (77%) EVAR) with 1/219 (0.5%) 30-day mortality. AAA repair was associated with significantly greater survival (p < 0.001, log-rank test) at 2 years. In multivariate analysis Glasgow Aneurysm Score, female gender and respiratory disease were significant predictors of the decision to treat patients conservatively (p < 0.001).
  
  
  CONCLUSIONS
  Most patients were suitable for surgical intervention with low perioperative mortality. Data on "turndown" rates should be routinely reported to quantify the denominator for operative success.
authors.affiliation: St George's Vascular Institute, St George's Hospital Healthcare NHS Trust, London SW17 0QT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: T K
authors.initials: TK
authors.lastname: Nicoli
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: N
authors.initials: N
authors.lastname: Pasha
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies