title: Long-term outcomes and factors influencing late survival following elective abdominal aortic aneurysm repair: A 24-year experience.
abstract: BACKGROUND
  Abdominal aortic aneurysms can be either treated by an open abdominal aortic aneurysm repair or an endovascular repair. Comparing clinical predictors of outcomes and those which influence survival rates in the long term is important in determining the choice of treatment offered and the decision-making process with patients.
  
  
  OBJECTIVE
  To determine the influence of pre-existing clinical predictors and perioperative determinants on late survival of elective open abdominal aortic aneurysm repair and endovascular repair at a tertiary hospital.
  
  
  METHODS
  Consecutive patients undergoing elective abdominal aortic aneurysm repair from 1990 to 2013 were included. Data were collected from a prospectively acquired database and death data were gathered from the Queensland state death registry. Pre-existing risks and perioperative factors were assessed independently. Kaplan-Meier and Cox regression modeling were performed.
  
  
  RESULTS
  During the study period, 1340 abdominal aortic aneurysms were repaired electively, of which 982 were open abdominal aortic aneurysm repair. The average age was 72.4 years old and 81.7% were males. The cumulative percentage survival rates for open abdominal aortic aneurysms repair at 5, 10, 15 and 20 years were 79, 49, 31 and 22, respectively. The corresponding 5-, 10- and 15-year survival rates for endovascular repair were not significantly different at 75, 49 and 33%, respectively (P = 0.75). Predictors of reduced survival were advanced age, American Society of Anaesthesiology scores, chronic obstructive pulmonary disease, renal impairment, bifurcated grafts, peripheral vascular disease and congestive heart failure.
  
  
  CONCLUSIONS
  Open repair offers a good long-term treatment option for patients with an abdominal aortic aneurysm and in our experience there is no significant difference in late survival between open abdominal aortic aneurysms repair and endovascular repair. Consideration of the factors identified in this study that predict reduced long-term survival for open abdominal aortic aneurysms repair and endovascular repair should be considered when deciding repair of abdominal aortic aneurysm.
authors.affiliation: Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia Manar.khashram@gmail.com.
authors.forename: Manar
authors.initials: M
authors.lastname: Khashram
authors.affiliation: Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Jenkins
authors.affiliation: Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Jenkins
authors.affiliation: Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Kruger
authors.affiliation: Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Boyne
authors.affiliation: Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia.
authors.forename: Wallace J
authors.initials: WJ
authors.lastname: Foster
authors.affiliation: Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia Discipline of Surgery and Centre for Clinical Research, University of Queensland, Brisbane, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Walker
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011793:Queensland; D012042:Registries; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Abdominal aortic aneurysm repair; EVAR; model; open aortic repair; risk factors; survival