title: Life expectancy and causes of death after repair of intact and ruptured abdominal aortic aneurysms.
abstract: BACKGROUND
  Life expectancy and causes of death after abdominal aortic aneurysm (AAA) repair are not well characterized. Population aging and improved secondary prevention may have modified the prognosis of these patients. We designed a retrospective cohort study to determine the vital prognosis, causes of death, and differences in outcome after intact and ruptured AAA.
  
  
  METHODS
  All patients with AAA treated from 2003 to 2011 at a single university institution in The Netherlands were analyzed. Survival status was derived from civil registry data. Causes of death were obtained from death certificates. The primary end point was overall mortality. Secondary end points were cardiovascular, cancer-related, and AAA-related mortality. Predictors for perioperative and late survival were obtained by logistic regression and Cox regression models, respectively.
  
  
  RESULTS
  The study included 619 consecutive AAA patients (12% women; mean age, 72 years), of whom 152 (24.5%) had ruptured AAAs. Endovascular repair was performed in 390 (63%). Rupture (odds ratio [OR], 10.63; 95% confidence interval [CI], 4.80-23.5), open repair (OR, 3.59; 95% CI, 1.69-7.62), renal insufficiency (OR, 2.94; 95% CI, 1.51-3.46), and age (OR, 1.08 per year; 95% CI, 1.09-1.15) were predictors of 30-day mortality. Five-year survival expectancy was 65% for intact AAA and 41% for ruptured AAA (P < .001). Cardiovascular deaths unrelated to the AAA occurred in 35% and cancer-related deaths in 29% of deceased patients. Predictors for late mortality were history of prior malignant disease (hazard ratio, 2.83; 95% CI, 1.99-4.03) and age (hazard ratio, 1.08 per year; 95% CI, 1.05-1.10). After 30 days, only six deaths (1.1%) were AAA related.
  
  
  CONCLUSIONS
  Endovascular repair reduced perioperative mortality by threefold, but no survival benefit was observed at long term. After the perioperative period, survival of ruptured AAA and intact AAA patients was not different. Deaths were distributed in similar proportions between cardiovascular and cancer-related causes.
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Vascular Surgery, Hospital de Santa Marta, CHLC, NOVA Medical School, Lisbon, Portugal. Electronic address: f.bastosgoncalves@erasmusmc.nl.
authors.forename: Frederico
authors.initials: F
authors.lastname: Bastos Gonçalves
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Klaas H J
authors.initials: KH
authors.lastname: Ultee
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stolker
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Hence J M
authors.initials: HJ
authors.lastname: Verhagen
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D009426:Netherlands; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*