title: Peripheral artery disease patients may benefit more from aggressive secondary prevention than aneurysm patients to improve survival.
abstract: Although it has become clear that aneurysmal and occlusive arterial disease represent two distinct etiologic entities, it is still unknown whether the two vascular pathologies are prognostically different. We aim to assess the long-term vital prognosis of patients with abdominal aortic aneurysmal disease (AAA) or peripheral artery disease (PAD), focusing on possible differences in survival, prognostic risk profiles and causes of death.
  
  
  
  Patients undergoing elective surgery for isolated AAA or PAD between 2003 and 2011 were retrospectively included. Differences in postoperative survival were determined using Kaplan-Meier and Cox regression analysis. Prognostic risk profiles were also established with Cox regression analysis.
  
  
  
  429 and 338 patients were included in the AAA and PAD groups, respectively. AAA patients were older (71.7 vs. 63.3 years, p < 0.001), yet overall survival following surgery did not differ (HR: 1.16, 95% CI: 0.87-1.54). Neither was type of vascular disease associated with postoperative cardiovascular nor cancer-related death. However, in comparison with age- and gender-matched general populations, cardiovascular mortality was higher in PAD than AAA patients (48.3% vs. 17.3%). Survival of AAA and PAD patients was negatively affected by age, history of cancer and renal insufficiency. Additional determinants in the PAD group were diabetes and ischemic heart disease.
  
  
  
  Long-term survival after surgery for PAD and AAA is similar. However, overall life expectancy is significantly worse among PAD patients. The contribution of cardiovascular disease towards mortality in PAD patients warrants more aggressive secondary prevention to reduce cardiovascular mortality and improve longevity.
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands.
authors.forename: Klaas H J
authors.initials: KHJ
authors.lastname: Ultee
authors.affiliation: Department of Anaesthesiology, Erasmus University Medical Center, The Netherlands.
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
authors.forename: Frederico Bastos
authors.initials: FB
authors.lastname: Gonçalves
authors.affiliation: Department of Cardiology, Erasmus University Medical Center, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.affiliation: Department of Anaesthesiology, Erasmus University Medical Center, The Netherlands.
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Stolker
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands.
authors.forename: Hence J M
authors.initials: HJM
authors.lastname: Verhagen
authors.affiliation: Department of Vascular Surgery, Erasmus University Medical Center, The Netherlands. Electronic address: e.rouwet@erasmusmc.nl.
authors.forename: Ellen V
authors.initials: EV
authors.lastname: Rouwet
mesh_terms: D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality* / Q000601:surgery; D003324:Coronary Artery Disease / Q000517:prevention & control; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology; D058729:Peripheral Arterial Disease / Q000150:complications / Q000401:mortality* / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Abdominal; Aortic aneurysm; Cause of death; Life expectancy; Peripheral arterial disease; Secondary prevention; Survival analysis