Limited survival in dialysis patients undergoing intact abdominal aortic aneurysm repair
| Autor: | Michel S. Makaroun, Efthymios D. Avgerinos, Rabih A. Chaer, Luke Marone, Joseph Sidaoui, Theodore H. Yuo |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Renal Dialysis medicine Humans Dialysis Aged Retrospective Studies Proportional hazards model business.industry Mortality rate Hazard ratio Endovascular Procedures Odds ratio Perioperative Middle Aged medicine.disease Abdominal aortic aneurysm United States Surgery Survival Rate Treatment Outcome Elective Surgical Procedures Current Procedural Terminology Kidney Failure Chronic Female business Cardiology and Cardiovascular Medicine Aortic Aneurysm Abdominal Follow-Up Studies |
| Zdroj: | Journal of Vascular Surgery. 60(4):908-913.e1 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2014.04.050 |
| Popis: | ObjectiveElective abdominal aortic aneurysm (AAA) repair in suitable candidates is a standard modality. The outcomes of AAA repair in patients with end-stage renal disease on dialysis are not well characterized, and there is questionable survival advantage in such patients with limited life expectancy. We sought to describe outcomes after AAA repair in U.S. dialysis patients.MethodsThe United States Renal Data System was used to collect data on intact asymptomatic AAA repair procedures in dialysis patients in the United States between 2005 and 2008. Endovascular AAA repair (EVAR) and open aortic repair (OAR) were identified by Current Procedural Terminology codes. Primary outcomes were perioperative (30-day) mortality and long-term survival. Predictors of mortality were identified by multivariate regression models.ResultsA total of 1557 patients were identified who had undergone elective AAA repair: 261 OAR and 1296 EVAR. The 30-day mortality was 11.3% (EVAR, 10.3%; OAR, 16.1%; P = .010), with increased age associated with increased mortality (odds ratio, 1.04; 95% confidence interval [CI], 1.02-1.07; P = .001). Kaplan-Meier survival estimates were 66.5% at 1 year (EVAR, 66.2%; OAR, 68%) and 37.4% at 3 years (EVAR, 36.8%; OAR, 40%; P = .33). Median survival was 25.3 months after EVAR and 27.4 months after OAR. Women had a higher mortality rate at 1 year (38.7%) compared with men (32.0%) (P = .015). There was no significant mortality difference at 1 year in comparing type of procedure in both men (EVAR, 31.6%; OAR, 34%; P = .55) and women (EVAR, 39.3%; OAR, 36%; P = .60). A Cox proportional hazards model demonstrated that male gender (hazard ratio [HR], 0.75; 95% CI, 0.62-0.92; P = .005), increased time on dialysis (HR for each year on dialysis, 0.79; 95% CI, 0.75-0.83; P < .001), kidney transplantation history (HR, 0.62; 95% CI, 0.43-0.88; P = .008), and diagnosis of hypertension (HR, 0.60; 95% CI, 0.48-0.75; P |
| Databáze: | OpenAIRE |
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