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. 2016;9(1):42-7.
doi: 10.3400/avd.oa.15-00129. Epub 2016 Mar 2.

Preoperative Predictors of Long-Term Mortality after Elective Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Saya Nagai  1 , Toshifumi Kudo  2 , Yoshinori Inoue  3 , Miho Akaza  1 , Tetsuo Sasano  1 , Yuki Sumi  1
Affiliations

Preoperative Predictors of Long-Term Mortality after Elective Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Saya Nagai et al. Ann Vasc Dis. 2016.

Abstract

Objective: This study aimed to clarify long-term mortality and its predictors in patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR).

Materials and methods: Patients with AAA who underwent elective EVAR at Tokyo Medical and Dental University hospital between 2008 and 2011 were reviewed. The patients' data were retrospectively collected from medical records.

Results: Sixty-four patients were identified for this study. In long-term follow-up, the survival rate was significantly lower in patients with high preoperative C-reactive protein (CRP) levels. Patients with obstructive lung disease (FEV1/FVC <70%) or anemia tended to have a poorer prognosis but the association was not statistically significant. Age, concurrent hyperlipidemia, and blood pressure levels were not predictors of mortality rates.

Discussion: High CRP level, COPD, and anemia reflect inflammation, which is associated with the pathogenesis of AAA. These inflammatory markers are predictors of long-term mortality after EVAR for AAA as well as for other diseases.

Conclusions: A high preoperative CRP level was a predictor of increased long-term mortality in patients with AAA who underwent EVAR. No specific leading causes of death were identified for this increase in the mortality rate.

Keywords: C-reactive protein; abdominal aorta aneurysm; endovascular aneurysm repair; mortality.

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Figures

Fig. 1
Fig. 1
Survival in patients with AAA undergoing EVAR. (A) Overall survival in patients with EVAR. The overall 5-year survival rate was 0.592 (95% CI: 0.440–0.715). (B) Patients with preoperatively elevated CRP (CRP ≥0.3 mg/dL) had poorer prognosis. The 5-year survival rate of patients with elevated CRP was 0.429 (95% CI: 0.170–0.667) and that of patients with normal CRP was 0.642 (95% CI: 0.458–0.777). AAA: abdominal aortic aneurysm; EVAR: endovascular aneurysm repair; CRP: C-reactive protein; CI: confident level
Fig. 2
Fig. 2
Causes of death. The causes of death in patients with preoperatively elevated CRP (CRP ≥0.3 mg/dL) were similar to those in all the patients with AAA undergoing EVAR. CRP: C-reactive protein; AAA: abdominal aortic aneurysm; EVAR: endovascular aneurysm repair
Fig. 3
Fig. 3
Patients with obstructive lung diseases (FEV1/FVC <70%). (A) Patients with obstructive lung diseases (FEV1/FVC <70%) tended to have poorer prognosis but this association was not statistically significant (p = 0.209). The five-year survival rate of patients with obstructive lung diseases was 0.595 (95% CI: 0.309–0.795) and that of patients without obstructive lung diseases was 0.619 (95% CI: 0.415–0.770). (B) Correlation between CRP levels and FEV1/FVC. Patients with obstructive pulmonary function tended to have high preoperative CRP levels. Spearman’s rank correlation coefficient = –0.391 and p = 0.0032. CI: confident level; CRP: C-reactive protein
Fig. 4
Fig. 4
Patients with anemia (male: serum hemoglobin <13.8 g/dL, female: serum hemoglobin <12.0 g/dL). (A) Patients with anemia tended to have poorer prognosis but this association did not reach statistical significance (p = 0.282). The 5-year survival rate of patients with anemia was 0.503 (95% CI: 0.248–0.712) and that of patients without anemia was 0.630 (95% CI: 0.438–0.773). (B) Correlation between CRP and hemoglobin levels. There were no correlations between CRP and hemoglobin levels. Spearman’s rank correlation coefficient = –0.0451 and p = 0.723. CI: confident level; CRP: C-reactive protein
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References

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