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Journal of Medical Case Reports

, 2:317

First Online: 30 September 2008Received: 16 October 2007Accepted: 30 September 2008DOI: 10.1186-1752-1947-2-317

Cite this article as: Schlösser, F.J., JMG van der Heijden, G., van der Graaf, Y. et al. J Med Case Reports 2008 2: 317. doi:10.1186-1752-1947-2-317

Abstract

IntroductionEndovascular abdominal aortic aneurysm repair is a life-saving intervention. Nevertheless, complications have a major impact. We review the evidence from case reports for risk factors of complications after endovascular abdominal aortic aneurysm repair.

Case presentationWe selected case reports from PubMed reporting original data on adverse events after endovascular abdominal aortic aneurysm repair. Extracted risk factors were: age, sex, aneurysm diameter, comorbidities, re-interventions, at least one follow-up visit being missed or refusal of a re-intervention by the patient. Extracted outcomes were: death, rupture and non-device-related complications.

In total 113 relevant articles were selected. These reported on 173 patients. A fatal outcome was reported in 15% N = 26 of which 50% came after an aneurysm rupture N = 13. Non-fatal aneurysm rupture occurred in 15% N = 25. Endoleaks were reported in 52% of the patients N = 90. In half of the patients with a rupture no prior endoleak was discovered during follow-up. In 83% of the patients one or more re-interventions were performed N = 143. Mortality was higher among women risk ratio 2.9; 95% confidence interval 1.4 to 6.0, while the presence of comorbidities was strongly associated with both ruptures risk ratio 1.6; 95% confidence interval 0.9 to 2.9 and mortality risk ratio 2.1; 95% confidence interval 1.0 to 4.7. Missing one or more follow-up visits ≥1 or refusal of a re-intervention by the patient was strongly related to both ruptures risk ratio 4.7; 95% confidence interval 3.1 to 7.0 and mortality risk ratio 3.8; 95% confidence interval 1.7 to 8.3.

ConclusionFemale gender, the presence of comorbidities and at least one follow-up visit being missed or refusal of a re-intervention by the patient appear to increase the risk for mortality after endovascular abdominal aortic aneurysm repair. Larger aneurysm diameter, higher age and multimorbidity at the time of surgery appear to increase the risk for rupture and other complications after endovascular abdominal aortic aneurysm repair. These risk factors deserve further attention in future studies.

AbbreviationsAAAabdominal aortic aneurysm

ASAAmerican Society for Anesthesiology

CIconfidence interval

EVARendovascular abdominal aortic aneurysm repair

GFRglomerular filtration rate

RRrisk ratio

SDstandard deviation.

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Author: Felix JV Schlösser - Geert JMG van der Heijden - Yolanda van der Graaf - Frans L Moll - Hence JM Verhagen

Source: https://link.springer.com/







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