Authors: R Hultgren Sayid Zommorodi Moa Gambe Joy Roy
Publish Date: 2016/08/22
Volume: 40, Issue: 12, Pages: 3080-3087
Abstract
Abdominal aortic aneurysm AAA is an asymptomatic potentially lethal condition predominantly found in elderly The mortality is 100 if rupture occurs and left untreated but even in treated patients the mortality is substantial Female sex and treatment with open repair rather than endovascular aortic repair EVAR have been reported to negatively affect outcome The objective was to describe the contemporary care and outcome of all treated and untreated patients with ruptured AAA rAAA admitted to hospitalPopulationbased retrospective investigation including all patients admitted to the emergency departments within Stockholm County diagnosed with rAAA 2009–2013 All identified patients’ charts n = 297 were analyzed the study cohort includes 283 verified patientsMen were in majority 214 76 69 24 women and were younger than women 78 vs 82 years p 0001 A majority of patients were treated 212/283 75 a similar proportion of women and men Untreated patients had a higher mean age 84 vs 77 years p 0001 The proportion treated with EVAR was 27 and they were older than OR treated 79 vs 76 years p = 0043 Fortyseven percentage of patients admitted with rAAA survived 30 days and 62 of treated patients survived 30 days The 30day mortality for women and men was similarOur results and other contemporary series show a shift toward a higher rate of treated patients with rAAA and improving outcomes similar for women and men The increased use of EVAR contributes to this improvement in shortterm outcome High age influences the willingness to treat patients with rAAAOur original work has been approved by all authors and all authors accept full responsibility for the design and conduct of the study had access to the data and controlled the decision to publish This work has not been published previously and is not under consideration for publication elsewhereMost studies have focused only on the treated patients and historically only a few studies have addressed and included the persons admitted but left untreated which indeed does affect the view on patient care of this group 2 9 10 11 Treated women both in series of ruptured and elective cases have been reported to have a worse outcome than men This can correlate with their higher age when treated poorer morphology or different distribution of risk factors 1 12 13 14 15 16 A risk of withholding corrective treatment in women with rupture compared to men has been described 73 of men treated versus 56 of women also confirmed in a singlecenter study from Australia fewer women were treated 37 vs 63 17 The strongest predictor for death due to most surgical procedures as well as rAAA is old age 1 12 18 19 20 21 22 It is not certain how influential the patient’s age is on the decision to offer corrective treatment to rAAA patients Mortality is higher after OR than EVAR according to retrospective studies 12 21 23 24 and this is also reported in the Swedish Vascular Registry 3 EVAR is a less invasive method than OR with a lower perioperative complication rate but randomized trials have failed to show a difference in shortterm mortality 25 26 27
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