The National Health Service Abdominal Aortic Aneurysm Screening Programme in England

Background

Ruptured abdominal aortic aneurysm (AAA) is responsible for the premature death of more than 4,000 men in England and Wales every year. AAAs are usually asymptomatic before they rupture, yet they are easily detected by a simple abdominal ultrasound scan.

Methods

This paper reviews the evidence for, and implementation of, a national AAA population screening programme in England.

Results

Population screening of 65-year-old men can reassure most that they will not get an AAA, but it can also detect a small number of men with a large AAA at immediate risk of rupture, and a larger number of men with a small or medium AAA at minimal immediate risk, but who may be offered ongoing ultrasound surveillance. Population screening of men aged 65–74 has a sound evidence base, and reduces subsequent AAA-related mortality for at least 13 years by up to 50?%. Some Western countries, including the UK, have adopted population screening using public funding, whereas others remain to be convinced, and continue to collate research. The epidemiology of AAA is changing quickly, with the prevalence in 65-year-old men decreasing rapidly as smoking habits change and more medical treatments are used to manage cardiovascular risk factors.

Conclusion

As evidence on the natural history of AAA continues to emerge, new and ongoing programmes will need to be responsive and adapt. The AAA screening programme of the future will evolve using emerging clinical and cost-effectiveness data.     

Wie ist die Umsetzung eines AAA-Screening-Programms in Deutschland möglich?

Background

Screening programs are currently of upmost importance in health politics. Large international studies of abdominal aortic aneurysm (AAA) screening programs showed a significant decrease in aneurysm-dependent mortality. In view of these findings, AAA screening programs have been implemented in various countries with variable healthcare infrastructures.

Aim

In Germany a screening program also urgently needs to be introduced but realization depends on a variety of factors. This article presents the health service system in Germany and compares it with countries that have already established AAA screening programs. A comparative analysis of factors influencing possible conditions for introducing an AAA screening program in Germany was carried out.

Material and methods

A nationwide written survey of 2000 representatively chosen German family practitioners was carried out in order to evaluate their knowledge of AAAs, the availability of ultrasound devices and the motivation for performing the screening.

Results

A majority of German family practitioners possess the required knowledge of AAAs and the ultrasound skills to perform the screening. In addition, more than two thirds were in possession of an ultrasound device. Most practitioners were confident of performing a screening and would participate in a nationwide screening of AAAs.

Conclusion

The conditions for a nationwide implementation of an AAA screening program performed with the help of general practitioners are fulfilled, considering knowledge, motivation und ultrasound availability. Owing to the lower logistic and financial expenditures in comparison to foreign AAA screening programs, the implementation by general practitioners seems to be advantageous.     

Abdominal aortic aneurysm screening program in Poland

Background

Screening for abdominal aortic aneurysms (AAA) is currently recommended by several vascular societies. In countries where it has been introduced the prevalence of AAAs differed greatly and was mainly related to cigarette smoking. The screening program also had an enormous impact on the decrease of AAA ruptures and reduced mortality rate. These facts have led to the introduction of the first screening program for AAAs in Poland.

Objective

The aim of the study was to determine the prevalence of AAAs among men aged 60 years and older undergoing ultrasound examination of the abdominal aorta.

Material and methods

A single ultrasonography of the abdomen was performed to assess the aorta from the renal arteries to the bifurcation and the diameter of the aorta was measured at its widest point. The cut-off value for determining an aortic aneurysm was set at a diameter of ≥?30 mm. All ultrasonography measurements were performed by physicians in outpatient departments throughout the Kuyavian-Pomeranian Province. Additionally, each subject had to fill out a questionnaire with demographic data, smoking habits, existing comorbidities and familial occurrence of AAAs. The study was conducted from October 2009 to November 2011.

Results

The abdominal aorta ultrasound examinations were carried out in 1556 men aged 60 years and older. The prevalence of AAA in the study population was 6.0?% (94 out of 1556). The average age of the men was 69 years (SD 6 years, range 60–92 years). In the study population 55?% of the men smoked or had smoked and 3?% were aware of the presence of AAAs in family members. There were three risk factors significantly associated with the presence of AAAs: age (p?Conclusion The prevalence of AAAs among men in Poland is higher than in other European countries and the USA. The screening program for AAAs is an easy and reliable method for detecting early stages of the disease and risk factors which are the driving forces for the development of AAAs.     

Medikamentöse Therapie zur Risikoreduktion und Progressionshemmung nicht interventionspflichtiger abdomineller Aortenaneurysmen

Background

An ultrasound screening examination is highly effective in the detection of abdominal aortic aneurysms (AAA) in males above the age of 65 years. Patients with small AAAs (diameter Objectives The effectiveness of medicinal treatment approaches on the overall cardiovascular risk and on the growth and rupture rate of small AAAs was analyzed.

Material and methods

This article presents and discusses the currently available literature on the effectiveness of medicinal treatment of small AAAs.

Results

Statins, beta blockers and angiotensin-converting enzyme (ACE) inhibitors reduce cardiovascular mortality in patients with AAAs and statins also reduce the growth rate of AAAs.

Conclusion

Screening programs must implement strategies to improve total cardiovascular prognosis of patients with small AAAs.     

Management of symptomatic abdominal aortic aneurysms following emergency computed tomography

Purpose

It is still difficult to determine the appropriate timing of surgery for a symptomatic abdominal aortic aneurysm (AAA). Since recent developments in computed tomography (CT) have made the procedure substantially less time-consuming, we used CT on patients with symptomatic AAA to determine the most appropriate management option.

Methods

CT was performed on 79 patients with symptomatic AAA. If rupture of the AAA was confirmed by CT, patients underwent emergency surgery. If there was no rupture, patients were observed in an intensive care unit, and surgery was scheduled according to the results of repeated CT (2.1 times on average) and physical examinations, as well as on their clinical signs and symptoms.

Results

By CT, we identified 42 ruptures, one contained rupture, one aortocaval fistula, five acute aortic dissections with AAAs, six inflammatory AAAs, six pseudoaneurysms and 18 non-ruptured AAAs. The mortality rate of the patients with ruptures was 33 %. For the 37 patients without rupture, as determined by CT, three emergency, nine urgent, and 20 elective operations were performed. Two patients who refused surgery experienced late rupture and died. Among the other 35 patients, the mortality rate was 6 %.

Conclusion

CT was an effective modality to classify patients with symptomatic AAA into those who needed emergency surgery and those who did not. We could observe patients with symptomatic non-ruptured AAAs before urgent/elective operations by repeated CT and monitor the clinical findings.     

Screening for abdominal aortic aneurysm with electronic clinical reminders

Background

Based on randomized, population-based screening protocols, a single ultrasound examination reduces mortality from an abdominal aortic aneurysm (AAA) by facilitating elective surgical intervention before rupture. Ultrasound screening is accurate, noninvasive, inexpensive, and cost effective. By using a comprehensive electronic medical record, we inquired whether an age-prompted clinical reminder would facilitate the detection of AAA.

Methods

The AAA risk screen was installed in May 2007 via a computerized patient record system prompt for male veterans ages 65 to 75 who ever smoked. This abbreviated ultrasound examination uses a 3.5- to 4-MHz scan head, measures anteroposterior and transverse planes, and reports the largest infrarenal aortic diameter.

Results

Of 1437 examinations there were 73 AAAs of 3.0-cm diameter or larger (5.1%); 33 AAAs of 4.0-cm diameter or larger (2.3%); 15 AAAs of 5.0-cm diameter or larger (1.0%); and 11 AAAs of 5.5-cm diameter or larger (.77%). Fifty (68%) received counseling for abnormal findings.

Conclusions

Recognition of newly diagnosed AAA compared favorably with that of previous screening studies. Electronic clinical reminders identify undiagnosed, life-threatening AAAs before rupture. Immediate counseling is available in the vascular setting.     

Measuring abdominal aortic diameters in routine abdominal computed tomography scans and implications for abdominal aortic aneurysm screening

Objective

This study aimed to determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the performance of radiologists to identify and report AAA.

Kardiovaskuläres Risiko bei EVAR und offener Operation des nicht rupturierten abdominalen Aortenaneurysmas

Background

Cardiovascular complications have a significant impact on the outcome of patients with an abdominal aortic aneurysm (AAA) treated by open repair (OR) or by endovascular aneurysm repair (EVAR). EVAR might be associated with fewer cardiovascular complications. This review was undertaken to analyze whether the selection of EVAR and OR has an effect on cardiovascular complications within randomized trials with intact AAA patients.

Methods

Analysis of cardiovascular complications reported in the prospective, randomised trials (RCTs) comparing EVAR and OR in the elective treatment of intact AAAs.

Results

Four RCTs give evidence that EVAR is associated with a significantly lower perioperative mortality rate. Cardiovascular mortality and complication rates do not differ significantly between the two treatment options; this is also true for the long-term follow-up. Cardiac complications are inconsistently reported and vary widely. These results are true for patients with a low or average surgical risk and an AAA which can be treated by OR and EVAR. Large registries indicate that especially for high-risk patients and patients >?80 years the cardiovascular event rate is significantly reduced by the use of EVAR rather than OR.

Conclusion

EVAR is associated with a significantly lower perioperative mortality rate. Patients with a normal or average surgical risk have similar cardiovascular outcomes. Elderly patients and high-risk patients may benefit from EVAR.     

Abdominal aortic aneurysm rupture rates: A 7-year follow-up of the entire abdominal aortic aneurysm population detected by screening

Purpose: The goal of the current study was to identify the risk of rupture in the entire abdominal aortic aneurysm (AAA) population detected through screening and to review strategies for surgical intervention in light of this information. Methods: Two hundred eighteen AAAs were detected through ultrasound screening of a family practice population of 5394 men and women aged 65 to 80 years. Subjects with an AAA of less than 6.0 cm in diameter were followed prospectively with the use of ultrasound, according to our protocol, for 7 years. Patients were offered surgery if symptomatic, if the aneurysm expanded more than 1.0 cm per year, or if aortic diameter reached 6.0 cm. Results: The maximum potential rupture rate (actual rupture rate plus elective surgery rate) for small AAAs (3.0 to 4.4 cm) was 2.1% per year, which is less than most reported operative mortality rates. The equivalent rate for aneurysms of 4.5 to 5.9 cm was 10.2% per year. The actual rupture rate for aneurysms up to 5.9 cm using our criteria for surgery was 0.8% per year Conclusion: In centers with an operative mortality rate of greater than 2%, (1) surgical intervention is not indicated for asymptomatic AAAs of less than 4.5 cm in diameter, and (2) elective surgery should be considered only for patients with aneurysms between 4.5 and 6 cm in diameter that are expanding by more than 1 cm per year or for patients in whom symptoms develop. In centers with elective mortality rates of greater than 10% for abdominal aortic aneurysm (AAA) repair, the benefit to the patient of any surgical intervention for an asymptomatic AAA of less than 6.0 cm in diameter is questionable. (J Vasc Surg 1998;28:124-8.)     

Ist das Screening auf abdominelle Aortenaneurysmen in Deutschland m?glich?

Introduction

Despite better clinical and surgical treatment options for abdominal aortic aneurysms (AAA) mortality rates are still increasing in Germany. The high rates are substantially due to spontaneous ruptures which in most cases prove fatal. International studies recommend screening programmes for AAA as these lead to a significant decrease in aneurysm-dependent mortality. However, in Germany such programmes are still lacking. The general possibility of ultrasound screening by family doctors was evaluated using a questionnaire.

Methods

A written survey of 2,000 representative family practitioners in Germany was initiated to determine the availability of ultrasound devices, knowledge relating to screening procedures and motivation to perform screening. The representativeness of the results was measured by a telephone re-test.

Results

The survey revealed that all of the approximately 60,000 family doctors in Germany are able to participate in an ultrasound screening program. More than two thirds of them possess an ultrasound machine and are trained to perform ultrasound screening. Most family doctors are motivated to take part in training courses and 75% would participate in a nationwide screening program.

Conclusions

A nationwide AAA screening in Germany is basically possible as participants are within easy reach of a family doctor with screening facilities in all areas of Germany. However, in order to do this it will be necessary to design a target group-oriented introduction campaign and a suitable financial remuneration structure must be established.     

Long-Term Survival and Quality of Life After Open Abdominal Aortic Aneurysm Repair

Background

Open repair of abdominal aortic aneurysm (AAA) generally involves postsurgery admission to the intensive care unit (ICU). Few studies have evaluated the impact of surgery for either ruptured or nonruptured AAA (with postoperative ICU treatment) on long-term survival and quality of life. The primary aim of this study was to quantify long-term survival and health-related quality of life (HrQpL) of a cohort of patients undergoing open AAA repair after hospital discharge.

Methods

Consecutive patients undergoing open elective or acute AAA reconstruction with postoperative admission to the ICU and discharged alive from the hospital during 2009 were identified. Primary outcome measures were 1-year and long-term mortality. The secondary outcome was the HrQoL using the EuroQol-6D (EQ-6D) questionnaire at the end of the follow-up period.

Results

A total of 263 patients were treated and postoperatively discharged alive: 56 had a ruptured AAA (rAAA), 35 a symptomatic AAA, and 172 an asymptomatic AAA. The 1-year mortality after open AAA repair was 8 %. Overall, 39 % of patients died within 10 postoperative years (mean 6.0 ± 2.8 years). Long-term survival of patients with a ruptured or symptomatic aneurysm was similar to that of patients undergoing elective aneurysm repair. Long-term HrQoL of the total study population was worse than that of an age-matched general Dutch population on the EQ-us (range 0–1, difference 0.12). This decrease in HrQoL was mainly seen in mobility, self-care, usual activities, and cognition.

Conclusions

Ten years after open AAA repair, the overall survival rate was 59 %. Long-term survival and HrQoL were similar for patients with a repaired ruptured or symptomatic aneurysm and those who underwent elective aneurysm repair. There were also no differences in patients with infrarenal versus juxtarenal/suprarenal aneurysms. Surviving patients had a lower HrQoL than the age-matched general Dutch population, especially regarding mobility, self-care, usual activities, and cognition.     

Abdominal aortic aneurysm screening: recommendations and controversies

Extensive level one evidence supports routine abdominal aortic aneurysm (AAA) screening in men aged 65 to 75 years, because AAAs are highly prevalent in this population. Physical examination is an insensitive means of detection. Ruptured AAAs are costly with respect to quality adjusted life years (QALY) lost and medical expenses. Large scale, randomized trials have demonstrated that AAA screening reduces all AAA-related mortality in the screened population and is cost-effective in mid-term follow-up. AAA screening by ultrasound has many advantages over other accepted medical screening programs in its simplicity in structure and the availability of an inexpensive, portable, and reliable means of screening. Additionally, AAA screening almost entirely avoids the negative consequences associated with other screening programs, including the adverse psychological effects and medical costs associated with false-positive examination results. There are subgroups of at-risk women who might benefit from AAA screening, and this issue should be further studied.     

Klinische Risikoindikatoren für die Entstehung abdominaler Aortenaneurysmen

Background

Evidence for ultrasound screening of abdominal aortic aneurysms (AAA) has been confirmed in several international studies. The efficiency could be increased by taking into account additional information about risk factors and secondary diagnoses to reduce the number of persons to be examined.

Material and methods

Population based studies from the years 2000 to 2014 concerning AAA screening were analyzed under the aspect of clinical risk factors. All randomized controlled studies (RCT) for AAA screening and health technology assessment (HTA) reports about clinical risk indicators were analyzed. The following variables were looked for: age, gender, smoking, family history, cardiovascular disease, peripheral arterial occlusive disease (PAOD), hypertension, obesity, chronic obstructive pulmonary disease (COPD), hypercholesterolemia and diabetes mellitus. In addition a short survey of rarely studied clinical variables is given.

Results

For the following risk factors a positive correlation for the development of AAA was found: body mass index (BMI), increasing age, male gender, nicotine history and a positive family history for AAA. Coronary artery disease (CAD), COPD and PAOD as comorbidities represent a significantly increased prevalence of AAA. Uncertain results and insufficient research results exist for obesity, hypercholesterolemia, COPD, physical activity and nutrition. The risk factors diabetes mellitus, non-white skin color as well as feminine gender were associated with a decreased probability of AAA.

Discussion

Many of the known risk factors for atherosclerosis are also associated with an increased prevalence of AAA; however, this is not always true. For example, female sex, diabetes mellitus and certain increases in fat metabolism are connected with a decreased prevalence. For female gender a differentiated approach should be recommended as a more sophisticated analysis is able to identify significant risks that need to be taken into account as women have a significantly increased risk of rupture and form a large part of the cases of rupture. A sophisticated algorithm for the identification of individuals who would benefit from an individualized indication for aortic screening could reduce the number needed to screen per identified aortic aneurysm.

Conclusion

In consideration of evident clinical risk factors further groups of patients could be defined which could particularly benefit from AAA screening. Under this aspect population-based prospective studies are necessary.     

Prevalence of abdominal aortic aneurysms in over 65-year-old men with inguinal hernias

INTRODUCTION

The aim of this study was to determine the prevalence of abdominal aortic aneurysms (AAAs) in over 65-year-old men who have inguinal hernias and discuss if pre-operative selective screening of this population is appropriate.

PATIENTS AND METHODS

A prospective study on 70 consecutive male patients with an age range of 65–88 years (mean, 74 years) who were referred to a single vascular consultant''s out-patient clinic with an inguinal hernia were screened for the presence of an AAA with an ultrasound scan before hernia repair over a period of 3 years.

RESULTS

Two patients were found to have an AAA measuring 3.8 cm and 6.0 cm giving an AAA prevalence of 3% (exact 95% confidence interval = 0–10%).

CONCLUSIONS

This study does not demonstrate an increased AAA prevalence in over 65-year-old male patients with inguinal hernias, scanned pre-operatively when compared to screening programmes. Selective screening of this cohort cannot be justified on this evidence.     

Aneurysmen der Bauchaorta und der Beckenarterien

Background

Therapy of abdominal aortic aneurysms (AAA) is currently based on a high level of evidence. This is not true in the same manner for iliac artery aneurysms (IAA) which are frequently associated with AAAs and occur only rarely as isolated lesions. The therapeutic principles apply in the same way to both aneurysm locations.

Objectives

New findings, improved perioperative care and the rapid development of minimally invasive techniques require a constant update which is the aim of this article concerning the therapy of AAAs and IAAs.

Material and methods

A systematic literature review was performed in PubMed and Medline and priority was given to recent publications with a high level of evidence.

Results

Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) result in a similar long-term survival. The perioperative survival advantage with EVAR persists only during medium-term postoperative courses. The reintervention rate after EVAR is substantially higher compared to OAR. For older patients and those who are considered unfit for OAR the expected benefits from EVAR has not been proven to date. Aneurysmal ruptures after EVAR demonstrate that a life-long surveillance of these patients is necessary.

Conclusion

Therapy of AAAs and IAAs is increasingly being performed by EVAR. Even the majority of complex aneurysms are amenable to minimally invasive treatment. Nevertheless, indications for OAR continue to exist. Screening for AAAs results in a decrease of aneurysmal ruptures for which EVAR is also gaining importance.     

Late survival after elective repair of aortic aneurysms detected by screening.

BACKGROUND: The aim of this study was to examine whether there was any survival advantage in men following elective repair of an abdominal aortic aneurysm (AAA) detected by ultrasound screening compared to those with an AAA detected incidentally. METHODS: A total of 424 men underwent elective AAA repair between 1990 and 1998; 181 were detected in an aneurysm screening programme and 243 were diagnosed incidentally. Follow-up survival data were collected until 2003 (minimum 5 years) and survival curves were compared using regression analysis. RESULTS: The postoperative 30-day mortality rate was significantly lower in men whose aneurysms were detected by screening (4.4%), compared with those detected incidentally (9.0%). Similarly, 5-year survival (78% vs. 65%) and 10-year survival rates (63% vs. 40%) were better after repair of a screen-detected AAA (p<0.0003 at all time intervals, by log rank testing). Multivariate analysis showed that this was largely due to the older age of men who had repair of an incidental AAA (71.2 vs. 67.1 years). CONCLUSION: Men who had elective repair of an AAA detected by screening had a better late survival rate than men whose aneurysm was discovered incidentally because they were younger at the time of surgery.     

Surgeon Elective Abdominal Aortic Aneurysm Repair Volume and Outcomes of Ruptured Abdominal Aortic Aneurysm Repair: A 12-year Nationwide Study

Background

The purpose of the present study was to examine the effects of surgeon elective abdominal aortic aneurysm repair volume on outcomes after ruptured abdominal aortic aneurysm (rAAA) repair.

Methods

A nationwide claims database was used to identify patients who underwent rAAA repair from 1998 to 2009. Surgeon elective open abdominal aortic aneurysm repair (EAR) volume was classified as low, medium, or high. Associations between surgeon EAR volume and in-hospital mortality, overall survival, and complications after open rAAA repair (RAR) were compared with multivariate analysis. Associations between surgeon elective endovascular abdominal aortic aneurysm repair (EER) volume and outcomes after endovascular rAAA repair (RER) were also analyzed.

Results

A total of 537 patients who underwent rAAA repair were identified, including 498 who underwent RAR and 39 who underwent RER. In-hospital mortality rates after RAR were 49, 38, and 24 % in the low, medium, and high EAR volume groups, respectively (p < 0.001). Patients in the low surgeon EAR volume group had higher in-hospital mortality than those in the high surgeon EAR volume group [odds ratio 3.39, 95 % confidence interval (CI) 1.52, 7.59; p = 0.003]. Patients in the low surgeon EAR volume group also had higher long-term mortality (hazard ratio 1.86, 95 % CI 1.21, 2.85; p = 0.005). There were no significant differences in complication rates among the surgeon EAR volume groups or in-hospital mortality after RER among the surgeon EER volume groups.

Conclusions

Surgeon EAR volume is associated with in-hospital mortality and long-term survival after RAR.     

Abdominal aortic aneurysm screening in Sweden

A large body of evidence from four international randomised controlled trials (RCT) on abdominal aortic aneurysm (AAA) screening indicate that ultrasound-based screening in elderly men with a high prevalence (4?%–7?%) reduces AAA-related mortality by 40?% through early AAA detection and increased preventive elective repair and subsequently halves rupture incidence. Coinciding with the planned launch of national AAA screening programs, a dramatic change in AAA epidemiology became evident: a lower AAA prevalence in the targeted population of men and falling mortality rates, most likely related to a drop in rates of smoking, and a paradoxical increase in elective AAA repairs. These changes have called AAA screening in today’s context into question. Sweden was the first country to provide national coverage with an AAA screening program targeting 65-year-old men. The scientifically evaluated screening initiative, started in 2006, reported the lower than expected prevalence (1.7?%) in 65-year-old men early on. Cost-effectiveness seems to be maintained despite the altered epidemiology, as shown in a health-economic study. The current prevalence of AAA among Swedish women is very low, and general population-based screening of women is likely to be futile, although targeted screening among female smokers should be evaluated. Sub-aneurysmal aortas detected at screening are likely to progress to a true AAA within 5 years, indicating a need for continued surveillance in this group. Differences in screening compliance seem to be linked to socio-economic factors. The aim of this topical review is to highlight AAA screening within a Swedish context and point to areas where information is lacking and further research is needed.     

Perspectives,personal experiences and personalized threshold for intervention in abdominal aortic aneurysm

Background

Current threshold for intervention for ubiquitous abdominal aortic aneurysm of 5.5 cm may not be one size fits all on a global perspective. We analysed long-term results with open repair of abdominal aortic aneurysm and postulated to provide proof of concept for personalized threshold, globally applicable for abdominal aortic aneurysm.

Methods

From 1998 to date, open conventional repair of abdominal aortic aneurysms performed in 274 consecutive patients, with 214 elective and 60 emergent, formed basis of this report. Thirty-two of the elective procedures were performed for small aneurysms of 4–5.4 cm. Concurrently, body weight and height were recorded in 100 patients undergoing computed tomography of abdomen for non-vascular reasons and 32 patients with small aneurysm who underwent elective repair. Aortic diameter was measured at predetermined domains of infrarenal aorta.

Results

Thirty-day mortality for elective and emergent groups was 3.73 and 28 %, respectively. Aortic diameter ranged from 1.4 to 1.8 cm and calculated body surface area from 1.44 to 1.7 m². Normal aortic size, with proven relationship to body surface area, becomes aneurismal when >150 % times its size. Threshold diameter of 5.5 cm has ingrained ‘defining number 3’ considering body surface area in Western males of ≥1.8 m² (5.5?÷?1.8?=?3).

Conclusion

Elective repair of abdominal aortic aneurysm is safe, durable with low reintervention rates and easy surveillance protocol. Body surface area, calculated using Mosteller formula from individual’s height and weight, multiplied by threshold factor ‘3’ to determine personalized threshold, so optimal size and time to intervene, in patients with small aneurysm, is at best proof of concept applicable to Indian and Asian populations.     

The Impact of Gender on Prognosis After Non-cardiac Vascular Surgery

Objectives

The objective was to evaluate the impact of gender on long-term survival of patients who underwent non-cardiac vascular surgery.

Design, Material and Methods

Our prospectively collected data contained information on 560 patients undergoing carotid endarterectomy (CEA), 923 elective abdominal aortic aneurysm repairs (AAA) and 1046 lower limb reconstructions (LLR). Patient characteristics and long-term mortality of women were compared to that of men. Kaplan–Meier (KM) survival curves were constructed for men and women, on which we superimposed age- and sex-matched KM survival curves of the general population. Cox proportional hazards regression was used to identify risk factors for mortality.

Results

Men in the CEA group had statistically significant higher all-cause mortality, hazard rate ratio (HRR) 1.41 (95% CI 1.01–1.98) No differences in mortality between the genders were observed in the AAA and LLR groups.Overall, men had more co-morbidities but received more disease-specific medication compared to women. Women retained their higher life expectancy after CEA but lost it in the AAA and LLR groups.

Conclusion

Women retain their higher life expectancy after CEA; however, after AAA repair and LLR, this advantage is lost. Both men and women received too little disease-specific medication, but women were worse off.