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Patients on AAA Surveillance are at Greater Threat of Cardiovascular Events or Malignancy than their AAA: Outcomes of AAA Surveillance over 19 years at a Tertiary Vascular Centre

Published:December 18, 2021DOI:https://doi.org/10.1016/j.avsg.2021.11.013

      Abstract

      Background

      To analyse 19 years’ worth of data from a Major UK Vascular Centre to determine the outcome of patients after they enter abdominal aortic aneurysm (AAA) surveillance (surgery, death, discharge or transfer), this may inform interventions to improve these outcomes in the AAA surveillance population.

      Methods

      This was a retrospective analysis of a prospectively collected database of outcomes of every patient entered on AAA surveillance at Manchester University NHS Foundation Trust – Wythenshawe Hospital between September 2000 and June 2019. Analyses included what proportion suffered death, discharge, transfer or surgery whilst on surveillance. Multi-variate analysis was used to determine the effect of initial AAA size, age when entering surveillance and gender. Boxplots were produced in those who had already reached an outcome to determine historic median times. Causes of death/discharge were also analysed.

      Results

      One thousand nine hundred fifty-one patients were identified from the databased after data cleaning and were included in the final analysis. Thirty-two percent of patients had died, 23.8% had surgery, 13.3% were discharged due to worsening/severe comorbidity, 3.1% had been transferred and 27.7% were still active in surveillance. A longer time to surgery was significantly associated with increasing age on entering surveillance OR (95% CI) 0.95 (0.94–0.96) (P < 0.001), smaller initial AAA size 4.26 (3.80–4.78) (P < 0.001) but not female gender. Impaired survival was associated with increasing age 1.06 (1.05–1.07) (P < 0.001), initial AAA size, 1.56 (1.39–1.74) (P < 0.001) and female gender 1.40 (1.18–1.67) (P < 0.001). Overall, death occurred more frequently than operative repair every year over all 15 years. Out of the deaths where cause was known (n = 401), 34.9% (n = 108) were due to cardiovascular events, 27.3% (n = 109) due to malignancy (primarily lung), and 19.3% due to respiratory disease.

      Conclusions

      Based on this data, death, primarily due to cardiovascular events, is a more likely outcome than operative repair in patients on AAA surveillance and is associated with increasing age, increasing AAA size and female gender. A median time on surveillance of over three and a half years provides sufficient time to affect subsequent health outcomes in this population and therefore a shift of focus of AAA surveillance programmes to address cardiovascular, malignancy and respiratory disease risk is warranted.
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