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HERDIN Record #: NCR-PHC-18073012065548 Submitted: 30 July 2018 Modified: 30 July 2018

In-hospital outcomes of patients with thoracic and abdominal aortic aneurysm who underwent surgical, endovascular and conservative medical management.

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Background: Aortic aneurysm is a life-threatening condition related to its catastrophic complications of rupture and dissection that warrants consideration of early surgical repair. The decision to intervene for aortic disease remained a challenging decision because of the concomitant high risk factors and comorbid illnesses as well as increased morbidity and mortality related to it.

Methods: We performed a retrospective cohort of 275 patients with thoracic and abdominal aortic aneurysms with indication/s for intervention. The population was divided into three groups, namely, surgical, endovascular or hybrid and medical management groups, respectively. Outcome measured included in-hospital mortality, cardiovascular, cerebrovascular, pulmonary and renal complications, embolic events and infection.

Results: Seventy-six percent of the subjects underwent surgical repair, sixteen percent underwent endovascular or hybrid strategy while eight percent had conservative medical management. The over-all mortality rate is 16.36% with a statistically significant higher risk for in-hospital mortality in the medical group (p 0.001) Infection rate was higher in the surgical group (54.07%, p 0.001). There were no statistical differences in the cardiovascular events (p 0.069), neurologic complications (p 0.094), renal failure (p 0.082), respiratory failure (p 0.908), and embolic events (p 0.381) between the groups. Although, higher percentages of mortality in the surgical group, multivariate logistic regression analysis for in-hospital mortality showed that strategies of endovascular repair did not show a significant survival benefit (adjusted OR 0.987; 95% CI 0.219 - 4.436 p 0.986).

Conclusion: Prompt evaluation for early aortic aneurysm intervention either by open surgery or endovascular procedure is needed, because of high mortality related to medical management of large aortic aneurysms. A strategy of endovascular and/or hybrid repair was not associated with significant reduction in in-hospital mortality, when compared to open surgery, but evaluation of its intermediate and long-term outcomes is warranted. The use of endovascular or hybrid technique can be considered a feasible alternative to surgical repair especially in high-risk patients.

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