Endovascular abdominal aortic aneurysm repair in high-risk patients: A single centre experience

Objectives: to evaluate the role of endovascular repair (ER) of abdominal a ortic aneurysm (AAA) repair in American Society for Anaesthesiology [ASA] c lass IV patients. Patients and Methods: between April 1997 and March 2000, 266 consecutive pa tients underwent ER for AAA. There were 26 patients (10%) with ASA grade IV . The remaining 240 patients, ASA grade between I and III (ASA < IV group), were compared with the ASA IV group. Mean follow-up was 11.6 months (range 1-32 months). Increase in AAA diameter after ER or persisting graft-relate d endoleak were defined as failure of AAA exclusion and perioperative morta lity. performed to test the effect of five confounding variables on failure of AAA exclusion and perioperative mortality. Results: patients in the ASA IV group were significantly older than patient s in ASA < IV group (mean age: 74 years vs 70 years; p =0.005). AAA were la rger (mean diameter: 56 mm vs 50 mm; p = 0.002) and more extensive (class E of EUROSTAR classification: 27% vs 5.8%; p = 0.002). There were two periop erative deaths in the ASA IV group and one in the ASA < IV group (8% vs 0.4 %; RR 19; 95% CI 1.8-202; p = 0.01). Major perioperative morbidity occurred in 8% of patients in the ASA IV group and in 3.3% in the ASA < IV group (n .s.). There were no conversions to open repair in the ASA IV group while si x were performed in the ASA < IV group (n.s). Length of hospitalisation was significantly longer for patients in the ASA IV group: 7.8 days vs 3.2 day s (p = 0.001). Operative times and blood loss were similar. Failure of AAA exclusion occurred in two patients (8%) in the ASA IV group and in four pat ients (1.6%) in the ASA < IV group (n.s.). On life table analysis, survival rates at 26 months were 76% in the ASA IV group and 89% in the ASA < IV gr oup (p = 0.004). Five variables were examined by regression analysis and no independent predictors of failure of AAA exclusion and operative mortality were found. Conclusions: ER in ASA IV patients is feasible and effective with acceptabl e actuarial survival rates. However the endovascular procedure in these pat ients is associated with higher major systemic morbidity, mortality, and pr olonged hospitalisation rates.