Aortic Disease Indication and Preparation
Sprache: D/E
Slides: E
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Impact of Aortic disease on Patients and Health Systems in middle Europe
- Presentation time:
- 3 min
Speaker: Thomas Lattmann (Winterthur)
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Choice of Procedure: Open vs. Endo
- Presentation time:
- 12 min
- Discussion time:
- 3 min
Speaker: Michael Jacobs (Berlin)
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Minimally Invasive Segmental Artery Coil Embolisation (MISACE): Concept and Results
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Daniela Branzan (München)
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Imaging in modern Hybrid Operating Room
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Maani Hakimi (Luzern)
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Planning Tools for Complex EVAR
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Miriam Elisabeth Kliewer (Wien)
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Standardisation in Aortic CT Reporting Protocols
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Chang De Hua (Luzern)
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Use of Holograms in Aortic Therapy
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Christian Uhl (Aachen)
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Risk Stratification and Treatment Selection in Patients with Asymptomatic Abdominal Aortic Aneurysms
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Presenting Author: Lorenz Meuli
Objective
Background: Open surgical repair (OSR) should be prioritized for patients with asymptomatic abdominal aortic aneurysm (AAA) and long life expectancy. In contrast, endovascular repair (EVAR) is preferred for patients with suitable anatomy and life expectancy >2–3 years. However, life expectancy estimation and risk stratification are not well-established.
Objective: To evaluate risk-stratified survival differences between OSR and EVAR following elective AAA treatment.
Methods
Danish national health registries were linked to identify all patients >60 years undergoing elective AAA treatment 2004-2023. Patients were categorised into four risk groups based on age, estimated glomerular filtration rate, and chronic obstructive pulmonary disease. Survival times were compared between treatments using restricted mean survival time after inversed probability weighting. Cumulative 10-year incidence rates of secondary AAA rupture or cancer were compared between treatment groups.
Results
Of 6’891 identified patients, 5’757 (83.4%) were men. Women were older (75.4 vs. 74.5 years, p=.001), more often had COPD (13.6% vs. 8.9%, p<.001), and had lower eGFR (68 vs. 70 ml/min/1.73m2, p=.001) compared to men. The median follow-up was 8.28 years (95%-CI: 8.1–8.5). OSR was associated with higher perioperative mortality in all risk groups. In low-risk patients, OSR was associated with a 10-month (2.2–18.3, p=.02) longer mean survival time restricted at 15 years compared to EVAR. In moderate-to-high-risk patients, OSR was associated with a 9-month (1.9–16.9, p=.008) shorter mean survival time restricted after 12.5 years compared to EVAR. No difference in mean survival time was seen in low-to-moderate and high-risk patients at the study end.
No differences in 10-year incidence of secondary AAA ruptures (OSR: 2.6% [95%-CI: 1.9–3.4] vs. EVAR: 2.2% [1.7–2.7], p=.43) or solid malignancy (OSR: 18.6% [16.7–20.5] vs. EVAR: 20.5% [18.9–22.1], p=.35) were detected.Conclusion
In this cohort study of 6’891 patients with AAA, the potential of risk stratification was highlighted. OSR was associated with higher perioperative mortality in all risk groups but with longer mean survival only in low-risk patients. Conversely, EVAR was associated with longer mean survival in moderate-to-high-risk patients. No differences in secondary ruptures or new malignancy diagnoses during follow-up were observed between the two treatments.