Is abdominal aortic aneurysm repair appropriate in oxygen-dependent chronic obstructive pulmonary disease patients?

Christopher N. Compton, Ellen D. Dillavou, Maureen K. Sheehan, Robert Y. Rhee, Michel S. Makaroun

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: The life expectancy of patients with oxygen-dependent chronic obstructive pulmonary disease (COPD) is significantly reduced, but the risk of any intervention is considered prohibitive. However, severe COPD may increase the risk of abdominal aortic aneurysm (AAA) rupture. We reviewed our experience with AAA repair in oxygen-dependent patients to determine whether operative risk and expected long-term survival justify surgical intervention. Methods: A retrospective review of 44 consecutive patients with oxygen-dependent COPD undergoing AAA repair over an 8-year period was performed. Information was recorded for survival, length of follow-up, patient age, medical comorbidities, pulmonary function tests, and operative approach. Survival data were analyzed by Kaplan-Meier curves and compared with published cohorts of oxygen-dependent patients and the natural history of untreated aneurysms. Results: Twenty-four patients underwent endovascular aneurysm repair (EVAR), and 20 underwent open procedures (14 retroperitoneal and 6 transabdominal). The mean AAA diameter was 6.1 cm (range, 5-9.5 cm). The mean age was 71.4 years, and 82% of patients were male. Operative mortality was 0%. The mean length of stay was 11.2 days for open procedures and 4.3 days for EVAR (significantly longer than that for standard-risk patients). The mean survival time was 37.9 months (range, 2-91 months). Preoperative medical comorbidities, type of repair, and pulmonary function tests were not predictive of survival. Postoperative morbidity was significantly higher with open repair. Long term survival was comparable to historical series of the natural history of O2 dependent patients without AAA but better than untreated 6 cm AAA cohorts. At 42 months, almost 50% of patients in our study group were still alive, compared to 20% survival at 34 months for those with untreated 6 cm AAAs. Conclusions: It is reasonable to continue to offer AAA repair to home oxygen-dependent COPD patients who are ambulatory and medically optimized and who are without untreated coronary artery disease. Although EVAR may be the most suitable treatment for oxygen-dependent COPD patients, our results show that even open repair may be safely performed in this population, with acceptable results.

Original languageEnglish (US)
Pages (from-to)650-653
Number of pages4
JournalJournal of Vascular Surgery
Volume42
Issue number4
DOIs
StatePublished - Oct 2005
Externally publishedYes

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Abdominal Aortic Aneurysm
Chronic Obstructive Pulmonary Disease
Oxygen
Aneurysm
Survival
Respiratory Function Tests
Comorbidity
Aortic Rupture
Life Expectancy
Natural History
Coronary Artery Disease
Length of Stay
Survival Rate
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Is abdominal aortic aneurysm repair appropriate in oxygen-dependent chronic obstructive pulmonary disease patients? / Compton, Christopher N.; Dillavou, Ellen D.; Sheehan, Maureen K.; Rhee, Robert Y.; Makaroun, Michel S.

In: Journal of Vascular Surgery, Vol. 42, No. 4, 10.2005, p. 650-653.

Research output: Contribution to journalArticle

Compton, Christopher N. ; Dillavou, Ellen D. ; Sheehan, Maureen K. ; Rhee, Robert Y. ; Makaroun, Michel S. / Is abdominal aortic aneurysm repair appropriate in oxygen-dependent chronic obstructive pulmonary disease patients?. In: Journal of Vascular Surgery. 2005 ; Vol. 42, No. 4. pp. 650-653.
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abstract = "Background: The life expectancy of patients with oxygen-dependent chronic obstructive pulmonary disease (COPD) is significantly reduced, but the risk of any intervention is considered prohibitive. However, severe COPD may increase the risk of abdominal aortic aneurysm (AAA) rupture. We reviewed our experience with AAA repair in oxygen-dependent patients to determine whether operative risk and expected long-term survival justify surgical intervention. Methods: A retrospective review of 44 consecutive patients with oxygen-dependent COPD undergoing AAA repair over an 8-year period was performed. Information was recorded for survival, length of follow-up, patient age, medical comorbidities, pulmonary function tests, and operative approach. Survival data were analyzed by Kaplan-Meier curves and compared with published cohorts of oxygen-dependent patients and the natural history of untreated aneurysms. Results: Twenty-four patients underwent endovascular aneurysm repair (EVAR), and 20 underwent open procedures (14 retroperitoneal and 6 transabdominal). The mean AAA diameter was 6.1 cm (range, 5-9.5 cm). The mean age was 71.4 years, and 82{\%} of patients were male. Operative mortality was 0{\%}. The mean length of stay was 11.2 days for open procedures and 4.3 days for EVAR (significantly longer than that for standard-risk patients). The mean survival time was 37.9 months (range, 2-91 months). Preoperative medical comorbidities, type of repair, and pulmonary function tests were not predictive of survival. Postoperative morbidity was significantly higher with open repair. Long term survival was comparable to historical series of the natural history of O2 dependent patients without AAA but better than untreated 6 cm AAA cohorts. At 42 months, almost 50{\%} of patients in our study group were still alive, compared to 20{\%} survival at 34 months for those with untreated 6 cm AAAs. Conclusions: It is reasonable to continue to offer AAA repair to home oxygen-dependent COPD patients who are ambulatory and medically optimized and who are without untreated coronary artery disease. Although EVAR may be the most suitable treatment for oxygen-dependent COPD patients, our results show that even open repair may be safely performed in this population, with acceptable results.",
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