Visser, L. (2012) Is regular follow-up after endovascular repair necessary in octogenarians? thesis, Medicine.
Full text available on request.Abstract
Introduction: An aneurysm of the aorta is defined as a permanent and irreversible dilatation of 150% or more in comparison to the normal diameter of the aorta. The majority is fusiform shaped and is situated infrarenal. Various risk factors seem to play a role such as atherosclerosis, male gender, hypertension and genetic factors. Another important risk factor is age. The prevalence rises from 1% in men aged 55-60 to 10% when aged >80. While the life expectancy in the Western world has increased over the past decades, and is expected to continue to rise in the forthcoming years, it can be predicted that the number of octogenarians seeking treatment for an AAA will rise in the future. The majority of aneurysms are asymptomatic and found by coincidence during abdominal utrasound examination or CT scan performed for other conditions. A feared complication of an AAA is rupture, a life treatening condition that accounts for 9000 deaths a year in the United States. Symptoms of rupture are acute back pain or pain in the mid-abdomen or flank and signs of hypovolemic shock. Treatment for an aneurysm may include open repair or endovascular aneurysm repair (EVAR). EVAR is much less invasive than open repair making EVAR the treatment of choice in octogenarians. Drawback is that patients require lifelong surveillance due to a high incidence of long term complications. The aim of this study was to determine whether long term follow up after EVAR is necessary in octogenarians by determining the reason and intervention rate after EVAR. Materials and methods: One hundred and thirty two octogenarians who underwent EVAR for an abdominal or thoracic aneurysm were included in this study. Data were collected by reviewing the computerized hospital registry and charts and by contacting the patients’ general practitioner or referring center. Statistical analysis was performed by the Statistical Package for the Social Sciences (SPSS) 16.0.1 Results: A total of 49 patients (37.1%) experienced 76 stent or procedure related postoperative complications after a mean of 11.6 ± 15.4 months. The most common complication was type II endoleak which occurred in 29 patients (21.9%). Twelve patients (9.1%) had reinterventions after 26.4 ± 27.0 months. Seventy-five patients have died by now, and in three patients the cause of death was AAA related. These patients died after a mean of 41.9 ± 36.9 months after EVAR. Conclusion: According to these results there is no reason for lifelong follow-up in all octogenarians after EVAR. More research needs to be done to define how long patients should be followed and in which circumstances lifelong follow up is necessary.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Zeebregts, C.J. MD and Professor of Vascular Surgery and Department of Surgery, Division of Vascular Surgery and University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:57 |
| Last Modified: | 25 Jun 2020 10:57 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1782 |
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