ORIGINAL ARTICLES   

International Angiology 2004 March;23(1):66-71

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

A comparison of physiology scores and morphology in a group of patients evaluated for endovascular repair of infrarenal aneurysms

Butcher W., Darke S. G.

The Royal Bournemouth Hospital, Bournemouth, UK

Aim. Endo­vas­cu­lar ­repair (EVR) of abdom­i­nal aor­tic aneu­rysms (AAA) is an accept­ed alter­na­tive to open ­repair (OR). Ana­tom­i­cal suit­abil­ity for EVR of 196 con­sec­u­tive AAA refer­rals is ana­lysed, accord­ing to aneu­rysm size and rel­a­tive phys­io­log­i­cal fit­ness for OR.
Meth­ods. ­Patients were eval­u­at­ed for suit­abil­ity accord­ing to 2 sets of arbi­trary EVR ana­tom­i­cal cri­te­ria: flex­ible cri­te­ria (FC), and a sub­group, rigid cri­te­ria (RC) with few tech­ni­cal risks. Suit­abil­ity was relat­ed to aneu­rysm size and oper­a­tive risk (POS­SUM).
­Results. ­Eighty-eight ­patients (45%) were suit­able by FC, 33 (17%) by RC, and 108 (55%) were unsuit­able for EVR. Inad­e­quate neck ­length (56%) and angu­la­tion (26%), were prin­ci­ple rea­sons for unsuit­abil­ity. Mean AAA diam­e­ter was 60.5 mm for the whole group, 58.4 mm for those suit­able by FC, 56.5 mm for those suit­able by RC and 62.1 mm in those unsuit­able (p<0.01). ­Median phys­iol­o­gy ­scores (inter­quar­tile rang­es) were 19 (17-21) over­all, 18 (17-21) in those suit­able FC, 18 (17-19) in those suit­able by RC and 19 (18-21) for unsuit­able ­patients (NS). High risk ­patients with large aneu­rysms. There were 133 larg­er aneu­rysms (≥55 mm in diam­e­ter), of which there were 56 ­patients with phys­iol­o­gy ­scores ≥20. Of these 16 (29%) and 4 (7%) were suit­able by FC and RC, respec­tive­ly. By com­par­i­son, of the remain­ing 77 with phys­iol­o­gy ­scores of ≤19.35 (45%) were suit­able for FC and 15 (19%) for RC (p<0.05).
Con­clu­sion. Unfit ­patients with sig­nif­i­cant­ly sized aneu­rysm; iron­i­cal­ly those most like­ly to ben­e­fit, tend to be less suit­able for EVR.