Risk factors influencing outcome of endovascular abdominal aortic aneurysm repair
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RU Radboud Universiteit Nijmegen, 22 november 2006
Promotor : Blankensteijn, J.D. Co-promotores : Buth, J., Laheij, R.J.F.
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SubjectNCEBP 14: Cardiovascular diseases; UMCN 2.2: Vascular medicine and diabetes
Abdominal Aortic Aneurysm (AAA) is a vascular disorder in which the abdominal aorta becomes permanently dilated to at least 1.5 times its normal diameter. The prevalence of AAA has increased rapidly during the last decade, and aneurysmal rupture is now the 13th most common cause of death in the Western world. Endovascular treatment of abdominal aortic aneurysms, introduced at the beginning of the 1990s, was a significant accomplishment in vascular surgery. In this PhD-thesis we analysed the effect of patient-related characteristics, device brands, aorto-iliac morphology, and follow-up strategy, on the outcomes after endovascular abdominal aortic aneurysm repair (EVAR). Our study revealed that although patients with diabetes mellitus had a higher 30-day mortality rate, long-term survival was similar to patients without diabetes. We also supported the proposition that EVAR may be considered when treating octogenarians since the risk for late complications, compared with open repair, may be outweighed by the lower early mortality and the shorter time for physical recovery. We also concluded that preoperative statin use was independently associated with improved overall-survival after EVAR. When analysing the different stent-graft brands, no single make of stent-graft emerged as the best. However, it was reassuring to note that the later models of stent-grafts performed better than the first generation commercially available versions. In our study assessing the influence of the infra-renal neck anatomy, we concluded that to obtain optimal results with EVAR, the accepted criteria of the infra-renal neck dimensions should be adhered to. With regard to the surveillance intensity, further assessment is indicated to evaluate the effectiveness of different frequencies of follow-up visits. From this thesis we may conclude that a range of different aspects can influence the outcomes after EVAR. These findings emphasize the importance of proper patient selection to obtain optimal results after endovascular aneurysm repair
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