Palliation of Abdominal Aortic Aneurysms in the Endovascular Era

ObjectivesTo establish outcome of patients with abdominal aortic aneurysm (AAA) deemed unfit for repair.DesignRetrospective non-randomised study.Materials and methodsIdentification of males with >5.5 cm or females with >5.0 cm AAA turned down for elective repair between 01/01/2006–24/07/2009 from a prospective database. Comorbidities, reasons for non-intervention, aneurysm size, survival, use of CPEX (cardio-pulmonary exercise) testing and cause of death were analysed. Although well-established at the time, patients unfit for open operation were not considered for endovascular repair.ResultsSeventy two patients were unsuitable for AAA repair. Aneurysm size ranged from 5.3 cm to 12 cm. Functional status, comorbidity and patient preference determined decision to palliate. Sixty percent of patients were alive at study close. Aneurysm rupture was cause of death in 46%. CPEX testing was performed in 54%, whose mortality was 28%, vs. 54% in the non-CPEX group (P < 0.05).Median survival of patients with 5.1–6.0 cm AAA was 44 months and 11% died of rupture. Between 6.1 and 7.0 cm median survival was 26 months and 20% died of rupture. However, with >7 cm aneurysms, survival was 6 months and 43% ruptured.ConclusionUnder half the deaths in our comorbid cohort were due to rupture. However, decision to palliate may be revisited as risk-benefit ratio changes with aneurysm expansion.