Five Year Post-Endovascular Aneurysm Repair Aneurysm Sac Evolution in the GREAT Registry: an Insight in Diabetics Using Propensity Matched Controls.

Publisher: Elsevier Country of Publication: England NLM ID: 9512728 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2165 (Electronic) Linking ISSN: 10785884 NLM ISO Abbreviation: Eur J Vasc Endovasc Surg Subsets: MEDLINE

Publication: 2002-: London : Elsevier
Original Publication: London, UK : W.B. Saunders Co. Ltd., c1995-

Aortic Aneurysm, Abdominal*/surgery ; Aortic Aneurysm, Abdominal*/mortality ; Aortic Aneurysm, Abdominal*/diagnostic imaging ; Endovascular Procedures*/adverse effects ; Endovascular Procedures*/instrumentation ; Endovascular Procedures*/mortality ; Registries* ; Propensity Score* ; Blood Vessel Prosthesis Implantation*/adverse effects ; Blood Vessel Prosthesis Implantation*/mortality ; Blood Vessel Prosthesis Implantation*/instrumentation ; Diabetes Mellitus*/epidemiology; Humans ; Male ; Aged ; Female ; Treatment Outcome ; Aged, 80 and over ; Risk Factors ; New Zealand/epidemiology ; Time Factors ; Prospective Studies ; Blood Vessel Prosthesis/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Australia/epidemiology ; Middle Aged ; Europe/epidemiology ; Endovascular Aneurysm Repair

Objective: To assess differences in the five year abdominal aortic aneurysm (AAA) sac regression rate after endovascular aneurysm repair (EVAR) in patients with and without diabetes mellitus (DM).
Methods: An international prospective registry (Europe, USA, Brazil, Australia, and New Zealand) of patients treated with the GORE EXCLUDER endograft. All scheduled EVARs for infrarenal AAA between 2014 and 2016 with complete five year imaging follow up were included. Emergency procedures, ancillary proximal procedures, and inflammatory and infectious aetiologies were excluded. Descriptive and inferential statistics, and Cox proportional hazards survival models were used. A control group of patients without DM with similar age and comorbidities was selected using propensity scores, matched in a 1:2 scheme.
Results: A total of 2 888 patients (86.1% male; mean age 73.5 ± 8 years) was included, of whom 545 (18.9%) had DM. Patients with DM had higher rates of hypertension (89.2% vs. 78.4%), dyslipidaemia (76.0% vs. 60.7%), coronary artery disease (52.3% vs. 37.9%), and chronic renal impairment (20.9% vs. 14.0%) (all p < .001). The mean pre-procedural AAA diameter was 58.1 ± 10 mm. Five years post-EVAR, the type 1A endoleak rate was 1.1% (0.6% DM vs. 1.2% non-DM), the endograft related re-intervention rate was 7.3% (6.2% vs. 7.6%), the major adverse cardiovascular event (MACE) rate was 1.4% (1.1% vs. 1.5%), and aortic related mortality rate was 1.0% (0.6% vs. 1.2%), without statistically significant differences between groups. The overall five year mortality rate was higher in diabetics (36.3% vs. 30.5%; hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.07 - 1.58; p = .001). No statistically significant differences were found in sac regression rate (≥ 5 mm) between diabetics and non-diabetics 70.0% vs. 73.1%; HR 0.88, 95% CI 0.75-1.04; p = .131. These differences remained statistically non-significant after excluding patients performed out of instructions for use (p = .61) and patients with types 1, 2 or 3 endoleaks (p = .39).
Conclusion: The paradoxical relationship between DM and AAA does not appear to result in differences in post-EVAR sac regression rates. However, even when controlling for other comorbidities, patients with DM undergoing EVAR may have a higher five year mortality rate.
(Copyright © 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Keywords: Abdominal aortic aneurysm; Diabetes mellitus; Endovascular aneurysm repair; Sac growth

Date Created: 20231028 Date Completed: 20240609 Latest Revision: 20240609

20240610

10.1016/j.ejvs.2023.10.033

37898359