Endovascular abdominal aortic aneurysm repair in high-risk patients: a single centre experience.

Objectives: to evaluate the role of endovascular repair (ER) of abdominal aortic aneurysm (AAA) repair in American Society for Anaesthesiology [ASA] class IV patients. Patients and Methods: between April 1997 and March 2000, 266 consecutive patients underwent ER for AAA. There were 26 patients (10%) with ASA grade IV. The remaining 240 patients, ASA grade between I and III (ASA < IV group), were compared with the ASA IV group. Mean follow-up was 11.6 months (range 1-32 months). Increase in AAA diameter after ER or persisting graft-related endoleak were defined as failure of AAA exclusion and perioperative mortality. performed to test the effect of five confounding variables on failure of AAA exclusion and perioperative mortality. Results: patients in the ASA IV group were significantly older than patients in ASA < IV group (mean age: 74 years vs 70 years; p =0.005). AAA were larger (mean diameter: 56 mm vs 50 mm; p = 0.002) and more extensive (class E of EUROSTAR classification: 27% vs 5.8%; p = 0.002). There were two perioperative deaths in the ASA IV group and one in the ASA < IV group (8% vs 0.4%; RR 19; 95% CI 1.8-202; p = 0.01). Major perioperative morbidity occurred in 8% of patients in the ASA IV group and in 3.3% in the ASA < IV group (n.s.). There were no conversions to open repair in the ASA IV group while six were performed in the ASA < IV group (n.s). Length of hospitalisation was significantly longer for patients in the ASA IV group: 7.8 days vs 3.2 days (p = 0.001). Operative times and blood loss were similar. Failure of AAA exclusion occurred in two patients (8%) in the ASA IV group and in four patients (1.6%) in the ASA < IV group (n.s.). On life table analysis, survival rates at 26 months were 76% in the ASA IV group and 89% in the ASA < IV group (p = 0.004). Five variables were examined by regression analysis and no independent predictors of failure of AAA exclusion and operative mortality were found. Conclusions: ER in ASA IV patients is feasible and effective with acceptable actuarial survival rates. However the endovascular procedure in these patients is associated with higher major systemic morbidity, mortality, and prolonged hospitalisation rates.