Chronic Obstructive Pulmonary Disease As An Independent Marker For Adverse Outcomes In Endograft Repair Of Abdominal Aortic Aneurysms

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Introduction and Objectives:
Endograft repair of Abdominal Aortic Aneurysms (AAA) has become a viable alternative to open surgical repair in the last decade. A significant proportion of our patient population suffers from significant co-morbid Chronic Obstructive Pulmonary Disease (FEV1 <80% and FEV1/FVC < 70%). COPD has been associated with higher morbidity for open repair. We report here our experience and analysis of the surgical outcomes associated with endograft AAA repair in our patients with and without COPD.
Methods:
Patients suffering from significant Abdominal Aortic Aneurysms (> 5cm in diameter by radiographic evidence) underwent AAA endograft repair. We report our experience with 342 consecutive patients from June 1998 to December 2004 (137 or 39% with COPD). Patient outcomes such as peri-operative mortality, length of admission, length of ICU admission, rates of post-operative congestive heart failure (CHF), rates of post-operative myocardial infarction (MI), rates of conversion to open surgery, duration of surgery, and the incidence of post-operative endoleaks were retrospectively reviewed and analyzed.
Results:
Differences in the rate of peri-operative mortality (1.5% vs. 1.9%, p=1.0), length of admission (4.3 vs. 5.3 days, p=0.4720), length of ICU admission (0.6 vs. 0.5 days, p=0.5475), rates of post operative CHF (1.5% vs. 0.9%,p=0.6509), rates of post-operative MI (0.7% vs. 1.0%, p=1.0), rates of conversion to open surgery (0% vs. 0.5%,p=1.0), duration of surgery (3.3 vs. 3.3 hours, p=0.8812), and the incidence of endoleaks (27% vs. 35%,p=0.1560) were not statistically significant when compared to our patients without COPD.
Conclusions:
Endograft repair of AAA demonstrated equivalent outcomes in patients with and without comorbid COPD. These results indicate that comparable surgical outcomes may be accomplished in those patients suffering from COPD, and those patients without this disease. However, these results were superior to those reported in the literature for open repair.