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Low Iliofemoral Calcium Score May Predict Higher Survival after EVAR and FEVAR

Vaccarino, Roberta LU ; Abdulrasak, Mohammed LU ; Resch, Timothy LU ; Edsfeldt, Andreas LU ; Sonesson, Björn LU and Dias, Nuno V. LU (2020) In Annals of Vascular Surgery 68. p.283-291
Abstract

Background: Abdominal aortic aneurysm is associated with an increased mortality, mostly cardiovascular events. Moreover, aortoiliac calcification is associated with increased mortality in patients with peripheral occlusive disease. The aim of this study is to assess the potential association between iliofemoral calcification, assessed by calcium score, in patients undergoing infrarenal (endovascular aneurysm repair [EVAR]) or fenestrated endovascular aortic repair (FEVAR) and long-term mortality, particularly caused by cardiac events. Methods: All patients with preoperative noncontrast-enhanced computed tomographic scans who underwent infrarenal EVAR and FEVAR of nonruptured abdominal aortic aneurysm between 2004 and 2012 at a single... (More)

Background: Abdominal aortic aneurysm is associated with an increased mortality, mostly cardiovascular events. Moreover, aortoiliac calcification is associated with increased mortality in patients with peripheral occlusive disease. The aim of this study is to assess the potential association between iliofemoral calcification, assessed by calcium score, in patients undergoing infrarenal (endovascular aneurysm repair [EVAR]) or fenestrated endovascular aortic repair (FEVAR) and long-term mortality, particularly caused by cardiac events. Methods: All patients with preoperative noncontrast-enhanced computed tomographic scans who underwent infrarenal EVAR and FEVAR of nonruptured abdominal aortic aneurysm between 2004 and 2012 at a single tertiary center were screened for inclusion. Agatston calcium score was measured from the aortic bifurcation to common femoral arteries using a dedicated postprocessing software. The values are presented as median and interquartile range. Results: About 404 (62.05%) of 651 patients who underwent EVAR and FEVAR had sufficient imaging quality to be included. There was no difference in survival between included and excluded patients (P = 0.33). Nine patients (2.2%) died within 30 days of the operation, whereas the remaining were followed up for 6.3 (4.7–8.4) years. The iliofemoral calcium score was 8348 (3830–14,179). Estimated overall survival at 5 years was 73 ± 2%. Patients within the lowest quartile of iliofemoral calcium score had significantly higher overall survival (5 years: 79 ± 4% vs. 71 ± 3%; P = 0.01) and cardiac event–free survival (5 years: 95 ± 2% vs. 91 ± 2%; P = 0.033) when compared with the remaining ones. Calcium score was associated with neither univariate regression analysis with survival (odds ratio, 1.016 [0.988–1.045]; P = 0.268) nor cardiac event–free survival (odds ratio, 1.024 [0.986–1.063]; P = 0.222). Conclusions: Low iliofemoral calcium score may be associated with lower incidence of fatal cardiac events and all-cause long-term mortality after EVAR and FEVAR. This may be partially a reflection of aging and cardiovascular comorbidity but needs to be studied further.

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published
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in
Annals of Vascular Surgery
volume
68
pages
9 pages
publisher
Springer
external identifiers
  • pmid:32339675
  • scopus:85084976665
ISSN
0890-5096
DOI
10.1016/j.avsg.2020.04.018
language
English
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yes
id
9fc2f0f1-8971-4620-bd8c-7ce1a448d93f
date added to LUP
2020-06-25 10:47:13
date last changed
2021-06-23 06:24:17
@article{9fc2f0f1-8971-4620-bd8c-7ce1a448d93f,
  abstract     = {<p>Background: Abdominal aortic aneurysm is associated with an increased mortality, mostly cardiovascular events. Moreover, aortoiliac calcification is associated with increased mortality in patients with peripheral occlusive disease. The aim of this study is to assess the potential association between iliofemoral calcification, assessed by calcium score, in patients undergoing infrarenal (endovascular aneurysm repair [EVAR]) or fenestrated endovascular aortic repair (FEVAR) and long-term mortality, particularly caused by cardiac events. Methods: All patients with preoperative noncontrast-enhanced computed tomographic scans who underwent infrarenal EVAR and FEVAR of nonruptured abdominal aortic aneurysm between 2004 and 2012 at a single tertiary center were screened for inclusion. Agatston calcium score was measured from the aortic bifurcation to common femoral arteries using a dedicated postprocessing software. The values are presented as median and interquartile range. Results: About 404 (62.05%) of 651 patients who underwent EVAR and FEVAR had sufficient imaging quality to be included. There was no difference in survival between included and excluded patients (P = 0.33). Nine patients (2.2%) died within 30 days of the operation, whereas the remaining were followed up for 6.3 (4.7–8.4) years. The iliofemoral calcium score was 8348 (3830–14,179). Estimated overall survival at 5 years was 73 ± 2%. Patients within the lowest quartile of iliofemoral calcium score had significantly higher overall survival (5 years: 79 ± 4% vs. 71 ± 3%; P = 0.01) and cardiac event–free survival (5 years: 95 ± 2% vs. 91 ± 2%; P = 0.033) when compared with the remaining ones. Calcium score was associated with neither univariate regression analysis with survival (odds ratio, 1.016 [0.988–1.045]; P = 0.268) nor cardiac event–free survival (odds ratio, 1.024 [0.986–1.063]; P = 0.222). Conclusions: Low iliofemoral calcium score may be associated with lower incidence of fatal cardiac events and all-cause long-term mortality after EVAR and FEVAR. This may be partially a reflection of aging and cardiovascular comorbidity but needs to be studied further.</p>},
  author       = {Vaccarino, Roberta and Abdulrasak, Mohammed and Resch, Timothy and Edsfeldt, Andreas and Sonesson, Björn and Dias, Nuno V.},
  issn         = {0890-5096},
  language     = {eng},
  month        = {10},
  pages        = {283--291},
  publisher    = {Springer},
  series       = {Annals of Vascular Surgery},
  title        = {Low Iliofemoral Calcium Score May Predict Higher Survival after EVAR and FEVAR},
  url          = {http://dx.doi.org/10.1016/j.avsg.2020.04.018},
  doi          = {10.1016/j.avsg.2020.04.018},
  volume       = {68},
  year         = {2020},
}