Outcome of abdominal aortic endografting in high-risk XXXX : a 4-year single-center study.

@entity1 @entity1755 @entity1070 @entity439 @entity204 @entity1028
PURPOSE: To evaluate feasibility, safety, and effectiveness of @entity1028 ( @entity1028 ) repair in @entity1 whose fitness for surgery is questionable. METHODS: Between April 1997 and December 2001, 389 consecutive @entity1 underwent endovascular @entity1028 repair. Of these, 51 (13.1%) were ASA grade IV. The perioperative and late outcomes of this group were compared to the remaining 338 @entity1 with ASA grades <IV. Failure of @entity1028 exclusion was defined as late conversion to open repair, @entity1755 , increased @entity439 diameter, or persisting graft-related @entity1070 . Gender, age, ASA grade IV, EUROSTAR class E, and @entity1028 diameter were examined by logistic regression analysis for their influence on perioperative @entity204 , survival, and failure of @entity1028 exclusion. RESULTS: Four (7.8%) perioperative @entity204 occurred in the ASA IV group compared to 1 (0.3%) in the ASA <IV group (p=0.001). Median follow-up was 22 months (range 1-56). Failure of @entity1028 exclusion occurred in 3 (5.9%) @entity1 in ASA IV group and in 25 (7.4%) in ASA <IV group (p>0.05). Actuarial survival at 30 months was 62.9% in ASA IV group and 88.0% in ASA <IV group (p=0.001, log-rank test). There were no independent predictors for failure of @entity1028 exclusion; ASA IV was independently associated with perioperative mortality (HR 17.8; 95% CI 1.6 to 188; p=0.016). CONCLUSIONS: Endovascular @entity1028 repair in ASA IV @entity1 is feasible and effective in preventing @entity1755 in the mid term. High-risk @entity1 experience a worse prognosis than their good-risk counterparts. An individualized approach in selecting high-risk @entity1 for endoluminal repair is mandatory.
