The Implications of Oxygen Dependent Chronic Obstructive Pulmonary Disease on Sac Growth and Mortality Following Endovascular Aneurysm Repair.

IF 1.4 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

Annals of vascular surgery Pub Date : 2025-03-11 DOI:10.1016/j.avsg.2025.02.019

Kirthi S Bellamkonda, Bjoern D Suckow, Jesse A Columbo, Gilbert R Upchurch, Benjamin Jacobs, Cassius I Ochoa Chaar, Rebecca E Scully, Philip P Goodney, Salvatore T Scali, David H Stone

{"title":"The Implications of Oxygen Dependent Chronic Obstructive Pulmonary Disease on Sac Growth and Mortality Following Endovascular Aneurysm Repair.","authors":"Kirthi S Bellamkonda, Bjoern D Suckow, Jesse A Columbo, Gilbert R Upchurch, Benjamin Jacobs, Cassius I Ochoa Chaar, Rebecca E Scully, Philip P Goodney, Salvatore T Scali, David H Stone","doi":"10.1016/j.avsg.2025.02.019","DOIUrl":null,"url":null,"abstract":"Objectives: Chronic obstructive pulmonary disease (COPD) is a known risk factor for abdominal aortic aneurysm (AAA) growth and rupture. The impact of COPD on AAA sac behavior following endovascular AAA repair (EVAR) is poorly understood. This study aimed to determine the association between COPD and sac remodeling after EVAR.Methods: We identified all EVAR patients (2010-2021) in the Society for Vascular Surgery-Vascular Quality Initiative (SVS-VQI) database. COPD severity (none, medication-treated, oxygen (O2)-dependent) was the primary exposure variable. The primary endpoint was 1-year sac growth post-EVAR. Mixed-effects linear and logistic regression were used to assess effects of COPD severity on sac remodeling, controlling for covariates. Cox-proportional hazards regression and competing risks regression identified predictors of mortality and reintervention.Results: 30,686 patients met inclusion criteria. COPD was present in 24% of patients (no COPD, 75.8%[n=23,260], medication-treated COPD, 19.7%[n=6,057], O2-dependent COPD, 4.5%[n=1,369]). O2-dependent COPD was associated with persistent sac growth (mean difference: +0.55mm, 95%CI[0.05-1.05], p=.03) following EVAR implantation; however, medication-treated COPD was not (mean difference: -0.06mm, 95%CI [-0.32-0.19]; p=.64). O2-dependent COPD patients did not experience increased reintervention rates (HR 0.82, 95%CI[0.65-1.02], p=0.07), but were identified to have significantly increased mortality (HR 1.8, 95%CI[1.52-2.22], p<.0001).Conclusions: O2-dependent COPD was significantly associated with increased sac growth after EVAR. O2-dependent COPD did not correlate with increased reintervention, likely due to the disproportionately elevated mortality rates in this group. These findings highlight that patients with O2-dependent COPD have limited life expectancy and potentially less favorable sac remodeling, and elective EVAR should thus be reserved for only those at greatest risk for AAA-related mortality.","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2025.02.019","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: Chronic obstructive pulmonary disease (COPD) is a known risk factor for abdominal aortic aneurysm (AAA) growth and rupture. The impact of COPD on AAA sac behavior following endovascular AAA repair (EVAR) is poorly understood. This study aimed to determine the association between COPD and sac remodeling after EVAR.

Methods: We identified all EVAR patients (2010-2021) in the Society for Vascular Surgery-Vascular Quality Initiative (SVS-VQI) database. COPD severity (none, medication-treated, oxygen (O₂)-dependent) was the primary exposure variable. The primary endpoint was 1-year sac growth post-EVAR. Mixed-effects linear and logistic regression were used to assess effects of COPD severity on sac remodeling, controlling for covariates. Cox-proportional hazards regression and competing risks regression identified predictors of mortality and reintervention.

Results: 30,686 patients met inclusion criteria. COPD was present in 24% of patients (no COPD, 75.8%[n=23,260], medication-treated COPD, 19.7%[n=6,057], O₂-dependent COPD, 4.5%[n=1,369]). O₂-dependent COPD was associated with persistent sac growth (mean difference: +0.55mm, 95%CI[0.05-1.05], p=.03) following EVAR implantation; however, medication-treated COPD was not (mean difference: -0.06mm, 95%CI [-0.32-0.19]; p=.64). O₂-dependent COPD patients did not experience increased reintervention rates (HR 0.82, 95%CI[0.65-1.02], p=0.07), but were identified to have significantly increased mortality (HR 1.8, 95%CI[1.52-2.22], p<.0001).

Conclusions: O₂-dependent COPD was significantly associated with increased sac growth after EVAR. O₂-dependent COPD did not correlate with increased reintervention, likely due to the disproportionately elevated mortality rates in this group. These findings highlight that patients with O₂-dependent COPD have limited life expectancy and potentially less favorable sac remodeling, and elective EVAR should thus be reserved for only those at greatest risk for AAA-related mortality.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of vascular surgery 医学-外科

CiteScore

3.00

自引率

13.30%

发文量

603

审稿时长

50 days

期刊介绍： Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence