The risk prediction model should help clinicians select patients who would benefit most from early TEVAR, and delay TEVAR in patients who might be better managed nonoperatively.
To evaluate whether surgeons at his institution were accounting for higher-risk patients, Dr. Beck and his associates performed a secondary analysis. As the number of risk factors for death within 1 year of TEVAR increased, so did the aneurysm diameter at which patients underwent repair. This suggests that surgeons were taking into account risk factors, at least to some extent, in deciding when to operate on these patients.
Patients in the study had a mean age of 61 years, and 63% were male. The average aneurysm diameter was 6.25 cm. At the time of treatment, 38% of patients had coronary artery disease, 28% had chronic obstructive pulmonary disease, and 12% had peripheral vascular occlusive disease. Nine percent of patients underwent an intraoperative adjunctive procedure.
Among other comorbidities, 85% had hypertension, 51% had dyslipidemia, 14% had diabetes, 11% had chronic renal insufficiency, and 7% had heart failure.
Eighty percent of patients were taking antiplatelet medications, 55% were on statins, and 67% were considered to be in American Society of Anesthesiologists classification 4.
Dr. Beck reported having no financial disclosures.