RESUMO
Abstract Objective: The aim of the study was to compare the immediate and long-term outcomes of endovascular aneurysm repair (EVAR) between patients under and over the age of 80 with abdominal aortic aneurysm (AAA). Methods: From 2011 to 2017, we conducted a retrospective cohort study with AAA patients who received elective EVAR. Primary outcomes included hospital mortality, length of stay, acute kidney injury, and the need for re-interventions. Secondary outcomes included aneurysm-related mortality, acute myocardial infarction, stroke, acute limb ischemia, and prolonged mechanical ventilation. Results: A total of 77 (62.6%) patients under the age of 80 years old and 46 (37.4%) octogenarians were included in the study. The male gender and AAA diameter did not differ among groups (92.2% vs. 82.6%, p = 0.11 and 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectively). The younger patients had a higher prevalence of tobacco use (72.7% vs. 41.7%, p = 0.01). There were no deaths during the index hospitalization. The incidence of reinterventions (5.3% vs. 15.2%, p = 0.11) and acute kidney injury (14.3% vs. 23.9%, p = 0.18) did not differ between groups, but the length of stay was longer for octogenarian patients (3 days [2-4] vs. 2 days [2-3, p = 0.04]). Endoleaks were the most common cause for re-interventions (81.8%), with a prevalence of 34% across the entire cohort. There were no differences in any of the secondary outcomes between groups. Conclusion: In octogenarian patients with AAA, EVAR represents a safe procedure both during the index hospitalization and during long-term follow-up.
Resumen Objetivo: Comparar los resultados inmediatos y a largo plazo de la reparación endovascular del aneurisma de aorta abdominal (REVA) entre pacientes menores de 80 años y octogenarios. Método: Cohorte retrospectiva que incluyó pacientes con aneurisma de aorta abdominal (AAA) sometidos a REVA electiva desde 2011 hasta 2017. Se evaluaron como punto finales primarios la mortalidad hospitalaria, la duración de la estadía hospitalaria, la incidencia de insuficiencia renal aguda y el requerimiento de reintervenciones. Los puntos finales secundarios incluyeron la mortalidad asociada al aneurisma, infarto agudo de miocardio, accidente cerebrovascular, isquemia arterial aguda de las extremidades y ventilación mecánica prolongada. Resultados: Se incluyeron 77 (62.6%) pacientes menores de 80 años y 46 (37.4%) octogenarios. La prevalencia de sexo masculino y el diámetro del AAA no difirieron entre ambos grupos (92.2% vs. 82.6%, p = 0.11 y 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectivamente). Los pacientes más jóvenes presentaron una mayor prevalencia de tabaquismo (72.7% vs. 41.7%, p = 0.01). No se registraron muertes durante la hospitalización índice. La incidencia de reintervenciones (5.3% vs. 15.2%, p = 0.11) e insuficiencia renal aguda (14.3% vs. 23.9%, p = 0.18) no difirieron entre ambos grupos, pero la estadía hospitalaria fue más prolongada en pacientes octogenarios (3 días [2-4 días] vs. 2 días [2-3 días], p = 0.04). La causa más frecuente de reintervenciones fue la presencia de endofugas (81.8%), con una prevalencia del 34% en toda la cohorte. No se observaron diferencias en ninguno de los puntos finales secundarios entre ambos grupos. Conclusión: En pacientes octogenarios con AAA, la REVA presentó un buen perfil de seguridad perioperatorio y a largo plazo.
RESUMO
PURPOSE: The aim of this case control study was to evaluate the prognostic value of automatically quantified retinal vessel tortuosity from fundus images and vessel density from OCT-A in Fabry disease and to evaluate the correlation of these with systemic disease parameters. METHODS: Automatically quantified perimacular retinal vessel tortuosity (MONA REVA software), acquired by fundus imaging, and perifoveal retinal vessel density, acquired by optic coherence tomography angiography (OCT-A) were compared between 26 FD patients and 26 controls. Gender and FD phenotype were analyzed to the obtained retinovascular data and correlated to the Mainz severity score index (MSSI) and plasma lyso-Gb3. RESULTS: Automatically quantified retinal vessel tortuosity indices of FD patients were significantly lower, reflecting an increased vessel tortuosity, compared to controls (p = 0.008). Males with a classical phenotype showed significantly lower retinal vessel tortuosity indices compared to males with an oligosymptomatic phenotype and females with a classical or oligosymptomatic phenotype (p < 0.001). The retinal vessel tortuosity index correlated significantly with systemic disease severity parameters [global MSSI (r = - 0.5; p < 0.01), cardiovascular MSSI (r = - 0.5; p < 0.01), lyso-Gb3 (r = - 0.6; p < 0.01)]. CONCLUSION: We advocate fundus imaging based automatically quantified retinal vessel tortuosity index over OCT-A imaging as it is a quick, non-invasive, easily assessable, objective and reproducible marker.
