Preoperative Spirometry Results as a Determinant for Long-term Mortality after EVAR for AAA

Objectives: The aim of this study was to analyse lung function test determinants for long-term mortality after standard endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). Design: Retrospective analysis. Materials: Three-hundred and four consecutive patients treated electively with EVAR (Zenith (R) stent grafts, Cook) between May 1998 and February 2006 were prospectively enrolled in a computerised database. Methods: The Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guideline was used to grade the severity of obstructive lung disease. Mortality was checked until 1 December 2010. Median follow-up time was 68 (interquartile range (IQR) 40-94) months. Results: The percentage of patients with mild, moderate or severe (grade 3) chronic obstructive pulmonary disease (COPD) was 9.9%, 23.2% and 7.7%, respectively. In a combined medical severity assessment, arterial partial pressure of oxygen (PaO2) < 8.0 kPa or COPD, grade >= 3 (hazard ratio (HR) 2.06; 95% confidence interval (CI) (1.24-3.42)), anaemia (HR 1.72; 95% CI (1.21-2.44)), chronic kidney disease, stage >= 3 (HR 1.55; 95% Cl (1.08-2.24)) and age >= 80 years (HR 1.55; 95% Cl (1.04-2.31)) were independently associated with long-term mortality. Lower forced expiratory volume in 1 s (FEV1) (p = 0.002) and lower forced vital capacity (FVC) (p = 0.003) were independently associated with long-term mortality. Conclusions: Our findings strengthen the need for formal evaluation of lung function with spirometry prior to proceeding to AAA repair. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.