Abdominal Aortic Aneurysm during the Pandemic: Should They Be Operated or Deferred?

Some European societies have recommended deferring the treatment of infrarenal abdominal aortic aneurysm (AAA) ≥5.5 cm during the COVID-19 pandemic. However, these documents have also suggested optimal deferral times, and everything must be adjusted according to the transmission risk/risk of rupture balance.

Annual risk of rupture can be estimated based on a prospective cohort published by McGuinness et al. Almost 200 patients had regrets about their elective treatment and, after 5 years of follow-up, had rupture rates of 9.5%, 10.2%, and 32.5% for aneurysms of 5.5-5.9 cm, 6-6.9 cm, and ≥7 cm, respectively.

We could assume that perioperative COVID-19-related mortality and community risk are equivalent.

This model calculates the “optimal strategy” (repair or deferral) at different timepoints (3, 6, 9, and 12 months) based on baseline characteristics, risk of rupture, surgical risk, and COVID-19-related mortality risk.

The COVID-19 infection risk was stratified by community virus prevalence and nosocomial transmission (estimated as at least twice the community transmission risk).

Results suggest any aneurysm could be deferred for 3 months.

Read also: La durabilidad del TAVI pasa a un segundo plano con los resultados del TRANSIT.

Surgical repair can be deferred up to 6 months only in young patients (<65 years old) with aneurysms >7cm when the risk of COVID-19 transmission is low.

Endovascular repair (non-open) can be deferred 3 months—or even 6 months—in most scenarios, based on the risk of COVID-19 transmission.

These recommendations support deferral for most patients, but also warn that not everyone will conform to this, and decisions must be made on a case-by-case basis.

Original Title: COVID-19 and abdominal aortic aneurysm intervention: when to defer and when to operate.

Reference: Brenig L. Gwilym et al. European Journal of Vascular & Endovascular Surgery 2021. Journal Pre-proof. https://doi.org/10.1016/j.ejvs.2021.05.034.

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