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Oxygen-dependent chronic obstructive pulmonary disease does not prohibit aortic aneurysm repair
M K Eskandari1, R Y Rhee, D L Steed
1Division of Vascular Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
American Journal of Surgery
|September 16, 1999
Summary
Patients with severe oxygen-dependent chronic obstructive pulmonary disease (COPD) can safely undergo open abdominal aortic aneurysm (AAA) repair. This study found no perioperative deaths in 14 such patients.
Area of Science:
- Vascular Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Severe oxygen-dependent chronic obstructive pulmonary disease (COPD) has historically been viewed as a contraindication for open abdominal aortic aneurysm (AAA) repair.
- This perception may limit treatment options for patients with complex comorbidities.
Purpose of the Study:
- To evaluate the safety and outcomes of elective open infrarenal AAA repair in patients with severe home oxygen-dependent COPD.
- To challenge the traditional contraindication for this patient group.
Main Methods:
- A retrospective review of medical records was conducted for 14 consecutive patients.
- All patients had severe home oxygen-dependent COPD and underwent elective open infrarenal AAA repair between July 1995 and March 1999.
Main Results:
- The mean aortic aneurysm size was 6.3 cm.
- Key respiratory parameters included mean PaO2 of 70 mm Hg, PaCO2 of 45 mm Hg, FEV1 of 34% predicted, and FVC of 67% predicted.
- All patients were extubated within 24 hours, with a mean hospital stay of 5.9 days and no perioperative deaths.
Conclusions:
- Severe home oxygen-dependent COPD is not an absolute contraindication for elective open AAA repair.
- Open AAA repair can be performed safely in carefully selected patients with severe COPD.
- These findings support reconsidering treatment strategies for AAA in this high-risk population.