LAUSR

OBJECTIVE Abdominal aortic aneurysm (AAA) is associated with an increased mortality, mostly cardiovascular events. Moreover, aorto-iliac calcification is associated with increased mortality in patients with peripheral occlusive disease. The aim of this study is to assess the potential association between ilio-femoral calcification, assessed by calcium score, in patients undergoing infrarenal (EVAR) or fenestrated endovascular aortic repair (FEVAR) and long-term mortality, particularly caused by cardiac events. METHODS All patients with preoperative non-contrast enhanced CT scans that underwent infrarenal EVAR and FEVAR of non-ruptured AAA between 2004 and 2012 at a single tertiary center were screened for inclusion. Agatston calcium score was measured from the aortic bifurcation to common femoral arteries using a dedicated postprocessing software. The values are presented as median and interquartile range (IQR) RESULTS: 404 (62,05%) out of 651 patients who underwent EVAR and FEVAR had sufficient imaging quality to be included. There was no difference in survival between included and excluded patients (P= 0.33). Nine patients (2.2%) died within 30 days of the operation, while the remaining were followed-up for 6.3 (4.7-8.4) years. The ilio-femoral calcium score was 8348 (3830 - 14179). Estimated overall survival at 5 years was 73±2%. Patients within the lowest quartile of ilio-femoral calcium score had significantly higher overall survival (5 years 79±4% vs 71±3%, p=0.01) and cardiac event-free survival (5 years 95±2% vs 91±2%, P=0.033) when compared to the remaining ones. Calcium score was not associated on univariate regression analysis with survival (OR=1.016 (0.988-1.045), P=0.268), nor with cardiac event-free survival (OR= 1.024 (0.986-1.063), P=0.222). CONCLUSION Low ilio-femoral calcium score may be associated with lower incidence of fatal cardiac events and all-cause long-term mortality after EVAR and FEVAR. This may be partially a reflection of aging and cardiovascular comorbility, but needs to be studied further.