Ilio-femoral calcium score may assist Glasgow Aneurysm Score prediction of long-term survival of low-risk patients after infrarenal EVAR

Background: The aim of this study is to evaluate if ilio-femoral calcium score (CS) combined with Glasgow Aneurysm Score (GAS) can improve the prediction of long-term survival after EVAR. Methods: All the patients who underwent infrarenal endovascular aortic repair (EVAR) for non-ruptured AAA between January 2004 and December 2012 at a tertiary referral center were retrospectively included if the preoperative imaging was of sufficient quality and they had survived for more than 30 days. Preoperative non-contrast enhanced CT were used to measure ilio-femoral calcium score using dedicated postprocessing software. GAS was calculated and patients were divided into low or high GAS by a cutoff of 80. Results: Two hundred and eighty-eight out of 500 patients were included in the study with no difference in survival compared to excluded patients (P=0.529). Patients were followed-up for a median of 7 (range 4-9) years. GAS correlated positively with ilio-femoral calcium score (r=0.123; P=0.037). One hundred and thirtyfive patients (46.9%) had low GAS, and 153 (53.1%) had high GAS. Patients with high GAS had lower survival compared to the ones with low GAS (P <= 0.0001). GAS was associated with long-term mortality in a uni- and multivariate regression (P <= 0.0001 and P <= 0.0001). Ilio-femoral calcium score was significantly associated with mortality in the group with low GAS (P=0.028), but not in the group with high GAS (P=0.297). Significance retained in multivariate regression analysis (P=0.029). Moreover, in the low GAS group, ilio-femoral calcium score was further divided in high and low according to the median. Patients with high calcium score had lower survival compared to the ones with low calcium score (P=0.047). Conclusions: Long-term survival in patients who have had infrarenal EVAR can be predicted by the clinically based Glasgow Aneurysm Score. Measuring the ilio-femoral calcium score preoperatively may refine GAS assessment in low-risk patients.