Impact of preoperative evaluation by vascular physician on mortality in patients undergoing elective endovascular repair for abdominal aortic aneurysm.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a potentially life-threatening condition associated with increased cardiovascular mortality. This study aims to evaluate effects of medical assessment prior to endovascular repair (EVAR) for AAA on long term survival and causes of death.

METHODS: A retrospective study comparing patients treated with EVAR for AAA from 1998 to 2006, having undergone standardized preoperative work-up including spirometry and echocardiography (group 1, N.=304), to patients undergoing EVAR 2007 to 2011 after individual assessment by a vascular physician aiming to optimize cardiovascular medication and reveal previously unknown illnesses (group 2, N.=201). Median follow-up was 84 months (Inter Quartile Range [IQR] 40-84) in group 1, and 60 months (IQR 45-75) in group 2.

RESULTS: The use of lipid lowering agents (92%; P<0.001), anti-platelet (85%; P<0.001), antihypertensive drugs (94%; P<0.001), and beta receptor blockers (78%; P<0.001) was higher in group 2. In multivariable analysis adjusting for AAA-size ≥6.0 cm, signs of ischemia on ECG, and chronic kidney disease stage ≥3, group 1 had significantly higher both 1-year (OR 3.2 [95% CI 1.2-9.0]) and 2-year mortality (OR 2.3 [95% CI 1.2-4.6]), whereas no differences were found between groups in survival beyond 2 years. Vascular disease was the most common cause of death in both groups (62% and 55%; P=0.29).

CONCLUSIONS: Individualized preoperative evaluation by a vascular physician prior to elective EVAR was associated with reduced 1- and 2-year mortality, presumably related to more effective pharmacological cardiovascular prevention.