Abdominal aortic aneurysm in patients affected by intermittent claudication: prevalence and clinical predictors

Giugliano, Giuseppe; Laurenzano, Eugenio; Rengo, Carlo; Rosa, G De; Brevetti, Linda; Sannino, Anna; Perrino, Cinzia; Chiariotti, Lorenzo; Schiattarella, Gabriele Giacomo; Serino, Federica; Ferrone, Marco; Scudiero, Fernando; Carbone, Andreina; Sorropago, Antonio; Amato, Bruno; Trimarco, Bruno; Esposito, Giovanni

doi:10.1186/1471-2482-12-s1-s17

Cited by 30 publications

(19 citation statements)

References 23 publications

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“…1,2 These risk factors make these patients vulnerable to developing postoperative major adverse cardiac events (MACEs), including myocardial infarction (MI), arrhythmia, congestive heart failure (CHF), or sudden death. 3,4 The primary factor leading to these outcomes is development of myocardial ischemia resulting from plaque rupture, prolonged subendocardial hypoperfusion, or both. β-Adrenergic blocking medications (β-blockers) theoretically offer ideal protection from MACEs because they lower myocardial oxygen demand and have plaque-stabilization properties.…”

mentioning

confidence: 99%

Preoperative β-blockers do not improve cardiac outcomes after major elective vascular surgery and may be harmful

Scali

Patel

Neal

et al. 2015

Journal of Vascular Surgery

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Objective Routine initiation β-blocker medications before vascular surgery is controversial due to conflicting data. The purpose of this analysis was to determine whether prophylactic use of β-blockers before major elective vascular surgery decreased postoperative cardiac events or mortality. Methods The Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) data set was used to perform a retrospective cohort analysis of infrainguinal lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm(AAA) repair patients. Chronic (>30 days preoperatively) β-blocker patients were excluded, and comparisons were made between preoperative (0–30 day) and no β-blocker groups. Patients were risk stratified using a novel prediction tool derived specifically from the SVS-VQI data set. Propensity-matched pairs and interprocedural specific risk stratification comparisons were performed. End points included in-hospital major adverse cardiac events (MACEs), including myocardial infarction (MI; defined as new ST or T wave electrocardiographic changes, troponin elevation, or documentation by echocardiogram or other imaging modality), dysrhythmia, and congestive heart failure, and 30-day mortality. Results The study analyzed 13,291 patients (LEB, 68% [n = 9047]; AFB, 11% [n = 1474]; and open AAA, 21% [n = 2770]); of these, 67.7% (n = 8999) were receiving β-blockers at time of their index procedure. Specifically, 13.2% (n = 1753) were identified to have been started on a preoperative β-blocker, 54.5% (n=7426) were on chronic β-blockers, and 32.3% (n=4286) were on no preoperative β-blockers. Among the three procedures, patients had significant demographic and comorbidity differences and thus were not combined. A 1:1 propensity-matched pairs analysis (1459 pairs) revealed higher rates of postoperative MI with preoperative β-blockers (preoperative β-blocker relative risk, 1.65; 95% confidence interval, 1.02–2.68; P = .05 vs no β-blocker), with no difference in dysrhythmia, congestive heart failure, or 30-day mortality. When stratified into low-risk, medium-risk, and high-risk groups within each procedure, all groups of preoperative β-blocker patients had no difference or higher rates of MACEs and 30-day mortality, with the exception of high-risk open AAA patients, who had a lower rate of MI (odds ratio, 0.35; 95% confidence interval, 011–0.87; P = .04). Conclusions Exclusive of high-risk open AAA patients, preoperative β-blockers did not decrease rates of MACEs or mortality after LEB, AFB, or open AAA. Importantly, exposure to prophylactic preoperative β-blockers increased the rates of some adverse events in several subgroups. Given these data, the SVS-VQI cannot support routine initiation of preoperative β-blockers before major elective vascular surgery in most patients.

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mentioning

confidence: 99%

Preoperative β-blockers do not improve cardiac outcomes after major elective vascular surgery and may be harmful

Scali

Patel

Neal

et al. 2015

Journal of Vascular Surgery

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“…In a study of Brevetti et al. the prevalence of AAA in patients with lower limb arterial disease was 11.9% in men and 8.8% in women, confirming the importance of peripheral obstructive arteriopathy as a risk factor for infrarenal AAA and underlining the importance of screening in this subpopulation .…”

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confidence: 89%

Abdominal aortic aneurysm: screening and management

Giugliano

Gerardi

Annunziata

et al. 2018

Continuing Cardiol Educ

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Abdominal aortic aneurysm (AAA) is a frequent cause of death. Management of AAA includes different strategies: open surgery repair, endovascular repair and, for small AAA, medical therapy and careful follow-up. Endovascular repair is a valid alternative to surgical repair, especially in patients whit high procedural risk.Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/ 6464194/Activity.aspx

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“…• Przesiewowa ocena w kierunku AAA za pomocą DUS [258,259] • Leczenie wewnątrznaczyniowe jako alternatywne w doświadczonych ośrodkach…”

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2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

Aboyans¹,

Ricco²,

Bartelink³

et al. 2017

Kardiol Pol

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Abdominal aortic aneurysm in patients affected by intermittent claudication: prevalence and clinical predictors

Cited by 30 publications

References 23 publications

Preoperative β-blockers do not improve cardiac outcomes after major elective vascular surgery and may be harmful

Preoperative β-blockers do not improve cardiac outcomes after major elective vascular surgery and may be harmful

Abdominal aortic aneurysm: screening and management

2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)

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