Effect of Statin Intensity on Postoperative Mortality after Open Repair of Intact Abdominal Aortic Aneurysm: Is Intensive Therapy Necessary?

Abstract

INTRODUCTION: Management of patients with mycotic aortic aneurysms and prosthetic aortic graft infections is associated with significant morbidity and mortality. We describe a single-center experience with the use of cryopreserved human allografts for in situ reconstruction of infected aortas and aortic grafts. METHODS: We retrospectively reviewed all patients who underwent implantation of cryopreserved aortic allograft at our tertiary care center from June 2010 to December 2016. Demographic data, preoperative work-up, procedural details, and outcomes were collected. RESULTS: Fifteen patients underwent cryopreserved allograft aortic reconstruction. Nine patients had aortic infection associated with a prosthetic graft, and 6 had primary aortic infections. Of these patients, 1 had involvement of the descending thoracic aorta, 6 of the paravisceral aorta, and 8 of the infrarenal abdominal aorta. Mean follow-up was 18.3 months. One (6.7 %) patient died within 30 days (multisystem organ failure). Postoperative complications included graft thrombosis in 1 (6.7%), reoperation for bleeding in 1 (6.7%), MI in 1 (6.7%), acute kidney injury requiring hemodialysis in 3 (20%), paraplegia in 1 (6.7 %), and stroke in 1 (6.7%). During follow-up, 2 patients developed graft stenosis requiring angioplasty, and 1 patient had graft rupture requiring stent placement. At 1 month, 6 months, 1 year, 3 years, and 6 years, estimated survivals were 93%, 78%, 67%, 67%, and 67%, respectively. No patient suffered limb loss. CONCLUSIONS: The management of mycotic aneurysms and infected aortic grafts continues to be challenging. Cryopreserved graft with in situ reconstruction provides a viable alternative for extra-anatomic bypass in the setting of infection.

Association between statin use and perioperative mortality after aortobifemoral bypass in patients with aortoiliac occlusive disease

“…13,14 Optimal medical management, such as the use of antiplatelets and statins, has a positive impact on patient outcomes after several vascular procedures including ABFB. [15][16][17][18] Our study is the largest analysis to date to describe the impact of statins on perioperative outcomes after ABFB for AIOD. We have shown an association between preoperative statin use and a 32% reduction in 30-day mortality after ABFB.…”

“…After comparison of different intensities, moderate, high, and supratherapeutic statin intensities were not associated with lower odds of mortality compared with low-intensity statin. 16 Despite the known long-term benefits of statin, short-term benefits are still controversial. Whereas the use of statins was shown to reduce the incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery, 19 another study failed to detect an association between statin use and short-term outcomes.…”