Long-Term Cardiac Outcome in High-Risk Patients Undergoing Elective Endovascular or Open Infrarenal Abdominal Aortic Aneurysm Repair

Abstract

Objective: To examine and compare existing pre-operative risk prediction methods for elective abdominal aortic aneurysm (AAA) repair.Design: Systematic review. Methods: Medline, EMBASE and the Cochrane library were searched for articles that related to risk prediction models used for elective AAA repair.Results: 680 abstracts were reviewed and after exclusions 28 articles encompassing 10 risk models were identified. The most frequently studied of these were the Glasgow Aneurysm Score (GAS), the Physiological and Operative Severity Score for enUmeration of Mortality (POSSUM) predictor equation and the Vascular Biochemistry and Haematology Outcome Model (VBHOM). All models had strengths and weaknesses and some had unique features which were identified and discussed.Conclusion: The GAS appeared to be the most useful and consistently validated score at present for open repair. Other systems were either not validated fully or were not consistently accurate. Some had significant drawbacks which appeared to severely limit their clinical application. Recent work has shown that no scores consistently predicted the risk associated with endovascular aneurysm repair (EVAR). Pre-operative risk stratification is a vital component of modern surgical practice, and we propose the need for a comprehensive new risk scoring method for AAA repair incorporating anatomical and physiological data.

Systematic review and meta-analysis of the effects of statin therapy on abdominal aortic aneurysms

“…All reported a lower mortality rate in patients taking a statin following AAA repair. Two studies found this difference to be significant by 1 year22, 23. All studies found the effect to be significant at 2 and 5 years.…”

“…Eleven of the 12 studies were retrospective cohort studies5–7, 19–26; one was a prospective cohort study27. Table S1 (supporting information) summarizes study characteristics.…”

“…Of the three studies reporting the type of statin used5, 21, 27, simvastatin was the most common, followed by atorvastatin then pravastatin. Of the five studies of outcome after AAA repair7, 19, 21–23, two reported on endovascular aneurysm repair (EVAR) alone19, 22, one on open repair alone21, and two on EVAR and open repair7, 23. The EVAR and open results could not be separated for analysis.…”

“…Four studies reported long‐term all‐cause mortality rates19, 21–23. All reported a lower mortality rate in patients taking a statin following AAA repair.…”

“…Two of the seven studies that described expansion rates were ostensibly about other potential prognostic variables; they also presented expansion data according to statin use within the results20, 25. One of the two 30‐day mortality studies focused on resource utilization7, and one of the four long‐term mortality studies examined multiple potential variables but presented the data in such a way that survival by statin therapy could be extracted as an outcome23. Including such studies reduced concern about publication bias as the decision to publish was unrelated to statin therapy and AAA outcome.…”