Impact of preoperative evaluation by vascular physician on mortality in patients undergoing elective endovascular repair for abdominal aortic aneurysm.
Nessvi, Sofia LU ; Gottsäter, Anders LU and Acosta, Stefan LU
(2015)
In International Angiology
35(6).
p.579-585
- Abstract
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 AAAon long term survival and causes of death. METHODS: Aretrospective study comparing patients treated with EVARfor AAAfrom 1998 to 2006, having undergone standardized preoperative work-up including spirometry and echocardiography (group 1, N.=304), to patients undergoing EVAR2007 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]... (More)
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 AAAon long term survival and causes of death. METHODS: Aretrospective study comparing patients treated with EVARfor AAAfrom 1998 to 2006, having undergone standardized preoperative work-up including spirometry and echocardiography (group 1, N.=304), to patients undergoing EVAR2007 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 (IQR45-75) 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 EVARwas associated with reduced 1- and 2-year mortality, presumably related to more effective pharmacological cardiovascular prevention.
(Less)
- author
- Nessvi, Sofia
LU
; Gottsäter, Anders
LU
and Acosta, Stefan
LU
- organization
- publishing date
- 2015-11-23
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aortic aneurysm abdominal, Endovascular procedures, Mortality, Preoperative care
- in
- International Angiology
- volume
- 35
- issue
- 6
- pages
- 7 pages
- publisher
- Minerva Medica
- external identifiers
-
- pmid:26603431
- scopus:84992209646
- pmid:26603431
- ISSN
- 1827-1839
- language
- English
- LU publication?
- yes
- id
- b3caf242-f406-480e-b005-91fd80d83326 (old id 8234627)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/26603431?dopt=Abstract
- date added to LUP
- 2016-04-04 08:41:33
- date last changed
- 2022-01-29 03:53:40
@article{b3caf242-f406-480e-b005-91fd80d83326,
abstract = {{<p>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 AAAon long term survival and causes of death. METHODS: Aretrospective study comparing patients treated with EVARfor AAAfrom 1998 to 2006, having undergone standardized preoperative work-up including spirometry and echocardiography (group 1, N.=304), to patients undergoing EVAR2007 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 (IQR45-75) 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 EVARwas associated with reduced 1- and 2-year mortality, presumably related to more effective pharmacological cardiovascular prevention.</p>}},
author = {{Nessvi, Sofia and Gottsäter, Anders and Acosta, Stefan}},
issn = {{1827-1839}},
keywords = {{Aortic aneurysm abdominal; Endovascular procedures; Mortality; Preoperative care}},
language = {{eng}},
month = {{11}},
number = {{6}},
pages = {{579--585}},
publisher = {{Minerva Medica}},
series = {{International Angiology}},
title = {{Impact of preoperative evaluation by vascular physician on mortality in patients undergoing elective endovascular repair for abdominal aortic aneurysm.}},
url = {{http://www.ncbi.nlm.nih.gov/pubmed/26603431?dopt=Abstract}},
volume = {{35}},
year = {{2015}},
}