Management of Modifiable Vascular Risk Factors Improves Late Survival following Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

• Published in: Annals of vascular surgery Vol. 39; pp. 301 - 311
• Main Authors: Khashram, Manar, Williman, Jonathan A, Hider, Phil N, Jones, Gregory T, Roake, Justin A
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2017
• Subjects: Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Humans; Odds Ratio; Protective Factors; Risk Assessment; Risk Factors; Surgery; Time Factors; Treatment Outcome
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2016.07.066

Background The main determinants of survival following abdominal aortic aneurysm (AAA) repair are preexisting risk factors rather than the method of repair chosen. The main aim of this meta-analysis was to assess the effect of modifiable risk factors on late survival following AAA repair. Methods Electronic databases were searched to identify all relevant articles reporting the influence of modifiable risk factors on long-term survival (≥1 year) following elective open aneurysm repair and endovascular aneurysm repair. Results Twenty-four studies which comprised 53,118 patients, published between 1989 and 2015, were included in the analysis. The use of statin, aspirin, beta-blockers, and a higher hemoglobin level was all significant predictors of improved survival following repair with a hazard ratio (HR) and 95% confidence interval (CI) of 0.75 (0.70–0.80), 0.81 (0.73–0.89), 0.75 (0.61–0.93), and 0.84 (0.74–0.96), respectively. Smoking history and uncorrected coronary disease were associated with a worse long-term survival of HR 1.27 (95% CI 1.07–1.51) and HR 2.59 (95% CI 1.14–5.88), respectively. Conclusions Addressing cardiovascular risk factors in patients preoperatively improves long-term survival following AAA repair. Global strategies to improve risk factor modifications in these patients are warranted to optimize long-term outcomes.