Factors with Impact on the Outcome after Surgical Interventions for Abdominal Aortic Aneurysms

Abstract

Since its introduction, endovascular aortic aneurysm repair (EVAR) has proved as a favourable alternative to open surgery (OR) in the treatment of abdominal aortic aneurysms (AAA). Long-term outcomes of EVAR and OR are similar while complications are more likely to develop after EVAR. Risk factors for mortality and complications after AAA surgery have been identified, however, a general overview is lacking. In a systematic literature search via PubMed, we identified publications on the topic of factors influencing the postoperative outcome of AAA surgery. Patient age > 80 years was found to be a significant predictor of increased mortality, whereas the influence of aneurysm diameter on OR remains moderate, the outcome of EVAR performed in AAA > 6.5 cm is associated with higher mortality and increased complication rates. In patients with ruptured AAA the postoperative mortality is higher than in those with intact aneurysms. Preoperative haemodynamic instability has a crucial influence on patient outcome and is strongly associated with intra- and postoperative death. The prevalence of cardiovascular co-morbidity leads to increased long-term mortality. Preoperative statin medication was found to reduce short- and long-term mortality by the factor of 0.5. Patients suffering from chronic lung disease such as COPD and patients with a deficiency in renal function are more likely to experience adverse events including death. While the prevalence of cerebrovascular disease is associated with an increase in mortality by the factor of 1.5 or higher, findings on patients with diabetes mellitus are conflicting with no definite point to be made. Several factors influencing the outcome of surgery for AAA present a condition developed from factors involved in the pathogenesis of AAA. The impact of non-disease factors like patient age and aneurysm diameter can be reduced by the means of population-wide screening for AAA, and optimised treatment of disease-related risk factors can reduce mortality. Studies comparing the outcome of EVAR and OR in patients with risk factors should be performed to support decision-making about the ideal individual treatment.