Influence of preoperative medical assessment prior to elective endovascular aneurysm repair for abdominal aortic aneurysm.

AIM: The aim of this study was to compare preoperative patient evaluation by a vascular physician with a standardized workup protocol prior to elective endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), in terms of differences in patient medication and mortality. METHODS: Consecutive patients with infrarenal AAA treated with standard EVAR from 1998 to 2006 (group 2) and 2007 to 2011 (group 1) were compared. Patients in group 1 (N.=201) were investigated preoperatively by a vascular physician, evaluating comorbidities and medication. Patients in group 2 (N.=304) underwent a standardized preoperative work-up including spirometry and echocardiography. Median time of follow-up was 23 months in group 1 and 71 months in group 2. RESULTS: The proportion of patients who had on-going medication with anti-platelet and lipid lowering medication at admission was higher in group 1 compared to group 2 (62% versus 51%; P=0.013 and 68% versus 35%; P<0.001). In group 1, the proportion of newly instituted or increased dosage of anti-hypertensive, anti-platelet or lipid lowering medication at preoperative evaluation was 40%, 24% and 31%, respectively. The total cost for preoperative assessment per patient was 272 € in group 1 and 293 € in group 2 (P<0.001). There was no difference in 30-day (P=0.29) or long-term (P=0.24) mortality between the two groups. CONCLUSION: Preoperative assessment by a vascular physician resulted in lower costs and improvement of medication against atherosclerosis, uncontrolled hypertension and perioperative ischemic cardiac events, but mortality was unaffected.

Preoperative spirometry results as a determinant for long-term mortality after EVAR for AAA.

OBJECTIVES: The aim of this study was to analyse lung function test determinants for long-term mortality after standard endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). DESIGN: Retrospective analysis. MATERIALS: Three-hundred and four consecutive patients treated electively with EVAR (Zenith(®) stent grafts, Cook) between May 1998 and February 2006 were prospectively enrolled in a computerised database. METHODS: The Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guideline was used to grade the severity of obstructive lung disease. Mortality was checked until 1 December 2010. Median follow-up time was 68 (interquartile range (IQR) 40-94) months. RESULTS: The percentage of patients with mild, moderate or severe (grade 3) chronic obstructive pulmonary disease (COPD) was 9.9%, 23.2% and 7.7%, respectively. In a combined medical severity assessment, arterial partial pressure of oxygen (PaO(2)) < 8.0 kPa or COPD, grade ≥3 (hazard ratio (HR) 2.06; 95% confidence interval (CI) (1.24-3.42)), anaemia (HR 1.72; 95% CI (1.21-2.44)), chronic kidney disease, stage ≥3 (HR 1.55; 95% CI (1.08-2.24)) and age ≥80 years (HR 1.55; 95% CI (1.04-2.31)) were independently associated with long-term mortality. Lower forced expiratory volume in 1 s (FEV(1)) (p = 0.002) and lower forced vital capacity (FVC) (p = 0.003) were independently associated with long-term mortality. CONCLUSIONS: Our findings strengthen the need for formal evaluation of lung function with spirometry prior to proceeding to AAA repair.

Emergency intervention for thrombosed popliteal artery aneurysm: can the limb be salvaged?

We present a review and our own experience of the demographic aspects of popliteal artery aneurysms (PAAs), their clinical presentation, the treatment alternatives and associated outcome. The incidence of PAA:s varies between 0,1-1%. 95% of the patients are male. 50% are asymptomatic at the time of diagnosis. Annually, 5-24% of PAAs develop symptoms. The clinical presentation varies widely with an amputation rate of up to 78% in acute ischemic cases. The main indication for PAA repair is prevention of embolisation but acute revascularisation is the primary task in the emergency setting. Open surgery and endovascular techniques are described and can be combined with intraarterial thrombolysis as pre- or intraoperative treatment. The literature proves often inconclusive due to small numbers of heterogenous cases. Each case, therefore, needs to be assessed individually and offered the most suitable treatment.