ORIGINAL ARTICLES   

International Angiology 2012 August;31(4):368-75

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

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

Ohrlander T. ¹, Nessvi S. ², Gottsäter A. ², Dencker M. ³, Acosta S. ² ✉

¹ Department of Surgery, Eksjö County Hospital, Eksjö, Sweden; ² Vascular Center, Malmö-Lund, Malmö, Sweden; ³ Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, Sweden

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.