Management of Modifiable Vascular Risk Factors Improves Late Survival following Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis.
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.
Department of Surgery, University of Otago, Christchurch, New Zealand; Department of Vascular, Endovascular & Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand. Electronic address: manar.khashram@gmail.com.
Manar
M
Khashram
Department of Population Health, University of Otago, Christchurch, New Zealand.
Jonathan A
JA
Williman
Department of Population Health, University of Otago, Christchurch, New Zealand.
Phil N
PN
Hider
Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand.
Gregory T
GT
Jones
Department of Surgery, University of Otago, Christchurch, New Zealand; Department of Vascular, Endovascular & Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand.
Justin A
JA
Roake
D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D016017:Odds Ratio; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome