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.