Skip to main content

Preoperative Evaluation and Clinical Risk Assessment

  • Chapter
  • First Online:
Endovascular Aortic Repair
  • 2696 Accesses

Abstract

Preoperative evaluation and clinical risk assessment are critical to achieve excellent outcomes during endovascular repair of complex aortic aneurysms. A thorough evaluation of cardiac, pulmonary, and renal performance coupled with detailed assessment of the patients anatomy is needed for adequate case selection and for planning successful repair. Indiscriminate treatment of high-risk patients with short anticipated survival is not recommended and should be avoided. This chapter summarizes standardized recommendations for evaluation of patients being considered for major open and endovascular aortic repair.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6):491–9.

    Article  CAS  PubMed  Google Scholar 

  2. Dua A, Kuy S, Lee CJ, Upchurch Jr GR, Desai SS. Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010. J Vasc Surg. 2014;59(6):1512–7.

    Article  PubMed  Google Scholar 

  3. Huang Y, Gloviczki P, Oderich GS, Duncan AA, Kalra M, Fleming MD, et al. Outcome after open and endovascular repairs of abdominal aortic aneurysms in matched cohorts using propensity score modeling. J Vasc Surg. 2015;62(2):304–11. e2.

    Article  PubMed  Google Scholar 

  4. Park BD, Azefor N, Huang CC, Ricotta JJ. Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care. J Am Coll Surg. 2013;216(4):745–54; discussion 54–5.

    Article  PubMed  Google Scholar 

  5. Patel RP, Katsargyris A, Verhoeven EL, Adam DJ, Hardman JA. Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results. Cardiovasc Intervent Radiol. 2013;36(6):1443–51.

    Article  PubMed  Google Scholar 

  6. Wilson A, Zhou S, Bachoo P, Tambyraja AL. Systematic review of chimney and periscope grafts for endovascular aneurysm repair. Br J Surg. 2013;100(12):1557–64.

    Article  CAS  PubMed  Google Scholar 

  7. Park JH, Chung JW, Choo IW, Kim SJ, Lee JY, Han MC. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience. J Vasc Interv Radiol. 1996;7(6):819–23.

    Article  CAS  PubMed  Google Scholar 

  8. Kitagawa A, Greenberg RK, Eagleton MJ, Mastracci TM. Zenith p-branch standard fenestrated endovascular graft for juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2013;58(2):291–300.

    Article  PubMed  Google Scholar 

  9. Panuccio G, Bisdas T, Berekoven B, Torsello G, Austermann M. Performance of bridging stent grafts in fenestrated and branched aortic endografting. Eur J Vasc Endovasc Surg. 2015;50(1):60–70.

    Article  CAS  PubMed  Google Scholar 

  10. Oderich GS, Greenberg RK, Farber M, Lyden S, Sanchez L, Fairman R, et al. Results of the United States multicenter prospective study evaluating the Zenith fenestrated endovascular graft for treatment of juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2014;60(6):1420–8.e1–5.

    Google Scholar 

  11. Cochennec F, Kobeiter H, Gohel M, Leopardi M, Raux M, Majewski M, et al. Early results of physician modified fenestrated stent grafts for the treatment of thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2015;50(5):583–92.

    Article  CAS  PubMed  Google Scholar 

  12. Mastracci TM, Eagleton MJ, Kuramochi Y, Bathurst S, Wolski K. Twelve-year results of fenestrated endografts for juxtarenal and group IV thoracoabdominal aneurysms. J Vasc Surg. 2015;61(2):355–64.

    Article  PubMed  Google Scholar 

  13. Heron M. Deaths: leading causes for 2011. Natl Vital Stat Rep. 2015;64(7):1–96.

    Google Scholar 

  14. Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005;365(9470):1577–89.

    Article  CAS  PubMed  Google Scholar 

  15. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(24):e278–333.

    Article  PubMed  Google Scholar 

  16. Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, et al. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35(35):2383–431.

    Article  PubMed  Google Scholar 

  17. Eagleton MJ, Kang J. Preoperative management. In: Cronenwett JL, Johnston KW, editors. Rutherford’s vascular surgery. 8th ed. Philadelphia: Saunders; 2014. p. 466–79.

    Google Scholar 

  18. Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4 Suppl):S2–49.

    Article  PubMed  Google Scholar 

  19. Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med. 1999;159(18):2185–92.

    Article  CAS  PubMed  Google Scholar 

  20. Girish M, Trayner Jr E, Dammann O, Pinto-Plata V, Celli B. Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery. Chest. 2001;120(4):1147–51.

    Article  CAS  PubMed  Google Scholar 

  21. American Society of Anesthesiologists. ASA physical status classification system. 2014. http://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system. [Cited 6 Aug 2015].

  22. Mak PH, Campbell RC, Irwin MG. The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care. 2002;30(5):633–40.

    CAS  PubMed  Google Scholar 

  23. Aronson WL, McAuliffe MS, Miller K. Variability in the American Society of Anesthesiologists Physical Status Classification Scale. AANA J. 2003;71(4):265–74.

    PubMed  Google Scholar 

  24. Chaikof EL, Fillinger MF, Matsumura JS, Rutherford RB, White GH, Blankensteijn JD, et al. Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair. J Vasc Surg. 2002;35(5):1061–6.

    Article  PubMed  Google Scholar 

  25. Golden MA, Whittemore AD, Donaldson MC, Mannick JA. Selective evaluation and management of coronary artery disease in patients undergoing repair of abdominal aortic aneurysms. A 16-year experience. Ann Surg. 1990;212(4):415–20. discussion 20-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Van Kuijk JP, Flu WJ, Dunckelgrun M, Bax JJ, Poldermans D. Coronary artery disease in patients with abdominal aortic aneurysm: a review article. J Cardiovasc Surg (Torino). 2009;50(1):93–107.

    Google Scholar 

  27. Smetana GW. Preoperative medical evaluation of the healthy patient. 2015. http://www.uptodate.com. [updated 10 Aug 2015; cited 13 Aug 2015].

  28. Hernesniemi JA, Vanni V, Hakala T. The prevalence of abdominal aortic aneurysm is consistently high among patients with coronary artery disease. J Vasc Surg. 2015;62(1):232–40. e3.

    Article  PubMed  Google Scholar 

  29. Durieux R, Van Damme H, Labropoulos N, Yazici A, Legrand V, Albert A, et al. High prevalence of abdominal aortic aneurysm in patients with three-vessel coronary artery disease. Eur J Vasc Endovasc Surg. 2014;47(3):273–8.

    Article  CAS  PubMed  Google Scholar 

  30. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2009;120(21):e169–276.

    Article  PubMed  Google Scholar 

  31. Nishimura RA, Otto CM, Benow RO, et al. 2014 AHA/ACC guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):2438–88.

    Article  PubMed  Google Scholar 

  32. Kristensen SD, Knuuti J. New ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014;35(35):2344–5.

    Article  PubMed  Google Scholar 

  33. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.

    Article  CAS  PubMed  Google Scholar 

  34. Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381–7.

    Article  PubMed  Google Scholar 

  35. Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X, et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg. 2013;217(2):336–46.e1.

    Google Scholar 

  36. Bertges DJ, Goodney PP, Zhao Y, Schanzer A, Nolan BW, Likosky DS, et al. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients. J Vasc Surg. 2010;52(3):674–83, 83.e1–83.e3.

    Google Scholar 

  37. Ford MK, Beattie WS, Wijeysundera DN. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med. 2010;152(1):26–35.

    Article  PubMed  Google Scholar 

  38. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833–42.e1–3.

    Google Scholar 

  39. Rodseth RN, Lurati Buse GA, Bolliger D, Burkhart CS, Cuthbertson BH, Gibson SC, et al. The predictive ability of pre-operative B-type natriuretic peptide in vascular patients for major adverse cardiac events: an individual patient data meta-analysis. J Am Coll Cardiol. 2011;58(5):522–9.

    Article  PubMed  Google Scholar 

  40. Biccard BM, Lurati Buse GA, Burkhart C, Cuthbertson BH, Filipovic M, Gibson SC, et al. The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients. Anaesthesia. 2012;67(1):55–9.

    Article  CAS  PubMed  Google Scholar 

  41. Fleisher LA. Preoperative evaluation of the patient with hypertension. JAMA. 2002;287(16):2043–6.

    Article  PubMed  Google Scholar 

  42. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol. 2002;39(3):542–53.

    Article  PubMed  Google Scholar 

  43. Schermerhorn ML, O’Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358(5):464–74.

    Article  CAS  PubMed  Google Scholar 

  44. Piffaretti G, Mariscalco G, Bonardelli S, Sarcina A, Gelpi G, Bellosta R, et al. Predictors and outcomes of acute kidney injury after thoracic aortic endograft repair. J Vasc Surg. 2012;56(6):1527–34.

    Article  PubMed  Google Scholar 

  45. Drews JD, Patel HJ, Williams DM, Dasika NL, Deeb GM. The impact of acute renal failure on early and late outcomes after thoracic aortic endovascular repair. Ann Thorac Surg. 2014;97(6):2027–33. discussion 33.

    Article  PubMed  Google Scholar 

  46. Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.

    Article  Google Scholar 

  47. Acute kidney injury: prevention, detection and management up to the point of renal replacement therapy. London: National Clinical Guideline Centre; 2013.

    Google Scholar 

  48. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Sakamaki F, Oya H, Nagaya N, Kyotani S, Satoh T, Nakanishi N. Higher prevalence of obstructive airway disease in patients with thoracic or abdominal aortic aneurysm. J Vasc Surg. 2002;36(1):35–40.

    Article  PubMed  Google Scholar 

  50. Meijer CA, Kokje VB, van Tongeren RB, Hamming JF, van Bockel JH, Moller GM, et al. An association between chronic obstructive pulmonary disease and abdominal aortic aneurysm beyond smoking: results from a case-control study. Eur J Vasc Endovasc Surg. 2012;44(2):153–7.

    Article  CAS  PubMed  Google Scholar 

  51. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–65.

    Article  CAS  PubMed  Google Scholar 

  52. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338–50.

    Article  PubMed  Google Scholar 

  53. Gupta H, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, et al. Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 2011;140(5):1207–15.

    Article  PubMed  Google Scholar 

  54. Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, et al. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc. 2013;88(11):1241–9.

    Article  PubMed  Google Scholar 

  55. Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1.9 million people. Lancet Diabetes Endocrinol. 2015;3(2):105–13.

    Article  PubMed  PubMed Central  Google Scholar 

  56. King Jr JT, Goulet JL, Perkal MF, Rosenthal RA. Glycemic control and infections in patients with diabetes undergoing noncardiac surgery. Ann Surg. 2011;253(1):158–65.

    Article  PubMed  Google Scholar 

  57. Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, et al. American Association of Clinical Endocrinologists and American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21 Suppl 1:1–87.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38.

    Article  CAS  PubMed  Google Scholar 

  59. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  CAS  PubMed  Google Scholar 

  60. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Mehta RL. Kidney disease: improving global outcomes (KDIGO) acute kidney injury workgroup. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gustavo S. Oderich .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Mayo Foundation for Medical Education and Research

About this chapter

Cite this chapter

Huang, Y., Oderich, G.S. (2017). Preoperative Evaluation and Clinical Risk Assessment. In: Oderich, G. (eds) Endovascular Aortic Repair. Springer, Cham. https://doi.org/10.1007/978-3-319-15192-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15192-2_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15191-5

  • Online ISBN: 978-3-319-15192-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics