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Abdominal aortic aneurysm repair in cardiac high risk patients – medication, surgery or stent?

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Abstract

With increasing age of the general population, a higher awareness of the disease, better screening methods and the option of less invasive therapeutical strategies, the incidence of abdominal aortic aneurysms (AAA) is rising steadily. Since AAA is a disease of the elderly patient with generalized atherosclerosis, there is a high coincidence with other vascular morbidities. Especially the presence of coronary artery disease and concomitant left ventricular dysfunction proves many of those patients to be cardiac high risk patients with respect to an operative approach. On the other hand, a high coincidence of severe peripheral arterial occlusive disease might hamper the endovascular approach and endovascular therapy might carry a high risk for these patients as well. Therefore, it is of utmost importance to consider how and when cardiac high risk patients with AAA should be treated. In this review therefore special aspects such as the choice of medical treatment, the need of preoperative coronary revascularization and the situation in old patients are discussed in detail.

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References

  1. Ashton HA, Buxton MJ, Day NE et al (2002) The multicentre aneurysm screening study (MASS) into the effect of abdominal aortic aneurysm screening on mortality on men: a randomised controlled trial. Lancet 360:1531–1539

    Article  PubMed  CAS  Google Scholar 

  2. Back MR, Leo F, Cuthbertson D, Johnson BL, Shmesmd ML, Bandyk DF (2004) Long term survival after vascular surgey: specific influence on cardiac factors and implications for preoperative evaluation. J Vasc Surg 40(4):752–760

    Article  PubMed  Google Scholar 

  3. Bardy AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT (2004) UK small aneurysm participants. Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 110(1):16–21

    Article  Google Scholar 

  4. Baril DT, Palchik E, Carroccio A, Olin JW, Ellozy SH, Jacobs TS, Ponzio MM, Teodorescu VJ, Marin ML, Baril J et al (2006) Experience with endovascular abdominal aortic aneurysm repair in nonagenarians. J Endovasc Ther 13(3):330–337

    Article  PubMed  Google Scholar 

  5. Bigatel DA, Elmore JR, Carey DJ, Cizmeci-Smith G, Franklin DP, Youkey JR (1999) The matrix metalloproteinase inhibitor BB-94 limits expansion of experimental abdominal aortic aneurysms. J Vasc Surg 29:130–138; discussion 138–139

    Article  PubMed  CAS  Google Scholar 

  6. Blankensteijn JD, de Jong SECA, Prinsson M, van der Ham AC, Buth J, van Sterkenburg SMM, Verhagen HJM, Buskens E, Grobbee DE for the Dutch Randomised Endovascular Aneurysm Management (DREAM) Trial Group (2005) N Engl J Med 352:2398–2405

  7. Brunner S, Kopp R, Franz W-M (2007) Endovascular repair of symptomatic abdominal aortic aneurysm complicated by postoperative acute myocardial infarction with cardiogenic shock. Clin Res Cardiol 96(4):236–239

    Article  PubMed  Google Scholar 

  8. Cornuz J, Sidoti Pinto C, Tevaearai H, Egger M (2004) Risk factors for asymptomatic abdominal aortic aneurysm: systematic review and meta-analysis of population-based screening studies. Eur J Public Health 14:343–349

    Article  PubMed  Google Scholar 

  9. Curci JA, Petrinec D, Liao S, Golub LM, Thompson RW (1998) Pharmacological suppression of experimental abdominal aortic aneurysms: a comparison of doxycycline and four chemically modified tetracyclines. J Vasc Surg 28:1082–1093

    Article  PubMed  CAS  Google Scholar 

  10. Evar trial participants (2005) Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 365(9478):2187–2192

    Article  Google Scholar 

  11. Feringa HH, Bax JJ, Boersma E, Kertai MD, Meij SH, Galal W, Schouten O, Thomson IR, Klootwijk P, van Sambeek MR, Klein J, Poldermans D (2006) High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients. Circulation 114(Suppl 1):I344–I349

    PubMed  Google Scholar 

  12. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG, EVAR trial participants (2005) Endovascular aneurysm repair versus open repir in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365:2179–2186

    Article  Google Scholar 

  13. Hackam D, Thiruchelvam D, Redelmeier DA (2006), Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study. Lancet 368:659–665

    Article  PubMed  CAS  Google Scholar 

  14. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC (1991) Suggested standards for reporting on arterial aneurysms. Subcommittee on reporting standards for arterial aneurysms, ad hoc committee on reporting standards, society for vascular surgery and north American chapter, international society for cardiovascular surgery. J Vasc Surg 13:452–458

    Article  PubMed  CAS  Google Scholar 

  15. Johnston JW, the Canadian Society for Vascular Surgery Aneurysm Study Group (1994) Nonruptured abdominal aortic aneurysm: six-year follow-up results from the multicenter prospective Canadian aneurysm study. J Vasc Surg 20(2):163–170

    PubMed  CAS  Google Scholar 

  16. Jordan WD, Alcocer F, Wirthlin DJ, Westfall AO, Whitley D (2003) Abdominal aortic aneysrysms in “high-risk” surgical patients: comparison of open and endovascular repair. Ann Surg 237(5):623–629

    Article  PubMed  Google Scholar 

  17. Kertai MD, Boersma E, Westerhout CM, Klein J, Van Urk H, Bax JJ, Roelandt JR, Poldermans D (2004) A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg 28(4):343–352

    Article  PubMed  CAS  Google Scholar 

  18. Laheij RJ, van Marrewijk CJ (2000) Endovascularstenting of abdominal aortic aneurysm in patients unfit for elective open surgery. Eurostar group. EUROpean collaborators registry on stent-graft techniques for abdominal aortic aneurysm repair. Lancet 356(9232):832

    Article  PubMed  CAS  Google Scholar 

  19. Lange C, Leurs LJ, Buth J, Myhre HO, Eurostar collaborators (2005) Endovascular repair of abdominal aortic aneurysm in octogenarians: an analysis based on EUROSTaR data. J Vasc Surg 42(4):624–630

    Article  PubMed  Google Scholar 

  20. Liddington MI, Healther BP (1992) The relationship aortic diameter and body habitus. Eur J Vasc Surg 6:89–92

    Article  PubMed  CAS  Google Scholar 

  21. Ligush J Jr, Pearce JD, Edwards MS, Escridge MR, Cherr GS, Plonk GW, Hansen KJ (2002) Analysis of medical risk factors and outcomes in patients undergoing open versus endovascular abdominal artic aneurysm repair. J Vasc Surg 36(3):492–499

    Article  PubMed  Google Scholar 

  22. Limet R, Sakalihassan N, Albert A (1991) Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms. J Vasc Surg 14(4):540–548

    Article  PubMed  CAS  Google Scholar 

  23. Lindsay TF (2006) Regression of aortic aneurysms through pharmacologic therapy? N Engl J Med 11, 354(19):2067–2068

    Google Scholar 

  24. Mackey WC, Fleisher LA, Haider S, Sheikh S, Cappelleri JC, Lee WC, Wang Q, Stephens JM (2006) Perioperative myocardial ischemic injury in high risk vascular surgery patients: incidence and clinical significance in a prospective clinical trial. J Vasc Surg 43(3):533–538

    Article  PubMed  Google Scholar 

  25. McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG (2004) Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 351(27):2795–2804

    Article  PubMed  CAS  Google Scholar 

  26. Menard MT, Chew DK, Chan RK, Conte MS, Donaldson MC, Mannick JA, Whittemore AD, Belin M (2003) Outcome in patients at high risk after open surgical repair of abdominal aortic aneurysm. J Vasc Surg 37(2):285–292

    Article  PubMed  Google Scholar 

  27. Minor ME, Ellozy S, Carroccio A, Oak J, Chae K, Agarwal G, Surmay R, Teodorescu V, Morrissey NJ, Jacobs T, Lookstein R, Hollier LH, Marin ML (2004) Endovascular aortic eneurysm repairin the octogenarian: is it worth while? Arch Surg 139(3):308–314

    Article  PubMed  Google Scholar 

  28. Mohr FW, Falk V, Autschbach R, Diegeler A, Schorn B, Weyland A, Vettelschoss M, Frank B, Gummert J, Dalichau H (1995) One-stage surgery of coronary arteries and abdominal aorta in patients with impaired left ventricular function. Circulation 91(2):379–385

    PubMed  CAS  Google Scholar 

  29. Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R, the EuroSCORE study group (1999) European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothora Surg 16:9–13

    Article  CAS  Google Scholar 

  30. Nilsson J, Hansson GK, Shah PK (2005) Immunomodulation of atherosclerosis: implications for vaccine development. Arterioscler Thromb Vasc Biol 25:18–28

    Article  PubMed  CAS  Google Scholar 

  31. Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499

    Article  PubMed  CAS  Google Scholar 

  32. Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, Baars HF, Yo TI, Trocino G, Vigna C, Roelandt JR, van Urk H (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic cardiac risk evaluation applying stress echocardiography study group. N Engl J Med 341(24):1789–1794

    Article  PubMed  CAS  Google Scholar 

  33. Prinssen M, Verhoeven EL, Buth J et al (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618

    Article  PubMed  CAS  Google Scholar 

  34. Rihal CS, Eagle KA, Mickel MC, Foster ED, Sopko G, Gersh BJ (1995) Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease. Circulation 91(1):46–53

    PubMed  CAS  Google Scholar 

  35. Sakalihasan N, Limet R, Defawe OD (2005) Abdominal aortic aneurysm. Lancet 365:1577–1589

    Article  PubMed  CAS  Google Scholar 

  36. Schouten O, van Waning VH, Kertai MD, Feringa HH, Bax JJ, Boersma E, Elhendy A, Biagini E, van Sambeek MR, van Urk H, Poldermans D (2005) Perioperative and long-term cardiovascular outcomes in patients undergoing endovascular treatment compared with open vascular surgery for abdominal aortic aneurysm or iliaco-femoro-popliteal bypass. Am J Cardiol 96(6):861–866

    Article  PubMed  Google Scholar 

  37. Scott RAP, Vardulaki KA, Walker NM, Day NE, Duffy W, Ashton HA (2001) The longterm benefits of a single scan for abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Eur J Vasc Endovasc Surg 21:535–540

    Article  PubMed  CAS  Google Scholar 

  38. Sicard GA, Zwoiak RM, SIdawy AN, Whitev RA, Siami FS (2006) Endovascular abdominal aortic aneurysm repair: long-term outcome measures in patients at high-risk for open surgery. J Vac Surg 44(2):229–236

    Article  Google Scholar 

  39. Takemoto M, Liao JK (2001) Pleiotropic effects of 3-hydroxy-3-methylglutary coenzyme A reductase inhibitors. Arterioscler Thromb Vasc Biol 21:1712–1719

    Article  PubMed  CAS  Google Scholar 

  40. The UK Small Aneurysm Trial Participants (1998) Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 352:1649–1655

    Article  Google Scholar 

  41. The United Kingdom Small Aneurysm Trial Participants (2002) Long-term outcomes of immediate repair compared with surveillance for small abdominal aortic aneurysm. N Engl J Med 346:1445–1452

    Article  Google Scholar 

  42. Yoshimura K, Aoki H, Ikeda Y, Fujii K, Akiyama N, Furutani A, Hoshii Y, Tanaka N, Ricci R, Ishihara T, Esato K, Hamano K, Matsuzaki M (2005) Regression of abdominal aortic aneurysm by inhibition of c-Jun N-terminal kinase. Nat Med 11(12):1330–1338

    Article  PubMed  CAS  Google Scholar 

  43. Zankl A, Schumacher H, Krumsdorf U, Katus HA, Jahn L, Tiefenbacher C (2007) Pathology, natural history and treatment of abdominal aortic aneurysms. Cin Res Cardiol 96(3):140–151

    Article  CAS  Google Scholar 

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  1. Department of Cardiology, Ruprecht-Karls University Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Christiane P. Tiefenbacher

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Correspondence to Christiane P. Tiefenbacher.

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Tiefenbacher, C.P. Abdominal aortic aneurysm repair in cardiac high risk patients – medication, surgery or stent?. Clin Res Cardiol 97, 215–221 (2008). https://doi.org/10.1007/s00392-007-0634-5

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  • DOI: https://doi.org/10.1007/s00392-007-0634-5

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