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Patients require optimal medical therapy to prevent CVD after EVAR
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HOLLYWOOD, Fla. — In patients with abdominal aortic aneurysm, endovascular repair confers better short-term but similar or worse long-term mortality compared with open surgery, likely because CVD prevention tactics are not sufficiently performed, an expert said at the International Symposium on Endovascular Therapy.
In previous randomized trials, EVAR was associated with a threefold to sixfold reduction in 30-day mortality compared with open surgery, but data have not shown any mid- to long-term mortality benefit. Further, EVAR may increase risk for late graft rupture, which is associated with a 70% mortality rate, George Vatakencherry, MD, from Kaiser Permanente Los Angeles Medical Center, said during a presentation.
“We are doing such a great job at 30 days, and we know we have to follow these patients longitudinally for the life of the patient. But why is the benefit still not there at 2 years?” he asked. “The answer is CVD. The bulk of [patients who had EVAR in randomized controlled trials], 60% or 70% died of MI or stroke, and they were not well-treated. They had low use of aspirin and statins. Even those with obstructive CAD often didn’t have beta-blockers or similar therapies, even though they were in a trial.”
In one study, aorta size — greater than 3 cm in women and greater than 3.5 cm in men — was an independent predictor of CV events, according to Vatakencherry. “This is a surrogate of global atherosclerotic burden and needs to be treated aggressively,” he said.
Patients with AAA who smoke, which is strongly linked to development to AAA, are encouraged to stop, he said.
“There are good data showing that smoking cessation reduces growth rate of aneurysms,” he said.
Statins, long known to reduce CVD in high-risk patients, were shown in the HOPE-3 trial to also reduce CVD risk in intermediate-risk patients, and need to be strongly considered for anyone who undergoes an EVAR procedure, he said.
“You absolutely must follow these patients [with AAA] for life,” Vatakencherry said. – by Erik Swain
Reference:
Vatakencherry G. Focused Symposium VI: Fundamentals of Endovascular Therapy. Presented at: International Symposium on Endovascular Therapy; Feb. 4-8, 2017; Hollywood, Fla.
Disclosure: Vatakencherry reports no relevant financial disclosures.