When abdominal aortic aneurysms (AAAs) ruptures occur, they usually strike without warning. Studies indicate that AAAs cause kill about half of all patients before they ever reach the hospital, and only half of people who arrive to hospitals alive survive these events. When diagnosed through screening, AAAs are carefully monitored for signs of enlargement, and surgical intervention is often needed to prevent ruptures.
Most patients with AAAs are older and tend to have other comorbidities, including high cholesterol. In an effort to prevent cardiovascular disease, patients are often given statins to protect blood vessels from plaque formation and stress and to possibly slow progression of AAAs. Little is known, however, about the impact statin use has on surgical outcomes when repairing AAAs.
Assessing the Impact
For a study published in the journal Vascular, Todd R Vogel, MD, and colleagues evaluated the utilization of preoperative statins and their impact on perioperative outcomes in patients undergoing open or endovascular AAA repair. The study involved nearly 20,000 AAA cases where patients received either type of repair, with the majority undergoing open repair. Slightly more than half of all patients involved in the study used statins prior to surgery.
According to the study results, patients who took statins before open or endovascular AAA repair had better outcomes than those who did not take the cholesterol-lowering drugs. Overall, patients taking statins and receiving endovascular repair had a 26% lower mortality rate when assessed up to 1 year after surgery. The investigators also broke down the death rate after endovascular repair based on different time segments (Table).
|Mortality After AAA Repair & Statin Use
The table below depicts a breakdown of mortality among patients undergoing endovascular AAA repair and taking statins:
|Mortality||Statin use after endovascular AAA repair||No statin use after endovascular AAA repair|
|Source: Adapted from: Galiñanes E, et al. Vascular. 2015;23:344-349.|
A Call to Action
“The bottom line is that patients who used statins were more likely to survive during and after an elective endovascular AAA procedure,” says Dr. Vogel. “Our findings should be viewed as a call to action for clinicians to increase utilization of statins when they are being considered for these surgeries.” The study noted that those taking statins and receiving open AAA repair also had a better mortality rate, but the difference was not as significant as what was observed with endovascular repair. In addition, the study showed that statin use also reduced postoperative complications for patients with other health issues, such as peripheral artery disease.
Data from the study support the beneficial role of statin use prior to surgery for patients undergoing AAA repair. This information could be beneficial to patients who are about to have an elective endovascular AAA repair because they can be educated on the survival benefits associated with using statins, according to the researchers. However, more research is needed to assess the benefits of statins prior to these surgeries and the repair of other types of aneurysms after 1 year.
Galiñanes EL, Reynolds S, Dombrovskiy, Vogel TR. The impact of preoperative statin therapy on open and endovascular abdominal aortic aneurysm repair outcomes. Vascular. 2015;23:344-349. Available at: http://vas.sagepub.com/content/23/4/344.abstract.
de Bruin JL, Baas AF, Heymans MW, et al; DREAM Study Group. Statin therapy is associated with improved survival after endovascular and open aneurysm repair. J Vasc Surg. 2014;59:39-44.
Davenport DL, O’Keeffe SD, Minion DJ, Sorial EE, Endean ED, Xenos ES. Thirty-day NSQIP database outcomes of open versus endoluminal repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2010;51:305-309.
Jonker FH, Trimarchi S, Verhagen HJ, Moll FL, Sumpio BE, Muhs BE. Meta-analysis of open versus endovascular repair for ruptured descending thoracic aortic aneurysm. J Vasc Surg. 2010;51:1026-1032.
Galiñanes EL, Dombrovskiy VY, Graham AM, Vogel TR. Endovascular versus open repair of popliteal artery aneurysms: outcomes in the US Medicare population. Vasc Endovascular Surg. 2013;47:267-273.