Predictors of long-term mortality following elective endovascular repair of abdominal aortic aneurysms

INTRODUCTION: Endovascular aneurysm repair (EVAR) became the preferred modality for abdominal aortic aneurysm (AAA) repair. However, long term survival benefit may sometimes be questionable as many patients would die from other causes rather than aneurysm rupture. It is paramount to identify critical risk factors for late mortality after EVAR to understand its real benefit. The aim of this review is to identify most clinically relevant determinants of late mortality after elective EVAR. EVIDENCE ACQUISITION: English literature was searched to identify publications on long-term predictors of mortality following elective EVAR. A follow-up extending for at least 5 years was the minimum required as inclusion criteria. Primary endpoint was all-cause mortality. We addressed clinical and demographic variables and observe if they had any associations with long-term all-cause mortality following EVAR. EVIDENCE SYNTHESIS: Twelve studies were included describing more than 82306 patients, exploring at least one predictor of long-term mortality. All-cause mortality was associated to age (Hazard ratio [HR] 1.06-3.34), gender (HR: 1.07), aneurysm diameter (HR: 1.09-1.64), smoking habits (HR: 1.51-1.73), heart failure (HR: 1.60-7.34), ischemic heart disease (HR: 1.60), peripheral vascular disease (HR: 1.30), cerebrovascular disease (HR: 1.55), diabetes mellitus (HR: 6.35), chronic obstructive pulmonary disease (HR: 1.50-2.06) and chronic renal disease (HR: 1.90-3.08). CONCLUSIONS: Risk factors associated with long-term mortality following elective EVAR remain scarcely published. Several demographic, anatomical, cardiovascular, pulmonary and renal comorbidities seem to have an association with long-term mortality. Critical scrutiny of clinical patient status remains fundamental for a fair health resources allocation.