Is Diabetes a Risk Factor for Patients Undergoing Open Abdominal Aortic Aneurysm Repair?

Abstract

A number of studies have compared results after aortic procedures in diabetics vs nondiabetics but few have focused specifically on abdominal aortic aneurysm surgery. An analysis of prospective data was carried out in the Vascular Surgery Registry (Beth Israel Deaconess Medical Center, Boston, MA) and identified 421 patients (422 grafts) who underwent elective open repair of an abdominal aortic aneurysm between 1990 and 1999. The influence of diabetes mellitus on outcome was assessed by dividing the patients into two groups: 52 diabetic and 370 nondiabetic patients. Postoperative mortality was 1.7% overall (n = 7) and proportionally higher in the diabetic population, although this did not reach statistical significance (3.8% vs 1.4%, p = 0.19). However, cumulative survival at 1 year and 3 years was essentially identical for diabetic vs nondiabetic patients (91.0% vs 92.6% and 70.0% vs 73.5%, respectively) and did not diverge until 5 years after surgery (25.0% vs 50.9% respectively [p > 0.05]). Overall, major complications occurred in 11 diabetics (21.2%) vs 58 nondiabetics (15.7%, p = 0.32). Specific complications that were increased in the diabetic population included pancreatitis (5.8% vs 1.1%, p = 0.01) and pneumonia (11.5% vs 3.2%, p = 0.006). Notably, overall cardiac morbidity was not higher in patients with diabetes mellitus (1.9% vs 4.3%, p = 0.41). Our data suggest that after elective open abdominal aortic aneurysm repair, patients with diabetes mellitus may have a higher rate of certain complications when compared to patients without diabetes mellitus. These differences however, do not preclude the expectation of excellent results of open abdominal aortic aneurysm repair in patients with diabetes mellitus.

Diabetes and Abdominal Aortic Aneurysms

“…A higher risk of complications in diabetics with AAA was also reported. 47,51,52,64 Owing to the variability in timing for assessment and reporting, long-term outcomes were not combined in a formal meta-analysis. Results of secondary analyses in diabetic patients and AAA Secondary meta-analyses were conducted to investigate the association of diabetes and AAA in overall incidence/prevalence studies and in sex subgroups.…”

Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm

“…Mackenzie et al 37 Urbonavicius et al 38 Rigberg et al 9 Sasaki et al 39 Stenbaek et al 40 Biancari et al 41 Upchurch et al 42 Rayan et al 43 Alonso-Pérez et al 44 El-Sabrout and Reul 45 Huber et al 11 Brady et al 46 Heller et al 18 Dardik et al 47 Akkersdijk et al 48 Semmens et al 49 Katz et al 8 Starr et al 50 Henderson and Effeney 51 For the elective open repair group, treatment criteria such as AAA diameter or rapid AAA growth were reported in two of 26 articles 32,46 . For the elective EVAR group this was six of 21 55,57,58,60,62,66 .…”

“…Berge et al 31 Ting et al 52 Azizzadeh et al 53 Biebl et al 54 Leon et al 36 Lifeline 20 Zarins et al 55 Sampaio et al 56 Criado et al 57 Elkouri et al 58 Nordness et al 59 Parlani et al 60 Shames et al 61 Slovut et al 62 Wyers et al 63 Sanchez et al 64 Wolf et al 65 1 1·54 1·22 Howell et al 66 Mathison et al 67 Romero et al 68 Cao et al 69 Pooled odds ratio 35 23 82 80·8 8 2 ·2 68 65 2 (9) 9 (11) Leon et al 36 2746 7974 73·2(8·0)# 71·4(8·0)# --225 (8·2)** 415 (5·2)** Lifeline 20 69 37 42 177 69·9 ‡ 69·9 ‡ --5 (12)** 3 (1·7)** Urbonavicius et al 38 17 52 ----3 (18) 5 (10) Rigberg et al 9 18 71 ----0 (0)** 0 (0)** Sasaki et al 39 11 89 71 ‡ 71 ‡ 57·9(10·2) ‡ 57·9(10·2) ‡ 0 (0)** 1 (1)** Stenbaek et al 40 109 488 71(6·4) 70 (7) --12 (11·0) § 42 (8·6) § Biancari et al 41 239 42 68 90 70·3 ‡ 70·3 ‡ 58 ‡ 58 ‡ 1 (1) 4 (4) Rayan et al 43 100 321 74·4(7·1) ‡ 74·4(7·1) ‡ --2 ( 2 ·0)** 5 (1·6)** Alonso-Pérez et al 44 13 170 77 ‡ 77 (2)…”

No increase in mortality after open infrarenal aortic surgery in the era of evar

“…Further testing is not thought to be particularly cost effective in this group, and the results of further cardiac testing should not change the management [10]. A test may show an abnormality, but that does not necessarily mean an increased risk [11].…”