Preoperative vascular screening in the presence of aortic, carotid and peripheral pathology for patients undergoing their first arterial intervention: 18 month follow-up.

BACKGROUND

The aim of this paper was to determine prevalence and incidence of intervention required for concomitant Asymptomatic Vascular Disease (AVD) on patients undergoing their first elective peripheral arterial intervention.

METHODS

This is a prospective observational study Data was obtained on patients undergoing peripheral revascularisation, abdominal aortic aneurysmal (AAA) repair or carotid procedure from 2006 to 2009. Of 542 complex arterial procedures, 328 patients had their first vascular intervention. (PAD=127, AAA=97, CAD=83, concomitant AAA and PAD=21). Primary endpoint is detection of any concomitant asymptomatic AAA, CAS or PAD. Secondary endpoints are need for intervention of AVD detected on screening, and major adverse clinical events during follow-up.

RESULTS

Prevalence of AVD detected was 13% PAD, 51% CAS and 8%AAA. Symptomatic and Asymptomatic PolyVasBed patients had 11.4- and 8.16-fold increased likelihood for detection of asymptomatic CAS respectively (P<0.0001) relative to the remaining study population. Asymptomatic PolyVasBed patients had 8.2 fold increased likelihood of asymptomatic AAA, P<0.0001, compared to the remaining study population. Likelihood for intervention in Asymptomatic PolyVasBed is OR 5.740 (P=0.044) and Symptomatic PolyVasBed is OR 4.500 (P<0.001). Asymptomatic AAA detected in both symptomatic and asymptomatic vascular disease patients, is the strongest predicting factor of intervention in 18 months follow-up. In Asymptomatic PolyVasBed patients, CAS and AAA have the highest prevalence.

CONCLUSIONS

Screening for AVD is mandatory prior to any vascular intervention.