Does endovascular aortic aneurysm repair justify a reduced cardiology work-up?

Endovascular repair of abdominal aortic aneurysms (EVAR) has been introduced as an alternative to open surgery with the purpose of reducing operative risk and improving survival. Since cardiac co-morbidity is a major risk factor for both the operative procedure and long-term survival, it seems worthwhile to compare the cardiac implication of the 2 procedures. If EVAR would indeed afford a cardioprotective effect, this could have clinical consequences. Preoperative cardiology work-up could be reduced and more high-risk patients could be treated. A review of the literature has been made focusing on studies that examined cardiology work-up and cardiac risk profile of EVAR and open surgery. Most literature data suggest that cardiac risk is indeed reduced with EVAR, since hemodynamic alterations are less severe, episodes of anaemia are less frequent, plasma catecholamine levels are lower and general anaesthesia can be avoided. There is no level I or II evidence that immediate or late cardiac complications are indeed reduced with EVAR. At present, there are not enough literature data on the cardiac implications of EVAR to justify a reduced preoperative cardiology work-up. Even if conclusive evidence was available that EVAR reduces operative cardiac risk, the value of preoperative cardiac screening and myocardial revascularisation would remain unchanged: the purpose of cardiology work-up is not only to reduce operative risk but also to improve long-term survival.