Routinary use of preoperative transthoracic echocardiography in abdominal aortic aneurysm, does it solve problems?

The prevalence of abdominal aorta aneurysm (AAA) is estimated at 1.4% of the population of the United States. This condition is strongly associated to age and the presence of hypertension which are progressively increasing. Over the last few years endovascular aneurysm repair (EVAR) has gained ground to traditional open surgical repair. This information arise from randomized clinical trials, such as OVER and EVAR, where both strategies were compared (1,2). In the first trial, the 30-day mortality was 0.5% vs. 3%; P=0.004, in the latter 1.8% vs. 4.3%; P=0.002. The results were favorable to EVAR approach compared to traditional open surgery. Due to the lower rate of perioperative complications the use of the EVAR approach has increased, whenever it is technically possible. In this context the importance of the evaluation of preoperative risk has decreased. The approach to preoperative risk assessment has traditionally been based on the examination of conventional cardiovascular risk factors which have been proved to be associated with major cardiovascular events in post-intervention setting. However this strategy is not useful on an individual basis (3). Based on the change of surgical technique and the weakness of preoperative evaluation, O’Driscoll et al. (4) propose using transthoracic echocardiography (TTE) to improve the long-term prognostic evaluation of patients undergoing EVAR.