Pharmacotherapy Before and After Endovascular Repair of Abdominal Aortic Aneurysms

Endovascular (EVAR) abdominal aortic aneurysm (AAA) repair has been established as a successful procedure in the short term and may constitute a viable long-term alternative to open repair (OR). The procedure has been associated with lower operative and mid-term morbidity and mortality compared to OR, but long-term results remain largely controversial. EVAR has also been associated with a significant risk of implant and procedure-related complications, such as graft thrombosis and cardiovascular events, necessitating interventional and pharmaceutical management. Medical management of patients undergoing EVAR is required for several different reasons. Patients with an AAA have an increased risk of cardiovascular death, necessitating treatment to reduce the overall risk for cardiovascular events. Treatment is inline with the medical management of coronary artery disease including anti-platelet therapy and statins. Anti-platelet therapy is also mandatory to prevent complications such as graft-limb thrombosis and peripheral arterial disease (PAD), which is common in patients with an AAA. Especially in patients with PAD, aspirin, clopidogrel and statins remain the mainstay of medical management. Unfortunately, there is a lack of prospective randomised trials concerning the medical management of patients that have undergone abdominal aortic endo-grafting. We review the current literature on the medical treatment of patients undergoing EVAR, focusing on peri-operative management, anti-platelet agents and statins.