1151
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Jiménez PM. [Aortic stents: anesthesiology implications]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:263-265. [PMID: 18661683 DOI: 10.1016/s0034-9356(08)70567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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1152
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Barnes M, Boult M, Maddern G, Fitridge R. A Model to Predict Outcomes for Endovascular Aneurysm Repair Using Preoperative Variables. Eur J Vasc Endovasc Surg 2008; 35:571-9. [DOI: 10.1016/j.ejvs.2007.12.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
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1153
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Paolini D, Chahwan S, Wojnarowski D, Pigott JP, LaPorte F, Comerota AJ. Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians. J Vasc Surg 2008; 47:924-7. [DOI: 10.1016/j.jvs.2007.12.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 12/10/2007] [Accepted: 12/13/2007] [Indexed: 11/15/2022]
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1154
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Lovegrove RE, Javid M, Magee TR, Galland RB. A meta-analysis of 21 178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 2008; 95:677-84. [DOI: 10.1002/bjs.6240] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results.
Methods
A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate.
Results
Forty-two studies comprising 21 178 patients (10 855 open; 10 323 endovascular) were included. In the elective setting (20 715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD − 36 h; P < 0·001) and a shorter total postoperative stay (WMD − 5·4 days; P < 0·001). Cardiac (OR 1·76; P = 0·002) and respiratory (OR 4·01; P < 0·001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0·46; P < 0·001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0·39; P < 0·001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD − 100·4 h; P = 0·005) and a significantly lower 30-day mortality (OR 0·45; P = 0·005).
Conclusions
The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality.
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Affiliation(s)
- R E Lovegrove
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - M Javid
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - T R Magee
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - R B Galland
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
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1155
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Abstract
Background—
Morbidity and mortality after conventional repair of thoracoabdominal aneurysms remain high. Alternative techniques have been proposed and are the subject of this report.
Methods and Results—
Endovascular grafts that have a means of incorporating the visceral vessels into the aortic repair were divided into devices with fenestrations and those with formal branches. Hybrid procedures whereby an extra-anatomic bypass procedure is used to provide inflow to the renal and mesenteric arteries followed by aortic relining with stent grafts were reviewed and tabulated. A description of the techniques and review of the current results are provided. Only 4 series with >10 cases of hybrid procedures have been published. The experience with such a procedure suggests feasibility, but most reports describe a persistently high risk of mortality (up to 25%). Larger series of fenestrated stent grafts to treat juxtarenal aneurysms have been published, and intermediate-term results confirm the safety and efficacy of the procedure. A larger multicenter trial is under way. Other pure endovascular methods have been used to treat thoracoabdominal aneurysms with both reinforced fenestrations and directional branches. Without counting small series (<10 cases), 2 series exist with ≈100 cases that noted perioperative mortality rates between 3% and 6%, without evidence of late ruptures.
Conclusions—
Endovascular repair of thoracoabdominal aneurysms is feasible and is associated with relatively low perioperative mortality. Several methods of visceral vessel incorporation have been described. Because of persistently high mortality, hybrid procedures will likely be relegated to nonsurgical and nonendovascular patients with sizable aneurysms. Endografts with branches continue to evolve and will be assessed in the context of clinical trials.
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Affiliation(s)
- Roy K. Greenberg
- From the Departments of Vascular Surgery (R.K.G.), Cardiothoracic Surgery (R.K.G., B.L.), and Biomedical Engineering (R.K.G.), The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bruce Lytle
- From the Departments of Vascular Surgery (R.K.G.), Cardiothoracic Surgery (R.K.G., B.L.), and Biomedical Engineering (R.K.G.), The Cleveland Clinic Foundation, Cleveland, Ohio
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1156
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Park B, Mavanur A, Drezner AD. Chronic obstructive pulmonary disease is not an independent marker for adverse outcomes in endograft repair of abdominal aortic aneurysms. Ann Vasc Surg 2008; 22:341-5. [PMID: 18430545 DOI: 10.1016/j.avsg.2008.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 11/01/2007] [Accepted: 01/03/2008] [Indexed: 11/19/2022]
Abstract
A significant proportion of patients undergoing endograft repair of abdominal aortic aneurysms (AAAs) suffer from chronic obstructive pulmonary disease (COPD). We report here our experience and analysis of 342 consecutive AAA endograft repairs in patients with and without COPD (137, or 39%, of patients with COPD and 55, or 16%, with moderate to severe COPD). Patient outcomes such as perioperative mortality, length of admission, intensive care unit admission, congestive heart failure, myocardial infarction, conversion to open surgery, duration of surgery, postoperative endoleaks, and combined respiratory complications were analyzed; differences were not statistically significant compared to patients without COPD (p > 0.05). Endograft repair of AAA demonstrated equivalent outcomes in patients with and without COPD.
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Affiliation(s)
- Brian Park
- Division of Vascular Surgery, Hartford Hospital, Hartford, CT 06102-5037, USA
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1157
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1158
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Goshima KR, Mills JL, Awari K, Pike SL, Hughes JD. Measure what matters: institutional outcome data are superior to the use of surrogate markers to define "center of excellence" for abdominal aortic aneurysm repair. Ann Vasc Surg 2008; 22:328-34. [PMID: 18411029 DOI: 10.1016/j.avsg.2007.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 08/19/2007] [Accepted: 09/14/2007] [Indexed: 11/26/2022]
Abstract
Outcome analysis is increasingly being used to develop health-care policy and direct patient referral. For example, the Leapfrog Group health-care quality initiative has proposed "evidence-based hospital" referral criteria for specific procedures including elective abdominal aortic aneurysm repair (AAA-R). These criteria include an annual hospital AAA operative volume exceeding 50 cases and provision of intensive care unit (ICU) care by board-certified intensivists. Outcomes after AAA-R are reportedly influenced by presentation (intact vs. ruptured), operative approach (endovascular vs. open, transperitoneal vs. retroperitoneal), surgeon subspecialty, case volume (hospital and surgeon), and provision of postoperative care by an intensivist. The purpose of this study was to compare our single-center results with those of high-volume centers to assess the validity of the concept that surrogate markers, such as case volume or intensivist involvement, can be used to estimate procedural outcome. A retrospective review was performed of AAA-Rs at one low-volume academic medical center from January 1994 to March 2005. Demographic data, aneurysm diameter and location, operative indications, and repair approach were documented. Postoperative complications, mortality rates, and hospital and ICU length of stay (LOS) were noted and compared to established benchmarks. During the study period, 270 patients underwent AAA-R (annual mean = 27 hospital cases and 13.4 cases/attending vascular surgeon). ICU care was provided by a dedicated vascular surgery service without routine intensivist involvement. Open, elective, infrarenal AAA-R was performed in 161 patients (60%), with a 2.5% hospital mortality rate (30-day, 3.1%). Thirty-three (12%) patients underwent elective endovascular aneurysm repair (EVAR), with no mortality. Both ICU (3.7 vs. 1.4 days, p = 0.03) and hospital (9.2 vs. 2.8 days, p = 0.002) LOS were significantly reduced after EVAR compared to open repair. Hospital LOS was significantly lower after open retroperitoneal repair compared to transperitoneal repair (6.1 vs. 10.3 days, p = 0.001). Thirty-five patients (13%) underwent ruptured AAA-R, with only 34.3% mortality (in-hospital and 30-day). Forty-one patients (15%) underwent repair of complex aortic aneurysms, with 14.1% mortality. There are increasing societal and economic pressures to direct patient referrals to "centers of excellence" for specific surgical procedures. Although our institution meets neither of the Leapfrog Group's proposed criteria, our mortality and LOS for both intact and ruptured infrarenal AAA-R are equivalent or superior to published benchmarks for high-volume hospitals. Individual institutional outcome results such as these suggest that patient referral and care should be based upon actual, carefully verified outcome data rather than utilization of surrogate markers such as case volume and subspecialist involvement in postoperative care.
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Affiliation(s)
- Kaoru R Goshima
- Department of Surgery, University of Arizona Health Sciences Center, Tucson, AZ 85719, USA.
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1159
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Aortic neck dilatation after endovascular abdominal aortic aneurysm repair: A word of caution. J Vasc Surg 2008; 47:886-92. [DOI: 10.1016/j.jvs.2007.09.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 09/04/2007] [Accepted: 09/13/2007] [Indexed: 11/23/2022]
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1160
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Outcome and Quality of Life in Patients Treated for Abdominal Aortic Aneurysms: A Single Center Experience. World J Surg 2008; 32:987-94. [DOI: 10.1007/s00268-008-9565-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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1161
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Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries. Cardiovasc Intervent Radiol 2008; 31:723-7. [DOI: 10.1007/s00270-008-9318-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 02/06/2008] [Accepted: 02/06/2008] [Indexed: 10/22/2022]
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1162
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Harthun NL. Current issues in the treatment of women with abdominal aortic aneurysm. ACTA ACUST UNITED AC 2008; 5:36-43. [DOI: 10.1016/s1550-8579(08)80006-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Indexed: 11/26/2022]
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1163
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1164
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Muhs BE, Vincken KL, Teutelink A, Verhoeven ELG, Prokop M, Moll FL, Verhagen HJM. Dynamic Cine-Computed Tomography Angiography Imaging of Standard and Fenestrated Endografts: Differing Effects on Renal Artery Motion. Vasc Endovascular Surg 2008; 42:25-31. [DOI: 10.1177/1538574407308200] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Different endograft configurations (fenestrated, transrenal, infrarenal) may varyingly affect aortic side branch movement. Renal artery motion was evaluated with 64-slice dynamic cine-computed tomography angiography before and after endovascular aneurysm repair in 16 patients (46 renal arteries). Center-of-mass displacement of the renals was determined per heartbeat for before repair for 3 different endografts; differences were compared, with significance at P < 0.5. Preoperative renal artery motion is significant (1.2 [SD 0.5] mm, range, 0.6-2.). Neither transrenal nor infrarenal endografts alter renal artery motion compared with before repair ( P < .05). Renal artery motion after fenestrated endovascular repair with renal stents reduces motion to 25% of the preoperative value (0.3 [SD, 0.1] mm, range, 0.2-0.5 mm; P = .01). Endograft implantation without stented side branches does not change renal artery motion, potentially allowing significant movement of the renal artery relative to the fenestration. Routine stenting of fenestrations limits postoperative renal artery motion to 0.3 mm, thereby preventing significant branch movement in relation the fenestration.
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Affiliation(s)
- Bart E. Muhs
- Department of Vascular Surgery University Medical Center Utrecht, Division of Vascular Surgery Yale University School of Medicine, New Haven, Connecticut
| | - Koen L. Vincken
- Department of Image Science Institute University Medical Center Utrecht
| | - Arno Teutelink
- Department of Vascular Surgery University Medical Center Utrecht
| | | | | | - Frans L. Moll
- Department of Vascular Surgery University Medical Center Utrecht
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1165
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Wanhainen A, Bylund N, Björck M. Outcome after abdominal aortic aneurysm repair in Sweden 1994–2005. Br J Surg 2008; 95:564-70. [DOI: 10.1002/bjs.6109] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The aim was to study the epidemiology of abdominal aortic aneurysm (AAA) repair in Sweden.
Methods
Primary AAA repairs registered in the Swedish Vascular Registry between 1994 and 2005 were studied. Mortality data were obtained from the national population registry, and age- and sex-specific populations for each calendar year from Statistics Sweden.
Results
Some 10 691 primary AAA repairs were identified. In the population aged 60 years or over the incidence of intact AAA repair increased from 27·0 per 100 000 in 1994–1999 to 28·8 per 100 000 in 2000–2005 (P = 0·006), while the incidence of surgery for ruptured AAA (rAAA) remained stable (13·8 versus 14·1 per 100 000; P = 0·595). Open repair with a bifurcated graft decreased, whereas endovascular repair (EVAR) increased to 35·0 per cent of intact AAA and 10·3 per cent of rAAA procedures in 2005. Patients who had EVAR were older than those undergoing open repair (74·1 versus 71·9 years; P < 0·001). The 30-day mortality rate decreased over time for intact and ruptured aneurysm operations (P = 0·001). Age, female sex and open repair (compared with EVAR) were independently associated with a higher 30-day mortality rate in a logistic regression model.
Conclusion
The introduction of EVAR was associated with an increasing incidence of intact AAA repair, whereas the rate of rAAA was stable. Perioperative mortality rates decreased over time.
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Affiliation(s)
- A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - N Bylund
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgery, Gävle County Hospital, Gävle, Sweden
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
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1166
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Laskowski I, Verhagen HJM, Gagne PJ, Moll FL, Muhs BE. Current state of dynamic imaging in endovascular aortic aneurysm repair. J Endovasc Ther 2008; 14:807-12. [PMID: 18052589 DOI: 10.1583/07-2116.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dynamic imaging, in which the time dimension has a specific function in data (image) interpretation, is becoming increasingly important when contemplating endovascular aneurysm repair. Clinical parameters and complications, including proper sizing, successful aneurysm sac exclusion, optimal stent-graft design, endoleaks, graft migration, and stent fracture are beginning to be better understood through dynamic magnetic resonance, ultrasound, and dynamic computed tomography. The current practice using static 3-dimensional reconstructions for the planning and follow-up of aortic aneurysm endograft treatment will most likely evolve, and the use of dynamic aortic imaging will continue to increase. Validation of these imaging modalities in larger scale trials is needed.
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Affiliation(s)
- Igor Laskowski
- Division of Vascular Surgery, New York University School of Medicine, New York, NY, USA
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1167
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Walsh SR, Boyle JR, Lynch AG, Sadat U, Carpenter JP, Tang TY, Gaunt ME. Suprarenal endograft fixation and medium-term renal function: systematic review and meta-analysis. J Vasc Surg 2008; 47:1364-1370. [PMID: 18280095 DOI: 10.1016/j.jvs.2007.11.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 11/05/2007] [Accepted: 11/11/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suprarenal fixation is widely used in endovascular aneurysm repair. Numerous small, underpowered studies have concluded that it does not increase the risk of renal impairment compared with infrarenal fixation. A recent meta-analysis demonstrated that renal infarction is more common with suprarenal fixation, but the effect on renal function remains unclear. METHODS Electronic abstract databases, article reference lists, and conference proceedings were searched for series reporting renal function data after suprarenal fixation. There was considerable study heterogeneity with respect to key factors such as pre-existing renal dysfunction and length of follow-up. Authors were contacted to obtain individual patient data for a pooled reanalysis using standardized criteria. RESULTS Of 46 potentially relevant citations, only 11 were eligible for inclusion in the meta-analysis. Complete data sets were available for four studies (1065 patients), with a median follow-up of 33 months. Kaplan-Meier curves were constructed for postoperative renal impairment in the suprarenal fixation and infrarenal fixation groups and compared by the log-rank test. Median time free of renal impairment was 38.5 months in the infrarenal fixation group compared with 32.4 months in the suprarenal fixation group (P = .0038). However, to account for significant methodologic differences, further analysis was required using a Weibull regression model fitted in open Bayesian inference using Gibbs sampling (BUGS). The pooled hazard ratio for deterioration of renal function after suprarenal fixation was 0.6 (95% confidence interval, 0.3-10). CONCLUSION Currently available data are insufficient to determine the precise effect of suprarenal fixation on medium-term renal function. Conventional Kaplan-Meier analysis of the pooled data set suggested that suprarenal fixation increased the risk of renal dysfunction; however, the effect disappeared when sophisticated statistical modelling was performed to account for study heterogeneity. A randomised controlled trial of suprarenal fixation may resolve this issue.
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Affiliation(s)
- Stewart R Walsh
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
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1168
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Ubbink DT, Knops AM, Molenaar S, Goossens A. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm. Patient Prefer Adherence 2008; 2:315-22. [PMID: 19920978 PMCID: PMC2770394 DOI: 10.2147/ppa.s4302] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To design, develop, and evaluate an evidence-based decision aid (DA) for patients with an asymptomatic abdominal aortic aneurysm (AAA) to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation) and to help them make a shared decision. METHODS A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS). Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool. RESULTS A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient's aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients. CONCLUSION This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients' understanding of the disease and treatment options, and may support decision making based on individual values.
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Affiliation(s)
- Dirk T Ubbink
- Department of Quality Assurance and Process Innovation and
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Correspondence: D T Ubbink, Department of Quality Assurance and Process Innovation, room J1B-215, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands, Tel +31 20 5669111, Fax +31 20 6912683, Email
| | - Anouk M Knops
- Department of Quality Assurance and Process Innovation and
| | - Sjaak Molenaar
- Department of Quality Assurance and Process Innovation and
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1169
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Coppi G, Silingardi R, Saitta G, Gennai S. Single-Center Experience With the Talent LPS Endograft in Patients With at Least 5 Years of Follow-up. J Endovasc Ther 2008; 15:23-32. [DOI: 10.1583/07-2157.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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1170
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Kao LS, Tyson JE, Blakely ML, Lally KP. Clinical research methodology I: introduction to randomized trials. J Am Coll Surg 2008; 206:361-9. [PMID: 18222393 PMCID: PMC2366892 DOI: 10.1016/j.jamcollsurg.2007.10.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/29/2007] [Accepted: 10/01/2007] [Indexed: 01/22/2023]
Affiliation(s)
- Lillian S Kao
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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1171
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Baas AF, Janssen KJ, Prinssen M, Buskens E, Blankensteijn JD. The Glasgow Aneurysm Score as a tool to predict 30-day and 2-year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial. J Vasc Surg 2008; 47:277-81. [DOI: 10.1016/j.jvs.2007.10.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 10/09/2007] [Accepted: 10/10/2007] [Indexed: 10/22/2022]
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1172
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Saratzis N, Melas N, Saratzis A, Lazarides J, Ktenidis K, Tsakiliotis S, Kiskinis D. Anaconda Aortic Stent-Graft:Single-Center Experience of a New Commercially Available Device for Abdominal Aortic Aneurysms. J Endovasc Ther 2008; 15:33-41. [PMID: 18254677 DOI: 10.1583/07-2277.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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1173
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Affiliation(s)
- Roger M Greenhalgh
- Imperial College London Vascular Surgery Research Group, Imperial College London, Charing Cross Hospital, London, United Kingdom.
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1174
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Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 2008; 358:464-74. [PMID: 18234751 DOI: 10.1056/nejmoa0707348] [Citation(s) in RCA: 528] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Randomized trials have shown reductions in perioperative mortality and morbidity with endovascular repair of abdominal aortic aneurysm, as compared with open surgical repair. Longer-term survival rates, however, were similar for the two procedures. There are currently no long-term, population-based data from the comparison of these strategies. METHODS We studied perioperative rates of death and complications, long-term survival, rupture, and reinterventions after open as compared with endovascular repair of abdominal aortic aneurysm in propensity-score-matched cohorts of Medicare beneficiaries undergoing repair during the 2001-2004 period, with follow-up until 2005. RESULTS There were 22,830 matched patients undergoing open repair of abdominal aortic aneurysm in each cohort. The average age of the patients was 76 years, and approximately 20% were women. Perioperative mortality was lower after endovascular repair than after open repair (1.2% vs. 4.8%, P<0.001), and the reduction in mortality increased with age (2.1% difference for those 67 to 69 years old vs. 8.5% for those 85 years or older, P<0.001). Late survival was similar in the two cohorts, although the survival curves did not converge until after 3 years. By 4 years, rupture was more likely in the endovascular-repair cohort than in the open-repair cohort (1.8% vs. 0.5%, P<0.001), as was reintervention related to abdominal aortic aneurysm (9.0% vs. 1.7%, P<0.001), although most reinterventions were minor. In contrast, by 4 years, surgery for laparotomy-related complications was more likely among patients who had undergone open repair (9.7%, vs. 4.1% among those who had undergone endovascular repair; P<0.001), as was hospitalization without surgery for bowel obstruction or abdominal-wall hernia (14.2% vs. 8.1%, P<0.001). CONCLUSIONS As compared with open repair, endovascular repair of abdominal aortic aneurysm is associated with lower short-term rates of death and complications. The survival advantage is more durable among older patients. Late reinterventions related to abdominal aortic aneurysm are more common after endovascular repair but are balanced by an increase in laparotomy-related reinterventions and hospitalizations after open surgery.
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Affiliation(s)
- Marc L Schermerhorn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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1175
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Rooke TW. Controversies in vascular screening art versus science. Vasc Med 2008; 12:235-42. [PMID: 17848484 DOI: 10.1177/1358863x07080836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whether or not to screen asymptomatic members of the general public for various forms of vascular disease is a controversial issue with huge medical, social, and financial ramifications. This article reviews several criteria for determining the appropriateness of vascular screening, including: (1) is it possible to detect occult vascular disease ;early'?; (2) what should we screen for, and how should we do it?; (3) who should be screened?; and (4) what standards for vascular screening should be set? While some of these controversies may ultimately be resolvable using an evidence-based approach, it is apparent that there are issues which will not be amenable to strict scientific analysis. Individualized approaches to screening will therefore remain the rule for the foreseeable future.
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Affiliation(s)
- Thom W Rooke
- Section of Vascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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1176
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Abstract
Promising–but quality evidence lacking
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Affiliation(s)
- R Balm
- Department of Vascular Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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1177
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McDonnell CO, Semmens JB, Allen YB, Jansen SJ, Brooks DM, Lawrence-Brown MMD. Large iliac arteries: a high-risk group for endovascular aortic aneurysm repair. J Endovasc Ther 2008; 14:625-9. [PMID: 17924726 DOI: 10.1177/152660280701400504] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine if the presence of large iliac arteries is a potential risk factor for the development of a type Ib endoleak (iliac sealing zone) or need for iliac artery-related secondary intervention in patients undergoing endovascular abdominal aortic aneurysm repair. METHODS The medical notes and all preoperative and postoperative plain abdominal radiographs and computer tomographic scans were reviewed for a consecutive series of 100 patients (89 men; mean age 75 years, range 56-91) with large iliac arteries (mean 19.7 mm, range 16-22) who had Zenith endovascular stent-grafts inserted for management of aortoiliac aneurysmal disease from January 1999 until September 2002. Endpoints were all-cause mortality, aneurysm-related death, endoleak, secondary intervention, secondary interventions, and stent-graft migration. RESULTS Mean follow-up was 30.1+/-8.3 months; at the last follow-up, 30% of patients were dead, 3% were aneurysm-related. Seven (7%) patients developed a type Ib endoleak, with the remainder being type II (29%), type Ia (2%), type III (1%), and type V (endotension, 1%). Eight (27.5%) type II endoleaks persisted, with the remainder closing spontaneously with sac shrinkage. The iliac artery-related secondary intervention rate was 10%, and the overall secondary intervention rate was 16%. CONCLUSION Iliac arteries between 16 and 22 mm in diameter may be treated with a cuff to the iliac limb with an expectation of 90% efficacy. Surveillance is required, with a high index of suspicion for type 1b endoleaks. Early secondary iliac intervention with extension to the external iliac artery is recommended if there is an increase in sac size after 6 months.
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Affiliation(s)
- Ciaran O McDonnell
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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1178
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Introduction of emerging medical devices on the market: a new procedure in Belgium. Int J Technol Assess Health Care 2008; 23:449-54. [PMID: 17937833 DOI: 10.1017/s0266462307070687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
When new medical technologies enter the market, there is often uncertainty about the added value for the patient and for society, hampering well-considered decision making about reimbursement. Current Belgian legislation already offered opportunities for the managed uptake of possibly innovative emerging implants. However, it has also some shortcomings such as the lack of a clear research design, rendering the scientific evaluation of clinical effectiveness, cost-effectiveness, and patient or organizational issues more difficult. Against this background, a new procedure was elaborated by the Belgian health insurance institute and the Belgian Health Care Knowledge Centre.
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1179
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1180
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Badger SA, O'Donnell ME, Loan W, Hannon RJ, Lau LL, Lee B, Soong CV. No Difference in Medium-Term Outcome Between Zenith and Talent Stent-Grafts in Endovascular Aneurysm Repair. Vasc Endovascular Surg 2008; 41:500-5. [DOI: 10.1177/1538574407307404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Many devices are available for endovascular aneurysm repair (EVAR). Our aim was to analyze morphological effects of the Zenith and Talent systems. Methods Patients included underwent EVAR from June 1999 to June 2005 using a Zenith or Talent stent-graft, with computed tomography follow-up. Aortic dimensions over time and clinical outcome were analyzed. Results Twenty-nine patients with Zenith stent-grafts and 33 with Talent devices were included. Mean preoperative age was similar (75.5 ± 6.0 years vs 74.2 ± 6.7 years; P = .29). Preoperative neck length was longer in the Zenith group (29.9 ± 15.2 mm vs 25.5 ± 10.8 mm; P = .10), and stent-graft oversizing was greater in the Talent patients (20.2% ± 7.9% vs 23.0% ± 11.3%). There was proximal aortic dilatation and aneurysm sac shrinkage in each group. Complication rates were comparable, with 83% of both groups free from 10-mm migration. Conclusion Although device designs differ, there is no difference in clinical outcome between Zenith and Talent stent-grafts. Migration rates were not influenced by suprarenal fixation.
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Affiliation(s)
- Stephen A. Badger
- Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, Northern Ireland, UK,
| | - Mark E. O'Donnell
- Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - William Loan
- Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Raymond J. Hannon
- Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Louis L. Lau
- Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Bernard Lee
- Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Chee V. Soong
- From the Vascular and Endovascular Surgery Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
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1181
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Abdominal Aortic Aneurysms. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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1182
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Svensson LG, Kouchoukos NT, Miller DC, Bavaria JE, Coselli JS, Curi MA, Eggebrecht H, Elefteriades JA, Erbel R, Gleason TG, Lytle BW, Mitchell RS, Nienaber CA, Roselli EE, Safi HJ, Shemin RJ, Sicard GA, Sundt TM, Szeto WY, Wheatley GH. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts⁎⁎Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc. Ann Thorac Surg 2008; 85:S1-41. [PMID: 18083364 DOI: 10.1016/j.athoracsur.2007.10.099] [Citation(s) in RCA: 550] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 01/15/2023]
Affiliation(s)
- Lars G Svensson
- Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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1183
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Higashiura W, Sakaguchi S, Tabayashi N, Taniguchi S, Kichikawa K. Impact of 3-Dimensional-Computed Tomography Workstation for Precise Planning of Endovascular Aneurysm Repair. Circ J 2008; 72:2028-34. [DOI: 10.1253/circj.cj-08-0331] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Nobuoki Tabayashi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University
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1184
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Piscione F, Sarno G, Iannelli G, Di Tommaso L, Furbatto F, D'Andrea C, Accardo D, Chiariello M. Acute aortic syndromes at high surgical risk: the endovascular approach. EUROINTERVENTION 2008; 3:499-505. [DOI: 10.4244/eijv3i4a88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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1185
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Baril DT, Silverberg D, Ellozy SH, Carroccio A, Jacobs TS, Sachdev U, Teodorescu VJ, Lookstein RA, Marin ML. Endovascular Stent-Graft Repair of Failed Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2008; 22:30-6. [DOI: 10.1016/j.avsg.2007.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 05/06/2007] [Accepted: 10/13/2007] [Indexed: 10/21/2022]
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1186
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Mastracci TM, Garrido-Olivares L, Cinà CS, Clase CM. Endovascular repair of ruptured abdominal aortic aneurysms: A systematic review and meta-analysis. J Vasc Surg 2008; 47:214-221. [DOI: 10.1016/j.jvs.2007.07.052] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 07/26/2007] [Accepted: 07/28/2007] [Indexed: 02/07/2023]
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1187
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Dick F, Diehm N, Gerber M, Widmer MK, Do DD, Triller J, Carrel T, Schmidli J. Aortitis Following Percutaneous Aortic Side Branch Embolization Prior to Endovascular Repair of Infrarenal Aortic Aneurysm. J Endovasc Ther 2007; 14:801-4. [DOI: 10.1583/07-2219.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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1188
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Young EL, Holt PJ, Poloniecki JD, Loftus IM, Thompson MM. Meta-analysis and systematic review of the relationship between surgeon annual caseload and mortality for elective open abdominal aortic aneurysm repairs. J Vasc Surg 2007; 46:1287-94. [DOI: 10.1016/j.jvs.2007.06.038] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 06/13/2007] [Indexed: 11/30/2022]
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1189
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Kusanagi M, Matsui O, Sanada J, Ogi T, Takamatsu S, Zhong H, Kimura Y, Tabata Y. Hydrogel-Mediated Release of Basic Fibroblast Growth Factor From a Stent-Graft Accelerates Biological Fixation With the Aortic Wall in a Porcine Model. J Endovasc Ther 2007; 14:785-93. [DOI: 10.1583/07-2189.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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1190
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1191
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Deux JF, Dai J, Rivière C, Gazeau F, Méric P, Gillet B, Roger J, Pons JN, Letourneur D, Boudghène FP, Allaire E. Aortic aneurysms in a rat model: in vivo MR imaging of endovascular cell therapy. Radiology 2007; 246:185-92. [PMID: 18033758 DOI: 10.1148/radiol.2461070032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate in rats whether magnetic cell labeling can be used to noninvasively assess the technical success of endovascular cell therapy for abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS The study was approved by an institutional animal care and use committee. Vascular smooth muscle cells (VSMCs) labeled with iron oxide nanoparticles were seeded endovascularly in already formed AAAs. T2*-weighted gradient-echo and T2-weighted spin-echo magnetic resonance (MR) imaging was performed in vivo at 1.5 T before and 30 minutes after the injection of iron-loaded VSMCs (14 rats), nonlabeled VSMCs (three rats), or iron-free particles (three rats). Ten rats were euthanized shortly after the injection (day 0). Of the 10 remaining rats, which were seeded with iron-loaded cells, three were imaged on day 7 after cell delivery; three, on day 14; and four, on day 28; then they were euthanized. Ex vivo high-field-strength MR imaging of two AAAs was performed 28 days after cell delivery. Histologic examination of cross sections of all AAAs was performed. Statistical evaluations were performed with a nonparametric Wilcoxon correlation test. RESULTS Magnetic cell labeling did not alter the capability of VSMCs to stabilize the diameter of the aneurysms. T2*-weighted gradient-echo images showed areas of hypointense signal within the aortic wall immediately and up to 1 month after cell therapy. The mean signal intensity decreased significantly after cell delivery (from 2362 +/- 244 [standard deviation] before to 434 +/- 275 after delivery, P < .001). Areas of hypointense signal and iron-loaded VSMCs were colocalized in the area of aortic wall reconstruction at both high-field-strength MR imaging and histologic analysis. CONCLUSION MR imaging with magnetic cell labeling can be used to document endovascular cell delivery in already formed AAAs in rats.
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Affiliation(s)
- Jean-François Deux
- INSERM U 698, Bioengineering Department, University Paris 7-University Paris 13, X. Bichat Hospital, Paris, France.
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1192
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 2007; 50:e159-241. [PMID: 17950159 DOI: 10.1016/j.jacc.2007.09.003] [Citation(s) in RCA: 257] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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1193
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Pearce JD, Edwards MS, Stafford JM, Deonanan JK, Davis RP, Corriere MA, Crutchley TA, Hansen KJ. Open Repair of Aortic Aneurysms Involving the Renal Vessels. Ann Vasc Surg 2007; 21:676-86. [DOI: 10.1016/j.avsg.2007.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 06/07/2007] [Accepted: 07/15/2007] [Indexed: 11/16/2022]
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1194
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Kan CD, Lee HL, Yang YJ. Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: A systematic review. J Vasc Surg 2007; 46:906-12. [PMID: 17905558 DOI: 10.1016/j.jvs.2007.07.025] [Citation(s) in RCA: 273] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 07/16/2007] [Accepted: 07/19/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical treatment for mycotic aortic aneurysms is not optimal. Even with a large excision, extensive debridement, in situ or extra-anatomical reconstruction, and with or without lifelong antibiotic treatment, mycotic aneurysms still carry very high mortality and morbidity. The use of endovascular aneurysm repair (EVAR) for mycotic aortic aneurysms simplifies the procedure and provides a good alternative for this critical condition. However, the question remains: if EVAR is placed in an infected bed, what is the outcome of the infection? Does it heal, become aggravated, or even cause a disastrous aortic rupture? In this study, we tried to clarify the risk factors for such an adverse response. METHODS A literature review was undertaken by using MEDLINE. All relevant reports on endoluminal management of mycotic aortic aneurysms were included. Logistic regressions were applied to identify predictors of persistent infection. RESULTS A total of 48 cases from 22 reports were included. The life-table analysis showed that the 30-day survival rate was 89.6% +/- 4.4%, and the 2-year survival rate was 82.2% +/- 5.8%. By univariate analysis, age 65 years or older, rupture of the aneurysm (including those with aortoenteric fistula and aortobronchial fistula), and fever at the time of operation were identified as significant predictors of persistent infection, and preoperative use of antibiotics for longer than 1 week and an adjunct procedure combined with EVAR were identified as significant protective factors for persistent infection. However, by multivariate logistic regression analysis, the only significant independent predictors identified were rupture of aneurysm and fever. CONCLUSIONS EVAR seems a possible alternative method for treating mycotic aortic aneurysms. Identification of the risk factors for persistent infection may help to decrease surgical morbidity and mortality. EVAR could be used as a temporary measure; however, a definite surgical treatment should be considered for patients present with aneurysm rupture or fever.
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Affiliation(s)
- Chung-Dann Kan
- Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
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1195
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Davit FE, Cole T, Helling T, Tretter J. Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: Experience in a Community Hospital. Am Surg 2007. [DOI: 10.1177/000313480707301106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The endovascular technique has been recently used as an alternative procedure for selected patients with ruptured abdominal aortic aneurysm (RAAA) as a result of the potential for decreasing morbidity, mortality, and recovery time. We examined our institution's results with endovascular repair of RAAA. Between July 2005 and April 2006, four patients underwent endovascular repair of infrarenal RAAA. We performed a retrospective analysis of our comorbidities, operation time, length of intensive care unit and hospital stay, morbidity and mortality, blood transfusions, and secondary interventions on these patients at our institution. The median age was 73.2 years (range, 66–82 years); 75 per cent were male and 25 per cent were female. Mean operating time was 90 minutes. We had no operative or postoperative mortalities. Five complications occurred in three patients. These included acute renal failure, common femoral artery intimal dissection, graft thrombosis of the iliac limb, ischemic colitis, and chronic obstructive pulmonary disease exacerbation. Endovascular repair of RAAA by an endovascular team is feasible in the community hospital setting. Our limited number of patients in this study does not allow us to compare it directly with results from the standard open procedure. A larger, multi-center study may eventually show this method to be helpful in patients who require repair of RAAA.
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Affiliation(s)
- Flavia E. Davit
- Conemaugh Memorial Hospital/Temple University, Department of Surgery, Vascular Service, Johnstown, Pennsylvania
| | - Theresa Cole
- Conemaugh Memorial Hospital/Temple University, Department of Surgery, Vascular Service, Johnstown, Pennsylvania
| | - Thomas Helling
- Conemaugh Memorial Hospital/Temple University, Department of Surgery, Vascular Service, Johnstown, Pennsylvania
| | - James Tretter
- Conemaugh Memorial Hospital/Temple University, Department of Surgery, Vascular Service, Johnstown, Pennsylvania
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1196
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Prinssen M, Buskens E, de Jong SE, Buth J, Mackaay AJ, Sambeek MR, Blankensteijn JD. Cost-effectiveness of conventional and endovascular repair of abdominal aortic aneurysms: Results of a randomized trial. J Vasc Surg 2007; 46:883-890. [DOI: 10.1016/j.jvs.2007.07.033] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 07/17/2007] [Accepted: 07/23/2007] [Indexed: 11/28/2022]
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1197
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Comparison of the incidences of cardiac arrhythmias, myocardial ischemia, and cardiac events in patients treated with endovascular versus open surgical repair of abdominal aortic aneurysms. Am J Cardiol 2007; 100:1479-84. [PMID: 17950812 DOI: 10.1016/j.amjcard.2007.06.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 05/24/2007] [Accepted: 06/03/2007] [Indexed: 11/20/2022]
Abstract
This study examines differences in cardiac arrhythmias, perioperative myocardial ischemia, troponin T release, and cardiovascular events between endovascular and open repair of abdominal aortic aneurysms (AAAs). Of 175 patients, 126 underwent open AAA repair and 49 underwent endovascular AAA repair. Continuous 12-lead electrocardiographic monitoring, starting 1 day before surgery and continuing through 2 days after surgery, was used for cardiac arrhythmia and myocardial ischemia detection. Troponin T was measured on postoperative days 1, 3, and 7 and before discharge. Cardiac events (cardiac death or Q-wave myocardial infarction) were noted at 30 days and at follow-up (mean 2.3 years). New-onset atrial fibrillation, nonsustained ventricular tachycardia, sustained ventricular tachycardia, and ventricular fibrillation occurred in 5%, 17%, 2%, and 1% of patients, respectively. Myocardial ischemia, troponin T release, and 30-day and long-term cardiac events occurred in 34%, 29%, 6%, and 10% of patients, respectively. Significantly higher heart rates and less heart rate variability were observed in the open AAA repair group. Cardiac arrhythmias were less prevalent in the endovascular AAA repair group (14% vs 29%, p = 0.04). Endovascular repair was also significantly associated with less myocardial ischemia (odds ratio 0.14, 95% confidence interval 0.05 to 0.40, p <0.001) and troponin T release (odds ratio 0.10, 95% confidence interval 0.02 to 0.32, p <0.001) and lower 30-day mortality (zero vs 8.7%, p = 0.03) and 30-day cardiac event rates (zero vs 7.9%, p = 0.04). Long-term mortality and cardiac event rates were not significantly lower in the endovascular AAA repair group. In conclusion, endovascular AAA repair is associated with a lower incidence of perioperative cardiac arrhythmias, myocardial ischemia, troponin T release, cardiac events, and all-cause mortality compared with open AAA repair.
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1198
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Tarkington LG, Yancy CW. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Circulation 2007; 116:e418-99. [PMID: 17901357 DOI: 10.1161/circulationaha.107.185699] [Citation(s) in RCA: 377] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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1199
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Abstract
Can save lives but only if operative mortality is low
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1200
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Ziegler P, Avgerinos ED, Umscheid T, Perdikides T, Stelter WJ. Fenestrated Endografting for Aortic Aneurysm Repair:A 7-Year Experience. J Endovasc Ther 2007. [DOI: 10.1583/1545-1550(2007)14[609:fefaar]2.0.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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