101
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Canavati R, Millen A, Brennan J, Fisher RK, McWilliams RG, Naik JB, Vallabhaneni SR. Comparison of fenestrated endovascular and open repair of abdominal aortic aneurysms not suitable for standard endovascular repair. J Vasc Surg 2012; 57:362-7. [PMID: 23044256 DOI: 10.1016/j.jvs.2012.08.040] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/30/2012] [Accepted: 08/02/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abdominal aortic aneurysms that are unsuitable for a standard endovascular repair (EVAR) could be considered for fenestrated endovascular repair (f-EVAR). The aim of this study was to conduct a risk-adjusted retrospective concurrent cohort comparison of f-EVAR and open repair for such aneurysms. METHODS All patients who underwent repair of an abdominal aortic aneurysm that was unsuitable for a standard EVAR due to inadequate neck within one institution between January 2006 and December 2010 were identified. Case notes were retrieved for clinical data, Vascular Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (V-POSSUM) score, and aneurysm morphology. Computed tomography scans were reviewed to establish aneurysm morphology. RESULTS A total of 107 patients were identified. The open surgery cohort included 54 patients (35 men) who were a median age of 72 years (interquartile range [IQR], 9.5; range, 60-86 years). The aortic cross-clamp was infrarenal in 20 patients, suprarenal or above in 21, and inter-renal in eight. Postoperatively, 63 major complications were noted in 30 patients, nine of whom required 16 reinterventions. Cumulative hospital stay of the cohort was 1170 days (median, 12; IQR, 13; range, 1-205 days) of which 234 days (median, 28; IQR, 36; range, 1-77 days) were in the intensive therapy unit (ITU). Perioperative mortality was 9.2% (n = 5), exactly as estimated by V-POSSUM. The f-EVAR cohort included 53 patients (47 men) who were a median age of 76 years (IQR, 11.50; range, 55-87 years). Two fenestrations and one scallop was the most frequent configuration (n = 31). Postoperatively, 37 major complications were noted in 18 patients, six requiring reintervention. Hospital stay was 559 days (median, 7; IQR, 4.5; range, 4-64 days), of which 31 days (median, 4; IQR, 10.5; range, 1-15 days) were in the ITU. Two patients died perioperatively (3.7%), resulting in an observed crude absolute risk reduction of 5.5% compared with open repair. The V-POSSUM estimated perioperative death in five patients (9.4%) in the f-EVAR cohort. In a hypothetic scenario of the f-EVAR cohort undergoing open repair, V-POSSUM estimated seven deaths (13.2%), resulting in an estimated risk-adjusted absolute risk reduction due to f-EVAR of 9.5%. CONCLUSIONS In this group of patients, f-EVAR reduced mortality and morbidity substantially compared with open repair and also reduced total hospital stay and ITU utilization.
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Affiliation(s)
- Rana Canavati
- Regional Vascular Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
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102
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Intraoperative Factors Affecting Renal Outcome After Open Repair of Suprarenal Aortic Aneurysms. Ann Vasc Surg 2012; 26:913-7. [DOI: 10.1016/j.avsg.2011.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 10/27/2011] [Accepted: 11/04/2011] [Indexed: 11/17/2022]
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103
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Antoniou GA, Schiro A, Antoniou SA, Farquharson F, Murray D, Smyth JV, Serracino-Inglott F. Chimney technique in the endovascular management of complex aortic disease. Vascular 2012; 20:251-61. [DOI: 10.1258/vasc.2011.ra0056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to systematically review the literature reporting on the chimney technique and perform an analysis of the outcomes. A search of electronic databases was undertaken to identify all studies reporting on the outcome of the chimney technique. The selected articles were divided into those reporting on the treatment of aortic pathology involving the visceral and those involving the supra-aortic branches. Twenty-one articles reporting on the treatment of juxta/supra-renal aorta and aortic arch disease in 102 and 37 patients, respectively, were identified. In the visceral group, an overall technical success rate of 91% was achieved, the perioperative major morbidity and mortality rates were 17 and 5%, respectively, and an early type I endoleak developed in 13 patients (13%). During follow-up, one patient died of intestinal ischemia. In the supra-aortic group, the technical success rate was recorded in 95%, and three patients (8%) developed an early type I endoleak. Three patients (13%) required conversion to open surgery during follow-up. In conclusion, this technique may be viewed as a complementary technique in high-surgical-risk patients.
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Affiliation(s)
- George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Andrew Schiro
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Stavros A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Finn Farquharson
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - David Murray
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - J Vincent Smyth
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Ferdinand Serracino-Inglott
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
- Cardiovascular Medicine Research Group, Research School of Clinical and Laboratory Sciences within the School of Medicine, The University of Manchester, Manchester M13 9NT, UK
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Yang SS, Park KM, Roh YN, Park YJ, Kim DI, Kim YW. Renal and abdominal visceral complications after open aortic surgery requiring supra-renal aortic cross clamping. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:162-70. [PMID: 22977763 PMCID: PMC3433553 DOI: 10.4174/jkss.2012.83.3.162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/21/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to assess renal or abdominal visceral complications after open aortic surgery (OAS) requiring supra-renal aortic cross clamping (SRACC). METHODS We retrospectively reviewed the medical records of 66 patients who underwent SRACC. Among them, 17 followed supra-celiac aortic cross clamping (SCACC) procedure, 42 supra-renal, and 7 inter-renal aorta. Postoperative renal, hepatic or pancreatic complications were investigated by reviewing levels of serum creatinine and hepatic and pancreatic enzymes. Preoperative clinical and operative variables were analyzed to determine risk factors for postoperative renal insufficiency (PORI). RESULTS Indications for SRACC were 25 juxta-renal aortic occlusion and 41 aortic aneurysms (24 juxta-renal, 12 supra-renal and 5 type IV thoraco-abdominal). The mean duration of renal ischemic time (RIT) was 30.1 ± 22.2 minutes (range, 3 to 120 minutes). PORI developed in 21% of patients, including four patients requiring hemodialysis (HD). However, chronic HD was required for only one patient (1.5%) who had preoperative renal insufficiency. RIT ≥ 25 minutes and SCACC were significant risk factors for PORI development by univariate analysis, but not by multivariate analysis. Serum pancreatic and hepatic enzyme was elevated in 41% and 53% of the 17 patients who underwent SCACC, respectively. CONCLUSION Though postoperative renal or abdominal visceral complications developed often after SRACC, we found that most of those complications resolved spontaneously unless there was preexisting renal disease or the aortic clamping time was exceptionally long.
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Affiliation(s)
- Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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105
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Tsai S, Conrad MF, Patel VI, Kwolek CJ, LaMuraglia GM, Brewster DC, Cambria RP. Durability of open repair of juxtarenal abdominal aortic aneurysms. J Vasc Surg 2012; 56:2-7. [PMID: 22534029 DOI: 10.1016/j.jvs.2011.12.085] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/19/2011] [Accepted: 12/30/2011] [Indexed: 10/28/2022]
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106
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Lee JT, Greenberg JI, Dalman RL. Early experience with the snorkel technique for juxtarenal aneurysms. J Vasc Surg 2012; 55:935-46; discussion 945-6. [PMID: 22244859 DOI: 10.1016/j.jvs.2011.11.041] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA 94305, USA.
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107
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Grant S, Grayson A, Grant M, Purkayastha D, McCollum C. What are the Risk Factors for Renal Failure following Open Elective Abdominal Aortic Aneurysm Repair? Eur J Vasc Endovasc Surg 2012; 43:182-7. [DOI: 10.1016/j.ejvs.2011.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 11/27/2011] [Indexed: 01/19/2023]
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108
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Management of Perioperative Endoleaks During Endovascular Treatment of Juxta-Renal Aneurysms. Ann Vasc Surg 2012; 26:175-84. [DOI: 10.1016/j.avsg.2010.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 09/26/2010] [Accepted: 10/25/2010] [Indexed: 11/17/2022]
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109
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Affiliation(s)
- Monish Aron
- Center for Advanced Robotic & Laparoscopic Surgery, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Inderbir S. Gill
- Center for Advanced Robotic & Laparoscopic Surgery, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven C. Campbell
- Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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110
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Predictive factors for mortality after open repair of paravisceral abdominal aortic aneurysm. J Vasc Surg 2011; 55:666-73. [PMID: 22209613 DOI: 10.1016/j.jvs.2011.09.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 09/20/2011] [Accepted: 09/21/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The use of fenestrated and branched stent graft technology for paravisceral abdominal aortic aneurysms (PAAA) is on the rise; however, its application is limited in the United States to only a few selected centers. Most PAAAs are currently repaired using an open approach. The objective of this study was to determine which patients are at highest risk with open PAAA repair and might benefit most from endovascular repair using fenestrated or branched stent grafts. METHODS This was a retrospective cohort study using data from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) hospitals. We identified 598 patients (27.5% women) who underwent elective open PAAA repair from the 2007 to 2009 NSQIP, a prospective database maintained at >250 centers. The main outcome measure was 30-day postoperative mortality. RESULTS The median patient age was 73 years. The 30-day major morbidity rate was 30.1%, and the mortality rate was 4.5%. Major complications included reintubation (10.0%), sepsis (10.7%), return to operating room (9.2%), new dialysis requirement (5.9%), cardiac arrest or myocardial infarction (4.5%), and stroke (1.2%). Multivariate analyses identified four predictors of postoperative mortality after open PAAA repair: peripheral arterial disease (PAD) requiring revascularization or amputation, chronic obstructive pulmonary disease (COPD), anesthesia time, and female sex. PAD and COPD were present in only 5.2% and 20.4% of patients but were associated with a 16.1% and 9.0% mortality rate, respectively. The mortality rate in women was 7.3% vs 3.5% for men (P = .045). CONCLUSIONS PAD, COPD, and female sex are major risk factors for postoperative mortality after open PAAA repair. Fenestrated or branched stent graft repair may be a more valuable alternative to open repair for patients with one or more of these characteristics who have suitable access vessels.
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111
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Jeyabalan G, Park T, Rhee RY, Makaroun MS, Cho JS. Comparison of modern open infrarenal and pararenal abdominal aortic aneurysm repair on early outcomes and renal dysfunction at one year. J Vasc Surg 2011; 54:654-9. [DOI: 10.1016/j.jvs.2011.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/15/2011] [Accepted: 03/01/2011] [Indexed: 12/11/2022]
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112
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Patel VI, Lancaster RT, Conrad MF, Lamuraglia GM, Kwolek CJ, Brewster DC, Cambria RP. Comparable mortality with open repair of complex and infrarenal aortic aneurysm. J Vasc Surg 2011; 54:952-9. [PMID: 21723071 DOI: 10.1016/j.jvs.2011.03.231] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/07/2011] [Accepted: 03/07/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND A consequence of endovascular aneurysm repair (EVAR) of anatomically straightforward infrarenal abdominal aortic aneurysm repair cohort (AAA) is that open aneurysm repair is more commonly performed for complex anatomy. Complex aneurysm repair with visceral vessel involvement (CAA) or combined aneurysm repair and visceral vessel reconstruction (VVR) has traditionally been considered to increase morbidity and mortality compared with repair of infrarenal AAA. This study evaluated contemporary outcomes of open abdominal aneurysm surgery, including AAA, CAA, and VVR using the National Surgical Quality Improvement Program (NSQIP) database. METHODS The NSQIP Participant Use File was queried by CPT code to identify patients undergoing AAA, CAA, and VVR (2005-2008). Comparative analysis of clinical features, technical details and 30-day outcomes was performed using univariate methods. Logistic regression analysis was used to identify predictors of morbidity and mortality. RESULTS A total of 2820 patients underwent AAA and 592 CAA. Renal insufficiency (ie, creatinine >1.4 mg/dL) rates were similar in AAA and CAA patients, however, more frequent in patients with VVR (51% vs 31% [no bypass]; P < .01). CAA was less likely to be performed urgently (6.3% vs 9.1%; P < .05) and was associated with increased operative time (254 ± 100 vs 224 ± 93; P < .01) compared with AAA. Univariate analysis showed that CAA did not increase mortality (5.7% vs 5.1%; P = .5). CAA slightly increased overall complications (32% vs 27%; P = .01) compared with AAA. 73 (2.5%) AAA and 84 (12%) CAA patients had simultaneous VVR and these patients exhibited a trend toward increased mortality (8.9% vs 5.2%; P = .07). VVR increased complications (43% (VVR) vs 26% [no bypass]; P < .01), including ventilation >48 hours (21% [VVR] vs 12% [no bypass]; P < .01), renal failure (7.6% [VVR] vs 4.1% [no bypass]; P = .04), and sepsis (13% [VVR] vs 6.3% ([no bypass]; P < .01). Multivariate analysis demonstrated that CAA (odds ratio [OR], 1.3 [95% confidence interval (CI), 1.1-1.6]; P = .01) and VVR (OR, 2.2 [95% CI, 1.8-3.6]; P < .01) increased the odds of any complication. Independent predictors of mortality included dependent functional status (OR, 3.6 [95% CI, 2.3-5.4]; P < .01), elevated pre-op creatinine (OR, 2.9 [95% CI, 2.2-4.0]; P < .01), type II diabetes (OR, 1.6 [95% CI, 1.05-2.4]; P = .03), and age (OR, 1.06 [95% CI, 1.03-1.08]; P < .01). Neither CAA (OR, 1.2 [95% CI, 0.84-1.8]; P = .3) nor VVR (OR, 1.6 [95% CI, 0.89-2.9]; P = .11) were associated with increased mortality compared with AAA. CONCLUSION In contemporary practice the migration of open repair to increasingly complex cases has been achieved with 30-day mortality essentially equivalent to open repair of infrarenal AAA. Patients who require VVR do sustain increased complications, in particular renal failure. These data also emphasize the importance of baseline renal insufficiency in clinical decision making. CAA and VVR are associated with increased morbidity in comparison to AAA repair; however, both procedures can be safely performed in patients without increased risk of operative mortality.
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Affiliation(s)
- Virendra I Patel
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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113
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Coscas R, Kobeiter H, Desgranges P, Becquemin JP. Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms. J Vasc Surg 2011; 53:1520-7. [PMID: 21514774 DOI: 10.1016/j.jvs.2011.01.067] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 01/20/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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114
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Hiromatsu S, Sakashita H, Okazaki T, Onitsuka S, Tanaka A, Fukunaga S. Perioperative outcomes for elective open abdominal aortic aneurysm repair since the adoption of endovascular grafting procedures. Eur J Vasc Endovasc Surg 2011; 42:178-84. [PMID: 21514186 DOI: 10.1016/j.ejvs.2011.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 03/20/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate and compare our perioperative outcomes for open abdominal aortic aneurysm (AAA) between the pre-endovascular aneurysm repair (pre-EVAR) and EVAR eras and to analyse whether the AAA that was excluded from EVAR could affect the perioperative outcome. MATERIALS AND METHODS The Kurume University Hospital vascular registry was reviewed to identify all patients undergoing an elective open AAA repair from January 2004 through November 2006 (pre-EVAR era, n = 99) and from December 2006 through June 2010 (EVAR era, n = 125). The early clinical outcomes between the two groups were compared. RESULTS In the EVAR era, the proportion of EVAR in all elective AAA repairs was 43.4%. The EVAR era had a significantly higher proportion of very elderly patients over 80 years of age (23.2% vs. 11.1%, P = 0.0391). The morbidity rates were similar between the two groups (22.3% vs. 24,8%) and the mortality rate was 0% for both. CONCLUSION Despite the increased complexity of OAR in the EVAR era, we believe that OAR remains a valid procedure for AAA repair.
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Affiliation(s)
- S Hiromatsu
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka-ken 830-0011, Japan.
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115
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Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA. Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 2011; 53:895-904; discussion 904-5. [PMID: 21211934 DOI: 10.1016/j.jvs.2010.10.068] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/29/2010] [Accepted: 10/09/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Kevin J Bruen
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla., USA
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116
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Eidt JF, Mills J, Rhodes RS, Biester T, Gahtan V, Jordan WD, Hodgson KJ, Kent KC, Ricotta JJ, Sidawy AN, Valentine J. Comparison of surgical operative experience of trainees and practicing vascular surgeons: A report from the Vascular Surgery Board of the American Board of Surgery. J Vasc Surg 2011; 53:1130-9; discussion 1139-40. [DOI: 10.1016/j.jvs.2010.09.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 12/01/2022]
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117
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Manning BJ, Agu O, Richards T, Ivancev K, Harris PL. Temporary axillobifemoral bypass as an adjunct to endovascular aneurysm repair using fenestrated stent grafts. J Vasc Surg 2011; 53:867-9. [PMID: 21236615 DOI: 10.1016/j.jvs.2010.09.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 09/30/2010] [Accepted: 09/30/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J Manning
- Multidisciplinary Endovascular Team, University College Londonand University College London Hospital, London NW12BU United Kingdom.
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118
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Cappello E, Spinetti F, Di Lorenzo M, Franco E. Surgical treatment of elderly patients with infrarenal abdominal aortic aneurysm. BMC Geriatr 2011. [PMCID: PMC3194389 DOI: 10.1186/1471-2318-11-s1-a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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119
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Forbes TL, Harris JR, Lawlor DK, Derose G. Midterm results of the Zenith endograft in relation to neck length. Ann Vasc Surg 2010; 24:859-62. [PMID: 20831986 DOI: 10.1016/j.avsg.2010.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/18/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Successful endovascular repair of abdominal aortic aneurysms (AAAs) requires specific infrarenal neck anatomy to allow for a durable seal and fixation. This is a single-center study reviewing outcomes in relation to neck length after placement of a Zenith endograft. METHODS Retrospective single-center review of all AAAs electively repaired with a Zenith endograft during a recent 5-year period. Patients were divided into those with infrarenal necks 4-15 mm in length and those >15 mm using center line measurements. Clinical outcomes and follow-up computed tomography scans were reviewed. RESULTS Between 2003 and 2008, 318 patients underwent elective repair of an infrarenal AAA with the Zenith endograft. Of 318 patients, 68 (21.4%) had necks measuring 4-15 mm in length and 250 (79.5%) had necks measuring >15 mm. Overall early mortality was 0.9% (p = 0.11) and the rate of type II endoleaks was 19% (p = 0.11); neither differed between the groups. Four patients in each group had immediate proximal type I endoleaks, which resolved spontaneously in two patients in each group. The remaining two in each group required further intervention (two endovascular and two conversion to open repair). Type I endoleaks and reinterventions did not differ statistically between groups (p = 0.06). On further analysis, those patients requiring reintervention or conversion for type I endoleaks had other unattractive neck features (large diameter, angulation). There have been no instances of new type I endoleaks during 5-yearfollow-up period. CONCLUSION These midterm results indicate that patients with shorter infrarenal necks can be treated as effectively as those with longer necks with the Zenith endograft unless these necks are tortuous or wide.
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Affiliation(s)
- Thomas L Forbes
- Division of Vascular Surgery, London Health Sciences Centre and the University of Western Ontario, London, Ontario, Canada.
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120
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Juxtarenal aortic aneurysm repair. J Vasc Surg 2010; 52:760-7. [PMID: 20382492 DOI: 10.1016/j.jvs.2010.01.049] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 01/12/2010] [Accepted: 01/16/2010] [Indexed: 11/22/2022]
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121
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A contemporary experience of open aortic reconstruction in patients with chronic atherosclerotic occlusion of the abdominal aorta. J Vasc Surg 2010; 52:1164-72. [PMID: 20732782 DOI: 10.1016/j.jvs.2010.05.112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 05/27/2010] [Accepted: 05/28/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine and report surgical results from a contemporary experience of open abdominal aortic reconstruction in patients with chronic atherosclerotic abdominal aortic occlusion (CAAAO). METHODS Between January 1999 through May 2010, 54 patients with CAAAO were identified and retrospectively reviewed. CAAAOs were categorized into infrarenal aortic occlusions (IRAOs) and juxtarenal aortic occlusions (JRAOs) based on superior extension of thrombus and requirement for supra-renal aortic clamping to repair. Morbidity, mortality, hospital stay, and operative variables were assessed. The χ2 or Fisher test and the Wilcoxon rank sum test were used to compare demographic and operative variables between two aortic occlusion groups (IRAO and JRAO). Univariate and multivariate analyses were performed to assess factors associated with surgical outcomes and hospital stay. The Kaplan-Meier method was used to calculate survival and patency rates. RESULTS Fifty patients underwent aortic reconstructions with aorto-bifemoral or iliac bypass, and three underwent a remote axillo-femoral bypass procedure. There were 35 (64.8%) males, and 19 (35.2%) females. Median age was 51.9 years (range, 32-72 years). Of the two CAAAO groups, there were 20 IRAOs and 33 JRAOs. Aorto-renal thromboendartectomy was performed in 26 (49.1%) patients; 26 (75.8%) among JRAOs versus 1 (5%) of IRAOs (P<.01). Proximal aortic clamps were required in 28 (85%) of JRAOs and 3 (15%) of IRAOs (P<.01). Thirty-day and in-hospital mortality was zero. Median length of hospital stay was 7 days (range, 4 to 66 days), and median intensive care unit length of stay was 3 days (range, 1-22 days). Complications included cardiopulmonary dysfunction in four (8%), postoperative renal insufficiency in 10 (18.9%), and other postoperative complications in 15 (28.3%). All 10 with renal insufficiency recovered renal function to baseline creatinine or a creatinine value<1.1 mg/dL. Mean increases in right and left ankle-brachial indicess were 0.54±0.25 and 0.59±0.22, respectively. On univariate analysis, coronary artery disease and African American race were predictors of postoperative complications (P=.048). Age was significantly associated with total complications. Patients with postoperative complications and/or renal insufficiency were older than those without such complications (P=.02) Independent predictors of prolonged hospital stay were intraoperative blood replacement (P=.003), postoperative complications (P<.01), and postoperative renal insufficiency (P<.01). Prolonged intensive care unit stay was predicted by JRAO (P=.04), postoperative complications (P=.02), and postoperative renal insufficiency (P=.013). Survival at 3, 5, and 7 years were 86.6%, 76.5% and 50.9%, respectively. The reduced survival rates were predicted by previous myocardial infarction and existing coronary artery disease (P<.01). CONCLUSION Abdominal aortic reconstruction is a safe method for treating CAAAO with low associated morbidity and mortality. Aorto-renal thromboendartectomy with supra-renal aortic clamping and aortic replacement remains an effective treatment for those with significant pararenal aortic disease, and can be performed without significant renal impairment.
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122
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Mukherjee DM, Hashemi HH, Aryavand B, Bade MA. Endovascular management of acute bleeding following recent and late open abdominal aortic aneurysm repair. Vascular 2010; 18:230-4. [PMID: 20643033 DOI: 10.2310/6670.2010.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Open repair of abdominal aortic aneurysm is still considered the gold standard against which endovascular repair is measured. We describe two cases of open repair complicated by bleeding where endovascular treatment proved to be life-saving.
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Affiliation(s)
- Dipankar M Mukherjee
- Cardiac, Vascular and Thoracic Surgery Associates, P.C., Falls Church, VA 22042, USA.
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123
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Speziale F, Ruggiero M, Sbarigia E, Marino M, Menna D. Factors Influencing Outcome after Open Surgical Repair of Juxtarenal Abdominal Aortic Aneurysms. Vascular 2010; 18:141-6. [DOI: 10.2310/6670.2010.00035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to seek factors predicting outcome after open surgical repair of juxtarenal abdominal aortic aneurysms (AAAs). From a series of 733 patients treated for AAAs, 92 patients underwent elective conventional open repair with suprarenal clamping. We assessed postoperative cardiorespiratory and renal morbidity and mortality and survival at 1, 3, and 5 years. One patient (1.1%) died after an acute myocardial infarction. Postoperative complications including myocardial infarction and renal failure arose in 22 patients (23.9%). Significant predicting factors of renal failure were a preoperative creatinine clearance ≤ 40 mL/min ( p = .03) and female sex ( p = .004). Kaplan-Meier survival analysis showed an overall survival rate of 98.9% at 1 year and 88.6% at 3 and 5 years. In patients carefully selected by preoperative imaging criteria to undergo open juxtarenal AAA repair, appropriate intraoperative management guarantees a good immediate postoperative outcome.
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Affiliation(s)
- Francesco Speziale
- *Vascular Surgery Unit, Department “Paride Stefanini,” Policlicnico Umberto I, “Sapienza” University Rome, Rome, Italy
| | - Massimo Ruggiero
- *Vascular Surgery Unit, Department “Paride Stefanini,” Policlicnico Umberto I, “Sapienza” University Rome, Rome, Italy
| | - Enrico Sbarigia
- *Vascular Surgery Unit, Department “Paride Stefanini,” Policlicnico Umberto I, “Sapienza” University Rome, Rome, Italy
| | - Mario Marino
- *Vascular Surgery Unit, Department “Paride Stefanini,” Policlicnico Umberto I, “Sapienza” University Rome, Rome, Italy
| | - Danilo Menna
- *Vascular Surgery Unit, Department “Paride Stefanini,” Policlicnico Umberto I, “Sapienza” University Rome, Rome, Italy
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124
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Verhoeven E, Vourliotakis G, Bos W, Tielliu I, Zeebregts C, Prins T, Bracale U, van den Dungen J. Fenestrated Stent Grafting for Short-necked and Juxtarenal Abdominal Aortic Aneurysm: An 8-Year Single-centre Experience. Eur J Vasc Endovasc Surg 2010; 39:529-36. [PMID: 20202868 DOI: 10.1016/j.ejvs.2010.01.004] [Citation(s) in RCA: 261] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
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125
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Amiot S, Haulon S, Becquemin JP, Magnan PE, Lermusiaux P, Goueffic Y, Jean-Baptiste E, Cochennec F, Favre JP. Fenestrated Endovascular Grafting: The French Multicentre Experience. Eur J Vasc Endovasc Surg 2010; 39:537-44. [PMID: 20093051 DOI: 10.1016/j.ejvs.2009.12.008] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 12/09/2009] [Indexed: 11/27/2022]
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126
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Martin MC, Giles KA, Pomposelli FB, Hamdan AD, Wyers MC, Schermerhorn ML. National Outcomes after Open Repair of Abdominal Aortic Aneurysms with Visceral or Renal Bypass. Ann Vasc Surg 2010; 24:106-12. [DOI: 10.1016/j.avsg.2009.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 09/17/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
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127
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Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009; 50:S2-49. [PMID: 19786250 DOI: 10.1016/j.jvs.2009.07.002] [Citation(s) in RCA: 453] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Elliot L Chaikof
- Department of Surgery, Emory University, Atlanta, Ga 30322, USA.
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128
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Joels CS, Langan EM, Daley CA, Kalbaugh CA, Cass AL, Cull DL, Taylor SM. Changing Indications and Outcomes for Open Abdominal Aortic Aneurysm Repair since the Advent of Endovascular Repair. Am Surg 2009. [DOI: 10.1177/000313480907500806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The indications for open abdominal aortic aneurysm (AAA) repair have changed with the development of endovascular techniques. The purpose of this study is to clarify the indications and outcomes for open repair since endovascular aneurysm repair (EVAR) and to compare contemporary AAA repair with the pre-EVAR era. Patients undergoing open AAA repair were identified; the demographics, outcomes, and indications for open repair were reviewed. Outcomes were compared based on indication for open repair in the EVAR era and between the pre-EVAR and EVAR eras. Open indications in the EVAR era included: age younger than 65 years with minimal comorbidities (AGE, n = 24 [9.8%]), unfavorable anatomy (ANAT, n = 146 [59.3%]), aortoiliac occlusive disease (AIOD, n = 38 [15.4%]), and miscellaneous (OTHER, n = 38 [15.4%]). Mortality (30-day and 5-year) was affected by indication: AGE = 0 and 0 per cent, ANAT = 4.1 and 49.7 per cent, AIOD = 13.5 and 32.3 per cent, and OTHER = 5.3 and 41.8 per cent. Age, sex, race, coronary artery disease, and peripheral artery disease were similar between the pre-EVAR and EVAR eras. EVAR-era patients had more diabetes mellitus, hypertension, and hyperlipidemia and longer operative time. Mortality was not different, but complication rates were lower in the pre-EVAR era (23.7 vs 43.5%, P = 0.025). Patients undergoing open AAA repair in the EVAR era have more comorbidities, longer operative times, and more complications. Outcomes for EVAR-era patients are affected by the indication for open repair. A preference for open repair in younger patients with minimal comorbidities is justified.
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Affiliation(s)
- Charles S. Joels
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina
| | - Eugene M. Langan
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina
| | - Charles A Daley
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina
| | - Corey A. Kalbaugh
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina
| | - Anna L. Cass
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina
| | - David L. Cull
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina
| | - Spence M. Taylor
- Academic Department of Surgery, Greenville Hospital System University Medical Center, Greenville, South Carolina
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129
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Modern Treatment of Juxtarenal Abdominal Aortic Aneurysms with Fenestrated Endografting and Open Repair – A Systematic Review. Eur J Vasc Endovasc Surg 2009; 38:35-41. [DOI: 10.1016/j.ejvs.2009.02.012] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 02/23/2009] [Indexed: 11/21/2022]
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130
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Beck AW, Bos WTGJ, Vourliotakis G, Zeebregts CJ, Tielliu IFJ, Verhoeven ELG. Fenestrated and branched endograft repair of juxtarenal aneurysms after previous open aortic reconstruction. J Vasc Surg 2009; 49:1387-94. [PMID: 19497496 DOI: 10.1016/j.jvs.2009.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 02/09/2009] [Accepted: 02/09/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Adam W Beck
- Department of Surgery, University Medical Center of Groningen, Groningen, The Netherlands
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131
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Chisci E, Kristmundsson T, de Donato G, Resch T, Setacci F, Sonesson B, Setacci C, Malina M. The AAA With a Challenging Neck: Outcome of Open Versus Endovascular Repair With Standard and Fenestrated Stent-Grafts. J Endovasc Ther 2009; 16:137-46. [DOI: 10.1583/08-2531.1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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132
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Mohabbat W, Greenberg RK, Mastracci TM, Cury M, Morales JP, Hernandez AV. Revised duplex criteria and outcomes for renal stents and stent grafts following endovascular repair of juxtarenal and thoracoabdominal aneurysms. J Vasc Surg 2009; 49:827-37; discussion 837. [DOI: 10.1016/j.jvs.2008.11.024] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 11/04/2008] [Accepted: 11/07/2008] [Indexed: 01/18/2023]
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133
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Beck AW, Goodney PP, Nolan BW, Likosky DS, Eldrup-Jorgensen J, Cronenwett JL. Predicting 1-year mortality after elective abdominal aortic aneurysm repair. J Vasc Surg 2009; 49:838-43; discussion 843-4. [PMID: 19341875 DOI: 10.1016/j.jvs.2008.10.067] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 10/18/2008] [Accepted: 10/29/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Adam W Beck
- Dartmouth-Hitchcock Medical Center Department of Surgery, Section of Vascular Surgery, Lebanon, NH, USA
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134
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Suprarenal aortic cross-clamp position: A reappraisal of its effects on outcomes for open abdominal aortic aneurysm repair. J Vasc Surg 2009; 49:873-80. [DOI: 10.1016/j.jvs.2008.10.057] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 10/20/2008] [Accepted: 10/20/2008] [Indexed: 11/23/2022]
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135
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Bos WTGJ, Cohen T, Vourliotakis G, Sambeek MRHMV, Verhoeven ELG. Open Treatment Versus Endovascular Repair for Aortic Abdominal Aneurysm-Keeping the Balance. Ann Vasc Dis 2009. [DOI: 10.3400/avd.sa09001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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136
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Bos W, Cohen T, Vourliotakis G, van Sambeek M, Verhoeven E. Open treatment versus endovascular repair for aortic abdominal aneurysm-keeping the balance. Ann Vasc Dis 2009; 2:95-9. [PMID: 23555366 DOI: 10.3400/avd.avdsa09001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2009] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wtgj Bos
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
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