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Lee S, Park D, Ju JW, Bae J, Cho YJ, Nam K, Jeon Y. Relationship between intraoperative dopamine infusion and postoperative acute kidney injury in patients undergoing open abdominal aorta aneurysm repair. BMC Anesthesiol 2022; 22:82. [PMID: 35346048 PMCID: PMC8962567 DOI: 10.1186/s12871-022-01624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute kidney injury (AKI) is one of the most common complications in patients undergoing open abdominal aortic aneurysm (AAA) repair. Dopamine has been frequently used in these patients to prevent AKI. We aimed to clarify the relationship between intraoperative dopamine infusion and postoperative AKI in patients undergoing open AAA repair. Methods We analyzed 294 patients who underwent open AAA repair at a single tertiary center from 2009 to 2018, retrospectively. The primary outcome was the incidence of postoperative AKI, determined by the Kidney Disease Improving Global Outcomes definition, after open AAA repair. Secondary outcomes included survival outcome, hospital and intensive care unit length of stay, and postoperative renal replacement therapy (RRT). Results Postoperative AKI occurred in 21.8% (64 out of 294 patients) The risk of postoperative AKI by intraoperative dopamine infusion was greater after adjusting for risk factors (odds ratio [OR] 2.56; 95% confidence interval [CI], 1.09–5.89; P = 0.028) and after propensity score matching (OR 3.22; 95% CI 1.12–9.24; P = 0.030). On the contrary, intraoperative norepinephrine use was not associated with postoperative AKI (use vs. no use; 19.3 vs. 22.4%; P = 0.615). Patients who used dopamine showed higher requirement for postoperative RRT (6.8 vs. 1.2%; P = 0.045) and longer hospital length of stay (18 vs. 16 days, P = 0.024). Conclusions Intraoperative dopamine infusion was associated with more frequent postoperative AKI, postoperative RRT, and longer hospital length of stay in patients undergoing AAA repair, when compared to norepinephrine. Further prospective randomized clinical trial may be necessary for this topic. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01624-6.
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Tantawy TG, Seriki D, Rogers S, Katsogridakis E, Ghosh J. Endovascular Aneurysm Repair Assisted by CO 2 Digital Subtraction Angiography and Intraoperative Contrast-Enhanced Ultrasonography: Single-Center Experience. Ann Vasc Surg 2020; 70:459-466. [PMID: 32599109 DOI: 10.1016/j.avsg.2020.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Allergy to iodinated contrast (IC) agent and advanced chronic kidney disease are major limitations to endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs). We describe our experience combining CO2-assisted EVAR with intraoperative contrast-enhanced ultrasound (CEUS) in an attempt to avoid contrast-induced allergy or nephropathy. METHODS Observational cohort study using prospectively acquired data on patients undergoing CO2-assisted EVAR in single institution. EVAR planning was performed using computed tomographic angiography or magnetic resonance aortography in patients contraindicated for IC. Patients were considered if their estimated glomerular filtration rate was <40 mL/min and anatomically suitable for conventional infrarenal EVAR. Outcomes of interest included technical success rate and reintervention rates, total radiation dose, length of hospital stay, and graft kinking or migration. RESULTS Fifteen patients (10 male) were treated across a 5-year period. Technical success was achieved in all cases. Completely IC-free EVAR was performed in 9 cases, whereas the remaining 6 required IC administration for adjunct procedures. CO2 completion angiography detected all type I endoleaks (2 Ia and 1 Ib) but was less sensitive to type II. Intraoperative CEUS confirmed all type I and 2 cases of type II endoleaks. Median hospital stay was 4 days. No significant deterioration in renal function was seen postoperatively. CONCLUSIONS In patients with abdominal aortic aneurysms and with contraindication for IC, a combined approach of using CO2 digital subtraction angiography and CEUS can be used safely and efficiently to minimize or obviate the need for IC agents with satisfactory mid-term results.
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Affiliation(s)
- Tamer Ghatwary Tantawy
- Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Dare Seriki
- Department of Interventional Radiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Steven Rogers
- Independent Vascular Services Ltd, The Vascular Studies Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Academic Surgery Unit, Division of Cardiovascular Sciences, The University of Manchester, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emmanuel Katsogridakis
- Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jonathan Ghosh
- Department of Vascular and Endovascular Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Al Adas Z, Shepard AD, Nypaver TJ, Weaver MR, Maatman T, Yessayan LT, Balraj P, Kabbani LS. Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2018; 68:739-748. [DOI: 10.1016/j.jvs.2017.12.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
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Takeuchi Y, Morikage N, Matsuno Y, Nakamura T, Samura M, Ueda K, Harada T, Ikeda Y, Suehiro K, Ito H, Sakata K, Hamano K. Midterm Outcomes of Endovascular Aortic Aneurysm Repair with Carbon Dioxide–Guided Angiography. Ann Vasc Surg 2018; 51:170-176. [DOI: 10.1016/j.avsg.2018.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 01/22/2018] [Accepted: 02/19/2018] [Indexed: 12/20/2022]
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Risk factors for postoperative renal dysfunction following open surgical repair of abdominal aortic aneurysms retrospective analysis. Oncotarget 2017; 8:97749-97757. [PMID: 29228648 PMCID: PMC5716688 DOI: 10.18632/oncotarget.22049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/03/2017] [Indexed: 02/05/2023] Open
Abstract
Objectives To identify the risk factors for postoperative renal dysfunction after open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) and to establish a scoring system. Results The overall 30-day mortality rates were 22.0%(ruptured) vs 2.6% (unruptured), respectively. For the ruptured group, the independent risk factors were hemodynamic instability (P = 0.002) blood loss >1 L (P = 0.041) and preoperative creatinine >150 μmol/L (P < 0.001). By contrast, for the unruptured group, factors were smoking (P = 0.028), blood loss >1 L (P = 0.018), and antihypertensive drugs (P < 0.001). The areas under the curve of the WCRDA scoring system are 0.794 (95% confidence interval (CI) 0.686–0.902, P < 0.001) and 0.811 (95% CI 0.691–0.932, P < 0.001) for the ruptured and unruptured groups, respectively. Conclusions Hemodynamic instability, blood loss >1 L and Hb <90 g/L are independent risk factors for postoperative renal dysfunction following rAAA OSR, whereas smoking, blood loss >1 L, and antihypertensive drugs are independent risk factors. WCRDA performs well in predicting postoperative renal dysfunction. Materials and Methods 287 patients from the Vascular Department of West China Hospital, Sichuan University, who were planned to perform OSR for AAA from November 2003 to January 2017. 274 patients underwent OSR for AAA were finally included in the study. A total of 118 patients had ruptured AAA and 156 unruptured AAA. The patients were divided into the ruptured and unruptured groups. Logistic regression was used to identify the independent risk factors for postoperative renal dysfunction. The receiver operating characteristic curve was used to evaluate the scoring system.
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Hoshina K, Akai T, Ohshima M, Watanabe T, Yamamoto S. Theoretical mechanism of temporary renal function improvement after abdominal aortic aneurysm surgery: Applications for clinical imaging and laboratory data. Medicine (Baltimore) 2017; 96:e7428. [PMID: 28746184 PMCID: PMC5627810 DOI: 10.1097/md.0000000000007428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We evaluated the effects of changes in blood flow due to abdominal aortic aneurysm (AAA) surgery by using a simple zero-dimension model and applied theoretical values to clinical data.The zero-dimension electronic circuit model and diagram of blood flow distribution were created by setting the resistance of the aorta, bilateral iliac arteries, renal arteries, and aneurysm. Resistance of the aneurysm and resistance of the aorta before surgery were compared with that of the aorta after surgery. We set the radius length of each anatomical parameter to calculate theoretical values.Renal flow increased 13.4% after surgery. Next, we analyzed contrast-enhanced computed tomography data of 59 patients who underwent AAA surgery. A total of 19 patients were treated with a Y graft and 7 patients were treated with a straight graft during open surgery. However, 33 patients were treated with a bifurcated stent graft. A significant linear relationship between the increased estimated glomerular filtration rate (eGFR) ratio and the decreased aneurysm ratio was found only for the straight graft group.Using a circuit model, renal blood flow theoretically increased after AAA surgery. Clinically, there was a correlation between volume regression and eGFR improvement only in the limited AAA group.
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Affiliation(s)
| | | | - Marie Ohshima
- Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo
| | | | - Sota Yamamoto
- Department of Mechanical Engineering, Graduate School, Shibaura Institute of Technology, Tokyo, Japan
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Mazzaccaro D, Nano G, Settembrini AM, Carmo M, Dallatana R, Salvati S, Malacrida G, Settembrini PG. Open and endovascular elective treatment of abdominal aortic aneurysms: a real-world experience. Surg Today 2017; 47:1347-1355. [PMID: 28386748 DOI: 10.1007/s00595-017-1525-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/03/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To present a real-world experience of the elective treatment of abdominal aortic aneurysms (AAAs) using both open repair (OR) and endovascular repair (EVAR). METHODS Data from patients treated consecutively between January 1, 2000 and December 31, 2014 were collected retrospectively and reviewed. The primary outcomes were 30-day mortality and complication rates, freedom from reintervention, and survival in the long-term. RESULTS We analyzed data on 1112 patients (660 EVAR, 452 OR). The 30-day mortality and complications rates were higher after OR than after EVAR (2.9 vs. 1.1%, P = .03 and 24.7 vs. 1.1%, P < .0001, respectively). At 10 years, survival was 66.1 ± 3.2% after OR and 78.1 ± 2.2% after EVAR (P = .0006) and freedom from reintervention was 93.5 ± 1.8% after OR and 88.4 ± 1.8% after EVAR (P = .005). The preoperative aneurysm diameter was significantly associated with the development of type Ia endoleaks after EVAR (P < .0001) and of a proximal pseudoaneurysm after OR (P < .0001). CONCLUSION In the long-term, EVAR was associated with higher reintervention rates, but better survival than OR. The preoperative AAA diameter was the most important predictor of the development of endoleaks after EVAR and proximal pseudoaneurysm after OR.
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Affiliation(s)
- Daniela Mazzaccaro
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, Piazza Malan,1, 20097, San Donato Milanese, MI, Italy.
| | - Giovanni Nano
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, Piazza Malan,1, 20097, San Donato Milanese, MI, Italy.,University of Milan, Milan, Italy
| | - Alberto M Settembrini
- Unit of Vascular Surgery, Azienda Ospedaliera Ospedale San Carlo Borromeo Milano, Milan, Italy
| | - Michele Carmo
- Unit of Vascular Surgery, Azienda Ospedaliera Ospedale San Carlo Borromeo Milano, Milan, Italy
| | - Raffaello Dallatana
- Unit of Vascular Surgery, Azienda Ospedaliera Ospedale San Carlo Borromeo Milano, Milan, Italy
| | - Simone Salvati
- Unit of Vascular Surgery, Azienda Ospedaliera Ospedale San Carlo Borromeo Milano, Milan, Italy
| | - Giovanni Malacrida
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, Piazza Malan,1, 20097, San Donato Milanese, MI, Italy
| | - Piergiorgio G Settembrini
- University of Milan, Milan, Italy.,Unit of Vascular Surgery, Azienda Ospedaliera Ospedale San Carlo Borromeo Milano, Milan, Italy
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Yang JK, Wang YY, Liu C, Shi TT, Lu J, Cao X, Yang FY, Feng JP, Chen C, Ji LN, Xu A. Urine Proteome Specific for Eye Damage Can Predict Kidney Damage in Patients With Type 2 Diabetes: A Case-Control and a 5.3-Year Prospective Cohort Study. Diabetes Care 2017; 40:253-260. [PMID: 27903615 DOI: 10.2337/dc16-1529] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/16/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The predictive value of microalbuminuria (MAU) for kidney damage is limited in type 2 diabetes (T2D). We studied whether a urine proteome specific for sight-threatening proliferative diabetic retinopathy (PDR) is an indicator to predict chronic renal insufficiency (CRI) in patients with T2D. RESEARCH DESIGN AND METHODS A shotgun urine proteomic analysis was performed in patients with MAU and PDR (case subjects) and in patients with MAU and a duration of T2D for >10 years but without any degree of retinopathy (control subjects). In the cohort study, 210 patients with T2D with an estimated glomerular filtration rate (eGFR) ≥80 mL/min/1.73 m2 were followed for a median of 5.3 years. Urine proteins specific for PDR were used for predicting CRI (eGFR <60 mL/min/1.73 m2). RESULTS The top two urine proteins with the highest difference in ratio of case subjects to control subjects were haptoglobin (8.7 times; P < 0.0001) and α-2-macroglobulin (5.7 times; P < 0.0001). In the cohort study, patients with baseline urinary haptoglobin ≥20 ng/min (haptoglobinuria) had a higher incidence of CRI than those without (hazard ratio [95% CI] 3.27 [1.41-7.58]; P = 0.006). The overall CRI rate was 3.2% for patients without haptoglobinuria or MAU, 9.5% for those with MAU, and 13.3% for those with haptoglobinuria. The highest rate for CRI (22.4%) was in patients with both MAU and haptoglobinuria (P < 0.001). CONCLUSIONS Urine haptoglobin, which is specific for PDR, is a novel biomarker and complement to urine albumin for predicting kidney damage in patients with T2D.
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Affiliation(s)
- Jin-Kui Yang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying-Ying Wang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Shi
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Lu
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xi Cao
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fang-Yuan Yang
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jian-Ping Feng
- Beijing Key Laboratory of Diabetes Research and Care, Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Chen
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Li-Nong Ji
- Endocrinology and Metabolism Department, Peking University People's Hospital, Beijing, China
| | - Aimin Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Medicine, University of Hong Kong, Hong Kong
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Coscas R, Wagner S, Vilaine E, Sartorius A, Javerliat I, Alvarez JC, Goeau-Brissonniere O, Coggia M, Massy Z. Preoperative Evaluation of the Renal Function before the Treatment of Abdominal Aortic Aneurysms. Ann Vasc Surg 2016; 40:162-169. [PMID: 27890838 DOI: 10.1016/j.avsg.2016.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic impaired renal function constitutes a major risk factor of morbi-mortality during the treatment of an abdominal aortic aneurism (AAA). The inflammatory state due to the AAA could result in a reduction in the muscular mass and an overestimation of the glomerular filtration rate (GFR) with the usual formulas. The objective of this study was to determine if the formulas used to evaluate the estimated GFR were adapted in patients with AAA. MATERIALS AND METHODS Between August 2013 and November 2014, we conducted an exploratory study to evaluate the renal function before surgery for AAA in 28 patients. The renal function was evaluated by (1) the dosage of plasmatic creatinine, (2) the GFR estimated with the Cockroft-Gault, Modification of Diet in Renal Disease (MDRD), and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas, (3) the creatinine clearance (CC), and (4) the direct measurement of the GFR with a reference method (iohexol clearance). Statistical analysis was carried out to compare and correlate the GFR estimated by the various formulas with the GFR measured by the reference technique. RESULTS The study included 21 men (75%) and 7 women (25%), with a median age of 76 years (58-89). The measured GFR was correlated with the GFR estimated from the CKD-EPI (rho = 0.78, P < 0.0001), the MDRD (rho = 0.78, P < 0.0001), the Cockroft-Gault (rho = 0.65, P = 0.0002), and CC (rho = 0.86, P < 0.0001). However, there were important individual variations between estimated and measured GFR. As regards the detection of the patients presenting a GFR <60 mL/min/1.73 m2, the sensitivities of the CKD-EPI, MDRD, Cockroft-Gault formulas and CC were 64%, 64%, 71%, and 70%, respectively. Specificities were 71%, 79%, 57%, and 100%, respectively. The estimation of the GFR by the CKD-EPI formula had the lowest bias (-3.0). Bland-Altman plots indicated that the estimation of the GFR by the CKD-EPI formula had the best performance in comparison with the other methods. CONCLUSIONS This study found a statistical correlation between the measurement of the GFR and the various formulas available to estimation the GFR among AAA patients. The CKD-EPI formula is most appropriate. However, there were important individual variations between the measurement and the estimations of the GFR. A larger scale study is necessary to determine the profile of the patients with a risk of error in the estimation of the GFR. The French recommendations on the evaluation of the renal function before AAA treatment remain based on serum creatinine and should be revalued.
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Affiliation(s)
- Raphael Coscas
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France; INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France.
| | - Sandra Wagner
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) Network, Vandoeuvre-lès-Nancy, France
| | - Eve Vilaine
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Service de Néphrologie-Dialyse, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Albane Sartorius
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Isabelle Javerliat
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Jean Claude Alvarez
- Department of Pharmacology and Toxicology, Raymond Poincare Hospital, AP-HP, and INSERM U-1173, Université de Versailles Saint-Quentin en Yvelines, Garches, France
| | - Olivier Goeau-Brissonniere
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France; INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Marc Coggia
- Service de chirurgie vasculaire, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Ziad Massy
- INSERM U1018, CESP, UVSQ, Université Paris-Saclay, Villejuif, France; Cardiovascular and Renal Clinical Trialists (F-CRIN INI-CRCT) Network, Vandoeuvre-lès-Nancy, France; Service de Néphrologie-Dialyse, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
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Yamada M, Nishi H, Sekiya N, Horikawa K, Takahashi T, Sawa Y. The efficacy of tolvaptan in the perioperative management of chronic kidney disease patients undergoing open-heart surgery. Surg Today 2016; 47:498-505. [DOI: 10.1007/s00595-016-1406-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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O'Mara JE, Bersin RM. Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:54. [PMID: 27376647 DOI: 10.1007/s11936-016-0470-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OPINION STATEMENT Endovascular aneurysm repair (EVAR) has become the predominant method of treatment for abdominal aortic aneurysms (AAA). The use of conscious sedation with local anesthesia and percutaneous femoral access has further decreased the morbidity of the procedure. Current devices can more effectively manage increasingly "hostile" aneurysm necks, while chimney grafts or dedicated fenestrated stent-grafts can be used for juxta-renal disease with favorable results. However, endovascular repair does present a new set of challenges, and endoleaks remain an area of concern. While there is general consensus that type I and type III endoleaks require treatment, type II endoleaks are the topic of ongoing research and debate. Development of devices and techniques to prevent and treat endoleak continues to progress. Advances in contrast-enhanced ultrasound are reducing reliance on computed tomography for post-operative monitoring. This is an important step in this population at high risk for the development of kidney failure. Despite these many innovations, further research is needed to optimize the care of patients with AAA.
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Affiliation(s)
- John E O'Mara
- Swedish Medical Center, Heart and Vascular Institute, Suite 680, 550 17th Ave, Seattle, WA, 98122, USA. John.O'
| | - Robert M Bersin
- Swedish Medical Center, Heart and Vascular Institute, Suite 680, 550 17th Ave, Seattle, WA, 98122, USA
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