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Louzada ACS, Wolosker MB, Astolfi RH, Colombo Junior J, El Hayek OR, Teivelis MP, Wolosker N. One-step Endovascular Aortic Aneurysm Repair With CO2 contrast and Robotic Partial Nephrectomy for Renal Cell Carcinoma: Case Report. Vasc Endovascular Surg 2022; 56:812-816. [PMID: 35950908 DOI: 10.1177/15385744221120975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although rare, as the population ages, abdominal aortic aneurysm synchronous to abdominal malignancies, as renal cell carcinoma, is expected to become more prevalent. There are only two case reports of minimally invasive surgeries to treat these synchronous diseases, with endovascular aortic repair and laparoscopic nephrectomy, but they were performed in two stages, with iodinated contrast and without robotic assistance. CASE REPORT We herein present a case of a 71-year-old patient with chronic kidney disease, a 6.4 cm infra-renal abdominal aortic aneurysm associated and a suspicious 6 cm solid-cystic expansile lesion in the right kidney, successfully treated at one stage with endovascular aortic repair using carbon dioxide as a contrast medium and with robotic right partial nephrectomy, aiming to preserve the renal function as much as possible. The patient's postoperative course was free of complications with hospital discharge on the fifth postoperative day, with a serum creatinine of 0.84 mg/dL. CONCLUSION single-stage minimally invasive surgical treatment of AAA and RCC can be a safe and feasible approach. Combining a robot-assisted laparoscopic partial nephrectomy with an EVAR using carbon dioxide as a contrast medium was safe and successfully preserved renal function.
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Affiliation(s)
- Andressa C S Louzada
- Department of Vascular and Endovascular Surgery, 37896Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marina B Wolosker
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Rafael H Astolfi
- Department of Surgery, Urology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - José Colombo Junior
- Department of Urology, 37896Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Omar R El Hayek
- Department of Urology, 37896Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo P Teivelis
- Department of Vascular and Endovascular Surgery, 37896Hospital Israelita Albert Einstein, São Paulo, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), 37896Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nelson Wolosker
- Department of Vascular and Endovascular Surgery, 37896Hospital Israelita Albert Einstein, São Paulo, Brazil.,Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), 37896Hospital Israelita Albert Einstein, São Paulo, Brazil
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Ahn S, Min JY, Kim HG, Mo H, Min SK, Min S, Ha J, Min KB. Outcomes after aortic aneurysm repair in patients with history of cancer: a nationwide dataset analysis. BMC Surg 2020; 20:85. [PMID: 32357930 PMCID: PMC7195758 DOI: 10.1186/s12893-020-00754-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/22/2020] [Indexed: 12/03/2022] Open
Abstract
Background Synchronous cancer in patients with abdominal aortic aneurysm (AAA) increases morbidity and mortality after AAA repair. However, little is known about the impact of the history of cancer on mortality after AAA repair. Methods Patients with intact AAA who were treated with endovascular aneurysm repair or open surgical repair were selected from the Health Insurance and Review Assessment data in South Korea between 2007 and 2016. Primary endpoints included the 30- and 90-day mortality and long-term mortality after AAA repair. The Cox proportional hazards models were constructed to evaluate independent predictors of mortality. Results A total of 1999 patients (17.0%, 1999/11785) were diagnosed with cancer prior to the AAA repair. History of cancer generally had no effect in short-term mortality at 30 and 90 days. However, short-term mortality rate of patients with a history of lung cancer was more than twice that of patients without it (3.07% vs. 1.06%, P = 0.0038, 6.14% vs. 2.69%, P = 0.0016). Furthermore, the mortality rate at the end of the study period was significantly higher in AAA patients with a history of cancer than in those without a history of cancer (21.21% vs. 17.08%, P < .0001, HR, 1.31, 95% CI, 1.17–1.46). Conclusions The history of cancer in AAA patients increases long-term mortality but does not affect short-term mortality after AAA repair. However, AAA repair could increase both short- and long-term mortality in patients with lung cancer history, and those cases should be more carefully selected.
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Affiliation(s)
- Sanghyun Ahn
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Min
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Hyunyoung G Kim
- Department of Family and Community Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Hyejin Mo
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongwon Ha
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea.
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Ferda J, Baxa J, Ferdova E, Kucera R, Topolcan O, Molacek J. Abdominal aortic aneurysm in prostate cancer patients: the "road map" from incidental detection to advanced predictive, preventive, and personalized approach utilizing common follow-up for both pathologies. EPMA J 2019; 10:415-423. [PMID: 31832115 DOI: 10.1007/s13167-019-00193-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/01/2019] [Indexed: 12/16/2022]
Abstract
Abdominal aortic aneurysm (AAA) is often a hidden pathological process showing no clinical symptoms. Genetic burden, smoking, male gender, age > 65 years, and white race have been identified as the main risk factors. A regular screening program has been introduced but is, as yet, unclear and is not performed in most countries. Prostate cancer is the most frequent male malignant disease in Western countries. Prostate cancer is a disease of older age with a median primary diagnosis of over 60 years. In recent years, advanced imaging methods have been established as important diagnostic tools in prostate cancer diagnostics. The incidental detection of AAA during diagnostic imaging performed due to prostate cancer diagnosis could reveal some asymptomatic aneurysms. Using our experience, the incidental detection of AAA during 18F-fluoromethylcholine PET/CT imaging, performed due to the staging, follow-up, and restaging of the prostate cancer, was reworked into a regular tool of secondary prevention within the framework of personalized medicine strategies. Experience with this type of AAA detection is demonstrated by a cohort of 500 patients who underwent 18F-fluorometylcholine PET/CT examination due to the staging or restaging of prostate cancer. A total of 28 aneurysms were detected (26 aneurysms < 50 mm, 2 aneurysms > 50 mm). In 2 cases (diameter < 50 mm), serious complications were found (penetrating aortic ulcer). The detection and monitoring of AAA in patients undergoing 18F-fluorometylcholine PET/CT due to the prostate cancer offers the possibility of a secondary prevention of AAA, patient stratification, and common follow-up for both pathologies.
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Affiliation(s)
- Jiri Ferda
- 1Department of Imaging Methods, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Jan Baxa
- 1Department of Imaging Methods, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Eva Ferdova
- 1Department of Imaging Methods, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Radek Kucera
- 2Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Ondrej Topolcan
- 2Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Jiri Molacek
- 3Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Pilsen, Czech Republic
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Li B, Khan S, Salata K, Hussain MA, de Mestral C, Greco E, Aljabri BA, Forbes TL, Verma S, Al-Omran M. A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm. J Vasc Surg 2019; 70:954-969.e30. [DOI: 10.1016/j.jvs.2019.01.076] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/11/2019] [Indexed: 01/09/2023]
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Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 873] [Impact Index Per Article: 174.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Elmallah A, Elnagar M, Bambury N, Ahmed Z, Dowdall J, Mehigan D, Sheehan S, Barry M. A study of outcomes in conservatively managed patients with large abdominal aortic aneurysms deemed unfit for surgical repair. Vascular 2018; 27:161-167. [PMID: 30319068 DOI: 10.1177/1708538118807075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current advancement and increasing use of diagnostic imaging has led to increased detection of abdominal aortic aneurysms (AAA). Many of these patients are unfit for elective AAA surgery. AIM To investigate the outcome of conservative management of unfit patients with large AAA (>5.5 cm) who are turned down for elective surgical intervention. PATIENTS AND METHODS Between January 2006 and April 2017, 457 patients presented with AAA >5.5 cm. Seventy-six patients (M: F 54:22) were deemed unfit for elective repair. Mean age was 79.8 years (range 64-96). Mean AAA size was 60.22 mm (55-83). RESULTS Forty-nine of the 76 patients (64%) had died by April 2017. Fifteen (19.7%) patients died directly because of their aneurysm rupture. A further 34 (44.7%) patients died from non-aneurysm-related causes. CONCLUSION Patients with large AAA deemed unfit for elective surgery have an overall poor prognosis and die mainly from other causes than AAA. Surgical intervention when rupture occurs results in poor survival.
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Affiliation(s)
- Ahmed Elmallah
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Mohamed Elnagar
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Niamh Bambury
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Zeeshan Ahmed
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Joseph Dowdall
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Denis Mehigan
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Stephen Sheehan
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Mary Barry
- Department of Vascular Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
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Kotsis T, Dellis AE. Surgical Repair of Abdominal Aortic Aneurysm in Patients with Simultaneous Urological Disorders: a Single Center Experience. Med Arch 2018; 72:230-233. [PMID: 30061774 PMCID: PMC6021157 DOI: 10.5455/medarh.2018.72.230-233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Although rare, co-existence of abdominal aortic aneurysms with urological manifestations, suggests a challenging surgical entity in terms of successful aneurysmal repair along with minimally or null urological complications. Case reports There are neither available data regarding the incidence of their co-existence nor consensus regarding optimal surgical management. Given the infrequency of their simultaneous presentation, the report of unusual cases as well as proposal for successful surgical management, are always useful and educative. Conclusion Precise imaging pre-operatively and meticulous surgical technique intra-operatively are of utmost importance and suggest our vast allies in successful outcomes. Herein, we present our small case series of 3 interesting cases.
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Affiliation(s)
- Thomas Kotsis
- Vascular Surgery Unit - 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios E Dellis
- Vascular Surgery Unit - 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
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