1
|
Kageyama S, Ohashi T, Kojima A, Kojima T. Emergency Open Surgical Repair for Ruptured Abdominal Aortic Aneurysm in Octogenarians and Nonagenarians: A Single-Center Retrospective Observational Study. Ann Vasc Surg 2024; 108:36-46. [PMID: 38942379 DOI: 10.1016/j.avsg.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/14/2024] [Accepted: 04/07/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND In the endovascular aneurysm repair era, open surgical repair (OSR) is performed for ruptured abdominal aorta aneurysm (RAAA) in patients with complex aneurysm neck and technical difficulties. Understanding the risk factors of OSR is essential for the clinical selection of the ideal surgical procedure. We aimed to re-evaluate the outcomes of OSR and treatment options for RAAA. METHODS Patients who underwent OSR for RAAA between January 2010 and December 2022 were enrolled in this single-center retrospective observational study. Preoperative status, operative findings, and postoperative course were retrospectively reviewed. The Cox proportional hazards model was used to evaluate the association between age and early postoperative mortality. RESULTS Among 142 patients, 43 (30.3%) and 99 (69.7%) were aged ≥80 and <80 years, respectively. Postoperative mortality within 30 days occurred in 24 (16.9%) patients (11/43 [25.6%] and 13/99 [13.1%] patients aged ≥80 and <80 years, respectively; hazard ratio = 1.95; P = 0.069). In a multivariable analysis, increased postoperative mortality within 30 days was associated with age ≥80 years (adjusted hazard ratio, aHR = 2.36; P = 0.049), the presence of preoperative or intraoperative cardiopulmonary arrest (aHR = 12.0; P < 0.001), and postoperative gastrointestinal disorder (aHR = 4.42; P = 0.003). CONCLUSIONS Endovascular aneurysm repair may be preferable in older people; however, its use in cases of preoperative or intraoperative cardiopulmonary arrest or perioperative gastrointestinal disorders remains controversial, and a careful discussion on the surgical indications is needed in such cases.
Collapse
Affiliation(s)
- Soichiro Kageyama
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Takeki Ohashi
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Akinori Kojima
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-shi, Aichi, Japan; Division of Comprehensive Pediatric Medicine, Graduate School of Nagoya University, Showa-ku, Nagoya, Japan.
| |
Collapse
|
2
|
Trenner M, Kirchhoff F, Knappich C, Heuberger S, Eckstein HH, Kuehnl A. Editor's Choice - Temporal fluctuations of hospital incidence and mortality of ruptured abdominal aortic aneurysms in Germany: A secondary data analysis of German hospital episode statistics 2009 - 2018. Eur J Vasc Endovasc Surg 2023; 66:766-774. [PMID: 37573938 DOI: 10.1016/j.ejvs.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm rupture (rAAA) is still associated with high mortality. Recent studies have shown higher incidences in autumn and winter, and worse outcomes after rAAA treatment on weekends in some countries. This study aimed to analyse seasonal, weekday, and daytime fluctuations of the hospital incidence, treatment modalities, and outcomes of rAAA, based on the most recent nationwide German real world data. METHODS A secondary data analysis of diagnosis related group statistics (2009 - 2018), obtained from the German Federal Statistical Office, was conducted. Cases encoded by a diagnosis of rAAA in conjunction with procedural codes for endovascular aortic repair (EVAR) or open aortic repair were included. Patient and procedural characteristics, comorbidities, and outcomes were analysed for seasonal (spring, summer, autumn, and winter), weekday (Monday - Sunday) and daytime (0:00 - 8:00, 8:00 -16:00, 16:00 -20:00, and 20:00 - 24:00) fluctuations by descriptive statistics and multivariable regression analyses. RESULTS Thirteen thousand and seventy patients (85% male, median age 75 years) were treated for rAAA. Endovascular aortic repair was associated with lower mortality (adjusted OR 0.40, 95% CI 0.37 - 0.44). While no significant seasonal fluctuations were found, on a weekday basis lower hospital incidences were found on Mondays (12%) and Sundays (11%) compared with other weekdays (15 - 16%). Similarly, EVAR rates were lower on Mondays and Sundays (25% and 24%, respectively) compared with other weekdays (30 - 33%). Multivariable analyses revealed higher mortality rates on Mondays and Sundays. On a daytime basis, lower EVAR rates and higher mortality rates were found during the 16:00 - 8:00 period. CONCLUSION In German hospitals, incidences and EVAR rates to treat rAAA were lowest on Mondays and Sundays. The associated overall mortality rates were highest on the respective days. Further restructuring and centralisation of AAA treatment in Germany could potentially mitigate this weekday effect.
Collapse
Affiliation(s)
- Matthias Trenner
- Department for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany; Division of vascular medicine, St.-Josefs Hospital, Wiesbaden, Germany. https://twitter.com/matthiastrenner
| | - Felix Kirchhoff
- Department for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Simon Heuberger
- Department for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany.
| |
Collapse
|
3
|
Troisi N, Bertagna G, Torri L, Canovaro F, D’Oria M, Adami D, Berchiolli R. The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge. J Clin Med 2023; 12:5530. [PMID: 37685601 PMCID: PMC10488063 DOI: 10.3390/jcm12175530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment. METHODS we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms' incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies. RESULTS the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention. CONCLUSIONS RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk-benefit assessment may improve outcomes.
Collapse
Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.B.); (L.T.); (F.C.); (D.A.); (R.B.)
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.B.); (L.T.); (F.C.); (D.A.); (R.B.)
| | - Lorenzo Torri
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.B.); (L.T.); (F.C.); (D.A.); (R.B.)
| | - Francesco Canovaro
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.B.); (L.T.); (F.C.); (D.A.); (R.B.)
| | - Mario D’Oria
- Vascular Surgery Unit, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy;
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.B.); (L.T.); (F.C.); (D.A.); (R.B.)
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.B.); (L.T.); (F.C.); (D.A.); (R.B.)
| |
Collapse
|
4
|
Perinajová R, Álvarez-Cuevas CB, Juffermans J, Westenberg J, Lamb H, Kenjereš S. Influence of aortic aneurysm on the local distribution of NO and O 2 using image-based computational fluid dynamics. Comput Biol Med 2023; 160:106925. [PMID: 37141651 DOI: 10.1016/j.compbiomed.2023.106925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
There is a pressing need to establish novel biomarkers to predict the progression of thoracic aortic aneurysm (TAA) dilatation. Aside from hemodynamics, the roles of oxygen (O2) and nitric oxide (NO) in TAA pathogenesis are potentially significant. As such, it is imperative to comprehend the relationship between aneurysm presence and species distribution in both the lumen and aortic wall. Given the limitations of existing imaging methods, we propose the use of patient-specific computational fluid dynamics (CFD) to explore this relationship. We have performed CFD simulations of O2 and NO mass transfer in the lumen and aortic wall for two cases: a healthy control (HC) and a patient with TAA, both acquired using 4D-flow magnetic resonance imaging (MRI). The mass transfer of O2 was based on active transport by hemoglobin, while the local variations of the wall shear stress (WSS) drove NO production. Comparing hemodynamic properties, the time-averaged WSS was considerably lower for TAA, while the oscillatory shear index and endothelial cell activation potential were notably elevated. O2 and NO showed a non-uniform distribution within the lumen and an inverse correlation between the two species. We identified several locations of hypoxic regions for both cases due to lumen-side mass transfer limitations. In the wall, NO varied spatially, with a clear distinction between TAA and HC. In conclusion, the hemodynamics and mass transfer of NO in the aorta exhibit the potential to serve as a diagnostic biomarker for TAA. Furthermore, hypoxia may provide additional insights into the onset of other aortic pathologies.
Collapse
Affiliation(s)
- Romana Perinajová
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands; J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands.
| | | | - Joe Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saša Kenjereš
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands; J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands
| |
Collapse
|
5
|
Gormley S, Bernau O, Xu W, Sandiford P, Khashram M. Incidence and Outcomes of Abdominal Aortic Aneurysm Repair in New Zealand from 2001 to 2021. J Clin Med 2023; 12:jcm12062331. [PMID: 36983332 PMCID: PMC10054325 DOI: 10.3390/jcm12062331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023] Open
Abstract
Purpose: The burden of abdominal aortic aneurysms (AAA) has changed in the last 20 years but is still considered to be a major cause of cardiovascular mortality. The introduction of endovascular aortic repair (EVAR) and improved peri-operative care has resulted in a steady improvement in both outcomes and long-term survival. The objective of this study was to identify the burden of AAA disease by analysing AAA-related hospitalisations and deaths. Methodology: All AAA-related hospitalisations in NZ from January 2001 to December 2021 were identified from the National Minimum Dataset, and mortality data were obtained from the NZ Mortality Collection dataset from January 2001 to December 2018. Data was analysed for patient characteristics including deprivation index, repair methods and 30-day outcomes. Results: From 2001 to 2021, 14,436 patients with an intact AAA were identified with a mean age of 75.1 years (SD 9.7 years), and 4100 (28%) were females. From 2001 to 2018, there were 5000 ruptured AAA with a mean age of 77.8 (SD 9.4), and 1676 (33%) were females. The rate of hospitalisations related to AAA has decreased from 43.7 per 100,000 in 2001 to 15.4 per 100,000 in 2018. There was a higher proportion of rupture AAA in patients living in more deprived areas. The use of EVAR for intact AAA repair has increased from 18.1% in 2001 to 64.3% in 2021. The proportion of octogenarians undergoing intact AAA repair has increased from 16.2% in 2001 to 28.4% in 2021. The 30-day mortality for intact AAA repair has declined from 5.8% in 2001 to 1.7% in 2021; however, it has remained unchanged for ruptured AAA repair at 31.6% across the same period. Conclusions: This study highlights that the incidence of AAA has declined in the last two decades. The mortality has improved for patients who had a planned repair. Understanding the contemporary burden of AAA is paramount to improve access to health, reduce variation in outcomes and promote surgical quality improvement.
Collapse
Affiliation(s)
- Sinead Gormley
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton 3204, New Zealand
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Oliver Bernau
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - William Xu
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Peter Sandiford
- Planning Funding and Outcomes Unit, Auckland and Waitemata District Health Boards, Auckland 1010, New Zealand
- School of Population Health, University of Auckland, Auckland 1010, New Zealand
| | - Manar Khashram
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton 3204, New Zealand
- Faculty of Medical & Health Sciences, University of Auckland, Auckland 1010, New Zealand
- Correspondence:
| |
Collapse
|
6
|
Ho VT, Rothenberg KA, George EL, Lee JT, Stern JR. Female sex is independently associated with in-hospital mortality after endovascular aortic repair for ruptured aortic aneurysm. Ann Vasc Surg 2021; 81:148-153. [PMID: 34752855 DOI: 10.1016/j.avsg.2021.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) can treat anatomically compatible ruptured abdominal aortic aneurysms (rAAA), but registry data suggests that women undergo more open abdominal aneurysm repairs than men. We evaluate in-hospital outcomes of EVAR for rAAA by sex. METHODS The Vascular Quality Initiative (VQI) registry was queried from 2013 to 2019 for rAAA patients treated with EVAR. Univariate analysis was performed with Student's t-test and chi-squared tests. Multivariable logistic regression was then performed to assess the association between female sex and inpatient mortality. RESULTS 1775 patients were included (23.8% female). Female rAAA patients were older (p < 0.01) and weighed less (p < 0.01). They were less likely to have smoked (p <. 001) and had lower creatinine (1.29 vs 1.43, p <0.01) and hemoglobin (10.7 vs 11.7, p < 0.01). Women had smaller maximum aortic diameters (74 vs 66 mm, p < 0.01) and were less likely to have iliac aneurysms (p <.001). Women were more likely to have concomitant femoral endarterectomy (8.5% vs 4.6%, p=.03). Despite having no significant difference in complication or reintervention rates, women had higher rates of in-hospital mortality (45.9% vs 34.5%, p < 0.01). In a logistic regression model for predictors of in-hospital mortality (χ2 < .01), increased age (OR 1.08, p < 0.01), female sex (OR 1.7, p=0.02), preoperative cardiac arrest (OR 5.29, p<0.01), concurrent iliac stenting (OR 2.38, p =0.02), postoperative mesenteric ischemia (OR 2.51, p<0.01) and postoperative transfusion (OR 1.06, p <0.01) were independently associated with in-hospital mortality. Increased preoperative hemoglobin was protective (OR 0.89, p < 0.01) CONCLUSIONS: Female sex is independently associated with in-hospital mortality after EVAR for rAAA, suggesting a relationship beyond anatomical, biochemical, and procedural covariates.
Collapse
Affiliation(s)
- Vy T Ho
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
| | - Kara A Rothenberg
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA; Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth L George
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Jason T Lee
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Jordan R Stern
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| |
Collapse
|
7
|
Nationwide study in France investigating the impact of diabetes on mortality in patients undergoing abdominal aortic aneurysm repair. Sci Rep 2021; 11:19395. [PMID: 34588565 PMCID: PMC8481485 DOI: 10.1038/s41598-021-98893-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this nationwide study was to analyze the impact of diabetes on post-operative mortality in patients undergoing AAA repair in France. This 10-year retrospective, multicenter study based on the French National electronic health data included patients undergoing AAA repair between 2010 and 2019. In-hospital post-operative mortality was analyzed using Kaplan–Meier curve survival and Log-Rank tests. A multivariate regression analysis was performed to calculate Hazard Ratios. Over 79,935 patients who underwent AAA repair, 61,146 patients (76.5%) had at least one hospital-readmission after the AAA repair, for a mean follow-up of 3.5 ± 2.5 years. Total in-hospital mortality over the 10-year study was 16,986 (21.3%) and 4581 deaths (5.8%) occurred during the first hospital stay for AAA repair. Age over 64 years old, the presence of AAA rupture and hospital readmission at 30-day were predictors of post-operative mortality (AdjHR = 1.59 CI 95% 1.51–1.67; AdjHR = 1.49 CI 95% 1.36–1.62 and AdjHR = 1.92, CI 95% 1.84–2.00). The prevalence of diabetes was significantly lower in ruptured AAA compared to unruptured AAA (14.8% vs 20.9%, P < 0.001 for type 2 diabetes and 2.5% vs 4.0%, P < 0.001 for type 1 diabetes). Type 1 diabetes was significantly associated with post-operative mortality (AdjHR = 1.30 CI 95% 1.20–1.40). For type 2 diabetes, the association was not statistically significant (Adj HR = 0.96, CI 95% 0.92–1.01). Older age, AAA rupture and hospital readmission were associated with deaths that occurred after discharge from the first AAA repair. Type 1 diabetes was identified as a risk factor of post-operative mortality. This study highlights the complex association between diabetes and AAA and should encourage institutions to report long-term follow-up after AAA repair to better understand its impact.
Collapse
|
8
|
Ergene Ş, Hemşinli D, Karakişi SO, Mercantepe T, Tumkaya L, Yilmaz A. The Role of Vaccinium Myrtillus in the Prevention of Renal Injury in an Experimental Model of Ruptured Abdominal Aortic Aneurysm. Braz J Cardiovasc Surg 2020; 35:490-497. [PMID: 32864929 PMCID: PMC7454617 DOI: 10.21470/1678-9741-2019-0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective To examine the biochemical and histopathological renal effects of ischemia/reperfusion (I/R) injury using a ruptured abdominal aortic aneurysm (RAAA) model in rats and to investigate the potential protective effects of whortleberry (Vaccinium myrtillus). Methods Thirty-two male Sprague-Dawley rats were randomly assigned into four groups - control, sham (I/R+glycerol), I/R, and I/R+whortleberry. Midline laparotomy alone was performed in the control group. Atraumatic abdominal clamps were attached under anesthesia to the abdominal aorta beneath the level of the renal artery in the groups subjected to I/R. Sixty-minute reperfusion was established one hour after ischemia. The sham group received five intraperitoneal doses of glycerol five days before I/R. The I/R+whortleberry group received a single intraperitoneal 50 mg/kg dose diluted with saline solution five days before I/R. All animals were finally euthanized by cervical dislocation following 60-min reperfusion. Results Increases were observed in malondialdehyde (MDA) levels and tubular necrosis scores (TNS) in thin kidney tissues and in numbers of apoptotic renal tubule cells, together with a decrease in glutathione (GSH) levels, in sham and I/R groups. In contrast, we observed a decrease in MDA levels, TNS, and numbers of apoptotic renal tubule cells, and an increase in GSH levels with whortleberry treatment compared to the I/R group. Conclusion Our findings suggest that whortleberry may be effective against acute kidney injury by reducing oxidative stress and apoptosis.
Collapse
Affiliation(s)
- Şaban Ergene
- Department of Cardiovascular Surgery, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Doğuş Hemşinli
- Department of Cardiovascular Surgery, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Sedat Ozan Karakişi
- Department of Cardiovascular Surgery, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Adnan Yilmaz
- Department of Medical Biochemistry, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| |
Collapse
|
9
|
The Potential Role of Neutrophil Gelatinase-Associated Lipocalin in the Development of Abdominal Aortic Aneurysms. Ann Vasc Surg 2019; 57:210-219. [DOI: 10.1016/j.avsg.2018.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 11/20/2022]
|
10
|
Martinelli O, Fenelli C, Ben-Hamida JB, Fresilli M, Irace FG, Picone V, Malaj A, Gossetti B, Irace L. One-Year Outcomes after Ruptured Abdominal Aortic Aneurysms Repair: Is Endovascular Aortic Repair the Best Choice? A Single-Center Experience. Ann Vasc Surg 2018; 53:63-69. [DOI: 10.1016/j.avsg.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/12/2017] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
|
11
|
Wu Z, Li Y, Zhou W, Ji C, Zhao H, Liu X, Han Y. Seasonal incidence of ruptured abdominal aortic aneurysm and the influence of atmospheric pressure: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1733-1743. [PMID: 29943073 DOI: 10.1007/s00484-018-1573-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/10/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition with a high mortality rate. Seasonal variations in the incidence of rAAA and the influence of atmospheric pressure have been studied throughout decades; however, the conclusions are contradictory. Therefore, we aimed to conduct a meta-analysis and systematic review of literature on seasonal variations in rAAA incidence and the influence of atmospheric pressure. Studies investigating seasonal variations in rAAA incidence and influence of atmospheric pressure were retrieved. For dichotomous data, we generated risk ratios (RRs) and 95% confidence intervals (CIs) for rAAA incidence compared among seasons. The studies were subdivided according to latitude, elevation, and climatic types, for subgroup comparisons. Studies reporting monthly incidence and seasonal mortality were further investigated. For continuous data, standardized mean differences (SMDs) and 95% CIs were generated for atmospheric pressure comparisons. Twenty-four eligible studies were included, comprising a total of 38,506 patients with rAAA. Pooled rAAA incidence was 25% in spring, 23% in summer, 26% in autumn, and 26% in winter. Pooled analysis demonstrated a statistically significant higher rAAA incidence in winter than in summer (RR 1.10, P = 0.04) and in autumn than in summer (RR 1.11, P < 0.00001). However, there was no statistically significant difference among other seasons. In the study of the influence of atmospheric pressure, no statistically significant difference was observed. In conclusion, our study revealed a higher incidence of rAAA in autumn and winter than in summer; however, atmospheric pressure was found to exert no influence.
Collapse
Affiliation(s)
- Zhiyuan Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Shenyang, 110000, China
| | - Yeni Li
- Liaoning Provincial Meteorological Training Center, Liaoning Branch of China Meteorological Administration Training Center (CMATC), Shenyang, China
| | - Wenlong Zhou
- Department of General Surgery, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Shenyang, 110000, China
| | - Chao Ji
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haibin Zhao
- Department of Emergency, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xun Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Shenyang, 110000, China
| | - Yanshuo Han
- Department of General Surgery, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Shenyang, 110000, China.
| |
Collapse
|
12
|
Pecoraro F, Gloekler S, Mader CE, Roos M, Chaykovska L, Veith FJ, Cayne NS, Mangialardi N, Neff T, Lachat M. Mortality rates and risk factors for emergent open repair of abdominal aortic aneurysms in the endovascular era. Updates Surg 2017; 70:129-136. [PMID: 28913787 DOI: 10.1007/s13304-017-0488-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/15/2017] [Indexed: 12/17/2022]
Abstract
The background of this paper is to report the mortality at 30 and 90 days and at mean follow-up after open abdominal aortic aneurysms (AAA) emergent repair and to identify predictive risk factors for 30- and 90-day mortality. Between 1997 and 2002, 104 patients underwent emergent AAA open surgery. Symptomatic and ruptured AAAs were observed, respectively, in 21 and 79% of cases. Mean patient age was 70 (SD 9.2) years. Mean aneurysm maximal diameter was 7.4 (SD 1.6) cm. Primary endpoints were 30- and 90-day mortality. Significant mortality-related risk factor identification was the secondary endpoint. Open repair trend and its related perioperative mortality with a per-year analysis and a correlation subanalysis to identify predictive mortality factor were performed. Mean follow-up time was 23 (SD 23) months. Overall, 30-day mortality was 30%. Significant mortality-related risk factors were the use of computed tomography (CT) as a preoperative diagnostic tool, AAA rupture, preoperative shock, intraoperative cardiopulmonary resuscitation (CPR), use of aortic balloon occlusion, intraoperative massive blood transfusion (MBT), and development of abdominal compartment syndrome (ACS). Previous abdominal surgery was identified as a protective risk factor. The mortality rate at 90 days was 44%. Significant mortality-related risk factors were AAA rupture, aortocaval fistula, peripheral artery disease (PAD), preoperative shock, CPR, MBT, and ACS. The mortality rate at follow-up was 45%. Correlation analysis showed that MBT, shock, and ACS are the most relevant predictive mortality factor at 30 and 90 days. During the transition period from open to endovascular repair, open repair mortality outcomes remained comparable with other contemporary data despite a selection bias for higher risk patients. MBT, shock, and ACS are the most pronounced predictive mortality risk factors.
Collapse
Affiliation(s)
- Felice Pecoraro
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. .,Vascluar Surgery Unit, University Hospital "P. Giaccone", Via Liborio Giuffrè, 5, 90100, Palermo, Italy.
| | - Steffen Gloekler
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Caecilia E Mader
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Malgorzata Roos
- Institute for Social- and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Lyubov Chaykovska
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Frank J Veith
- Division of Vascular Surgery, New York University Medical Center, New York, NY, USA
| | - Neal S Cayne
- Division of Vascular Surgery, New York University Medical Center, New York, NY, USA
| | | | - Thomas Neff
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
13
|
Perceived barriers to endovascular repair of ruptured abdominal aortic aneurysm among Australasian vascular surgeons. J Vasc Surg 2016; 64:328-332. [PMID: 27066950 DOI: 10.1016/j.jvs.2016.01.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/15/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Although endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is widely accepted for elective surgery, the uptake of emergency EVAR for ruptured AAA (REVAR) has trailed behind. This study was intended to identify the barriers to widespread application of REVAR in Australia and New Zealand. METHODS A cross-sectional survey of members of the Australia and New Zealand Society of Vascular Surgeons was performed in late 2013. Primary themes explored were (1) perceived barriers to performing REVAR and (2) advantages of REVAR compared with open repair. Secondary data measures were the volume of AAA surgery, standard protocol use, and staff accreditation among vascular units. RESULTS A total of 85 surgeons responded to an anonymous online questionnaire (41% response rate); of these, 23 surgeons (27%) had no experience with REVAR, and 65% currently perform more EVAR than open repair for elective procedures, compared with 18% for ruptured AAA. Of the perceived barriers explored, respondents agreed that poor availability of endovascular facilities (73% agreed or strongly agreed) and ancillary staff (56%) were barriers to REVAR. Most surgeons agreed that the advantages of REVAR include reduced intraoperative blood loss, length of stay, and postoperative complications. Four of 11 vascular units performing REVAR had standard protocols in use, and four had mandatory staff accreditation. CONCLUSIONS The most common barrier to REVAR identified by surgeons was the poor availability of endovascular facilities, many of which are not ideally suited for this type of procedure. Australian and New Zealand vascular units have low rates of standard protocol use and staff accreditation for REVAR, which may have implications for patient care.
Collapse
|
14
|
Nowicka M, Kowalczyk A, Rusak G, Ratajczak P, Sobociński B. Evaluation the Aortic Aneurysm Remodeling After a Successful Stentgraft Implantation. Pol J Radiol 2016; 81:486-490. [PMID: 27800038 PMCID: PMC5066507 DOI: 10.12659/pjr.900116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 11/09/2022] Open
Abstract
Background Routine imaging follow-up after endovascular treatment of abdominal aortic aneurysms (EVAR) is mainly aimed at detection of endoleaks. The aim of the study was to assess changes in the size of the abdominal aortic aneurysm sack using CT angiography (CTA) after successful treatment using endovascular stent graft implantation. Material/Methods A retrospective analysis of CTA results included 102 patients aged 54–88, who had no postoperative complications. Patients underwent CTA before EVAR and after the treatment (mean time between studies, 7.6 months). The largest cross-sectional area of the aneurysm sac was measured using a curved multiplanar reconstruction. A change of the aneurysm cross-sectional over 10% was considered significant. Results The average cross-sectional area decreased after EVAR by 3% and this change was not statistically significant. Regression of the cross-sectional area was observed in 18.6% of patients, progression was in 23.5%, and no change was seen in 57.8%. Cross-sectional areas before and after EVAR were significantly correlated (r=0.75, p<0.0001). There was no correlation between the cross-sectional area change after EVAR and patients’ age or the time between the treatment and the follow-up CTA. Cross-sectional area before the treatment predicted changes in the aneurysm size after EVAR (p=0.0045). Conclusions Remodeling of abdominal aortic aneurysms after EVAR is not uniform. The change of aneurysm size depends on the initial aneurysm size but not on the time from EVAR. The size of the aneurysm after EVAR should not be considered as a measure of the treatment efficacy.
Collapse
Affiliation(s)
- Monika Nowicka
- Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Agnieszka Kowalczyk
- Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Grażyna Rusak
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Przemysław Ratajczak
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Bartosz Sobociński
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| |
Collapse
|
15
|
Spanos K, Saleptsis V, Karathanos C, Makris D, Stamoulis K, Giannoukas AD. Transition from Open Surgery to Endovascular Treatment of Abdominal Aortic Aneurysm Rupture. Ann Vasc Surg 2016; 36:85-91. [PMID: 27421198 DOI: 10.1016/j.avsg.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/08/2016] [Accepted: 03/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND To review the outcome before and after the implementation of protocol-based strategy for endovascular repair (EVAR) of abdominal aortic aneurysm rupture (rAAA). METHODS A retrospective analysis of prospectively collected data from a tertiary center during the period 2006-2011. Demographics, comorbidities, blood examinations, perioperative patients' status, and mortality rates were recorded. Univariate and multivariate analyses were used to assess the association of the type of the procedure with various factors. RESULTS A total of 58 (46 open surgical repair [OSR] and 12 EVAR) patients with mean age of 74 ± 17 years (91% males) were treated for rAAA. However, 39 (11 EVAR and 28 OSR) were operated with protocol-based strategy available. Total mortality rate was 52.6% (10 of 19) initially and 38.5% (15 of 39) after the implementation of a protocol-based strategy. During protocol-based treatment, the survival rate did not differ between the 2 procedures (7 of 11 EVAR and 17 of 28 OSR; P, ns). A 30-day mortality rate was associated with preoperative number of platelets (unadjusted P values, P = 0.013), age (odds ratio [OR] 0.796; 95% confidence interval [CI], 0.685-0.925; P = 0.003), and diastolic blood pressure (OR, 1.053; 95% CI, 1.016-1.093; P = 0.005). After mean follow-up of 48 ± 11 months, EVAR patients presented better outcome regarding mortality rate (36% OSR vs. 0% EVAR; P = 0.0464). CONCLUSIONS After the adoption of an available rEVAR protocol-based strategy, EVAR and OSR were equally effective during postoperative 30 days. The role of hypotension and age is important on poor outcomes during this period. However, after midterm follow-up, EVAR demonstrates better survival rates than OSR.
Collapse
Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - Vasileios Saleptsis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimosthenis Makris
- Department of Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Stamoulis
- Department of Anesthesiology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| |
Collapse
|
16
|
Pereira BMT, Chiara O, Ramponi F, Weber DG, Cimbanassi S, De Simone B, Musicki K, Meirelles GV, Catena F, Ansaloni L, Coccolini F, Sartelli M, Di Saverio S, Bendinelli C, Fraga GP. WSES position paper on vascular emergency surgery. World J Emerg Surg 2015; 10:49. [PMID: 26500690 PMCID: PMC4618918 DOI: 10.1186/s13017-015-0037-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/24/2015] [Indexed: 12/18/2022] Open
Abstract
Trauma, both blunt and penetrating, is extremely common worldwide, as trauma to major vessels. The management of these patients requires specialized surgical skills and techniques of the trauma surgeon. Furthermore few other surgical emergencies require immediate diagnosis and treatment like a ruptured abdominal aortic aneurysm (rAAA). Mortality of patients with a rAAA reaches 85 %, with more than half dying before reaching the hospital. These are acute events demanding immediate intervention to save life and limb and precluding any attempt at transfer or referral. It is the purpose of this position paper to discuss neck, chest, extremities and abdominal trauma, bringing to light recent evidence based data as well as expert opinions; besides, in this paper we present a review of the recent literature on rAAA and we discuss the rationale for transfer to referral center, the role of preoperative imaging and the pros and cons of Endoluminal repair of rAAA (REVAR) versus Open Repair (OR).
Collapse
Affiliation(s)
- Bruno Monteiro T. Pereira
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | | | - Fabio Ramponi
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Dieter G. Weber
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | | | - Belinda De Simone
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Korana Musicki
- />Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW Australia
| | - Guilherme Vieira Meirelles
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Fausto Catena
- />Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Luca Ansaloni
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Federico Coccolini
- />Department of general and emergency surgery, Papa Giovanni XIII Hospital, Bergamo, Italy
| | | | | | - Cino Bendinelli
- />Department of Traumatology, John Hunter Hospital, Newcastle, NSW Australia
| | - Gustavo Pereira Fraga
- />Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| |
Collapse
|
17
|
Abstract
BACKGROUND The UK prevalence of abdominal aortic aneurysm (AAA) is estimated at 4.9% in over 65-year olds. Progressive and unpredictable enlargement can lead to rupture. Endovascular repair of AAAs involves a stent graft system being introduced via the femoral artery and manipulated within the aorta under radiological guidance. Following endograft deployment, a seal is formed at the proximal and distal landing zones to exclude the aneurysm sac from the circulation. With the increasing popularity of endovascular repair there has been an increase in the number of commercially available stent graft designs on the market. This is an update of the review first published in 2013. OBJECTIVES This review aimed to assess the different stent graft types for endovascular repair of AAA. SEARCH METHODS The Cochrane Vascular Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched February 2015) and the Cochrane Register of Studies (2015, Issue 1). Trial databases were searched by the TSC for details of ongoing and unpublished studies. SELECTION CRITERIA All published and unpublished randomised controlled trials (RCTs) of stent graft types in the repair of AAAs were sought without language restriction and in consultation with the Cochrane Vascular Group TSC. DATA COLLECTION AND ANALYSIS We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS No studies were identified that met the inclusion criteria. It was not possible to review the quality of the evidence in the absence of studies eligible for inclusion in the review. AUTHORS' CONCLUSIONS Unfortunately, no data exist regarding direct comparisons of the performance of different stent graft types. High quality randomised controlled trials evaluating stent graft types in abdominal endovascular aneurysm repair are required.
Collapse
Affiliation(s)
- James MN Duffy
- Balliol College, University of OxfordiHOPE: International Collaboration to Harmonise Outcomes for Pre‐eclampsiaOxfordOxfordshireUKOX2 6NW
| | - Rachel Rolph
- Guys and St Thomas' NHS Foundation TrustDepartment of Plastic and Reconstructive SurgeryWestminster Bridge RoadLondonUKSE1 7EH
| | - Matthew Waltham
- Guy's and St Thomas' NHS Foundation TrustAcademic Vascular DepartmentWestminster Bridge RoadLondonUKSE1 9RT
| | | |
Collapse
|
18
|
Reite A, Søreide K, Ellingsen CL, Kvaløy JT, Vetrhus M. Epidemiology of ruptured abdominal aortic aneurysms in a well-defined Norwegian population with trends in incidence, intervention rate, and mortality. J Vasc Surg 2015; 61:1168-74. [PMID: 25659456 DOI: 10.1016/j.jvs.2014.12.054] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/18/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Ruptured infrarenal abdominal aortic aneurysms (rAAAs) represent both a life-threatening emergency for the affected patient and a considerable health burden globally. The aim of this study was to investigate the contemporary epidemiology of rAAA in a defined Norwegian population for which both hospital and autopsy data were available. METHODS This was a retrospective, single-center population-based study of rAAA. The study includes all consecutively diagnosed prehospital and in-hospital cases of rAAA in the catchment area of Stavanger University Hospital between January 2000 and December 2012. Incidence and mortality rates (crude and adjusted) were calculated using national demographic data. RESULTS A total of 216 patients with primary rAAA were identified. The adjusted incidence rate for the study period was 11.0 per 100,000 per year (95% confidence interval [CI], 9.6-12.5). Twenty patients died out of the hospital, and 144 of the 196 patients (73%) admitted to the hospital underwent surgery. The intervention rate varied from 48% to 81% during the study period. The adjusted mortality rate was 7.5 per 100,000 per year (95% CI, 6.3-8.8). No differences in the incidence and mortality rates were found in comparing early and late periods. The 90-day standardized mortality ratio for the study period was 37.2 (95% CI, 31.6-43.7). The overall 90-day mortality was 68% (146 of 216 persons) and 51% (74 of 144 persons) for the patients treated for rAAA. CONCLUSIONS We found a stable incidence and mortality rate during a decade. The prehospital death rate was lower (9%), the intervention rate (73%) higher, and the total mortality (68%) lower than in most other studies. Geographic and regional differences may influence the epidemiologic description of rAAA and hence should be taken into consideration in comparing outcomes for in-hospital mortality and intervention rates.
Collapse
Affiliation(s)
- Andreas Reite
- Vascular Surgery Unit, Stavanger University Hospital, Stavanger, Norway
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Lycke Ellingsen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway; Department of Health Registries, Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Terje Kvaløy
- Research Department, Stavanger University Hospital, Stavanger, Norway; Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
| | - Morten Vetrhus
- Vascular Surgery Unit, Stavanger University Hospital, Stavanger, Norway.
| |
Collapse
|
19
|
Tulga UA, Fahrettin K, Erdal S, Sarper O, Serkan M, Mustafa O, Ahmet S, Kerem V, Levent B. Ruptured abdominal aortic aneurysm treatment in the stent graft era. Vasc Endovascular Surg 2014; 48:503-8. [PMID: 25487249 DOI: 10.1177/1538574414561232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aim to decrease mortality and morbidity by early diagnosis and endovascular aneurysm repair (EVAR) or by using open surgery. METHODS The patients who had underwent open surgery and EVAR with a diagnosis of ruptured abdominal aortic aneurysms were evaluated retrospectively. Patients with EVAR were separated as group I and the patients with surgical operations constituted group II. The risk factors, duration of the operation, blood product usage, drainage amounts, complications, mortality, and morbidity rates were evaluated. RESULTS The duration of the operation and the required blood and blood products were lower in group I (P < .05). There is no any significant difference between the groups in terms of mortality, complications, short-, and long-term results. CONCLUSION We support the idea that better results can be obtained by showing regard to suitable patient, suitable clinical condition, and suitable anatomy together with the correct choice of operation type.
Collapse
Affiliation(s)
- Ulus A Tulga
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Kucukay Fahrettin
- Department of Radiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Simsek Erdal
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Oktem Sarper
- Department of Radiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Mola Serkan
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ozdemir Mustafa
- Department of Radiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Saritas Ahmet
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Vural Kerem
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Birincioglu Levent
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
20
|
Endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes. J Vasc Surg 2014; 61:304-8. [PMID: 25154564 DOI: 10.1016/j.jvs.2014.07.098] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/26/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Proximal aortic control by endovascular balloon occlusion (EBO) is an alternative to conventional aortic cross-clamping (CAC) in hemodynamically unstable patients presenting with a ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the potential clinical benefit of EBO over CAC. METHODS Data from 72 patients with rAAA treated at our institution from 2001 to 2013 were retrospectively analyzed. All patients were hemodynamically unstable (mean arterial blood pressure at admission <65 mm Hg or associated unconsciousness, cardiac arrest, or emergency endotracheal intubation). Clinical end points of hemodynamic restoration, mortality rate, and major postoperative complications were assessed for CAC (group 1) and EBO (group 2). RESULTS At admission, 72 patients were unstable. CAC was performed in 40 and EBO in 32. Intraoperative mortality was 43% in group 1 vs 19% in group 2 (P = .031). In group 1, the approach for CAC (thoracotomy [n = 23] vs laparotomy [n = 17]) did not influence intraoperative mortality (43% vs 41%). There was no significant difference in 30-day (75% vs 62%) and in-hospital (77% vs 69%) mortality rates between groups. After EBO, the treatment-open vs endovascular repair-did not influence the intraoperative mortality rate (31% vs 43%; P = .5). Eight surgical complications were secondary to CAC (1 vena cava injury, 3 left renal vein injuries, 1 left renal artery injury, 1 pancreaticoduodenal vein injury, and 2 splenectomies), but no EBO-related complication was noted (P = .04). Differences in colon ischemia (15% vs 28%) and renal failure (12% vs 9%) were not statistically significant. Abdominal compartment syndrome occurred in four patients in group 2 and in no patients in group 1. CONCLUSIONS Compared with CAC, EBO is a feasible and valuable strategy and is associated with reduced intraoperative mortality of unstable rAAA patients, but not in-hospital mortality, in this retrospective study.
Collapse
|
21
|
Vu KN, Kaitoukov Y, Morin-Roy F, Kauffmann C, Giroux MF, Thérasse E, Soulez G, Tang A. Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms. Insights Imaging 2014; 5:281-93. [PMID: 24789068 PMCID: PMC4035490 DOI: 10.1007/s13244-014-0327-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) rupture has a high mortality rate. Although the diagnosis of a ruptured AAA is usually straightforward, detection of impending rupture signs can be more challenging. Early diagnosis of impending AAA rupture can be lifesaving. Furthermore, differentiating between impending and complete rupture has important repercussions on patient management and prognosis. The purpose of this article is to classify and illustrate the entire spectrum of AAA rupture signs and to review current treatment options for ruptured AAAs. METHODS Using medical illustrations supplemented with computed tomography (CT), this essay showcases the various signs of impending rupture and ruptured AAAs. Endovascular aneurysm repair (EVAR) and open surgical repair are also discussed as treatment options for ruptured AAAs. RESULTS CT imaging findings of ruptured AAAs can be categorised according to location: intramural, luminal, and extraluminal. Intramural signs generally indicate impending AAA rupture, whereas luminal and extraluminal signs imply complete rupture. EVAR has emerged as an alternative and possibly less morbid method to treat ruptured AAAs. CONCLUSIONS AAA rupture occurs at the end of a continuum of growth and wall weakening. This review describes the CT imaging findings that may help identify impending rupture prior to complete rupture. TEACHING POINTS • AAA rupture occurs at the end of a continuum of growth and wall weakening. • Intramural imaging findings indicate impending AAA rupture. • Luminal and extraluminal imaging findings imply complete AAA rupture. • Some imaging findings are not specific to AAA ruptures and can be seen in other pathologies. • EVAR has emerged as an alternative and possibly less morbid method of treating ruptured AAAs.
Collapse
Affiliation(s)
- Kim-Nhien Vu
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc, 1058 Saint-Denis, Montréal, Québec, Canada, H2X 3J4
| | | | | | | | | | | | | | | |
Collapse
|
22
|
van Beek SC, Reimerink JJ, Vahl AC, Wisselink W, Reekers JA, van Geloven N, Legemate DA, Balm R. Effect of regional cooperation on outcomes from ruptured abdominal aortic aneurysm. Br J Surg 2014; 101:794-801. [PMID: 24752802 DOI: 10.1002/bjs.9518] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Care for patients with a ruptured abdominal aortic aneurysm (rAAA) in the Amsterdam ambulance region (The Netherlands) was concentrated into vascular centres with a 24-h full emergency vascular service in cooperation with seven referring regional hospitals. Previous population-based survival after rAAA in the Netherlands was 46 (95 per cent confidence interval (c.i.) 43 to 49) per cent. It was hypothesized that regional cooperation would improve survival. METHODS This was a prospective observational cohort study carried out simultaneously with the Amsterdam Acute Aneurysm Trial. Consecutive patients with an rAAA between 2004 and 2011 in all ten hospitals in the Amsterdam region were included. The primary outcome was 30-day survival after admission. Multivariable logistic regression, including age, sex, co-morbidity, intervention (endovascular or open repair), preoperative systolic blood pressure, cardiopulmonary resuscitation and year of intervention, was used to assess the influence of hospital setting on survival. RESULTS Of 453 patients with rAAA from the Amsterdam ambulance region, 61 did not undergo intervention; 352 patients were treated surgically at a vascular centre and 40 at a referring hospital. The regional survival rate was 58.5 (95 per cent c.i. 53.9 to 62.9) per cent (265 of 453). After multivariable adjustment, patients treated at a vascular centre had a higher survival rate than patients treated surgically at a referring hospital (adjusted odds ratio 3.18, 95 per cent c.i. 1.43 to 7.04). CONCLUSION After regional cooperation, overall survival of patients with an rAAA improved. Most patients were treated in a vascular centre and in these patients survival rates were optimal.
Collapse
Affiliation(s)
- S C van Beek
- Department of Vascular Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Edwards ST, Schermerhorn ML, O'Malley AJ, Bensley RP, Hurks R, Cotterill P, Landon BE. Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. J Vasc Surg 2014; 59:575-82. [PMID: 24342064 PMCID: PMC4454372 DOI: 10.1016/j.jvs.2013.08.093] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. METHODS We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. RESULTS Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P < .001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P < .001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P < .001; all surgical complications, 4.4% vs 9.1%; P < .001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%. CONCLUSIONS EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.
Collapse
Affiliation(s)
- Samuel T Edwards
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | - A James O'Malley
- Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - Rodney P Bensley
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Rob Hurks
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Bruce E Landon
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Health Care Policy, Harvard Medical School, Boston, Mass.
| |
Collapse
|
24
|
Liao TH, Watson JJ, Mansour MA, Cuff RF, Banegas SL, Chambers CM, Slaikeu JD, Wong PY. Preliminary results of Zenith Fenestrated abdominal aortic aneurysm endovascular grafts. Am J Surg 2013; 207:417-21; discussion 421. [PMID: 24581767 DOI: 10.1016/j.amjsurg.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with juxtarenal aortic aneurysms who are unfit for open repair may be considered for fenestrated endovascular repair (fenEVAR). We report our initial experience with fenEVAR. METHODS We reviewed the data on all our patients receiving fenEVAR for juxtarenal aortic aneurysms. RESULTS Eight patients, average age 75 years, underwent fenEVAR. Endografts were designed from details obtained from preoperative computed tomography angiography. There were 6 grafts with superior mesenteric scallops and bilateral renal fenestrations, 1 with bilateral renal scallops, and 1 with a single renal fenestration. All patients survived 30 days. There was no renal failure requiring dialysis. At 10 weeks, 1 patient died from acute intestinal ischemia and multisystem organ failure, and another died from respiratory failure. CONCLUSIONS It is feasible to offer fenEVAR to patients who are poor candidates for open repair. However, these procedures are technically challenging. Early outcomes are less favorable than other aortic endovascular procedures.
Collapse
Affiliation(s)
- Timothy H Liao
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Jennifer J Watson
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - M Ashraf Mansour
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Robert F Cuff
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Shonda L Banegas
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Christopher M Chambers
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Jason D Slaikeu
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Peter Y Wong
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| |
Collapse
|
25
|
|
26
|
Investigation of Outcomes Following Recombinant Activated FVII Use for Refractory Bleeding During Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2013; 45:617-25. [DOI: 10.1016/j.ejvs.2013.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 01/14/2013] [Indexed: 11/22/2022]
|
27
|
Duffy JMN, Rolph R, Clough RE, Modarai B, Taylor P, Waltham M. Stent graft types for endovascular repair of abdominal aortic aneurysms. Cochrane Database Syst Rev 2013:CD008447. [PMID: 23543563 DOI: 10.1002/14651858.cd008447.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The UK prevalence of abdominal aortic aneurysm (AAA) is estimated at 4.9% in over 65-year olds. Progressive and unpredictable enlargement can lead to rupture. Endovascular repair of AAAs involves a stent graft system being introduced via the femoral artery and manipulated within the aorta under radiological guidance. Following endograft deployment, a seal is formed at the proximal and distal landing zones to exclude the aneurysm sac from the circulation. With the increasing popularity of endovascular repair there has been an increase in the number of commercially available stent graft designs on the market. OBJECTIVES This review aimed to assess the different stent graft types for endovascular repair of AAA. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched November 2012) and CENTRAL (2012, Issue 10). Trial databases were searched by the TSC for details of ongoing and unpublished studies. SELECTION CRITERIA All published and unpublished randomised controlled trials (RCTs) of stent graft types in the repair of AAAs were sought without language restriction and in consultation with the Peripheral Vascular Disease Group TSC. DATA COLLECTION AND ANALYSIS We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS No studies were identified that met the inclusion criteria. AUTHORS' CONCLUSIONS Unfortunately, no data exist regarding direct comparisons of the performance of different stent graft types. Therefore, this review cannot recommend guidance to clinicians in their selection of stent graft types. High quality randomised controlled trials evaluating stent graft types in abdominal endovascular aneurysm repair are required.
Collapse
Affiliation(s)
- James M N Duffy
- Academic Vascular Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Decreased smoking has likely had the most significant impact on reducing the prevalence of AAAs. In a review of public data in England and Wales, Anjum and colleagues illustrated a reduction of AAA rupture from 1997 to2009 across all ages attributed to a concurrent decrease in prevalence of smoking. This trend has also been noted in a meta-analysis from Sweeting and colleagues and attributed to a reduction in the prevalence of smoking since the mid-1970s along with an enhanced awareness of cardiovascular risk factor reduction and selective aneurysm screening. Along with an effort to reduce AAA progression and rupture, tools to predict patient-specific risk of AAA rupture are evolving with refined models that incorporate both aneurysm wall stress and wall strength likely to provide the most promising approach. Although the role of statins, ACE inhibitors, beta-blockers, and aspirin in preventing or slowing aneurysmal rupture remains unresolved, their proven benefit in reducing long-term cardiovascular mortality suggests that these medications should be considered in any patient with a small AAA. Currently, randomized trials do not show any survival benefit for open or endovascular repair for small aneurysms in the range of 4.0 to 5.4 cm. AAA repair, whether through an endovascular or open approach, is not without potential complication. Even at centers of excellence, the 30-day mortality rate for conventional AAA surgery is 3% to 5%, with rates of major morbidityranging from 15% to 40%. The Society for Vascular Surgery guidelines recommends surveillance for patients with a fusiform AAA of 4.0 to 5.4 cm. The risk of AAA rupture appears to be decreasing through heightened public awareness, advanced technology for AAA detection, screening and surveillance, improved understanding of biomechanics and natural progression in AAA rupture, along with the availability of a wide range of medical therapies for risk factor reduction and minimally invasive options for AAA repair.
Collapse
Affiliation(s)
- Andy M Lee
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA 02215, USA
| | | |
Collapse
|
29
|
Sandiford P, Mosquera D, Bramley D. Trends in incidence and mortality from abdominal aortic aneurysm in New Zealand. Br J Surg 2011; 98:645-51. [PMID: 21381003 DOI: 10.1002/bjs.7461] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study examined trends in abdominal aortic aneurysm (AAA) incidence and mortality in New Zealand (NZ) and compared these with mortality rates from England and Wales. METHODS Cause-specific death data were obtained from the NZ Ministry of Health, UK Office for National Statistics and National Archives (for England and Wales). The NZ National Minimum Data Set provided hospital discharge data from July 1994 to June 2009. RESULTS In 2005-2007 the age-standardized AAA mortality rate for men was 33·3 per cent less in NZ than in England and Wales (5·21 versus 7·81 per 100 000), whereas for women it was 9·8 per cent less (2·12 versus 2·35 per 100 000). Standardized mortality rates in NZ fell by 53·0 per cent for men and 34·1 per cent for women from 1991 to 2007. Between 1991-1992 and 2005-2007 the probability of a 65-year-old dying from an AAA fell by 28·2 per cent (from 1·872 to 1·344 per cent) in men, and by 6·3 per cent (from 0·837 to 0·784 per cent) in women. New AAA admission and hospital death rates in NZ peaked in 1999 for men, and in 2001 for women, and have since declined sharply. Hospital mortality ratios have also fallen, except for women with a ruptured aneurysm. CONCLUSION The burden of AAA disease has been falling since at least 1991 in NZ, and since 1995 in England and Wales. Although survival appears to be improving, most of the reduction is due to lower disease incidence.
Collapse
Affiliation(s)
- P Sandiford
- Department of Funding and Planning, Waitemata District Health Board, Takapuna, Auckland, New Zealand.
| | | | | |
Collapse
|
30
|
Letterstål A, Eldh AC, Olofsson P, Forsberg C. Patients' experience of open repair of abdominal aortic aneurysm--preoperative information, hospital care and recovery. J Clin Nurs 2011; 19:3112-22. [PMID: 21040016 DOI: 10.1111/j.1365-2702.2010.03428.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim was to elucidate patients' lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm. BACKGROUND Open surgical treatment has a great impact on patients' health-related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high-quality care, patients' needs must be better understood. DESIGN An exploratory descriptive design was chosen to describe and understand patients' lived experience. METHOD Audio-taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis. RESULTS The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff. CONCLUSIONS To facilitate the transition process, health care staff should consider patients' unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery. RELEVANCE TO CLINICAL PRACTICE Throughout the care pathway, patients' need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.
Collapse
Affiliation(s)
- Anna Letterstål
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
| | | | | | | |
Collapse
|
31
|
Schlösser FJ, Vaartjes I, van der Heijden GJ, Moll FL, Verhagen HJ, Muhs BE, de Borst GJ, Tiel Groenestege AT, Kardaun JW, Reitsma JB, van der Graaf Y, Bots ML. Mortality After Hospital Admission for Ruptured Abdominal Aortic Aneurysm. Ann Vasc Surg 2010; 24:1125-32. [DOI: 10.1016/j.avsg.2010.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/23/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
|
32
|
Perrott S, Puckridge P, Foreman R, Russell D, Spark J. Anatomical Suitability For Endovascular AAA Repair May Affect Outcomes following Rupture. Eur J Vasc Endovasc Surg 2010; 40:186-90. [DOI: 10.1016/j.ejvs.2010.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 04/04/2010] [Indexed: 10/19/2022]
|
33
|
Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients. J Vasc Surg 2010; 52:13-8. [DOI: 10.1016/j.jvs.2010.02.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 12/16/2009] [Accepted: 02/06/2010] [Indexed: 11/19/2022]
|
34
|
Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm. Br J Surg 2010; 97:1169-79. [DOI: 10.1002/bjs.7134] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
Background
The aim of this study was to assess possible differences in mortality between men and women with an abdominal aortic aneurysm (AAA) treated either by elective repair or following aneurysm rupture.
Methods
A systematic literature search was performed using the MEDLINE, Cochrane and Embase databases. Data were analysed by means of bivariate random-effects meta-analysis. Data were pooled and odds ratios (ORs) calculated for women compared with men.
Results
Sixty-one studies (516 118 patients) met the predetermined inclusion criteria. Twenty-six reported on elective open AAA repair, 21 on elective endovascular repair, 25 on open repair for ruptured AAA and one study on endovascular repair for ruptured AAA. Mortality rates for women compared with men were 7·6 versus 5·1 per cent (OR 1·28, 95 per cent confidence interval (c.i.) 1·09 to 1·49) for elective open repair, 2·9 versus 1·5 per cent (OR 2·41, 95 per cent c.i. 1·14 to 5·15) for elective endovascular repair, and 61·8 versus 42·2 per cent (OR 1·16, 95 per cent c.i. 0·97 to 1·37) in the group that had open repair for rupture. The group that had endovascular repair for ruptured AAA was too small for meaningful analysis.
Conclusion
Women with an AAA had a higher mortality rate following elective open and endovascular repair.
Collapse
|
35
|
Kimball EJ, Adams DM, Kinikini DV, Mone MC, Alder SC. Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm. Vascular 2010; 17:309-15. [PMID: 19909677 DOI: 10.2310/6670.2009.00048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to compare initial use of the open abdomen using the vacuum-pack technique followed by delayed abdominal closure with standard primary abdominal closure in the treatment of ruptured abdominal aortic aneurysm (rAAA) repair. A retrospective review identified 122 rAAA cases, which were divided into two management eras: era 1 (primarily closed) and era 2 (47% open abdomen).One hundred three patients were included in this review: 58 in era 1 and 45 in era 2. Evidence of one of three ischemia-reperfusion (IR) criteria, preoperative hypotension, estimated blood loss > or = 6 L, or intraoperative resuscitation with > or = 12 L, predicted mortality. These criteria were also used as surrogate clinical markers for abdominal compartment syndrome. The in-hospital mortality was higher in those with at least one IR criterion: 43% versus 10% (p = .0003). In those with at least one IR criterion, the initial 24-hour mortality was 21% for era 1 versus 0% for era 2 (p = .03), and the 30-day mortality was 40% for era 1 and 32% for era 2 (p = .77).Three IR criteria were identified and were associated with increased mortality. Patients with these risk factors who were treated with delayed abdominal closure had an improved acute survival rate and a trend for improved long-term survival.
Collapse
|
36
|
Berge C, Haug ES, Romundstad PR, Lange C, Myhre HO. Improved long-term survival following infrarenal abdominal aortic aneurysm repair. SCAND CARDIOVASC J 2009; 42:354-9. [DOI: 10.1080/14017430802061656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
37
|
Walsh SR, Noorani A, Sadat U, Tang TY, Hayes PD, Boyle JR. The future of EVAR in the management of ruptured AAAs. J Endovasc Ther 2009; 16 Suppl 1:I127-33. [PMID: 19317575 DOI: 10.1583/08-2595.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endovascular repair of ruptured abdominal aortic aneurysms is an evolving technique. Data from nonrandomized series suggest that it may be beneficial in selected patients. In the next few years, a number of large randomized clinical trials will clarify its role. Issues regarding anatomical suitability, techniques, perioperative care, and service provision need to be addressed in order to optimize outcomes.
Collapse
Affiliation(s)
- Stewart R Walsh
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | | |
Collapse
|
38
|
Shahidi S, Schroeder TV, Carstensen M, Sillesen H. Outcome and Survival of Patients Aged 75 Years and Older Compared to Younger Patients after Ruptured Abdominal Aortic Aneurysm Repair: Do the Results Justify the Effort? Ann Vasc Surg 2009; 23:469-77. [DOI: 10.1016/j.avsg.2008.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 08/15/2008] [Accepted: 10/27/2008] [Indexed: 11/29/2022]
|
39
|
McPhee J, Eslami MH, Arous EJ, Messina LM, Schanzer A. Endovascular treatment of ruptured abdominal aortic aneurysms in the United States (2001-2006): A significant survival benefit over open repair is independently associated with increased institutional volume. J Vasc Surg 2009; 49:817-26. [DOI: 10.1016/j.jvs.2008.11.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Revised: 11/02/2008] [Accepted: 11/03/2008] [Indexed: 02/06/2023]
|
40
|
Haveman JW, Zeebregts CJ, Verhoeven ELG, van Den Berg P, van Den Dungen JJAM, Zwaveling JH, Nijsten MWN. Changes in laboratory values and their relationship with time after rupture of an abdominal aortic aneurysm. Surg Today 2008; 38:1091-101. [DOI: 10.1007/s00595-008-3798-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 04/09/2008] [Indexed: 11/29/2022]
|
41
|
Slater BJ, Harris EJ, Lee JT. Anatomic Suitability of Ruptured Abdominal Aortic Aneurysms for Endovascular Repair. Ann Vasc Surg 2008; 22:716-22. [DOI: 10.1016/j.avsg.2008.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 04/29/2008] [Accepted: 06/10/2008] [Indexed: 11/26/2022]
|
42
|
Peti NA, Kopriva D, McCarville D. Ruptured abdominal aortic aneurysms in southern Saskatchewan: a 10-year mortality review. Vasc Endovascular Surg 2008; 42:551-4. [PMID: 18799496 DOI: 10.1177/1538574408322656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Regina Qu'Appelle Health Region (RQHR) provides all tertiary vascular care for southern Saskatchewan and portions of southwestern Manitoba. The present study was undertaken to determine the regional mortality rates following rupture of an abdominal aortic aneurysm and to compare these rates with the published literature. A retrospective chart review was undertaken on all cases of ruptured abdominal aortic aneurysms (rAAA) presenting to the RQHR between March 1, 1996, and February 28, 2006. The demographic data and clinical outcomes were collected from hospital charts by a single reviewer. Over the 10-year study period, 101 cases of rAAA were presented to the RQHR. Patient demographics and comorbidities were comparable to other studies in the published literature. Thirty-seven percent of patients presented with systolic blood pressure below 90 mm Hg, and 7% had no recordable blood pressure. The overall mortality was 25%. Mortality risk was not statistically different between patients presenting within Regina (30%) and those referred from a distance of more than 35 km (21%, P = .353). Seven patients were treated palliatively, and 94 proceeded to open surgical repair. Within the group of patients undergoing surgery, there was a 19% mortality rate. The data show a low observed mortality rate for rAAA presenting to the RQHR. The favorable outcome of the patients is not associated with preselection bias of patients transported long distances to specialist vascular care.
Collapse
|
43
|
Grant MW, Thomson IA, van Rij AM. IN-HOSPITAL MORTALITY OF RUPTURED ABDOMINAL AORTIC ANEURYSM*. ANZ J Surg 2008; 78:698-704. [DOI: 10.1111/j.1445-2197.2008.04621.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
Larsson E, Granath F, Swedenborg J, Hultgren R. More patients are treated for nonruptured abdominal aortic aneurysms, but the proportion of women remains unchanged. J Vasc Surg 2008; 48:802-7. [PMID: 18639419 DOI: 10.1016/j.jvs.2008.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 04/25/2008] [Accepted: 05/04/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Large variations in the intervention rates for ruptured and nonruptured abdominal aortic aneurysm (AAA) over time have been reported, both decreasing and increasing numbers. Women have been reported to constitute an increasing proportion of patients treated for several manifestations of cardiovascular disease; whether a similar trend is true for AAA is not well understood. This study investigated recent temporal trends in a complete national register regarding the number and type of procedure performed for AAA, and outcome, with special emphasis on gender differences. METHODS Data for all individuals treated for nonruptured or ruptured AAA in Sweden (1990 to 2005) were obtained from the Swedish National Board of Health and Welfare (NBHW). A total of 14369 individuals were identified; 2327 (16%) were women. Date and type of intervention, date and cause of death, age, and sex were included in the statistical model. RESULTS There was a relative annual increase in interventions for nonruptured AAA; 4% for women (P < .0001) and 2% for men (P < .0001). No significant trends were observed for interventions for rupture during the observation period. No significant increase in the proportion of women was recorded for nonrupture (17%) or rupture (15%). Women had higher crude 30-day mortality rate than men after treatment for both nonruptured (5.7% vs 4.9%) and ruptured (41.9% vs 36.8%) AAA. In a logistic regression model, survival improved over time after intervention for nonrupture (P < .0001) and rupture (P < .0001). Increasing age (P < .0001 for both nonrupture and rupture) but not sex (P = .49 for non rupture and P = .42 for rupture) had a negative influence on mortality. CONCLUSION Interventions for nonruptured but not for ruptured AAA increased over time, with an expected rapid increase of endovascular repair in the nonruptured group. The unchanged fraction of women over time possibly reflects the true distribution of AAA between the sexes. The outcome after treatment for both nonruptured and ruptured AAA improved, as anticipated, over time. No increase in mortality among women was recorded after adjustment for age.
Collapse
Affiliation(s)
- Emma Larsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | | | | |
Collapse
|
45
|
Lepäntalo M, Venermo M, Laukontaus S, Kantonen I. The Role of Vascular Registries in Improving the Management of Abdominal Aortic Aneurysm. Scand J Surg 2008; 97:146-53; discussion 153. [DOI: 10.1177/145749690809700215] [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
Treatment of abdominal aortic aneurysm (AAA) is one of the vascular surgical index procedures and an important part of the total workload. Whichever way treated, it typically has high mortality and morbidity. Furthermore, endovascular repair is still a relatively new treatment method and under evolution. Therefore continuous quality control with subsequent outcome analysis, benchmarking, intervention and reassessment are mandatory to achieve high level aneurysm care. Vascular registries are tools for this audit. The aim of this review is to focus on the problems and solutions related to attempts to improve the management of abdominal aortic aneurysm with emphasis on the experience gathered in Finland. This includes great variations in dynamics over time in southern Finland. To control the influence of patient selection and case-mix, total hospital mortality is emphasized as the most appropriate outcome measure of the level of treatment of ruptured abdominal aortic aneurysm (RAAA). Total aneurysm mortality (including total hospital mortality of RAAA and other AAA surgery) is introduced as an outcome measure of vascular service.
Collapse
Affiliation(s)
- M. Lepäntalo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - M. Venermo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - S. Laukontaus
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - I. Kantonen
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
46
|
Wanhainen A, Mani K, Björck M. The Value of a Nationwide Vascular Registry in Understanding Contemporary Time Trends of Abdominal Aortic Aneurysm Repair. Scand J Surg 2008; 97:142-5. [DOI: 10.1177/145749690809700214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nationwide vascular registries offer rapid feed-back in an environment of fast new technical development, as is the case with the treatment of abdominal aortic aneurysm (AAA). Furthermore, they offer an opportunity to study non-selected, population-based data. The aim of this review was to analyze time-trends in published papers from nationwide registries on AAA-repair. In contrast to several US reports, an increased rate of intact AAA repair, associated with the introduction of endovascular repair, was reported in a recent publication based on the Swedish Vascular Registry (Swedvasc). The rate of ruptured abdominal aortic aneurysm (rAAA) repair is stable in most reports, while some report a decreasing incidence. Most nationwide studies report a reducing mortality over time after intact AAA repair, while time trends on the mortality after ruptured AAA repair are more heterogenic.
Collapse
Affiliation(s)
- A. Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - K. Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - M. Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
47
|
Hoornweg L, Storm-Versloot M, Ubbink D, Koelemay M, Legemate D, Balm R. Meta Analysis on Mortality of Ruptured Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2008; 35:558-70. [DOI: 10.1016/j.ejvs.2007.11.019] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 11/24/2007] [Indexed: 11/29/2022]
|
48
|
Kimura N, Kawahito K, Ito S. Rupture of an abdominal aortic aneurysm in a patient with a situs inversus totalis: report of a case. Surg Today 2008; 38:249-52. [PMID: 18307000 DOI: 10.1007/s00595-007-3616-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 07/05/2007] [Indexed: 11/29/2022]
Abstract
An 80-year-old woman was admitted to our hospital complaining of severe abdominal and back pain. Computed tomography (CT) showed an 8.5 x 7.0-cm infrarenal abdominal aortic aneurysm (AAA) with a large contained retroperitoneal hematoma. Known situs inversus totalis was reconfirmed by CT. Just after the CT examination, the patient collapsed and was immediately taken to the operating room. Her hemodynamics stabilized after clamping of the descending aorta via a right anterolateral thoracotomy. A resection of the abdominal aneurysm and prosthetic graft replacement were successfully performed. To our knowledge, there has been no other report of a ruptured AAA in a patient with situs inversus totalis.
Collapse
Affiliation(s)
- Naoyuki Kimura
- Department of Cardiovascular Surgery, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi, Tokyo 174-0051, Japan
| | | | | |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Dzieciuchowicz Ł, Majewski W, Słowiński M, Krasiński Z, Jawien AA, Bieda K, Oszkinis G, Gabriel M, Zapalski S. Improved Outcome after Rupture of Abdominal Aortic Aneurysm over an 18-Year Period. Ann Vasc Surg 2008; 22:25-9. [DOI: 10.1016/j.avsg.2007.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Revised: 08/30/2007] [Accepted: 09/14/2007] [Indexed: 11/29/2022]
|