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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Holewijn S, Vermeulen JJM, van Helvert M, van de Velde L, Reijnen MMPJ. Changes in Noninvasive Arterial Stiffness and Central Blood Pressure After Endovascular Abdominal Aneurysm Repair. J Endovasc Ther 2021; 28:434-441. [DOI: https:/doi.org/10.1177/15266028211007460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Purpose: To evaluate the impact of elective endovascular aneurysm repair (EVAR) on the carotid-femoral pulse wave velocity (cfPWV) and central pressure waveform, through 1-year follow-up. Materials and Methods: A tonometric device was used to measure cfPWV and estimate the central pressure waveform in 20 patients with an infrarenal abdominal aortic aneurysm scheduled for elective EVAR. The evaluated central hemodynamic parameters included the central pressures, the augmentation index (AIx), and the subendocardial viability ratio (SEVR). AIx quantifies the contribution of reflected wave to the central systolic pressure, whereas SEVR describes the myocardial perfusion relative to the cardiac workload. Measurements were performed before EVAR, at discharge, and 6 weeks and 1 year after EVAR. Results: CfPWV was increased at discharge (12.4±0.4 vs 11.3±0.5 m/s at baseline; p=0.005) and remained elevated over the course of 1-year follow-up (6 weeks: cfPWV = 12.2±0.5 m/s; 1 year: cfPWV = 12.2±0.7 m/s, p<0.05). After an initial drop in systolic central pressure at discharge, all the central pressures increased thereafter up to 1 year, without significant differences compared with baseline. The same was observed for the AIx and SEVR. Conclusion: Endovascular aortic aneurysm repair caused an increase in pulse wave velocity compared with baseline, which remained elevated through 1 year follow-up, which may be related to an increased cardiovascular risk. However, no differences in central pressure, augmentation index, and subendocardial viability ration were observed during follow-up.
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Affiliation(s)
- Suzanne Holewijn
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jenske J. M. Vermeulen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Majorie van Helvert
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Michel M. P. J. Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Holewijn S, Vermeulen JJM, van Helvert M, van de Velde L, Reijnen MMPJ. Changes in Noninvasive Arterial Stiffness and Central Blood Pressure After Endovascular Abdominal Aneurysm Repair. J Endovasc Ther 2021; 28:434-441. [PMID: 33834904 DOI: 10.1177/15266028211007460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the impact of elective endovascular aneurysm repair (EVAR) on the carotid-femoral pulse wave velocity (cfPWV) and central pressure waveform, through 1-year follow-up. MATERIALS AND METHODS A tonometric device was used to measure cfPWV and estimate the central pressure waveform in 20 patients with an infrarenal abdominal aortic aneurysm scheduled for elective EVAR. The evaluated central hemodynamic parameters included the central pressures, the augmentation index (AIx), and the subendocardial viability ratio (SEVR). AIx quantifies the contribution of reflected wave to the central systolic pressure, whereas SEVR describes the myocardial perfusion relative to the cardiac workload. Measurements were performed before EVAR, at discharge, and 6 weeks and 1 year after EVAR. RESULTS CfPWV was increased at discharge (12.4±0.4 vs 11.3±0.5 m/s at baseline; p=0.005) and remained elevated over the course of 1-year follow-up (6 weeks: cfPWV = 12.2±0.5 m/s; 1 year: cfPWV = 12.2±0.7 m/s, p<0.05). After an initial drop in systolic central pressure at discharge, all the central pressures increased thereafter up to 1 year, without significant differences compared with baseline. The same was observed for the AIx and SEVR. CONCLUSION Endovascular aortic aneurysm repair caused an increase in pulse wave velocity compared with baseline, which remained elevated through 1 year follow-up, which may be related to an increased cardiovascular risk. However, no differences in central pressure, augmentation index, and subendocardial viability ration were observed during follow-up.
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Affiliation(s)
- Suzanne Holewijn
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jenske J M Vermeulen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Majorie van Helvert
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,MultiModality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study. Can J Anaesth 2019; 66:1338-1346. [DOI: 10.1007/s12630-019-01438-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 12/19/2022] Open
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de Mik SML, Indrakusuma R, Legemate DA, Balm R, Ubbink DT. Reporting of Complications and Mortality in Relation to Risk Communication in Patients with an Abdominal Aortic Aneurysm: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 57:796-807. [PMID: 31128986 DOI: 10.1016/j.ejvs.2019.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES High-quality reporting of surgical risks is necessary for evidence-based risk communication in clinical practice. Risk communication is defined as the process of discussing benefits and harms of treatment options with patients. This review addressed the current quality of reporting of complications and mortality in publications on abdominal aortic aneurysm treatment, with a focus on items relevant to risk communication. DESIGN A systematic review. MATERIALS Randomised clinical trials, comparative observational studies and registries from 2010 onwards were eligible if they reported complications and/or mortality in patients with an asymptomatic abdominal aortic aneurysms who received primary treatment. METHODS Quality of reporting was assessed by scoring items relevant to risk communication from the reporting standards of the Society for Vascular Surgery (SVS) and the Consolidated Standards of Reporting Trials (CONSORT) statement. Screening, quality assessment and data extraction were independently undertaken by two authors. RESULTS Forty-seven publications were included. Nine of 47 publications (19%) provided no definition of complications. In 14 of 47 publications (30%), it was unclear whether the number of adverse events or the number of patients with adverse events were presented. Absolute risk differences were provided in 1 of 32 publications (3.1%) that compared complications between two treatment options. Forty-six of 47 publications reported mortality, of which 42 reported overall mortality rates (91%). Absolute risk differences were given in 2 of the 31 publications (6.5%) that compared mortality between two treatment options. CONCLUSIONS The quality of reporting of complications and mortality following primary abdominal aortic aneurysm treatment varied considerably. Better adherence to the SVS reporting standards and the CONSORT statement, as well as stating absolute risk differences may improve the quality of reporting and facilitate evidence-based risk communication.
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Affiliation(s)
- Sylvana M L de Mik
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Reza Indrakusuma
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Dink A Legemate
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ron Balm
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Sun Z, Ng CKC, Sá Dos Reis C. Synchrotron radiation computed tomography versus conventional computed tomography for assessment of four types of stent grafts used for endovascular treatment of thoracic and abdominal aortic aneurysms. Quant Imaging Med Surg 2018; 8:609-620. [PMID: 30140623 DOI: 10.21037/qims.2018.07.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background To determine the accuracy of synchrotron radiation computed tomography (CT) for measurement of stent wire diameters for in vitro simulation of endovascular aneurysm repair by four different types of stent grafts when compared to conventional CT images. Methods This study was performed using an aorta model with implantation of four aortic stent grafts for endovascular treatment of thoracoabdominal and abdominal aortic aneurysms. The aorta model was scanned using synchrotron radiation CT with beam energies ranging from 60 to 90 keV with 10 keV increment at each scan and spatial resolution of 41.6 µm per pixel. Stent wire diameters were measured at the top and body regions of each stent graft based on 2-dimensional (2D) axial and 3-dimensional (3D) reconstruction images, with measurements compared to those obtained from 128-slice CT images which were acquired with slice thickness of 0.5 mm. Results Synchrotron radiation CT images clearly demonstrated stent graft details with accurate assessment of stent wire diameters, with measurements at the top of stent grafts (between 0.32±0.02 and 0.47±0.02 mm) similar to the actual diameters (between 0.32±0.01 and 0.48±0.01 mm) when the beam energies of 70 and 80 keV were used, regardless of the types of stent grafts assessed. A beam energy of 60 keV resulted in stent wires thicker than the actual sizes, although this did not reach statistical significance (P=0.07-0.29), while the beam energy of 90 keV led to stent wires smaller than the actual sizes at the top (P=0.16) and body region (P=0.02) of stent grafts on 2D axial images. The stent wire sizes measured at the body region of stent grafts on 3D synchrotron radiation images (between 0.19±0.02 and 0.43±0.02 mm) were significantly smaller than the actual diameters (P=0.02-0.04). Stent wires were overestimated on conventional CT images with diameters more than 2-fold larger than the actual sizes (P=0.007-0.03) at both top and body regions of all four stent grafts. Conclusions This study further confirms the accuracy of high-resolution synchrotron radiation CT in image visualization and size measurement of different aortic stent grafts with measured wire diameters similar to the actual ones, thus allowing for more accurate assessment of stent wire details for endovascular repair of aortic aneurysms.
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Affiliation(s)
- Zhonghua Sun
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Curtise K C Ng
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
| | - Cláudia Sá Dos Reis
- Discipline of Medical Radiation Sciences, School of Molecular and Life Sciences, Curtin University, Perth, Western Australia, Australia
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Sun Z, Ng CKC. Use of Synchrotron Radiation to Accurately Assess Cross-Sectional Area Reduction of the Aortic Branch Ostia Caused by Suprarenal Stent Wires. J Endovasc Ther 2017; 24:870-879. [PMID: 28922970 DOI: 10.1177/1526602817732315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare in vivo the use of synchrotron radiation to computed tomography angiography (CTA) for the measurement of cross-sectional area (CSA) reduction of the aortic branch ostia caused by suprarenal stent-graft wires. METHODS This study was performed with a Zenith stent-graft placed in a phantom of the human aorta to simulate treatment of abdominal aortic aneurysm. Synchrotron radiation scans were performed using beam energies between 40 and 100 keV and spatial resolution of 19.88 μm per pixel. CSA reduction of the aortic branch ostia by suprarenal stent wires was calculated based on these exposure factors and compared with measurements from CTA images acquired on a 64-row scanner with slice thicknesses of 1.0, 1.5, and 2.0 mm. RESULTS Images acquired with synchrotron radiation showed <10% of the CSA occupied by stent wires when a single wire crossed a renal artery ostium and <20% for 2 wires crossing a renovisceral branch ostium. The corresponding areas ranged from 24% to 25% for a single wire and from 40% to 48% for double wires crossing the branch ostia when measured on CT images. The stent wire was accurately assessed on synchrotron radiation with a diameter between 0.38±0.01 and 0.53±0.03 mm, which is close to the actual size of 0.47±0.01 mm. The wire diameter measured on CT images was greatly overestimated (1.15±0.01 to 1.57±0.02 mm). CONCLUSION CTA has inferior spatial resolution that hinders accurate assessment of CSA reduction. This experiment demonstrated the superiority of synchrotron radiation over CTA for more accurate assessment of aortic stent wires and CSA reduction of the aortic branch ostia.
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Affiliation(s)
- Zhonghua Sun
- 1 Department of Medical Radiation Sciences, Curtin University, Perth, Western Australia, Australia
| | - Curtise K C Ng
- 1 Department of Medical Radiation Sciences, Curtin University, Perth, Western Australia, Australia
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Healy GM, Redmond CE, Gray S, Iacob L, Sheehan S, Dowdall JF, Barry M, Cantwell CP, Brophy DP. Midterm Analysis of Survival and Cause of Death Following Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2017. [DOI: 10.1177/1538574417703268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To assess rates of complications, secondary interventions, survival, and cause of death following endovascular abdominal aortic aneurysm (AAA) repair over a 10-year period. Materials and Methods: Single-institution retrospective cohort study of all patients undergoing primary endovascular aortic aneurysm repair (EVAR) between July 2006 and June 2015. The population constituted 175 patients with 163 fusiform and 12 saccular AAAs. Of these, 149 (85%) were male, with mean age 75.4 (±7.1) years. Patients were followed up until June 30, 2016. Cause of death was determined from the national death register. Results: Mean follow-up was 34.4 (±24.4) months. The secondary intervention rate was 9.7%, and there were 4 aneurysm ruptures (0.8% annual incidence). Thirty-day mortality was 0.6%. Survival at 1, 3, and 5 years was 93.1%, 84%, and 64.9%, respectively. Forty-eight patients died during follow-up, 3 secondary to rupture, leading to overall and aneurysm-related death rates of 9.7 and 0.6 per 100 person-years. All other deaths were due to nonaneurysm causes, most commonly cardiovascular (n = 15), pulmonary (n = 13), and malignancy (n = 9). Baseline renal impairment ( P < .001), ischemic heart disease ( P < .05), age greater than 75 years ( P < .05), and urgent/emergency EVAR were associated with inferior long-term survival. Type II endoleak negatively influenced fusiform aneurysm sac regression ( P = .02), but there was no association between survival and occurrence of any complication or secondary intervention. Conclusion: The majority of deaths during medium-term follow-up post-EVAR are due to nonaneurysm-related causes. Survival is determined by the following baseline factors: renal impairment, ischemic heart disease, advanced age, and the presence of a symptomatic/ruptured aneurysm.
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Affiliation(s)
- Gerard M. Healy
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Ciaran E. Redmond
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Sam Gray
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Lucian Iacob
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Stephen Sheehan
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Joseph F. Dowdall
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Mary Barry
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Colin P. Cantwell
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - David P. Brophy
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
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Guthrie S, Bienkowska-Gibbs T, Manville C, Pollitt A, Kirtley A, Wooding S. The impact of the National Institute for Health Research Health Technology Assessment programme, 2003-13: a multimethod evaluation. Health Technol Assess 2016; 19:1-291. [PMID: 26307643 DOI: 10.3310/hta19670] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact. METHODS Interviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research. RESULTS We make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence - its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers - the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality - the Health Technology Assessment journal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine - it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.
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Life expectancy and causes of death after repair of intact and ruptured abdominal aortic aneurysms. J Vasc Surg 2016; 63:610-6. [DOI: 10.1016/j.jvs.2015.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022]
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Moulakakis KG, Mylonas SN, Kakisis J, Kadoglou NPE, Papadakis I, Sfyroeras GS, Antonopoulos CCN, Mantas G, Ikonomidis I, Liapis CD. Arterial Stiffness Alterations and Inflammatory Response Following Endovascular Aortic Repair: Based on a Presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA). AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:75-80. [PMID: 26798761 DOI: 10.12945/j.aorta.2015.14-071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/27/2015] [Indexed: 11/18/2022]
Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) and thoracic aortic aneurysm repair (TEVAR) have been widely incorporated into clinical practice. However, changes in arterial stiffness and post-implantation syndrome after aortic endografting remain important issues under investigation. The aneurysm sac wall motion after successful EVAR and TEVAR reflects complex interactions between all the components of the excluded aneurysm, including true compliance of the aneurysm wall itself, intra-aneurysm sac pressure, remodeling of the thrombus, and mechanical characteristics of the endograft. Experimental and clinical studies have shown that aortic endografting results in increased arterial stiffness in animal models. It can be assumed that the alterations of aortic mechanical properties can have a direct impact on heart output. The long-term impact of these mechanical changes on cardiovascular outcomes and the potential effects of different endografts on hemodynamics are important issues under investigation. Post-implantation syndrome (PIS) is a systemic inflammatory response frequently observed after endovascular treatment of aortic pathologies. The main features of PIS include fever, leukocytosis, elevated C-reactive protein levels, and coagulation disturbances. Endograft design appears to influence this inflammatory response following aortic endografting; woven polyester endografts have been shown to be associated with greater inflammatory response compared to PTFE stent grafts. The purpose of this paper is to review the literature to elucidate arterial stiffness alterations and inflammatory response after EVAR and TEVAR and the impact of endograft design on aortic stiffness and the post-inflammatory response.
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Affiliation(s)
| | - Spyridon N Mylonas
- Department of Vascular Surgery, Medical School, University of Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Medical School, University of Athens, Greece
| | | | - Ioannis Papadakis
- Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - George S Sfyroeras
- Department of Vascular Surgery, Medical School, University of Athens, Greece
| | | | - George Mantas
- Department of Vascular Surgery, Medical School, University of Athens, Greece
| | | | - Christos D Liapis
- Department of Vascular Surgery, Medical School, University of Athens, Greece
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Sun Z, Al Moudi M, Cao Y. CT angiography in the diagnosis of cardiovascular disease: a transformation in cardiovascular CT practice. Quant Imaging Med Surg 2014; 4:376-96. [PMID: 25392823 DOI: 10.3978/j.issn.2223-4292.2014.10.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
Computed tomography (CT) angiography represents the most important technical development in CT imaging and it has challenged invasive angiography in the diagnostic evaluation of cardiovascular abnormalities. Over the last decades, technological evolution in CT imaging has enabled CT angiography to become a first-line imaging modality in the diagnosis of cardiovascular disease. This review provides an overview of the diagnostic applications of CT angiography (CTA) in cardiovascular disease, with a focus on selected clinical challenges in some common cardiovascular abnormalities, which include abdominal aortic aneurysm (AAA), aortic dissection, pulmonary embolism (PE) and coronary artery disease. An evidence-based review is conducted to demonstrate how CT angiography has changed our approach in the diagnosis and management of cardiovascular disease. Radiation dose reduction strategies are also discussed to show how CT angiography can be performed in a low-dose protocol in the current clinical practice.
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Affiliation(s)
- Zhonghua Sun
- 1 Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, 6102, Western Australia, Australia ; 2 Department of Medical Imaging and Nuclear Medicine, King Saud Medical City, Riyadh, Saudi Arabia ; 3 Department of Medical Imaging, Shandong Medical College, Jinan 276000, China
| | - Mansour Al Moudi
- 1 Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, 6102, Western Australia, Australia ; 2 Department of Medical Imaging and Nuclear Medicine, King Saud Medical City, Riyadh, Saudi Arabia ; 3 Department of Medical Imaging, Shandong Medical College, Jinan 276000, China
| | - Yan Cao
- 1 Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, 6102, Western Australia, Australia ; 2 Department of Medical Imaging and Nuclear Medicine, King Saud Medical City, Riyadh, Saudi Arabia ; 3 Department of Medical Imaging, Shandong Medical College, Jinan 276000, China
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Thomas D, Anderson D, Hulten E, McRae F, Ellis S, Malik JA, Villines TC, Slim AM. Open versus endovascular repair of abdominal aortic aneurysm: Incidence of cardiovascular events in 632 patients in a department of defense cohort over 6-year follow-up. Vascular 2014; 23:234-9. [PMID: 25134851 DOI: 10.1177/1708538114546207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is common with unacceptably high rates of mortality and morbidity with unknown rates of complications after repair in the Department of Defense (DoD). METHODS All patients treated at a DOD or VA clinic or medical facility with a diagnosis of AAA identified by ICD-9 code search were identified by Patient Administration Systems and Biostatistics Activity (PASBA) using the Standard Inpatient Data Record (SIDR) and Composite Ambulatory Patient Encounter Record (CAPER) from January 2006 till December 2011. The primary outcome was death, myocardial infarction (MI), stroke, and cardiac arrhythmia between subjects who underwent endovascular aortic repair (EVAR) or open aortic repair (OAR). RESULTS A total of 8314 patients were screened to identify 632 patients who underwent surgical repair of non-ruptured AAA. EVAR was performed in 497 patients (78.6%) and OAR in 135 patients (21.4%). Mortality at 30 days was less common in EVAR patients (1.6% vs. 6.7%, p = 0.004), but was not sustained (16.9% vs. 17.8%, p = 0.797). Mean survival free from mortality was not different between the two groups (EVAR vs. OAR: 6.14 ± 0.13 years vs. 6.11 ± 0.22 years, p = 0.378). The composite endpoint of MI, stroke, arrhythmia, or death was not different between groups at 30 days (EVAR vs. OAR: 12.9% vs. 14.1%, p = 0.774) or in long-term follow-up population (EVAR vs. OAR: 40.6% vs. 31.9%, p = 0.073) though there was a trend toward higher event rates in the EVAR. The composite endpoint of MI, stroke, and arrhythmia occurred in 198 patients (31%). CONCLUSION EVAR was associated with lower 30-day mortality rates; however, this benefit was not sustained in longer-term follow-up. There is no difference in the rates of stroke, myocardial infarction, or cardiac arrhythmia at 30 days or in long-term follow-up.
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Affiliation(s)
- Dustin Thomas
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - David Anderson
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Edward Hulten
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Fiora McRae
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Shane Ellis
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Jamil A Malik
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ahmad M Slim
- Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA
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15
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Paravastu SCV, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev 2014; 2014:CD004178. [PMID: 24453068 PMCID: PMC10749584 DOI: 10.1002/14651858.cd004178.pub2] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND An abnormal dilatation of the abdominal aorta is referred to as an abdominal aortic aneurysm (AAA). Due to the risk of rupture, surgical repair is offered electively to individuals with aneurysms greater than 5.5 cm in size. Traditionally, conventional open surgical repair (OSR) was considered the first choice approach. However, over the past two decades endovascular aneurysm repair (EVAR) has gained popularity as a treatment option. This article intends to review the role of EVAR in the management of elective AAA. OBJECTIVES To assess the effectiveness of EVAR versus conventional OSR in individuals with AAA considered fit for surgery, and EVAR versus best medical care in those considered unfit for surgery. This was determined by the effect on short, intermediate and long-term mortality, endograft related complications, re-intervention rates and major complications. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (January 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12). The TSC also searched trial databases for details of ongoing or unpublished studies. SELECTION CRITERIA Prospective randomised controlled trials (RCTs) comparing EVAR with OSR in individuals with AAA considered fit for surgery. and comparing EVAR with best medical care in individuals considered unfit for surgery. We excluded studies with inadequate data or using an inadequate randomisation technique. DATA COLLECTION AND ANALYSIS Three reviewers independently evaluated trials for appropriateness for inclusion and extracted data using pro forma designed by the Cochrane PVD Group. We assessed the quality of trials using The Cochrane Collaboration's 'Risk of bias' tool. We entered collected data in to Review Manager (version 5.2.3) for analysis. Where direct comparisons could be made, we determined odds ratios (OR). We tested studies for heterogeneity and, when present, we used a random-effects model; otherwise we used a fixed-effect model. We tabulated data that could not be collated. MAIN RESULTS Four high-quality trials comparing EVAR with OSR (n = 2790) and one high-quality trial comparing EVAR with no intervention (n = 404) fulfilled the inclusion criteria. In individuals considered fit for surgery, a pooled analysis, including 1362 individuals randomised to EVAR and 1361 randomised to OSR, found short-term mortality (including 30-day or inhospital mortality, excluding deaths prior to intervention) with EVAR to be significantly lower than with OSR (1.4% versus 4.2%, OR 0.33, 95% confidence interval (CI) 0.20 to 0.55; P < 0.0001). Using intention-to-treat analysis (ITT) there was no significant difference in mortality at intermediate follow-up (up to four years from randomisation), with 221 (15.8%) and 237 (17%) deaths in the EVAR (n = 1393) and OSR (n = 1390) groups, respectively (OR 0.92, 95% CI 0.75 to 1.12; P = 0.40). There was also no significant difference in long-term mortality (beyond four years), with 464 (37.3%) deaths in the EVAR and 470 (37.8%) deaths in the OSR group (OR 0.98, 95% CI 0.83 to 1.15; P = 0.78). Similarly, there was no significant difference in aneurysm-related mortality between groups, either at the intermediate- or long-term follow up.Studies showed that both EVAR and OSR were associated with similar incidences of cardiac deaths (OR 1.14, 95% CI 0.86 to 1.52; P = 0.36) and fatal stroke rate (OR 0.81, 95% CI 0.42 to 1.55; P = 0.52). The long-term reintervention rate was significantly higher in the EVAR group than in the OSR group (OR 1.98, 95% CI 1.12 to 3.51; P = 0.02; I(2) = 85%). Results of the reintervention analysis should be interpreted with caution due to significant heterogeneity. Operative complications, health-related quality of life and sexual dysfunction were generally comparable between the EVAR and OSR groups. However, there was a slightly higher incidence of pulmonary complications in the OSR group compared with the EVAR group (OR 0.36, 95% CI 0.17 to 0.75; P = 0.006).In individuals considered unfit for conventional OSR, the one included trial found no difference between the EVAR and no-intervention groups with regard to all-cause mortality at final follow up, with 21.0 deaths per 100 person-years in the EVAR group and 22.1 deaths per 100 person years in the no-intervention group (adjusted hazard ratio (HR) with EVAR 0.99, 95% CI 0.78 to 1.27; P = 0.97). Aneurysm-related deaths were, however, significantly higher in the no-intervention group than in the EVAR group (adjusted HR 0.53, 95% CI 0.32 to 0.89; P = 0.02). There was no difference in myocardial events (HR 1.07, 95% CI 0.60 to 1.91) between the groups in this study. AUTHORS' CONCLUSIONS In individuals considered fit for conventional surgery, EVAR was associated with lower short-term mortality than OSR. However, this benefit from EVAR did not persist at the intermediate- and long-term follow ups. Individuals undergoing EVAR had a higher reintervention rate than those undergoing OSR. Most of the reinterventions undertaken following EVAR, however, were catheter-based interventions associated with low mortality. Operative complications, health-related quality of life and sexual dysfunction were generally comparable between EVAR and OSR. However, there was a slightly higher incidence of pulmonary complications in the OSR group than in the EVAR group.In individuals considered unfit for open surgery, the results of a single trial found no overall short- or long-term benefits of EVAR over no intervention with regard to all-cause mortality, but individuals may differ and individual preferences should always be taken into account.
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Affiliation(s)
| | - Rubaraj Jayarajasingam
- Northern General HospitalDepartment of Clinical RadiologyHerries RoadSheffieldSouth YorkshireUKS5 7AU
| | - Rachel Cottam
- Sheffield Teaching Hospital NHS Foundation TrustVascular AngiographyHerries RoadSheffieldSouth YorkshireUKS5 7AU
| | - Simon J Palfreyman
- Sheffield Teaching Hospitals NHS Foundation TrustTissue ViabilityNorthern General HospitalSheffieldUKS5 7AU
| | - Jonathan A Michaels
- University of Sheffield, ScHARRSchool of Health and Related ResearchRegent Court, Regent StreetSheffieldUKS1 4DA
| | - Steven M Thomas
- Northern General HospitalSheffield Vascular InstituteHerries RoadSheffieldUKS5 7AU
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16
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Saratzis A, Mohamed S. Endovascular abdominal aortic aneurysm repair in the geriatric population. J Geriatr Cardiol 2012; 9:285-91. [PMID: 23097659 PMCID: PMC3470028 DOI: 10.3724/sp.j.1263.2012.06271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/06/2012] [Accepted: 08/13/2012] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.
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Affiliation(s)
- Athanasios Saratzis
- Warwickshire Vascular and Endovascular Unit, University Hospital Coventry & Warwickshire, Coventry CV22DX, United Kingdom
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17
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Kadoglou NP, Moulakakis KG, Papadakis I, Ikonomidis I, Alepaki M, Lekakis J, Liapis CD. Changes in Aortic Pulse Wave Velocity of Patients Undergoing Endovascular Repair of Abdominal Aortic Aneurysms. J Endovasc Ther 2012; 19:661-6. [DOI: 10.1583/jevt-12-3916mr.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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WYLIE SJ, WONG GTC, CHAN YC, IRWIN MG. Endovascular aneurysm repair: a perioperative perspective. Acta Anaesthesiol Scand 2012; 56:941-9. [PMID: 22621365 DOI: 10.1111/j.1399-6576.2012.02681.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2012] [Indexed: 11/28/2022]
Abstract
Endovascular aneurysm repair (EVAR), has surpassed open repair as the technique of choice in many centres in response to several large studies which showed significantly improved 30-day mortality. While several multicentre EVAR trials looked at surgical outcomes, very few have specifically investigated the effect of anaesthetic techniques or perioperative care of these patients. The purpose of this review to is to present some of the current evidence for the different aspects of perioperative management of patients undergoing EVAR. This includes surgical considerations, pre-operative assessment, and choice of anaesthetic technique as well as pharmacological protective strategies.
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Affiliation(s)
- S. J. WYLIE
- Barts and the Royal London NHS Trust; London
| | - G. T. C. WONG
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
| | - Y. C. CHAN
- Department of Surgery; University of Hong Kong; Hong Kong
| | - M. G. IRWIN
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
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19
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Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures. J Geriatr Cardiol 2012; 9:49-60. [PMID: 22783323 PMCID: PMC3390098 DOI: 10.3724/sp.j.1263.2012.00049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm is a common vascular disease that affects elderly population. Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm, however, endovascular aneurysm repair has rapidly expanded since its first introduction in 1990s. As a less invasive technique, endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair, especially in patients with co-morbid conditions. Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up. 2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair. CT has the disadvantage of high cummulative radiation dose, of particular concern in younger patients, since patients require regular imaging follow-ups after endovascular repair, thus, exposing patients to repeated radiation exposure for life. There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair. Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts, but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta. This article reviews the treatment options of abdominal aortic aneurysm, various image visualization tools, and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods. Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.
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Álvarez Salgado A, Vaquero Lorenzo F, Vicente Santiago M, Ramos Gallo M, Vallina Vázquez Victorero M, Álvarez Fernández L. Escalas de riesgo preoperatorio para el tratamiento endovascular de aneurismas aórticos. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Thompson AR, Peters N, Lovegrove RE, Ledwidge S, Kitching A, Magee TR, Galland RB. Cardiopulmonary exercise testing provides a predictive tool for early and late outcomes in abdominal aortic aneurysm patients. Ann R Coll Surg Engl 2011; 93:474-81. [PMID: 21929919 DOI: 10.1308/003588411x587235] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine if cardiopulmonary exercise testing (CPET) predicts 30-day and mid-term outcomes when assessing suitability for abdominal aortic aneurysm (AAA) repair. METHODS Since July 2006 consecutive patients from a single centre identified with a large (≥5.5 cm) AAA were sent for CPET. Follow-up was completed on 1 August 2009. Univariate logistical regression was used to compare CPET parameters with the Detsky score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (VPOSSUM) in predicting predefined early and late outcome measures. RESULTS Full data were available for 102 patients (93% male, median age: 75 years, interquartile range (IQR): 70-80 years, median follow up: 28 months, IQR: 18-33 months). Ventilatory equivalents for oxygen and APACHE II predicted postoperative inotrope requirement (p=0.018 and p=0.019 respectively). The Detsky score predicted the length of stay in the intensive care unit (p=0.008). Mid-term (30-month) survival was predicted by the anaerobic threshold (p=0.02). CONCLUSIONS CPET provided the only means in this study of predicting both 30-day outcome and 30-month mortality. CPET could therefore become an increasingly important tool in determining the optimum management for AAA patients.
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Affiliation(s)
- A R Thompson
- Vascular Surgery Department, Royal Berkshire Hospital, Reading, UK
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23
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Wibmer A, Nolz R, Teufelsbauer H, Kretschmer G, Prusa AM, Funovics M, Lammer J, Schoder M. Complete ten-year follow-up after endovascular abdominal aortic aneurysm repair: survival and causes of death. Eur J Radiol 2011; 81:1203-6. [PMID: 21524867 DOI: 10.1016/j.ejrad.2011.03.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/22/2011] [Accepted: 03/30/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the hazard and causes of death after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms during a complete ten year follow-up. METHODS This is a retrospective clinical study of 130 consecutive patients undergoing EVAR between 1995 and 1998. One-hundred twenty-one patients (93.1%) were treated with first-generation stentgrafts and nine patients (6.9%) received second-generation devices. All patients completed a follow-up of at least 10 years, unless death occurred before then. Time and causes of death were provided by the Austrian central register of deaths. RESULTS The median follow-up was 7.6 years, and the 130 patients had 968.5 person-years of follow-up. The ten-year mortality rate was 62.3%. Cardiovascular events were the most frequent causes of death, with a 3.9 incidence rate per 100 person-years. Cancer death and death due to other causes occurred in 2.1 and 1.8 cases per 100 person-years, respectively. Lethal late aneurysm rupture happened in 4.6% (n=6), which corresponds to an annual incidence rate of 0.6 per 100 person-years. All of those patients had been treated with first-generation devices. CONCLUSIONS Cardiovascular events were the most frequent cause of death after EVAR, followed by malignancy and other diseases. The risk of dying from secondary rupture was clearly lower than that of death due to other reasons during ten years after EVAR, even in patients with first-generation stentgrafts.
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Affiliation(s)
- Andreas Wibmer
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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24
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Brown LC, Thompson SG, Greenhalgh RM, Powell JT. Incidence of cardiovascular events and death after open or endovascular repair of abdominal aortic aneurysm in the randomized EVAR trial 1. Br J Surg 2011; 98:935-42. [PMID: 21484775 DOI: 10.1002/bjs.7485] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim was to compare rates of myocardial infarction, stroke and cardiovascular death in patients with a large abdominal aortic aneurysm who had endovascular (EVAR) or open repair to determine whether cardiovascular mortality explains the convergence in survival curves after these procedures. METHODS Between 1999 and 2004, 1252 patients were randomized to EVAR or open repair in the UK EVAR trial 1. All patients were followed for death, myocardial infarction or stroke until September 2009. Cox regression was used to compare cardiovascular events and deaths between the randomized groups during different time intervals. RESULTS Over 5 years of follow-up, a total of 187 first non-fatal or fatal cardiovascular events (98 myocardial infarctions and 89 strokes) and 256 cardiovascular deaths occurred. Although the endovascular group had a lower cardiovascular event rate than the open repair group (2·6 versus 3·2 per 100 person-years respectively) this was not statistically significant (adjusted hazard ratio (HR) 0·83, 95 per cent confidence interval 0·62 to 1·10; P = 0·199). Overall, there was little difference in cardiovascular mortality between the randomized groups (adjusted HR 1·06, 0·83 to 1·36; P = 0·638), but a non-significant excess of cardiovascular deaths was apparent in the endovascular group during the 6-24-month interval (adjusted HR 1·44, 0·79 to 2·62; P = 0·237). CONCLUSION Patients who had EVAR appeared to have a lower subsequent cardiovascular event rate during all time intervals. Cardiovascular mortality was similar between the two groups overall, but more cardiovascular deaths in the EVAR group appeared to contribute to the convergence in all-cause mortality during the first 2 years.
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Affiliation(s)
- L C Brown
- Vascular Surgery Research Group, Imperial College, London, UK
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25
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Smaka TJ, Cobas M, Velazquez OC, Lubarsky DA. Perioperative management of endovascular abdominal aortic aneurysm repair: update 2010. J Cardiothorac Vasc Anesth 2010; 25:166-76. [PMID: 21093297 DOI: 10.1053/j.jvca.2010.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Todd J Smaka
- Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, FL, USA.
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