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AlOthman O, Bobat S. Comparison of the Short and Long-Term Outcomes of Endovascular Repair and Open Surgical Repair in the Treatment of Unruptured Abdominal Aortic Aneurysms: Meta-Analysis and Systematic Review. Cureus 2020; 12:e9683. [PMID: 32923276 PMCID: PMC7486022 DOI: 10.7759/cureus.9683] [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: 11/10/2022] Open
Abstract
Background Although the initial results of endovascular repair (EVAR) were promising, a comparison of its long-term efficacy against open surgical repair (OSR) remains largely elusive, and late-onset adverse events have not been systematically evaluated. Since OSR and EVAR are currently the only treatment options available in the management of abdominal aortic aneurysms (AAAs), the main question arising in clinical practice is whether EVAR or OSR confers more favourable short and long-term outcomes for patients presenting with unruptured AAAs. Aims The present meta-analysis aims to draw a head-to-head comparison between EVAR and OSR and facilitate the formulation of an evidence-based approach to the clinical management of unruptured AAAs. Methods A systematic review was conducted using three databases to identify all relevant studies with comparative data on EVAR vs. OSR. All-cause mortality was the primary outcome. Procedural outcomes, such as stroke, myocardial infarction, renal complications, rupture, and reintervention rates, were determined as secondary outcomes. Results Sixteen studies were included for comparative analysis, including four randomised-controlled trials and six non-randomised comparative clinical trials. EVAR conferred a clear perioperative survival advantage as compared to OSR (P < 0.00001). However, this survival advantage did not persist beyond two years post-procedure; all-cause mortality rates were comparable between the two treatment groups at two years (P = 0.09), four years (P = 0.58), and six years (P = 0.88) post-procedure. Although no statistically significant differences in aneurysm-related mortality, postoperative stroke, or myocardial infarction were identified, the OSR group had a statistically significant higher rate of postoperative renal complications. On the other hand, there was a statistically significant higher rate of rupture and reintervention following EVAR. Conclusion Whether the initial survival advantage afforded by EVAR is sufficient to justify the long-term risk of rupture, reintervention, and long-term mortality should be determined on a case-by-case basis by the multidisciplinary team overseeing the clinical care of the patient. Currently, it is reasonable to conclude that EVAR is as efficacious as OSR, but it would be invalid to claim it as superior. Ultimately, longer follow-up data must be presented before any definitive conclusions can be established for this potentially revolutionary technique. Presently, one can neither advocate nor refute EVAR over OSR.
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Affiliation(s)
- Othman AlOthman
- Surgery, School of Medicine, University of Nottingham, Nottingham, GBR
| | - Suleiman Bobat
- Vascular Surgery, Queen's Medical Centre, Nottingham, GBR
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Morisaki K, Furuyama T, Yoshiya K, Kurose S, Yoshino S, Nakayama K, Yamashita S, Kawakubo E, Matsumoto T, Mori M. Frailty in patients with abdominal aortic aneurysm predicts prognosis after elective endovascular aneurysm repair. J Vasc Surg 2020; 72:138-143. [DOI: 10.1016/j.jvs.2019.09.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/23/2019] [Indexed: 12/21/2022]
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3
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Li B, Khan S, Salata K, Hussain MA, de Mestral C, Greco E, Aljabri BA, Forbes TL, Verma S, Al-Omran M. A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm. J Vasc Surg 2019; 70:954-969.e30. [DOI: 10.1016/j.jvs.2019.01.076] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/11/2019] [Indexed: 01/09/2023]
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Yalcin M, Tiryakioglu O. Single-center Study Comparing Short and Mid-Term Results of EVAR in Old and Young Populations. Braz J Cardiovasc Surg 2019; 34:279-284. [PMID: 31310465 PMCID: PMC6629225 DOI: 10.21470/1678-9741-2018-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The purpose of this study was to compare the operative mortality rate and
outcomes of endovascular aneurysm repair (EVAR) between young and geriatric
people in a single center. Methods Eighty-five patients with abdominal aortic aneurysms who underwent EVAR
between January 2012 and September 2016 were included. Outcomes were
compared between two groups: the young (aged < 65 years) and the
geriatric (aged ≥ 65 years). The primary study outcome was technical
success; the secondary endpoints were mortality and secondary interventions.
The mean follow-up time was 36 months (3-60 months). Results The study included 72 males and 13 females with a mean age of
71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18
(21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years
old. There was no statistically significant correlation between chronic
disease and age. We found no statistically significant difference between
aneurysm diameter, neck angle, neck length, or right and left iliac angles.
The secondary intervention rate was 7% (six patients). The conversion to
open surgery was necessary for only one patient and only three deaths were
reported (3.5%). There was no statistically significant difference in the
mortality and reintervention rates between the age groups. The three deaths
occurred only in the geriatric group and two died secondary to rupture.
Kidney failure was observed in three patients in the geriatric group
(4.5%). Conclusion Our single-center experience shows that EVAR can be used safely in both young
and geriatric patients.
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Affiliation(s)
- Mihriban Yalcin
- Ordu State Hospital Department of Cardiovascular Surgery Ordu Turkey Department of Cardiovascular Surgery, Ordu State Hospital, Ordu, Turkey
| | - Osman Tiryakioglu
- Bahcesehir University Medical Faculty Department of Cardiovascular Surgery Bursa Turkey Department of Cardiovascular Surgery, Medical Faculty, Bahcesehir University, Bursa, Turkey
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Chen ZG, Tan SP, Diao YP, Wu ZY, Miao YQ, Li YJ. The long-term outcomes of open and endovascular repair for abdominal aortic aneurysm: A meta-analysis. Asian J Surg 2019; 42:899-906. [PMID: 30914154 DOI: 10.1016/j.asjsur.2019.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
To provide a meta-analysis of studies evaluating long-term all-cause mortality, aneurysm-related mortality and re-intervention after open or endovascular repair for abdominal aortic aneurysm. Electronic bibliographic sources were interrogated using a combination of free text and controlled vocabulary searches to identify studies comparing the long-term outcomes of open and endovascular repair for abdominal aortic aneurysm. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Fixed effect or random effects models were used. We retrieved 4 randomized controlled trials (RCTs; 2,783 patients), 7 nonrandomized trials (86,035 patients). The primary outcome was all-cause mortality. Heterogeneity was high and publication bias could not be excluded. Despite these limitations, the analysis showed that open and endovascular abdominal aortic aneurysm repair had similar all-cause mortality (OR 1.16, 95% CI, 0.89-1.51) over 5 years follow up, which was maintained after at least 10 years of follow-up (OR 0.87, 95% CI, 0.73-1.03). There was no significant difference in aneurysm-related mortality by 5 years or longer follow-up. A significantly lower proportion of patients undergoing open repair required reintervention (OR 0.38, 95% CI 0.24-0.64), which was maintained over 5 years of follow-up. There is no long-term survival difference between the patients who underwent open or endovascular aneurysm repair. There is significantly higher risk of reinterventions after endovascular aneurysm repair.
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Affiliation(s)
- Zuo-Guan Chen
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, 100730, PR China; Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, PR China
| | - Shu-Ping Tan
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, 100730, PR China
| | - Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, 100730, PR China
| | - Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, 100730, PR China; Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, PR China
| | - Yu-Qing Miao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, 100730, PR China; Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, PR China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, 100730, PR China; Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100730, PR China.
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Bulder RMA, Bastiaannet E, Hamming JF, Lindeman JHN. Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm. Br J Surg 2019; 106:523-533. [PMID: 30883709 DOI: 10.1002/bjs.11123] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/06/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) has become the preferred strategy for elective repair of abdominal aortic aneurysm (AAA) for many patients. However, the superiority of the endovascular procedure has recently been challenged by reports of impaired long-term survival in patients who underwent EVAR. A systematic review of long-term survival following AAA repair was therefore undertaken. METHODS A systematic review was performed according to PRISMA guidelines. Articles reporting short- and/or long-term mortality of EVAR and open surgical repair (OSR) of AAA were identified. Pooled overall survival estimates (hazard ratios (HRs) with corresponding 95 per cent c.i. for EVAR versus OSR) were calculated using a random-effects model. Possible confounding owing to age differences between patients receiving EVAR or OSR was addressed by estimating relative survival. RESULTS Some 53 studies were identified. The 30-day mortality rate was lower for EVAR compared with OSR: 1·16 (95 per cent c.i. 0·92 to 1·39) versus 3·27 (2·71 to 3·83) per cent. Long-term survival rates were similar for EVAR versus OSR (HRs 1·01, 1·00 and 0·98 for 3, 5 and 10 years respectively; P = 0·721, P = 0·912 and P = 0·777). Correction of age inequality by means of relative survival analysis showed equal long-term survival: 0·94, 0·91 and 0·76 at 3, 5 and 10 years for EVAR, and 0·96, 0·91 and 0·76 respectively for OSR. CONCLUSION Long-term overall survival rates were similar for EVAR and OSR. Available data do not allow extension beyond the 10-year survival window or analysis of specific subgroups.
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Affiliation(s)
- R M A Bulder
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J F Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - J H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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7
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Majd P, Ahmad W, Becker I, Brunkwall JS. Ten-Year Single-Center Results of Abdominal Aortic Aneurysm Treatment: Endovascular versus Open Repair. Ann Vasc Surg 2017; 44:113-118. [DOI: 10.1016/j.avsg.2017.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
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Locham S, Lee R, Nejim B, Dakour Aridi H, Malas M. Mortality after endovascular versus open repair of abdominal aortic aneurysm in the elderly. J Surg Res 2017; 215:153-159. [DOI: 10.1016/j.jss.2017.03.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/22/2017] [Accepted: 03/30/2017] [Indexed: 01/19/2023]
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Väärämäki S, Pimenoff G, Heikkinen M, Suominen V, Saarinen J, Zeitlin R, Salenius J. Ten-Year Outcomes after Endovascular Aneurysm Repair (Evar) and Magnitude of Additional Procedures. Scand J Surg 2016; 96:221-8. [DOI: 10.1177/145749690709600307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The long-term outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Materials and Methods: Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54–85) with AAA (average 57mm, range 40–90mm) were treated with a Vanguard® endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. Results: The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6–120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery disease. There were ten late conversions to open surgical repair, including three emergency operations: two due to rupture and one to thrombosis. EVAR-related complications were encountered in 43 patients (90%): 12 primary endoleaks (all type II), 36 late endoleaks (16 type I, 2 type II and 18 type III), 22 migrations, 25 row separations, 20 thromboses, one endotension and 3 ruptures of the AAA. Secondary procedures were required in 39 patients (81%): 1 re-endografting by aortoiliac bifurcated graft and 3 with a uni-iliac graft; 33 limb graft repairs were performed and 19 infrarenal cuffs were placed. There were 4 late embolizations and 4 attempts, and 6 thrombolyses, four of which were successful. Further, 9 femoro-femoral crossover by-pass and 2 axillo-femoral by-pass operations and 2 amputations were carried out during the follow-up. Only one patient was alive without complications. Conclusions: The impact of long-term follow-up of patients treated with the new technology was emphasized in this patient population. A careful surveillance protocol and active endovascular treatment of complications can yield acceptable results and low AAA rupture and aneurysm mortality rates, also with the first-generation endovascular graft. A new technology, however, may involve unpredictable problems which can magnify the workload and incur high costs over several years after the initial procedure.
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Affiliation(s)
- S. Väärämäki
- Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland
| | - G. Pimenoff
- Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland
| | - M. Heikkinen
- Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland
| | - V. Suominen
- Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland
| | - J. Saarinen
- Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland
| | - R. Zeitlin
- Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland
| | - J. Salenius
- Division of Vascular Surgery and Interventional Radiology, University Hospital and Medical School, Tampere, Finland
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Haji Zeinali AM, Marzban M, Zafarghandi M, Shirzad M, Shirani S, Mahmoodian R, Sheikhvatan M, Lotfi-Tokaldany M. Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e16021. [PMID: 27110330 PMCID: PMC4836048 DOI: 10.5812/iranjradiol.16021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 07/12/2014] [Accepted: 08/25/2014] [Indexed: 11/16/2022]
Abstract
Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients.
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Affiliation(s)
- Ali Mohammad Haji Zeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Ali Mohammad Haji Zeinali, Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, P. O. Box: 1411713138, Tehran, Iran. Tel: +98-218802960060, Fax: +98-2188029731, E-mail:
| | - Mehrab Marzban
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Zafarghandi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Shirzad
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shapour Shirani
- Department of Radiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Mahmoodian
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Lotfi-Tokaldany
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Kristmundsson T, Dias N, Resch T, Sonesson B. Morphology of Small Abdominal Aortic Aneurysms Should be Considered before Continued Ultrasound Surveillance. Ann Vasc Surg 2015; 31:18-22. [PMID: 26631772 DOI: 10.1016/j.avsg.2015.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate abdominal aortic aneurysm (AAA) morphology in a cohort of patients presenting with ruptured AAA (rAAA) and to explore if aneurysms with diameters below the recommended threshold for elective repair (<55 mm) have some distinctive morphological characteristics. METHODS All patients diagnosed with rAAA using computed tomography (CT) scans between January 2006 and June 2013 were eligible for this study. Where CT scans of acceptable quality were available, images were reconstructed in a dedicated three-dimensional vascular workstation for evaluation of aneurysm diameters and morphology. All morphological characteristics were defined according to the reporting standards for endovascular aortic aneurysm repair. Additionally, fusiform AAAs were defined as aneurysms involving the whole circumference of the aortic wall and saccular AAAs as spherical aneurysms involving only a portion of the aortic circumference. RESULTS A total of 248 patients were identified. Of those, 83% (n = 206) had high-quality CT scans available and were included in the study. Patients were on average 75 years old and 85% were men. Mean aneurysm diameter was 76 ± 14 mm and 95% (n = 197) had fusiform morphology. Six percent (n = 12) were <55 mm and those included all saccular aneurysms in women (n = 3) and 22% of saccular aneurysms in men (n = 2). The remaining saccular aneurysms (n = 4) were small with a maximal diameter of 56 mm. Aneurysms <55 mm had less angulated proximal necks than their larger counterparts (P < 0.01). No other morphological differences were found between the groups. CONCLUSIONS Ruptured aneurysms are often large and the ≥55 mm threshold for elective repair is probably appropriate. However, approximately 6% of rAAAs are <55 mm, with a significant portion being saccular, especially in women. Morphological assessment of AAAs with CT scans should be considered in small aneurysms (40-55 mm), particularly in women, to exclude saccular morphology before continued ultrasound surveillance.
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Affiliation(s)
| | - Nuno Dias
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Tim Resch
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Björn Sonesson
- Vascular Center, Skåne University Hospital, Malmö, Sweden
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12
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Montgomery JP, Kolbeck KJ, Kaufman JA. Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms. Semin Intervent Radiol 2015; 32:249-58. [PMID: 26327743 DOI: 10.1055/s-0035-1556879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature.
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Affiliation(s)
- Jennifer P Montgomery
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Kenneth J Kolbeck
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - John A Kaufman
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
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13
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Morisaki K, Matsumoto T, Matsubara Y, Inoue K, Aoyagi Y, Matsuda D, Tanaka S, Okadome J, Maehara Y. Elective endovascular vs. open repair for abdominal aortic aneurysm in octogenarians. Vascular 2015. [PMID: 26223528 DOI: 10.1177/1708538115594967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to investigate the operative mortality and short-term and midterm outcomes of treatment of abdominal aortic aneurysm in Japanese patients over 80 years of age. METHODS Between January 2007 and December 2011, 207 patients underwent elective repair of infrarenal abdominal aortic aneurysms. Comorbidities, operative morbidity and mortality, midterm outcomes were analyzed retrospectively. RESULTS The average age (endovascular aneurysm repair, 84.4 ± 0.3; open, 82.8 ± 0.3, P < 0.01) and the percentage of hostile abdomen (endovascular aneurysm repair, 22.2%; open repair, 11.1%, P < 0.05) were higher in the endovascular aneurysm repair group. Percentage of outside IFU was higher in open repair (endovascular aneurysm repair, 38.5%; open repair, 63.3%, P < 0.01). The cardiac complication (endovascular aneurysm repair, 0%; open repair, 5.6%, P < 0.01) and length of postoperative hospital stay (endovascular aneurysm repair, 10.3 ± 0.8 days; open, 18.6 ± 1.6 days, P < 0.05) were significantly lower in the endovascular aneurysm repair group. There were no differences in operative mortality (endovascular aneurysm repair, 0%; open, 1.1%, P = 0.43) and the aneurysm-related death was not observed. The rate of secondary interventions (EVAR, 5.1%; open repair, 0%, P < 0.01) and midterm mortality rate were much higher in the endovascular aneurysm repair group. CONCLUSIONS Endovascular aneurysm repair is less invasive than open repair and useful for treating abdominal aortic aneurysm in octogenarians; however, open repair can be acceptable treatment in the inappropriate case treated by endovascular aneurysm repair.
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Affiliation(s)
- Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Matsumoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentaro Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukihiko Aoyagi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Matsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichi Tanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Okadome
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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14
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Timmers TK, van Herwaarden JA, de Borst GJ, Moll FL, Leenen LPH. Long-term survival and quality of life after open abdominal aortic aneurysm repair. World J Surg 2015; 37:2957-64. [PMID: 24132818 DOI: 10.1007/s00268-013-2206-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Open repair of abdominal aortic aneurysm (AAA) generally involves postsurgery admission to the intensive care unit (ICU). Few studies have evaluated the impact of surgery for either ruptured or nonruptured AAA (with postoperative ICU treatment) on long-term survival and quality of life. The primary aim of this study was to quantify long-term survival and health-related quality of life (HrQpL) of a cohort of patients undergoing open AAA repair after hospital discharge. METHODS Consecutive patients undergoing open elective or acute AAA reconstruction with postoperative admission to the ICU and discharged alive from the hospital during 2009 were identified. Primary outcome measures were 1-year and long-term mortality. The secondary outcome was the HrQoL using the EuroQol-6D (EQ-6D) questionnaire at the end of the follow-up period. RESULTS A total of 263 patients were treated and postoperatively discharged alive: 56 had a ruptured AAA (rAAA), 35 a symptomatic AAA, and 172 an asymptomatic AAA. The 1-year mortality after open AAA repair was 8 %. Overall, 39 % of patients died within 10 postoperative years (mean 6.0 ± 2.8 years). Long-term survival of patients with a ruptured or symptomatic aneurysm was similar to that of patients undergoing elective aneurysm repair. Long-term HrQoL of the total study population was worse than that of an age-matched general Dutch population on the EQ-us (range 0-1, difference 0.12). This decrease in HrQoL was mainly seen in mobility, self-care, usual activities, and cognition. CONCLUSIONS Ten years after open AAA repair, the overall survival rate was 59 %. Long-term survival and HrQoL were similar for patients with a repaired ruptured or symptomatic aneurysm and those who underwent elective aneurysm repair. There were also no differences in patients with infrarenal versus juxtarenal/suprarenal aneurysms. Surviving patients had a lower HrQoL than the age-matched general Dutch population, especially regarding mobility, self-care, usual activities, and cognition.
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Affiliation(s)
- Tim K Timmers
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands,
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15
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Sveinsson M, Sobocinski J, Resch T, Sonesson B, Dias N, Haulon S, Kristmundsson T. Early versus late experience in fenestrated endovascular repair for abdominal aortic aneurysm. J Vasc Surg 2015; 61:895-901. [DOI: 10.1016/j.jvs.2014.11.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022]
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16
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Cirugía aórtica por laparoscopia: resultados a largo plazo. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Off-the-Shelf Branched Endograft for Emergent Aneurysm Repair. Ann Vasc Surg 2013; 27:972.e11-5. [DOI: 10.1016/j.avsg.2012.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/20/2012] [Accepted: 10/02/2012] [Indexed: 11/22/2022]
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18
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Xiong J, Guo W, Liu X, Wang L, Jia X, Ma X, Zhang H, Zhang T. In-hospital efficacy of endovascular aortic repair in patients with impending rupture versus contained rupture of abdominal aortic aneurysms. Ann Vasc Surg 2013; 27:1054-60. [PMID: 23972436 DOI: 10.1016/j.avsg.2013.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 02/08/2013] [Accepted: 02/15/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of our study was to compare the efficacy of endovascular aortic repair (EVAR) in patients with impending rupture of abdominal aortic aneurysm (IRAAA) versus contained rupture of abdominal aortic aneurysm (CRAAA). METHODS Of the 21 patients who underwent EVAR for infrarenal AAA from January 2009 to May 2011, 11 did so for IRAAA and 10 for CRAAA. We compared their demographic and aneurysmal characteristics, comorbidities, complications, and clinical outcomes during hospitalization. RESULTS The CRAAA group was younger than the IRAAA group. There were no group differences in AAA size, operation time, volume of contrast agent, length of hospital stay (LOHS), or preoperative LOHS. A small difference in mean intraoperative blood loss of ∼4 mL was noted, but was recognized as clinically insignificant. ICU stay and postoperative LOHS were greater in the CRAAA than in the IRAAA. One patient in the IRAAA group had a mild headache after EVAR. Four patients in the CRAAA group had postoperative complications: 1 had acute renal dysfunction; 1 had retroperitoneal infection; 1 had respiratory failure and myocardial infarction; and 1 died of respiratory tract infection and respiratory and cardiac failure. CONCLUSIONS Patients undergoing EVAR for CRAAA have a higher incidence of postprocedural severe complications and death than patients undergoing EVAR for IRAAA.
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Affiliation(s)
- Jiang Xiong
- Department of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital and Postgraduate Medical School, Beijing, China
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19
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Kristmundsson T, Sonesson B, Dias N, Malina M, Resch T. Association Between the SVS/AAVS Anatomical Severity Grading Score and Operative Outcomes in Fenestrated Endovascular Repair of Juxtarenal Aortic Aneurysm. J Endovasc Ther 2013; 20:356-65. [DOI: 10.1583/12-4155mr.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Kristmundsson T, Sonesson B, Dias N, Malina M, Resch T. Anatomic suitability for endovascular repair of abdominal aortic aneurysms and possible benefits of low profile delivery systems. Vascular 2013; 22:112-5. [DOI: 10.1177/1708538112473980] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to evaluate the anatomic suitability for endovascular abdominal aneurysm repair (EVAR) according to instructions for use (IFUs) of three commercially available bifurcated stent graft devices and explore the possible benefits of low-profile delivery systems. Computed tomography scans of 241 patients with abdominal aortic aneurysm (AAA) were evaluated for suitability of Zenith Flex®, Gore Excluder® and Endurant® bifurcated stent graft systems according to their IFUs. The most common exclusion criteria and possible benefits of smaller diameter delivery systems were analyzed. When choosing the most suitable graft model for each patient, the overall suitability was 49.4%. By brand, the suitability was 28.6% for Zenith®, 25.7% for Gore Excluder® and 48.1% for Endurant®. By step wise accepting iliac diameters of ≥6 mm, ≥5 mm and ≥4 mm the overall suitability increased to 56.7, 58.9 and 60.2%, respectively ( P < 0.001). Diameters below 4 mm had no additional effect on suitability as combinations of other anatomical features, with or without narrow iliacs, accounted for the remaining excluding factors. In conclusion, Less than half of patients with AAAs are suitable for EVAR according to current IFUs. Low-profile delivery systems may allow for endovascular treatment in up to 60% of patients.
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21
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Ando T, Iizuka N, Sato T, Chikada M, Kurokawa MS, Arito M, Okamoto K, Suematsu N, Makuuchi H, Kato T. Autoantigenicity of carbonic anhydrase 1 in patients with abdominal aortic aneurysm, revealed by proteomic surveillance. Hum Immunol 2013; 74:852-7. [PMID: 23557951 DOI: 10.1016/j.humimm.2013.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/25/2013] [Accepted: 02/19/2013] [Indexed: 01/01/2023]
Abstract
Abdominal aortic aneurysm (AAA) is sometimes detected in patients with atherosclerosis. One of the histological characteristics of AAA walls is infiltration of inflammatory cells, in which autoimmunity may be involved. Thereby, we here surveyed autoantigens in AAA walls by proteomics. Specifically, we separated proteins extracted from AAA wall samples by 2-dimensional electrophoresis and detected candidate autoantigens by western blotting. One of the detected candidates was carbonic anhydrase 1 (CA1). ELISA confirmed that the autoantibodies to CA1 were detected more frequently in AAA patients (n=13) than in healthy donors (n=25) (p=0.03). Interestingly, some serum samples from the AAA patients reacted to CA1 of the AAA walls stronger than to CA1 of peripheral blood mononuclear cells from healthy donors. Our data indicate that CA1 in the AAA walls would be modified to express neo-epitope(s) and that the autoimmunity to CA1 may be involved in the pathogenesis of AAA.
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Affiliation(s)
- Takashi Ando
- Clinical Proteomics and Molecular Medicine, St. Marianna University Graduate School of Medicine, Kanagawa, Japan
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22
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Stather PW, Sidloff D, Dattani N, Choke E, Bown MJ, Sayers RD. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg 2013; 100:863-72. [DOI: 10.1002/bjs.9101] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 12/18/2022]
Abstract
Abstract
Background
Any possible long-term benefit from endovascular (EVAR) versus open surgical repair for abdominal aortic aneurysm (AAA) remains unproven. Long-term data from the Open Versus Endovascular Repair (OVER) trial add to the debate regarding long-term all-cause and aneurysm-related mortality. The aim of this study was to investigate 30-day and long-term mortality, reintervention, rupture and morbidity after EVAR and open repair for AAA in a systematic review.
Methods
Standard PRISMA guidelines were followed. Random-effects Mantel–Haenszel meta-analysis was performed to evaluate mortality and morbidity outcomes.
Results
The existing published randomized trials, together with information from Medicare and SwedVasc databases, were included in a meta-analysis. This included 25 078 patients undergoing EVAR and 27 142 undergoing open repair for AAA. Patients who had EVAR had a significantly lower 30-day or in-hospital mortality rate (1·3 per cent versus 4·7 per cent for open repair; odds ratio (OR) 0·36, 95 per cent confidence interval 0·21 to 0·61; P < 0·001). By 2-year follow-up there was no difference in all-cause mortality (14·3 versus 15·2 per cent; OR 0·87, 0·72 to 1·06; P = 0·17), which was maintained after at least 4 years of follow-up (34·7 versus 33·8 per cent; OR 1·11, 0·91 to 1·35; P = 0·30). There was no significant difference in aneurysm-related mortality by 2 years or longer follow-up. A significantly higher proportion of patients undergoing EVAR required reintervention (P = 0·003) and suffered aneurysm rupture (P < 0·001).
Conclusion
There is no long-term survival benefit for patients who have EVAR compared with open repair for AAA. There are also significantly higher risks of reintervention and aneurysm rupture after EVAR.
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Affiliation(s)
- P W Stather
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - D Sidloff
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - N Dattani
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - E Choke
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - M J Bown
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Leicester National Institute for Health Research Cardiovascular Biomedical Research Unit, Leicester, UK
| | - R D Sayers
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Lee HG, Clair DG, Ouriel K. Ten-year Comparison of All-Cause Mortality after Endovascular or Open Repair of Abdominal Aortic Aneurysms: A Propensity Score Analysis. World J Surg 2012; 37:680-7. [DOI: 10.1007/s00268-012-1863-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Open Surgical and Endovascular Conduits for Difficult Access During Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2012; 26:1022-9. [DOI: 10.1016/j.avsg.2012.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 12/20/2022]
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25
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Belczak SQ, Sincos IR, Aun R, Mioto Neto B, Lobato M, Saliture F, Ledermain A. Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%). O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.
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Hybrid procedure in a patient with symptomatic thoraco-abdominal aneurysm and prior abdominal aortic reconstruction - case report. Wideochir Inne Tech Maloinwazyjne 2012; 7:132-6. [PMID: 23256015 PMCID: PMC3516978 DOI: 10.5114/wiitm.2011.26765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 10/03/2011] [Accepted: 11/18/2011] [Indexed: 11/17/2022] Open
Abstract
Open repair of thoracoabdominal aortic aneurysm is connected with high mortality and morbidity. On the other hand, endovascular treatment of thoraco-abdominal aneurysms, which started 10 years ago, reduced perioperative mortality and morbidity. However, it results in a high level of late complications. It seems that an interesting solution to the problem is a hybrid procedure, which allows late complications to be reduced with acceptable levels of operative mortality and morbidity. This case report presents the use of a hybrid procedure in treatment of symptomatic thoraco-abdominal aneurysm in a patient with prior abdominal aortic reconstruction. In the first stage the patient underwent open revascularization of visceral vessels of the aorta. One week later a thoraco-abdominal stent-graft was implanted. The perioperative and postoperative period was uncomplicated. Two months after the second intervention the patient returned to work. Control imaging conducted 30 and 90 days after the procedure confirmed patency of all revascularized vessels and did not reveal any graft-related complications. The hybrid procedure seems to be an interesting alternative for open and endovascular repair of thoraco-abdominal aneurysms because it combines the advantages of open and endovascular repair. It also gives an opportunity to perform the procedure within a reasonable period of time from diagnosis of symptomatic thoraco-abdominal aneurysm.
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27
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Nathan DP, Brinster CJ, Jackson BM, Wang GJ, Carpenter JP, Fairman RM, Woo EY. Predictors of decreased short- and long-term survival following open abdominal aortic aneurysm repair. J Vasc Surg 2011; 54:1237-43. [DOI: 10.1016/j.jvs.2011.05.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 12/01/2022]
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28
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Rouwet E, Torsello G, de Vries JP, Cuypers P, van Herwaarden J, Eckstein HH, Beuk R, Florek HJ, Jentjens R, Verhagen H. Final Results of the Prospective European Trial of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2011; 42:489-97. [DOI: 10.1016/j.ejvs.2011.06.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
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29
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Pua U, Tan K. Radiology of advanced EVAR techniques in complex abdominal aortic aneurysms. Eur Radiol 2011; 22:387-97. [DOI: 10.1007/s00330-011-2261-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/03/2011] [Accepted: 08/08/2011] [Indexed: 10/17/2022]
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Argalious MY, Dalton JE, Mascha EJ, Cywinski JB, Clair DG. Association of red blood cell transfusion and postoperative outcomes after endovascular aortic repair. Semin Cardiothorac Vasc Anesth 2011; 15:49-55. [PMID: 21719550 DOI: 10.1177/1089253211410714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies have documented worse postoperative outcomes in patients who received red blood cell (RBC) transfusion perioperatively during cardiac surgery or in critical care settings. These findings were attributed to activation of the inflammatory response with the release of cytokines and immune suppression. The aim of this study was to evaluate the association of RBC transfusion on the day of surgery and postoperative outcomes following endovascular aortic repair (EVAR). METHODS A total of 510 patients who underwent EVAR from April 2005 to March 2007 were considered for analysis. The exposure of interest was whether or not patients receive RBC transfusion on the day of surgery. The primary outcome was a composite in-hospital morbidity/mortality outcome. The authors assessed the association between RBC transfusion and our composite outcome using logistic regression after adjusting for the available potential confounders using propensity score matching. RESULTS Propensity scores were estimated for 418 out of the 510 patients; 92 patients were not included because of missing data. Propensity matching resulted in 42 successfully matched pairs. Median (quartiles) propensity score was 0.46 (0.28, 0.66) for the matched patients with transfusion and 0.46 (0.29, 0.61) for the matched patients without transfusion (P = .75, Wilcoxon rank sum test). Results of the multivariable model developed after propensity score matching suggest that RBC transfusion was not significantly associated with experiencing a postoperative complication; estimated odds ratio (95% confidence interval) of 2.7 (0.8, 9.0), P = .11. CONCLUSION In this study, RBC transfusion was not independently associated with an increased incidence of in-hospital morbidity and mortality after EVAR.
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Affiliation(s)
- Maged Y Argalious
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA.
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31
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32
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Woo EY, Ullery BW, Carpenter JP, Wang GJ, Fairman RM, Jackson BM. Open abdominal aortic aneurysm repair is feasible and can be done with excellent results in octogenarians. J Vasc Surg 2011; 53:278-84. [DOI: 10.1016/j.jvs.2010.08.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 08/19/2010] [Accepted: 08/19/2010] [Indexed: 11/28/2022]
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33
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Post-Endovascular Aneurysm Repair Patient Outcomes and Follow-Up Are Not Adversely Impacted by Long Travel Distance to Tertiary Vascular Surgery Centers. Ann Vasc Surg 2010; 24:1075-81. [DOI: 10.1016/j.avsg.2010.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 03/30/2010] [Accepted: 05/16/2010] [Indexed: 11/17/2022]
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34
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Mahgerefteh S, Blachar A, Fraifeld S, Sosna J. Dual-Energy Derived Virtual Nonenhanced Computed Tomography Imaging: Current Status and Applications. Semin Ultrasound CT MR 2010; 31:321-7. [DOI: 10.1053/j.sult.2010.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Bakoyiannis CN, Tsekouras NS, Georgopoulos SE, Skrapari IC, Economopoulos KP, Tsigris C, Bastounis EA. Minilaparotomy abdominal aortic aneurysm repair in the era of minimally invasive vascular surgery: preliminary results. ANZ J Surg 2010; 79:829-35. [PMID: 20078535 DOI: 10.1111/j.1445-2197.2009.05111.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the early post-operative clinical impact of minimal incision aortic surgery (MIAS) for infrarenal abdominal aortic aneurysm (AAA) repair in comparison with the standard open repair. METHODS A case-control study was conducted. Patients of groups A (19 patients) and B (18 patients) were treated with the MIAS technique and the standard open method, respectively. RESULTS There were significant differences between the two groups in fluid resuscitation during the operation. Post-operatively, there were significant differences between groups A and B in the time until starting liquid diet (2 +/- 0.74 versus 3.55 +/- 0.85 post-operative days (PD), respectively; P < 0.05), the time until starting the solid diet (3.05 +/- 0.77 versus 5.11 +/- 0.75 PD, respectively; P < 0.05), the time of ambulation (2 +/- 0.74 versus 3.4 +/- 0.98 PD, respectively; P < 0.05) and in the hospital length of stay (4 +/- 0.81 versus 9.7 +/- 2.66 days, respectively; P < 0.05). CONCLUSIONS The MIAS technique, for repair of infrarenal aortic aneurysms, is a safe and feasible procedure that combines the early advantages of endovascular repair with the long-term advantages of the traditional open repair.
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Affiliation(s)
- Chris N Bakoyiannis
- First Department of Surgery, Vascular Department, University of Athens Medical School, 'Laiko' General Hospital, Athens, Greece.
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36
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Endovascular Abdominal Aortic Aneurysm Repair: Part I. Ann Vasc Surg 2009; 23:799-812. [DOI: 10.1016/j.avsg.2009.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 03/21/2009] [Indexed: 12/20/2022]
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37
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Marrocco-Trischitta MM, Melissano G, Castellano R, Coppi G, Chiesa R. Endovascular abdominal aortic aneurysm repair in a patient with severe hemophilia B. J Endovasc Ther 2009; 16:120-3. [PMID: 19281292 DOI: 10.1583/08-2584.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report a case of endovascular aneurysm repair (EVAR) in a patient with severe hemophilia B. CASE REPORT A 63-year-old man with severe hemophilia B was referred for the treatment of a symptomatic infrarenal aortic aneurysm that had enlarged from 3.1 to 4.2 cm in diameter in the last 6 months. The patient was successfully treated with EVAR, associated with perioperative administration of titrated doses of high-purity factor IX concentrate. There were no perioperative complications, but a small type II endoleak was found on the initial postoperative computed tomographic scan; on the 6 month scan, the endoleak had not changed, and it is under intensive surveillance. CONCLUSION This case demonstrates that endovascular abdominal aortic repair is safe and feasible in severe hemophilic patients managed perioperatively with deficient coagulant protein replacement.
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Kristmundsson T, Sonesson B, Malina M, Björses K, Dias N, Resch T. Fenestrated endovascular repair for juxtarenal aortic pathology. J Vasc Surg 2009; 49:568-74; discussion 574-5. [PMID: 19135836 DOI: 10.1016/j.jvs.2008.10.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 09/30/2008] [Accepted: 10/05/2008] [Indexed: 11/28/2022]
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40
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Corbett TJ, Callanan A, Morris LG, Doyle BJ, Grace PA, Kavanagh EG, McGloughlin TM. A review of the in vivo and in vitro biomechanical behavior and performance of postoperative abdominal aortic aneurysms and implanted stent-grafts. J Endovasc Ther 2008; 15:468-84. [PMID: 18729555 DOI: 10.1583/08-2370.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms has generated widespread interest since the procedure was first introduced two decades ago. It is frequently performed in patients who suffer from substantial comorbidities that may render them unsuitable for traditional open surgical repair. Although this minimally invasive technique substantially reduces operative risk, recovery time, and anesthesia usage in these patients, the endovascular method has been prone to a number of failure mechanisms not encountered with the open surgical method. Based on long-term results of second- and third-generation devices that are currently becoming available, this study sought to identify the most serious failure mechanisms, which may have a starting point in the morphological changes in the aneurysm and stent-graft. To investigate the "behavior" of the aneurysm after stent-graft repair, i.e., how its length, angulation, and diameter change, we utilized state-of-the-art ex vivo methods, which researchers worldwide are now using to recreate these failure modes.
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Affiliation(s)
- Timothy J Corbett
- Centre for Applied Biomedical Engineering Research, MSSI, Department of Mechanical and Aeronautical Engineering, University of Limerick, Ireland
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Chandarana H, Godoy MCB, Vlahos I, Graser A, Babb J, Leidecker C, Macari M. Abdominal Aorta: Evaluation with Dual-Source Dual-Energy Multidetector CT after Endovascular Repair of Aneurysms—Initial Observations. Radiology 2008; 249:692-700. [DOI: 10.1148/radiol.2492080359] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Endovascular Abdominal Aortic Aneurysm Repair: A Community Hospital's Experience. Vasc Endovascular Surg 2008; 43:25-9. [DOI: 10.1177/1538574408322754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) has become the first-line approach for the treatment of abdominal aortic aneurysms. Outcomes outside of tertiary care settings remain unknown. The purpose of this study is to report the midterm outcomes of EVAR in a community hospital. A retrospective review of 75 elective, consecutive EVARs performed at a single nonacademic community hospital was performed. There were no conversions to open repair during or after endovascular repair. The mean follow-up was 18 months. There were no postoperative ruptures or aneurysm-related deaths. At 24 months, freedom from aneurysm-related death was 100%, freedom from secondary interventions was 91%, and freedom from endoleak was 69%. EVAR in the community setting is a safe and durable procedure, even in a medically high-risk population. Comparable outcomes can be achieved to tertiary care centers, in carefully selected patients with favorable anatomy.
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Lange C, Aasland JK, Ødegård A, Myhre HO. The Durability of Evar — What are the Evidence and Implications on Follow-Up? Scand J Surg 2008; 97:205-12. [DOI: 10.1177/145749690809700227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of follow-up investigations, and how complications and secondary procedures influence cost-effectiveness. Material and Methods: 263 patients were treated by EVAR from february 1995-february 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program. Results: There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well. Conclusions: Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This follow-up regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.
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Affiliation(s)
- C. Lange
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
| | - J. K. Aasland
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
| | - A. Ødegård
- Department of Radiology, St. Olavs Hospital, University Hospital of Trondheim
| | - H. O. Myhre
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
- Department of Circulation Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Paolini D, Chahwan S, Wojnarowski D, Pigott JP, LaPorte F, Comerota AJ. Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians. J Vasc Surg 2008; 47:924-7. [DOI: 10.1016/j.jvs.2007.12.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 12/10/2007] [Accepted: 12/13/2007] [Indexed: 11/15/2022]
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