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Blair R, Harkin D, Johnston D, Lim A, McFetridge L, Mitchell H. Open Surgery for Abdominal Aortic Aneurysm: 980 Consecutive Patient Outcomes from a High-Volume Centre in the United Kingdom. Vasc Endovascular Surg 2023:15385744221149585. [PMID: 36714998 DOI: 10.1177/15385744221149585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy persists regarding the optimal treatment for large abdominal aortic aneurysm (AAA), highlighted by the publication of the National Institute for Health and Care Excellence (NICE) guideline (NG156) on March 2020. The pendulum of opinion swings once more from endovascular to open surgical treatment. We report our experience over the last 15 years in treating consecutive AAA by open surgery. METHODS A retrospective review of a prospectively collected vascular database of all patients undergoing infra-renal open abdominal aortic aneurysm repair (OR) repair from 2004 to 2019 at the largest aneurysm centre in the United Kingdom. OR for elective and emergency (ruptured and symptomatic) outcomes included early morbidity and 30-day mortality, and long-term survival. RESULTS 1017 patients underwent OR between 2004-2019, on application of our inclusion-criteria 994 patients formed our cohort for analysis (81.2% male) with a mean age 73.6 ± 7.8 years treated by OR for AAA. In that group 672 were elective and 308 were emergency (for ruptured or symptomatic). Overall 30 day mortality was 11.3%, elective 30 day mortality was 2.5%, and emergency 30 day mortality was 29.9%. 30 day re-intervention rate was 9.5%, (elective 7.0%, emergency 15.9%). Survival at 1000 days for elective repair was 72 v 46.7% for emergency and at 2000 days was 43.4% for elective v 25% for emergency. CONCLUSION Our data confirm that open surgery for AAA can be performed in large volume centres quite safely. Elective and Emergency surgery does affect early 30 day mortality but does not influence long-term outcome.
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Affiliation(s)
- Robert Blair
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Denis Harkin
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK.,Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Dorothy Johnston
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Adrian Lim
- Belfast Vascular Centre, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Lisa McFetridge
- Mathematical Sciences Research Centre, 227990Queen's University Belfast, Belfast, UK
| | - Hannah Mitchell
- Mathematical Sciences Research Centre, 227990Queen's University Belfast, Belfast, UK
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Kapila V, Jetty P, Wooster D, Vucemilo V, Dubois L. Screening for abdominal aortic aneurysms in Canada: 2020 review and position statement of the Canadian Society for Vascular Surgery. Can J Surg 2021; 64:E461-E466. [PMID: 34467750 PMCID: PMC8526155 DOI: 10.1503/cjs.009120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abdominal aortic aneurysms (AAAs) remain a major risk to patients, despite level 1 evidence for screening to prevent rupture events and decrease mortality. In 2007, the Canadian Society for Vascular Surgery (CSVS) published a review and position statement for AAA screening in Canada. Since that publication, there have been a number of updates in the published literature affecting screening recommendations. In this paper, we present a review of some of the controversies in the AAA screening literature to help elucidate differences in the various published screening guidelines. This article represents a review of the data and updated recommendations for AAA screening in the Canadian population on behalf of the CSVS. Les anévrismes de l’aorte abdominale (AAA) continuent de poser un risque majeur pour les patients, malgré des données probantes de niveau 1 à l’appui du dépistage pour prévenir les ruptures et réduire la mortalité. En 2007, la Société canadienne de chirurgie vasculaire (SCCV) a publié une revue et un énoncé de position sur le dépistage de l’AAA au Canada. Depuis lors, plusieurs mises à jour ont paru dans la littérature et elles ont un impact sur les recommandations relatives au dépistage. Dans le présent article, nous présentons une synthèse de quelques controverses soulevées dans la littérature sur le dépistage de l’AAA afin d’expliquer les différences entre les diverses lignes directrices publiées à ce sujet. Cet article propose au nom de la SCCV une revue des données probantes et des recommandations à jour sur le dépistage de l’AAA dans la population canadienne.
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Affiliation(s)
- Varun Kapila
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Prasad Jetty
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Doug Wooster
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Vic Vucemilo
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
| | - Luc Dubois
- From the William Osler Health System, Brampton, Ont. (Kapila); the University of Ottawa, Ottawa, Ont. (Jetty); the University of Toronto, Toronto, Ont. (Wooster); Trillium Health Partners, Mississauga, Ont. (Vucemilo); and Western University, London, Ont. (Dubois)
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Tang GHL, Tadros RO. Endovascular Aortic Repair in Nonagenarians: Select Well and Time Appropriately. J Am Coll Cardiol 2021; 77:1900-1902. [PMID: 33858627 DOI: 10.1016/j.jacc.2021.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA.
| | - Rami O Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, New York, USA
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Comparing and Correlating Outcomes between Open and Percutaneous Access in Endovascular Aneurysm Repair in Aortic Aneurysms Using a Retrospective Cohort Study Design. Int J Vasc Med 2020; 2020:8823039. [PMID: 33312729 PMCID: PMC7719509 DOI: 10.1155/2020/8823039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022] Open
Abstract
Objective This retrospective cohort study is aimed at determining the safety and efficacy between Femoral Open-Cutdown access and Percutaneous access with Endovascular Aneurysm Repair (EVAR) by contrasting perioperative complication rates. We hypothesized that the percutaneous approach is a better alternative for aortic aneurysm patients as it is minimally invasive and has been demonstrated to decrease the length of hospital stay. Methods We retrospectively reviewed data for patients undergoing EVAR between the years of 2005 and 2013. We then compared overall mortality, hematoma or seroma formation, graft infection, arterio-venous injury, distal embolization, limb loss, myocardial infarction or arrhythmia, and renal dysfunction. Results were demonstrated using a retrospective cohort study design to confirm the hematoma rate associated with EVAR open compared to percutaneous access. Results Our series involves 73 patients who underwent percutaneous access for EVAR (n = 49) or traditional open cutdown (n = 24). Percutaneous access resulted in significantly less hematoma formation when compared to the traditional open cutdown (4% vs. 12.5%; p < 0.059). Our analysis suggests decreased mortality rates associated with EVAR as compared to the Open-Cutdown method using Northside Medical Center's Study and the OVER Veterans Affairs Cooperative Study (p = 0.0053). Conclusion Percutaneous access for EVAR is safe and effective when compared to Open-Cutdown access for aortic aneurysm patients. Percutaneous access was associated with decreased rates of in-hospital mortality, hematoma formation, graft infection, and respiratory failure.
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Raju S, Eisenberg N, Montbriand J, Roche-Nagle G. Endovascular repair of abdominal aortic aneurysm in octogenarians: clinical outcomes and complications. Can J Surg 2020; 63:E329-E337. [PMID: 32644318 PMCID: PMC7458675 DOI: 10.1503/cjs.009019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/01/2022] Open
Abstract
Background Endovascular aneurysm repair (EVAR) is associated with decreased perioperative morbidity and mortaliy in comparison with open repair, and thus octagenarians are traditionally offered EVAR given their age and medical comorbidities. The aim of this study was to investigate outcomes and predictors of complications associated with EVAR in octogenarians. Methods We conducted a retrospective chart review of consecutive patients aged 80 years and older who received an EVAR between August 2010 and January 2017 at a single centre in Toronto, Ontario. We conducted univariate comparisons and then completed logistic regression to determine predictors of complications. We used Kaplan-Meier analysis to explore survival times. Results A total of 154 octogenarians underwent an EVAR during the study period for an infrarenal aneurysm with a mean size of 64.8 (standard deviation [SD] 12.7) mm. The mean age of the patients was 84.1 (SD 3.7) years, and most patients (81%) were men. Eighteen patients presented with a ruptured abdominal aortic aneurysm (AAA). Ninety-five (62%) patients sustained a complication. Fifty percent of patients experienced an intraoperative complication. A majority of these (77%) resulted in an endoleak, with type II endoleaks requiring no further intervenion being the most common (58%, n = 45). The remaining complications (n = 70) occurred postoperatively, with myocardial ischemia (n = 24) and dysrhythmias (n = 10) being the most common. Past aortic surgery (χ2 = 8.62, p = 0.014, Cramer V = 0.27) was found to be a multivariate predictor of complications. Most patients (88%) continued follow-up to an average of 20.9 months. Twenty-one patients (13%) died. Nine of these deaths (43%) occurred during the index admission and involved a ruptured AAA. Past aortic surgery was the only predictor of vascular complications. The mean survival time after EVAR was 57.63 months for patients without events. Conclusion Endovascular aneurysm repair in octogenarians is a suitable form of therapy with acceptable short- and long-term results in the elective setting. Past aortic surgery was a predictor of complications in this population.
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Affiliation(s)
- Sneha Raju
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); the Division of Vascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); and the Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ont. (Eisenberg, Montbriand)
| | - Naomi Eisenberg
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); the Division of Vascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); and the Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ont. (Eisenberg, Montbriand)
| | - Janice Montbriand
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); the Division of Vascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); and the Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ont. (Eisenberg, Montbriand)
| | - Graham Roche-Nagle
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); the Division of Vascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ont. (Raju, Roche-Nagle); and the Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ont. (Eisenberg, Montbriand)
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Mwipatayi BP, Oshin OA, Faraj J, Varcoe RL, Wong J, Becquemin JP, Riambau V, Böckler D, Verhagen HJ. Analysis of Midterm Outcomes of Endovascular Aneurysm Repair in Octogenarians From the ENGAGE Registry. J Endovasc Ther 2020; 27:836-844. [PMID: 32436808 DOI: 10.1177/1526602820923827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess periprocedural results and secondary endovascular procedure outcomes over 5 years in patients aged ≥80 vs <80 years undergoing endovascular aneurysm repair (EVAR). MATERIALS AND METHODS Data from the Endurant Stent Graft Natural Selection Global post-market registry (ENGAGE) were used for the analyses. A total of 1263 consecutive patients were enrolled in the prospective, observational, single-arm registry and divided into 2 groups according to age: ≥80 years (290, 22.9%) and <80 years (973, 77.1%). Baseline patient characteristics, risk scores according to the Society for Vascular Surgery (SVS) reporting standards, American Society of Anesthesiologists (ASA) classification, quality of life assessments [EuroQol 5 (EQ5D) index], and treatment outcomes, including all-cause mortality, aneurysm-related mortality, major adverse events, secondary endovascular procedures, and endoleaks were compared between groups. RESULTS Octogenarians were classified into the highest category of the SVS risk stratification system; however, this did not result in a significant difference in the 30-day mortality [1.4% (4/290) vs 1.2% (12/973) for controls; p=0.85] or major adverse event rates [5.2% (15/290) vs 3.6% (35/973), p=0.23]. Multivariable analysis confirmed that age ≥80 years, pulmonary disease, large aneurysm diameter, and renal insufficiency were significantly associated with all-cause mortality, whereas diameter was the only parameter associated with increased aneurysm-related mortality. The differences in freedom from secondary endovascular procedures over 5 years between octogenarians and controls did not reach statistical significance (88.5% vs 83.2%, p=0.07). CONCLUSION EVAR can be performed in individuals aged ≥80 years with no statistically significant difference in midterm aneurysm-related deaths compared with younger patients. The findings in this elderly patient cohort show that EVAR can be safely performed with acceptable morbidity rates in octogenarians.
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Affiliation(s)
- Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Olufemi A Oshin
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Joseph Faraj
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ramon L Varcoe
- Department of Surgery, Prince of Wales Hospital and the University of New South Wales, Sydney, Australia
| | - Jackie Wong
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Vincente Riambau
- Division of Vascular Surgery, Thorax Institute, Hospital Clinic, University of Barcelona, Spain
| | - Dittmar Böckler
- Division of Vascular Surgery, University Hospital Heidelberg, Germany
| | - Hence J Verhagen
- Division of Vascular and Endovascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Sheikh Z, Crockett S, Selvakumar S. Endovascular aneurysm repair in a centenarian: case report and systematic literature review. J Surg Case Rep 2020; 2020:rjaa025. [PMID: 32269752 PMCID: PMC7121094 DOI: 10.1093/jscr/rjaa025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/06/2020] [Indexed: 11/13/2022] Open
Abstract
The prevalence of abdominal aortic aneurysms (AAA) in the nonagenarian and centenarian populations is set to increase. Endovascular aneurysm repair (EVAR) has been shown to be achievable with excellent outcomes in carefully selected nonagenarians. However, experience with centenarians is limited. We report the case of a 100-year-old who presented with a tender 8-cm AAA and successfully underwent EVAR. This report describes the second case of AAA repair in a centenarian in the literature and the first reported EVAR in this demographic. The patient survived for 2 years after the procedure, was free of EVAR or aneurysm-related complications. Furthermore, we present a systematic review of the existing literature and insights pertaining to outcomes in nonagenarians undergoing EVAR.
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Affiliation(s)
- Zara Sheikh
- Department of Vascular Surgery, East and North Hertfordshire NHS Foundation Trust, Lister Hospital, Stevenage, UK
| | - Stephen Crockett
- Department of Vascular Surgery, East and North Hertfordshire NHS Foundation Trust, Lister Hospital, Stevenage, UK
| | - Sadasivam Selvakumar
- Department of Vascular Surgery, East and North Hertfordshire NHS Foundation Trust, Lister Hospital, Stevenage, UK
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Juraszek A, Rylski B, Kondov S, Scheumann J, Kreibich M, Morlock J, Schröfel H, Berger T, Kari F, Siepe M, Beyersdorf F, Czerny M. Late surgical conversions after abdominal endovascular aortic repair: underlying mechanisms, clinical results and strategies for prevention. Interact Cardiovasc Thorac Surg 2019; 29:944-949. [DOI: 10.1093/icvts/ivz207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 01/31/2023] Open
Abstract
Abstract
OBJECTIVES
Our goal was to report our results of late surgical conversion after endovascular aneurysm repair (EVAR).
METHODS
Variables analysed included baseline data, preinterventional anatomy, type of endovascular intervention, indications for conversion, operative technique, postoperative complications and follow-up survival rate.
RESULTS
Between April 2011 and May 2018, 16 patients with late complications after EVAR underwent open surgical conversion at our institution. The mean age was 73.6 [standard deviation (SD) 8.9] years. There were 3 (18.8%) female patients. In 15 patients, the indication for primary EVAR was abdominal aortic aneurysm, and in 1 patient, chronic abdominal aortic dissection. Five patients underwent secondary EVAR service interventions for endoleak treatment between the index EVAR and the final secondary surgical conversion. Thirteen patients underwent surgery in an elective setting and 3 patients underwent emergency surgery. The mean time from EVAR to open surgical conversion was 6.31 (SD 4.0) years (range 1.2–16.0 years). The most common indication for conversion was endoleak formation (n = 12, 75%), followed by 3 cases of aortic rupture (1 patient with primary type 1 endoleak) and 2 cases of stent graft infection—1 with and 1 without an aortoduodenal fistula. One patient died during emergency open surgery of cardiopulmonary instability. Three patients developed postoperative renal dysfunction with recovery of their renal function before discharge. The in-hospital mortality rate was 12.5%. The median follow-up was 16.5 months (interquartile range 21 months). Freedom from death and aortic reintervention was 100%, respectively. After careful review of the index computed tomography scans for EVAR, the majority of failures could have been anticipated due to trade-offs with regard to length, diameter, morphology, shape and angulation of the proximal and/or distal landing zone.
CONCLUSIONS
Despite being a challenging operation, late surgical conversion after EVAR yields excellent results with regard to outcome and freedom from the need for further aortic interventions. An anticipative strategy adhering to current recommendations for using or refraining from using EVAR in patients with anatomical challenges will help reduce the need for secondary surgical conversions and keep them to minimum.
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Affiliation(s)
- Andrzej Juraszek
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszyński Institute of Cardiology, Warsaw, Poland
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Johannes Scheumann
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Julia Morlock
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Fabian Kari
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
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Pini R, Gallitto E, Faggioli G, Mascoli C, Vacirca A, Fenelli C, Gargiulo M, Stella A. Predictors of perioperative and late survival in octogenarians undergoing elective endovascular abdominal aortic repair. J Vasc Surg 2019; 69:1405-1411. [DOI: 10.1016/j.jvs.2018.07.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/09/2018] [Indexed: 02/04/2023]
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Shan L, Saxena A, Goh D, Robinson D. A systematic review on the quality of life and functional status after abdominal aortic aneurysm repair in elderly patients with an average age older than 75 years. J Vasc Surg 2019; 69:1268-1281. [DOI: 10.1016/j.jvs.2018.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
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Matteo J, Hood P, Hulsberg PC, Eadie E, Soule E, Shabandi M, Harmon TS. Larger Sizes Matter More! Applying the Matteo Mathematics Method for Endovascular Aortic Bifurcation Reconstruction to Large Venous Vascular Repair. Cureus 2018; 10:e3537. [PMID: 30648070 PMCID: PMC6318114 DOI: 10.7759/cureus.3537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/02/2018] [Indexed: 11/05/2022] Open
Abstract
Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction is a well-established option with mortality benefits compared to conventional surgical management. The same theory, formulas, and techniques can be applied to the central venous system as long as there are commercially available devices. Using mathematically derived criteria for optimal stent size selection, endovascular aortic bifurcation reconstruction with kissing stents was extrapolated to the inferior vena cava (IVC). This report describes a traumatic case of IVC injury that was successfully repaired using the standard aortic grafts while adhering to the guidelines for proper stent size selection.
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Affiliation(s)
- Jerry Matteo
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Preston Hood
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Paul C Hulsberg
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Eadie
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Soule
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Michael Shabandi
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Taylor S Harmon
- Interventional Radiology, The University of Texas Medical Branch, Galveston, USA
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12
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Law Y, Chan Y, Cheng S. Predictors of early operative mortality and long-term survival in octogenarians undergoing open and endovascular repair of abdominal aortic aneurysm. Asian J Surg 2018; 41:490-497. [DOI: 10.1016/j.asjsur.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/17/2017] [Accepted: 09/07/2017] [Indexed: 11/15/2022] Open
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13
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Hye RJ, Janarious AU, Chan PH, Cafri G, Chang RW, Rehring TF, Nelken NA, Hill BB. Survival and Reintervention Risk by Patient Age and Preoperative Abdominal Aortic Aneurysm Diameter after Endovascular Aneurysm Repair. Ann Vasc Surg 2018; 54:215-225. [PMID: 30081171 DOI: 10.1016/j.avsg.2018.05.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/01/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) has become the standard of care for abdominal aortic aneurysm (AAA), but questions remain regarding the benefit in high-risk and elderly patients. The purpose of this study was to examine the effect of age, preoperative AAA diameter, and their interaction on survival and reintervention rates after EVAR. METHODS Our integrated health system's AAA endograft registry was used to identify patients who underwent elective EVAR between 2010 and 2014. Of interest was the effect of patient age at the time of surgery (≤80 vs. >80 years old), preoperative AAA diameter (≤5.5 cm vs. >5.5 cm), and their interaction. Primary endpoints were all-cause mortality and reintervention. Between-within mixed-effects Cox models with propensity score weights were fit. RESULTS Of 1,967 patients undergoing EVAR, unadjusted rates for survival at 4 years after EVAR was 76.1%, and reintervention-free rate was 86.0%. For mortality, there was insufficient evidence for an interaction between age and AAA size (P = 0.309). Patient age >80 years was associated with 2.53-fold higher mortality risk (hazard ratios [HR] = 2.53; 95% confidence intervals [CI], 1.73-3.70; P < 0.001), whereas AAA > 5.5 cm was associated with 1.75-fold higher mortality risk (HR = 1.75; 95% CI, 1.26-2.45; P = 0.001). For reintervention risk, there were no significant interactions or main effects for age or AAA diameter. CONCLUSIONS Age and AAA diameter are independent predictors of reduced survival after EVAR, but the effect is not amplified when both are present. Age >80 years or AAA size >5.5 cm did not increase the risk of reintervention. No specific AAA size, patient age, or combination thereof was identified that would contraindicate AAA repair.
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Affiliation(s)
- Robert J Hye
- Department of Surgery, Southern California Permanente Medical Group, San Diego, CA
| | - Afra U Janarious
- Department of Surgery, Southern California Permanente Medical Group, San Diego, CA
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Guy Cafri
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA
| | - Robert W Chang
- Department of Surgery, The Permanente Medical Group, South San Francisco, CA
| | - Thomas F Rehring
- Department of Vascular Surgery, Colorado Permanente Medical Group, Denver, CO
| | - Nicolas A Nelken
- Department of Vascular Therapy, Hawaii Permanente Group, Honolulu, HI
| | - Bradley B Hill
- Department of Vascular Surgery, The Permanente Medical Group, Santa Clara, CA.
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14
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Prospective cohort 20 years after endovascular treatment for abdominal aortic aneurysm. J Vasc Surg 2017; 67:1102-1109. [PMID: 29074113 DOI: 10.1016/j.jvs.2017.08.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the factors associated with survival 20 years after endovascular treatment of an abdominal aortic aneurysm (AAA) in a single center. METHODS Prospective cohort of asymptomatic patients with an infrarenal aortic aneurysm treated with a bifurcated endovascular graft (Talent) between June 1997 and August 2008. Cox proportional hazard multivariable regression was used for analysis of independent risk factors for survival. Kaplan-Meier curves were done with the long-rank test. P < .05 was considered significant. RESULTS We followed 229 patients, 184 without an endoleak and 45 with an endoleak. Ages ranged between 52 and 89 years, and the mean diameter of the aneurysm was 59.51 ± 14.6 mm. Implantation of the endovascular graft was possible in 99% of the patients. The 30-day mortality rate was 3.4%. In the Cox regression, age <73 years (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.27-0.64), aneurysm size ≤55 mm (HR, 0.62; 95% CI, 0.40-0.95), male sex (HR, 0.17; 95% CI, 0.05-0.52), American Society of Anesthesiologists surgical risk category I and II vs III and IV (HR, 0.51; 95% CI, 0.34-0.75), and aneurysm size reduction ≤3 mm after treatment (HR, 2.23; 95% CI, 1.11-4.51) were significantly correlated with the survival of the patients followed in this long-term case series. CONCLUSIONS This 20-year prospective cohort included patients with an AAA treated with a bifurcated endovascular graft (Talent) at a university hospital in Brazil. This study supports that sex, age, aneurysm size, aneurysm size reduction, and American Society of Anesthesiologists surgical risk category are significantly correlated with patient survival after endovascular treatment of the AAA.
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Tan TW, Eslami M, Rybin D, Doros G, Zhang WW, Farber A. Outcomes of endovascular and open surgical repair of ruptured abdominal aortic aneurysms in elderly patients. J Vasc Surg 2017; 66:64-70. [PMID: 28216354 DOI: 10.1016/j.jvs.2016.10.119] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/24/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is becoming the preferred treatment modality for patients with a ruptured abdominal aortic aneurysm (rAAA). Although the survival advantage of EVAR over open aortic repair (OAR) has been shown in some studies, it is unclear whether this benefit extends to elderly patients. We sought to evaluate the outcomes of rAAA repair in octogenarians. METHODS We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data set (2005-2014) to identify patients older than 80 years who were treated with EVAR and OAR for rAAA. Procedural trends were evaluated during the course of the study period. Perioperative outcomes including mortality, morbidity, and hospital length of stay (LOS) were compared. Multivariable regression models were used to identify predictors of perioperative mortality and morbidity. RESULTS Among 1048 elderly patients who underwent rAAA repair, 450 (43%) and 598 (57%) were treated with EVAR and OAR, respectively. The use of EVAR to treat rAAA had increased significantly in this population of patients (0% in 2005 vs 56% in 2014; P < .001). The overall 30-day mortality rate among octogenarians was 41%. The mortality rate was significantly higher among those treated with OAR compared with EVAR (47% vs 33%; P < .001). Pneumonia (21% vs 10%; P < .001), reintubation (14% vs 9%; P < .001), and >48-hour ventilator dependence (43% vs 21%; P < .001) were significantly higher in patients undergoing OAR. Hospital LOS (13 vs 10 days; P < .001) was also longer in the OAR cohort. Compared with EVAR, OAR was independently predictive of 30-day mortality (adjusted odds ratio [AOR], 1.7; 95% confidence interval [CI], 1.3-2.2; P < .001), pneumonia (AOR, 2.4; 95% CI, 1.7-3.6; P < .001), >48-hour ventilator dependence (AOR, 2.5; 95% CI, 1.8-3.3; P < .001), and longer LOS (adjusted mean ratio, 1.4; 95% CI, 1.2-1.6; P < .001). CONCLUSIONS Elderly patients have significant but acceptable perioperative mortality and morbidity after rAAA repair. Use of endovascular repair in the elderly population has increased and is associated with better perioperative survival and 30-day outcomes compared with traditional open repair in this study.
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Affiliation(s)
- Tze-Woei Tan
- Division of Vascular Surgery, University of Arizona, Tucson, Ariz.
| | - Mohammad Eslami
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
| | - Wayne W Zhang
- Division of Vascular Surgery, Louisiana State University Health Sciences Center, Shreveport, La
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass
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Nakano M, Kimura N, Matsumoto H, Hirano T, Adachi K, Yuri K, Yamaguchi A, Adachi H. Characteristics of Abdominal Aortic Aneurysm in Japanese Patients Aged 50 Years or Younger. Ann Vasc Dis 2017; 10:119-124. [PMID: 29034037 PMCID: PMC5579777 DOI: 10.3400/avd.oa.16-00083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective: We investigated the characteristics and surgical outcomes of abdominal aortic aneurysm (AAA), which typically occurs in elderly persons, in Japanese patients aged 50 years or younger. Materials and Methods: Clinical records of 999 patients who underwent open or endovascular repair for AAA at our hospital between 2007 and 2015 were reviewed to identify the clinical characteristics and surgical outcomes of young patients with AAA. The cohort included 14 patients aged 50 years or younger (mean, 40.4 years; young group) and 985 patients aged older than 50 years (mean, 72.8 years; old group). Results: Marfan syndrome, prior aortic dissection, and a history of aortic surgery were more prevalent in the young group, and 50% of the patients in the young group had dissecting aneurysms. All patients in the young group underwent open repair. Overall in-hospital mortality rates were 7.1% (1/14) and 1.9% (19/985) in the young and old groups, respectively (P=0.67). Seven-year survival and aortic event-free survival rates in the young group were 82.5%±11.5%, and 71.2±14.5%, respectively. Conclusion: AAA in patients aged 50 years or younger tended to be associated with Marfan syndrome, a history of aortic surgery, and prior aortic dissection. Early outcomes of AAA among young patients are acceptable, but close postoperative monitoring is important.
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Affiliation(s)
- Mitsunori Nakano
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Harunobu Matsumoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Tomoyasu Hirano
- Department of Cardiovascular Surgery, IMS Fujimi General Hospital, Fujimi, Saitama, Japan
| | - Koichi Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
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Aitken SJ, Naganathan V, Blyth FM. Aortic aneurysm trials in octogenarians: Are we really measuring the outcomes that matter? Vascular 2016. [DOI: 10.1177/1708538115597079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose This study is a systematic review to determine the types of outcomes reported in abdominal aortic aneurysm (AAA) studies of patients aged 80 and over. Specifically, it determines the types of patient-centered outcomes reported. Method MEDLINE and EMBASE were searched from 2000 to 2014 for studies on AAA surgery with outcome data on patients aged 80 and over. Outcomes were categorized according to Donabedian’s framework for health quality indicators, with further classification as procedural, complication, resource or patient-centered outcome indicators. Findings Forty studies were reviewed. Patient-centered outcomes were infrequently reported (13%, n=5), with limited outcomes specifically relevant to older patients. No studies reported physical function, activities of daily living or cognition using validated assessment methods. Short-term mortality (95%, n=38) and complications (85%, n=34) were reported most frequently. Conclusion Reporting of aortic surgery outcomes in patients aged 80 and over requires a focus upon outcomes of primary importance to people of this age.
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Affiliation(s)
- SJ Aitken
- Concord Clinical School, Professorial Surgery Unit, Department of Vascular Surgery, New South Wales, Australia
| | - V Naganathan
- Concord Clinical School, Centre for Education and Research on Ageing, Concord, Sydney, New South Wales, Australia
| | - FM Blyth
- Concord Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Silveira D, Pitoulias G, Torsello G, Donas KP. Outcomes of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians. J Vasc Surg 2016; 63:909-14. [DOI: 10.1016/j.jvs.2015.10.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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Gloviczki P, Huang Y, Oderich GS, Duncan AA, Kalra M, Fleming MD, Harmsen WS, Bower TC. Clinical presentation, comorbidities, and age but not female gender predict survival after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2015; 61:853-61.e2. [DOI: 10.1016/j.jvs.2014.12.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 12/03/2014] [Indexed: 12/20/2022]
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20
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Hughes K, Abdulrahman H, Prendergast T, Rose DA, Ongu'ti S, Tran D, Cornwell EE, Obisesan T, Amankwah KS. Abdominal Aortic Aneurysm Repair in Nonagenarians. Ann Vasc Surg 2015; 29:183-8. [DOI: 10.1016/j.avsg.2014.07.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/12/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
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21
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Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians. J Vasc Surg 2014; 60:308-17. [DOI: 10.1016/j.jvs.2014.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/21/2022]
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Visser L, Pol RA, Tielliu IFJ, van den Dungen JJAM, Zeebregts CJ. A limited and customized follow-up seems justified after endovascular abdominal aneurysm repair in octogenarians. J Vasc Surg 2014; 59:1232-40. [PMID: 24440677 DOI: 10.1016/j.jvs.2013.11.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/23/2013] [Accepted: 11/17/2013] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether long-term follow-up after endovascular aneurysm repair (EVAR) is justified in octogenarians. METHODS Between September 1996 and October 2011, all patients, including octogenarians, treated for an abdominal aortic aneurysm (AAA) by EVAR were included in a prospective database. Patients older than 80 years and with a nonruptured infrarenal aneurysm treated electively or urgently were included in the study (study group [SG]). Patients with ruptured aneurysms and patients who died during surgery or within the first postoperative month were excluded from further analysis. The control group (CG) consisted of patients younger than 80 years, matched for gender and AAA diameter. All patients were evaluated 4 to 8 weeks after EVAR and then annually thereafter. Follow-up data were complemented by review of the computerized hospital registry and charts and by contact of the patient's general practitioner or referring hospital. Primary outcomes were stent- or aneurysm-related complications and interventions. Secondary outcomes were additional surgical complications and patient survival. RESULTS A total number of 193 patients (SG, n = 97; CG, n = 96) were included for analysis. Median age was 80 years, and 88.6% were male. Median follow-up time was 33.6 months (interquartile range [IQR], 12.9-68.3). Stent- and procedure-related postoperative complications were comparable between groups (SG, 41.2%; CG, 39.6%; P = .82). Median time to complication was 2.3 months (IQR, 0.2-19.4) in the SG compared with 18.1 months (IQR, 6.8-50.5) in the CG. The 2-year complication-free survival rates were 58% (SG) and 60% (CG). Interventions were performed significantly less frequently in octogenarians (SG, 8.2%; CG, 19.8%; P < .05). Median time to intervention was 11.1 months (IQR, 2.0-31.0) in the SG compared with 54.3 months (IQR, 15.0-93.2) in the CG. The 2-year intervention-free survival rates were 90% (SG) and 92% (CG). During follow-up, 98 patients died (SG, n = 54; CG, n = 44); median time to death was 31.8 months (IQR, 13.3-66.0) in the SG compared with 44.4 months (IQR, 15.0-77.7) in the CG. One aneurysm-related death occurred in the CG. The 2- and 5-year survival rates were 71% and 32% for the SG compared with 77% and 66% for the CG (P < .05). CONCLUSIONS Because of the low incidence of secondary procedures and AAA-related deaths in octogenarians, long-term and frequent follow-up after EVAR seems questionable. An adapted and shortened follow-up seems warranted in this patient group.
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Affiliation(s)
- Linda Visser
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ignace F J Tielliu
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan J A M van den Dungen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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de Blic R, Alsac JM, Julia P, El Batti S, Mirault T, Di Primio M, Sapoval M, Messas E, Fabiani JN. Elective treatment of abdominal aortic aneurysm is reasonable in patients >85 years of age. Ann Vasc Surg 2013; 28:209-16. [PMID: 24084274 DOI: 10.1016/j.avsg.2013.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 12/03/2012] [Accepted: 01/12/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The numbers of patients >85 years of age referred for abdominal aortic aneurysm (AAA) repair have increased in recent decades. With the population aging, increased screening of AAA, and introduction of less invasive surgical techniques, vascular surgeons will be treating more elderly patients. Few data are available for estimating the risks and benefits of prophylactic repair among those with such an advanced age. The aim of this single-center study was to evaluate the short-term to midterm results after AAA repair in patients >85 years of age. METHODS Between 2004 and 2012, data of patients >85 years old who required an elective AAA repair at our institution were collected prospectively. According to the current guidelines, patients underwent endovascular aneurysm repair (EVAR) each time the aortic anatomy was suitable. Open repair (OR) was performed in those patients with hostile proximal neck anatomy and/or severe iliac tortuosity. Type of repair (EVAR or OR) and perioperative and midterm outcomes were analyzed. Primary end points were 30-day mortality and midterm survival. RESULTS Among 1016 patients undergoing elective AAA repair during the study period, 59 (5.8%) were ≥85 years of age (54 men, mean age 87 ± 2 years), with a mean aneurysm diameter of 61.5 ± 20.3 mm. Thirty-three patients (56%) underwent EVAR and 26 (44%) had an OR. Thirty-day mortality was 6.7% (6% with EVAR and 7.6% with OR, P <0.05). Mean follow-up was 24.7 ± 18 months. Kaplan‒Meier analyses for survival were 85.5%, 64.5%, and 50% at 1, 3, and 5 years, respectively. No aneurysm-related death was observed during follow-up. CONCLUSION Elective repair may be proposed in patients >85 years of age in cases of threatening AAA, showing acceptable perioperative mortality and reasonable midterm survival results. Even if EVAR did not seem to offer significant benefits in perioperative mortality in our study, it appears reasonable to suggest this less invasive technique as first-line treatment in cases of suitable anatomy in such an advanced-age population.
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Affiliation(s)
- Romain de Blic
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Jean-Marc Alsac
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
| | - Pierre Julia
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Salma El Batti
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Tristan Mirault
- Department of Vascular Medecine, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Maximiliano Di Primio
- Department of Interventional Radiology, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Marc Sapoval
- Department of Interventional Radiology, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Emmanuel Messas
- Department of Vascular Medecine, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
| | - Jean-Noël Fabiani
- Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France
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Kuivaniemi H, Sakalihasan N, Lederle FA, Jones GT, Defraigne JO, Labropoulos N, Legrand V, Michel JB, Nienaber C, Radermecker MA, Elefteriades JA. New Insights Into Aortic Diseases: A Report From the Third International Meeting on Aortic Diseases (IMAD3). AORTA (STAMFORD, CONN.) 2013; 1:23-39. [PMID: 26798669 PMCID: PMC4682695 DOI: 10.12945/j.aorta.2013.13.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/08/2013] [Indexed: 12/11/2022]
Abstract
The current state of research and treatment on aortic diseases was discussed in the "3rd International Meeting on Aortic Diseases" (IMAD3) held on October 4-6, 2012, in Liège, Belgium. The 3-day meeting covered a wide range of topics related to thoracic aortic aneurysms and dissections, abdominal aortic aneurysms, and valvular diseases. It brought together clinicians and basic scientists and provided an excellent opportunity to discuss future collaborative research projects for genetic, genomics, and biomarker studies, as well as clinical trials. Although great progress has been made in the past few years, there are still a large number of unsolved questions about aortic diseases. Obtaining answers to the key questions will require innovative, interdisciplinary approaches that integrate information from epidemiological, genetic, molecular biology, and bioengineering studies on humans and animal models. It is more evident than ever that multicenter collaborations are needed to accomplish these goals.
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Affiliation(s)
- Helena Kuivaniemi
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania
| | | | - Frank A. Lederle
- Minneapolis Center for Epidemiological and Clinical Research, Department of Medicine (III-0), VA Medical Center, Minneapolis, Minnesota
| | | | | | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Victor Legrand
- Cardiology Departments, University Hospital of Liège, CHU, Liège, Belgium
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Trenner M, Haller B, Söllner H, Storck M, Umscheid T, Niedermeier H, Eckstein HH. 12 Jahre „Qualitätssicherung BAA“ der DGG. GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00772-013-1159-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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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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Female and Elderly Abdominal Aortic Aneurysm Patients More Commonly Have Concurrent Thoracic Aortic Aneurysm. Ann Vasc Surg 2012; 26:918-23. [DOI: 10.1016/j.avsg.2012.01.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/15/2012] [Accepted: 01/28/2012] [Indexed: 11/19/2022]
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Cadili A, Turnbull R, Hervas-Malo M, Ghosh S, Chyczij H. Identifying patients with AAA with the highest risk following endovascular repair. Vasc Endovascular Surg 2012; 46:455-9. [PMID: 22717782 DOI: 10.1177/1538574412450752] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It has been demonstrated that endovascular repair of arterial disease results in reduced perioperative morbidity and mortality compared to open surgical repair. The rates of complications and need for reinterventions, however, have been found to be higher than that in open repair. The purpose of this study was to identify the predictors of endograft complications and mortality in patients undergoing endovascular abdominal aortic aneurysm (AAA) repair; specifically, our aim was to identify a subset of patients with AAA whose risk of periprocedure mortality was so high that they should not be offered endovascular repair. METHODS We undertook a prospective review of patients with AAA receiving endovascular therapy at a single institution. Collected variables included age, gender, date of procedure, indication for procedure, size of aneurysm (where applicable), type of endograft used, presence of rupture, American Society of Anesthesiologists (ASA) class, major medical comorbidities, type of anesthesia (general, epidural, or local), length of intensive care unit (ICU) stay, and length of hospital stay. These factors were correlated with the study outcomes (overall mortality, graft complications, morbidity, and reintervention) using univariate and multivariate logistic regression. RESULTS A total of 199 patients underwent endovascular AAA repair during the study period. The ICU stay, again, was significantly correlated with the primary outcomes (death and graft complications). In addition, length of hospital stay greater than 3 days, also emerged as a statistically significant predictor of graft complications in this subgroup (P = .024). Survival analysis for patients with AAA revealed that age over 85 years and ICU stay were predictive of decreased survival. Statistical analysis for other subgroups of patients (inflammatory AAA or dissection) was not performed due to the small numbers in these subgroups. CONCLUSIONS Patients with AAA greater than 85 years of age are at a greater risk of mortality following endovascular repair. In addition, patients who are expected to require postprocedure ICU admission are also at an increased risk of mortality following endovascular repair.
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Affiliation(s)
- Ali Cadili
- University of Alberta Hospital, Edmonton, Canada.
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Matteo J, Cunningham J. Size matters! A reliable endovascular method to avoid infolding and endoleaks when reconstructing aortic bifurcations using stent grafts. Vascular 2012; 20:124-8. [PMID: 22700583 DOI: 10.1258/vasc.2011.oa0340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Conventional revascularization of the lower extremities secondary to aortoiliac atherosclerotic vascular disease (ASVD) involves major intra-abdominal surgery with aortobifemoral bypass grafting. Complication rates are as high as 10% and perioperative mortality can be as high as 5%; therefore, careful patient selection is paramount. Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction is an emerging option in patients deemed unsuitable for conventional surgical management. Emerging techniques such as snorkel/chimney method are expanding the number of patients who can undergo endovascular repair of abdominal aortic aneurysms and/or revascularization of the lower extremities. However, until now, objective criteria for stent size selection used in these hybrid techniques have not been described.
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Affiliation(s)
- Jerry Matteo
- University of Florida, Shands Jacksonville, Jacksonville, FL 32209, USA.
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Robich MP, Hagberg R, Schermerhorn ML, Pomposelli FB, Nilson MC, Gendron ML, Sellke FW, Rodriguez R. Hypothermia severely effects performance of nitinol-based endovascular grafts in vitro. Ann Thorac Surg 2012; 93:1223-7. [PMID: 22385821 DOI: 10.1016/j.athoracsur.2011.12.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/18/2011] [Accepted: 12/21/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nitinol is an alloy that serves as the base for numerous medical devices, including the GORE TAG Thoracic Endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ) thoracic aortic graft device. Given the increasing use of therapeutic hypothermia used during the placement these devices and in post-cardiac arrest situations, we sought to understand the impact of hypothermia on this device. METHODS Five 34-mm TAG devices were deployed in a temperature-controlled chamber at 20°C, 25°C, 30°C, 35°, and 37°C (25 total devices). A halographic measurement device was used to measure radial expansive force and normalized to the force at 37°C. Three 34-mm TAG devices were similarly deployed in a temperature-controlled water bath at each of the above temperatures. A laser micrometer was utilized to measure deployed diameter. RESULTS A statistically significant decrease in expansive force at 20°C, 25°C, and 30°C of 65%, 46%, and 6%, respectively, was noted. A statistically significant decrease in radial diameter at 20°C and 25°C of 17% and 11%, respectively, was noted. Although a 9% difference was noted at 30°C, it was not significant. CONCLUSIONS The nitinol-based TAG device shows marked decreases in radial expansive force and deployed diameter at temperatures at or below 30°C. Surgeons should be aware of the potential implications of placing nitinol-based endoprostheses in hypothermic conditions. In addition, all health care providers should be aware of the changes that occur in nitinol-based endoprostheses during therapeutic hypothermia.
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Affiliation(s)
- Michael P Robich
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Geisbüsch P, Katzen BT, Tsoukas AI, Arango D, Peña CS, Benenati JF. Endovascular repair of infrarenal aortic aneurysms in octogenarians and nonagenarians. J Vasc Surg 2011; 54:1605-13. [DOI: 10.1016/j.jvs.2011.06.096] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/24/2011] [Accepted: 06/24/2011] [Indexed: 12/01/2022]
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Torsello G, Troisi N, Donas KP, Austermann M. Evaluation of the Endurant stent graft under instructions for use vs off-label conditions for endovascular aortic aneurysm repair. J Vasc Surg 2011; 54:300-6. [DOI: 10.1016/j.jvs.2010.12.062] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/07/2010] [Accepted: 12/18/2010] [Indexed: 11/16/2022]
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Local anaesthesia for endovascular repair of infrarenal aortic aneurysms. Eur J Vasc Endovasc Surg 2011; 42:467-73. [PMID: 21693382 DOI: 10.1016/j.ejvs.2011.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/19/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The study aimed to analyse and report the results of a 'local anaesthesia first' approach in elective endovascular aneurysm repair (EVAR) patients. MATERIAL AND METHODS Between January 2007 and August 2010, a total of 217 continuous patients (187 men, median age 76 years, range 52-94 years) underwent elective EVAR using this approach, with predefined exclusion criteria for local anaesthesia (LA). A retrospective analysis regarding technical feasibility, mortality, complication and endoleak rate was performed. The results are reported as an observational study. RESULTS LA was applied in 183 patients (84%), regional anaesthesia (RA) in nine patients (4%) and general anaesthesia (GA) in 25 patients (12%). Anaesthetic conversion from LA to GA was necessary in 14 patients (7.6%). Airway obstruction (n = 4) and persistent coughing (n = 3) were the most common causes for conversion to GA. Thirty-day mortality in the LA group was 2.7%, with 16/183 patients (8.7%) experiencing postoperative complications. All type I endoleaks (n = 5, 2.7%) occurred in patients with LA and challenging aneurysm morphologies. CONCLUSIONS A 'local anaesthesia first' strategy can successfully be applied in 75% of patients undergoing EVAR. The use of LA can impact imaging quality and thus precise endograft placement, which should be considered in patients with challenging aneurysm morphologies.
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Martínez-Mira C, Alonso-Argüeso G, Fernández-Samos R, Ortega-Martín J, Peña-Cortes R, Vaquero-Morillo F. Tratamiento endovascular de aneurismas de aorta abdominal en octogenarios: 10 años de experiencia. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Open repair of abdominal aortic aneurysm in a centenarian. J Vasc Surg 2010; 53:216-8. [PMID: 20864297 DOI: 10.1016/j.jvs.2010.07.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 11/21/2022]
Abstract
We present the case of a 101-year-old female who was successfully operated for an open elective repair of a symptomatic 9 cm abdominal aortic aneurysm. This is the oldest case reported in the literature for elective open abdominal aortic aneurysm repair with successful outcome. This case raises an important ethical issue of human life expectancy and the appropriateness of high-risk surgery on a centenarian.
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