1
|
Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
Collapse
|
2
|
Stage II Pancreatic Adenocarcinoma after Endovascular Repair of Abdominal Aortic Aneurysm: A Case Report and Literature Review. J Clin Med 2023; 12:jcm12020443. [PMID: 36675372 PMCID: PMC9865745 DOI: 10.3390/jcm12020443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUNDS Concomitant abdominal aortic aneurysms (AAA) and gastrointestinal malignancies are uncommon. Endovascular repair (EVAR) is widely used to treat AAA. However, no consensus exists on the optimal strategy for treating AAA when associated with pancreatic adenocarcinoma. In addition, only few reports of pancreaticoduodenectomy (PD) after EVAR exist. PRESENTATION OF CASE A pancreatic tumor was detected during follow-up after EVAR for AAA in an 83-year-old female patient. The diagnosis was high-grade intraepithelial neoplasia. Modified pylorus-preserving pancreaticoduodenectomy was safely performed. The patient recovered moderately and was discharged two weeks after surgery. The pathological diagnosis was middle-grade pancreatic ductal adenocarcinoma. The patient survived for 24 months with no recurrence or cardiovascular complications. CONCLUSIONS Conducting periodic follow-ups after AAA surgery is helpful for the early discovery of gastrointestinal tumors. EVAR surgery is safe and feasible and thus recommended for AAA patients with pancreatic cancer, although it may increase the risk of cancer. The stage of malignancy and post-EVAR medical history can be valuable in evaluating the benefits of pancreatic surgery for such cases.
Collapse
|
3
|
Kobus K, Bohmann B, Wilbring M, Kapalla M, Eckstein HH, Bassermann F, Stratmann JA, Wahida A, Reeps C, Schwaiger BJ, Busch A, von Rose AB. Cancer, cancer treatment and aneurysmatic ascending aorta growth within a retrospective single center study. VASA 2023; 52:38-45. [PMID: 36373268 DOI: 10.1024/0301-1526/a001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Multi-morbidity poses a substantial challenge for health care in an aging population. Recent studies did not provide evidence for general side effects of anti-cancer therapy regarding the growth rate of coincident abdominal aortic aneurysms, although it was suggested that specific therapeutic substances might accelerate growth. Aneurysm pathology, however, differs with respect to localization. Hence, we present the first ever analysis on the association of cancer and cancer therapy with growth alteration of aneurysms of the ascending aorta (AscAA). Patients and methods: A retrospective single-center identification of AscAA+cancer patients was performed in the institutional picture archiving and communication system (PACS). Included were all patients with ≥2 CT angiograms over ≥6 months and additional malignancy. Clinical data and aneurysm diameters were retrieved and analyzed for an association of cancer (stratified by tumor entity) or cancer therapy (stratified by several classes of chemotherapeutic agents and radiation therapy) with annual growth rate, respectively. Statistics included t-test, Wilcoxon test, and a linear regression model accounting for initial AscAA diameter and type of treatment. Results: From 2003 to 2021, 151 patients (median age 70 years; 85% male) with AscAA and coincident 163 malignancies were identified. Prostate (37%) and hematologic cancer (17%) were most frequent. One-hundred-eleven patients (74%) received chemotherapy and 75 patients (50%) had radiation. After exclusion of six patients with an initial AscAA diameter >55 mm, the average annual AscAA growth rate was 0.18±0.64 mm/year, with only 12 patients experiencing a growth rate >1mm/year. Neither tumor entity nor radiation or chemotherapy - alone or in combination - were significantly associated with an alteration of the annual AscAA growth rate. Likewise, a subanalysis for singular chemotherapeutic agents did not reveal a specific association with AscAA growth alteration. Conclusions: Growth rates of AscAA are low in this cohort with coincident malignancy. Cancer and/or chemotherapy or radiation are not associated with an alteration of the annual growth rate. Additional control examinations seem unnecessary.
Collapse
Affiliation(s)
- Kathrin Kobus
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Bianca Bohmann
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Germany
| | - Marvin Kapalla
- Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Florian Bassermann
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Jan A Stratmann
- Department of Hematology and Oncology, Johann Wolfgang Goethe University of Frankfurt, Frankfurt am Main, Germany
| | - Adam Wahida
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Germany
| | - Benedikt J Schwaiger
- Department of Radiology and Department of Neuroradiology, School of Medicine, Technical University of Munich, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Germany.,Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Germany
| | - Aaron Becker von Rose
- III. Medical Department for Hematology and Oncology, Klinikum rechts der Isar, Technical University Munich, Germany
| |
Collapse
|
4
|
Reina N, Galzerano G, Diliberti S, Calì F, Savaia M, Benevento D, Setacci C. Midterm outcomes of 71 consecutive abdominal aortic aneurysm patients treated with the TREO stent-graft in a single center. INT ANGIOL 2020; 39:405-410. [DOI: 10.23736/s0392-9590.20.04336-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
5
|
Maxwell DW, Kenney L, Sarmiento JM, Rajani RR. Aortic Aneurysm Natural Progression is Not Influenced by Concomitant Malignancy and Chemotherapy. Ann Vasc Surg 2020; 71:29-39. [PMID: 32927035 DOI: 10.1016/j.avsg.2020.08.137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic aneurysms occur concomitantly with malignancy in approximately 1.0-17.0% of patients. There is little published information regarding the effects of subsequent oncological therapies on aortic aneurysm growth. The aim of this study was to determine the effects of chemoradiation therapies on the natural progression of small abdominal aortic aneurysm (AAA), thoracic aortic aneurysm, and thoracoabdominal aortic aneurysm. METHODS Patients with aortic aneurysms with and without malignancy between 2005 and 2017 were identified within institutional databases using Current Procedural Terminology and International Classification of Disease codes. Inclusion criteria included complete chemotherapy documentation, a minimum of 3 multiplanar axial/coronal imaging or ultrasonography before, during, and after receiving therapy or 2 studies for patients without malignancy. Propensity matching, Cox and linear regression, and Kaplan-Meier survival analyses were performed. RESULTS A total of 159 (172 aneurysms) patients with malignancy and 127 (149 aneurysms) patients without malignancy were included. Average patient demographics were 74.4 ± 9.8-years-old, Caucasian (66.8%), male (70.3%), with hypertension (71.1%), current smoking (24.5%), coronary atherosclerotic disease (26.2%), and AAA (71.0%). The most common malignancy was lung cancer (48.4%) with most chemotherapy regimens including a platinum-based alkylating agent and concurrent antimetabolite (56.0%). The overall median follow-up time was 28.2 (range 3.1-174.4) months. Aortic aneurysms in patients without malignancy grew to larger sizes (4.43 ± 0.96 vs. 4.14 ± 1.00, P = 0.008) with similar median growth rates (0.12 vs. 0.12 cm/year, P = 0.090), had more atypical morphologic features (14.1% vs. 0.6%, P < 0.001), more frequently underwent repair (22.1% vs. 8.7%, P = 0.001), and more frequently required emergency repair for rupture (5.4% vs. 0.0%, P = 0.087). Cox regression identified initial aortic size ≥4.0 cm (hazard ratio [HR] 3.028), AAA (HR 2.146), chronic aortic findings (3.589), and the use of topoisomerase inhibitors (HR 2.694). Linear regression demonstrated increased growth rates predicted by antimetabolite chemotherapy (β 0.170), initial aortic size (β 0.086), and abdominal aortic location (β 0.139, all P < 0.002). CONCLUSIONS Small aortic aneurysms with concomitant malignancies are discovered at smaller initial sizes, grow at similar rates, require fewer interventions, and have fewer ruptures and acute dissections than patients without malignancy. Antimetabolite therapies modestly accelerate aneurysmal growth, and patients receiving topoisomerase inhibitors may require earlier repair. Patients with concomitant disease can be confidently treated according to standard institutional aneurysm surveillance protocols. Overall, we recommend treatment of the malignancy before small aortic aneurysm repair as these aneurysms behave similarly to those in patients without malignancy.
Collapse
Affiliation(s)
| | - Lisa Kenney
- School of Medicine, Emory University Hospital, Atlanta, GA
| | - Juan M Sarmiento
- Department of Surgery, Emory University Hospital, Atlanta, GA; Winship Cancer Center, Division of Oncologic Surgery, Emory University Hospital, Atlanta, GA
| | - Ravi R Rajani
- Department of Surgery, Emory University Hospital, Atlanta, GA; Division of Vascular Surgery, Emory University Hospital, Atlanta, GA.
| |
Collapse
|
6
|
Alvarez-Cardona J, Mitchell J, Lenihan D. Vascular Toxicity in Patients with Cancer: Is There a Recipe to Clarify Treatment? CME. Methodist Debakey Cardiovasc J 2020; 15:289-299. [PMID: 31988690 DOI: 10.14797/mdcj-15-4-289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The acknowledgement of cardiovascular disease as one of the leading causes of mortality and morbidity among cancer survivors is the cornerstone of the growing field of cardio-oncology. Although standardizing treatment for any given disease is often considered ideal, it is important to recognize the value of pursuing a practical and personalized approach when caring for an oncology patient to minimize the risk of treatment-related cardiotoxicity. We hereby discuss a series of cases that illustrate the ways vascular toxicity can manifest in patients with cancer and, when appropriate, provide scientific evidence that supports clinical decision making. We also raise questions about the complex management of these patients while shedding light on future research in this growing field.
Collapse
|
7
|
Ohara H, Ishibashi Y, Yoshimura S, Yamazaki R, Hatao F, Koshiishi T, Morita Y, Imamura K. Intratumoral pseudoaneurysm within a liver metastasis of gastric cancer: a case report. Surg Case Rep 2020; 6:39. [PMID: 32072324 PMCID: PMC7028880 DOI: 10.1186/s40792-020-00806-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intrahepatic artery pseudoaneurysms are mostly iatrogenic and result from hepatobiliary interventions. The incidence of intrahepatic artery pseudoaneurysms within liver tumors without prior intervention is extremely rare. We presented herein the first report of a case of an intratumoral pseudoaneurysm within a liver metastasis of gastric cancer without any prior intervention during chemotherapy. CASE PRESENTATION A 59-year-old male patient underwent a distal gastrectomy and D2 lymph node dissection for gastric cancer. He was treated in the emergency room for right abdominal pain following the 4th cycle of nivolumab administration as second-line chemotherapy after adjuvant chemotherapy with S-1 and first-line chemotherapy for a liver metastasis of gastric cancer with ramucirumab plus paclitaxel. CT showed a 72-mm metastatic liver tumor containing a 9-mm pseudoaneurysm and fluid collection around the hepatic edge. Intrahepatic artery pseudoaneurysm within the metastatic liver tumor was diagnosed, with the surrounding fluid indicating potential, active bleeding. An emergency angiography confirmed the presence of a pseudoaneurysm in the intrahepatic artery, which was embolized using microcoils. The contributory causes of the intratumoral pseudoaneurysm were assumed to be the following: (1) tumor necrosis leading to encasement, erosion of the vessel wall, and subsequent arterial wall weakening; and (2) inhibition of vascular endothelial growth by ramucirumab resulting in a vessel wall breach and pseudoaneurysm formation. CONCLUSION It is necessary to recognize that pseudoaneurysms can arise within a metastatic liver tumor during chemotherapy.
Collapse
Affiliation(s)
- Hiroki Ohara
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan.
| | - Shuntaro Yoshimura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Ryoto Yamazaki
- Department of Surgery, Tokyo Metropolitan Matsuzawa Hospital, 2-1-1 Kamikitazawa, Setagaya-ku, Tokyo, 156-0057, Japan
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Takeshi Koshiishi
- Department of Radiology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| | - Kazuhiro Imamura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-shi, Tokyo, 183-8524, Japan
| |
Collapse
|
8
|
Inra ML, McCormick MG, Bagameri G, Lin PT. Thoracic aortic dissection associated with involvement by small lymphocytic lymphoma/chronic lymphocytic leukemia: a possible underappreciated risk factor? Cardiovasc Pathol 2019; 45:107179. [PMID: 31865269 DOI: 10.1016/j.carpath.2019.107179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/18/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
We report a case of a 77-year-old man with small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) thought to be in remission who developed an acute type A thoracic aortic dissection despite no known risk factors for aortic dissection. Surgical pathology evaluation of the aorta specimen removed at surgery showed direct lymphocytic infiltration of the aortic adventitia and media in the region of the aortic dissection. The potential causative role and pathophysiologic mechanisms of SLL/CLL in aortic dissection are discussed.
Collapse
Affiliation(s)
- Matthew L Inra
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter T Lin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
9
|
Cosic L, Theivendren M, Spanger M, Weinberg L. Popliteal pseudoaneurysm after FOLFOX chemotherapy for metastatic colorectal cancer. Int J Surg Case Rep 2019; 63:1-4. [PMID: 31494411 PMCID: PMC6734032 DOI: 10.1016/j.ijscr.2019.08.028] [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] [Received: 05/04/2019] [Revised: 08/03/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Popliteal artery aneurysms are a rare occurrence in the general population. We present the case of a male who developed a popliteal artery pseudoaneurysm following chemotherapy for metastatic colorectal cancer. CASE PRESENTATION A 49-year old male presented with a popliteal artery pseudoaneurysm after completing four two-weekly cycles of FOLFOX chemotherapy. There was no history of infection, knee trauma, inflammatory diseases, or any family history of cardiovascular disease or aneurysms. Examination revealed a tender pulsatile mass in the right popliteal fossa with calf oedema. Computed tomography angiography demonstrated a right popliteal pseudoaneurysm, that was treated with endovascular stent grafting. DISCUSSION Anecdotal evidence suggests a link between chemotherapy and the rapid development of abdominal aortic aneurysms exists. Aneurysms have been reported following cisplatin and 5-fluorouracil treatment and trans-arterial administration of irinotecan, a key component of chemotherapy. Chemotherapeutic agents have also been shown to compromise the integrity of the vascular wall through apoptosis of endothelial and smooth muscle cells. In our case, the pseudoaneurysm developed acutely after treatment with FOLFOX, therefore a mechanistic association is plausible. CONCLUSION Differentiating aneurysms as false (pseudo) or true is important to help determine the underlying aetiology. Common causes of pseudoaneurysms include arterial blunt or penetrating trauma. True aneurysms commonly develop from inflammatory atherosclerosis, however mycotic infection, inflammatory arteritis, and entrapment syndrome should be excluded. There may be some evidence to suggest a genetic predisposition to popliteal artery aneurysms. Anecdotal evidence suggests a weak association between chemotherapy and aneurysm progression, warranting further investigation into a causative link.
Collapse
Affiliation(s)
- Luka Cosic
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia
| | - Mayo Theivendren
- Department of Vascular Surgery, Austin Hospital, Victoria, 3084, Australia
| | - Manfred Spanger
- Department of Radiology, Box Hill Hospital, Box Hill, Victoria, 3128, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia; Department of Surgery, Austin Health, University of Melbourne, Victoria, 3084, Australia.
| |
Collapse
|
10
|
Endovascular Exclusion of Abdominal Aortic Aneurysms and Simultaneous Resection of Colorectal Cancer. Ann Vasc Surg 2019; 58:1-6. [PMID: 31009731 DOI: 10.1016/j.avsg.2019.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND No consensus exists on the optimal strategy for treatment of abdominal aortic aneurysm (AAA) associated with colorectal cancer (CRC). The purpose of this study was to evaluate the results of endovascular treatment of AAA with simultaneous resection of CRC. METHODS Twenty-two consecutive patients presenting with AAA associated with a CRC were treated by endovascular AAA exclusion and simultaneous CRC resection. Median diameter of the aneurysm was 6.5 cm (range, 4.8-8 cm). Two patients (9%) had grade I cancer, 5 patients (23%) grade II, 13 patients (59%) grade III, and 2 patients (9%) grade IV. The 2 surgical procedures were performed under the same general anesthesia. Aneurysm exclusion was achieved using an infrarenal aorto-bi-iliac endoprosthesis (13 patients) and using an aorto-bi-iliac endoprosthesis with suprarenal fixation (9 patients), with 1 patient receiving bilateral renal chimney stent implantation. In all cases, vascularization of the hypogastric arteries was preserved. After AAA exclusion, colic resection was carried out by laparotomy with right colectomy (7 patients) and anterior rectocolic resection (15 patients). In all patients, AAA exclusion was controlled by a computed tomographic angioscan (CTA) at 1 month and duplex ultrasound every 6 months, and at some later stage, it was through inclusion of CTA as part of oncology surveillance. The mean duration of follow-up was 42 months (10-120 months). The primary endpoint was composite and regrouped any death occurring during the first 30 days after procedures, any type I endoleak, any aortic reintervention, and any AAA-related mortality. RESULTS No patient died during the first 30 postoperative days, and no patient was lost to follow-up. No aortic endoprosthesis infection and no type I endoleak were observed. Five endoleaks arising from the lumbar arteries (n = 4) or from the inferior mesenteric artery (n = 1) were identified. As they were not associated with an increase of the AAA diameter >5 mm, they were not treated. 1 colic anastomotic leak and 2 incisional abscesses were successfully cured by local care only. Nine patients (41%) died of cancer evolution during the follow-up period. CONCLUSIONS In this series, treatment of AAA and CRC during the same operative session yields results comparable to those observed when surgery is performed in 2 distinct operative sessions. Synchronous treatment reduced waiting time of colic resection. It may also shorten total hospitalization duration, although this last hypothesis is not supported by comparison with a control group.
Collapse
|
11
|
Peeters B, Moreels N, Vermassen F, van Herzeele I. Management of abdominal aortic aneurysm and concomitant malignant disease. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:468-475. [PMID: 30916530 DOI: 10.23736/s0021-9509.19.10946-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Concomitant malignant disease and abdominal aortic aneurysms (AAA) represent a challenging issue in terms of treatment priority, timing and perspectives. This systematic review provides an overview of the available literature about AAA and concomitant malignant disease. EVIDENCE ACQUISITION We conducted a literature search of all the English-language medical literature in Medline (through PubMed), Embase, Clinical Trial databases and the Cochrane Library up to December 31st, 2018. EVIDENCE SYNTHESIS The literature about AAA and concomitant malignant disease is mostly based on retrospective small case series. Two recently published meta-analyses focusing on the management of AAA and concomitant abdominal neoplasms came to the same conclusion "treat what is most threatening or symptomatic first." The threshold to treat asymptomatic AAA should not be altered in patients with AAA and concomitant cancer including cases under chemotherapy. An asymptomatic AAA of at least 55 mm anatomically suitable for EVAR, should only be treated first in patients with at least a life expectancy of two years followed by staged cancer surgery two weeks later. CONCLUSIONS Decisions about management of AAA and concomitant malignant disease should be based on clinical judgment applied individually in a multidisciplinary setting ("treat first what kills first"). The indication for treatment is not different than in patients with AAA without cancer. A staged approach is preferable and ideally the AAA should be excluded by endovascular means if anatomically suitable. An international registry should be initiated to gather more evidence about the management and outcomes of patients with AAA and concomitant carcinoma.
Collapse
Affiliation(s)
- Bernard Peeters
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium -
| |
Collapse
|
12
|
Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 873] [Impact Index Per Article: 174.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
13
|
Kotsis T, Dellis AE. Surgical Repair of Abdominal Aortic Aneurysm in Patients with Simultaneous Urological Disorders: a Single Center Experience. Med Arch 2018; 72:230-233. [PMID: 30061774 PMCID: PMC6021157 DOI: 10.5455/medarh.2018.72.230-233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Although rare, co-existence of abdominal aortic aneurysms with urological manifestations, suggests a challenging surgical entity in terms of successful aneurysmal repair along with minimally or null urological complications. Case reports There are neither available data regarding the incidence of their co-existence nor consensus regarding optimal surgical management. Given the infrequency of their simultaneous presentation, the report of unusual cases as well as proposal for successful surgical management, are always useful and educative. Conclusion Precise imaging pre-operatively and meticulous surgical technique intra-operatively are of utmost importance and suggest our vast allies in successful outcomes. Herein, we present our small case series of 3 interesting cases.
Collapse
Affiliation(s)
- Thomas Kotsis
- Vascular Surgery Unit - 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios E Dellis
- Vascular Surgery Unit - 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| |
Collapse
|
14
|
Raupach J, Vales J, Vojacek J, Hoffmann P, Lojik M, Kamaradova K, Cabelkova P, Chovanec V, Renc O, Krajina A, Maly R. Endovascular Treatment of Symptomatic Thoracic Aneurysm Due to Periaortic Lymphoma. Vasc Endovascular Surg 2018. [PMID: 29528841 DOI: 10.1177/1538574418762649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell lymphoma by computed tomography-guided biopsy, the antilymphoma therapy was initiated. Despite the full treatment, the patient died 12 months later.
Collapse
Affiliation(s)
- Jan Raupach
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Jan Vales
- 2 Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- 3 Faculty of Medicine, Department of Cardiac Surgery, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Petr Hoffmann
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Miroslav Lojik
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Katerina Kamaradova
- 4 Faculty of Medicine, The Fingerland Department of Pathology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Pavla Cabelkova
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Vendelin Chovanec
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Ondrej Renc
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Antonin Krajina
- 1 Faculty of Medicine, Department of Radiology, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Radovan Maly
- 5 Faculty of Medicine, Department of Medicine, Charles University and University Hospital, Hradec Kralove, Czech Republic
| |
Collapse
|
15
|
Leopardi M, Di Marco E, Musilli A, Ricevuto E, Bruera G, Ventura M. Effects of Chemotherapy in Patients with Concomitant Aortic Aneurysm and Malignant Disease. Ann Vasc Surg 2017; 45:268.e13-268.e20. [PMID: 28739458 DOI: 10.1016/j.avsg.2017.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 07/01/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of the study is to present the results in a consecutive series of patients affected by aortic abdominal aneurysm and to underline the aneurysmal growth and evolution in oncological patients submitted to dedicated oncological medical therapy. METHODS Between January 2010 and June 2016 we treated in our center 19 patients for coexisting aortic aneurysms (>3 cm) and malignancy. We observed patients undergoing oncological treatment and patients who did not undergo medical treatment. We studied computed tomography (CT) scan at the time when patients were addressed at our follow-up or treatment and we analyzed retrospectively prior CT scan at 6 and 12 months. RESULTS Among those 19 patients, 7 patients were affected by colorectal cancer (36.8%), 6 by urinary tract cancer (31.6%), 4 by lymphoma (21%), and 2 by lung cancer (10.6%). In 8 patients who did not undergo oncological therapy, we did not observe any aortic growth; instead, in other 4 patients who underwent oncological medical therapy (3 abdominal aortic aneurysms and 1 thoracic aneurysm), we observed a mean sac growth of 2.9 cm in 6 months with 2 cases of aortic rupture treated in urgent fashion. The treatment was open surgery in 2 cases and endovascular in other cases. CONCLUSIONS We observed that oncological drugs may play a role in aneurysm growth. Few case reports are found in the literature and more evidences are to be found. Those information may influence intention-to-treat small aneurysms in short life expectancy patients.
Collapse
Affiliation(s)
- Marco Leopardi
- Vascular Surgery Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
| | - Evelina Di Marco
- Vascular Surgery Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Aldo Musilli
- Vascular Surgery Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Enrico Ricevuto
- Oncology Territorial Care Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Gemma Bruera
- Oncology Territorial Care Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Marco Ventura
- Vascular Surgery Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
16
|
Vaislic CD, Fabiani JN, Chocron S, Robin J, Costache VS, Villemot JP, Alsac JM, Leprince PN, Unterseeh T, Portocarrero E, Glock Y, Rousseau H. Three-Year Outcomes With the Multilayer Flow Modulator for Repair of Thoracoabdominal Aneurysms. J Endovasc Ther 2016; 23:762-72. [DOI: 10.1177/1526602816653095] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate midterm outcomes of endovascular repair of types II and III thoracoabdominal aortic aneurysms (TAAA) using the Multilayer Flow Modulator (MFM) in patients unsuitable for open surgery or fenestrated stent-grafts. Methods: In the prospective, multicenter, nonrandomized STRATO trial (EudraCT registration: 2009-013678-42; ClinicalTrials.gov identifier NCT01756911), 23 patients (mean age 75.8 years; 19 men) with Crawford type II and III TAAA (mean diameter 6.5 cm) were implanted between April 2010 and February 2011. Outcomes included all-cause mortality and stable aneurysm thrombosis with associated branch vessel patency. Results: Through 36 months, there were 7 deaths (none confirmed as aneurysm-related), and no cases of spinal cord injury, device migration or fracture, or respiratory, renal, or peripheral complications. Three patients were lost to follow-up and 2 devices were explanted. The device was patent in the 11 remaining patients at 3 years. Stable aneurysm thrombosis was achieved for 15 of 20 patients at 12 months, 12 of 13 at 24 months, and 10 of 11 at 36 months. The rate of branch patency was 96% at 12 months (primary patency), 100% at 24 months, and 97% at 36 months. Nine patients suffered from endoleaks (attachment site or device overlap); 9 patients underwent 11 reinterventions (3 surgical). Maximum aneurysm diameter was stable for 18 of 20 patients at 12 months, 11 of 13 at 24 months, and 9 of 11 at 36 months. For 10 patients with computed tomography at 36 months, the mean ratio of aneurysm flow volume to total volume had decreased by 83%; the mean ratio of thrombus volume to total volume increased by 159%. Conclusion: Through 3 years, endovascular repair with the MFM appears to be safe and effective while successfully maintaining branch vessel patency.
Collapse
Affiliation(s)
- Claude D. Vaislic
- Department of Cardiac, Vascular, and Thoracic Surgery, Centre Hospitalier Privé Parly 2, Le Chesnay, France
| | - Jean Noël Fabiani
- Department of Cardiovascular Surgery, Hôpital Européen Georges-Pompidou, Paris, France
| | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, Hôpital Jean Minjoz, Besançon, France
| | - Jacques Robin
- Department of Cardiovascular Surgery, Hôpital Louis Pradel, Lyon-Bron, France
| | - Victor S. Costache
- Department of Cardiac Surgery, Centre Hospitalier de la Région d’Annecy, Metz-Tessy, France
| | - Jean-Pierre Villemot
- Department of Cardiovascular Surgery and Transplantation, CHU-Nancy, Hôpital d’adultes de Brabois, Nancy, France
| | - Jean Marc Alsac
- Department of Cardiovascular Surgery, Hôpital Européen Georges-Pompidou, Paris, France
| | - Pascal N. Leprince
- Department of Thoracic and Cardiovascular Surgery, Hôpital Pitié-Salpétrière, Paris, France
| | - Thierry Unterseeh
- Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Claude Galien, Quincy-sous-Sénart, France
| | - Eric Portocarrero
- Department of Cardiovascular Surgery and Transplantation, CHU-Nancy, Hôpital d’adultes de Brabois, Nancy, France
| | - Yves Glock
- Department of Cardiovascular Surgery, CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | - Hervé Rousseau
- Department of Radiology, CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | | |
Collapse
|
17
|
Treatment of Abdominal Aortic Aneurysms in Cancer Patients. Ann Vasc Surg 2016; 30:159-65. [DOI: 10.1016/j.avsg.2015.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/04/2015] [Accepted: 07/18/2015] [Indexed: 11/22/2022]
|
18
|
Maeda K, Ohki T, Kanaoka Y, Toya N, Baba T, Hara M, Hagiwara S. Current surgical management of abdominal aortic aneurysm with concomitant malignancy in the endovascular era. Surg Today 2015; 46:985-94. [PMID: 26471508 DOI: 10.1007/s00595-015-1262-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/02/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE The management of abdominal aortic aneurysm (AAA) with concomitant malignancy is controversial in terms of which treatment should come first. The aim of this study was to evaluate the outcomes of endovascular aortic repair (EVAR) as the initial treatment prior to the treatment of malignancy for patients with AAA and concomitant malignancy. METHODS EVAR for AAA was performed in 1,175 cases between April 2007 and April 2014, of which 63 patients (5.4 %) who had AAAs and malignancy were identified. The clinical details and outcomes for patients with AAA and malignancy were evaluated. RESULTS The mean age of patients with AAA and malignancy was 76.6 years. Thirty-three patients underwent EVAR before surgery for their malignancies, and 30 patients received chemoradiotherapy following EVAR. No significant differences in the length of stay (LOS), 30-day mortality, and morbidities were observed in all groups. However, the overall survival rate of the patients who had AAA and malignancy was lower than those who had only AAA (P < 0.0001). The mean intervals from EVAR to surgery and chemoradiotherapy for malignancy in our institution were 13.4 days (overall 38.1 days) and 5.8 days (overall 18.2 days), respectively. CONCLUSION EVAR for patients with AAA and concomitant malignancy may be acceptable in terms of a short LOS and resulting in treatment for malignancy without delay.
Collapse
Affiliation(s)
- Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Naoki Toya
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takeshi Baba
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masayuki Hara
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shin Hagiwara
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| |
Collapse
|
19
|
Rapid aneurysm growth after transarterial chemoembolization. J Vasc Surg Cases 2015; 1:65-67. [PMID: 31724565 PMCID: PMC6849894 DOI: 10.1016/j.jvsc.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022] Open
Abstract
Chemotherapy has been anecdotally related to aneurysm growth, but no correlation has been noted to date for localized transarterial chemoembolization. We present the case of a 64-year-old man with clearly documented accelerated aortic and iliac artery aneurysm dilation after two rounds of transarterial chemoembolization for hepatocellular carcinoma. Given the large size with rapid growth of his aneurysms and inability to be listed for transplant consideration before repair, he was offered endovascular repair and was successfully treated.
Collapse
|
20
|
The effect of chemotherapy for malignancy on the natural history of aortic aneurysm. J Vasc Surg 2014; 61:50-7. [PMID: 25149862 DOI: 10.1016/j.jvs.2014.06.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/25/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Surgical dogma holds that chemotherapy increases the risk of aneurysm growth and rupture. We sought to determine the effect of cytotoxic chemotherapy on the growth of aortic aneurysms. METHODS All patients undergoing chemotherapy for malignancy with coexisting aortic aneurysms at our institution between 2000 and 2011 were identified. Review of electronic medical records and rereview of serial cross-sectional imaging was performed. An additional cohort of patients undergoing aneurysm surveillance during the same period was identified, and demographic and anatomic variables were collected. Planned analysis included descriptive analysis, change in aneurysm diameter over time, and association of growth or need for intervention with type of chemotherapy and type of malignancy. RESULTS Between 2000 and 2011, 125 patients at our institution had a concurrent diagnosis of aortic aneurysm and malignancy requiring cytotoxic chemotherapy. Cross-sectional imaging was available for 91 patients. The predominant malignancy type was lung cancer (34 of 91 [38%]), followed by lymphoma (21 of 91 [23%]) and colorectal cancer (10 of 91 [11%]). Most aneurysms were infrarenal (53 of 91 [58%]). Most patients were treated with more than one class of chemotherapeutic agent over 267 days (interquartile range [IQR], 144-469 days), and most had at least one cycle of alkylating agents (73 of 91), in addition to antimetabolites (42 of 91) and plant alkaloids/terpenoids (40 of 92). Chemotherapy regimens included steroids in 84 patients (92%). The baseline aneurysm diameter was 41.4 mm (IQR, 34.9-51.3 mm) for patients who received chemotherapeutic agents and 46.0 mm (IQR, 40-52 mm) for those who did not. Eight of the 91 patients (9%) underwent aneurysm repair during chemotherapy, but only two required urgent repair due to aneurysm rupture. The rate of aneurysm growth per year for patients who did and did not receive chemotherapy was similar at 2.3 mm vs 2.4 mm (P = .69). CONCLUSIONS In 91 patients over 10 years at our institution, chemotherapy did not increase aneurysm growth compared with patients not undergoing treatment for malignancy.
Collapse
|
21
|
Varetto G, Castagno C, Ripepi M, Garneri P, Quaglino S, Rispoli P. Rupture of giant superficial femoral artery aneurysm in a leukemic patient submitted to chemotherapy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:413-5. [PMID: 25207255 PMCID: PMC4157509 DOI: 10.5090/kjtcs.2014.47.4.413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/28/2013] [Accepted: 12/31/2013] [Indexed: 11/23/2022]
Abstract
The superficial femoral artery (SFA) is a relatively rare location for lower limb aneurysmatic disease. In the literature, this disease is described an association between a relatively high growth rate and/or the rupture of aneurysms and chemotherapeutic agents. We report a case of the rupture of a giant SFA aneurysm in a patient during chemotherapy for acute lymphatic leukemia.
Collapse
|
22
|
Rupture of abdominal aortic aneurysm after intravitreal bevacizumab injection: a case report. J Med Case Rep 2014; 8:48. [PMID: 24520842 PMCID: PMC3938302 DOI: 10.1186/1752-1947-8-48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/20/2013] [Indexed: 01/04/2023] Open
Abstract
Introduction We describe the case of a man who died of an abdominal aortic aneurysm rupture after an intravitreal injection of bevacizumab for neovascular age-related macular degeneration. Case presentation A 74-year-old Korean man presented with visual disturbance in his right eye. He had previously been diagnosed with diabetes and hypertension, which were controlled with oral medications. We diagnosed him with neovascular age-related macular degeneration and he was treated by monthly intravitreal injection of bevacizumab for three months. Four days after his third intravitreal bevacizumab injection, he died of an abdominal aortic aneurysm rupture and uncontrolled bleeding. Conclusion Abdominal aortic aneurysm rupture is highly lethal and there is a possible correlation with intravitreal injection of bevacizumab. Thus, we need to consider the risks of intravitreal bevacizumab injections for patients with abdominal aortic aneurysms.
Collapse
|
23
|
Affiliation(s)
- Wai-ki Yiu
- Division of Vascular & Endovascular Surgery, Department of Surgery, The University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Pokfulam Rd, Hong Kong.
| | | | | |
Collapse
|
24
|
Tsilimparis N, Ricotta JJ, Dayama A, Reeves JG, Perez S, Sweeney JF. The effect of recent chemotherapy in aorto-iliac aneurysm repair. Vascular 2013; 22:98-104. [DOI: 10.1177/1708538112473970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of the study was to investigate the effect of recent chemotherapy (Chx) on outcome of aorto-iliac aneurysm (AAA) repair. The 2005–2010 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify vascular patients undergoing AAA repair within 30 days after Chx. Seventy-one patients underwent AAA repair within 30 days of receiving Chx, group A (71 ± 8.4 years, 77.5% males) and 20,024 patients underwent AAA repair without prior Chx, group B (73 ± 9 years, 79.2% males). The two groups did not significantly differ with respect to open or endovascular repair (open repair A: 32%, B: 35%, P = 0.66). However, patients in group A presented more often as emergent cases (A: 27%, B: 12%, P = 0.001). Multivariable regression analysis for emergent cases after adjustment for relevant confounders also demonstrated that patients with recent Chx present more often as emergency ( P = 0.001, odds ratio [OR]: 2.4). Thirty-day non-surgical complications were more common in group A (A: 25%, B: 16.5%, P = 0.046) while surgical complications were equivalent (A: 15.5%, B: 12.3%, P = 0.414). Risk of death was significantly higher in group A in univariate analysis (A: 13%, B: 5%, P = 0.005, OR: 2.6). Patients who receive Chx within 30 days prior to AAA repair present more frequently as emergencies leading to higher mortality. The reason for this cannot be sufficiently explained by the current database but patient selection for elective repair or the effect of Chx on the natural course of AAA may play a role.
Collapse
Affiliation(s)
- Nikolaos Tsilimparis
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA, USA
- University Heart Center Hamburg, Germany, Department of Vascular Medicine - Vascular Surgery
| | - Joseph J Ricotta
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Anand Dayama
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - James G Reeves
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Sebastian Perez
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - John F Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
25
|
Zanow J, Leistner Y, Ludewig S, Rauchfuss F, Settmacher U. Unusual course of an abdominal aortic aneurysm in a patient treated with chemotherapy for gastric cancer. J Vasc Surg 2012; 55:841-3. [DOI: 10.1016/j.jvs.2011.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/11/2011] [Accepted: 09/03/2011] [Indexed: 11/29/2022]
|
26
|
Concomitant abdominal aortic aneurysm and rectal cancer: a treatment dilemma. Tech Coloproctol 2009; 13:327-8. [PMID: 19813076 DOI: 10.1007/s10151-009-0541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
27
|
Khan NU, Khan U, Al-Aloul M, Yonan N, Khasati N, Machaal A, Doran H, Leonard C. Segmental Mediolytic Arteriopathy With Post-transplant Lymphoproliferative Disorder of the Lung: Case Report and Review of the Literature. J Heart Lung Transplant 2009; 28:977-80. [DOI: 10.1016/j.healun.2009.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 04/12/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022] Open
|
28
|
Shalhoub J, Naughton P, Lau N, Tsang JS, Kelly CJ, Leahy AL, Cheshire NJW, Darzi AW, Ziprin P. Concurrent colorectal malignancy and abdominal aortic aneurysm: a multicentre experience and review of the literature. Eur J Vasc Endovasc Surg 2009; 37:544-56. [PMID: 19233691 DOI: 10.1016/j.ejvs.2009.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES There is lack of consensus regarding concurrent vs. staged approaches, and the prioritisation of staged procedures in cases presenting with colorectal carcinoma (CRC) and abdominal aortic aneurysm (AAA) synchronously. We aim to present our experience, review the literature on this therapeutic dilemma and examine the role of endovascular aortic repair (EVAR). DESIGN, MATERIALS AND METHODS An observational study of the experience of two centres and a systematic review of the published literature. RESULTS Twenty-four patients were identified from the prospective databases of two tertiary referral centres between 2001 and 2006. Intervention for both malignancy and aneurysm was performed in 13 patients. In 10 patients, cancer resection was performed initially and was followed by open aneurysm repair (n=3) or EVAR (n=7). Two patients (AAA diameters: 7.0 and 8.0cm) underwent EVAR prior to colonic resection. One patient was selected for synchronous surgery. There were no interval AAA ruptures, graft infection or postoperative mortalities. Literature review identified 269 such cases; of these 101 were treated by combined surgery. In staged surgery, there were nine interval aneurysmal ruptures and one aortic graft infection. CONCLUSIONS In our experience, staged management can be undertaken, without interval aneurysmal rupture. EVAR has an evolving role in preventing delay in CRC management, in high-risk patients, and during combined intervention.
Collapse
Affiliation(s)
- J Shalhoub
- Department of Bio Surgery & Surgical Technology, Faculty of Medicine, Imperial College London, St Mary's Hospital, London, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Blochle R, Lall P, Cherr GS, Harris LM, Dryjski ML, Hsu HK, Dosluoglu HH. Management of patients with concomitant lung cancer and abdominal aortic aneurysm. Am J Surg 2008; 196:697-702. [PMID: 18823617 DOI: 10.1016/j.amjsurg.2008.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 07/02/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Management of patients with an abdominal aortic aneurysm (AAA) and malignancy is challenging. We aimed to define the coincidence of AAA and lung cancer and to determine a treatment strategy. METHODS The outcomes for patients diagnosed with AAA and lung cancer between 1991 and 2004 at our institution were reviewed retrospectively. RESULTS We identified 75 patients with both lesions among 1,096 AAA and 1,875 lung cancer patients. Survival correlated with cancer stage; only 3 deaths were directly attributable to the patient's AAA. Of 59 patients who did not have AAA repair at the time of cancer diagnosis, 12 were repaired. Twenty-seven of those 59 patients had a 5.0-cm or larger AAA; only 1 patient with a 7.5-cm AAA had a rupture 5 months after thoracotomy and died. CONCLUSIONS The co-existence of AAA and lung cancer is not rare; prognosis is poor and largely determined by the lung cancer stage. Open or endovascular repair of AAA rarely is justified in patients with advanced disease unless the AAA is symptomatic or large (>7 cm). Treatment for AAAs greater than 5.5 cm should be based on stage, histology, and patient comorbidities.
Collapse
Affiliation(s)
- Raphael Blochle
- Department of Surgery, Division of Vascular Surgery, State University of New York at Buffalo, 3495 Bailey Ave., Buffalo, NY 14215, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Porcellini M, Nastro P, Bracale U, Brearley S, Giordano P. Endovascular versus open surgical repair of abdominal aortic aneurysm with concomitant malignancy. J Vasc Surg 2007; 46:16-23. [PMID: 17606118 DOI: 10.1016/j.jvs.2006.09.070] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 09/16/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of patients with abdominal aortic aneurysm (AAA) and concurrent malignancy is controversial. This study retrospectively assessed the outcome of endovascular repair (EVAR) and open repair (OR) for the treatment of AAA in patients undergoing curative treatment for concomitant malignancies. METHODS All patients who underwent surgery for a nonruptured infrarenal AAA of > or =5.5 cm and concomitant malignancy between 1997 and 2005 were retrospectively reviewed. RESULTS Identified were 25 patients (22 men; mean age, 70.3 years) with nonruptured infrarenal AAA of > or =5.5 cm (mean size, 6.4 cm) and concomitant malignancy amenable for curative treatment. EVAR was used to treat 11 patients, and 14 underwent OR. The EVAR patients had a smaller mean aneurysm size (5.9 cm vs 6.8 cm; P = .006) than the OR patients. The mean cumulative length of stay for all patients who received treatment for both AAA and cancer was 12.8 days (range, 4 to 26) for EVAR and 18.2 days (range, 9 to 42 days) for OR. In the EVAR group, no patients died perioperatively; in the OR group, three patients died perioperatively (21.4%; P = NS). Postoperative complications occurred in one patient in the EVAR group and in seven in the OR group for a morbidity rate, respectively, of 9.1% and 50% (P = .04). One late complication (9.1%) occurred in the EVAR group. The mean follow-up was 37.7 months (range, 16 to 60 months) in the EVAR group and 29.6 months (range, 11 to 55 months) in the OR group. At 1 and 2 years, survival rates were 100% and 90.9% in the EVAR group and 71.4% and 49% in the OR group (log-rank P = .103) CONCLUSIONS With low morbidity and mortality, EVAR is a safe technique for the treatment of AAA in patients with concomitant malignancy and could be considered as an alternative to OR.
Collapse
Affiliation(s)
- Massimo Porcellini
- Department of General and Vascular Surgery, Federico II University, via Pansini 5, 80131 Naples, Italy.
| | | | | | | | | |
Collapse
|
31
|
Choke E, Cockerill G, Wilson WRW, Sayed S, Dawson J, Loftus I, Thompson MM. A Review of Biological Factors Implicated in Abdominal Aortic Aneurysm Rupture. Eur J Vasc Endovasc Surg 2005; 30:227-44. [PMID: 15893484 DOI: 10.1016/j.ejvs.2005.03.009] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 03/16/2005] [Indexed: 10/25/2022]
Abstract
Abdominal aortic aneurysm (AAA) rupture is the 13th commonest cause of death in the Western World. Although considerable research has been applied to the aetiology and mechanism of aneurysm expansion, little is known about the mechanism of rupture. Aneurysm rupture was historically considered to be a simple physical process that occurred when the aortic wall could no longer contain the haemodynamic stress of the circulation. However, AAAs do not conform to the law of Laplace and there is growing evidence that aneurysm rupture involves a complex series of biological changes in the aortic wall. This paper reviews the available data on patient variables associated with aneurysm rupture and presents the evidence implicating biological factors in AAA rupture.
Collapse
Affiliation(s)
- E Choke
- Department of Vascular Surgery, St George's Hospital Medical School, London, UK
| | | | | | | | | | | | | |
Collapse
|
32
|
Fazel S, Lawlor DK, Forbes TL. Abdominal aortic aneurysms following orthotopic heart transplantation. Vasc Endovascular Surg 2004; 38:149-55. [PMID: 15064846 DOI: 10.1177/153857440403800207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of these authors' study was to analyze their center's experience with orthotopic heart transplantation (OHT) and abdominal aortic aneurysms (AAA) with particular attention to corticosteroid dosing, hemodynamic parameters, and aneurysm growth rate. A retrospective review of all patients (453) who underwent OHT at their university-affiliated medical center over an 18-year period (1981-1999) was undertaken. Nine (2%) patients who developed AAAs were identified and aneurysm growth was correlated with corticosteroid immunosuppression and hemodynamic parameters. The mean age of OHT patients was 44.5 +/-15 years and the majority were males (371 males, 82%). Median follow-up was 5.7 years. Ischemic cardiomyopathy (IC) was the most common indication for transplantation (45.5% of patients). All AAA patients were male (p=0.157), with a mean age of 58.4 +/-4.8 years (p=0.001), and had undergone OHT for IC (p=0.001). Mean arterial blood pressure and ejection fraction in the AAA patients had increased from pretransplant values of 107 mm Hg and 14.3 +/-5.7% to 142 mm Hg (p=0.017) and 54.1 +/-14.1% (p<0.001), respectively, before aneurysm repair. Mean aneurysm diameter at the time of repair was 6.0 +/-0.8 cm, and the average growth rate was 1.2 +/-0.4 cm/year in the 4 patients in whom it could be measured. Aneurysm repair was performed urgently in 2 patients and electively in 7 patients with 1 early postoperative death (11%). The extent of corticosteroid immunosuppression, corticosteroid pulses, and total corticosteroid dosing did not correlate with the rate of aneurysm growth. Improved hemodynamics and progressive posttransplant hypertension may contribute to aneurysm formation and growth in this group of patients.
Collapse
Affiliation(s)
- Shafie Fazel
- Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | | | | |
Collapse
|
33
|
Ballardini P, Incasa E, Del Noce A, Cavazzini L, Martoni A, Piana E. Spontaneous Splenic Rupture after the Start of Lung Cancer Chemotherapy. A Case Report. TUMORI JOURNAL 2004; 90:144-6. [PMID: 15143989 DOI: 10.1177/030089160409000129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hamartoma of the spleen, first described by Rokitansky in 1861 under the name of “splenoma”, is a rare benign lesion that is nearly always asymptomatic. Apart from the congenital forms there are also acquired forms of splenoma that are frequently associated with hematological diseases or solid tumors. We describe the case of a man suffering from splenoma who had a spontaneous rupture of the spleen with serious hemoperitoneum a few hours after the start of polychemotherapy for squamous cell lung cancer. The close temporal relationship with the event led us to suspect that the drugs used (cisplatin, vinorelbine and corticosteroids) could have played a causal role. From a review of the literature this seems to be the third case reported of spontaneous rupture of the spleen with hamartoma, and the first with the concomitant occurrence of lung cancer.
Collapse
|
34
|
von Rahden BHA, Stein HJ, Reiter R, Becker I, Siewert JR. Delayed aortic rupture after radiochemotherapy and esophagectomy for esophageal cancer. Dis Esophagus 2003; 16:346-9. [PMID: 14641303 DOI: 10.1111/j.1442-2050.2003.00366.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous rupture of major vessels is a known though rare complication in treatment of patients with esophageal cancer, but its pathophysiology is not very well understood. We herein report about the sudden death of a 42-year-old man due to spontaneous aortic rupture, 11 days after transthoracic esophagectomy. Because of a locally advanced squamous cell carcinoma of the distal esophagus, which was considered irresectable at the time of presentation, the patient had received one course of chemotherapy followed by synchronous chemoradiation (60 Gy, 5-fluorouracil and cisplatin) prior to surgery. We discuss the patho-anatomic findings of the postmortem examination concerning alterations of the aortic wall and the potential correlations with aggressive radiochemotherapy protocols.
Collapse
Affiliation(s)
- B H A von Rahden
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Germany.
| | | | | | | | | |
Collapse
|