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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 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.
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Sterpetti AV, Arici V, Franciscone M, D'Ermo G, Di Marzo L, Carati MV, Costi U, Ragni F, Arbustini E, Bozzani A. Heterogeneous Characteristics of Patients with Inflammatory Abdominal Aortic Aneurysm. Systematic Review of Therapeutic Solutions. Ann Vasc Surg 2023; 97:311-319. [PMID: 37454897 DOI: 10.1016/j.avsg.2023.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Endovascular repair of inflammatory abdominal aortic aneurysms (IAAAs) has emerged as an alternative to open surgery, but direct comparisons are limited. The aim of the study was to compare clinical outcomes of endovascular and open repair for IAAA according with specific clinical characteristics. METHODS We performed a literature review of reports describing patients who had open or endovascular repair for IAAA. A literature search was performed in June 2022 by 2 investigators who conducted a review of papers reported in PubMed, Embase, MEDLINE, and Cochrane Database. The strings "Inflammatory aneurysm" and "Abdominal Aortic Aneurysms" were used. There was no language restriction and screened reports were published from March 1972 to December 2021. We identified 2,062 patients who had open (1,586) or endovascular repair (476) for IAAA. Primary outcomes were operative mortality and morbidity. Secondary outcomes were complications during follow-up (mean follow-up: 48 months). Propensity score matching was performed between patients who had open or endovascular surgery. RESULTS In Western countries, propensity-weighted postoperative mortality (in-hospital) (1.5% endovascular vs. 6% open) and morbidity rates (6% vs. 18%) were significantly lower in patients who had endovascular repair (P < 0.0001); patients with larger aneurysm (more than 7 cm diameter), signs of active inflammation, and retroperitoneal rupture of the aneurysm had better outcomes after endovascular repair than after open surgery. Hydronephrosis was present in 20% of the patients. Hydronephrosis regressed in most patients when signs of active inflammation were present suggesting an acute onset of the hydronephrosis itself (fever, elevated serum C Reactive Protein) either after endovascular or open surgery. Long-standing hydronephrosis as suggested by the absence of signs of active inflammation rarely regressed after endovascular surgery despite associated steroid therapy. During a mean follow-up of 48 months, propensity-weighted graft-related complications were more common in patients who had endovascular repair (20% vs. 8%). For patients from Asia, short-term and medium-term results were similar after open and endovascular repair. IAAAs related with aortitis were more common in Asia. In Western countries, IAAAs were commonly associated with atherosclerosis. CONCLUSIONS Patients with IAAA represent a heterogeneous population, suggesting biological differences from continent to continent; conservative therapy and endovascular or open surgery should be chosen according to the patient clinical condition. Endovascular repair presents advantages in patients with signs of active inflammation and contained rupture of the IAAA and larger aneurysms. Hydronephrosis, without signs of active inflammation, rarely regresses after endovascular repair associated with steroid therapy. Further studies are needed to establish the long-term results of endovascular repair.
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Wang M, Yao C, Yin HH, Wang JS, Liao BY, Li ZL, Wu RD, Peng GY, Chang GQ. Endovascular Treatment of Ruptured or Symptomatic Thoracoabdominal and Pararenal Aortic Aneurysms Using Octopus Endograft Technique: Mid-Term Clinical Outcomes. J Endovasc Ther 2023; 30:163-175. [PMID: 35179077 DOI: 10.1177/15266028221075236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of using off-the-shelf "Octopus" technique to treat ruptured or symptomatic thoracoabdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PRAAA). METHODS AND RESULTS All cases who underwent "Octopus" technique from May 2016 to May 2019 at our center were retrospectively analyzed. A total of 10 cases (8 males) were included. The mean age was 54.5±14.2 years (range: 31-80 years). Eight cases presented as aneurysm rupture or impending rupture accepted emergency repair. Technical success, defined by placement of all endografts as planned, was achieved in all cases. A total of 30 target visceral branches were successfully cannulated, 9 celiac arteries were covered intentionally. Intraoperative endoleak was observed in 6 patients, all of them were gutter leak. During hospital stay, there was no death, no side branch occlusion or spinal cord ischemia. Median follow-up was 30 months (range: 12-50 months). One patient died of lung cancer at 14-month follow-up. There was no secondary endoleak. The primary endoleak were found spontaneously resolved in 3 cases at 7 days, 3-month, and 1-year imaging. One persistent endoleak totally resolved after sealing of gutter spaces at 4-month follow-up. The other 2 persistent endoleak decreased during follow-up, which are still under observation. The branch patency rate was 90.3% (28/31). All the 3 occluded branches were renal arteries. Branch occlusion occurred in 2 cases at 1-month follow-up and 1 case at 2-year follow-up, but renal insufficiency was not observed in these cases. Obvious aneurysm sac shrinkage (≥5 mm) was observed in all cases. The aneurysm size shrunk from 7.6±1.9 to 5.5±1.4 cm. No spinal cord ischemia occurred during follow-up. CONCLUSION Treatment of ruptured TAAA and PRAAA with "Octopus" technique is feasible and safe for high surgical risk patients in the absence of fenestrated and branched devices. The long-term clinical outcomes needed to be investigated.
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Affiliation(s)
- Mian Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chen Yao
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hen-Hui Yin
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jin-Song Wang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing-Ye Liao
- Anesthesia Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zi-Lun Li
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ri-Dong Wu
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gui-Yan Peng
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guang-Qi Chang
- Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Gyi R, Cho BC, Hensley NB. Patient Blood Management in Vascular Surgery. Anesthesiol Clin 2022; 40:605-625. [PMID: 36328618 DOI: 10.1016/j.anclin.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Patient blood management (PBM) is an evidence-based, multidisciplinary approach aimed at appropriately allocating blood products to patients requiring transfusion while simultaneously minimizing inappropriate transfusions. The 3 pillars of patient blood management are optimizing erythropoiesis, minimizing blood loss, and optimizing physiological reserve of anemia. Benefits seen from PBM include limiting hospital costs and mitigating harm from numerous risks of transfusion.
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Affiliation(s)
- Richard Gyi
- Department of Anesthesiology, Johns Hopkins Hospital, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA
| | - Brian C Cho
- Department of Anesthesiology, Johns Hopkins Hospital, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA; Division of Cardiothoracic Anesthesiology, Johns Hopkins University School of Medicine, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA
| | - Nadia B Hensley
- Division of Cardiothoracic Anesthesiology, Johns Hopkins University School of Medicine, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA.
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Tsolakis IA, Kakkos SK, Papageorgopoulou CP, Papadoulas S, Lampropoulos G, Fligou F, Nikolakopoulos KM, Ntouvas I, Kouri A. Predictors of Operative Mortality of 928 Intact Aortoiliac Aneurysms. Ann Vasc Surg 2020; 71:370-380. [PMID: 32890639 DOI: 10.1016/j.avsg.2020.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study is to identify preoperative and intraoperative factors associated with in-hospital mortality of intact abdominal aortoiliac aneurysm repair. METHODS In this observational study, prospectively collected information included demographics, risk factors, comorbidities, aneurysm characteristics (including special aneurysm presentation, i.e., inflammatory, mycotic/infected, aortocaval fistula), investigations, and operative variables. Receiver operating characteristic) curve analysis of the Glasgow aneurysm score (GAS) and the Vascular Study Group of New England (VSGNE) score was performed in the subgroup of bland aneurysms undergoing isolated elective repair. RESULTS A total of 928 cases with intact aortoiliac aneurysms had an elective (n = 882) or urgent (n = 46) repair, associated with an in-hospital mortality of 1.7% and 8.7%, respectively (P = 0.01). Open repair (n = 514) was a predictor of higher mortality (3.3% vs. 0.5% for endovascular aneurysm repair [EVAR], n = 414, odds ratio [OR] 7.1, P = 0.003), and so was the pre-EVAR era (4.8% vs. 1.3% in the EVAR era, OR 4.0, P = 0.004). Other significant predictors included the presence of abdominal/back pain (7.5% vs. 1.3%, OR = 6.0, P = 0.001), preoperative angiography (7% vs. 1.6%, OR = 4.5, P = 0.01), special aneurysm presentation (10.9% vs. 1.5%, OR = 8.1, P < 0.001), concomitant major procedures (19% vs. 1.7%, OR = 14.0, P < 0.001), serious intraoperative complications (9.1% vs. 1.5%, OR = 6.6, P = 0.001), median number of transfused units of blood intraoperatively (2 and 0 for cases with and without mortality, respectively, P < 0.001), and procedure duration (270 and 150 min for cases with and without mortality, respectively, P < 0.001). Open repair (OR = 4.5, P = 0.05), special aneurysm presentation (OR = 6.58, P = 0.001), and concomitant major procedures (OR = 14.3, P < 0.001) were independent predictors of higher mortality. ROC curve analysis for the GAS (P = 0.87) and VSGNE score (P = 0.10) failed to demonstrate statistical significance in the subgroup of bland aneurysms undergoing isolated elective repair. CONCLUSIONS Our study has demonstrated independent risk factors for mortality, which should be considered when contemplating aortoiliac aneurysm repair. We failed to externally validate the GAS and VSGNE score.
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Affiliation(s)
- Ioannis A Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | | | - Spyros Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Lampropoulos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras Medical School, Patras, Greece
| | | | - Ioannis Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Anastasia Kouri
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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Xiang Y, Chen X, Zhao J, Huang B, Yuan D, Yang Y. Endovascular Treatment Versus Open Surgery for Isolated Iliac Artery Aneurysms: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2019; 53:401-407. [PMID: 30895896 DOI: 10.1177/1538574419836835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuwei Xiang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiyang Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Cardaci MB, Destraix R, Van Houte B, Vazquez C. Endovascular Repair of Inflammatory Aortic Aneurysms: Experience in a Single Center. Ann Vasc Surg 2019; 58:255-260. [PMID: 30735769 DOI: 10.1016/j.avsg.2018.10.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysm (IAAA) remained a rare cause of aneurysmal aortic disease, with incidences between 5% and 10%. The current treatment for IAAA consists of open surgical repair and endovascular aneurysm repair (EVAR). Avoiding an inflamed, fibrotic retroperitoneum is the driving force behind the desire to repair IAAA endovascularly. The latest published works confirm the promising results after EVAR for IAAA, but there is still a paucity of data regarding hydroureter and hydronephrosis. In this article, we describe our experience with 5 patients diagnosed with IAAA and treated by EVAR, of whom 3 presented with associated hydronephrosis. METHODS A retrospective review of our endovascular database identified five patients who underwent EVAR for IAAA. Unilateral ureteral involvement in the inflammatory process was seen in 3 patients, accompanied by secondary hydronephrosis. One patient presented retroperitoneal fibrosis with duodenal stenosis. Primary outcomes were primary technical success, aneurysm-related mortality, change in aneurysm size, perianeurysmal fibrosis (PAF), and hydronephrosis. Secondary outcomes were requirement for reintervention, progression/resolution of symptoms, and short-term clinical success. RESULTS Follow-up duration ranged from 3 to 61 months. No patients were lost to follow-up. Primary technical success was obtained in all patients. One patient died three months after the operation due to persistence of the duodenal stenosis in spite of subsequent endoscopic treatments and corticotherapy. The aneurysm sac progressively reduced in 4 patients and remained unchanged in one patient. PAF regressed in 2 patients, reduced in two, and remained unchanged in one patient. Hydronephrosis persisted in all three patients preoperatively diagnosed with this condition. No patient required subsequent intervention. Four patients had complete resolution of their symptoms at a follow-up visit at 1 month. CONCLUSIONS This series suggests that EVAR for IAAA is technically feasible, excludes the aneurysm effectively, and reduces PAF with an acceptable morbidity and mortality rate. EVAR does not seem to offer any benefits for hydronephrosis, and closer follow-up in patients presenting renal or ureter involvement treated by EVAR is necessary.
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Affiliation(s)
- Miguel Bouzas Cardaci
- Department of General, Vascular and Thoracic Surgery, Centre Hospitalière Regional du Val de Sambre Rue Chère-Voie, Sambreville, Belgium.
| | - Renaud Destraix
- Department of Urology, Centre Hospitaliere Regional du Val de Sambre, Sambreville, Belgium
| | - Bernard Van Houte
- Department of Gastroenterology, Centre Hospitaliere Regional du Val de Sambre, Sambreville, Belgium
| | - Cesar Vazquez
- Department of General, Vascular and Thoracic Surgery, Centre Hospitalière Regional du Val de Sambre Rue Chère-Voie, Sambreville, Belgium
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8
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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]
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9
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Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms. GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00772-018-0465-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Debus ES, Heidemann F, Gross-Fengels W, Mahlmann A, Muhl E, Pfister K, Roth S, Stroszczynski C, Walther A, Weiss N, Wilhelmi M, Grundmann RT. Kurzfassung S3-Leitlinie zu Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas. GEFÄSSCHIRURGIE 2018. [DOI: 10.1007/s00772-018-0435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kakkos SK, Verhoeven EL. Open Surgical Conversion After Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2018; 55:151-152. [DOI: 10.1016/j.ejvs.2017.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 12/12/2022]
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12
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Duque Santos Á, Reyes Valdivia A, Romero Lozano MA, Aracil Sanus E, Ocaña Guaita J, Gandarias C. Outcomes of open and endovascular repair of inflammatory abdominal aortic aneurysms. Vascular 2017; 26:203-208. [PMID: 28841130 DOI: 10.1177/1708538117728865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Reports on inflammatory aortic abdominal aneurysm treatment are scarce. Traditionally, open surgery has been validated as the gold standard of treatment; however, high technical skills are required. Endovascular aortic repair has been suggested as a less invasive treatment by some authors offering good results. The purpose of our study was to report our experience and outcomes in the treatment of inflammatory aortic abdominal aneurysm using both approaches. Material and methods A retrospective review and data collection of all patients treated for inflammatory aortic abdominal aneurysm between 2000 and 2015 was done in one academic center. Diagnosis of inflammatory aortic abdominal aneurysm was based on preoperative CT-scan imaging. Type of treatment, postoperative and long-term morbidity and mortality are described. Abdominal compressive symptoms (hydronephrosis) severity and relief after treatment are described. Results Thirty-four patients with intact inflammatory aortic abdominal aneurysm were included. Twenty-nine (85.3%) patients were treated by open means and the remaining five (14.7%) with endovascular aortic repair. Nearly 90% were considered high-risk patients. Median follow-up was 46 months (range 24-112). The two groups were comparable, except for the age and preoperative hydronephrosis. There was no statistical significance in blood transfusion requirements, intensive care hospitalization, 30-day and long-term mortality between the two groups. Preoperative hydronephrosis was diagnosed in four (13.8%) patients in the open surgery group and three (60%) patients in the endovascular aortic repair group. Improvement of hydronephrosis was recognized in three out of the four patients in the open repair group and two out of the three in the endovascular aortic repair group. Renal function remained stable in both groups during follow-up. Conclusions Open surgery remains a safe and valid option for the treatment of inflammatory aortic abdominal aneurysm. Although our study included a small number of patients with endovascular aortic repair treatment, results are promising. Further randomized controlled studies may be necessary to assess long-term effectiveness of endovascular aortic repair treatment in this disease.
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Affiliation(s)
- África Duque Santos
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | - Andrés Reyes Valdivia
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | | | - Enrique Aracil Sanus
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | - Julia Ocaña Guaita
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | - Claudio Gandarias
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
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Surgical Versus Endovascular Aortic Aneurysm Repair: Evidence to Guide the Optimal Approach for the Individual Patient. Curr Atheroscler Rep 2017; 18:76. [PMID: 27815827 DOI: 10.1007/s11883-016-0621-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The choice between an open surgical and an endovascular approach for abdominal aortic aneurysm (AAA) repair remains an individualized clinical decision. As the technology and applications of endovascular aortic aneurysm repair (EVAR) continue to evolve, so does the literature investigating its outcomes. Multiple high-quality, randomized controlled trials comparing EVAR to open surgical repair (OSR) have now been published with long-term follow-up. Experience with ruptured aneurysms and the use of complex endografts is growing as well. This review is an up-to-date compilation of pertinent clinical trials for practitioners placed in the context of individual patient considerations to guide the choice of an optimal approach to the management of AAAs.
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Floros N, Papadakis M, Wagenhäuser MU, Duran M, Simon F, Schelzig H, Oberhuber A. Outcomes after Open Surgery for Inflammatory Abdominal Aortic Aneurysm: A 10-Year Single-Center Experience. Ann Vasc Surg 2017; 43:144-150. [PMID: 28478162 DOI: 10.1016/j.avsg.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/23/2017] [Accepted: 04/11/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Nikolaos Floros
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany.
| | - Marios Papadakis
- Department of Plastic Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany
| | - Markus Udo Wagenhäuser
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Mansur Duran
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Florian Simon
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
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15
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Ben Jmaà H, Karray R, Jmal H, Cherif T, Dhouib F, Souissi I, Karoui A, Bahloul Z, Masmoudi S, Elleuch N, Frikha I. [Surgical and endoluminal management of the inflammatory aortitis: A Tunisian center experience]. JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:213-220. [PMID: 28705339 DOI: 10.1016/j.jdmv.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 04/08/2017] [Indexed: 11/26/2022]
Abstract
Non-infectious aortitis is usually due to giant-cell arteritis, Takayasu disease or Behçet disease. The main aortic lesions are stenoses, occlusions and aneurysms in the Takayasu disease and aneurysms in the Behçet disease and giant-cell arteritis. Treatment is based on corticosteroid therapy and surgery. Endoluminal management is now the rule. We report a retrospective descriptive study of 10 patients who underwent surgical or endoluminal management of inflammatory lesions of the aorta between January 2000 and December 2015. There were 4 cases of Takayasu disease and 6 cases of Behçet disease. The aortic lesions were aneurysmal in all of the patients with Behçet disease. In the patients with Takayasu disease, aortic occlusions predominated, associated with other arterial lesions. Four patients with Behçet disease were managed surgically, and 2 patients underwent endovascular repair. All of the patients with Takayasu disease underwent surgery. Two patients died in the postoperative period, and two patients died during long-term follow-up. Systematic screening, as well as regular monitoring of the entire aorta during the follow-up, is necessary due to the frequency of aortic aneurysms.
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Affiliation(s)
- H Ben Jmaà
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie.
| | - R Karray
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - H Jmal
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - T Cherif
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - F Dhouib
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - I Souissi
- Service d'anesthésie-réanimation, hôpital Habib Bourguiba, Sfax, Tunisie
| | - A Karoui
- Service d'anesthésie-réanimation, hôpital Habib Bourguiba, Sfax, Tunisie
| | - Z Bahloul
- Service de médecine interne, hôpital Hédi Chaker, Sfax, Tunisie
| | - S Masmoudi
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - N Elleuch
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
| | - I Frikha
- Service de chirurgie cardiovasculaire et thoracique, hôpital Habib Bourguiba, 3029 Sfax, Tunisie
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