1
|
Pastor Alconchel L, Inaraja Pérez GC, Herrando Medrano M, García Nieto B, Hidalgo Iranzo N, Marzo Álvarez AC. Influence of Proximal Fixation on Aneurysm Neck Evolution after Endovascular Treatment of Infrarenal Aneurysms. Ann Vasc Surg 2024; 109:414-423. [PMID: 39098726 DOI: 10.1016/j.avsg.2024.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND We analyzed the long-term influence of fixation systems on proximal aortic neck (PAN) evolution by comparing 2 late-generation endoprostheses, Endurant (Medtronic Vascular, Minneapolis, Minn) with suprarenal fixation (SRF) and Excluder (W.L Gore & Associates, Flagstaff, Ariz) with infrarenal fixation (IRF). METHODS Our retrospective observational study included consecutive patients undergoing endovascular aneurysm repair (EVAR) for aorto-iliac aneurysms (2011-2020). Primary end points: neck enlargement and freedom from significative PAN enlargement (5 mm). Secondary end points: neck-related reintervention, endoleaks and graft migration. Results were reported following the Society of Vascular Surgery reporting standards. RESULTS 139 patients were included (97 in SRF group and 42 in IRF group). A difference in growth at 10 mm caudal to lowest renal artery at 2 years follow-up was found (mean growth of 1.92 ± 3.38 mm in SRF and 0.16 ± 6.86 mm in IRF; P < 0.001). A tendency to a major growth in SRF at 4 years follow-up at the lowest renal artery (1.27 ± 3.36 mm vs. 0.63 ± 2.2 mm; P = 0.06), 5 mm distal to lowest renal artery (2.17 ± 3.52 mm vs. 0.94 ± 2.76 mm; P = 0.001) and 10 mm distal to lowest renal artery (2.65 ± 3.86 mm vs. 1.12 ± 1.5 mm; P < 0.001) was shown. Freedom from PAN enlargement was 96.65% and 88.20% in SRF and 100% and 94.4% in IRF at 2 and 4 years follow-up respectively (log rank 0.041). A greater incidence of type II endoleaks in IRF was observed (40.48% vs. 15.46%; P = 0.001). Oversizing >15% showed to be a risk factor of PAN enlargement (odds ratio 6.85; 95% confident interval: 1.67-28.4; P = 0.007). CONCLUSIONS A small but significative percentage of patients after EVAR show a progressive PAN enlargement, being significatively greater in SRF, without increasing neck-related complications 4 years after graft deployment.
Collapse
Affiliation(s)
| | - Gabriel Cristian Inaraja Pérez
- Angiology and Vascular Surgery Service, Lozano Blesa Clinical Hospital, Zaragoza, Spain; Grupo de Investigación en patología vascular GISSA019, Instituto de Investigación Sanitaria Aragón, Zaragoza, Aragón, Spain
| | | | | | | | | |
Collapse
|
2
|
Naiem AA, Doonan R, Guigui A, Obrand DI, Bayne JP, MacKenzie KS, Steinmetz OK, Girsowicz E, Gill HL. Feasibility and Cost Analysis of Ambulatory Endovascular Aneurysm Repair. J Endovasc Ther 2024; 31:576-583. [PMID: 36346006 PMCID: PMC11290021 DOI: 10.1177/15266028221133694] [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: 02/17/2024]
Abstract
PURPOSE We sought to compare the costs of ambulatory endovascular aneurysm repair (a-EVAR) and inpatient EVAR (i-EVAR) at up to 1-year of follow-up. MATERIALS AND METHODS A retrospective cohort study of consecutive patients undergoing elective EVAR between April 2016 and December 2018 at two academic centers. Patients planned for a-EVAR were compared with i-EVAR. Costs at 30 days and 1 year were extracted. These included operating room (OR) use, bed occupancy, laboratory and imaging, emergency department (ED) visits, readmissions, and reinterventions. Baseline characteristics were compared. Multiple regression model was used to identify predictors of increased EVAR costs. Repeated measures analysis of variance (ANOVA) was used to compare cost differences at 30 days and 1 year via an intention-to-treat analysis. Bonferroni post hoc test compared between-group differences. A p value<0.05 was considered statistically significant. RESULTS One hundred seventy patients were included. Most underwent percutaneous EVAR (>94%) under spinal anesthesia (>84%). Ambulatory endovascular aneurysm repair was successful in 84% (84/100). Ambulatory endovascular aneurysm repair patients (76±8 years) were younger than i-EVAR (78±9 years). They also had a smaller mean aneurysm diameter (56±6 mm) compared with i-EVAR (59±6 mm). Emergency department visits, readmissions, and reinterventions were similar up to 1 year (all p=NS). Ambulatory endovascular aneurysm repair costs showed a non-statistically significant reduction in total costs at 30 days and 1 year by 27% and 21%, respectively. Patients younger than 85 years and males had a 30-day cost reduction by 34% (p=0.027) and 33% (p=0.035), respectively with a-EVAR. CONCLUSIONS Same-day discharge is feasible and successful in selected patients. Patients younger than 85 years and males have a short-term cost benefit with EVAR done in the ambulatory setting without increased complications or reinterventions. CLINICAL IMPACT This study shows the overall safety of ambulatory EVAR with proper patient selection. These patient had similar post-intervention complications to inpatients. Same day discharge also resulted in short-term reduction in costs in male patients and patients younger than 85 years.
Collapse
Affiliation(s)
- Ahmed A. Naiem
- Division of vascular surgery, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - R.J. Doonan
- Division of vascular surgery, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Andre Guigui
- Financial systems and process improvement finance, McGill University Health Centre, Montreal, QC, Canada
| | - Daniel I. Obrand
- Division of vascular surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Jason P. Bayne
- Division of vascular surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Kent S. MacKenzie
- Division of vascular surgery, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Oren K. Steinmetz
- Division of vascular surgery, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Elie Girsowicz
- Division of vascular surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Heather L. Gill
- Division of vascular surgery, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
3
|
Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
| |
Collapse
|
4
|
Wang Y, Zhou M, Ding Y, Li X, Xie T, Zhou Z, Fu W, Shi Z. Unsupervised machine learning cluster analysis to identification EVAR patients clinical phenotypes based on radiomics. Vascular 2024:17085381241262575. [PMID: 38885967 DOI: 10.1177/17085381241262575] [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: 06/20/2024]
Abstract
OBJECTIVE This study used unsupervised machine learning (UML) cluster analysis to explore clinical phenotypes of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) patients based on radiomics. METHOD We retrospectively reviewed 1785 patients with infra-renal AAA who underwent elective EVAR procedures between January 2010 and December 2020. Pyradiomics was used to extract the radiomics features. Statistical analysis was applied to determine the radiomics features that related to severe adverse events (SAEs) after EVAR. The selected features were used for UML cluster analysis in training set and validation in test set. Comparison of basic characteristics and radiomics features of different clusters. The Kaplan-Meier analysis was conducted to generate the cumulative incidence of freedom from SAEs rate. RESULT A total of 1180 patients were enrolled. During the follow-up, 353 patients experienced EVAR-related SAEs. In total, 1223 radiomics features were extracted from each patient, of which 23 radiomics features were finally preserved to identify different clinical phenotypes. 944 patients were allocated to the training set. Three clusters were identified in training set, in which patients had identical clinical characteristics and morphological features, while varied considerably of selected radiomics features. This encouraging performance was further approved in the test set. In addition, each cluster was well differentiated from other clusters and Kaplan-Meier analysis showed significant differences of freedom from SAEs rate between different clusters both in the training (p = .0216) and test sets (p = .0253). CONCLUSION Based on radiomics, UML cluster analysis can identify clinical phenotypes in EVAR patients with distinct long-term outcomes.
Collapse
Affiliation(s)
- Yonggang Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Min Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yong Ding
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xu Li
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Tianchen Xie
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhenyu Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai, China
| |
Collapse
|
5
|
Li C, Böckler D, Rastogi V, Verhagen HJM, Loftus IM, Reijnen MMPJ, Arko FR, Guo J, Schermerhorn ML. The Effect of One Year Aneurysm Sac Dynamics on Five Year Mortality and Continued Aneurysm Sac Evolution. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00476-3. [PMID: 38871213 DOI: 10.1016/j.ejvs.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 05/05/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE One year aneurysm sac dynamics after endovascular abdominal aortic aneurysm repair (EVAR) were independently associated with a greater all cause mortality risk in prior registry studies but were limited in completeness and granularity. This retrospective analysis aimed to study the impact of sac dynamics on survival within the Endurant Stent Graft Global Registry (ENGAGE) with five year follow up. METHODS A total of 1 263 subjects were enrolled in the ENGAGE Registry between March 2009 and April 2011. One year aneurysm sac changes were calculated between the one month post-operative imaging scans and the scan closest to the time of one year follow up. Sac regression was defined as a sac decrease of ≥ 5 mm and sac expansion as aneurysm sac growth ≥ 5 mm. The primary outcome was the five year all cause mortality rate. Kaplan-Meier estimates for freedom from all cause death were calculated. Multivariable Cox regression was used to determine the association between sac dynamics and all cause death. RESULTS At one year, 441 of the 949 study participants with appropriate imaging (46%) had abdominal aortic aneurysm sac regression, 462 (49%) remained stable, and 46 (4.8%) had sac expansion. For patients with sac regression, the five year all cause mortality rate was 20%, compared with 28% for stable sac (p = .007) and 37% for the sac expansion (p = .010) cohorts. After adjustment, the sac expansion and stable sac cohorts were associated with a greater all cause mortality rate (expansion: hazard ratio [HR] 1.8; 95% CI 1.1 - 3.2; p = .032; stable: HR 1.4; 95% CI 1.1 - 1.9; p = .019). CONCLUSION In the ENGAGE Global Registry, the one year rate of sac regression was 46%, and one year sac regression was observed to be associated with greater five year survival, corroborating prior findings using data from vascular registries. Sac regression could become the new standard for success after EVAR.
Collapse
Affiliation(s)
- Chun Li
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston MA, USA
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
| | - Vinamr Rastogi
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian M Loftus
- St. George's Vascular Institute, London, United Kingdom
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, and MultiModality Medical Imaging Group, University of Twente, Enschede, The Netherlands
| | - Frank R Arko
- Division of Vascular and Endovascular Surgery, Sanger Heart and Vascular Institute, Charlotte, NC, USA
| | - Jia Guo
- Department of Clinical Research, Peripheral and Endovenous Health, Medtronic Plc., Santa Rosa, CA, USA
| | - Marc L Schermerhorn
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston MA, USA
| |
Collapse
|
6
|
Ide T, Shimamura K, Kuratani T, Shijo T, Sakaniwa R, Watanabe Y, Maeda K, Masada K, Yamashita K, Matsumoto R, Miyagawa S. Impact of the Patency of Inferior Mesenteric Artery on 7-Year Outcomes After Endovascular Aneurysm Repair. J Endovasc Ther 2024; 31:371-380. [PMID: 36120997 DOI: 10.1177/15266028221121748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE The impact of preoperative patent inferior mesenteric artery (IMA) on late outcomes following endovascular aneurysm repair (EVAR) remains unclear. This study aimed to investigate the specific influence of IMA patency on 7-year outcomes after EVAR. MATERIALS AND METHODS In this retrospective cohort study, 556 EVARs performed for true abdominal aortic aneurysm cases between January 2006 and December 2019 at our institution were reviewed. Endovascular aneurysm repairs performed using a commercially available device with no type I or type III endoleak (EL) during follow-up and with follow-up ≥12 months were included. A total of 336 patients were enrolled in this study. The cohort was divided into the patent IMA group and the occluded IMA group according to preoperative IMA status. The late outcomes, including aneurysm sac enlargement, reintervention, and mortality rates, were compared between both groups using propensity-score-matched data. RESULTS After propensity score matching, 86 patients were included in each group. The median follow-up period was 56 months (interquartile range: 32-94 months). The incidence of type II EL at discharge was 50% in the patent IMA group and 19% in the occluded IMA group (p<0.001). The type II EL from IMA and lumbar arteries was significantly higher in the patent IMA group than in the occluded IMA group (p<0.001 and p=0.002). The rate of freedom from aneurysm sac enlargement with type II EL was significantly higher in the occluded IMA group than in the patent IMA group (94% vs 69% at 7 years; p<0.001). The rate of freedom from reintervention was significantly higher in the occluded IMA group than in the patent IMA group (90% vs 74% at 7 years; p=0.007). Abdominal aortic aneurysm-related death and all-cause mortality did not significantly differ between groups (p=0.32 and p=0.34). CONCLUSIONS Inferior mesenteric artery patency could affect late reintervention and aneurysm sac enlargement but did not have a significant impact on mortality. Preoperative assessment and embolization of IMA might be an important factor for improvement in late EVAR outcomes. CLINICAL IMPACT The preoperative patency of the inferior mesenteric artery was significantly associated with a higher incidence of sac enlargement and reintervention with type II endoleak following endovascular aneurysm repair, even after adjustment for patient background. Preoperative assessment and embolization of inferior mesenteric artery might be an important factor for improvement in late EVAR outcomes.
Collapse
Affiliation(s)
- Toru Ide
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryoto Sakaniwa
- Department of Public Health, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Watanabe
- Department of Cardiovascular Surgery, Kinan Hospital, Tanabe, Japan
| | - Koichi Maeda
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryota Matsumoto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| |
Collapse
|
7
|
Nargesi S, Abutorabi A, Mohamadi Y, Salimi J, Tajdini M, Alipour V. Cost-effectiveness analysis of endovascular versus open repair in patients with abdominal aortic aneurysm in Iran: a cross-sectional study. Int J Surg 2024; 110:3338-3345. [PMID: 38502855 PMCID: PMC11175740 DOI: 10.1097/js9.0000000000001321] [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] [Received: 11/24/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) is one of the most important cardiovascular diseases, especially in the elderly. People with this disease are at risk of rupture of the abdominal aorta and death. The present study was conducted with the aim of analyzing the cost-effectiveness of endovascular repair compared to open surgery in AAA patients in Iran. METHODS A Markov chain model was developed based on the use of endovascular repair and open surgery. The base-case patient was defined as a 65-year-old man presenting with AAA diameter greater than 5 cm. The determination of costs was from the perspective of the public sector provider. QALY was used to calculate the effectiveness. Incremental cost-effectiveness ratio (ICER) and TreeAge software were used for cost-effectiveness analysis. The follow-up period was 10 years and the willingness to pay (WTP) was determined as three times the Gross domestic product (GDP) per capita. RESULT At the end of year 10, the endovascular aneurysm repair (EVAR) strategy gained 1 318 313 559 Iranian Rial (IRR) (67 885.29$) in cost and 3.57 QALYs in effectiveness. In contrast, the use of the open surgery repair (OSR) strategy gained 1 186 761 858 IRR (61 111.16$) in cost and 3·32 QALYs in effectiveness. The incremental cost-effectiveness ratio, comparing EVAR versus OSR, was 53, 346, 3757 IRR (178.36$) per QALYs, which is lower than the proposed WTP, indicating that EVAR is more expensive and more effective. Based on the Monte Carlo simulation test, EVAR is the preferred strategy in 58.6% of the population. CONCLUSION Endovascular repair has a relative superiority compared to open surgery, and the probability of the effectiveness of endovascular repair compared to open surgery does not change with increasing willingness to pay.
Collapse
Affiliation(s)
- Shahin Nargesi
- Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam
| | - Ali Abutorabi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran
| | - Yousef Mohamadi
- Department of Anatomy, School of Medicine, Ilam University of Medical Sciences, Ilam
| | - Javad Salimi
- Vascular and Endovascular Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran
| |
Collapse
|
8
|
Budge J, Carrell T, Yaqub M, Wafa H, Waltham M, Pilecka I, Kelly J, Murphy C, Palmer S, Wang Y, Clough RE. The ARIA trial protocol: a randomised controlled trial to assess the clinical, technical, and cost-effectiveness of a cloud-based, ARtificially Intelligent image fusion system in comparison to standard treatment to guide endovascular Aortic aneurysm repair. Trials 2024; 25:214. [PMID: 38528619 DOI: 10.1186/s13063-023-07710-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/06/2023] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Endovascular repair of aortic aneurysmal disease is established due to perceived advantages in patient survival, reduced postoperative complications, and shorter hospital lengths of stay. High spatial and contrast resolution 3D CT angiography images are used to plan the procedures and inform device selection and manufacture, but in standard care, the surgery is performed using image-guidance from 2D X-ray fluoroscopy with injection of nephrotoxic contrast material to visualise the blood vessels. This study aims to assess the benefit to patients, practitioners, and the health service of a novel image fusion medical device (Cydar EV), which allows this high-resolution 3D information to be available to operators at the time of surgery. METHODS The trial is a multi-centre, open label, two-armed randomised controlled clinical trial of 340 patient, randomised 1:1 to either standard treatment in endovascular aneurysm repair or treatment using Cydar EV, a CE-marked medical device comprising of cloud computing, augmented intelligence, and computer vision. The primary outcome is procedural time, with secondary outcomes of procedural efficiency, technical effectiveness, patient outcomes, and cost-effectiveness. Patients with a clinical diagnosis of AAA or TAAA suitable for endovascular repair and able to provide written informed consent will be invited to participate. DISCUSSION This trial is the first randomised controlled trial evaluating advanced image fusion technology in endovascular aortic surgery and is well placed to evaluate the effect of this technology on patient outcomes and cost to the NHS. TRIAL REGISTRATION ISRCTN13832085. Dec. 3, 2021.
Collapse
Affiliation(s)
- James Budge
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- St George's Vascular Institute, St George's University, London, UK
| | | | - Medeah Yaqub
- King's Clinical Trials Unit, King's College London, London, UK
| | - Hatem Wafa
- Department of Population Health Sciences, King's College London, London, UK
| | | | - Izabela Pilecka
- King's Clinical Trials Unit, King's College London, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, King's College London, London, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Yanzhong Wang
- Department of Population Health Sciences, King's College London, London, UK
| | - Rachel E Clough
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| |
Collapse
|
9
|
Songra LAK, Baker DM, Agu O, Constantinou J, Hynes N. An Analysis of Cost-Effectiveness and Clinical Outcomes of a Comprehensive Aortic Service in a Tertiary Center over One Year. Ann Vasc Surg 2024; 99:125-134. [PMID: 37926139 DOI: 10.1016/j.avsg.2023.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Endovascular aortic repair (EVAR) is an established and attractive alternative to open surgical repair (OSR) of abdominal aortic aneurysms (AAA) due to its superior short-term safety profile. However, opinions are divided regarding its long-term cost-effectiveness. We compared the total yearly cost of running endovascular and OSR services in a single tertiary center to determine whether fenestrated EVAR (FEVAR) represents a clinically efficacious, affordable treatment option. METHODS A single-center retrospective review was performed on 109 patients undergoing a procedure related to index or previous abdominal aortic repair, with 1 year follow-up. Data was collected from the National Vascular Registry and hospital records. The primary outcome was cost per quality-adjusted life year. Secondary outcomes included 30-day mortality and morbidity, reintervention rates, length of hospital stay, aneurysm, and all-cause mortality at 1 year for elective index procedures. RESULTS The average cost per patient of all FEVAR was £16,041.53 (±8,857.54), £13,893.51 (±£21,425.25) for standard EVAR, and £15,357.22 (±£15,904.49) for OSR (FEVAR versus EVAR P = 0.55, FEVAR versus OSR P = 0.83, OSR versus EVAR P = 0.76). Of the secondary outcomes, significant findings included increased length of stay and respiratory morbidity for patients undergoing open versus endovascular repair. There was no significant difference in 30-day or 1-year mortality between groups. CONCLUSIONS FEVAR, EVAR, and OSR all represent cost-effective options for aortic repair with similar outcomes. Our data highlights the potential for FEVAR to present a viable alternative to open repair, particularly in higher-risk groups, when performed in specialist centers.
Collapse
Affiliation(s)
- Lalana A K Songra
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Daryll M Baker
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, UK; UCL Division of Medicine, Royal Free Campus, University College, London, London, UK.
| | - Obiekezie Agu
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Jason Constantinou
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Niamh Hynes
- CÚRAM, SFI Research Centre for Medical Devices, Biomedical Sciences, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
10
|
Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| |
Collapse
|
11
|
Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
Collapse
|
12
|
Ide T, Shimamura K, Shijo T, Kuratani T, Sakaniwa R, Miyagawa S. Impact of Patent Lumbar Arteries on Aneurysm Sac Enlargement with Type II Endoleak after Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 66:513-520. [PMID: 37330200 DOI: 10.1016/j.ejvs.2023.06.003] [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] [Received: 09/20/2022] [Revised: 04/10/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE This study aimed to investigate the impact of the number of patent lumbar arteries (LAs) on sac enlargement after endovascular aneurysm repair (EVAR). METHODS This was a retrospective cohort single centre registry study. Between January 2006 and December 2019, 336 EVARs were reviewed using a commercially available device excluding type I or type III endoleaks during a follow up of ≥ 12 months. Patients were divided into four groups based on the pre-operative patency of the inferior mesenteric artery (IMA) and high (≥ 4) or low (≤ 3) number of patent LAs: Group 1, patent IMA and high number of patent LAs; Group 2, patent IMA and low number of patent LAs; Group 3, occluded IMA and a high number of patent LAs; Group 4, occluded IMA and low number of patent LAs. RESULTS Groups 1, 2, 3, and 4 included 124, 104, 45, and 63 patients, respectively. The median follow up duration was 65.1 months. Significant differences in the incidence of overall type II endoleak (T2EL) at discharge between Group 1 and Group 2 (59.7% vs. 36.5%, p < .001) and between Group 3 and Group 4 (33.3% vs. 4.8%, p < .001) were observed. In patients with a pre-operatively patent IMA, the rate of freedom from aneurysm sac enlargement was significantly lower in Group 1 than in Group 2 (69.0% vs. 81.7% five years after EVAR, p < .001). In patients with a pre-operatively occluded IMA, the freedom rate from aneurysm sac enlargement was not significantly different between Groups 3 and Group 4 (95.0% vs. 100% five years after EVAR, p = .075). CONCLUSION A high number of patent LAs seemed to have a significant role in sac enlargement with T2EL when the IMA was patent pre-operatively, whereas a high number of patent LAs seemed to have limited influence on sac enlargement when the IMA was occluded pre-operatively.
Collapse
Affiliation(s)
- Toru Ide
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Department of Public Health, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
13
|
Kahlberg A, Bilman V, Bugna C, Rinaldi E, Mascia D, Loschi D, Chiesa R, Melissano G. Silver acetate and Triclosan Antimicrobial Graft Evaluation for surgical Repair of aortic disease (STAGER Study). INT ANGIOL 2023; 42:402-411. [PMID: 37943291 DOI: 10.23736/s0392-9590.23.05101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND The aim of this study was to assess perioperative and late performance of a silver acetate and triclosan impregnated antimicrobial vascular graft (Intergard Synergy, Intervascular SAS, La Ciotat, France) during open surgical repair of abdominal aortic aneurysms (AAA), and to compare it with standard polyester grafts ones. METHODS This retrospective single-centre study (STAGER Study, clinicaltrials.gov: NCT04557254) included patients undergone non-infectious AAA surgical repair between 2012 and 2019, divided into two groups according to the implanted aortic prosthesis: standard polyester graft (PolyG) and silver-triclosan graft (SynG). Early primary endpoints were 30-day mortality, major adverse events (MAEs), and reintervention rates; late primary endpoints were overall and aortic-related survival, reintervention-free survival, and graft infection rate at a mean follow-up (FU) of 49.4±26.8 months. RESULTS Five hundred forty-seven patients were included [PolyG 49%, and SynG 51%]. Both groups were substantially homogeneous in risk factors and demographics. Two patients died within 30 days. In-hospital MAE rate [PolyG 14.2% vs. SynG 10.7%; P=.248] and 30-day reintervention rate were not significantly different [PolyG 2.6% vs. SynG 1.4%; P=.374]. At 5 years, overall survival in the PolyG and SynG groups were 85% and 84%, respectively. Reintervention-free survival was 82% for both groups. Aortic-related survival was 95% and 96%, respectively. Graft infection was observed in 8 (3.3%) PolyG patients and 5 (1.8%) SynG patients. CONCLUSIONS Silver acetate and triclosan impregnated grafts demonstrated good early and mid-term results, being considered safe and durable for AAA open repair. Similar graft infection and related death rates were observed compared to polyester standard grafts, supporting non-superiority of one graft over the other.
Collapse
Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Victor Bilman
- Department of Vascular Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carlotta Bugna
- Department of Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Enrico Rinaldi
- Department of Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Mascia
- Department of Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diletta Loschi
- Department of Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
14
|
Akintoye OO. Pre-operative Aortic Anatomic Features as Predictors of Clinical Outcomes Following Endovascular Repair of Abdominal Aortic Aneurysm: A Retrospective Cohort Study. Cureus 2023; 15:e46983. [PMID: 38022100 PMCID: PMC10640889 DOI: 10.7759/cureus.46983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
ARTICLE REMOVED.
Collapse
|
15
|
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
16
|
Lu S, Yang Z, Guo L. Lumbar spine and paravertebral muscle infarction after endovascular abdominal aortic aneurysm repair: a case description. Quant Imaging Med Surg 2023; 13:6334-6337. [PMID: 37711788 PMCID: PMC10498227 DOI: 10.21037/qims-23-210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/07/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Shanyu Lu
- Department of Radiology, Kunming Medical University Second Hospital, Kunming, China
| | - Zhendong Yang
- Department of Orthopedics, Kunming Medical University Second Hospital, Kunming, China
| | - Li Guo
- Department of Radiology, Kunming Medical University Second Hospital, Kunming, China
| |
Collapse
|
17
|
Golledge J, Thanigaimani S, Powell JT, Tsao PS. Pathogenesis and management of abdominal aortic aneurysm. Eur Heart J 2023:ehad386. [PMID: 37387260 PMCID: PMC10393073 DOI: 10.1093/eurheartj/ehad386] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) causes ∼170 000 deaths annually worldwide. Most guidelines recommend asymptomatic small AAAs (30 to <50 mm in women; 30 to <55 mm in men) are monitored by imaging and large asymptomatic, symptomatic, and ruptured AAAs are considered for surgical repair. Advances in AAA repair techniques have occurred, but a remaining priority is therapies to limit AAA growth and rupture. This review outlines research on AAA pathogenesis and therapies to limit AAA growth. Genome-wide association studies have identified novel drug targets, e.g. interleukin-6 blockade. Mendelian randomization analyses suggest that treatments to reduce low-density lipoprotein cholesterol such as proprotein convertase subtilisin/kexin type 9 inhibitors and smoking reduction or cessation are also treatment targets. Thirteen placebo-controlled randomized trials have tested whether a range of antibiotics, blood pressure-lowering drugs, a mast cell stabilizer, an anti-platelet drug, or fenofibrate slow AAA growth. None of these trials have shown convincing evidence of drug efficacy and have been limited by small sample sizes, limited drug adherence, poor participant retention, and over-optimistic AAA growth reduction targets. Data from some large observational cohorts suggest that blood pressure reduction, particularly by angiotensin-converting enzyme inhibitors, could limit aneurysm rupture, but this has not been evaluated in randomized trials. Some observational studies suggest metformin may limit AAA growth, and this is currently being tested in randomized trials. In conclusion, no drug therapy has been shown to convincingly limit AAA growth in randomized controlled trials. Further large prospective studies on other targets are needed.
Collapse
Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, Australia
| | - Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Douglas, Townsville, QLD, Australia
| | - Janet T Powell
- Department of Surgery & Cancer, Imperial College London, Fulham Palace Road, London, UK
| | - Phil S Tsao
- Department of Cardiovascular Medicine, Stanford University, 450 Serra Mall, Stanford, CA, USA
- VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, USA
- Stanford Cardiovascular Institute, Stanford University, 450 Serra Mall, Stanford, CA, USA
| |
Collapse
|
18
|
D'Oria M, Trimarchi S, Lomazzi C, Upchurch GR, Suominen V, Bissacco D, Taglialavoro J, Lepidi S. Incidence, predictors, and prognostic impact of in-hospital serious adverse events in patients ≥75 years of age undergoing elective endovascular aneurysm repair. Surgery 2023; 173:1093-1101. [PMID: 36526489 DOI: 10.1016/j.surg.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/26/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study sought to identify the factors associated with the occurrence of in-hospital serious adverse events after elective endovascular aortic repair (EVAR) in older patients within the Global Registry for Endovascular Aortic Treatment. METHODS Consecutive patients ages ≥75 years who received GORE EXCLUDER AAA Endoprosthesis (W.L. Gore & Associates, Inc, Flagstaff, AZ) for elective EVAR. Based on the age at index elective EVAR, patients were categorized into 3 groups for subsequent analyses: those ages 75 to 79, 80 to 84, and ≥85 years. The primary end points for this study were the incidence of serious adverse events and all-cause mortality. In-hospital complications were defined according to the International Organization for Standardization 14155 standard (https://www.iso.org/standard/71690.html) and considered serious adverse events if they led to any of the following: (1) a life-threatening illness or injury, (2) a permanent impairment of a body structure or a body function, (3) in-patient or prolonged hospitalization, or (4) medical or surgical intervention to prevent life-threatening illness or injury or permanent impairment to a body structure or a body function. RESULTS Overall, 1,333 older patients (ages 75-79: n = 601; 80-84: n = 474; and ≥85: n = 258) underwent elective EVAR in the Global Registry for Endovascular Aortic Treatment data set and were included in the present analysis. In total, 12 patients (0.9%) died perioperatively, and 103 patients (7.7%) experienced ≥1 in-hospital serious adverse event, with 18 patients (1.3%) experiencing >1 in-hospital complications. No significant differences were seen between the age groups in the rates of in-hospital serious adverse events (7.3% vs 8.2% vs 7.8%; P = .86). In logistic regression analysis, a history of chronic obstructive pulmonary disease (odds ratio = 2.014; 95% confidence interval, 1.215-3.340; P = .006) and prior requirement for dialysis (odds ratio = 4.655; 95% confidence interval, 1.087-19.928; P = .038) resulted as predictors for occurrence of in-hospital serious adverse events. In the whole cohort, the 5-year survival was 63% for patients who did not experience any in-hospital serious adverse events compared with 51% for those who experienced any complications (P = .003). Using multivariable Cox proportional hazards models, it was found that the occurrence of in-hospital serious adverse events (hazard ratio = 6.2; 95% confidence interval, 1.8-21.317; P = .003) and being underweight (hazard ratio = 7.0; 95% confidence interval, 1.371-35.783; P = .019) were the only independent predictors of death in ≤30 days from the initial intervention. Although age did not independently affect the risk for all-cause mortality in ≤180 days after the initial intervention, increasing age was associated with a higher risk for long-term death (ie, ≥181 days from index elective EVAR) in the multivariable analysis (ages 75-79: hazard ratio = 0.379; 95% confidence interval, 0.281-0.512; P < .001; and 80-84: hazard ratio = 0.562; 95% confidence interval, 0.419-0.754; P < .001). CONCLUSION After elective EVAR in older patients (ie, ≥75 years), the occurrence of in-hospital serious adverse events appears to increase the risk of death, particularly in ≤180 days after the initial elective EVAR intervention, and might be related to patient baseline characteristics, including history of pulmonary and renal disease.
Collapse
Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy.
| | - Santi Trimarchi
- Division of Vascular and Endovascular Surgery, IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Lomazzi
- Division of Vascular and Endovascular Surgery, IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Velipekka Suominen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, and Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Daniele Bissacco
- Division of Vascular and Endovascular Surgery, IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy
| | | |
Collapse
|
19
|
Mezzetto L, D’Oria M, Lepidi S, Mastrorilli D, Calvagna C, Bassini S, Taglialavoro J, Bruno S, Veraldi GF. A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms. J Clin Med 2023; 12:jcm12062324. [PMID: 36983324 PMCID: PMC10054682 DOI: 10.3390/jcm12062324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/20/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background: To define proximal neck dilation (PND) after standard endovascular aneurysm repair (EVAR) and fenestrated EVAR (FEVAR), determining: incidence and risk factors; evidence base that links PND to outcomes of patients; recurring themes or gaps in the literature. Methods: We performed a scoping review and included only full-text English articles with follow-up focusing on PND in patients undergoing EVAR or FEVAR, published between 2000 and 2022. The following PICO question was used to build the search equation: in patients with abdominal-aortic-aneurysm (AAA) (Population) undergoing endovascular repair (Intervention), what are the incidence, risk factors and prognosis of radiologically defined PND (Comparison) on short-term and long-term outcomes (Outcomes)? Results: 15 articles were included after review. Measurement protocols for proximal aortic neck (PAN) varied among individual studies and the definition of PND resulted as heterogeneous. Rate of patients with a PND ranged between 0% and 41%. Large proximal neck (>28 mm) and excessive graft sizing (30%) were predictors for PND. New endografts with low outward radial forces and FEVAR seemed to be protective. Surgical conversion was the definitive option in the case of patients unfit for other endovascular treatments. Conclusions: PND is a frequent finding after EVAR and FEVAR. Excessive graft oversizing and large baseline PAN were predictors of neck enlargement, independently by the type of standard endograft used. FEVAR may be considered protective against complications, together with endografts using low outward radial forces. Lifelong radiological follow-up is mandatory.
Collapse
Affiliation(s)
- Luca Mezzetto
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
- Correspondence: ; Tel.: +39-045-812-2505
| | - Mario D’Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Davide Mastrorilli
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Salvatore Bruno
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
| | - Gian Franco Veraldi
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
| |
Collapse
|
20
|
Antoniou GA, Kontopodis N, Rogers SK, Golledge J, Forbes TL, Torella F, Verhagen HJM, Schermerhorn ML. Editor's Choice - Meta-Analysis of Compliance with Endovascular Aneurysm Repair Surveillance: The EVAR Surveillance Paradox. Eur J Vasc Endovasc Surg 2023; 65:244-254. [PMID: 36273676 DOI: 10.1016/j.ejvs.2022.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/24/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant. DATA SOURCES MEDLINE and Embase were searched using the Ovid interface. REVIEW METHODS A systematic review was conducted complying with the PRISMA guidelines. Eligible studies compared survival in EVAR surveillance compliant patients with non-compliant patients. Non-compliance was defined as failure to attend at least one post-EVAR follow up. The risk of bias was assessed with the Newcastle-Ottawa scale, and the certainty of evidence using the GRADE framework. Primary outcomes were survival and aneurysm related death. Effect measures were the hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (CI) calculated using the inverse variance or Mantel-Haenszel statistical method and random effects models. RESULTS Thirteen cohort studies with a total of 22 762 patients were included. Eight studies were deemed high risk of bias. The pooled proportion of patients who were non-compliant with EVAR surveillance was 43% (95% CI 36 - 51). No statistically significant difference was found in the hazard of all cause mortality (HR 1.04, 95% CI 0.61 - 1.77), aneurysm related mortality (HR 1.80, 95% CI 0.85-3.80), or secondary intervention (HR 0.66, 95% CI 0.31 - 1.41) between patients who had incomplete and complete follow up after EVAR. The odds of aneurysm rupture were lower in non-compliant patients (OR 0.63, 95% CI 0.39 - 1.01). The certainty of evidence was very low for all outcomes. Subgroup analysis for patients who had no surveillance vs. those with complete surveillance showed no significant difference in all cause mortality (HR 1.10, 95% CI 0.43 - 2.80). CONCLUSION Patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant. These findings question the value of intense surveillance in all patients post-EVAR and highlight the need for further research on individualised or risk adjusted surveillance.
Collapse
Affiliation(s)
- George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Steven K Rogers
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Francesco Torella
- Liverpool Vascular & Endovascular Service, Liverpool, UK; School of Physical Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Hence J M Verhagen
- Division of Vascular and Endovascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| |
Collapse
|
21
|
Santosa F, Beckerath OV, Cremer S, Katoh M, Juntermanns B, Kröger K, Gäbel G. Increased aortic repair in Germany correlates with reduction of death caused by aortic aneurysms but not aortic dissections. Vascular 2023; 31:18-25. [PMID: 35119319 DOI: 10.1177/17085381211054263] [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
INTRODUCTION We asked if there is a significant correlation between the increasing trend in aortic repair (AR) and decreasing aortic aneurysm (AA) and aortic dissection (AD) mortality? Therefore, we retrospectively analyzed all aortic repairs in patients with AA and AD and its correlation with disease-specific death rates and hospitalizations for ruptured AA and AD in Germany. METHODS We retrieved the number of cases hospitalized for AA and AD as well as the procedures in these cases from the Federal Bureau of Statistics (DRG statistics) and death rates from the national mortality statistic published by the Federal Statistical Office in Germany for the years 2006-2017. RESULTS From 2006 to 2017, the total number of hospitalized cases admitted with principal diagnosis of AA increased by 25.8% and that of AD by 56.7%. That of cases with the principal diagnosis of ruptured AA (rAA) remained unchanged (-2.5%) and that with rAD increased by 54.6%. The number of (open and endovascular) procedures in cases hospitalized for AA increased by 39.4% and for AD by 126.4%. The age-adjusted death rates in Germany for AA decreased from 4.0 to 2.9 per 100,000 inhabitants and that for AD increased from 1.0 to 1.4. The decrease in death attributed to AA cases can be described by linear regression as y = -0.0003*y + 6.7076 (p < 0.0001). Accepting this association between increased elective procedures and reduced AA mortality, each/all 1000 procedures save 0.3 lives per 100,000 inhabitants. CONCLUSION Despite increasing numbers of AR for AA and AD, only the mortality rate for all AAs decreased, while we did not observe a decrease in overall mortality of AD in Germany.
Collapse
Affiliation(s)
- Frans Santosa
- Medical Faculty Universitas Pembangunan Nasional Veteran Jakarta, Depok, Indonesia
| | - Olga von Beckerath
- Department of Vascular Medicine, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Svenja Cremer
- Department of Vascular Medicine, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Marcus Katoh
- Department of Radiology, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Knut Kröger
- Department of Vascular Medicine, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Gabor Gäbel
- Department of Vascular Medicine, HELIOS Klinikum Krefeld, Krefeld, Germany
| |
Collapse
|
22
|
Chen Q, Zhang Y, Lei K, Fu L, Zhang D, Sun W, Shi C, Niu Q. Efficacy and safety of prophylactic intraoperative sac embolization in EVAR for abdominal aortic aneurysm: A meta-analysis. Front Surg 2023; 9:1027231. [PMID: 36684193 PMCID: PMC9852339 DOI: 10.3389/fsurg.2022.1027231] [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: 08/24/2022] [Accepted: 10/24/2022] [Indexed: 01/09/2023] Open
Abstract
Objective We aimed to investigate the effectiveness and safety of prophylactic sac embolization during endovascular aneurysm repair (EVAR) in patients suffering from abdominal aortic aneurysms. Methods We performed a systematic literature search of PubMed, Web of Science, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, Wanfang and China Biomedical Literature Database (CBM) to identify studies evaluating the outcomes of sac embolization vs. no embolization among patients who had received EVAR. The time limit of the search was from the establishing database to July 22, 2022. Outcome measures involved the type II endoleak rate, the other endoleak rate, the reintervention rate, mortality, and operation time. Fixed (no heterogeneity) or random effects models were constructed for each outcome. The outcomes are represented as the odds ratio (OR) with a 95% confidence interval (CI). Results Among the 2,622 studies screened, 13 studies involving 747 participants were included in the review. The incidence of early-term type II endoleak (OR = 0.2, 95% CI (0.13,0.31), P < 0.00001), mid-term type II endoleak (OR = 0.23, 95% CI (0.15,0.37), P < 0.00001), late-term type II endoleak (OR = 0.27, 95% CI (0.16,0.46), P < 0.00001) and reintervention (OR = 0.50, 95% CI (0.37,0.78), P = 0.002) within the sac embolization group were significantly lower than those in the non-embolization group. No significant differences were observed between the two groups were found for the other endoleak rates (OR = 0.67, 95% CI (0.34,1.32), P = 0.25), mortality (OR = 0.64, 95% CI (0.25,1.66), P = 0.36) and operation time operation (MD = 5.76, 95% CI (-8.30,19.83), P = 0.42). Conclusions EVAR combined with sac embolization effectively reduces the incidence of type II endoleak and the reintervention rate without enhancing the operation time. Therefore, more high-quality studies are still needed for validation due to the limited amount and quality of included literature. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022365648.
Collapse
Affiliation(s)
- Quan Chen
- Department of Intervention and Vascular Surgery, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yuan Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, Gansu, China
| | - Kangqing Lei
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, Gansu, China
| | - Liangyin Fu
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, Gansu, China
| | - Dengxiao Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, Gansu, China
| | - Wanli Sun
- Department of Vascular Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Chaohai Shi
- Department of Vascular Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qibing Niu
- Department of Vascular Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China,Correspondence: Qibing Niu
| |
Collapse
|
23
|
Cost of Follow Up After Endovascular Abdominal Aortic Aneurysm Repair in Patients With an Initial Post-Operative Computed Tomography Angiogram Without Abnormalities. Eur J Vasc Endovasc Surg 2022; 64:602-608. [PMID: 36089184 DOI: 10.1016/j.ejvs.2022.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The Observing a Decade of Yearly Standardised Surveillance in EVAR patients with Ultrasound or CT Scan (ODYSSEUS) study was conducted to assess differences in outcomes of patients with continued or discontinued yearly follow up after endovascular abdominal aortic aneurysm repair (EVAR). Earlier results of this study showed that discontinued follow up was not associated with poor outcomes. Therefore, an incremental cost analysis and budget impact analysis of de-implementation of yearly imaging following EVAR was performed. METHODS In total, 1 596 patients from the ODYSSEUS study were included. The expected cost savings were assessed if yearly imaging was reduced in patients with a post-operative computed tomography angiogram without abnormalities made around 30 days after EVAR. Costs were derived from the Dutch costs manual, benchmark cost prices, and literature review. Costs were expressed in euros (€) and displayed at 2019 prices. Sensitivity analysis was performed by varying costs. RESULTS A difference of 24% in cost was found between patients with continued and discontinued imaging follow up. The cost per patient was €1 935 in the continued group vs. €1 603 per patient in the discontinued group at five years post-EVAR, with a mean difference of €332 (95% bias corrected and accelerated bootstrap confidence interval -741 to 114). De-implementation of yearly imaging would result in an annual nationwide cost saving of €678 471. Sensitivity analysis with variation in adherence rates, imaging, or secondary intervention costs resulted in a saving of at least €271 388 per year. CONCLUSION This study provided an in depth analysis of hospital costs for post-EVAR patients in the Netherlands with a modest impact on the Dutch healthcare budget.
Collapse
|
24
|
Meuli L, Zimmermann A, Menges AL, Stefanikova S, Reutersberg B, Makaloski V. Prognostic model for survival of patients with abdominal aortic aneurysms treated with endovascular aneurysm repair. Sci Rep 2022; 12:19540. [PMID: 36380101 PMCID: PMC9666454 DOI: 10.1038/s41598-022-24060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
The role of endovascular aneurysm repair (EVAR) in patients with asymptomatic abdominal aortic aneurysm (AAA) who are unfit for open surgical repair has been questioned. The impending risk of aneurysm rupture, the risk of elective repair, and the life expectancy must be balanced when considering elective AAA repair. This retrospective observational cohort study included all consecutive patients treated with standard EVAR for AAA at a referral centre between 2001 and 2020. A previously published predictive model for survival after EVAR in patients treated between 2001 and 2012 was temporally validated using patients treated at the same institution between 2013 and 2020 and updated using the overall cohort. 558 patients (91.2% males, mean age 74.9 years) were included. Older age, lower eGFR, and COPD were independent predictors for impaired survival. A risk score showed good discrimination between four risk groups (Harrel's C = 0.70). The 5-years survival probabilities were only 40% in "high-risk" patients, 68% in "moderate-to-high-risk" patients, 83% in "low-to-moderate-risk", and 89% in "low-risk" patients. Low-risk patients with a favourable life expectancy are likely to benefit from EVAR, while high-risk patients with a short life expectancy may not benefit from EVAR at the current diameter threshold.
Collapse
Affiliation(s)
- Lorenz Meuli
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Zimmermann
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Anna-Leonie Menges
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sandra Stefanikova
- grid.411656.10000 0004 0479 0855Department for Vascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Benedikt Reutersberg
- grid.412004.30000 0004 0478 9977Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Vladimir Makaloski
- grid.411656.10000 0004 0479 0855Department for Vascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
25
|
Kontopodis N, Galanakis N, Charalambous S, Matsagkas M, Giannoukas AD, Tsetis D, Ioannou CV, Antoniou GA. Editor's Choice - Endovascular Aneurysm Repair in High Risk Patients: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 64:461-474. [PMID: 35872342 DOI: 10.1016/j.ejvs.2022.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/06/2022] [Accepted: 07/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate outcomes of endovascular aneurysm repair (EVAR) in high risk patients. METHODS Bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) were searched using combinations of thesaurus and free text terms. The review protocol was registered in PROSPERO (CRD42021287207) and reported according to PRISMA 2020. Pooled estimates were calculated using odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) applying the Mantel-Haenszel or inverse variance method. EVAR peri-operative mortality in high risk patients over time was examined with mixed effects meta-regression. The GRADE framework was used to rate the certainty of evidence. RESULTS The pooled peri-operative mortality in 18 416 high risk patients who underwent EVAR was 3% (95% CI 2.3 - 4%) and has significantly reduced over time (year of publication p = .003; median study point p = .023). The peri-operative mortality was significantly lower in high risk patients treated with EVAR compared with open repair (OR 0.64; 95% CI 0.45 - 0.92), but no significant difference was found in overall (HR 1.06; 95% CI 0.76 - 1.49) or aneurysm related mortality (HR 0.57; 95% CI 0.21 - 1.55). No significant difference was found in overall mortality between high risk patients treated with EVAR vs. no intervention (HR 0.42; 95% CI 0.14 - 1.26), but the aneurysm related mortality was significantly lower in the former (HR 0.30; 95% CI 0.14 - 0.63). The peri-operative mortality was higher in high risk than normal risk patients treated with EVAR (OR 2.33; 95% CI 1.75 - 3.10), as was the overall mortality (HR 3.50; 95% CI 2.55 - 4.80). The certainty of evidence was very low for EVAR vs. open surgery or no intervention and low for high vs. normal risk patients. CONCLUSION The EVAR peri-operative mortality in high risk patients has improved over time. Even though the aneurysm related mortality of EVAR is lower compared with no intervention, EVAR may confer no overall survival benefit.
Collapse
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece
| | - Stavros Charalambous
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece; Department of Radiology, Division of Interventional Radiology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miltiadis Matsagkas
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Tsetis
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.
| |
Collapse
|
26
|
Sterpetti AV, Arici V, Bozzani A. Cancer and the vascular surgeon. J Vasc Surg 2022; 76:1109. [PMID: 36150775 DOI: 10.1016/j.jvs.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 10/14/2022]
Affiliation(s)
| | - Vittorio Arici
- Department of Surgery, University of Rome Sapienza, Rome, Italy
| | - Antonio Bozzani
- Department of Surgery, University of Rome Sapienza, Rome, Italy
| |
Collapse
|
27
|
Sultan S, Acharya Y, Soliman O, Parodi JC, Hynes N. TEVAR and EVAR, the unknown knowns of the cardiovascular hemodynamics; and the immediate and long-term consequences of fabric material on major adverse clinical outcome. Front Surg 2022; 9:940304. [PMID: 36111231 PMCID: PMC9468223 DOI: 10.3389/fsurg.2022.940304] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
This review discusses the impact of endovascular aneurysm repair on cardiovascular (CV) hemodynamics and the role of stent-graft material, i.e., polytetrafluoroethylene (PTFE) vs. polyester in post-procedural outcomes. Endovascular aneurysm repair has been widely employed in the last decades for thoracic and abdominal aneurysm repair. However, aortic endografts are stiff and alter the native flow hemodynamics. This failure to simulate the native aorta could lead to added strain on the heart, manifesting as increased left ventricular strain, higher pulse pressure, and congestive heart failure later. This could result in adverse CV outcomes. Also, evidence is mounting to support the implication of stent-graft materials, i.e., PTFE vs. polyester, in adverse post-procedural outcomes. However, there is an absence of level one evidence. Therefore, the only way forward is to plan and perform a randomised controlled trial to demonstrate the alterations in the CV hemodynamics in the short and long run and compare the available stent-graft materials regarding procedural and clinical outcomes. We believe the best solution, for now, would be to reduce the stented length of the aorta. At the same time, in the longer term, encourage continuous improvement in stent-graft materials and design.
Collapse
Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
- Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Galway, Ireland
- CÚRAM-CORRIB-Vascular Group, National University of Ireland, Galway, Ireland
- Correspondence: Sherif Sultan ,
| | - Yogesh Acharya
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
- Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland, Galway Affiliated Hospital, Galway, Ireland
| | - Osama Soliman
- CÚRAM-CORRIB-Vascular Group, National University of Ireland, Galway, Ireland
| | - Juan Carlos Parodi
- Department of Vascular Surgery and Biomedical Engineering Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Niamh Hynes
- CÚRAM-CORRIB-Vascular Group, National University of Ireland, Galway, Ireland
| |
Collapse
|
28
|
Wu Y, Yin J, Hongpeng Z, Wei G. Systematic review and network meta-analysis of pre-emptive embolization of the aneurysm sac side branches and aneurysm sac coil embolization to improve the outcomes of endovascular aneurysm repair. Front Cardiovasc Med 2022; 9:947809. [PMID: 35935638 PMCID: PMC9354492 DOI: 10.3389/fcvm.2022.947809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 06/29/2022] [Indexed: 01/02/2023] Open
Abstract
Objective Previous reports have revealed a high incidence of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR). The incidence of T2EL after EVAR is reduced by pre-emptive embolization of aneurysm sac side branches (ASSB) and aneurysm sac coil embolization (ASCE). This study aimed to investigate whether different preventive interventions for T2EL were correlated with suppression of aneurysm sac expansion and reduction of the re-intervention rate. Methods The PubMed, Web of Science, MEDLINE and Embase databases, and conference proceedings were searched to identify articles on EVAR with or without embolization. The study was developed in line with the Participants, Interventions, Comparisons, Outcomes, and Study design principles and was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We used network meta-analysis based on multivariate random-effects meta-analysis to indirectly compare outcomes of different strategies for embolization during EVAR. Results A total of 31 studies met all inclusion criteria and were included in the qualitative and quantitative syntheses. The included studies were published between 2001 and 2022 and analyzed a total of 18,542 patients, including 1,882 patients who received prophylactic embolization treatment during EVAR (experimental group) and 16,660 who did not receive prophylactic embolization during EVAR (control group). The effect of pre-emptive embolization of the inferior mesenteric artery (IMA) (IMA-ASSB) in preventing T2EL was similar (relative risk [RR] 1.01, 95% confidence interval [CI] 0.38–2.63) to the effects of non-selective embolization of ASSB (NS-ASSB) and ASCE (RR 0.88, 95% CI 0.40–1.96). IMA-ASSB showed a better clinical effect in suppressing the aneurysm sac expansion (RR 0.27, 95% CI 0.09–2.25 compared with NS-ASSB; RR 0.93, 95% CI 0.16–5.56 compared with ASCE) and reducing the re-intervention rate (RR 0.34, 95% CI 0.08–1.53 compared with NS-ASSB; RR 0.66, 95% CI 0.19–2.22 compared with ASCE). All prophylactic embolization strategies improved the clinical outcomes of EVAR. Conclusion Prophylactic embolization during EVAR effectively prevents T2EL, suppresses the aneurysm sac expansion, and reduces the re-intervention rate. IMA embolization demonstrated benefits in achieving long-term aneurysm sac stability and lowering the risk of secondary surgery. NS-ASSB more effectively reduces the incidence of T2EL, while IMA embolization alone or in combination with ASCE enhances the clinical benefits of EVAR. In addition, as network meta-analysis is still an indirect method based on a refinement of existing data, more studies and evidence are still needed in the future to establish more credible conclusions.
Collapse
Affiliation(s)
- Ye Wu
- Department of Vascular Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Medical College of Chinese PLA, Beijing, China
| | - Jianhan Yin
- Department of Vascular Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Nankai University, Tianjin, China
| | - Zhang Hongpeng
- Department of Vascular Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guo Wei
- Department of Vascular Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
29
|
Spangler EL, Jackson EA, Richman J. Mortality Trends in Contemporary Abdominal Aortic Aneurysm Repairs Among Veterans. J Surg Res 2022; 279:383-392. [PMID: 35820320 DOI: 10.1016/j.jss.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 05/10/2022] [Accepted: 06/08/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Clinical trials at the advent of endovascular aortic aneurysm repairs (EVARs) demonstrated improved early survival with EVAR compared to open repairs; however, characterizations of routine contemporary care have been limited. This study compares postoperative survival among Veterans in clinical care following abdominal aortic aneurysm (AAA) repair with EVAR versus open repairs since the widespread adoption of EVAR. MATERIALS AND METHODS This retrospective cohort analysis of Veterans with AAA repairs from 2007 to 2020 at Veterans Affairs (VA) facilities evaluated survival by a repair method. Administrative International Classification of Diseases 9/10 codes and sociodemographic characteristics from structured charting were used for characterization and adjusted analyses. Demographics were compared via Chi-squared and Wilcoxon rank-sum testing and mortality evaluated using Kaplan-Meier and Cox proportional hazard analyses. RESULTS Among 15,480 AAA repairs (3566 open, and 11,914 EVAR), patients receiving open repairs were younger with lower Charlson scores compared to EVARs. EVAR was associated with better survival until 2.4 y post-procedure. Mean long-term survival, however, was higher for open surgery (6.3 ± 3.8 versus 5.8 ± 3.1 y in EVAR). After adjustment for gender, race, and ethnicity, EVAR was associated with worse survival (mortality hazard ratio [HR] 1.17; 95% confidence interval [CI], 1.11-1.24) as was each increment in Charlson score (HR 1.11; CI 1.10-1.12), whereas service-connected care (HR 0.73; CI, 0.70-0.77) and age (HR 0.99; CI, 0.98-0.99) were associated with better survival. CONCLUSIONS In contemporary Veteran aneurysm repairs, although a higher early survival rate was observed in EVAR repairs, long-term survival was higher for open repairs. Service-connected care was independently associated with greater survival after aneurysm repair.
Collapse
Affiliation(s)
- Emily L Spangler
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama; Birmingham VA Medical Center, Birmingham, Alabama.
| | - Elizabeth A Jackson
- Birmingham VA Medical Center, Birmingham, Alabama; Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | | |
Collapse
|
30
|
Pratesi C, Esposito D, Apostolou D, Attisani L, Bellosta R, Benedetto F, Blangetti I, Bonardelli S, Casini A, Fargion AT, Favaretto E, Freyrie A, Frola E, Miele V, Niola R, Novali C, Panzera C, Pegorer M, Perini P, Piffaretti G, Pini R, Robaldo A, Sartori M, Stigliano A, Taurino M, Veroux P, Verzini F, Zaninelli E, Orso M. Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:328-352. [PMID: 35658387 DOI: 10.23736/s0021-9509.22.12330-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The objective of these Guidelines was to revise and update the previous 2016 Italian Guidelines on Abdominal Aortic Aneurysm Disease, in accordance with the National Guidelines System (SNLG), to guide every practitioner toward the most correct management pathway for this pathology. The methodology applied in this update was the GRADE-SIGN version methodology, following the instructions of the AGREE quality of reporting checklist as well. The first methodological step was the formulation of clinical questions structured according to the PICO (Population, Intervention, Comparison, Outcome) model according to which the Recommendations were issued. Then, systematic reviews of the Literature were carried out for each PICO question or for homogeneous groups of questions, followed by the selection of the articles and the assessment of the methodological quality for each of them using qualitative checklists. Finally, a Considered Judgment form was filled in for each clinical question, in which the features of the evidence as a whole are assessed to establish the transition from the level of evidence to the direction and strength of the recommendations. These guidelines outline the correct management of patients with abdominal aortic aneurysm in terms of screening and surveillance. Medical management and indication for surgery are discussed, as well as preoperative assessment regarding patients' background and surgical risk evaluation. Once the indication for surgery has been established, the options for traditional open and endovascular surgery are described and compared, focusing specifically on patients with ruptured abdominal aortic aneurysms as well. Finally, indications for early and late postoperative follow-up are explained. The most recent evidence in the Literature has been able to confirm and possibly modify the previous recommendations updating them, likewise to propose new recommendations on prospectively relevant topics.
Collapse
Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | | | - Luca Attisani
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Filippo Benedetto
- Department of Vascular Surgery, AOU Policlinico Martino, Messina, Italy
| | | | | | - Andrea Casini
- Department of Intensive Care, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Elisabetta Favaretto
- Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, Parma University Hospital, Parma, Italy
| | - Edoardo Frola
- Department of Vascular Surgery, AO S. Croce e Carle, Cuneo, Italy
| | - Vittorio Miele
- Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | - Chiara Panzera
- Department of Vascular Surgery, AOU Sant'Andrea, Rome, Italy
| | - Matteo Pegorer
- Department of Vascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Paolo Perini
- Department of Vascular Surgery, Parma University Hospital, Parma, Italy
| | | | - Rodolfo Pini
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessandro Robaldo
- Department of Vascular Surgery, Ticino Vascular Center - Lugano Regional Hospital, Lugano, Switzerland
| | - Michelangelo Sartori
- Department of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | - Fabio Verzini
- Department of Vascular Surgery, AOU Città della Salute e della Scienza, Turin, Italy
| | - Erica Zaninelli
- Department of General Medical Practice, ATS Bergamo - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| |
Collapse
|
31
|
Single centre experience with Excluder ® stent graft; 17-year outcome. Radiol Oncol 2022; 56:156-163. [PMID: 35417109 PMCID: PMC9122300 DOI: 10.2478/raon-2022-0008] [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] [Received: 12/19/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed. PATIENTS AND METHODS This study included 123 patients (104 men; mean age 73.0 years, range 51-89) with abdominal aorta aneurysm, treated with Excluder® stent graft between October 2002 and June 2008. Periprocedural and follow-up data were retrieved by reviewing the records of our institution, while time and cause of death were retrieved from the National Institute of Public Health. If an abdominal aortic aneurysm rupture was listed as the cause of death, records were retrieved from the institution that issued the death certificate. Our primary goal was to assess the primary technical success rate, type 1 and type 2 endoleak, reintervention free survival, 30-day mortality, the overall survival and aneurysm rupture-free survival. RESULTS The median follow-up was 9.7 years (interquartile range, 4.6-13.8). The primary technical success was 98.4% and the 30-day mortality accounted for 0.8%. Secondary procedures were performed in 29 (23.6%) patients during the follow-up period. The one-, five-, ten-, fifteen- and seventeen-year overall survival accounted for 94.3%, 74.0%, 47.2%, 35.8% and 35.8%, while the aneurysm-related survival was 98.4%, 96.3%, 92.6%, 92.6%, 92.6%. In seven (5.7%) patients, abdominal aortic rupture was found as the primary cause of death during follow-up. CONCLUSIONS Our data showed that EVAR with Excluder® stent graft offers good long-term results. More than 75% of patients can be treated completely percutaneously. Late ruptures do occur in the first ten years, raising awareness about regular medical controls.
Collapse
|
32
|
Gibello L, Verzini F, Spalla F, Frola E, Porro L, Peluttiero I, Ripepi M, Boero M, Varetto G. Long-term outcomes of open and endovascular abdominal aortic repair in younger patients. Ann Vasc Surg 2022; 85:323-330. [PMID: 35271964 DOI: 10.1016/j.avsg.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To evaluate long-term results in abdominal aortic aneurysm (AAA) surgery by either open (OAR) or endovascular (EVAR) repair in patients under 70 years of age. METHODS A retrospective analysis of a prospectively collected database of patients with age under 70 years old undergoing elective infrarenal AAA surgery between 2010 and 2018 was performed. The study population was divided into two groups: OAR and EVAR. The primary end-points were overall survival and aneurysm-related death, while secondary outcomes were need for reintervention and development of minor and major complications. RESULTS 191 patients younger than 70 years old treated for elective AAA surgery were enrolled: 157 OAR (98% males, mean age 65 ± 4 years) and 34 EVAR (94% males, mean age 66 ± 4 years). Hospital stay, 30-day mortality and need for reintervention were similar; OAR population presented higher incidence of postoperative major complications (18% vs 2.9%; p .01) while minor complications were 32% in OAR vs 21% in EVAR group (p .08). Median follow-up was 69 months for OAR (IQR 53 months) vs. 79 months (IQR 51 months) for EVAR (p .9): long-term AAA-related reinterventions were more frequent after EVAR (1.9% OAR vs. 17% EVAR; p .01) while AAA-related long-term mortality was similar in both sugroups (1.3% OAR and 3% EVAR; p .8). At univariate analysis a higher risk of reintervention was reported for conical necks in EVAR group (p .03) and for the concomitant presence of iliac aneurysms in both groups (p .01). CONCLUSIONS In our population, the presence of a conical neck is an independent predictor of EVAR failure and late reintervention, while it does not play a significant role in OAR group. For this reason, in such cases, open surgery must be considered as the first option in younger patients with a long-life expectancy.
Collapse
Affiliation(s)
- Lorenzo Gibello
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy.
| | - Fabio Verzini
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| | - Flavia Spalla
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| | - Edoardo Frola
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| | - Luca Porro
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| | - Ilaria Peluttiero
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| | - Matteo Ripepi
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| | - Michele Boero
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| | - Gianfranco Varetto
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette Hospital; Turin, Italy
| |
Collapse
|
33
|
Anaesthesia for endovascular repair of ruptured abdominal aortic aneurysms. BJA Educ 2022; 22:208-215. [DOI: 10.1016/j.bjae.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
|
34
|
Gozzo C, Caruana G, Cannella R, Farina A, Giambelluca D, Dinoto E, Vernuccio F, Basile A, Midiri M. CT angiography for the assessment of EVAR complications: a pictorial review. Insights Imaging 2022; 13:5. [PMID: 35032231 PMCID: PMC8761205 DOI: 10.1186/s13244-021-01112-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Endovascular aneurysm repair (EVAR) is a minimally invasive treatment proposed as an alternative to open repair in patients with abdominal aortic aneurysms. EVAR consists in a stent-graft placement within the aorta in order to exclude the aneurysm from arterial circulation and reduce the risk of rupture. Knowledge of the various types of devices is mandatory because some stents/grafts are more frequently associated with complications. CT angiography is the gold standard diagnostic technique for preprocedural planning and postprocedural surveillance. EVAR needs long-term follow-up due to the high rate of complications. Complications can be divided in endograft device-related and systemic complications. The purpose of this article is to review the CT imaging findings of EVAR complications and the key features for the diagnosis.
Collapse
Affiliation(s)
- Cecilia Gozzo
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia". Catania, Italy, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Caruana
- Neuroradiology Section, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Roberto Cannella
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
| | - Arduino Farina
- Vascular Surgery Unit ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Dario Giambelluca
- Section of Radiology, Asp Siracusa, Ospedale Umberto I, Via Giuseppe Testaferrata 1, Siracusa, SR, Italy
| | - Ettore Dinoto
- Vascular Surgery Unit AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - Federica Vernuccio
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia". Catania, Italy, Via Santa Sofia 78, 95123, Catania, Italy
| | - Massimo Midiri
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| |
Collapse
|
35
|
Ketting S, Zoethout AC, Heyligers J, Wiersema AM, Yeung KK, Schurink GW, Verhagen HJ, de Vries JPP, Reijnen MM, Mees BM. Nationwide experience with EVAS relining of previous open or endovascular AAA treatment in the Netherlands. Ann Vasc Surg 2022; 84:250-264. [DOI: 10.1016/j.avsg.2021.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022]
|
36
|
Nguyen J, Li A, Tam DY, Forbes TL. ANALYSIS OF SPIN IN VASCULAR SURGERY RANDOMIZED CONTROLLED TRIALS WITH NONSIGNIFICANT OUTCOMES. J Vasc Surg 2021; 75:1074-1080.e17. [PMID: 34923067 DOI: 10.1016/j.jvs.2021.09.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/25/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Spin is the manipulation of language that distorts the interpretation of objective findings. The purpose of this study is to describe the characteristics of spin found in statistically nonsignificant randomized controlled trials (RCT) comparing carotid endarterectomy (CEA) to carotid artery stenting (CAS) for carotid stenosis (CS), and endovascular repair (EVAR) to open repair (OR) for abdominal aortic aneurysms (AAA). METHODS A search of MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials was performed in June 2020 for studies published describing AAA or CS. All phase three RCTs with nonsignificant primary outcomes comparing OR to EVAR or CEA to CAS were included. Studies were appraised for the characteristics and severity of spin using a validated tool. Binary logistic regression was performed to assess the association of spin grade to (1) funding source (commercial vs non-commercial) and (2) the publishing journal's impact factor. RESULTS Thirty-one of 355 articles captured were included for analysis. Spin was identified in nine abstracts (9/18) and 13 main texts (13/18) of AAA articles and seven abstracts (7/13) and ten main texts (10/13) of CS articles. For both AAA and CS articles, spin was most commonly found in the manuscript discussion section, with the most commonly employed strategy being the interpretation of statistically nonsignificant primary results to show treatment equivalence or rule out adverse treatment effects. Increasing journal impact factor was associated with a statistically significant lower likelihood of spin in the study title or abstract conclusion (βOR = 0.96, 95% CI: 0.94 - 0.98, p < 0.01) while no significant association could be found with funding source (βOR = 1.33, 95% CI: 0.30-5.92, p = 0.71). CONCLUSIONS A large proportion of statistically nonsignificant RCTs contain interpretations that are inconsistent with their results. These findings should prompt authors and readers to appraise study findings independently and to limit the use of spin in study interpretations.
Collapse
Affiliation(s)
| | - Allen Li
- University of Ottawa, Faculty of Medicine
| | - Derrick Y Tam
- Division of Cardiac Surgery, University of Toronto; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network; Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
37
|
Avril S, Gee MW, Hemmler A, Rugonyi S. Patient-specific computational modeling of endovascular aneurysm repair: State of the art and future directions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3529. [PMID: 34490740 DOI: 10.1002/cnm.3529] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Endovascular aortic repair (EVAR) has become the preferred intervention option for aortic aneurysms and dissections. This is because EVAR is much less invasive than the alternative open surgery repair. While in-hospital mortality rates are smaller for EVAR than open repair (1%-2% vs. 3%-5%), the early benefits of EVAR are lost after 3 years due to larger rates of complications in the EVAR group. Clinicians follow instructions for use (IFU) when possible, but are left with personal experience on how to best proceed and what choices to make with respect to stent-graft (SG) model choice, sizing, procedural options, and their implications on long-term outcomes. Computational modeling of SG deployment in EVAR and tissue remodeling after intervention offers an alternative way of testing SG designs in silico, in a personalized way before intervention, to ultimately select the strategies leading to better outcomes. Further, computational modeling can be used in the optimal design of SGs in cases of complex geometries. In this review, we address some of the difficulties and successes associated with computational modeling of EVAR procedures. There is still work to be done in all areas of EVAR in silico modeling, including model validation, before models can be applied in the clinic, but much progress has already been made. Critical to clinical implementation are current efforts focusing on developing fast algorithms that can achieve (near) real-time solutions, as well as ways of dealing with inherent uncertainties related to patient aortic wall degradation on an individualized basis. We are optimistic that EVAR modeling in the clinic will soon become a reality to help clinicians optimize EVAR interventions and ultimately reduce EVAR-associated complications.
Collapse
Affiliation(s)
- Stéphane Avril
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, Saint-Étienne, France
| | - Michael W Gee
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - André Hemmler
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - Sandra Rugonyi
- Biomedical Engineering Department, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
38
|
Abstract
Jin-Ling Tang and Li-Ming Li argue that despite the lure of vaccines and new drugs, established public health measures will remain our best tool to control covid-19 and future epidemics
Collapse
Affiliation(s)
- Jin-Ling Tang
- Shenzhen Institute of Advanced Technology of the Chinese Academy of Sciences, Shenzhen, China
- Guangzhou Women and Children's Medical Centre, Guangzhou, Guangdong Province, China
| | - Li-Ming Li
- School of Public Health, Peking University, Beijing, China
| |
Collapse
|
39
|
Churchill D, Motaganahalli R, LaRoche T, Ramkaransingh J. A novel approach for treating type II endoleaks utilizing contrast-enhanced ultrasound. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:581-585. [PMID: 34504986 PMCID: PMC8411011 DOI: 10.1016/j.jvscit.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/29/2021] [Indexed: 12/04/2022]
Abstract
Endoleaks are a frequent and well-known complication after endovascular repair of aortic aneurysms. An endoleak can lead to increased intrasac pressure, sac enlargement, and potential aneurysm rupture. Type II endoleaks result from retrograde filling of aortic branch vessels and can be treated with surgical, endovascular, or direct percutaneous approaches. Direct percutaneous treatment typically involves embolization of the perfused endoleak cavity typically using a translumbar approach with fluoroscopic guidance. We illustrate a novel image-guided approach for percutaneous transabdominal endoleak treatment using contrast-enhanced ultrasound in combination with fluoroscopy.
Collapse
Affiliation(s)
- Dennis Churchill
- Division of Interventional Radiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind
| | - Raghu Motaganahalli
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
- Correspondence: Raghu Motaganahalli, MD, Department of Surgery, Division of Vascular Surgery, Indiana University School of Medicine, 1801 N Senate Blvd, MPC-2 Ste 3500, Indianapolis, IN 46202
| | - Thomas LaRoche
- Division of Interventional Radiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind
- Division of Interventional Radiology, Department of Radiology, Richard L. Roudebush VA Medical Center, Indianapolis, Ind
| | - Jeffrey Ramkaransingh
- Division of Interventional Radiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind
- Division of Interventional Radiology, Department of Radiology, Richard L. Roudebush VA Medical Center, Indianapolis, Ind
| |
Collapse
|
40
|
Sarafidis P, Martens S, Saratzis A, Kadian-Dodov D, Murray PT, Shanahan CM, Hamdan AD, Engelman DT, Teichgräber U, Herzog CA, Cheung M, Jadoul M, Winkelmayer WC, Reinecke H, Johansen K. Diseases of the Aorta and Kidney Disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Cardiovasc Res 2021; 118:2582-2595. [PMID: 34469520 PMCID: PMC9491875 DOI: 10.1093/cvr/cvab287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease (CKD) is an independent risk factor for the development of abdominal aortic aneurysm (AAA), as well as for cardiovascular and renal events and all-cause mortality following surgery for AAA or thoracic aortic dissection. In addition, the incidence of acute kidney injury (AKI) after any aortic surgery is particularly high, and this AKI per se is independently associated with future cardiovascular events and mortality. On the other hand, both development of AKI after surgery and the long-term evolution of kidney function differ significantly depending on the type of AAA intervention (open surgery vs. the various subtypes of endovascular repair). Current knowledge regarding AAA in the general population may not be always applicable to CKD patients, as they have a high prevalence of co-morbid conditions and an elevated risk for periprocedural complications. This summary of a Kidney Disease: Improving Global Outcomes Controversies Conference group discussion reviews the epidemiology, pathophysiology, diagnosis, and treatment of Diseases of the Aorta in CKD and identifies knowledge gaps, areas of controversy, and priorities for future research.
Collapse
Affiliation(s)
- Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sven Martens
- Department of Cardiothoracic Surgery - Division of Cardiac Surgery, Münster, University Hospital, Universitätsklinikum, Münster, Germany
| | - Athanasios Saratzis
- Department of Vascular Surgery, Leicester University Hospital and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick T Murray
- Department of Nephrology, School of Medicine, University College Dublin, Dublin, Ireland
| | - Catherine M Shanahan
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Allen D Hamdan
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel T Engelman
- Heart, Vascular & Critical Care Services Baystate Medical Center, and University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Ulf Teichgräber
- Department of Radiology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA.,Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | | | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Holger Reinecke
- Department of Cardiology I: Coronary and peripheral vessel disease, heart failure; Münster University Hospital, Universitätsklinikum, Münster, Germany
| | - Kirsten Johansen
- Division of Nephrology, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
41
|
Singh B, Resch T, Sonesson B, Abdulrasak M, Dias NV. Simple diameter measurements with ultrasound can be safely used to follow the majority of patients after infrarenal endovascular aneurysm repair. INT ANGIOL 2021; 40:425-434. [PMID: 34282856 DOI: 10.23736/s0392-9590.21.04706-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The optimal imaging follow-up after infrarenal EVAR is still undefined. The objective was to study the outcome of a personalized follow-up program after infrarenal EVAR based on ultrasound AAA diameter measurements for low-risk patients. METHODS All consecutive patients followed-up locally after elective and acute infrarenal EVAR between 2010 and 2015 were retrospectively reviewed. Patients underwent CTA at 1 month post-EVAR whereby the attending surgeon defined the subsequent follow-up. Patients considered at low risk were followed with ultrasound only assessing AAA diameter at 1, 2, 3 and every 5 years postoperatively (group A). Low-risk required a favourable preoperative anatomy especially regarding the aneurysm neck, satisfactory intraoperative result and uneventful 1 month CTA (type 2 endoleaks acceptable). Patients not fulfilling the criteria for group A were followed with yearly 3-phase-CTAs (group B). RESULTS 222 patients with a AAA median diameter of 58 (54-68) mm were included. 191 were allocated into group A and 31 in group B. Median follow-up time was 36 (24-59) months. Five year primary and primary assisted success was 82 ± 5 % and 93 ± 3 % for group A and 70 ± 13% and 93 ± 5% for group B, respectively (P= 0.042 and P= 0.504, respectively). 16 late aneurysm-related re-interventions were performed in 12 patients (7 in group A and 9 in group B). In group A, 5 re-interventions were rupture-preventing and 2 were symptomatic. All late re-interventions in group B were performed following findings on follow-up imaging. Five-year late re-intervention-free survival was 95 ± 2 % and 84 ± 7 % for groups A and B, respectively (P=0.046). Five-year survival was 80 ± 3 % and 63 ± 10 % for group A and B, respectively (P= 0.024). CONCLUSIONS A customized follow-up program after infrarenal EVAR based on ultrasound AAA diameter measurements in low-risk patients seems to be effective in maintaining a very high mid-term clinical success rate.
Collapse
Affiliation(s)
- Bharti Singh
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden - .,Clinical Sciences Malmö, Lund University, Malmö, Sweden -
| | - Timothy Resch
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.,Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Björn Sonesson
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.,Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Mohammed Abdulrasak
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.,Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Nuno V Dias
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.,Clinical Sciences Malmö, Lund University, Malmö, Sweden
| |
Collapse
|
42
|
Michaels J, Wilson E, Maheswaran R, Radley S, Jones G, Tong TS, Kaltenthaler E, Aber A, Booth A, Buckley Woods H, Chilcott J, Duncan R, Essat M, Goka E, Howard A, Keetharuth A, Lumley E, Nawaz S, Paisley S, Palfreyman S, Poku E, Phillips P, Rooney G, Thokala P, Thomas S, Tod A, Wickramasekera N, Shackley P. Configuration of vascular services: a multiple methods research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Vascular services is changing rapidly, having emerged as a new specialty with its own training and specialised techniques. This has resulted in the need for reconfiguration of services to provide adequate specialist provision and accessible and equitable services.
Objectives
To identify the effects of service configuration on practice, resource use and outcomes. To model potential changes in configuration. To identify and/or develop electronic data collection tools for collecting patient-reported outcome measures and other clinical information. To evaluate patient preferences for aspects of services other than health-related quality of life.
Design
This was a multiple methods study comprising multiple systematic literature reviews; the development of a new outcome measure for users of vascular services (the electronic Personal Assessment Questionnaire – Vascular) based on the reviews, qualitative studies and psychometric evaluation; a trade-off exercise to measure process utilities; Hospital Episode Statistics analysis; and the development of individual disease models and a metamodel of service configuration.
Setting
Specialist vascular inpatient services in England.
Data sources
Modelling and Hospital Episode Statistics analysis for all vascular inpatients in England from 2006 to 2018. Qualitative studies and electronic Personal Assessment Questionnaire – Vascular evaluation with vascular patients from the Sheffield area. The trade-off studies were based on a societal sample from across England.
Interventions
The data analysis, preference studies and modelling explored the effect of different potential arrangements for service provision on the resource use, workload and outcomes for all interventions in the three main areas of inpatient vascular treatment: peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. The electronic Personal Assessment Questionnaire – Vascular was evaluated as a potential tool for clinical data collection and outcome monitoring.
Main outcome measures
Systematic reviews assessed quality and psychometric properties of published outcome measures for vascular disease and the relationship between volume and outcome in vascular services. The electronic Personal Assessment Questionnaire – Vascular development considered face and construct validity, test–retest reliability and responsiveness. Models were validated using case studies from previous reconfigurations and comparisons with Hospital Episode Statistics data. Preference studies resulted in estimates of process utilities for aneurysm treatment and for travelling distances to access services.
Results
Systematic reviews provided evidence of an association between increasing volume of activity and improved outcomes for peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. Reviews of existing patient-reported outcome measures did not identify suitable condition-specific tools for incorporation in the electronic Personal Assessment Questionnaire – Vascular. Reviews of qualitative evidence, primary qualitative studies and a Delphi exercise identified the issues to be incorporated into the electronic Personal Assessment Questionnaire – Vascular, resulting in a questionnaire with one generic and three disease-specific domains. After initial item reduction, the final version has 55 items in eight scales and has acceptable psychometric properties. The preference studies showed strong preference for endovascular abdominal aortic aneurysm treatment (willingness to trade up to 0.135 quality-adjusted life-years) and for local services (up to 0.631 quality-adjusted life-years). A simulation model with a web-based interface was developed, incorporating disease-specific models for abdominal aortic aneurysm, peripheral arterial disease and carotid artery disease. This predicts the effects of specified reconfigurations on workload, resource use, outcomes and cost-effectiveness. Initial exploration suggested that further reconfiguration of services in England to accomplish high-volume centres would result in improved outcomes, within the bounds of cost-effectiveness usually considered acceptable in the NHS.
Limitations
The major source of evidence to populate the models was Hospital Episode Statistics data, which have limitations owing to the complexity of the data, deficiencies in the coding systems and variations in coding practice. The studies were not able to address all of the potential barriers to change where vascular services are not compliant with current NHS recommendations.
Conclusions
There is evidence of potential for improvement in the clinical effectiveness and cost-effectiveness of vascular services through further centralisation of sites where major vascular procedures are undertaken. Preferences for local services are strong, and this may be addressed through more integrated services, with a range of services being provided more locally. The use of a web-based tool for the collection of clinical data and patient-reported outcome measures is feasible and can provide outcome data for clinical use and service evaluation.
Future work
Further evaluation of the economic models in real-world situations where local vascular service reconfiguration is under consideration and of the barriers to change where vascular services do not meet NHS recommendations for service configuration is needed. Further work on the electronic Personal Assessment Questionnaire – Vascular is required to assess its acceptability and usefulness in clinical practice and to develop appropriate report formats for clinical use and service evaluation. Further studies to assess the implications of including non-health-related preferences for care processes, and location of services, in calculations of cost-effectiveness are required.
Study registration
This study is registered as PROSPERO CRD42016042570, CRD42016042573, CRD42016042574, CRD42016042576, CRD42016042575, CRD42014014850, CRD42015023877 and CRD42015024820.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Jonathan Michaels
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Wilson
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ravi Maheswaran
- Department of Public Health, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Radley
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Thai-Son Tong
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eva Kaltenthaler
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ahmed Aber
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - James Chilcott
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rosie Duncan
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Munira Essat
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edward Goka
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aoife Howard
- Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - Anju Keetharuth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elizabeth Lumley
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Shah Nawaz
- Department of Vascular Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzy Paisley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Edith Poku
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Patrick Phillips
- Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gill Rooney
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steven Thomas
- Department of Vascular Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angela Tod
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Nyantara Wickramasekera
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Phil Shackley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
43
|
Nargesi S, Abutorabi A, Alipour V, Tajdini M, Salimi J. Cost-Effectiveness of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm: A Systematic Review. Cardiovasc Drugs Ther 2021; 35:829-839. [PMID: 33559809 DOI: 10.1007/s10557-020-07130-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Abdominal aortic aneurysm (AAA) is a life-threatening condition which, in the absence of increasing diameter or rupture, often remains asymptomatic, and a diameter greater than 5.5 cm requires elective surgical repair. This study aimed to evaluate the cost-effectiveness of endovascular repair (EVAR) versus open surgical repair (OSR) in patients with AAA through a systematic review of published health economics studies. METHODS Using a systematic review method, an electronic search was conducted for cost-effectiveness studies published on AAA (both in English and Persian) on PubMed, Embase, ISI/Web of Science (WoS), SCOPUS, Global Health databases, and the national databases of Iran from 1990 to 2020 including the keywords "cost-effectiveness", "endovascular", "open surgical", and "abdominal aortic aneurysms". The quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist. RESULTS In total, 958 studies were found, of which 16 were eligible for further study. All studies were conducted in developed countries, and quality-adjusted life years (QALY) and life years (LY) were used to measure the outcomes. According to the QHES checklist, most studies were of good quality. In European countries and Canada, EVAR has not been cost-effective, while most studies in the United States regard this technique as a cost-effective intervention. For example, incremental cost-effectiveness ratio (ICER) values ranged from $14,252.12 to $34,446.37 per QALY in the USA, while ICER was €116,600.40 per QALY in Portugal. CONCLUSION According to the results, the EVAR technique has been more cost-effective than OSR for high-risk patients, but the need for continuous follow-up, increased costs, and re-intervention over the long term and for low-risk patients has reduced the cost-effectiveness of this method. As the health systems vary among different countries (i.e. quality of care, cost of devices, etc.), and due to the heterogeneity of studies in terms of the follow-up period, time horizon, and threshold, all of which are inherent features of economic evaluation, generalizing the results should be done with much caution, and policymaking must be based on national evidence.
Collapse
Affiliation(s)
- Shahin Nargesi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Abutorabi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Vahid Alipour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Salimi
- Vascular Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
44
|
Maybe Neck Dilation Matters after All? Eur J Vasc Endovasc Surg 2021; 62:37. [PMID: 33431290 DOI: 10.1016/j.ejvs.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022]
|
45
|
Gavish L, Gilon D, Beeri R, Zuckerman A, Nachman D, Gertz SD. Photobiomodulation and estrogen stabilize mitochondrial membrane potential in angiotensin-II challenged porcine aortic smooth muscle cells. JOURNAL OF BIOPHOTONICS 2021; 14:e202000329. [PMID: 32888351 DOI: 10.1002/jbio.202000329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
Rupture of Abdominal aortic aneurysm (AAA) is among the 15 leading causes of death after age 65. Using high frequency ultrasound, we showed that photobiomodulation (PBM) prevents formation and progression of AAA in the angiotensin-II (Ang-II)-infused, apolipoprotein-e-deficient mouse model. In the current study we report that while challenge of porcine aortic Smooth Muscle Cells (SMCs) with Ang-II (1 μM) resulted in a marked decay in mitochondrial membrane potential (MitMP) vs non-challenged cells, treatment with PBM (continuous diode laser, 780 nm, 6.7 mW/cm2 , 5 minutes, 2 J/cm2 ) or pre-incubation with estrogen (50 nM, 1 hour) significantly attenuated this deterioration in MitMP. We also report that PBM and estrogen markedly affected porcine aortic SMC contraction and modified mitochondrial dispersion reflecting important influence on SMC function. These studies provide strong evidence of the important underlying role of mitochondria in the preventive effect of PBM on formation and progression of AAA and its reduced incidence and delayed onset in women.
Collapse
Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Gilon
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiology, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Beeri
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiology, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ayelet Zuckerman
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dean Nachman
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S David Gertz
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
46
|
Fabre D, Mougin J, Mitilian D, Cochennec F, Garcia Alonso C, Becquemin JP, Desgranges P, Allaire E, Hamdi S, Brenot P, Bourkaib R, Haulon S. Prospective, Randomised Two Centre Trial of Endovascular Repair of Abdominal Aortic Aneurysm With or Without Sac Embolisation. Eur J Vasc Endovasc Surg 2020; 61:201-209. [PMID: 33342658 DOI: 10.1016/j.ejvs.2020.11.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The benefit of aneurysm sac coil embolisation (ASCE) during endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) remains unclear. This prospective randomised two centre study (SCOPE 1: Sac COil embolisation for Prevention of Endoleak) compared the outcomes of standard EVAR in patients with AAA at high risk of type II endoleak (EL with EVAR with ASCE during the period 2014-2019. METHODS Patients at high risk of type II EL were randomised to standard EVAR (group A) or EVAR with coil ASCE (group B). The primary endpoint was the rate of all types of EL during follow up. Secondary endpoints included freedom from type II EL related re-interventions, and aneurysm sac diameter and volume variation at two year follow up. Adverse events included type II EL and re-interventions. CTA and Duplex ultrasound scans were scheduled at 30 days, six months, one year, and two years after surgery. RESULTS Ninety-four patients were enrolled, 47 in each group. There were no intra-operative complications. At M1, 16/47 early type II EL occurred (34%) in group A vs. 2/47 (4.3%) in group B (p < .001). At M6, 15/36 type II EL (41.7%) occurred in group A vs. 2/39 (4.26%) in group B (p < .001). At M12, 15/37 type II El (40.5%) occurred in group A vs. 5/35 (14.3%) in group B (p = .018). At 24 months, 8/32 type 2 El (25%) occurred in group A vs. 3/29 (6.5%) in group B (p = .19). Kaplan-Meier curves of survival free from EL and re-interventions were significantly in favour of group B (p < .001). Aneurysm sac volume decreased significantly in group B compared with group A at M6 (p = .081), at M12 (p = .004), and M24 (p = .001). CONCLUSION For selected patients at risk of EL, ASCE seems effective in preventing EL at one, six, and at 12 months. However, the difference was not statistically significant at 24 months. ASCE decreases the re-intervention rate two years after EVAR. A significantly faster aneurysm volume shrinkage was observed at one and two years following surgery. (SCOPE 1 trial: NCT01878240).
Collapse
Affiliation(s)
- Dominique Fabre
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France.
| | - Justine Mougin
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Delphine Mitilian
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | | | - Carlos Garcia Alonso
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | | | | | - Eric Allaire
- Henri Mondor Hospital, University Paris XII, Creteil, France
| | - Sarah Hamdi
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Philippe Brenot
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Riyad Bourkaib
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Stephan Haulon
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| |
Collapse
|
47
|
Eagleton MJ, Stoner M, Henretta J, Dryjski M, Panneton J, Tassiopoulos A, Mehta M, Pearce B, Sharafuddin MJ. Safety and effectiveness of the TREO stent graft for the endovascular treatment of abdominal aortic aneurysms. J Vasc Surg 2020; 74:114-123.e3. [PMID: 33253871 DOI: 10.1016/j.jvs.2020.10.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The short- and mid-term outcomes of endovascular aortic aneurysm repair have made it a standard treatment of abdominal aortic aneurysms. However, newer generation devices have yet to demonstrate improved long-term rates for complications, reinterventions, and survival. The TREO stent graft is a latest generation device and was evaluated for approval in the United States. METHODS In a multicenter, nonrandomized, investigational device exemption clinical trial, we assessed the safety and effectiveness of the TREO device, with core laboratory assessment of the imaging studies and an independent adjudication of safety. The primary effectiveness endpoint was successful aneurysm treatment at 1 year. The primary safety endpoint was the incidence of major adverse events (MAE) at 30 days. RESULTS A total of 150 patients (132 men; 88.0%) with infrarenal abdominal aortic (87.3%) or aortoiliac (12.7%) aneurysms were enrolled. The data were normally distributed. The mean age was 71.7 ± 7.4 years. The MAE incidence at 30 days was 0.7%. One subject experienced two MAE: myocardial infarction and procedural blood loss of 1000 mL. The proportion of successful aneurysm treatment at 1 year was 93.1%. Longer term follow-up continues, with no aneurysm-related mortality at the latest follow-up. At 3 years, the cumulative all-cause mortality and incidence of type I and type III endoleaks was 10.7% (n = 16), 2.7% (n = 4), and 0% (n = 0), respectively. In addition, aneurysm sac shrinkage >5 mm at 3 years had occurred in 54.3% of patients, and 9.3% had required a secondary intervention (n = 14). CONCLUSIONS The safety and effectiveness of endovascular repair of abdominal aneurysms with TREO were demonstrated, with 93.1% successful aneurysm treatment at 1 year and aneurysm sac shrinkage >5 mm at 3 years in 54.3% of patients. Long-term follow-up continues to determine whether these favorable outcomes will be sustained.
Collapse
Affiliation(s)
- Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Boston, Mass
| | - Michael Stoner
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY.
| | - John Henretta
- Department of Vascular Surgery, Mission Hospital, Asheville, NC
| | - Maciej Dryjski
- Department of Surgery, Buffalo General Medical Center, Buffalo, NY
| | - Jean Panneton
- Department of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va
| | | | - Manish Mehta
- Department of Vascular Surgery, Vascular Health Partners of Community Care Physicians, PC, Latham, NY
| | - Benjamin Pearce
- Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
| | | | | |
Collapse
|
48
|
Yu HYH, Lindström D, Wanhainen A, Tegler G, Hassan B, Mani K. Systematic review and meta-analysis of prophylactic aortic side branch embolization to prevent type II endoleaks. J Vasc Surg 2020; 72:1783-1792.e1. [DOI: 10.1016/j.jvs.2020.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/09/2020] [Indexed: 11/24/2022]
|
49
|
Barleben A, Mathlouthi A, Mehta M, Nolte T, Valdes F, Malas MB. Long-term outcomes of the Ovation Stent Graft System investigational device exemption trial for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2020; 72:1667-1673.e1. [DOI: 10.1016/j.jvs.2020.01.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/31/2020] [Indexed: 12/22/2022]
|
50
|
Meuli L, Yu LM, Wyss TR, Schmidli J, Makaloski V. Development and internal validation of a prognostic model for mortality of patients with abdominal aortic aneurysms treated with endovascular aneurysm repair. VASA 2020; 50:125-131. [PMID: 33118475 DOI: 10.1024/0301-1526/a000921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Morbidity and mortality associated with elective endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) must be balanced against the impending risk of aneurysm rupture and the estimated remaining lifetime. The aim of this study is to develop and validate a prognostic model for mortality of patients with AAA treated with EVAR. Methods: This retrospective observational study included 251 consecutive patients treated with EVAR for asymptomatic AAA between January 2001 and December 2012 at the University Hospital in Bern, Switzerland. Pre-selection of variables was based on a literature review; least absolute shrinkage and selection operator technique was used for the final variable selection. A Firth's bias reduced Cox proportional hazard model was developed and validated using 10,000 bootstrap samples to predict survival after EVAR. Results: The median follow-up time was 5.3 years (range 0.1 to 15.9). At the study closing date 95% of follow-up information was available. The mortality rates were 31.9% at 5 years and 50.5% at the study closing date, respectively. Identified predictors for overall mortality after EVAR were age, hazard ratio (HR) = 2.24 per 10-year increase (95% CI 1.64 to 3.09), the presence of chronic obstructive pulmonary disease (COPD), HR = 2.22 (95% CI 1.48 to 3.31), and lower estimated glomerular filtration rate, HR = 1.24 per 10 ml/min/1.73 m2 decrease (95% CI 1.12 to 1.39). The model showed good discrimination ability, Harrell's C = 0.722 (95% CI 0.667 to 0.778) and was very robust in the bootstrap in-sample validation Harrell's C = 0.726 (95% CI 0.662 to 0.788). Conclusion: Higher age, the presence of COPD and impaired kidney function are independent predictors for impaired survival after EVAR. The expected remaining lifetime should be considered in patients with AAA. This prognostic model can help improving patient care; however, external validation is needed prior to clinical implementation.
Collapse
Affiliation(s)
- Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Switzerland.,Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom.,Department of Vascular Surgery, Kantonsspital St. Gallen, Switzerland
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Juerg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Vladimir Makaloski
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|