MedWorm: Abdominal Aneurysm Repair

Endovascular Repair of Descending Thoracic Aortic Aneurysm: Review of Literature

Seminars in Thoracic and Cardiovascular Surgery — Thu, 11 Mar 2010 18:09:36 +0100

Descending thoracic aortic aneurysmal disease is associated with poor 5-year survival rates as low as 10%-15% if untreated. This is probable because of a combination of the aneurysmal disease, comorbidities, and in many patients advanced age. In the search for better outcomes and newer techniques, the endovascular approach for the treatment of these aneurysms has developed over the last 20 years. Many advances in the materials and techniques have been made since the first reports of abdominal and thoracic aortic endovascular repair in the early 1990s. Currently, clinical trials have proven that several different commercially available endovascular grafts can be deployed safely, with early results equal to or better than conventional open repairs. Most of the data reported have been on earl...

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Hybrid Thoracoabdominal Aortic Aneurysm Repair: Concomitant Visceral Revascularization and Endovascular Aneurysm Exclusion

Seminars in Thoracic and Cardiovascular Surgery — Thu, 11 Mar 2010 18:09:36 +0100

Thoracoabdominal aortic aneurysms (TAAA) remain a formidable surgical challenge, with conventional open repair associated with significant rates of mortality and morbidity. Furthermore, many of these patients are elderly with significant comorbidities and may not be candidates for repair. Consequently, the availability of a “hybrid” option, including open visceral debranching with concomitant endovascular aneurysm exclusion, may have advantages in these high-risk patients, including the potential to offer therapy to those ineligible for conventional repair. Our technique for hybrid TAAA repair is performed by means of midline laparotomy. A commercially manufactured custom multibranched Dacron graft is used to sequentially bypass, in extranatomic manner, the left renal artery, superior ...

Primary aorto-enteric fistula: A rare complication of abdominal aortic aneurysm

Journal of Postgraduate Medicine — Tue, 09 Mar 2010 16:15:37 +0100

Thomson V S, Gopinath K G, Joseph E, Joseph GJournal of Postgraduate Medicine 2009 55(4):267-269A 70-year-old lady presented with recurrent gastrointestinal bleeding and septicemia caused by multiple enteric pathogens. She was diagnosed to have primary aorto-enteric fistula (PAEF) complicating abdominal aortic aneurysm. Endovascular aneurysm repair was carried out that arrested gastrointestinal bleeding, but despite prolonged antibiotic therapy the patient died a month later of probable sepsis. PAEF refers to abnormal communication between the aorta and the intestine resulting from disease at either site; this rare condition should be suspected in patients with abdominal aortic aneurysm who present with unexplained life-threatening gastrointestinal bleeding. Computerized tomography is the ...

Endoluminal abdominal aortic aneurysm repair: the latest advances in prevention of distal endograft migration and type 1 endoleak.

Texas Heart Institute Journal — Sat, 06 Mar 2010 23:20:04 +0100

Authors: Ghouri M, Krajcer Z Endovascular abdominal aortic aneurysm repair (EVAR) is an attractive alternative to open surgical repair. Distal endograft migration and type 1 endoleak are recognized to be the 2 main complications of EVAR. First-generation endografts had a stronger propensity for distal migration, modular component separation, thrombosis, and loss of structural integrity. Substantial progress has been made in recent years with 2nd- and 3rd-generation devices to prevent these complications. Some of the most common predictors of endograft failure are angulated and short infrarenal necks, large-diameter necks, and thrombus in the aneurysmal sac. The purpose of this study is to describe and review our experience in using innovative techniques and a newer generation of endogr...

Fenestrated Stent Grafting for Short-necked and Juxtarenal Abdominal Aortic Aneurysm: An 8-Year Single-centre Experience.

PubMed: Eur J Vasc Endovasc ... — Tue, 02 Mar 2010 00:00:00 +0100

CONCLUSIONS: Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm appears safe and effective on the longer term. Renal function deterioration, however, is a major concern. PMID: 20202868 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Five-year results for the Talent enhanced Low Profile System abdominal stent graft pivotal trial including early and long-term safety and efficacy

Journal of Vascular Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: In a population with challenging anatomic characteristics, EVAR with the Talent eLPS and use of the CoilTrac delivery system compared favorably with open repair through 1 year. Sustained protection from ARM, with minimal reinterventions, was attained through 5 years. (Source: Journal of Vascular Surgery)

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Delayed permanent paraplegia after endovascular repair of abdominal aortic aneurysm

Journal of Vascular Surgery — Mon, 01 Mar 2010 00:00:00 +0100

We report the first case of significantly delayed permanent paraplegia after endovascular abdominal aortic aneurysmorrhaphy. (Source: Journal of Vascular Surgery)

Outcome Following Endovascular vs. Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial

Journal of Vascular Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Conclusion: Perioperative mortality is lower for endovascular than open AAA repair. There is no significant difference in all cause-mortality at 2 years. Summary: Previous randomized trials of open vs endovascular aneurysm repair have shown reduced perioperative mortality, hospital stay, and intensive care unit days in the endovascularly treated patients. In randomized trials conducted in Europe, at 2 years the early survival advantage of the endovascular patients was lost, while the relative effects of endovascular and open repair on quality of life and erectile function remain unclear. This study was conducted in 881 veterans aged >49 years drawn from 42 Department of Veterans Affairs Medical Centers. To be eligible for the trial, the patient had to have had an abdominal aortic aneurysm...

Regarding “SVS practice guidelines for the care of patients with an abdominal aortic aneurym: Executive summary”

Journal of Vascular Surgery — Mon, 01 Mar 2010 00:00:00 +0100

In the executive summary of the new Society for Vascular Surgery (SVS) practice guidelines for abdominal aortic aneurysm (AAA), Chaikof et al state, in reference to the United Kingdom Small Aneurysm Trial (UKSAT) and Aneurysm Detection and Management (ADAM) trials, that “a trend towards a beneficial effect of early surgery was observed in both studies in the younger patient and for those with larger aneurysms.” This is incorrect; in Table 2 of the ADAM trial report, the relative risks for the youngest patients (age 50-59) and for the largest AAA (5.0-5.4 cm) are each given as 1.02, representing a slight trend favoring surveillance. The authors then state that “Young healthy patients, and especially women, with AAA between 5.0 and 5.4 cm may benefit from early repair.” ADAM patients...

The evaluation of morbidity and mortality in abdominal aortic aneurysm repair patients as related to body mass index

American Journal of Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Conclusions: The outcomes for this population show a significant trend toward early mortality in open AAA repair patients with an elevated preoperative BMI. Appropriate patient selection and preoperative optimization are recommended for all AAA repair candidates; however, some innate characteristics such as patient age, may play the largest role in determining outcomes. (Source: American Journal of Surgery)

Incidence and prediction of permanent neurological deficits after cardiac surgery -- are the existing models of prediction truly global? [Original articles]

European Journal of Cardio-Thoracic Surgery — Fri, 26 Feb 2010 22:01:57 +0100

Conclusion: PND after cardiac operation is associated with a high mortality and poor prognosis. The incidence of PND varies depending on the procedure. Predictive models of neurological injury post-cardiac surgery should be more centre-specific. (Source: European Journal of Cardio-Thoracic Surgery)

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The drama of being diagnosed with an aortic aneurysm and undergoing surgery for two different procedures: Open repair and endovascular techniques

Journal of Vascular Nursing — Wed, 24 Feb 2010 15:12:30 +0100

The purpose of this study is to describe and interpret what it means for patients to be diagnosed with an abdominal aortic aneurysm (AAA) and how they experience treatment. AAA is usually asymptomatic and often discovered coincidentally in conjunction with a diagnostic workup for other medical problems. Twenty patients who had undergone 2 different surgical procedures were sequentially invited for interviews 1 month following surgery. A hermeneutic approach was used. For all patients three themes emerged: an inability to come to terms with a life-threatening condition, a sense of living on borrowed time, and a sense of being granted a new lease on life. The theme that emerged for patients with open repair was that diagnosis with AAA was an ordeal to endure, while the theme for patients who...

Screened individuals' preferences in the delivery of abdominal aortic aneurysm repair

British Journal of Surgery — Thu, 18 Feb 2010 00:00:00 +0100

This study aimed to determine preferences for service attributes in a population screened for abdominal aortic aneurysm.A questionnaire was designed to encompass various aspects of service provision. Questions were calibrated against the time an individual was willing to travel to access specific attributes. Subjects attending an aneurysm screening programme were asked to complete a questionnaire before their screening ultrasound scan. Statistical analysis was through pairwise analysis of the median travel times with the signed rank test. The Wilcoxon rank sum, analysed by the Kruskal-Wallis test, was used to compare preference ratings.A total of 262 individuals were asked to complete the questionnaire; the response rate was 98·5 per cent. Approximately 92 per cent of individuals stated a...

Screened individuals' preferences in the delivery of abdominal aortic aneurysm repair.

The British Journal of Surgery — Thu, 18 Feb 2010 00:00:00 +0100

CONCLUSION:: Patients attending aneurysm screening were willing to travel beyond their nearest hospital to access a service with better outcomes, higher surgical volumes and endovascular surgery. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 20169573 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

AAA Stent-Grafts: Past Problems and Future Prospects.

Annals of Biomedical Engineering — Wed, 17 Feb 2010 00:00:00 +0100

Authors: Desai M, Eaton-Evans J, Hillery C, Bakhshi R, You Z, Lu J, Hamilton G, Seifalian AM Endovascular aneurysm repair (EVAR) has quickly gained popularity for infrarenal abdominal aortic aneurysm repair during the last two decades. The improvement of available EVAR devices is critical for the advancement of patient care in vascular surgery. Problems are still associated with the grafts, many of which can necessitate the conversion of the patient to open repair, or even result in rupture of the aneurysm. This review attempts to address these problems, by highlighting why they occur and what the failings of the currently available stent grafts are, respectively. In addition, the review gives critical appraisal as to the novel methods required for dealing with these problems and ident...

Racial and Ethnic Differences in the Use of High-Volume Hospitals and Surgeons [Original Article]

Archives of Surgery — Mon, 15 Feb 2010 20:50:40 +0100

Conclusions Minority patients in New York City are doubly disadvantaged in their surgical care; they are substantially less likely to use both high-volume hospitals and surgeons for procedures with an established volume-mortality association. Better information is needed about which providers minority patients have access to and how they select them. (Source: Archives of Surgery)

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Limb occlusion after endovascular repair of an abdominal aortic aneurysm: beware the narrow distal aorta

Irish Journal of Medical Science — Mon, 15 Feb 2010 18:03:37 +0100

Conclusion We suggest clinicians should be aware of this potential pitfall during EVAR planning and beware the narrow distal aorta. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11845-010-0464-8Authors Stephen O’Neill, Royal Victoria Hospital, Belfast Health and Social Care Trust Regional Vascular Surgery Unit Belfast Northern Ireland, UKAnton Collins, Royal Victoria Hospital, Belfast Health and Social Care Trust Regional Vascular Surgery Unit Belfast Northern Ireland, UKDenis Harkin, Royal Victoria Hospital, Belfast Health and Social Care Trust Regional Vascular Surgery Unit Belfast Northern Ireland, UK Journal Irish Journal of Medical ScienceOnline ISSN 1863-4362Print ISSN 0021-1265 (Source: Irish Journal of Medical Science)

Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm

British Journal of Surgery — Fri, 12 Feb 2010 00:00:00 +0100

This study examined the population outcome of ruptured abdominal aortic aneurysm (rAAA) in England, the role of endovascular repair (EVAR), and the relationship between outcome and hospital workload.Data were retrieved from Hospital Episode Statistics between 1 April 2003 and 31 March 2008. Propensity scoring was used to compare the outcomes of stratified patients undergoing EVAR and open repair. The relationship between workload and outcome was determined.Some 3725 urgent and 4414 rAAA repairs were included. Mortality rates were 21·3 per cent for urgent repair and 46·3 per cent for rAAA repair. EVAR was employed for 16·3 and 7·6 per cent of urgent and rAAA repairs respectively. EVAR was associated with significantly reduced mortality for urgent repair (odds ratio (OR) 0·531, 95 per c...

Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm.

The British Journal of Surgery — Fri, 12 Feb 2010 00:00:00 +0100

CONCLUSION:: EVAR offered a survival advantage over open repair for non-elective aneurysm procedures. Services for the treatment of rAAA should incorporate access to EVAR and would benefit from being based in units with a high elective caseload. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 20155793 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm [Letters]

JAMA — Tue, 09 Feb 2010 20:50:49 +0100

(Source: JAMA)

Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm [Letters]

JAMA — Tue, 09 Feb 2010 20:50:49 +0100

(Source: JAMA)

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Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm [Letters]

JAMA — Tue, 09 Feb 2010 20:50:49 +0100

(Source: JAMA)

Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm--Reply [Letters]

JAMA — Tue, 09 Feb 2010 20:50:49 +0100

(Source: JAMA)

Catheter-delivered Transducer-tipped Ultrasound Thrombolysis of a Chronically Occluded Aortic Stentgraft Limb

EJVES Extra — Mon, 08 Feb 2010 00:00:00 +0100

We describe a unique case of successful treatment of a chronically occluded stentgraft limb after EVAR with catheter-delivered transducer-tipped US thrombolysis. (Source: EJVES Extra)

Lithium Does Not Protect Against Spinal Cord Ischemia-Reperfusion Injury in Rabbits

Annals of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

This study was aimed to evaluate the effect of lithium on SCIRI in rabbits. (Source: Annals of Vascular Surgery)

Endovascular repair of ruptured thoracic aortic aneurysms is associated with high perioperative mortality and morbidity

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions: The endovascular treatment of ruptured thoracic aortic aneurysms is associated with a high perioperative mortality and morbidity as well as poor midterm survival. Renal insufficency proved to be an independent risk factor for perioperative death. (Source: Journal of Vascular Surgery)

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Invited commentary

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Management of right renal artery reconstruction during complex aortic aneurysm repair, particularly through a flank or thoracoabdominal exposure, can be challenging and may require orificial endarterectomy for stenotic lesions as well as incorporation of the right renal artery into the suture line as a button, most commonly in conjunction with the superior mesenteric and celiac arteries. The use of intraoperative balloon-expandable stents (BESs) in the visceral arteries during open thoracoabdominal aneurysm repair was first described in 2004 by Lemaire et al, who reported 93 patients. In that study, however, only 9% of the patients had postoperative imaging. In the current study, Patel et al describe their technique and midterm results in 67 patients who underwent BES placement into the ri...

Secondary Intervention After Endovascular Abdominal Aortic Aneurysm Repair

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: Secondary interventions are common after endovascular aneurysm repair but do not adversely affect aneurysm related death or overall actuarial 5-year survival. Summary: A substantial number of secondary interventions are performed in patients who have undergone endovascular aneurysm repair (EVAR). Rates of secondary intervention range from 10% to 18%, with most problems addressed with endovascular procedures. The authors sought to determine the indications for secondary interventions after EVAR in their institution and the effect of these interventions on long-term survival. (Source: Journal of Vascular Surgery)

Endovascular Repair of Thoracoabdominal Aortic Aneurysms

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Objectives: To evaluate the early outcomes following thoracoabdominal aortic aneurysm (TAAA) repair utilising fenestrated and branched endografts. Design and materials and methods: A prospective analysis of all patients undergoing endovascular repair of TAAA in a single academic centre. All patients were deemed unfit for open surgical repair. Customised endografts were designed using CT data reconstructed on 3D workstations. Post-operatively all patients were evaluated radiologically at hospital discharge, at 6, 12, 18 and 24months, and annually thereafter. (Source: Journal of Vascular Surgery)

Outcome of Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians and Nonagenarians: Single-Center Experience

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

This study sought to determine if the advantage of EVAR extends to patients ≥80 years of age. (Source: Journal of Vascular Surgery)

Outcomes of Symptomatic Abdominal Aortic Aneurysm Repair: A Multicenter Review from the Vascular Surgery Study Group of Northern New England (VSGNNE)

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Objective: Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (AAA) repair has been reported to be 6% to 30% during the past 25 years. We sought to describe the contemporary outcomes of patients undergoing repair of symptomatic AAA using a multicenter, regional database. (Source: Journal of Vascular Surgery)

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Volume Outcome Relationship for Endovascular Aortic Aneurysm Repair and Open Abdominal Aortic Aneurysm Repair in United States Medicare Patients

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Introduction: Mortality after open abdominal aortic aneurysm (AAA) repair is inversely proportional to procedure volume. It is unclear if this is true for endovascular AAA repair (EVAR) or if EVAR volume predicts outcome with open repair or vice versa. This will become important as centers shift volume to EVAR. (Source: Journal of Vascular Surgery)

Accuracy of Cardiac Risk Prediction Models in Patients Undergoing Open Abdominal Aortic Aneurysm Repair or Lower Extremity Bypass

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Objective: The Revised Cardiac Risk Index (RCRI) is a widely used model for predicting cardiac events after noncardiac surgery. We tested the accuracy of the RCRI in vascular surgery patients compared with a specific model developed from these patients. (Source: Journal of Vascular Surgery)

Preoperative Statin Therapy Is Associated with Improved Outcomes and Lower Resource Utilization in Patients Undergoing Open or Endovascular Aortic Aneurysm Repair

Journal of Vascular Surgery — Mon, 01 Feb 2010 00:00:00 +0100

This study hypothesized that preoperative statin therapy would have a protective effect on patients undergoing elective abdominal aortic aneurysm (AAA) repair owing to the pleiotropic effect of these agents. (Source: Journal of Vascular Surgery)

Rvb1-Rvb2: essential ATP-dependent helicases for critical complexes.

Biochemistry and Cell Biology — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Huen J, Kakihara Y, Ugwu F, Cheung KL, Ortega J, Houry WA Rvb1 and Rvb2 are highly conserved, essential AAA+ helicases found in a wide range of eukaryotes. The versatility of these helicases and their central role in the biology of the cell is evident from their involvement in a wide array of critical cellular complexes. Rvb1 and Rvb2 are components of the chromatin-remodeling complexes INO80, Swr-C, and BAF. They are also members of the histone acetyltransferase Tip60 complex, and the recently identified R2TP complex present in Saccharomyces cerevisiae and Homo sapiens; a complex that is involved in small nucleolar ribonucleoprotein (snoRNP) assembly. Furthermore, in humans, Rvb1 and Rvb2 have been identified in the URI prefoldin-like complex. In Drosophila, the Polycomb Repr...

Repair of extensive thoracoabdominal aortic aneurysm with a tetrafurcate graft: midterm results of 63 cases.

The Heart Surgery Forum — Mon, 01 Feb 2010 00:00:00 +0100

Conclusion: The N-IA may play an important role in spinal cord protection, and N-IA pseudoaneurysm should be avoided in Marfan syndrome patients. The use of a tetrafurcate graft is a reliable method for TAAA repair, with satisfactory midterm results. PMID: 20150031 [PubMed - in process] (Source: The Heart Surgery Forum)

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Improved cannulation: technique for thoracoabdominal aortic aneurysm repair.

The Annals of Thoracic Surgery — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Civilini E, Melissano G, Chiesa R PMID: 20103386 [PubMed - indexed for MEDLINE] (Source: The Annals of Thoracic Surgery)

Pulmonary sequestration supplied by giant aneurysmal aortic branch.

The Annals of Thoracic Surgery — Mon, 01 Feb 2010 00:00:00 +0100

We report a case of an intralobar sequestration supplied by a 13-cm aneurysmal vessel originating from the abdominal aorta. The malformation was discovered during a roentgenogram investigation of an abdominal infrarenal aneurysm. During the endovascular repair of the abdominal aneurysm, the giant feeding vessel of the pulmonary sequestration was embolized. Two days later the patient underwent an uneventful resection of the malformation en bloc with the right lower lobe through a standard right thoracotomy. PMID: 20103294 [PubMed - indexed for MEDLINE] (Source: The Annals of Thoracic Surgery)

Morphometric analysis of anatomic variables affecting endovascular stent design in patients undergoing elective and emergency repair of endovascular abdominal aortic aneurysm.

Canadian Journal of Surgery — Fri, 29 Jan 2010 06:14:34 +0100

CONCLUSION: Significant anatomic differences between elective and emergency patients will require hospitals to stock separate endovascular devices to treat abdominal aortic aneurysms in both groups. PMID: 20100409 [PubMed - in process] (Source: Canadian Journal of Surgery)

Pulmonary Sequestration Supplied by Giant Aneurysmal Aortic Branch [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 27 Jan 2010 19:27:19 +0100

Improved Cannulation: Technique for Thoracoabdominal Aortic Aneurysm Repair [CORRESPONDENCE]

The Annals of Thoracic Surgery — Wed, 27 Jan 2010 19:27:19 +0100

(Source: The Annals of Thoracic Surgery)

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Type B Aortic Dissections: Risk Factors and Outcome of Medical and Surgical Management

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:01 +0100

Conclusion: Early mortality for type B dissections has been shown to be 10-15% which is consistent with the findings in this study. The low mortality in the surgical group is likely a reflection of the small sample size though the results are encouraging. We are using TEVAR for intervening on complicated type B dissections with malperfusion to improve short term outcomes. We look forward to reporting the long term outcomes of these patients. (Source: Journal of Surgical Research)

Evaluation of a Parsimonious Risk-Adjustment Model for Vascular Surgery

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:22 +0100

Conclusions: Hospital quality comparisons for vascular surgery can be adequately risk-adjusted using a small number of the most important variables. Reducing the number of variables collected will significantly decrease the burden of data collection for hospitals choosing to participate in the vascular module of the ACS-NSQIP. (Source: Journal of Surgical Research)

Composite Quality Measures for Abdominal Aortic Surgery: Moving Beyond Hospital Volume

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:22 +0100

Background: The Leapfrog Group, a consortium of healthcare purchasers, reports quality rankings on major surgery from hospitals nationwide. The Leapfrog Group uses a “Survival Predictor”, a composite measure, to generate rankings of surgical quality. We assessed whether this composite measure discriminates differences in quality between hospitals better than hospital volume alone. Methods: Data from the Leapfrog Hospital Survey (2008) from all hospitals performing elective abdominal aortic aneurysm repairs (N=623) was obtained. Leapfrog ranks hospitals using the “Survival Predictor”, a composite measure that incorporates both mortality and hospital volume. The composite measure is calculated by combining the mortality rate with the mortality expected given the hospitals volume usin...

Hospital Quality Rankings in Vascular Surgery: The Impact of Adjusting for Reliability

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:22 +0100

Conclusions: Adjusting mortality for reliability reduces statistical noise and provides more stable estimates of hospital quality. This technique should be standard for reporting relative hospital quality. (Source: Journal of Surgical Research)

Emergency Endovascular Repair for Ruptured Abdominal Aortic Aneurysms Results in Improved Outcomes

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:20 +0100

Conclusion: Historically, the literature has demonstrated a mortality of around 48% in patients with rAAA that reach the hospital. Our study found a statistically significant reduction in mortality by nearly half. In addition, a reduction in ICU stay, total hospital stay, and blood loss were demonstrated in comparison to the traditional open AAA repair. These data support the use of emergency EVAR in patients with rAAA that meet the standard criteria for EVAR. (Source: Journal of Surgical Research)

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Investigation of Reduced Permeability Expanded Polytetrafluoroethylene Graft Material for Endovascular Aortic Aneurysm Repair Using a Canine Model

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:20 +0100

Conclusion: The new low permeable Gore ePTFE graft significantly reduced the intra-aneurysmal pressure as compared to the original Gore graft. These pressure readings were eqivalent to the low porosity, commercially available dacron stent grafts. This correlates with clinical data indicating decreased sac size and no progression in sac expansion in the abscence of an endoleak. (Source: Journal of Surgical Research)

A Single-Center Experience n Endovascular Treatment of Symptomatic Abdominal Aortic Aneursym Disease

Journal of Surgical Research — Mon, 25 Jan 2010 16:41:18 +0100

Background: Endovascular aneurysm repair (EVAR) is widely accepted as the preferred technique for the elective treatment of abdominal aortic aneurysm (AAA) disease. The success of EVAR in the elective setting has generated interest in its potential as a treatment for ruptured and symptomatic AAAs. The purpose of this study was to examine the immediate, mid and long-term outcomes for EVARs performed on symptomatic and asymptomatic patients at our institution. Methods: The records of 442 consecutive patients who underwent EVAR at two university-affiliated hospitals from March 2000 through December 2007 were retrospectively reviewed. Pertinent preoperative and intraoperative information was collected. Disease was considered symptomatic when patients presented with complications secondary to d...

Is CT Scan Useful for the Diagnosis Bowel Ischemia in Cardiac Surgical Patients?

Journal of Surgical Research — Mon, 25 Jan 2010 16:40:26 +0100

Conclusions: Laparotomy is a late complication in cardiac surgical patients. The 30-day mortality rate reported here is lower than the rate reported in a previous large retrospective study of cardiac surgery patients with GIC, and most patients will survive hospitalization. CT scan was less sensitive and specific for the diagnosis of bowel ischemia. (Source: Journal of Surgical Research)

Increased Phosphorylated Extracellular Signal-Regulated Kinase (ERK) in Abdominal Aortic Aneurysms in a Rodent Model and in Humans

Journal of Surgical Research — Mon, 25 Jan 2010 16:40:15 +0100

Conclusions. These data document increased phosphorylated ERK in a rodent AAA model, as well as in human AAAs compared with control tissue. These data support the role of ERK in modulating the inflammatory and extracellular matrix remodeling environment that occurs during AAA formation. (Source: Journal of Surgical Research)

Open surgical repair of ruptured juxtarenal aortic aneurysms with and without renal cooling: Observations regarding morbidity and mortality

Journal of Vascular Surgery — Mon, 25 Jan 2010 00:00:00 +0100

Conclusions: Open surgical repair of RJAAs is still associated with high mortality and morbidity. To our knowledge, this is the first report of cold perfusion of the kidneys during RJAA repair. Although numbers are small, a beneficial effect of renal cooling on the outcome of RJAA repair is suggested, warranting further research with this technique. (Source: Journal of Vascular Surgery)

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Unexpectedly difficult intubation caused by subglottic stenosis in Wegener’s granulomatosis

Journal of Anesthesia — Fri, 22 Jan 2010 10:09:14 +0100

Abstract A 76-year-old woman was scheduled to undergo abdominal aortic repair for progressive abdominal aortic aneurysm. After inducing general anesthesia, the 7.5-mm internal diameter (ID) tracheal tube could not be advanced below the level of the vocal cords because of resistance, and intubation was re-attempted several times using smaller tubes. An otolaryngologist was consulted and subglottic stenosis of unknown origin was suggested. The aortic repair was cancelled and tracheostomy was performed instead. She was diagnosed with Wegener’s granulomatosis 46 days after the operation because she developed symptoms of renal dysfunction, hemoptysis, gastrointestinal bleeding, and presence of anti-neutrophil cytoplasmic autoantibodies (c-ANCA). The patient was treated w...

Aorto-oesophageal and Aortobronchial Fistulae Following Thoracic Endovascular Aortic Repair: A National Survey

European Journal of Vascular and Endovascular Surgery — Fri, 22 Jan 2010 00:00:00 +0100

Abstract: Objective: We evaluated the incidence of aorto-oesophageal (AEF) and aortobronchial (ABF) fistulae after thoracic endovascular aortic repair (TEVAR), and investigated their clinical features, determinants, therapeutic options and results.Methods: We conducted a voluntary national survey among Italian universities and hospital centres with a thoracic endovascular programme.Results: Thirty-nine centres were contacted, and 17 participated. Of the patients who underwent TEVAR between 1998 and 2008, 19/1113 (1.7%) developed AEF/ABF. Among indications to TEVAR, aortic pseudo-aneurysm was associated with the development of late AEF/ABF (P = 0.009). Further, emergent and complicated procedures resulted in increased risk of AEF/ABF (P = 0.008 and P (Source: European Journal of Vascu...

Abdominal Aortic Aneurysm Repair in Obese Patients: Improved Outcome After Endovascular Treatment Compared With Open Surgery

Vascular and Endovascular Surgery — Wed, 20 Jan 2010 12:05:08 +0100

Conclusions: We observed improved short-term outcomes among obese AAA patients after EVAR compared to open repair. Endovascular repair may be preferable in obese patients with AAA. (Source: Vascular and Endovascular Surgery)

Atorvastatin Modulates Matrix Metalloproteinase Expression, Activity, and Signaling in Abdominal Aortic Aneurysms

Vascular and Endovascular Surgery — Wed, 20 Jan 2010 12:05:08 +0100

Statins may reduce abdominal aortic aneurysm (AAA) progression. We sought to measure how atorvastatin (AT) treatment might modulate matrix metalloproteinase (MMP) expression and/or activity in human AAA. Tissue from human AAAs at surgical repair was obtained from patients who were either not on statins (NST, n = 19) or treated with AT (n = 19). Immunoblots measured expression and zymography measured activity. Expression of most proteins was greater in the central compared with distal AAA region. Matrix metalloproteinase 1, MMP2, MMP3, MMP9, Tissue Inhibitor of Metalloproteinase (TIMP2), TIMP3, TIMP4, or total Sma Mothers Against Decapentaplegia (SMAD2) expression did not differ with treatment. There was a trend toward reduced MMP8 and TIMP1 expression and MMP2 zymographic activity in the A...

Endovascular Therapy for Recurrent Type III Endoleak

Vascular and Endovascular Surgery — Wed, 20 Jan 2010 12:05:08 +0100

In this report, we discuss the pitfalls that should be considered when aortouniiliac revision procedures are performed for type III endoleaks in bifurcated endografts. (Source: Vascular and Endovascular Surgery)

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Early Inflammatory Response in Patients With Ruptured Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery — Wed, 20 Jan 2010 11:55:16 +0100

In conclusion, the current data indicate that rupture of an AAA activates the inflammatory system with a compensatory anti-inflammatory response. (Source: Vascular and Endovascular Surgery)

Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm in a Patient With Unfavorable Anatomy

Vascular and Endovascular Surgery — Wed, 20 Jan 2010 11:55:16 +0100

Endovascular repair of an abdominal aortic aneurysm (AAA) offers hope of improved outcomes in patients presenting with acute rupture. However, a high proportion of such patients have unfavorable proximal neck anatomy and are not suitable for treatment with conventional endografts. In this case report, the authors describe a successful endovascular repair of a ruptured AAA with very short and angulated proximal neck. (Source: Vascular and Endovascular Surgery)

Does EVAR Alter the Rate of Cardiovascular Events in Patients with Abdominal Aortic Aneurysm Considered Unfit for Open Repair? Results from the Randomised EVAR Trial 2.

PubMed: Eur J Vasc Endovasc ... — Wed, 20 Jan 2010 00:00:00 +0100

CONCLUSIONS: Cardiovascular event rates were high in these unfit patients and medical therapy was sub-optimal. Events rates were slightly higher in the EVAR group but this was not statistically significant. PMID: 20096611 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Fenestrated Endovascular Grafting: The French Multicentre Experience.

PubMed: Eur J Vasc Endovasc ... — Tue, 19 Jan 2010 00:00:00 +0100

CONCLUSIONS: The use of endovascular prostheses with graft material incorporating the visceral arteries is safe and effective in preventing rupture in the medium term. A predictable high mortality rate was depicted during follow-up in this high-risk cohort. Meticulous follow-up to assess sac behaviour and visceral ostia is critical to ensure optimal results. PMID: 20093051 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Primary aorto-enteric fistula: A rare complication of abdominal aortic aneurysm

Journal of Postgraduate Medicine — Thu, 14 Jan 2010 15:55:39 +0100

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“Homemade” Oversized Fenestrations for Emergency Endovascular Repair of a Mycotic Saccular Aortic Aneurysm

Journal of Vascular and Interventional Radiology : JVIR — Thu, 14 Jan 2010 00:00:00 +0100

We describe a patient with an expanding symptomatic mycotic aortic aneurysm with adverse anatomy successfully treated endovascularly with a “homemade” fenestration technique. According to Swedish law, institutional review board approval is not required for single retrospective case studies such as this. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Heparin-induced thrombocytopenia and endovascular procedures: report of two cases

Jornal Vascular Brasileiro — Tue, 12 Jan 2010 16:51:41 +0100

We report two cases associating the use of heparin during endovascular repair of abdominal aortic aneurysm with the development of HIT.Trombocitopenia induzida por heparina (TIH) é um distúrbio transitório causado pela ativação de anticorpos anti-plaquetários contra o fator plaquetário 4 (FP4) combinado com a molécula de heparina, formando complexos que clinicamente se traduzem em tromboses arteriais ou venosas com alta morbimortalidade. O uso de altas doses de heparina durante procedimentos endovasculares para o tratamento de aneurisma de aorta abdominal pode aumentar a incidência de TIH. Relatamos dois casos em que o uso de heparina durante tratamento endovascular de aneurisma de aorta abdominal estava associado ao aparecimento de TIH. (Source: Jornal Vascular Brasileiro)

Late Survival After Endovascular Repair of an Aortobronchial Fistula

EJVES Extra — Mon, 11 Jan 2010 00:00:00 +0100

We present an interesting case of a patient who underwent initial open repair of a descending thoracic aortic aneurysm in 1996, who subsequently had a pseudo-aneurysm that arose from his prosthetic graft, which was repaired with open surgery in 1998. He then developed a second pseudo-aneurysm with an aortobronchial fistula. This was successfully treated with an endovascular stent graft in 1999. The patient has survived 10years after this procedure. (Source: EJVES Extra)

Incidental abdominal aortic aneurysm on lumbosacral magneticresonance imaging — a case series

Magnetic Resonance Imaging — Mon, 11 Jan 2010 00:00:00 +0100

We report a case series of four patients who had incidental AAA detected on lumbosacral MRI. All patients were suffering from degenerative spinal disease and had been referred to the orthopedic spinal clinic. After history, examination and review of the imaging, all patients were referred to a vascular surgeon, and three were found to be completely asymptomatic from their aneurysm. One patient required open repair with an aortic graft due to the size of the aneurysm, although his symptoms were attributable to his spinal disease. All patients still required management of their degenerative spinal disease after their vascular review. We can find no other case reports of AAA as an incidental finding on lumbosacral MRI. This case series highlights the importance of looking at all aspects of ou...

Late Survival After Endovascular Repair of an Aortobronchial Fistula

European Journal of Vascular and Endovascular Surgery — Mon, 11 Jan 2010 00:00:00 +0100

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Analysis of Outcome after Using High-risk Criteria Selection to Surgery Versus Endovascular Repair in the Modern Era of Abdominal Aortic Aneurysm Treatment.

PubMed: Eur J Vasc Endovasc ... — Thu, 07 Jan 2010 00:00:00 +0100

CONCLUSION: The high-risk AFSSAPS criteria were not predictive of postoperative mortality and should not be used to determine the choice of treatment technique. Other criteria therefore need to be established to determine whether open or EVAR repair should be used. PMID: 20060753 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Spinal cord protection and thoracic aortic surgery

Current Opinion in Anaesthesiology — Tue, 05 Jan 2010 13:41:25 +0100

Purpose of review: Spinal cord ischemia remains an important complication of open surgical and endovascular stent graft repair of thoracic and thoracoabdominal aortic aneurysm despite advances in operative technique. Identification of risk factors and interventions to prevent and treat spinal cord ischemia has the potential to prevent spinal cord infarction and the morbidity and mortality associated with paraplegia. Recent findings: Risk factors for spinal cord ischemia are aneurysm extent, open surgical repair, prior distal aortic operations, and perioperative hypotension. Augmenting spinal cord perfusion by increasing arterial pressure, lumbar cerebrospinal fluid drainage, and reattachment of segmental arteries are effective for the treatment of spinal cord ischemia. Early detection of ...

Ruptured Endovascular Abdominal Aortic Aneurysm Repair: Part II

Annals of Vascular Surgery — Tue, 05 Jan 2010 00:00:00 +0100

Rupture of an abdominal aortic aneurysm (AAA) carries a high morbidity and mortality despite vast improvements in the care of critically ill patients over the past two decades. Between 50% and 80% of all patients with ruptured AAA do not survive. Endovascular treatment of ruptured AAA has recently become popularized because of its purported advantages to open repair in terms of mortality and morbidity due to its minimally invasive approach. The tabular review herein presented is the second part of our series on endovascular therapy for AAA. Similar to part 1, which emphasized elective procedures, we summarize the results of the world's literature for ruptured endovascular AAA repair in table format to serve as a comprehensive and concise search tool to be utilized in the vascular surgeon's...

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta

Annals of Vascular Surgery — Tue, 05 Jan 2010 00:00:00 +0100

We report the case of a 37-year-old woman with tuberculous pseudoaneurym of the descending aorta that was initially mistaken for a lung lesion and was successfully repaired surgically. (Source: Annals of Vascular Surgery)

Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario

Journal of Vascular Surgery — Mon, 04 Jan 2010 00:00:00 +0100

Conclusion: Compared with open repair, EVAR significantly reduced short-term but not long-term mortality. The EVAR patients spent less time in health institutions, including long-term care facilities, but underwent more imaging studies. Future improvements in EVAR could result in further decreases in reinterventions and subsequent radiologic monitoring. (Source: Journal of Vascular Surgery)

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Determining who trains vascular surgery fellows in endovascular techniques

Journal of Vascular Surgery — Mon, 04 Jan 2010 00:00:00 +0100

Conclusion: Vascular surgeons involved in resident education have been able to retrain themselves in endovascular techniques such that they are now able to provide greater than 80% of the endovascular experience to vascular surgery residents. (Source: Journal of Vascular Surgery)

Percutaneous transabdominal approach for the treatment of endoleaks after endovascular repair of infrarenal abdominal aortic aneurysm.

Korean J Radiol — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSION: The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed. PMID: 20046501 [PubMed - in process] (Source: Korean J Radiol)

Fenestrated stent graft repair of abdominal aortic aneurysm: hemodynamic analysis of the effect of fenestrated stents on the renal arteries.

Korean J Radiol — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSION: Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair. PMID: 20046500 [PubMed - in process] (Source: Korean J Radiol)

Estimating risk associated with radiation exposure during follow-up after endovascular aortic repair (EVAR).

The Journal of Cardiovascular Surgery — Fri, 01 Jan 2010 00:00:00 +0100

Authors: White HA, Macdonald S Late rupture incidence following endovascular repair (EVAR) of abdominal aortic aneurysm does not appear to decrease with time, mandating life-long surveillance. Popular regimes based on computed tomography (CT) originated in early registry and randomised trial protocols and are not evidence-based. We evaluated the radiation burden (and implications) associated with "conventional" CT surveillance and explored alternative surveillance paradigms. An EVAR program comprising planning CT, EVAR and surveillance CT at 1, 3, 6 and 12 months and yearly thereafter, equates to a total effective radiation dose of around 145-205 mSv over five years. A 70-year-old exposed to 145 mSv has a lifetime attributable cancer risk of 0.42% (i.e., odds of 1 in 240). Similarly, f...

Endovascular repair of nonruptured thoracic aortic aneurysms: systematic review.

Vascular — Fri, 01 Jan 2010 00:00:00 +0100

Authors: Mustafa ST, Sadat U, Majeed MU, Wong CM, Michaels J, Thomas SM Thoracic aortic aneurysms represent a major health problem. Untreated thoracic aortic aneurysms may rupture, which has a dismal outcome. The standard treatment for thoracic aneurysms is open surgical repair, but it is associated with high mortality and morbidity. Endovascular repair provides a less invasive and safer alternative.A systematic review was performed of all published literature on the above subject. Our primary objective was to measure 30-day mortality for nonruptured thoracic aortic aneurysms. Studies describing other pathologies, such as aortic dissection, mycotic aneurysms, penetrating ulcers, traumatic transactions, and pseudoaneurysms, and studies from which independent data for thoracic aortic ane...

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Infrarenal abdominal aortic aneurysm with concomitant urologic malignancy: treatment results in the era of endovascular aneurysm repair.

Vascular — Fri, 01 Jan 2010 00:00:00 +0100

The objective of this study was to assess, in an institutional series of patients receiving EVAR, the early and long-term survival and complication rates in patients with urologic malignancies. In a series of 385 patients receiving EVAR, 14 had a concomitant urologic malignancy: renal cell carcinoma (5 patients), prostate carcinoma (6 patients), and carcinoma of the bladder (3 patients). The first-month mortality was nil. Long-term survival was 80%, 83%, and 67% for the three tumor types, respectively. EVAR offers improved treatment in patients with concomitant AAA and urologic malignancy and should be considered the first choice for these patients. PMID: 20122355 [PubMed - in process] (Source: Vascular)

Correction

Journal of Vascular Surgery — Thu, 31 Dec 2009 15:19:01 +0100

For the article titled, “Perioperative asymptomatic cardiac damage after endovascular abdominal aneurysm repair is associated with poor long-term outcome” published in J Vasc Surg 2009;50:749-754, the mortality rates provided in the abstract are incorrect. The sentence should read: (Source: Journal of Vascular Surgery)

Regarding “Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair”

Journal of Vascular Surgery — Thu, 31 Dec 2009 15:18:59 +0100

We read with interest the article “Analysis of motor and somatosensory-evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair” by Keyhani et al. However, several questions arise concerning the interpretation of the statistical tests as well as the motor-evoked potentials (MEP) methodology. (Source: Journal of Vascular Surgery)

Intra-aneurysm Sac Pressure in Patients with Unchanged AAA Diameter after EVAR

Journal of Vascular Surgery — Thu, 31 Dec 2009 15:18:58 +0100

Objective: To study intra-aneurysm sac pressure and subsequent abdominal aortic aneurysm (AAA) diameter changes in patients without endoleaks that remain unchanged in AAA diameter more than 1 year after endovascular aneurysm repair (EVAR). (Source: Journal of Vascular Surgery)

Re-interventions, Readmissions and Discharge Destination: Modern Metrics for the Assessment of the Quality of Care

Journal of Vascular Surgery — Thu, 31 Dec 2009 15:18:58 +0100

Aim: To determine whether administrative data can be used to determine metrics to inform the quality agenda. To determine the relationship between these metrics and the method of abdominal aortic aneurysm (AAA) repair undertaken. (Source: Journal of Vascular Surgery)

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Patient Preference for Surgical Method of Abdominal Aortic Aneurysm Repair: Postal Survey

Journal of Vascular Surgery — Thu, 31 Dec 2009 15:18:58 +0100

Objectives: To determine whether men with small abdominal aortic aneurysm have a preference between either endovascular or open aneurysm repair for future treatment. Design: Prospective study of self-declared treatment preference following receipt of a validated patient information pack. (Source: Journal of Vascular Surgery)

Management of ruptured abdominal aortic aneurysm in the endovascular era

Journal of Vascular Surgery — Thu, 31 Dec 2009 15:18:57 +0100

The authors describe their experience with an algorithm to promote endovascular repair of ruptured abdominal aortic aneurysms when feasible. They successfully treated 27 patients with this technique and identified a significant decrease in 30-day mortality when compared to an open approach. (Source: Journal of Vascular Surgery)

Symptomatic 7-cm Abdominal Aortic Aneurysm in an Otherwise Healthy 31-Year-Old Woman

Vascular and Endovascular Surgery — Wed, 30 Dec 2009 05:49:26 +0100

We report the case of a 31-year-old woman who underwent open surgical repair of a symptomatic 7-cm abdominal aortic aneurysm (AAA). The patient had no identifiable AAA risk factors. Laboratory and pathological analyses demonstrated a nonspecific inflammatory component. (Source: Vascular and Endovascular Surgery)

Complete Endograft Collapse 91/2 Years Following Endograft Repair of an Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery — Wed, 30 Dec 2009 05:49:26 +0100

This report describes our recent experience in a patient in whom complete endograft collapse was discovered 91/2 years following EVAR necessitating conversion to open repair. (Source: Vascular and Endovascular Surgery)

Novel Surgeon-Modified Hypogastric Branch Stent Graft to Preserve Pelvic Perfusion

Annals of Vascular Surgery — Fri, 25 Dec 2009 00:00:00 +0100

Conclusion: Surgeon-modified hypogastric branch stent grafts to maintain perfusion to one or both hypogastric arteries is feasible and provides an alternative to hypogastric artery exclusion. Long-term follow-up is needed to evaluate stent-graft patency and failure rates. (Source: Annals of Vascular Surgery)

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Infection of an Aortic Stent Graft with Suprarenal Fixation

Annals of Vascular Surgery — Fri, 25 Dec 2009 00:00:00 +0100

We report a case of an elderly man admitted with abdominal pain and fever, 5 months after endovascular aortic aneurysm repair of a suspected inflammatory abdominal aortic aneurysm. He underwent successful explantation of an infected stent graft with suprarenal fixation following extra-anatomic revascularization. After a prolonged hospitalization, he was discharged on antibiotics and at follow-up has returned to baseline activity level. Although explantation of an infected prosthesis following endovascular aortic aneurysm repair has been previously reported, our case prompted a review of the literature to evaluate mode of presentation, putative factors, and management decisions associated with reduced morbidity and mortality. (Source: Annals of Vascular Surgery)

Reinfusion of Blood within Aneurysm Sac: A Simple Method of Intraoperative Blood Conservation in Elective Abdominal Aortic Surgery

Annals of Vascular Surgery — Fri, 25 Dec 2009 00:00:00 +0100

We present a simple method of additional blood conservation in elective abdominal aortic surgery, which involves reinfusion of autologous blood within the aneurysm sac in the perioperative period. (Source: Annals of Vascular Surgery)

National Outcomes after Open Repair of Abdominal Aortic Aneurysms with Visceral or Renal Bypass

Annals of Vascular Surgery — Thu, 24 Dec 2009 15:16:27 +0100

Background: We evaluated national outcomes after open repair of abdominal aortic aneurysms (AAAs) with visceral or renal bypass (VRB).Methods: Using the National Inpatient Sample database from 1993 through 2006, AAA repairs were identified by ICD9 codes for diagnosis of intact AAA combined with a procedure of open AAA repair. VRB patients also had an aortorenal and/or mesenteric bypass or mesenteric endarterectomy. Dissections as well as thoracic and thoracoabdominal aneurysms were excluded. Demographics and comorbidities were noted. Mortality and complications were compared to infrarenal AAA (IRA) repairs without VRB. Predictors of perioperative mortality were analyzed by multivariate logistic regression.Results: A total of 41,166 VRB and 362,808 IRA repairs were identified. VRB repair vo...

Variations in Early Outcomes of Endovascular Aneurysm Repair with Alternate Endograft Configurations

Annals of Vascular Surgery — Thu, 24 Dec 2009 15:16:26 +0100

Background: Most endovascular abdomincal aortic aneurysm (AAA) repairs (EVARs) performed in the United States utilize a bifurcated configuration. The purpose of this study was to examine the effect of alternate graft configurations on early outcomes during EVAR.Methods: Patients in the National Surgical Quality Improvement Program (NSQIP) participant use file who underwent elective EVAR for AAA from 2005 to 2007 were stratified by configuration using CPT codes. Bifurcated configurations (CPT 34802, 34803, 34804) were compared to straight configurations such as tube or aortouni-iliac grafts (CPT 34800, 34805). Preoperative risk factors, intraoperative variables, 30-day outcome measures, and length of stay were compared. Composite morbidity included patients experiencing one or more of 21 co...

Emergency Management of a Fenestration-related Endoleak

Journal of Vascular and Interventional Radiology : JVIR — Thu, 24 Dec 2009 15:07:52 +0100

Open surgical repair of nonruptured thoracoabdominal aortic aneurysms, in specialist centers, is associated with an operative and 1-year mortality of 4%–16% () and 31%, respectively (). Since 1997, when Inoue et al () reported the first case of endovascular management of a thoracoabdominal aortic aneurysm with a branched stent-graft, considerable progress has been made and endovascular repair seems to be a promising alternative to conventional surgical repair (). However, periprocedural and longer-term complications (eg, leaks, migration, component separation, and occlusions) continue to evolve. The management of a branched graft's complications, particularly in thoracoabdominal aneurysms, has not been efficiently elaborated in the current literature. Herein, we report our technique to m...

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Endovascular Aortic Aneurysm Repair with the Endurant Stent-graft: Early and 1-year Results from a European Multicenter Experience

Journal of Vascular and Interventional Radiology : JVIR — Thu, 24 Dec 2009 15:07:49 +0100

Conclusions: The initial experience shows that the Endurant stent-graft appears to be effective in endovascular repair of AAAs in patients with hostile aortoiliac anatomy. This graft permits a broader group of patients to be treated with endovascular aneurysm repair; however, further studies are needed to evaluate the long-term results. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Impact of Obesity on Outcomes after Open Surgical and Endovascular Abdominal Aortic Aneurysm Repair

Journal of the American College of Surgeons — Thu, 24 Dec 2009 00:00:00 +0100

Conclusions: Obesity is an independent risk factor that surgeons should consider during patient selection and operative planning for abdominal aortic aneurysm repair. Obese patients appear to particularly benefit from successful EVAR over open repair, but if open repair is required, special attention should be paid to cardiac risk, perioperative renal protection, and aggresive wound infection prevention measures. (Source: Journal of the American College of Surgeons)

Identifying Paraplegia Risk Associated with Thoracic Endografting [ORIGINAL ARTICLE]

Asian Cardiovascular and Thoracic Annals — Mon, 21 Dec 2009 12:36:19 +0100

Endografting, like open surgical repair of the thoracic aorta, can be complicated by paraplegia. We reviewed our thoracic endografting experience regarding the incidence and treatment of spinal cord neurologic events. Between February 2000 and July 2008, 346 patients underwent endoluminal grafting of the descending thoracic aorta. Indications for intervention included atherosclerotic aneurysms (45.9%), acute and chronic dissections (31.5%), miscellaneous lesions (13.6%), and penetrating aortic ulcers (8.9%). Ten women and 4 men (4.0%), with a mean age of 71.3 years, developed either paraparesis (1.7%) or paraplegia (2.3%). Nine (64.3%) of these patients had an aneurysm, 4 (28.6%) had acute or chronic type B aortic dissection, and 1 (7.1%) had a penetrating aortic ulcer; 3 (21.4%) of them h...

Type A Aortic Dissection, Right-Sided Aortic Arch, and Thoracic Aortic Aneurysm [CASE STUDIES]

Asian Cardiovascular and Thoracic Annals — Mon, 21 Dec 2009 12:36:19 +0100

A previously healthy 78-year-old woman presented with severe chest pain. Computed tomography revealed a right-sided aortic arch with an aberrant left subclavian artery originating from Kommerell’s diverticulum, a thoracic aortic aneurysm, and Stanford type A acute aortic dissection. Successful emergency repair of the ascending aorta, total arch, and descending aorta were performed through a median sternotomy only. (Source: Asian Cardiovascular and Thoracic Annals)

Inferior Mesenteric Artery Embolization before Endovascular Repair of an Abdominal Aortic Aneurysm: Effect on Type II Endoleak and Aneurysm Shrinkage

Journal of Vascular and Interventional Radiology : JVIR — Mon, 21 Dec 2009 00:00:00 +0100

Conclusions: Preoperative coil embolization of the IMA reduced the frequency of type II endoleaks after EVAR, but the authors failed to show any influence on late postoperative aneurysm shrinkage. (Source: Journal of Vascular and Interventional Radiology : JVIR)

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Intraoperative Buttock Ischemia with Postoperative Necrosis following Infrainguinal Bypass Surgery

European Journal of Vascular and Endovascular Surgery — Mon, 21 Dec 2009 00:00:00 +0100

We present an exceptional case of buttock necrosis following infrainguinal bypass in a patient with bilateral internal iliac and left external iliac artery occlusions. The case is the first such reported to our knowledge. (Source: European Journal of Vascular and Endovascular Surgery)

Two-Stage Safe Repair of Aortobronchial Fistula [CASE REPORTS]

The Annals of Thoracic Surgery — Fri, 18 Dec 2009 23:25:12 +0100

Aortobronchial fistulas are a rare and frequently misdiagnosed cause of massive hemoptysis, which is often fatal. Aortic stent grafts now allow for a safer emergency repair. However, there is a high (40% to 50%) recurrence risk, with a high fatality rate. A patient with an aortobronchial fistula due to a ruptured thoracic aortic aneurysm underwent a two-stage repair. An aortic stent graft was deployed as an emergency, and a second surgical durable repair was performed 4 months later. The patient recovered well. The best management of aortobronchial fistula may be emergency use of stent graft, followed by a delayed durable open repair when the patient has achieved stability. (Source: The Annals of Thoracic Surgery)

Do Popular Media and Internet-Based Hospital Quality Ratings Identify Hospitals with Better Cardiovascular Surgery Outcomes?

Journal of the American College of Surgeons — Fri, 18 Dec 2009 15:23:01 +0100

Conclusions: Popular hospital rating systems identify high-quality hospitals for cardiovascular operations. However, patients can experience equivalent outcomes by seeking care at high-volume hospitals. (Source: Journal of the American College of Surgeons)

Technical aspects and midterm patency of iliac branched devices

Journal of Vascular Surgery — Fri, 18 Dec 2009 00:00:00 +0100

This study presents technical aspects and initial results with iliac bifurcated devices (IBDs).Methods: Since 2006, 47 IBDs were scheduled for 37 patients who were followed up between 2 and 31 months. Iliac aneurysms were unilateral in 27 patients and bilateral in 10. Two patients with bilateral common iliac artery aneurysms (CIAAs) did not have a simultaneous aortic aneurysm. Two patients underwent combined thoracoabdominal aneurysm treatment with branched stent grafts, and one underwent combined juxtarenal aneurysm repair with a fenestrated device. The helical iliac side branch device was used in 11 CIAA (23.4%), and the Zenith bifurcated iliac side branch device was used in the remaining 36 (76.6%).Results: The technical success rate was 97.3% within the 47 intended-to-treat CIAAs (fail...

Brown-Sequard syndrome after thoracic endovascular aortic repair [Case report - Aortic and aneurysmal]

Interactive CardioVascular and Thoracic Surgery — Thu, 17 Dec 2009 16:35:41 +0100

A 76-year-old female had suffered from distal arch aortic aneurysm and chronic DeBakey IIIB type dissecting aneurysm. The patient underwent thoracic endovascular aortic repair (TEVAR). After TEVAR the patient had a motor and proprioceptive loss on the left side and a pain and body temperature loss on the right side below the level of T7. At diagnosis of Brown-Sequard syndrome, corticosteroid and free radical scavenger were administered soon afterwards. Her neurological deficits gradually improved and the patient was discharged with the aid of a walking stick three months after TEVAR. (Source: Interactive CardioVascular and Thoracic Surgery)

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A single centre experience of simultaneous open abdominal aortic aneurysm and cardiac surgery [ESCVS article - Aortic and aneurysmal]

Interactive CardioVascular and Thoracic Surgery — Thu, 17 Dec 2009 16:35:39 +0100

Conclusion: Simultaneous open repair of AAA and cardiac surgery is a feasible option for this high-risk and anatomically challenging patient group. This experience highlights the need for close cooperation between vascular and cardiac teams. (Source: Interactive CardioVascular and Thoracic Surgery)

Intraoperative Buttock Ischemia with Postoperative Necrosis following Infrainguinal Bypass Surgery

EJVES Extra — Mon, 07 Dec 2009 00:00:00 +0100

Spinal Cord Injury is Not Negligible after TEVAR for Lower Descending Aorta

European Journal of Vascular and Endovascular Surgery — Fri, 04 Dec 2009 00:00:00 +0100

Conclusions: Paraplegia after TEVAR occurred in one of eight patients in whom the stent graft covered ICA-AKA. Long coverage of the aorta including the ICA-AKA was critical. To prevent this serious complication, identification of the ICA-AKA is crucial. (Source: European Journal of Vascular and Endovascular Surgery)

Endovascular Aneurysm Repair with Preservation of the Internal Iliac Artery Using the Iliac Branch Graft Device

European Journal of Vascular and Endovascular Surgery — Fri, 04 Dec 2009 00:00:00 +0100

Conclusion: IBD was performed with high technical success rates and encouraging mid-term patency. Formalised risk stratification and morphological data are required to identify the group of patients who will benefit most. Cost-effectiveness appraisals are needed for this technique. (Source: European Journal of Vascular and Endovascular Surgery)

Survey of Currently Used Materials for Fabrication of Extraoral Maxillofacial Prostheses in North America, Europe, Asia, and Australia

Journal of Prosthodontics — Thu, 03 Dec 2009 00:00:00 +0100

Conclusions: The responses to this survey indicate that the majority of AAA and AAMP members are using or have used a variety of RTV silicones, pigments, and colorants in the quest to provide the best possible facial prosthetic service. Further research is needed to further refine and improve extraoral maxillofacial materials/techniques based on the results of this study. (Source: Journal of Prosthodontics)

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Early and midterm outcome of a novel technique to simplify the hybrid procedures in the treatment of thoracoabdominal and pararenal aortic aneurysms

Journal of Vascular Surgery — Tue, 01 Dec 2009 00:00:00 +0100

Conclusion: VORTEC allows performance of easy, safe, and minimally invasive revascularization of renal and visceral arteries and may represent a significant technical advance in the hybrid repair of TAAAs and PAAAs. However, the questions of reproducibility by other centers and long-term results are mandatory to establish this alternative revascularization option. (Source: Journal of Vascular Surgery)

Type B Thoracic Aortic Dissection: Open vs Endovascular Repair

Journal of Vascular Surgery — Tue, 01 Dec 2009 00:00:00 +0100

This study assessed morbidity and mortality in patients with type B thoracic aortic dissection (TADB) who undergo operative repair. Methods: We queried the Nationwide Inpatient Sample (NIS) database, examining all records between 2005 and 2007. Using International Classification of Diseases (9th ed) diagnosis codes, we selected patients who underwent an open repair or an endovascular stent graft repair for a diagnosis of TAD. We isolated only those patients undergoing repair for TADB by excluding patients with diagnosis codes for aortic aneurysm and procedure codes for cardioplegia or for operations on vessels of the heart or valves. We compared demographics and comorbidities, as well as adjusted complications and mortality between the cohorts. (Source: Journal of Vascular Surgery)

Diabetes No Liability in Endovascular AAA Repaird

Cardiology News — Tue, 01 Dec 2009 00:00:00 +0100

PHILADELPHIA — Patients with diabetes fared no worse during hospitalization for an endovascular aortic aneurysm repair than did others undergoing similar percutaneous repair in an analysis of more than 12,000 U.S. patients. (Source: Cardiology News)

Abdominal aortic aneurysm repair in a renal transplant recipient using a femoral v-a bypass.

Annals of Thoracic and Cardiovascular Surgery — Tue, 01 Dec 2009 00:00:00 +0100

We report a successful repair of an abdominal aortic aneurysm (AAA) in a renal transplant recipient using a femoral V-A bypass to protect the renal allograft during aortic cross-clamping. A 49-year-old male patient with renal failure had received a second allogenic renal transplantation in the right iliac fossa in 2002. Four years later, computed tomography showed an enlargement of the AAA extending to the distal aorta with involvement of the common iliac arteries. He received resection and graft replacement of the AAA through a midline laparotomy using a femoral V-A bypass without cold perfusion or local hypothermia. The postoperative course was uneventful, and he was discharged on the 16th postoperative day with no impairment of renal function. To protect the renal allograft injury durin...

Hybrid treatment for aortic arch and proximal descending thoracic aneurysm: experience with stent grafting for second-stage elephant trunk repair [Original articles]

European Journal of Cardio-Thoracic Surgery — Mon, 30 Nov 2009 19:37:41 +0100

Conclusions: Staged procedures using endovascular grafting in the treatment of the arch and proximal descending thoracic aneurysm may have the potential to reduce morbidity and mortality rates. Although long-term results are still pending, this early experience demonstrates the safety and early-term effectiveness of this hybrid approach, which consists both of endovascular and open surgical procedures. (Source: European Journal of Cardio-Thoracic Surgery)

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The mechanical role of thrombus on the growth rate of an abdominal aortic aneurysm

Journal of Vascular Surgery — Mon, 30 Nov 2009 00:00:00 +0100

Conclusion: A larger thrombus in AAA was associated with a higher AAA growth rate, but also with a lower wall stress. Therefore, weakening of the AAA wall, under the influence of thrombus, may play a more imminent role in the process of AAA growth than the stress acting on the wall. (Source: Journal of Vascular Surgery)

Endovascular Repair of Thoracoabdominal Aortic Aneurysms

European Journal of Vascular and Endovascular Surgery — Mon, 30 Nov 2009 00:00:00 +0100

Conclusion: This preliminary study, which includes our learning curve, confirms the feasibility and safety of the endovascular repair of TAAA in high-risk patients. Meticulous follow-up to assess sac behaviour and visceral perfusion is critical in order to ensure optimal results of these complex endovascular repairs requiring numerous mating components. (Source: European Journal of Vascular and Endovascular Surgery)

Hepatorenal Bypass Allowing Fenestrated Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysm: A Case Report

European Journal of Vascular and Endovascular Surgery — Mon, 30 Nov 2009 00:00:00 +0100

Abstract: A 61-year-old man presented with a 66-mm juxtarenal aortic aneurysm. He was unfit for open repair. The anatomical proximity of his right renal artery (RRA) and his superior mesenteric artery (SMA) precluded fabrication of an endograft allowing perfusion of both vessels. He underwent a hepato-renal bypass to his RRA and subsequent fenestrated endovascular aneurysm repair (EVAR) using an endoprosthesis with fenestrations for the SMA and the left renal artery (LRA), and a scallop for the coeliac trunk. Follow-up imaging showed all visceral vessels to be perfused. The use of this limited hybrid approach allows endovascular treatment of aneurysms that are initially unsuitable for such an approach. (Source: European Journal of Vascular and Endovascular Surgery)

Staged repair of a chronic dissecting aneurysm with the two elephant trunks technique.

The Annals of Thoracic Surgery — Sat, 28 Nov 2009 00:10:14 +0100

We present the "two elephant trunks" technique. In this procedure, a single side-branched graft is placed in the descending aorta without excising the dissecting septum during a first-stage operation. This modification is simple to perform and has the possibility to prevent interval rupture for a chronic dissecting aneurysm. PMID: 19932223 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Rapid Exchange of Bound ADP on the Staphylococcus aureus Replication Initiation Protein DnaA [Dna: Replication, Repair, Recombination, and Chromosome Dynamics]

Journal of Biological Chemistry — Fri, 27 Nov 2009 17:05:44 +0100

This study examined the roles of ATP binding and its hydrolysis in the regulation of the S. aureus DnaA activity. In vitro, S. aureus DnaA melted S. aureus oriC in the presence of ATP but not ADP by a mechanism independent of ATP hydrolysis. Unlike E. coli DnaA, binding of ADP to S. aureus DnaA was unstable. As a result, at physiological concentrations of ATP, ADP bound to S. aureus DnaA was rapidly exchanged for ATP, thereby regenerating the ability of DnaA to form the open complex in vitro. Therefore, we examined whether formation of ADP-DnaA participates in suppression of replication initiation in vivo. Induction of the R318H mutant of the AAA+ sensor 2 protein, which has decreased intrinsic ATPase activity, caused over-initiation of chromosome replication in S. aureus, suggesting that ...

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Screening for Abdominal Aortic Aneurysm among Patients Referred to the Vascular Laboratory is Cost-effective

European Journal of Vascular and Endovascular Surgery — Fri, 27 Nov 2009 00:00:00 +0100

Conclusions: Patients in whom AAA was detected at selective screening had inferior long-term survival and were operated on less frequently, compared with AAA patients described in previous studies. Yet, selective screening at the vascular laboratory was cost-effective. (Source: European Journal of Vascular and Endovascular Surgery)

Endovascular Repair of Thoracoabdominal Aortic Aneurysms.

PubMed: Eur J Vasc Endovasc ... — Thu, 26 Nov 2009 00:00:00 +0100

CONCLUSION: This preliminary study, which includes our learning curve, confirms the feasibility and safety of the endovascular repair of TAAA in high-risk patients. Meticulous follow-up to assess sac behaviour and visceral perfusion is critical in order to ensure optimal results of these complex endovascular repairs requiring numerous mating components. PMID: 19945316 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Hepatorenal Bypass Allowing Fenestrated Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysm: A Case Report.

PubMed: Eur J Vasc Endovasc ... — Thu, 26 Nov 2009 00:00:00 +0100

Authors: Lerussi G, O'Brien N, Sessa C, D'Elia P, Sobocinski J, Perrot C, Azzaoui R, Haulon S A 61-year-old man presented with a 66-mm juxtarenal aortic aneurysm. He was unfit for open repair. The anatomical proximity of his right renal artery (RRA) and his superior mesenteric artery (SMA) precluded fabrication of an endograft allowing perfusion of both vessels. He underwent a hepato-renal bypass to his RRA and subsequent fenestrated endovascular aneurysm repair (EVAR) using an endoprosthesis with fenestrations for the SMA and the left renal artery (LRA), and a scallop for the coeliac trunk. Follow-up imaging showed all visceral vessels to be perfused. The use of this limited hybrid approach allows endovascular treatment of aneurysms that are initially unsuitable for such an approach. ...

Endovascular vs open repair of ruptured abdominal aortic aneurysms remains controversial

theHeart.org — Wed, 25 Nov 2009 16:45:00 +0100

Thirty-day mortality is approximately 20% for endovascular repair of ruptured abdominal aortic aneurysm and 36% for open surgical repair. (Source: theHeart.org)

Endovascular vs open repair of ruptured abdominal aortic aneurysms remains controversial

theHeart.org — Wed, 25 Nov 2009 16:45:00 +0100

Thirty-day mortality is approximately 20% for endovascular repair of ruptured abdominal aortic aneurysm and 36% for open surgical repair. For complete story visit theheart.org. (Source: theHeart.org)

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Contemporary results for open repair of suprarenal and type IV thoracoabdominal aortic aneurysms

British Journal of Surgery — Wed, 25 Nov 2009 00:00:00 +0100

This study reviewed a 10-year experience of open repair of non-ruptured type IV and suprarenal TAAA. All procedures were performed using a totally abdominal approach with supracoeliac clamping of the aorta.There were 53 patients (31 men; 58 per cent) of median age 69 (range 54-82) years. Forty-four patients had a type IV TAAA and nine a suprarenal aneurysm. Three patients (6 per cent) died within 30 days and the 12-month mortality rate for patients followed for at least 1 year was 6 per cent (three of 49). Ten patients (19 per cent) had a cardiac complication, 20 (38 percent) a respiratory complication, three (6 percent) required early reoperation, and one patient (2 percent) developed permanent paraplegia. There was one late death resulting from an aneurysm-related complication.Open repai...

Contemporary results for open repair of suprarenal and type IV thoracoabdominal aortic aneurysms.

The British Journal of Surgery — Wed, 25 Nov 2009 00:00:00 +0100

CONCLUSION:: Open repair of suprarenal aneurysms and type IV TAAA may be undertaken using a totally abdominal approach with acceptable levels of morbidity and mortality. Copyright (c) 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 19941300 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)

The use of dynamic volumetric CT angiography (DV-CTA) for the characterization of endoleaks following fenestrated endovascular aortic aneurysm repair (f-EVAR)

Journal of Vascular Surgery — Wed, 25 Nov 2009 00:00:00 +0100

Accurate endoleak classification is essential following fenestrated endovascular aneurysm repair (f-EVAR). Both endoleak type and exact source of endoleak have implications upon the urgency and complexity of future management strategies. Herein we report on a patient with a documented endoleak post-f-EVAR, in which the source of blood flow into the aneurysm sac could not be determined using conventional computed tomographic angiography. Consequently, dynamic volumetric computed tomographic angiography (DV-CTA) was employed, which clearly illustrated the site of origin of the endoleak. DV-CTA enables accurate endoleak characterization following f-EVAR, with excellent conspicuity of the source of blood flow into the aneurysm sac. (Source: Journal of Vascular Surgery)

Thirty-day NSQIP database outcomes of open versus endoluminal repair of ruptured abdominal aortic aneurysms

Journal of Vascular Surgery — Wed, 25 Nov 2009 00:00:00 +0100

We examined the National Surgical Quality Improvement Program (NSQIP) database to compare 30-day multicenter outcomes for EVAR vs open rAAA repair.Methods: Patients that underwent rAAA repair in the NSQIP database from 2005 to 2007 were identified through a combination of Current Procedural Terminology (CPT) codes and International Classification of Diseases-Ninth Revision (ICD-9) diagnoses. Preoperative comorbidities, operative duration and transfusion, and 30 day outcomes were evaluated using t tests or Chi-squared tests depending on the variable. A separate multivariable regression was performed for each outcome adjusting for all independently predictive preoperative and intraoperative risk factors.Results: A total of 427 patients were identified and 76.8% of patients underwent open rep...

Primary Aortoenteric Fistula Due to a Swallowed Twig in a Three-year-old Child

European Journal of Vascular and Endovascular Surgery — Wed, 25 Nov 2009 00:00:00 +0100

We report a primary aortoenteric fistula (PAEF) occurring in a 3 year old as a result of duodenal perforation after ingestion of a twig. To our knowledge this is the first case of a primary aortoenteric fistula reported in a child. Emergency aortic surgery in children needs certain considerations which are briefly discussed. (Source: European Journal of Vascular and Endovascular Surgery)

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Endovascular vs Open Repair of Ruptured Abdominal Aortic Aneurysms Remains Controversial

Medscape FamilyMedicine Headlines — Tue, 24 Nov 2009 15:02:13 +0100

Thirty-day mortality is approximately 20% for endovascular repair of ruptured abdominal aortic aneurysm and 36% for open surgical repair. Medscape Medical News (Source: Medscape FamilyMedicine Headlines)

Screening for Abdominal Aortic Aneurysm among Patients Referred to the Vascular Laboratory is Cost-effective.

PubMed: Eur J Vasc Endovasc ... — Tue, 24 Nov 2009 00:00:00 +0100

CONCLUSIONS: Patients in whom AAA was detected at selective screening had inferior long-term survival and were operated on less frequently, compared with AAA patients described in previous studies. Yet, selective screening at the vascular laboratory was cost-effective. PMID: 19942460 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Staged Repair of a Chronic Dissecting Aneurysm With the Two Elephant Trunks Technique [HOW TO DO IT]

The Annals of Thoracic Surgery — Mon, 23 Nov 2009 19:29:55 +0100

Secondary Interventions Following Endovascular Aneurysm Repair (EVAR) and the Enduring Value of Graft Surveillance.

PubMed: Eur J Vasc Endovasc ... — Mon, 23 Nov 2009 00:00:00 +0100

DISCUSSION: Some format of surveillance following EVR probably remains necessary despite a reduction in secondary interventions with modern stent-grafts. Surveillance should be targeted at those stent-grafts and patients at high risk of complications. Further work is justified to identify this group. PMID: 19939711 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Primary Aortoenteric Fistula Due to a Swallowed Twig in a Three-year-old Child.

PubMed: Eur J Vasc Endovasc ... — Mon, 23 Nov 2009 00:00:00 +0100

We report a primary aortoenteric fistula (PAEF) occurring in a 3 year old as a result of duodenal perforation after ingestion of a twig. To our knowledge this is the first case of a primary aortoenteric fistula reported in a child. Emergency aortic surgery in children needs certain considerations which are briefly discussed. PMID: 19939710 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

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Branched Endograft for Aortoiliac Artery Aneurysms.

Vascular — Thu, 19 Nov 2009 17:10:13 +0100

Authors: Lee WA Iliac aneurysms can occur concomitantly in 15 to 20% of abdominal aortic aneurysms. The common iliac arteries serve as the distal landing zones for the iliac limbs of abdominal aortic stent grafts, and for most currently available devices, the maximum treatable iliac size is 20 mm. When the iliac artery diameter exceeds this, alternative landing zones or adjunctive techniques are required to achieve an adequate distal seal and fixation, which typically involves occlusion of the hypogastric artery origin and extension to the external iliac artery. The clinical sequelae of acute hypogastric occlusion mostly involve symptoms of hip and buttock ischemia (claudication), which can occur in up to 40% of cases. In this article, a novel method of endovascular management of commo...

Gore Announces Availability of the Q50 Stent Graft Balloon Catheter

HSMN NewsFeed — Wed, 18 Nov 2009 13:37:01 +0100

Balloon Catheter from QXMédical complements GORE EXCLUDER® AAA Endoprosthesis for endovascular aortic repair FLAGSTAFF, Ariz., Nov 18--(HSMN NewsFeed)--W. L. Gore & Associates (Gore) today announced it has entered into a partnership with QXM&... Devices, InterventionalW. L. Gore, QXMédical, Q50, Stent Graft Balloon Catheter, AAA, (Source: HSMN NewsFeed)

Micromechanical Characterization of Intra-luminal Thrombus Tissue from Abdominal Aortic Aneurysms.

Annals of Biomedical Engineering — Tue, 17 Nov 2009 00:00:00 +0100

Authors: Gasser TC, Martufi G, Auer M, Folkesson M, Swedenborg J The reliable assessment of Abdominal Aortic Aneurysm rupture risk is critically important in reducing related mortality without unnecessarily increasing the rate of elective repair. Intra-luminal thrombus (ILT) has multiple biomechanical and biochemical impacts on the underlying aneurysm wall and thrombus failure might be linked to aneurysm rupture. Histological slices from 7 ILTs were analyzed using a sequence of automatic image processing and feature analyzing steps. Derived microstructural data was used to define Representative Volume Elements (RVE), which in turn allowed the estimation of microscopic material properties using the non-linear Finite Element Method. ILT tissue exhibited complex microstructural arrangemen...

EVAR vs. Open Repair of AAA

Internal Medicine News — Sun, 15 Nov 2009 00:00:00 +0100

Dr. Ebbert and Dr. Tangalos are with the Mayo Clinic in Rochester, Minn. To respond to this column write to Dr. Ebbert and Dr. Tangalos at our editorial offices or e-mail them at imnews@elsevier.com. (Source: Internal Medicine News)

[Anesthesiologic procedure for elective aortic surgery.]

Der Anaesthesist — Thu, 12 Nov 2009 00:00:00 +0100

Authors: Knapp J, Bernhard M, Rauch H, Hyhlik-Dürr A, Böckler D, Walther A Aortic aneurysms are frequent in the elderly who often suffer from relevant co-morbidities. In Germany it is estimated that approximately 250,000 patients suffer from an aortic aneurysm. Due to the high risk of cardiac or pulmonary complications operative management poses a challenge to the anesthesiologist. Especially hemodynamic management during aortic cross-clamping requires anesthesiologic know-how and an anticipatory use of vasodilators and catecholamines. Furthermore, the anesthesiologist has to protect renal function. In order to avoid paraplegia due to spinal ischemia cerebrospinal fluid drainage may be necessary in patients with aneurysms of the thoracic aorta. In recent years endovascular re...

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Intra-aneurysm Sac Pressure in Patients with Unchanged AAA Diameter after EVAR

European Journal of Vascular and Endovascular Surgery — Wed, 11 Nov 2009 00:00:00 +0100

Conclusions: AAAs without endoleak and unchanged diameter more than 1 year after EVAR will often continue unchanged. Expansion can eventually occur in the absence of intra-sac fluid accumulation and is associated with higher and more pulsatile intra-sac pressure. However, in patients with intra-sac fluid, expansion can occur with low intra-sac pressures. (Source: European Journal of Vascular and Endovascular Surgery)

A 66-Year-Old Man With an Abdominal Aortic Aneurysm: Review of Screening and Treatment [Clinical Crossroads]

JAMA — Tue, 10 Nov 2009 20:51:44 +0100

Ruptured abdominal aortic aneurysm (AAA) is a common cause of death. Abdominal aortic aneurysms tend to be asymptomatic until the time of rupture, which has a mortality rate of greater than 80%. Therefore, elective repair prior to rupture is preferred if life expectancy is reasonable and the risk of rupture outweighs the risk of repair. Mr F, a 66-year-old man with a 5.2-cm AAA, illustrates the issues surrounding monitoring and treating AAA. Risk factors for AAA include older age, male sex, smoking history, and a family history of AAA. Screening for AAA with ultrasound has been shown to prevent rupture, prevent AAA-related death, and be cost-effective. Risk factors for rupture include larger diameter, female sex, and smoking history. Endovascular repair has lower operative mortality and co...

Intra-aneurysm Sac Pressure in Patients with Unchanged AAA Diameter after EVAR.

PubMed: Eur J Vasc Endovasc ... — Mon, 09 Nov 2009 00:00:00 +0100

CONCLUSIONS: AAAs without endoleak and unchanged diameter more than 1 year after EVAR will often continue unchanged. Expansion can eventually occur in the absence of intra-sac fluid accumulation and is associated with higher and more pulsatile intra-sac pressure. However, in patients with intra-sac fluid, expansion can occur with low intra-sac pressures. PMID: 19906545 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Antegrade Hypogastric Revascularization During Endovascular Aortoiliac Aneurysm Repair: An Alternative to Bilateral Embolization

Annals of Vascular Surgery — Mon, 09 Nov 2009 00:00:00 +0100

We report the case of a 68-year-old man, at high risk for an open procedure, who presented with bilateral iliac aneurysm and minor aortic ectasia; no iliac landing zone was available. A regular bifurcated graft was deployed and extended into one of the external iliac arteries, preceded by ipsilateral hypogastric embolization. Through an upper extremity approach, an endograft was deployed from the remaining bifurcated graft branch into the other hypogastric artery, followed by ipsilateral external iliac occlusion. Finally a femorofemoral crossover bypass was performed. The patient recovered event free, and patency of the endograft and absence of endoleak were demonstrated on computed tomography. Minor unilateral buttock claudication resolved in 6 weeks and sexual function was preserved. Thi...

[Abdominal aorta aneuyrsms - endovascular and open surgery.]

Tidsskrift for den Norske Laegeforening — Thu, 05 Nov 2009 00:00:00 +0100

Authors: Vetrhus M, Viddal B, Loose H, Neverdal NO, Nordang E Background. In Norway, repair of abdominal aortic aneurysms is performed in more than 800 patients annually. Open repair is an established procedure, but an increasing number of patients have undergone endovascular repair during the last decades. The paper delivers an up to date discussion of infrarenal abdominal aortic aneurysm repair. Materials and methods. A systematic search was performed in Pubmed and literature containing the search terms <<abdominal aortic aneurysm>> and <<mortality>> (from 2004 to 2009) was retrieved. The review is based on randomized, multi-centre and registry studies examining complications and mortality in endovascular and open repair. Results. Perioperative mortality is lo...

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Challenges in analysis and interpretation of cost data in vascular surgery

Journal of Vascular Surgery — Thu, 05 Nov 2009 00:00:00 +0100

Conclusions: Conclusions of health economic reports can be highly dependent on how the data are presented and the statistical methods that are used. We recommend that cost data be presented as mean values with distributions. Exclusion of outliers and focus on P values should be avoided. (Source: Journal of Vascular Surgery)

Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High-risk Patients Is Not Recommended in Emergency Departments That Are Frequently Crowded

Academic Emergency Medicine — Wed, 04 Nov 2009 00:00:00 +0100

Conclusions: Routine screening for asymptomatic AAA required substantial ED resources for a relatively low success rate of completed screens. The prevalence rate of AAA in our ED sample was not significantly different than prevalence estimates obtained from older men in the general population. ED sonographers reported benefits of screening in terms of improving the quality of emergency care and patient satisfaction, but also reported that it reduced operational efficiency. For EDs that have problems with crowding, we do not recommend implementing a routine screening program for AAA, even among high-risk patients. ACADEMIC EMERGENCY MEDICINE 2009; 16:1242[ndash]1250 © 2009 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine)

Efficacy of TachoSil patches in controlling Dacron suture-hole bleeding after abdominal aortic aneurysm open repair

BioMed Central — Wed, 04 Nov 2009 00:00:00 +0100

Purpose.The aim of this study is evaluate the efficacy of TachoSil patches in controlling suture-hole bleeding after elective infrarenal abdominal aortic aneurysm (AAA) replacement with Dacron graft.Materials and Methods.Patients undergoing elective replacement of infrarenal AAA with Dacron grafts were prospectively randomized to TachoSil patches (Group I) or standard compression with surgical swabs (Group II). We evaluated time to haemostasis, blood loss during the operation, blood loss after cross-clamp removal, duration of operation, drain volume, requirement for blood transfusion and surgeons rating of efficacy. Results: Twenty patients were randomized (10 patients in each treatment Group). The mean time to haemostasis was 264 +/- 127.1 s (range: 180-600 s) in Group I and 408 +/- 159.5...

First Device Designed to Preserve Blood Flow to Iliac Arteries During Aneurysm Repair Receives Approval from Health Canada

HSMN NewsFeed — Tue, 03 Nov 2009 17:19:55 +0100

Minimally Invasive Treatment for Aortic Disease Is Safe, Effective Alternative to Open Surgery BLOOMINGTON, Ind.--(HSMN NewsFeed)--Canadian physicians can now treat patients suffering from life-threatening aneurysms in one of the bodys largest arteries... Devices, Interventional, RegulatoryCook Medical, Endovascular Graft, abdominal aortic aneurysm, iliac artery (Source: HSMN NewsFeed)

The incidence of epidural abscess following epidural analgesia in open abdominal aortic aneurysm repair.

Annals of the Royal College of Surgeons of England — Mon, 02 Nov 2009 00:00:00 +0100

CONCLUSIONS The incidence of epidural abscess following epidural analgesia in patients undergoing open AAA repair withinour department was 0.48%. Although a rare complication, epidural abscess can cause significant morbidity. Epidural abscessesrarely develop before the third postoperative day. PMID: 19887020 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)

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Management of ruptured abdominal aortic aneurysm in the endovascular era

Journal of Vascular Surgery — Mon, 02 Nov 2009 00:00:00 +0100

Conclusion: Use of an algorithm favoring endovascular repair resulted in a highly significant reduction in rAAA mortality in our urban hospital. Thirty-day mortality for open repair was no different between pre- and post-protocol eras. With modern techniques of resuscitation and surgical management, a majority of patients presenting with rAAA can survive. (Source: Journal of Vascular Surgery)

Contemporary management of vascular complications associated with Ehlers-Danlos syndrome

Journal of Vascular Surgery — Mon, 02 Nov 2009 00:00:00 +0100

Conclusions: The elective surgical management of vascular disorders in EDS patients using open and endovascular procedures has been associated with good outcomes. Our results suggest that vascular interventions in these EDS patients can be safely performed and should not be withheld until rupture or acute symptoms arise. (Source: Journal of Vascular Surgery)

Re-interventions, Readmissions and Discharge Destination: Modern Metrics for the Assessment of the Quality of Care

European Journal of Vascular and Endovascular Surgery — Mon, 02 Nov 2009 00:00:00 +0100

Abstract: Aim: To determine whether administrative data can be used to determine metrics to inform the quality agenda. To determine the relationship between these metrics and the method of abdominal aortic aneurysm (AAA) repair undertaken.Methods: The Hospital Episode Statistics (HES) data were taken for a 5-year period (01.04.2003–31.03.2008). Cases of elective AAA repair were identified. Outcomes were determined in terms of mortality, discharge destination, re-intervention rates and emergency readmission rates. The results were interpreted in light of whether AAA repair was open or endovascular and whether patients were octogenarians or younger patients.Results: There were 18,060 elective AAA repairs with a mean in-hospital mortality rate of 5.9%. Of these 14,141 were open repairs with...

The Influence of Different Types of Stent Grafts on Aneurysm Neck Dynamics after Endovascular Aneurysm Repair

European Journal of Vascular and Endovascular Surgery — Mon, 02 Nov 2009 00:00:00 +0100

The objective of this study is to analyse the influence of different types of stent grafts on dynamic changes of the aneurysm neck.Methods: Pre- and postoperative electrocardiography (ECG)-gated computed tomographic angiography (CTA) scans were obtained in 30 abdominal aortic aneurysm (AAA) patients, 10 each from three different types of stent grafts (10 Talent, Endurant, and Excluder). Each dynamic CTA dataset consisted of eight reconstructed images over the cardiac cycle. Aortic area and radius changes during the cardiac cycle were determined at two levels: (A) 3 cm above and (B) 1 cm below the lowermost renal artery. Radius changes were measured over 360 axes, and plotted in a polar plot. An ellipse was fitted over the plots to determine radius changes over the major and minor axis fo...