MedWorm: Abdominal Aneurysm Repair

Repair of Thoracic Aortic Aneurysm Due to Noninfectious Aortitis

Journal of Cardiac Surgery — Tue, 07 Feb 2012 05:00:00 +0100

Conclusions: Surgical treatment of ITA has acceptable short‐ and mid‐term results. Because follow‐up serum levels of IgG and IgG4 were normal in survivors, postoperative corticosteroid therapy may not be indicated in patients in the absence of active vasculitis.(J Card Surg 2012;**:1‐6) (Source: Journal of Cardiac Surgery)

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The Results of a Needs Assessment to Guide a Vascular Surgery Skills Simulation Curriculum

Annals of Vascular Surgery — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Our needs assessment identified vascular procedures where simulation may be beneficial to improve the skill level of vascular trainees in Southern California. With economic and logistical constraints for simulation at each individual training facility, a potential approach to this educational challenge is a regional Southern California vascular surgery skills simulation center. (Source: Annals of Vascular Surgery)

Aortic Endograft Infection With Aortoduodenal Fistula Associated With Adjacent Vertebral Body Mycobacterial Osteomyelitis (Pott's Disease)

Annals of Vascular Surgery — Wed, 01 Feb 2012 05:00:00 +0100

Aortoenteric fistulas (AEFs) are a rare complication of infrarenal abdominal aortic aneurysm repair. They occur in (Source: Annals of Vascular Surgery)

Successful Treatment for Infected Aortic Aneurysm Using Endovascular Aneurysm Repairs as a Bridge to Delayed Open Surgery

Annals of Vascular Surgery — Wed, 01 Feb 2012 05:00:00 +0100

Management of infected aortic aneurysms, which can be life-threatening, remains challenging. Open surgical treatments, including debridement of the infected aorta and the surrounding tissue and either in situ reconstruction or extra-anatomic bypass covering with omentum or muscle flap, are the mainstay of therapy. However, increasing advances in technology have made endovascular treatment of infected aneurysms feasible. The present study describes the first clinical report of successful treatment of an infected aneurysm using endovascular techniques in the acute phase, followed by delayed open surgery. (Source: Annals of Vascular Surgery)

Current Endovascular Management of Abdominal Aortic Aneurysm

Current Cardiology Reports — Sat, 28 Jan 2012 16:52:05 +0100

Abstract Fatal rupture of abdominal aortic aneurysm (AAA) remains a feared complication. Development of vascular surgery techniques over 50 years ago has fulfilled the promise of preventing rupture, but the significant morbidity associated with open repair causes physicians and their older patients pause. With the advent of less invasive endovascular techniques and devices, patients now have another viable treatment option. We review some of the important trials as well as discuss developments in the continually evolving field of endovascular repair of AAAs. Content Type Journal ArticleCategory Peripheral Vascular Disease (M Shishehbor, Section Editor)Pages 1-10DOI 10.1007/s11886-012-0247-0Authors April A. Grant, 701 Grove Road, Greenville, SC 20605, USAStephen L...

A one-stage operation for abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas: report of a case

Surgery Today — Wed, 25 Jan 2012 18:04:10 +0100

Abstract Pancreatic surgery concomitant with abdominal aortic repair is rarely chosen due to concerns about prosthetic infection following pancreatic leakage and the poor prognosis of pancreatic neoplasms. We herein report a successfully treated case of infrarenal abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas treated by a one-stage operation. A 75-year-old male with a history of cerebral infarction and chronic subdural hematoma was referred to our department with a pulsatile abdominal mass. A 70-mm infrarenal abdominal aortic aneurysm with severe proximal neck angulation and a 28-mm multilocular cystic tumor with mural nodules in the pancreas body were detected. Abdominal aortic repair with a prosthetic graft and distal pancreatecto...

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Extracorporeal membrane oxygenation support for abdominal aortic aneurysms surgery in high-risk patients

Interactive CardioVascular and Thoracic Surgery — Wed, 25 Jan 2012 05:00:00 +0100

Surgical treatment of an abdominal aortic aneurysm in patients with a heart disease is risky. Aortic cross-clamping is featured by important consequences on cardiac, renal and gastrointestinal functions. Endovascular aortic repair is considered to be the gold standard in patients with severe comorbidities. However, in the case of unsuccessful endovascular treatment, surgery can be reconsidered with the use of extracorporeal membrane oxygenation, which seems to be a new tool for the management of cardiac and gastrointestinal events ensuring better post-operative outcomes. (Source: Interactive CardioVascular and Thoracic Surgery)

Endovascular Therapy of Saccular Aortic Aneurysm

Journal of Vascular and Interventional Radiology : JVIR — Sat, 21 Jan 2012 08:07:50 +0100

Based on a computed tomographic (CT) angiography study, a 23-year-old woman with Takayasu aortitis and abdominal pain was diagnosed with large 5.2-cm saccular abdominal aortic aneurysm near an occluded left renal artery (a; available in color online at www.jvir.org) and nonfunctional left kidney, small ectasia of inferior mesenteric artery origin, and mild diffuse aortic disease. There was no previous trauma or abdominal sepsis. Open surgical repair was undesirable, as the aortic tissue in the vicinity of the aneurysm was abnormal. The close proximity to right renal artery precluded endovascular stent-grafting. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Candidates and major determinants for endovascular repair of abdominal aortic aneurysms in Korean patients

Heart and Vessels — Thu, 19 Jan 2012 08:04:40 +0100

Abstract The purpose of this study was to determine what proportion of patients with an abdominal aortic aneurysm (AAA) would be eligible for endovascular aneurysm repair (EVAR) and to examine the major determinants for suitability of EVAR with the currently available indications. We retrospectively reviewed 3-D reconstructed computed tomography angiography of 88 patients with an atherosclerotic AAA who underwent open repair or EVAR between October 2003 and October 2010 at the Cardiovascular Center, Seoul National University Bundang Hospital. Of the 88 patients, 71 (80.7%) were treated with open repair and 17 (19.3%) were treated with EVAR. The rate of minor complications, postprocedural intensive care unit stay, and total hospital stay were significantly lower in the EVAR...

Perioperative Myocardial Injury and Hemostasis in Patients Undergoing Endovascular Aneurysm Repair for Asymptomatic Infrarenal Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions: Endovascular aortic aneurysm repair is associated with a significant risk of perioperative myocardial injury that is underdetected clinically and associated with a procoagulopathic state. (Source: Vascular and Endovascular Surgery)

A Meta-Analysis of Randomized and Risk-Adjusted Observational Studies of Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery — Thu, 19 Jan 2012 05:00:00 +0100

(Source: Vascular and Endovascular Surgery)

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Treatment of a Mycotic Descending Thoracic Aortic Aneurysm Using Endovascular Stent-Graft Placement and Rifampin Infusion With Postoperative Aspiration of the Aneurysm Sac

Vascular and Endovascular Surgery — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion: By combining traditional surgical strategies with a contemporary endovascular approach, the perioperative mortality and long-term risk of infection associated with mycotic thoracic aneurysms can potentially be decreased. (Source: Vascular and Endovascular Surgery)

Listeria monocytogenes: A Rare Cause for an Infected Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery — Thu, 19 Jan 2012 05:00:00 +0100

We describe a case of an infrarenal abdominal aortic aneurysm infected by Listeria monocytogenes. The aneurysm was diagnosed using a contrast-enhanced computed tomography (CT) scan and the infective organism identified within positive blood cultures. The patient underwent a successful urgent open aortic aneurysm repair and completed a 6-week course of antibiotics. (Source: Vascular and Endovascular Surgery)

Mid-term Outcomes following Emergency Endovascular Aortic Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms.

PubMed: Eur J Vasc Endovasc ... — Tue, 17 Jan 2012 05:00:00 +0100

CONCLUSION: EEVAR is associated with excellent mid-term survival in this cohort. We would recommend eEVAR as the management of choice for rAAA in anatomically suitable patients where local facilities and expertise exist. PMID: 22261485 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Hospital Characteristics and Participation in the National Surgical Quality Improvement Program

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:02 +0100

Conclusions: NSQIP participants do not represent the diversity of hospitals performing high-risk general and vascular surgery nationwide. to enable quality improvement efforts in small, rural, and critical access hospitals, which may have high surgical mortality rates and limited resources, other methods of outcome feedback are needed. (Source: Journal of Surgical Research)

An Objective System for Measuring Surgical Complexity in Elderly Patients

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:02 +0100

Conclusions: This pilot study demonstrates that clinical data from ACS NSQIP can be used to assess surgical complexity. the CRS provides a single index value, reflecting both severity and likelihood of adverse outcomes that allows objective comparisons of the surgical risk across procedure groups. the work RVU does not strongly correlate with the CRS. the CRS more strongly correlated to the surgeons' rankings of procedures compared to the work RVU. in the next phase, the CRS will be refined based on surveys from a larger group of surgeons. (Source: Journal of Surgical Research)

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Reliability of Risk-Adjusted Outcomes as Hospital Quality Measures

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:01 +0100

Conclusions: Except for rates of colon resection morbidity, risk-adjusted outcome measures are unreliable as indicators of hospital quality. to improve the reliability of outcome measures, quality measurement programs should increase sample size by collecting one hundred percent of cases for targeted procedures, and use statistical techniques to adjust for reliability. (Source: Journal of Surgical Research)

Racial Disparities in Readmission Rates Among Medicare Beneficiaries Undergoing Aortic Aneurysm Surgery

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:01 +0100

Conclusions: Black patients experience a significantly higher risk-adjusted 30-day readmission rate following AAA repair compared to non-black patients. This disparity was even more pronounced at minority-serving hospitals. (Source: Journal of Surgical Research)

Surgical repair for abdominal aortic aneurysm concomitant with iliac arterial disease using InterGard™ Quadrifurcated

Journal of Artificial Organs — Thu, 12 Jan 2012 16:48:10 +0100

Abstract InterGard™ Quadrifurcated [InterVascular S.A. (MAQUET Cardiovascular), La Ciotat, France], a knitted quadrifurcated prosthetic graft, is useful to simplify the procedures for patients with abdominal aortic aneurysm concomitant with iliac arterial disease. From March 2008 to April 2010, 59 patients underwent abdominal aortic aneurysm repair in our department. InterGard™ Quadrifurcated was used in 22 patients (37.3%). All patients were male with a mean age of 72.1 ± 12.1 years (range from 45 to 90 years). Four were emergency cases. Nineteen patients had common iliac arterial lesions, and 19 patients had internal iliac arterial lesions. In addition to abdominal aortic aneurysm repair, reconstruction of bilateral internal iliac arteries was per...

Systematic approach to ruptured abdominal aortic aneurysm in the endovascular era: Intention-to-treat eEVAR protocol.

The Journal of Cardiovascular Surgery — Wed, 11 Jan 2012 12:55:06 +0100

Authors: Willigendael EM, Cuypers PW, Teijink JA, Van Sambeek MR Abstract Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still a relatively new treatment option. A pre-defined strategy of an eEVAR first approach for rAAA is associated with improved mortality rates. After establishing and implementing the Intention-to-treat eEVAR protocol for rAAAs the mortality and morbidity rates improved significantly. The presented Intention-to-treat eEVAR protocol starts at the first telephone call to the ambulance department and lasts until the post-operative care unit. The protocol involves the close collaboration between the ambulance department, vascular surgeon, emergency department physicians, anaesthesiologists, operating room staff and, ...

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Endovascular treatment of ruptured abdominal aortic aneurysm: is there a long-term benefit at follow-up?

The Journal of Cardiovascular Surgery — Wed, 11 Jan 2012 12:54:57 +0100

CONCLUSION: Our study shows that rEVAR is feasible irrespective of hemodynamic condition and that it is associated with relative low mortality rates. Challenging rAAA anatomy may not affect overall long-term survival, but six out of ten patients remain unsuitable for rEVAR because of inappropriate anatomy. PMID: 22231534 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

Long-term Results of Iliac Aneurysm Repair with Iliac Branched Endograft: A 5-Year Experience on 100 Consecutive Cases☆

PubMed: Eur J Vasc Endovasc ... — Tue, 10 Jan 2012 05:00:00 +0100

CONCLUSIONS: Long-term results show that IBD use can ensure persistent iliac aneurysm exclusion at 5 years, with low risk of reintervention. This technique can be considered as a first endovascular option in patients with extensive iliac aneurysm disease and favourable anatomy. PMID: 22240335 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Surveillance Imaging Modality does not Affect Detection Rate of Asymptomatic Secondary Interventions following EVAR.

PubMed: Eur J Vasc Endovasc ... — Tue, 10 Jan 2012 05:00:00 +0100

CONCLUSIONS: The detection rate of asymptomatic SI following EVAR is not affected by the type of surveillance imaging. A surveillance schedule based primarily on CDU and XR appears to be justified. PMID: 22240330 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Outcomes after Open Surgery and Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm in Patients with Massive Neck Atheroma.

PubMed: Eur J Vasc Endovasc ... — Sat, 07 Jan 2012 05:00:00 +0100

CONCLUSION: Compared to OS patients, EVAR patients with massive neck atheroma tend to develop late-phase complications possibly related to cholesterol crystal embolisation. The clinical features of massive neck atheroma patients receiving EVAR should be carefully monitored even after hospital discharge. PMID: 22230600 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Identification and proteomic profiling of exosomes in human cerebrospinal fluid

Journal of Translational Medicine — Thu, 05 Jan 2012 05:00:00 +0100

Conclusions: Exosomes were identified in human CSF and their proteome is a potential new reservoir for biomarker discovery in neurological disorders such as Alzheimer's disease. However, techniques used to concentrate exosomes from CSF need refinement to reduce variability. In this study we used relatively large starting volumes of human CSF, future studies will focus on exosome isolation from smaller 'real life' clinical samples; a key challenge in the development of exosomes as translational tools. (Source: Journal of Translational Medicine)

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Treatment With Simvastatin Inhibits the Formation of Abdominal Aortic Aneurysms in Rabbits

Annals of Vascular Surgery — Thu, 05 Jan 2012 05:00:00 +0100

Conclusions: Simvastatin may prove clinically significant in suppressing the development and expansion of AAAs and, thereby, in reducing the risk of rupture and the need for repair. (Source: Annals of Vascular Surgery)

Reduction of small infrarenal abdominal aortic aneurysm expansion rate by statins.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: This study confirms the considerable individual variations in the AAA expansion rate, and emphasizes the need for regular aortic diameter assessments. In this study, patients treated with statin demonstrate a significant decrease in the ER compared to controls. This finding need to be evaluated in prospective interventional studies powered to demonstrate the potential benefit of statin treatment. PMID: 22247058 [PubMed - in process] (Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases)

Diverse Presentation of Secondary Aortoenteric Fistulae

Journal of Biomedicine and Biotechnology — Thu, 29 Dec 2011 16:36:22 +0100

Secondary aortoenteric fistula, due to mechanical erosion or infection of a prosthetic graft, is a very rare cause of gastrointestinal bleeding and an uncommon complication of abdominal aortic aneurysm repair. A retrospective chart review conducted at our institution revealed 5 cases of secondary AEF occurring between 2006 and 2010. Presentations were diverse, including hematemesis, coffee-ground emesis, and unexplained sepsis. Delay in diagnosis was common. In reporting these cases, we seek to highlight the diverse clinical spectrum and potentially misleading features of this condition. Clinicians must retain a high index of suspicion to avoid potentially catastrophic outcomes. (Source: Journal of Biomedicine and Biotechnology)

Surgery Volume Predicts AAA Outcomes (CME/CE)

MedPage Today Surgery — Thu, 22 Dec 2011 13:00:00 +0100

(MedPage Today) -- Patients treated by surgeons who perform more open vascular operations of various types have better outcomes following open repair of an abdominal aortic aneurysm, researchers found. (Source: MedPage Today Surgery)

Management of the Proximal Anastomosis in Open, Hybrid Repair of Thoracoabdominal Aortic Aneurysm [CORRESPONDENCE]

The Annals of Thoracic Surgery — Wed, 21 Dec 2011 05:00:00 +0100

(Source: The Annals of Thoracic Surgery)

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Deep Venous Thrombosis After Abdominal Aneurysm Repair

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:58 +0100

The objective of this study was to examine venous thromboembolism (VTE) rates, timing and risk factors after nonruptured open or endoluminal (ELG) Abdominal Aortic Aneurysm repair. (Source: Journal of Vascular Surgery)

Correction

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:58 +0100

In the October 2011 issue of the Journal of Vascular Surgery, the article by Dr Matthew P. Sweet et al (Sweet MP, Fillinger MF, Morrison TM, Abel D. The influence of gender and aortic aneurysm size on eligibility for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2011;54:931-7) listed the affiliations for the authors incorrectly. The correct affiliations are as follows: (Source: Journal of Vascular Surgery)

Novel single-stage operation and inflow source for thoracic aortic aneurysm and limb ischemia.

Texas Heart Institute Journal — Mon, 19 Dec 2011 09:30:03 +0100

Authors: Kawajiri H, Mochizuki Y, Kashima I Abstract Patients with thoracic aortic aneurysms sometimes also have peripheral vascular disease. In such cases, staged operations are usually performed in order to avoid additional morbidity. We have achieved good long-term outcomes in 2 patients with use of a single-stage surgical technique. Our novel procedure uses a pre-sewn side branch with a Dacron graft as the inflow source for the aortofemoral bypass during thoracic aortic aneurysm repair. As of 25 and 52 months' follow-up, these grafts were patent in our 2 patients. We believe that this procedure is a safe and easy single-stage operation that achieves favorable patency. To our knowledge, this is the first report to document the use of a pre-sewn perfusion branch of a Dacron graft...

Is the Incidence of Abdominal Aortic Aneurysm Declining in the 21st Century? Mortality and Hospital Admissions for England & Wales and Scotland

European Journal of Vascular and Endovascular Surgery — Mon, 19 Dec 2011 05:00:00 +0100

Conclusions: These data suggest that the age at which clinically-relevant aneurysms present has increased by 5–10 years and that incidence of clinically-relevant AAA in men in England & Wales and Scotland is declining rapidly. The reasons for this are unclear. (Source: European Journal of Vascular and Endovascular Surgery)

What are the Risk Factors for Renal Failure following Open Elective Abdominal Aortic Aneurysm Repair?

European Journal of Vascular and Endovascular Surgery — Mon, 19 Dec 2011 05:00:00 +0100

The objective of this study was to identify risk factors for renal failure following open elective AAA repair.Design: A retrospective analysis of prospectively collected multi-centre data.Materials: Consecutive data on patients undergoing open elective AAA repair were collected between January 2000 and December 2010. Patients with pre-operative serum creatinine >200 μmol/L were excluded.Methods: Renal failure was reported by clinicians and included all patients requiring post-operative renal-replacement therapy. Univariate and multivariate analyses were used to identify renal failure risk factors. A simplified clinical risk score was developed.Results: Post-operative renal failure occurred in 140 (6.0%) of 2347 patients and was associated with age >75 (OR = 1.58, 95%CI 1.11–2.26), sy...

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Emergency Abdominal Aortic Aneurysm Repair in a Patient with Failing Heart: Axillofemoral Bypass Using a Centrifugal Pump Combined with Levosimendan for Inotropic Support

Clinical and Developmental Immunology — Sun, 18 Dec 2011 23:53:19 +0100

We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA). The patient was known to have coronary artery disease (CAD) with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This p...

Preservation of Hypogastric Artery Blood Flow During Endovascular Aneurysm Repair of an Abdominal Aortic Aneurysm With Bilateral Common and Internal Iliac Artery Involvement: Utilization of Off-the-Shelf Stent-Graft Components

Annals of Vascular Surgery — Fri, 16 Dec 2011 23:24:35 +0100

A 72-year-old male presented with a 7.4-cm abdominal aortic aneurysm with bilateral common and internal iliac involvement. To maintain pelvic perfusion, preservation of the patient’s left hypogastric artery (HA) was pursued. Two weeks after right HA embolization, endovascular repair of the patient’s aneurysms was performed using a branched endograft approach. A 22-mm main body bifurcated endograft was unsheathed and the proximal covered stent was removed. The contralateral gate was preloaded with a wire and catheter. The device was resheathed and placed in the left common iliac artery. The preloaded wire in the contralateral gate was snared from the right side, establishing through-and-through femoral access. A contralateral femoral sheath was advanced up and over the aortic bifurcatio...

Is the Incidence of Abdominal Aortic Aneurysm Declining in the 21st Century? Mortality and Hospital Admissions for England & Wales and Scotland.

PubMed: Eur J Vasc Endovasc ... — Fri, 16 Dec 2011 05:00:00 +0100

CONCLUSIONS: These data suggest that the age at which clinically-relevant aneurysms present has increased by 5-10 years and that incidence of clinically-relevant AAA in men in England & Wales and Scotland is declining rapidly. The reasons for this are unclear. PMID: 22178251 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

What are the Risk Factors for Renal Failure following Open Elective Abdominal Aortic Aneurysm Repair?

PubMed: Eur J Vasc Endovasc ... — Fri, 16 Dec 2011 05:00:00 +0100

CONCLUSIONS: Renal failure following open elective AAA repair was associated with an increased risk of mortality. Risk factors for post-operative renal failure were identified and a simple clinical risk score developed to facilitate focussed care strategies for high-risk patients. PMID: 22178250 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Contralateral Iliac Occlusion can be Successfully Achieved Using an Amplatz Vascular Plug During Aorto-uni-iliac Endovascular Aneurysm Repair

EJVES Extra — Thu, 15 Dec 2011 05:00:00 +0100

Discussion: Access limitations are a consideration for both device deployment and contralateral occlusion whilst undertaking aorto-uni-iliac endovascular aneurysm repair. This paper describes a simple and effective method for achieving iliac occlusion when access vessels are stenosed. (Source: EJVES Extra)

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Plasma Levels of Matrix Metalloproteinase-9: A Possible Diagnostic Marker of Successful Endovascular Aneurysm Repair.

PubMed: Eur J Vasc Endovasc ... — Tue, 13 Dec 2011 05:00:00 +0100

CONCLUSIONS: Plasma MMP-9 levels appear to discriminate between patients with and without an endoleak with high sensitivity and specificity. PMID: 22172237 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Treatment of Delayed Neurological Deficits after Surgical Repair of Thoracic Aortic Aneurysm.

Annals of Thoracic and Cardiovascular Surgery — Fri, 09 Dec 2011 05:00:00 +0100

We describe one patient (Case 1), in whom descending thoracic and abdominal aortic aneurysms were treated by endovascular aortic repair, and another (Case 2) with Crawford type II TAAA, who developed delayed neurological deficits that were treated with immediate COPS therapy (Modified Tarlov scale; Case1, improved from 2 to 4; Case 2, from 0 to 4). These findings indicate the benefit of COPS for treating delayed neurological deficits after descending thoracic and TAAA. PMID: 22156278 [PubMed - as supplied by publisher] (Source: Annals of Thoracic and Cardiovascular Surgery)

Hypothermic renal perfusion during aortic surgery reduces the presence of lipocalin-2 and preserves renal extraction of dimethylarginines in rats

AJP: Renal Physiology — Fri, 02 Dec 2011 05:00:00 +0100

Cold perfusion through the renal arteries during renal ischemia has been suggested to diminish postoperative renal damage after juxtarenal aortic aneurysm repair. As the kidneys play a key role in dimethylarginine metabolism, which in turn is associated with renal hemodynamics, we hypothesized that the protective effect of cold perfusion is associated with a preserved renal extraction of dimethylarginines. Renal ischemia was induced in three groups of anesthetized Wistar rats (n = 7/group), which underwent suprarenal aortic clamping (45 min) with no perfusion (group 1), renal perfusion with 37°C saline (group 2), or renal perfusion with 4°C saline (group 3), respectively, followed by 90 min of renal reperfusion in all groups. The sham group had no clamping. In group 3 (renal ischem...

Long-term single institution comparison of endovascular aneurysm repair and open aortic aneurysm repair

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: EVAR requires more late secondary vascular interventions than open AAA repair, but patients who undergo open repair have more nonvascular long-term morbidity. Long-term survival is better after EVAR compared to open repair in this selected patient group. (Source: Journal of Vascular Surgery)

Comparative Predictors of Mortality for Endovascular and Open Repair of Ruptured Infrarenal Abdominal Aortic Aneurysms

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Mortality rates for EVAR treatment and open treatment of ruptured aortic aneurysm are equal with regard to 30 day and long term mortality. Many patients with ruptured abdominal aortic aneurysm (rAAA) die before reaching surgery (Acosta S. J Vasc Surg 2006;44:237-43). In-hospital mortality rates range between 30 and 70%. A large meta analysis found an overall 48% mortality (Brown MJ Br J Surg 2002;89:714-30). EVAR for rAAA was first described in 1994 (Marin ML et al. Ann Surg 1995;222:449-65) and is gaining in popularity. The authors sought to evaluate their results of treatment of rAAA with a particular focus in comparing endovascular repair of rAAA versus open surgery repair. Between January of 1990 and May of 2008 there were 160 patients who underwent repair of rAAA. Twenty percent (n =...

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Single-centre Prospective Comparison Between Contrast-Enhanced Ultrasound and Computed Tomography Angiography after EVAR

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

To evaluate contrast-enhanced ultrasound (CEUS) as an effective alternative to CT-angiography (CTA) for endoleak detection and aneurismal sac diameter measurement in the follow-up after endovascular abdominal aortic aneurysm repair (EVAR). (Source: Journal of Vascular Surgery)

Novel Endovascular Approach to an Aortocaval Fistula Complicating a Ruptured AAA

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

We report a novel method of endovascular repair of a AAA rupture into the inferior vena cava. (Source: Journal of Vascular Surgery)

Preoperative Prediction of One-Year Mortality After Thoracic Endovascular Aortic Aneurysm Repair (TEVAR)

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Thoracic endovascular aortic aneurysm repair (TEVAR) is known to have a mortality benefit over open repair in thoracic aneurysm patients, and has become a mainstay of therapy. Because death before 1 year after TEVAR likely indicates an ineffective therapy, we have created a predictive model for 1-year mortality after elective TEVAR for aneurysm using preoperatively available risk factors. (Source: Journal of Vascular Surgery)

Survival Comparison of Patients Undergoing Secondary Aortic Repair

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Infrarenal abdominal aortic aneurysm (AAA) repair requires lifelong surveillance due to continued disease. The outcome of a second aortic intervention may further be affected by therapeutic approach. In the current study, we evaluated outcomes in patients who underwent secondary aortic procedures after initial aortic repair, either EVAR or open. (Source: Journal of Vascular Surgery)

Aortoduodenal Fistula After Endograft Repair of Abdominal Aortic Aneurysm Secondary to a Retained Guidewire

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

This report describes a unique complication of aortoduodenal fistula secondary to duodenal perforation by previously placed embolic material. (Source: Journal of Vascular Surgery)

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Regarding “Evaluation of the Endurant stent graft under instructions for use vs off label conditions for endovascular aortic aneurysm repair”

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

We read the article by Torsello et al with interest. While the use of endovascular aneurysm repair (EVAR) has revolutionized the management of infrarenal abdominal aortic aneurysm (AAA) its use has only been shown feasible in 40% to 60% of AAA. Advances in technology, imaging, graft design, and operator experience has lead to an extension of their use beyond initial manufacturer's guidelines. The device studied in this article is licensed to a 10-mm neck extending or rather shortening the previous benchmark of 15 mm. Nevertheless, the ability to place the graft at operation outside this use is shown to be associated with increased type I endoleak. Numbers did not reach significance as the primary endpoint frequency was low and study group small. (Source: Journal of Vascular Surgery)

Regarding “Repairing immediate proximal endoleaks during abdominal aortic aneurysm repair”

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Rajani et al retrospectively reviewed data of 72 infrarenal abdominal aortic aneurysm (AAA) patients with an intraoperatively diagnosed type Ia endoleak requiring a Palmaz stent or covered stent graft cuff placement. They concluded that both methods appear to be durable long-term options to facilitate endovascular exclusion of AAA, with the results that no recurrent type Ia endoleak developed in the Palmaz stent group and three reinterventions were required in the cuff group. Given the lack of data assessing long-term outcomes of cuff and Palmaz (Cordis, Miami Lakes, Fla) stent placement after immediate type Ia endoleak, we would like to provide our single-center results and support their conclusions. (Source: Journal of Vascular Surgery)

Coronary Malperfusion due to Flap Suffocation after Acute Type A Dissection Surgery.

Annals of Thoracic and Cardiovascular Surgery — Wed, 30 Nov 2011 05:00:00 +0100

Authors: Isoda S, Osako M, Kimura T, Mashiko Y, Yamanaka N, Nakamura S, Maehara T Abstract A 24-year-old man presented with chest pain. He was diagnosed as having a type A acute aortic dissection and an annulo-aortic aneurysm. After emergency surgery for an aortic root replacement, his electrocardiogram showed ST-segment depression and T-wave inversion. Echocardiography showed asynergy of the left ventricle without coronary ostial pathology. Heart catheterization revealed no coronary stenosis, but the true lumen of the residual ascending aorta had extreme diastolic narrowing due to flap suffocation. This resulted in coronary malperfusion. The pullback pressure curve confirmed the mechanism. The patient underwent a surgical re-intervention for a total arch repair, which diminished t...

Cardiovascular predictors for long-term mortality after EVAR for AAA

Vascular Medicine recent issues — Tue, 29 Nov 2011 05:00:00 +0100

In conclusion, ischemia on ECG and anemia were independently related to an increased long-term mortality rate after EVAR, and these predictive factors seem to be most important for critical assessment in the preoperative medical work-up. (Source: Vascular Medicine recent issues)

Use of a bifurcated endovascular graft for treatment of endograft migration with major endoleak.

Vascular — Tue, 29 Nov 2011 05:00:00 +0100

In conclusion, treatment with a bifurcated Zenith endograft has advantages over the use of an aortic cuff or aortouniiliac reconstruction. To perform this technique, there must be a sufficient distance between the proximal landing zone and the flow divider of the migrated endograft to allow for deployment of the Zenith device. While there remain limitations in its applicability, the use of a bifurcated endovascular graft is a viable alternative for endovascular salvage in treatment of endograft migration with major endoleaks. PMID: 22126799 [PubMed - as supplied by publisher] (Source: Vascular)

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E-VITA Jotec Open Hybrid Stent Graft System in Use of the Treatment of Complex Aortic Aneurysm and Dissection—A 3 Year Experience

Heart, Lung and Circulation — Fri, 25 Nov 2011 02:38:01 +0100

Introduction: The management of complex aortic aneurysms and dissections involving both the aortic arch and descending aorta are difficult operations fraught with significant risks of mortality and morbidity . The advent of hybrid systems such as the E-VITA Jotec open hybrid stent graft system has seen the addition of an important weapon in the armamentarium of the cardiothoracic surgeon with the advantage of single stage repair and follow-up repair of any remaining downstream aneurysm and dissection being easier to treat. (Source: Heart, Lung and Circulation)

System That Fixes Failed Or Problematic Aortic Endograft Approved By FDA

Health News from Medical News Today — Wed, 23 Nov 2011 17:00:00 +0100

The first system able to repair a failed or problematic aortic endograft, called the Aptus EndoStapling System, which consists of a fabric tube used for repairing dangerously large aortic aneurysm has been approved for marketing by the U.S. Food and Drug Administration. The FDA's approval means that surgeons are provided with a minimal-invasive alternative for repairing aortic endografts (endovascular grafts) that are incorrectly positioned. An aortic aneurysm is a general term for any swelling of the aorta, which over time, can weaken and result in a life-threatening rupture... (Source: Health News from Medical News Today)

The Elephant Trunk Procedure for Aortic Aneurysm Repair: An Illustrated Guide to Surgical Technique With CT Correlation

American Journal of Roentgenology — Tue, 22 Nov 2011 05:00:00 +0100

CONCLUSION. This article explains the rationale behind a staged thoracic aortic surgery, describes and illustrates the surgical technique used to perform the elephant trunk procedure and the normal postoperative imaging appearance, and discusses potential complications specific to the elephant trunk procedure. (Source: American Journal of Roentgenology)

Impact of Quantitatively Determined Native Thoracic Aortic Tortuosity on Endoleak Development After Thoracic Endovascular Aortic Repair

American Journal of Roentgenology — Tue, 22 Nov 2011 05:00:00 +0100

CONCLUSION. Quantification of aortic tortuosity using CT angiograms may help to predict whether an endoleak will develop after thoracic endovascular aortic repair, and this quantification method may become an important tool for risk stratification before thoracic endovascular aortic repair. (Source: American Journal of Roentgenology)

Aptus Endosystems, Inc. Receives U.S. FDA Clearance For EndoStapling System

HSMN NewsFeed — Tue, 22 Nov 2011 01:43:28 +0100

Breakthrough Aortic Aneurysm Repair Technology Approved for use with Market-Leading Endografts SUNNYVALE, Calif.--(Healthcare Sales & Marketing Network)-- Aptus Endosystems, Inc., a medical device company developing advanced technology for endovascular ... Devices, Interventional, FDAAptus Endosystems, Aptus EndoStapling System, HeliFX, Aortic Securement System (Source: HSMN NewsFeed)

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FDA permits marketing of a system to repair failed, problematic fix for aortic aneurysms

Food and Drug Administration — Mon, 21 Nov 2011 21:37:00 +0100

The U.S. Food and Drug Administration today allowed marketing of the first system that can repair a failed or problematic aortic endograft, a fabric tube used to repair a dangerously large aortic aneurysm, a bulge in the large blood vessel that carries blood away from the heart. (Source: Food and Drug Administration)

FDA Permits Marketing Of A System To Repair Failed, Problematic Fix For Aortic Aneurysms

Medical Design Online News — Mon, 21 Nov 2011 05:18:00 +0100

The U.S. Food and Drug Administration recently allowed marketing of the first system that can repair a failed or problematic aortic endograft, a fabric tube used to repair a dangerously large aortic aneurysm, a bulge in the large blood vessel that carries blood away from the heart. (Source: Medical Design Online News)

A case report and review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting

Journal of Cardiothoracic Surgery — Mon, 21 Nov 2011 05:00:00 +0100

Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass); general surgery; urology; gynaecology; liposuction; and liver transplantation. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone), alteration of venous drainage of the retina, hypertension, sm...

Single Stage Repair of a Complex Pathology: End Stage Ischaemic Cardiomyopathy, Ascending Aortic Aneurysm and Thoracic Coarctation

Journal of Cardiothoracic Surgery — Sun, 20 Nov 2011 05:00:00 +0100

The not uncommon combination of ascending aortic pathology with late presenting coarctation is a difficult surgical challenge. The two stage approach is usually adopted. The necessity for cardiac transplantation adds to the complexity: a trans-sternal approach and single stage repair become mandatory. (Source: Journal of Cardiothoracic Surgery)

Plasmatic vasopressin in patients undergoing conventional infra-renal abdominal aorta aneurysm repair

Revista Brasileira de Cirurgia Cardiovascular — Fri, 18 Nov 2011 11:23:26 +0100

Stent strut penetration during thoracic endovascular aortic repair: report of a case

Surgery Today — Fri, 18 Nov 2011 06:53:55 +0100

Abstract We experienced a serious complication of proximal stent strut penetration (PSSP) during thoracic endovascular aortic repair in a 74-year-old man who underwent two-stage hybrid treatment for a distal arch thoracic aortic aneurysm. First, a debranching right common carotid–left common carotid–left subclavian artery bypass was performed. Second, a TALENT Thoracic Stent Graft (Medtronic, Tokyo, Japan) was inserted at Zone 1 (Ishimaru). At deployment, a proximal bare strut accidentally everted and penetrated the aortic wall vertically. Postoperative computed tomography revealed that one crown of the proximal strut had penetrated the aortic wall vertically and had produced an intramural hematoma around the strut. The patient was observed carefully and discharged fro...

Aortic-neck dilation after endovascular abdominal aortic aneurysm repair (EVAR): can it be predicted?

La Radiologia Medica — Fri, 18 Nov 2011 06:53:20 +0100

Conclusions Dynamic CT provided insight into the abdominal aorta pathophysiology. Identifying patients with higher infrarenal distensibility could change selection of graft size to improve proximal fixation. Content Type Journal ArticleCategory Vascular and Interventional Radiology / Radiologia Vascolare e InterventisticaPages 1-11DOI 10.1007/s11547-011-0750-1Authors R. Iezzi, Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168 Rome, ItalyM. Santoro, Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital, Catholic University, L.go A. Gemelli 8, 00168 Rome, ItalyG. Di Natale, Department of Bioimaging and Radiological Sciences,...

Cost disparity between open repair and endovascular aneurysm repair for abdominal aortic aneurysm: a single-institute experience in Japan

Surgery Today — Wed, 09 Nov 2011 17:45:26 +0100

Conclusions New technologies should not only be clinically effective, but also cost effective. EVAR is less invasive clinically, but the cost of endovascular prostheses and other materials remains high. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00595-011-0041-4Authors Hirofumi Morimae, Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, JapanTakashi Maekawa, Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8560, JapanHiroaki Tamai, Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-c...

Evolution of the upper and lower landing site after endovascular aortic aneurysm repair

Journal of Vascular Surgery — Mon, 07 Nov 2011 05:00:00 +0100

Conclusions: Our results show a trend toward dilatation of the aortic neck and iliac arteries, with no correlation between the two levels, even in patients with a regression of the aneurysm sac during follow-up. Although this study found no correlation with the occurrence of endoleaks, our results suggest the need for a longer follow-up, especially on the landing sites. (Source: Journal of Vascular Surgery)

Endovascular abdominal aortic aneurysm repair: methods of radiological risk reduction.

The Journal of Cardiovascular Surgery — Sun, 06 Nov 2011 18:52:25 +0100

CONCLUSION: The optimum strategy, including equipment-related factors, procedure-conduct factors and follow-up procedures, has to be studied, justified and optimized in each medical facility. PMID: 22051986 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

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FDA Approves System To Repair Abdominal Aneurysms In People With Small Arteries

Health News from Medical News Today — Fri, 04 Nov 2011 10:00:00 +0100

The U.S. Food and Drug Administration has approved a stent graft system that provides patients with small arteries the option of less invasive surgery to repair their potentially life-threatening abdominal aortic aneurysm. An abdominal aortic aneurysm is a bulge in the part of the aorta that runs through the abdomen and divides into the arteries that supply blood to each leg. Over time, this bulge can become weak, and the force of normal blood pressure can cause it to rupture, which can be life-threatening... (Source: Health News from Medical News Today)

Open repair of ruptured abdominal aortic aneurysm in patients aged 80 years and older.

The British Journal of Surgery — Fri, 04 Nov 2011 05:47:26 +0100

CONCLUSION: Survival after open repair of RAAA among patients aged 80 years and older is sufficient to justify the procedure, particularly in patients in a stable haemodynamic condition. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 22034180 [PubMed - in process] (Source: The British Journal of Surgery)

Preoperative Spirometry Results as a Determinant for Long-term Mortality after EVAR for AAA

European Journal of Vascular and Endovascular Surgery — Thu, 03 Nov 2011 04:00:00 +0100

Abstract: Objectives: The aim of this study was to analyse lung function test determinants for long-term mortality after standard endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA).Design: Retrospective analysis.Materials: Three-hundred and four consecutive patients treated electively with EVAR (Zenith® stent grafts, Cook) between May 1998 and February 2006 were prospectively enrolled in a computerised database.Methods: The Global Initiative for Chronic Obstructive Lung Diseases (GOLD) guideline was used to grade the severity of obstructive lung disease. Mortality was checked until 1 December 2010. Median follow-up time was 68 (interquartile range (IQR) 40–94) months.Results: The percentage of patients with mild, moderate or severe (grade 3) chronic obstr...

The feasibility of endovascular aortic repair strategy in treating infected aortic aneurysms

Journal of Vascular Surgery — Thu, 03 Nov 2011 04:00:00 +0100

Conclusions: This small multi-institutional study summarizing the experiences of patients with an infected aortic aneurysm managed by EVAR and an aggressive antibiotic strategy revealed that this EVAR strategy might be a suitable approach to treating this disease. These favorable results may be typical for Salmonella infection, which was present in most of the patients. Further experience is needed to assess whether this therapeutic strategy works equally well in aneurysm infection caused by other organisms. (Source: Journal of Vascular Surgery)

Long-term incidence of myocardial infarct, stroke, and mortality in patients operated on for abdominal aortic aneurysms

Journal of Vascular Surgery — Thu, 03 Nov 2011 04:00:00 +0100

Conclusion: AAA patients of both sexes have a high risk of atherosclerotic events (MI, stroke) and death, so lifelong prophylaxis must be considered from our epidemiologic data. Randomized trials investigating the potential benefit of aspirin and statin therapy in AAA patients are needed. (Source: Journal of Vascular Surgery)

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FDA approves system to repair abdominal aneurysms in people with small arteries

Food and Drug Administration — Wed, 02 Nov 2011 16:59:00 +0100

Preoperative Spirometry Results as a Determinant for Long-term Mortality after EVAR for AAA.

PubMed: Eur J Vasc Endovasc ... — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSIONS: Our findings strengthen the need for formal evaluation of lung function with spirometry prior to proceeding to AAA repair. PMID: 22051733 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Less Invasive Anesthetic Methods Better For Endovascular Aneurysm Repair

Health News from Medical News Today — Mon, 31 Oct 2011 07:00:00 +0100

Researchers have identified a safer, more cost effective way to provide anesthesia for patients undergoing endovascular repair of an abdominal aortic aneurysm - a common, often asymptomatic condition that, if not found and treated, can be deadly. A new study done by investigators at Wake Forest Baptist Medical Center found that using less invasive spinal, epidural and local/monitored anesthesia care (MAC) is better than general anesthesia for elective endovascular repair of infrarenal abdominal aortic aneurysms (EVAR)... (Source: Health News from Medical News Today)

Aneurysm Diameter Measurement: A Challenging and Frustrating Task

European Journal of Vascular and Endovascular Surgery — Mon, 31 Oct 2011 04:00:00 +0100

Diameter is the stronger predictor of abdominal aortic aneurysm (AAA) rupture and related death. In the past decades, the expansion of screening and of surveillance programmes for AAA detection and management as well as the remarkable evolution in imaging technology, especially after the introduction of endovascular aneurysm repair (EVAR), has notably increased our training in measuring an AAA. Nevertheless, it is challenging and frustrating to see that we still do not know how to calculate reliably an aneurysm diameter and the related risk of rupture. This is a worrying awareness for the effectiveness and safety of surveillance and screening management of AAA. (Source: European Journal of Vascular and Endovascular Surgery)

Secondary Procedures After Infrarenal Abdominal Aortic Aneurysms Endovascular Repair With Second-Generation Endografts

Annals of Vascular Surgery — Mon, 31 Oct 2011 04:00:00 +0100

Conclusions: In patients treated for AAA with second generation stentgrafts, in the long term, secondary procedure rate was 19.7%. Survival rate for patients who underwent a secondary procedure was better, which was probably related to the fact that they were younger at the time of stentgraft implantation. Large AAA diameter was a secondary-procedure risk factor. (Source: Annals of Vascular Surgery)

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Postoperative complications of surgically treated ascending aortic dissection

Revista Brasileira de Terapia Intensiva — Thu, 27 Oct 2011 19:24:27 +0100

CONCLUSION: Ascending aortic dissection correction is associated with an increased incidence of postoperative complications and an increased hospital length of stay, but 1 and 6-month mortality is similar to that of paired-matched coronary artery bypass graft surgery patients. (Source: Revista Brasileira de Terapia Intensiva)

The Role of Cell Salvage Autotransfusion in Abdominal Aortic Aneurysm Surgery

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Abdominal aortic aneurysm (AAA) repairs, both elective and rupture, are associated with significant blood loss often requiring transfusion. Cell-salvage autotransfusion has been developed to reduce the need for allogeneic blood. We review the literature to delineate the role of cell salvage in reducing allogeneic blood use in open AAA repairs. (Source: Journal of Vascular Surgery)

Elective Endovascular vs. Open Repair for Abdominal Aortic Aneurysm in Patients Aged 80 Years and Older: Systematic Review and Meta-Analysis

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Endovascular treatment (EVAR) of abdominal aortic aneurysm (AAA) is thought to be of benefit, particularly in patients aged ≥80 years. This issue was investigated in the present meta-analysis. (Source: Journal of Vascular Surgery)

Endovascular Repair of Abdominal Aortic Aneurysm Does Not Improve Survival versus Open Repair in Patients Sixty Years or Younger

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Objectives: Multiple randomized trials have demonstrated lower postoperative morbidity and mortality after endovascular repair (EVAR) compared to open repair (OAR) for infrarenal abdominal aortic aneurysms (AAA). This advantage for EVAR has, however, been mostly in relatively older patients with no study specifically comparing EVAR and OAR for patients 60 years or younger. (Source: Journal of Vascular Surgery)

Long-Term Persistent Type 2 Endoleak Following Endovascular Abdominal Aortic Aneurysm

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Objective: Management of type 2 endoleak (T2E) following endovascular abdominal aortic aneurysm repair (EVAR) has evolved over the last decade to observation and selective intervention. The aim of this study was to evaluate long-term outcomes in patients with T2E. (Source: Journal of Vascular Surgery)

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Endovascular Aortic Aneurysm Repair with Carbon Dioxide Guided Angiography in Patients With Renal Insufficiency

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

We examined the use of carbon dioxide (CO2) as a non-nephrotoxic contrast agent for EVAR. (Source: Journal of Vascular Surgery)

Stent Graft Repair of Para-Anastomotic Aneurysms Following Open Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

We report on our experience with endovascular treatment of these lesions. (Source: Journal of Vascular Surgery)

Angiosarcoma Involving Native Abdominal Aortic Aneurysm Sac Following Endograft Repair

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Objectives: Angiosarcoma (AS) is a rapidly proliferating epithelioid tumor with high propensity for local recurrence and widespread metastases. This pathology presents challenges from the standpoints of diagnosis and treatment. (Source: Journal of Vascular Surgery)

Regarding “Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysm”

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

The article by Kirkwood et al, “Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysm,” raises a pertinent question. I believe there are two methodological issues that may affect the study's validity. (Source: Journal of Vascular Surgery)

Regarding “Effect of gender on long-term survival after abdominal aortic aneurysm repair based on results from the Medicare national database”

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Egorova et al compared long-term survival of propensity score-matched cohorts of endovascular (EVAR) and open aneurysm repair (OAR) for abdominal aortic aneurysm (AAA) from the Medicare Beneficiary Database. The survival benefit of EVAR for elective AAA was sustained for the 6-year follow-up in both men (hazafor the 6-year followrd ratio [HR], 0.96; 95% confidence interval [CI], 0.93-0.99; P = .0049) and women (HR, 0.88; 95% CI, 0.83-0.93; P < .0001). In a recent meta-analysis by Lovegrove et al of three randomized controlled trials (RCTs) and eight observational comparative studies, however, EVAR for elective AAA was not associated with a reduction in long-term all-cause mortality (HR, 0.94; 95% CI, 0.79-1.13; P = .52). The authors extracted unadjusted HRs from crude Kaplan-Meier survival...

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Reply

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

We would like to thank Dr Takagi for his interest in our publication. His meta-analysis is both thoughtful and raises some methodological and substantive issues. Meta-analyses of published data present a number of challenges that are amplified in the current case. In particular, studies to be collated may have differing length of follow-up, or that the time span being covered by these studies may capture the technical evolution of the intervention or a learning curve of its performance. Thus, greater selectivity of studies or the introduction of a weighting scheme that discounts the weight of older studies when collating studies that span a significant time horizon are important considerations. Another concern in the selection of studies is whether different publications report the results...

Thoracic Endovascular Aortic Repair for Treatment of Late Complications After Aortic Coarctation Repair

Annals of Vascular Surgery — Thu, 27 Oct 2011 11:40:48 +0100

Conclusions: TEVAR is appealing for patients with late complications after aortic coarctation repair, but necessitates long-term follow-up. (Source: Annals of Vascular Surgery)

Assessment of Abdominal Aortic Aneurysm Wall Distensibility With Electrocardiography-Gated Computed Tomography

Annals of Vascular Surgery — Thu, 27 Oct 2011 11:40:48 +0100

Conclusion: In our opinion, electrocardiography-synchronized computed tomographic angiography may contribute to diagnostics in the future. Lumen distensibility is significantly higher than distensibility of the wall. The thrombus acts in this respect as a buffer, thus inhibiting the effect of pulse waves on the wall. From a mechanical point of view, the thrombus rather acts protectively against the risk of rupture. Distensibility assessment could be another fragment of the diagnostic algorithm and decision making on intervention. (Source: Annals of Vascular Surgery)

Less invasive anesthetic methods better for endovascular aneurysm repair

EurekAlert! - Medicine and Health — Thu, 27 Oct 2011 04:00:00 +0100

(Wake Forest Baptist Medical Center) Researchers have identified a safer, more cost effective way to provide anesthesia for patients undergoing endovascular repair of an abdominal aortic aneurysm -- a common, often asymptomatic condition that, if not found and treated, can be deadly. (Source: EurekAlert! - Medicine and Health)

Use of an aortic bifurcation-sparing endograft facilitates hypogastric preservation during aortoiliac aneurysm repair.

Vascular — Wed, 26 Oct 2011 04:00:00 +0100

In conclusion, until commercially-produced branched hypogastric endografts are widely available, techniques such as those described above can allow for hypogastric preservation during aortoiliac aneurysm repair without the need for device modification or brachial access for hypogastric limb delivery. PMID: 22030355 [PubMed - as supplied by publisher] (Source: Vascular)

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Techniques in Endovascular Aneurysm Repair

Clinical and Developmental Immunology — Wed, 26 Oct 2011 00:06:55 +0100

Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies. (Source: Clinical and Developmental Immunology)

Case Scenario: Anesthetic Considerations for Thoracoabdominal Aortic Aneurysm Repair

Anesthesiology — Tue, 25 Oct 2011 20:52:13 +0100

No abstract available (Source: Anesthesiology)

Response to Comment on "Intraabdominal Hypertension and Abdominal Compartment Syndrome after Endovascular Repair of Ruptured Abdominal Aortic Aneurysm"

PubMed: Eur J Vasc Endovasc ... — Tue, 25 Oct 2011 04:00:00 +0100

Response to Comment on "Intraabdominal Hypertension and Abdominal Compartment Syndrome after Endovascular Repair of Ruptured Abdominal Aortic Aneurysm" Eur J Vasc Endovasc Surg. 2011 Oct 25; Authors: Björck M, Djavani Gidlund K, Wanhainen A PMID: 22032968 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Postoperative Pulmonary Function After Open Abdominal Aortic Aneurysm Repair in Patients With Chronic Obstructive Pulmonary Disease: Epidural Versus Intravenous Analgesia

Annals of Vascular Surgery — Mon, 24 Oct 2011 04:00:00 +0100

Conclusions: Epidural anesthesia and postoperative epidural analgesia improve the postoperative respiratory function, compared with general anesthesia and systemic analgesia, and reduce postoperative pain as well, in COPD patients undergoing elective infrarenal abdominal aortic aneurysm repair. (Source: Annals of Vascular Surgery)

Direct relationship between cell density and FDG uptake in asymptomatic aortic aneurysm close to surgical threshold: an in vivo and in vitro study

European Journal of Nuclear Medicine and Molecular Imaging — Thu, 20 Oct 2011 05:56:37 +0100

Conclusion The loss of tissue structure and the marked decrease in cell density account for the low prevalence of positive findings at FDG PET imaging, at least in asymptomatic patients bearing AAAs whose diameter is close to surgical indication. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s00259-011-1955-1Authors Cecilia Marini, CNR Institute of Bioimaging and Molecular Physiology, Milan, Genoa Section, Genoa, ItalySilvia Morbelli, Department Internal Medicine, Chair of Nuclear Medicine, University of Genoa, Genoa, ItalyRiccardo Armonino, Department Internal Medicine, Chair of Nuclear Medicine, University of Genoa, Genoa, ItalyGiovanni Spinella, Division of Vascular and Endovascular Surgery, San Martino University Hospital, University ...

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Multicentre study of the quality of a large administrative data set and implications for comparing death rates

British Journal of Surgery — Thu, 13 Oct 2011 04:00:00 +0100

Conclusion:This study confirmed that HES data can be used effectively to compare mortality between hospitals. Administrative data will be used increasingly for assessing performance and clinicians should accept responsibility to improve coding. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. (Source: British Journal of Surgery)

Risk factors for the development of persistent type II endoleaks after endovascular repair of infrarenal abdominal aortic aneurysms.

Diagnostic and Interventional Radiology — Tue, 11 Oct 2011 04:00:00 +0100

CONCLUSION: Anatomic characteristics of a preoperative aorta can be used to predict patients with higher risk for persistent type II endoleak development. PMID: 21986961 [PubMed - as supplied by publisher] (Source: Diagnostic and Interventional Radiology)

New Emergency Treatment For Burst Aortic Aneurysm

Health News from Medical News Today — Sat, 08 Oct 2011 07:00:00 +0100

Jack Kory of Mokena, Il. was eating his breakfast oatmeal when he suddenly felt the worst pain in his life. The searing pain came on suddenly in his stomach and spread to his knees. It was caused by an abdominal aortic aneurysm (AAA) that had suddenly burst, causing massive internal bleeding. Traditionally, few patients have survived such ruptures. But Loyola University Medical Center vascular surgeon Dr. Richard Hershberger was able to repair Kory's aneurysm with a minimally invasive emergency procedure. "I'm very happy with how it worked out," Kory said... (Source: Health News from Medical News Today)

Obesity is not an Independent Risk Factor for Adverse Perioperative and Long-Term Clinical Outcomes Following Open AAA Repair or EVAR

Vascular and Endovascular Surgery — Fri, 07 Oct 2011 04:00:00 +0100

Conclusions: The results of this study indicate that moderate and morbid obesity are not independently associated with adverse perioperative and long-term clinical outcomes for patients undergoing open AAA repair or EVAR. Therefore, either open AAA repair or EVAR can be accomplished safely in moderately obese and morbidly obese patients. (Source: Vascular and Endovascular Surgery)

Elective endovascular repair of abdominal aortic aneurysm at 10 years: Is the initial aneurysm diameter a valid tool to predict outcome?

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Aims: To assess the validity of the preoperative maximum abdominal aortic aneurysm (AAA) diameter as a predictive tool for long-term complications after Endovascular Aneurysm Repair (EVAR). (Source: International Journal of Surgery)

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Contrast enhanced aortic duplex ultrasonography scanning (CEADUSS) – A laboratory model phantom to compare and determine the limitations of enhanced and unenhanced ultrasonography scanning for post-operative surveillance of endovascular abdominal aortic aneurysm repair (EVAR)

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Objectives: To detect the subgroup of patients whom may require post-EVAR intervention, currently all patients undergoing endovascular treatments enter a programme of surveillance, usually with regular CT scan follow-up. (Source: International Journal of Surgery)

The feasibility and early results of fenestrated endografting for juxtarenal abdominal aortic aneurysms

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Aims: To assess the early results following fenestrated endovascular aneurysm repair (F-EVAR) for juxtarenal abdominal aortic aneurysm from a single centre. Methods: Data were collected prospectively and analysed retrospectively for consecutive patients undergoing F-EVAR from September 2007-August 2010. All patients were unsuitable for conventional endovascular repair. (Source: International Journal of Surgery)

How close are we to achieving the quality improvement framework (QIF) for abdominal aortic aneurysm (AAA) repair: A temporal progression

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Aims: The aim of this work was to assess AAA patient management compared to the QIF guidelines and review our patient's outcomes. Methods: We sampled 103 elective AAA notes, undergoing open repair between April 1999-July 2010. Demographic, pre operative workup and outcome details were recorded. The median AAA size was 6.5cm (range 3.7-12). There were 82 males (median age 74, range: 46-83 years) and 21 females (median age 75 range: 61-84 years). (Source: International Journal of Surgery)

Correlation analysis of stair climbing test, anaerobic threshold in cardiopulmonary exercise testing & length of hospital stay in patients undergoing repair of abdominal aortic aneurysm (AAA)

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

This study analyses the correlation amongst stair climbing test, anaerobic threshold (AT) in cardiopulmonary exercise testing (CPET) & length of hospital stay in patients undergoing Abdominal Aortic Aneurysm (AAA) repair. (Source: International Journal of Surgery)

Role of pre-operative cardiopulmonary exercise testing in evaluation of outcomes in patients undergoing repair of abdominal aortic aneurysm

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Background: Pre operative risk assessment is important in patients undergoing repair of Abdominal Aortic Aneurysm (AAA). The aim of this study was to assess the role of Anaerobic Threshold (AT) in cardiopulmonary exercise testing (CPET) as an independent predictor of outcomes in patients undergoing repair of AAA. (Source: International Journal of Surgery)

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A case control study of identification of risk factors affecting peri-operative mortality in patients undergoing open repair of abdominal aortic aneurysm

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Introduction: Pre operative risk assessment is important in patients undergoing major vascular surgery. The aim of this study was to identify factors influencing 30 day mortality in patients undergoing Abdominal Aortic Aneurysm (AAA) repair. (Source: International Journal of Surgery)

Changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair

Journal of Vascular Surgery — Wed, 05 Oct 2011 04:00:00 +0100

Conclusions: The prothrombotic, hypofibrinolytic diathesis associated with AAA is normalized 12 months after EVAR. This beneficial systemic effect of EVAR for AAA disease may help protect patients against future thromboembolic cardiovascular events. (Source: Journal of Vascular Surgery)

Mid-term results of endovascular abdominal aortic aneurysm repair: Is it possible to predict sac shrinkage?

Surgery Today — Tue, 04 Oct 2011 05:59:14 +0100

Conclusions The mid-term results of endovascular aneurysm repair were satisfactory. Although it was difficult to predict the fate of a sac after stent grafting, persistent type-2 endoleaks were observed to have a slightly negative impact on sac shrinkage. Content Type Journal ArticleCategory Original ArticlePages 1605-1609DOI 10.1007/s00595-011-4531-1Authors Hiroyuki Ishibashi, Department of Vascular Surgery, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195 JapanTsuneo Ishiguchi, Department of Radiology, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195 JapanTakashi Ohta, Department of Vascular Surgery, Aichi Medical University Hospital, Nagakute, Aichi, 480-1195 JapanIkuo Sugimoto, Department of Vascular Surgery, Aichi Medical University Hospi...

Defining the type of surgeon volume that influences the outcomes for open abdominal aortic aneurysm repair

Journal of Vascular Surgery — Mon, 03 Oct 2011 04:00:00 +0100

Conclusions: The current study suggests that composite surgeon volume—not operation-specific volume—is a key determinant of in-hospital mortality for open AAA repair. This finding needs to be considered for future credentialing of surgeons. (Source: Journal of Vascular Surgery)

Editors' commentary

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Our debaters have examined the volume-outcome relationship with abdominal aortic aneurysm repair (AAA) and both sides of the centralization of care argument. Several unanswered questions warrant further exploration. (Source: Journal of Vascular Surgery)

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Rural Hospitals Face a Higher Burden of Ruptured Abdominal Aortic Aneurysm and are More Likely to Transfer Patients for Emergent Repair

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: Compared with urban hospitals, rural hospitals have a higher burden of ruptured abdominal aortic aneurysms (AAAs) and are more likely to transfer patients with ruptured AAAs before performing repair. (Source: Journal of Vascular Surgery)

Ultrasound-Guided Percutaneous Aortic Aneurysm Repair can be Performed Safely With High Success and Improved Rates of Local Wound Complications

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Ultrasound-guided access allows for direct visualization of the access artery during percutaneous endovascular aneurysm repair (EVAR). We hypothesize that the use of ultrasound guidance allowed us to safely increase the use of percutaneous EVAR and to benefit from its lower rates of wound complications. (Source: Journal of Vascular Surgery)

Influence of Establishment of a Protocol for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm in Patient Outcomes

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Ruptured abdominal aortic aneurysm (RAAA) continues to carry a high mortality. A randomized trial and a few single-center experiences have shown improved short-term results with endovascular aneurysm repair (EVAR) compared with open repair of RAAA. An EVAR for RAAA (R-EVAR) program was started in 2007 at our institute. We studied our own experience with repair of RAAA during 10-year period, comparing outcomes between the two time periods. (Source: Journal of Vascular Surgery)

Impact of Chronic Kidney Disease on Outcomes After Abdominal Aortic Aneurysm Repair

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

This study highlights the effect of CKD on outcomes after endovascular AAA repair (EVAR) and OAR in contemporary practice. (Source: Journal of Vascular Surgery)

Utility of a Standardized Measurement Protocol to Simplify Case Planning for Branched-Fenestrated Endovascular Aortic Aneurysm Repair

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Standardization of branch vessel measurement for branched-fenestrated endovascular aortic aneurysm repair could simplify the teaching of patient selection, case planning, and device selection. The purpose of this study was to determine (1) the accuracy of measurements obtained by a novice nonclinician using a standardized computer-aided protocol, and (2) interobserver variability between an experienced clinician and a clinical fellow. (Source: Journal of Vascular Surgery)

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The Impact of Endovascular Procedures on Vascular Fellowship Training in Lower Extremity Revascularization

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

The introduction of endovascular aneurysm repair has resulted in a decline in open abdominal aortic aneurysm repairs performed by vascular fellows. We evaluated if increased endovascular procedures produced a decrease in the number of open lower extremity revascularizations. (Source: Journal of Vascular Surgery)

Case images: Surgical repair of interrupted aorta and ascending aortic aneurysm.

Turk Kardiyoloji Dernegi arsivi — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Emiroğulları ON, Kaya MG, Mavili E, Tunçay A PMID: 21983779 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)

Late abdominal aortic endograft explants: Indications and outcomes

Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Conclusion: Most delayed EVAR conversions are because of device failure or infection and can be successfully converted to open surgical reconstruction. Supraceliac control is often required, and the perioperative complications are greater than primary elective open or endovascular repair. This study addresses how best to manage failed abdominal aortic endografts and what can be done to improve patient outcomes with this difficult clinical problem. (Source: Surgery)

The value of computed tomography scans in the diagnosis and management following invasive arterial investigation.

Vascular — Thu, 29 Sep 2011 04:00:00 +0100

We report a patient who was known to have an abdominal aortic aneurysm and was being assessed for endovascular repair by calibrated angiogram, who developed back pain and cardiovascular collapse, where a computed tomography scan proved essential in establishing the correct diagnosis - bleed from an accessory renal artery branch. PMID: 21960505 [PubMed - as supplied by publisher] (Source: Vascular)

Single-centre Prospective Comparison Between Contrast-Enhanced Ultrasound and Computed Tomography Angiography after EVAR

European Journal of Vascular and Endovascular Surgery — Thu, 29 Sep 2011 04:00:00 +0100

Conclusions: CEUS demonstrated to be as accurate as CTA in endoleak detection and abdominal aortic aneurysm diameter measurements during EVAR follow-up, without carrying the risks of radiation exposure or nephrotoxicity. Even if it cannot be proposed as the sole imaging modality during follow-up, our analysis suggests that it should have a major role. (Source: European Journal of Vascular and Endovascular Surgery)

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Use of a remotely steerable “robotic” catheter in a branched endovascular aortic graft

Journal of Vascular Surgery — Thu, 29 Sep 2011 04:00:00 +0100

We report the use of a remotely steerable catheter to treat kinked renal bridging stents 8 months after branched endovascular repair of a type III thoracoabdominal aortic aneurysm. Conventional techniques using single, coaxial, and manually steerable sheaths proved too unstable to provide the support required to pass a wire against resistance through the kinked stent. A remotely steerable “robotic” catheter provided sufficient precision and stability to cross the kink and reline it with an additional stent, restoring renal perfusion. This technology can help achieve precise and stable introducer sheath position. Further evaluation is necessary to understand the wider applications. (Source: Journal of Vascular Surgery)

Staged Surgical Repair for Extensive Cardiovascular Damage by Syphilis [CASE REPORTS]

The Annals of Thoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

We describe the successful management of extensive cardiovascular syphilitic damage. (Source: The Annals of Thoracic Surgery)

Contained Ruptured Paravisceral Aortic Aneurysm Related to Immunoglobulin G4 Aortitis

Annals of Vascular Surgery — Fri, 23 Sep 2011 04:00:00 +0100

Conclusion: IgG4-related inflammatory AAAs are rare; this is the first report of one with a contained rupture. The patient’s symptoms, the unusual appearance on computed tomography, the presence of popliteal aneurysms in a woman, and the normal WBC scan were indicative of an inflammatory etiology. Tissue biopsy was critical to obtain histological diagnosis and direct treatment. (Source: Annals of Vascular Surgery)

Editors’ Comment

European Journal of Vascular and Endovascular Surgery — Fri, 23 Sep 2011 00:13:55 +0100

Detection of type II endoleaks in abdominal aortic aneurysms after endovascular repair

Computers in Biology and Medicine — Tue, 20 Sep 2011 06:05:29 +0100

Abstract: Abdominal aortic aneurysm (AAA) is a condition where the weakening of the aortic wall leads to its widening and the generation of a thrombus. To prevent a possible rupture of the aortic wall, AAA can be treated non-invasively by means of the endovascular aneurysm repair technique (EVAR), consisting of placing a stent-graft inside the aorta by a cateter to exclude the aneurysm sac from the blood circulation. A major complication is the presence of liquid blood turbulences, called endoleaks, in the thrombus formed in the space between the aortic wall and the stent-graft. In this paper we propose an automatic method for the detection of type II endoleaks in computer tomography angiography (CTA) images. The lumen and thrombus in the aneurysm area are first segmented using a radial mo...

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Combined valve-sparing root replacement and total arch replacement with frozen elephant trunk [Case report - Aortic and aneurysmal]

Interactive CardioVascular and Thoracic Surgery — Tue, 20 Sep 2011 04:00:00 +0100

We report a case of simultaneous repair of an extensive thoracic aortic aneurysm from the aortic root to the distal aortic arch. A 54-year-old male had annuloaortic ectasia and a transverse aortic and distal arch aneurysm. Aneurysms of the descending aorta and the abdominal aorta were also demonstrated. The patient underwent aortic valve-sparing root reconstruction, replacement of the aortic arch and placement of a frozen elephant trunk stent-graft concomitantly through a median sternotomy incision. Because a complicated procedure was necessary, root reconstruction was performed first and coronary perfusion was resumed. This case suggests that the surgical procedure should be determined on the bases of the situation of thoracic aortic aneurysm and the general condition of the patient. Trea...

Stent graft modification with mini-cuff reinforced fenestrations for urgent repair of thoracoabdominal aortic aneurysms

Journal of Vascular Surgery — Tue, 20 Sep 2011 04:00:00 +0100

We describe a technique of stent graft modification in a high-risk male patient with two prior open aortic repairs, end ileostomy, and a rapidly enlarging 10-cm supra-graft type IV thoracoabdominal aortic aneurysm. A Z-stent thoracic stent graft was modified on-site using mini-cuff reinforced fenestrations to incorporate the visceral arteries and improve overlap at the side branch attachment sites. After successful repair, the patient was discharged at 4 days without complications and with patent branched stent grafts without endoleak. On-site modifications of endografts may allow urgent endovascular treatment of complex aortic aneurysms in high-risk patients who are not good candidates for open repair or who do not have access to manufactured fenestrated devices. (Source: Journal of Vascu...

The International E-vita Open Registry: data sets of 274 patients.

The Journal of Cardiovascular Surgery — Thu, 15 Sep 2011 00:09:02 +0100

CONCLUSION: Favorable single center results could be confirmed by an International community of cardiac surgical centers in regard to hospital mortality and morbidity, as well as a low postoperative complication rate and exclusion of false lumen in aortic dissection. PMID: 21894139 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

Annual rupture risk of abdominal aortic aneurysm enlargement without detectable endoleak after endovascular abdominal aortic repair

Journal of Vascular Surgery — Wed, 14 Sep 2011 04:00:00 +0100

This study evaluated AAA rupture risk in patients without detectable endoleaks but with AAA enlargement after EVAR treatment.Methods: Baseline characteristics and follow-up data were collected prospectively by case record forms. Follow-up visits were scheduled at 1, 3, 6, 12, 18, and 24 months, and annually thereafter. The follow-up assessment included clinical examination and imaging studies. Patients were divided into three groups according to the degree of shrinkage or enlargement of the aneurysm. Group A included patients with >8 mm aneurysm shrinkage, group B consisted of patients with ≤8 mm shrinkage to ≤8 mm enlargement, and group C patients had an aneurysm enlargement of >8 mm.Results: The basis for this analysis was 6337 patients who were enrolled prospectively in the European...

Telomerase expression on aortic wall endothelial cells is attenuated in abdominal aortic aneurysms compared to healthy nonaneurysmal aortas

Journal of Vascular Surgery — Wed, 14 Sep 2011 04:00:00 +0100

Conclusion: Patients with AAAs have attenuated telomerase endothelial expression compared to controls, implying a protective role of telomerase against AAA formation. Further investigation of pathways involved in vascular aging may contribute to elucidation of AAA pathogenetic mechanisms.Clinical Relevance: Telomeres are special chromatin structures located at the ends of eukaryotic chromosomes, which shorten with each cell division, thus reflecting cell age. Cells compensate for such a telomere loss by producing telomerase, a reverse transcriptase that adds back telomeric repeats at the telomere ends. Telomerase is considered a key enzyme modulating cell aging, and several studies have associated telomerase function with cardiovascular diseases such as hypertension, atherosclerosis, and s...

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Robotic-assisted aortic surgery with and without minilaparotomy for complicated occlusive disease and aneurysm

Journal of Vascular Surgery — Wed, 14 Sep 2011 04:00:00 +0100

Conclusions: For aortic procedures completed total robotically without an abdominal incision, the estimated blood loss was significantly less than in robotic-assisted procedures with a minilaparotomy. In these selected patients, robotic-assisted technology may be part of the armamentarium for the vascular surgeon as another less invasive method for the treatment of complicated occlusive disease or aneurysm. (Source: Journal of Vascular Surgery)

Endovascular versus open repair of ruptured descending thoracic aortic aneurysms: A nationwide risk-adjusted study of 923 patients

The Journal of Thoracic and Cardiovascular Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Objective: Recent studies support the use of endovascular treatment for ruptured abdominal aortic aneurysms, but few studies have examined the use of thoracic endovascular aortic repair (TEVAR) for ruptured descending thoracic aortic aneurysm. We evaluated nationwide data regarding short-term outcomes of TEVAR and open aortic repair (OAR) for ruptured descending thoracic aortic aneurysm.Methods: From US Nationwide Inpatient Sample data, we identified 923 patients who underwent ruptured descending thoracic aortic aneurysm repair in 2006–2008 and who had no concomitant aortic disorders. Of these patients, 364 (39.4%) underwent TEVAR and 559 (60.6%) underwent OAR. Multivariable regression was used to assess the effect of TEVAR versus OAR after adjusting for potential confounding factors. Ou...

Simultaneous thoracic endovascular aortic repair and endovascular aortic repair is feasible with minimal morbidity and mortality

Journal of Vascular Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Conclusion: Combined TEVAR and EVAR can be performed successfully with minimal morbidity and mortality. In particular, in this limited series of eight patients, there have been no occurrences of lower extremity paralysis or renal failure despite a high proportion of emergent cases. When anatomically feasible, simultaneous TEVAR and EVAR can be considered as a viable alternative to staged or hybrid repair. (Source: Journal of Vascular Surgery)

Endovascular repair of infrarenal aortic aneurysms in octogenarians and nonagenarians

Journal of Vascular Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Conclusion: EVAR in octogenarians and nonagenarians is associated with a significantly higher but still low perioperative mortality compared to younger patients. Midterm survival in octogenarians and nonagenarians, although significantly lower than in younger patients, is still acceptable, indicating that age >80 years should not be an exclusion criteria for EVAR. Even high-risk patients >80 years can be treated safely with a low perioperative mortality and comparable midterm outcome to younger high-risk patients. (Source: Journal of Vascular Surgery)

Osteopontin expression and its possible functions in the aortic disorders and coronary artery disease

Revista Brasileira de Cirurgia Cardiovascular — Sun, 11 Sep 2011 07:27:46 +0100

CONCLUSION: These data may provide evidences that OPN may play a role in the pathogenesis of aortopathies including aortic dissection, aortic aneurysm, and coronary artery disease. OPN might be of potential perspective as a clinically diagnostic tool in the evaluations of the complex remodeling process incorporating vascular injury and repair.OBJETIVOS: A osteopontina (OPN) está estreitamente associada com os processos de oncogênese e remodelação. Entretanto, essa citocina era raramente avaliada na presença de aortopatias, especialmente na dissecção aórtica aguda. O objetivo do presente estudo foi avaliar a expressão de OPN por meio de abordagens moleculares biológicas, de modo a oferecer uma melhor compreensão dos possíveis mecanismos das aortopatias. MÉTODOS: Pacientes conse...

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Outcome after Open Repair of Ruptured Abdominal Aortic Aneurysm in Patients >80 Years Old: A Systematic Review and Meta-analysis: Reply

World Journal of Surgery — Thu, 08 Sep 2011 06:08:03 +0100

Outcome after Open Repair of Ruptured Abdominal Aortic Aneurysm in Patients >80 Years Old: A Systematic Review and Meta-analysis: Reply Content Type Journal ArticlePages 1-1DOI 10.1007/s00268-011-1259-4Authors Fausto Biancari, Division of Cardio-thoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland Journal World Journal of SurgeryOnline ISSN 1432-2323Print ISSN 0364-2313 (Source: World Journal of Surgery)

Evaluation of Texture for Classification of Abdominal Aortic Aneurysm After Endovascular Repair

Journal of Digital Imaging — Thu, 08 Sep 2011 06:05:44 +0100

Abstract The use of the endovascular prostheses in abdominal aortic aneurysm has proven to be an effective technique to reduce the pressure and rupture risk of aneurysm. Nevertheless, in a long-term perspective, complications such as leaks inside the aneurysm sac (endoleaks) could appear causing a pressure elevation and increasing the danger of rupture consequently. At present, computed tomographic angiography (CTA) is the most common examination for medical surveillance. However, endoleak complications cannot always be detected by visual inspection on CTA scans. The investigation on new techniques to detect endoleaks and analyse their effects on treatment evolution is of great importance for endovascular aneurysm repair (EVAR) technique. The purpose of this work was to ev...

Prothrombin Complex Concentrate Such as Therapy and Prophylaxis in Factor X-Deficient Patient (Friuli Variant)

Clinical and Applied Thrombosis/Hemostasis — Thu, 08 Sep 2011 04:00:00 +0100

Conclusion: Waiting for specific therapeutic options for FX deficiency, currently, the best treatment is represented by PCC. Its correct use permits an improvement in life quality and a reduction in bleeding frequency in FX-deficient patients. (Source: Clinical and Applied Thrombosis/Hemostasis)

Abdominal aortic aneurysm treatment: minimally invasive fast-track surgery and endovascular technique.

Vascular — Thu, 08 Sep 2011 04:00:00 +0100

This study demonstrates that minimally invasive treatment with the fast-track protocol may be a valid alternative to EVAR. PMID: 21903855 [PubMed - as supplied by publisher] (Source: Vascular)

Hypothermic renal perfusion during aortic surgery reduces the presence of lipocalin-2 and preserves renal extraction of dimethylarginines in rats.

American Journal of Physiology. Renal Physiology — Wed, 07 Sep 2011 04:00:00 +0100

Authors: Yeung KK, De Gouyon Matignon C, Renwarin L, Tjon-A-Fat MR, Teerlink T, van Leeuwen PA, Musters RJ, Wisselink W, Tangelder GJ Abstract Cold perfusion through the renal arteries during renal ischemia has been suggested to diminish postoperative renal damage after juxtarenal aortic aneurysm(JAA)-repair. As the kidneys play a key role in the dimethylarginine-metabolism, which is in turn is associated with renal hemodynamics, we hypothesized that the protective effect of cold perfusion is associated with a preserved renal extraction of dimethylarginines. Renal ischemia was induced in 3 groups of anesthetized Wistar rats(n=7 per group) who underwent suprarenal aortic-clamping(45 minutes) with no perfusion (group 1), renal perfusion with 37ºC saline (group 2) or renal perfusion ...

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New method for absolute spinal cord ischemia protection in rabbits

Journal of Vascular Surgery — Mon, 05 Sep 2011 04:00:00 +0100

Conclusion: In a rabbit model with aortic clamping up to 30 minutes, which consistently produces complete paraplegia in rabbits, spinal cord damage was partially reduced by topical cooling with transvertebral cooling pads or the injection of edaravone into the clamped segment of aorta, but was more effectively protected by a combined use of these two strategies.Clinical Relevance: Spinal cord injury after surgical repair of the thoracic or thoracoabdominal aorta is a disastrous complication. Cold blood infusion into the clamped segment of aorta during thoracoabdominal aortic aneurysm surgery has been used in human operations in our department to detect the presence of a critical Adamkiewicz artery. Edaravone might be used in the same manner, with additional protective effect against spinal...

Endovascular treatment of ruptured abdominal aortic aneurysms: aorto-uni-iliac or bifurcated endograft?

La Radiologia Medica — Sun, 04 Sep 2011 10:53:48 +0100

Conclusions In our experience, a higher mortality rate was observed for the aorto-uni-iliac configuration; shock at admission was confirmed as the most important factor for postoperative survival. Content Type Journal ArticleCategory Vascular and Interventional Radiology / Radiologia Vascolare e InterventisticaPages 1-16DOI 10.1007/s11547-011-0717-2Authors G. Carrafiello, Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri 57, 21100 Varese, ItalyG. Piffaretti, Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, ItalyD. Laganà, Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri 57, 21100 Varese, ItalyF. Fontana, Interventional Radiology, Department of Radiology, Univ...

Management of concurrent colorectal cancer and vascular disease in the endovascular era

Techniques in Coloproctology — Fri, 02 Sep 2011 05:48:23 +0100

Conclusions Priority of treating concurrent vascular disease and CRC remains a dilemma. Combined treatment with a single-stage procedure is feasible. Risk of graft infection may be lower than expected. Content Type Journal ArticlePages 1-4DOI 10.1007/s10151-011-0732-2Authors C. P. Spanos, First Department of Surgery, Aristotelian University, Thessaloniki, GreeceG. Tsoulfas, First Department of Surgery, Aristotelian University, Thessaloniki, GreeceG. Georgantis, First Department of Surgery, Aristotelian University, Thessaloniki, GreeceN. Melas, First Department of Surgery, Aristotelian University, Thessaloniki, GreeceN. Saratzis, First Department of Surgery, Aristotelian University, Thessaloniki, GreeceK. Ktenidis, First Department of Surgery, Aristotelian University,...

Inadvertent placement of a pulmonary artery catheter in the coronary sinus: is it time to increase our sweep speed?

Journal of Clinical Anesthesia — Thu, 01 Sep 2011 04:00:00 +0100

Abstract: A patient was scheduled for open infrarenal abdominal aortic aneurysm repair and the procedure was performed without complication. The pulmonary artery catheter (PAC) was unintentionally placed in the coronary sinus via an undiagnosed persistent left superior vena cava anomaly. Interpreting the waveform produced by the PAC in standard and abnormal locations such as the coronary sinus is equally as important as measuring and monitoring hemodynamic status. (Source: Journal of Clinical Anesthesia)