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Abdominal Aortic Aneurysm

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1. PIUR tUS for abdominal aortic aneurysm surveillance and endovascular aneurysm repair endoleak detection

PIUR tUS for abdominal aortic aneurysm surveillance and endovascular aneurysm repair endoleak detection PIUR tUS for abdominal aortic aneurysm surveillance and endovascular aneurysm repair endoleak detection Medtech innovation briefing Published: 9 December 2019 www.nice.org.uk/guidance/mib200 pathways Summary Summary The technology technology described in this briefing is PIUR tUS (3D tomographic ultrasound). It is for abdominal aortic aneurysm (AAA) surveillance and endovascular aneurysm (...) vessel by extending regular 2D ultrasound scanners. This imaging can be used for abdominal aortic aneurysm (AAA) surveillance and endovascular aneurysm repair (EVAR) endoleak detection and classification. PIUR tUS can be used with any 2D ultrasound device and transducer. It turns the images collected into high-resolution tomographic 3D ultrasound images. The images are viewed and reported in a similar way to other 3D imaging techniques using multi-planar reconstructions and 3D volume, such as CT

2019 National Institute for Health and Clinical Excellence - Advice

2. Abdominal aortic aneurysm: diagnosis and management

, because of adverse anatomical features. For AAA repair, these features can include large abdominal wall defects or intra- abdominal adhesions. A hostile abdomen is most common in people who have had multiple previous episodes of intra-abdominal open surgery. Infrarenal abdominal aortic aneurysm Infrarenal abdominal aortic aneurysm An abdominal aortic aneurysm arising below the arteries that supply the kidneys. Permissive hypotension Permissive hypotension A method of fluid administration that aims (...) 1.5.1 and who have abdominal copathology, such as a hostile abdomen, horseshoe kidney or a stoma, or other considerations, specific to and discussed with the person, that may make EVAR the preferred option. 1.5.5 Consider EVAR or conservative management for people with unruptured AAAs meeting the criteria in recommendation 1.5.1 who have anaesthetic risks and/or medical comorbidities that would contraindicate open surgical repair. Abdominal aortic aneurysm: diagnosis and management (NG156) © NICE

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

3. Complex endovascular aneurysm repair in patients with juxta-renal or thoraco-abdominal aortic aneurysm

Complex endovascular aneurysm repair in patients with juxta-renal or thoraco-abdominal aortic aneurysm 78 1 Health technology description Key points ? A single prospective observational study compared 30-day outcomes of fenestrated/branched endovascular aneurysm repair (F/B-EVAR) with open surgery repair (OSR) for the treatment of complex aortic aneurysm anatomies: para/juxta-renal aortic aneurysm (PRAA/JRAA) and thoraco-abdominal aortic aneurysm (TAAA). There was no statistically significant (...) to be comparable in terms of urgency of treatment (elective/non-elective), aneurysm anatomy, risk profile, and other demographics. The systematic reviews reported a 30-day mortality for the treatment of JRAA ranging from 1.4% to 4.1% with F-EVAR, 3.1% to 4.1% with OSR, and 5.3% with chimney-EVAR (Ch-EVAR). What is the clinical and cost-effectiveness of complex endovascular aneurysm repair in patients with juxta-renal or thoraco-abdominal aortic aneurysm compared with open surgical repair, and how should

2018 Evidence Notes from Healthcare Improvement Scotland

4. Risk factors and outcomes for bowel ischemia after open and endovascular abdominal aortic aneurysm repair. (Abstract)

Risk factors and outcomes for bowel ischemia after open and endovascular abdominal aortic aneurysm repair. Bowel ischemia (BI) is a serious complication after abdominal aortic aneurysm (AAA) repair. We sought to identify the incidence and risk factors associated with the development of postoperative BI and the post-BI outcomes for patients undergoing open aortic repair (OAR) and endovascular aortic repair (EVAR) of AAAs.A retrospective analysis was conducted for all patients who had undergone (...) was associated with a threefold increased odds of BI compared with EVAR (adjusted odds ratio [aOR], 3.24; 95% confidence interval [CI], 2.49-4.22; P < .001). The independent factors associated with BI after OAR included older age (aOR per year of age, 1.02; 95% CI, 1.00-1.03), congestive heart failure (aOR, 1.44; 95% CI, 1.05-1.98), and ruptured aneurysm (aOR, 4.16; 95% CI, 2.98-5.81; P < .01 for all). We also found that transfusion ≥1 U (aOR, 1.69; 95% CI, 1.30-2.20), a transperitoneal approach (aOR, 2.13

2019 Journal of Vascular Surgery

5. Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial: Erratum. (Abstract)

Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial: Erratum. 31149931 2019 07 23 1528-1175 131 1 2019 07 Anesthesiology Anesthesiology Limb Remote Ischemic Preconditioning for Intestinal and Pulmonary Protection during Elective Open Infrarenal Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial: Erratum. 222 10.1097/ALN.0000000000002766 eng Journal Article

2019 Anesthesiology Controlled trial quality: predicted high

6. Abdominal aortic aneurysm screening: ultrasound equipment guidelines

Abdominal aortic aneurysm screening: ultrasound equipment guidelines Abdominal aortic aneurysm screening: ultrasound equipment quality assurance guidelines - GOV.UK GOV.UK uses cookies to make the site simpler. Accept cookies You’ve accepted all cookies. You can at any time. Hide Search Guidance Abdominal aortic aneurysm screening: ultrasound equipment quality assurance guidelines Updated 22 March 2019 Contents © Crown copyright 2019 This publication is licensed under the terms of the Open (...) Government Licence v3.0 except where otherwise stated. To view this licence, visit or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: . Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at https://www.gov.uk/government/publications/abdominal-aortic-aneurysm-screening-ultrasound-equipment-guidance/abdominal-aortic-aneurysm-screening-ultrasound

2019 Public Health England

7. Management and Transfer of Patients with a Diagnosis of Ruptured Abdominal Aortic Aneurysm to a Specialist Vascular Centre

Management and Transfer of Patients with a Diagnosis of Ruptured Abdominal Aortic Aneurysm to a Specialist Vascular Centre 0 The Royal College of Emergency Medicine Best Practice Guideline Management and Transfer of Patients with a Diagnosis of Ruptured Abdominal Aortic Aneurysm to a Specialist Vascular Centre January 2019 1 Summary of recommendations 1. A clinical diagnosis of ruptured abdominal aortic aneurysm (rAAA) should be considered: • In patients over the age of 50 years presenting (...) colic. Clinical Diagnosis A clinical diagnosis of rAAA can be made: • In patients over the age of 50 years presenting with acute onset of abdominal/back pain AND hypotension • In patients with known AAA symptoms of either abdominal/back pain OR hypotension/collapse Patients with other combinations of signs/symptoms may need further investigation to confirm/exclude the diagnosis of rAAA. Radiological Diagnosis Ultrasound can confirm the presence and size of an aortic aneurysm. 13 It cannot exclude

2019 Royal College of Emergency Medicine

8. Abdominal aortic aneurysm

Abdominal aortic aneurysm Abdominal aortic aneurysm - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Abdominal aortic aneurysm Last reviewed: February 2019 Last updated: June 2018 Summary Patients are usually asymptomatic and their abdominal aortic aneurysm is detected incidentally. In the minority of patients who experience symptoms, abdominal, back, and groin pain are typical. Ultrasound remains the definitive test (...) % vs. 5.2%) and endovascular aneurysm repair (EVAR) (2.1% vs. 1.3%). Complications of treatment include acute kidney injury, limb ischaemia, spinal cord ischaemia, anastomotic pseudoaneurysm, graft infection, graft limb occlusion, and distal embolisation. Endoleak is a complication of EVAR. Definition Abdominal aortic aneurysm (AAA) is a permanent pathological dilation of the aorta with a diameter >1.5 times the expected anteroposterior (AP) diameter of that segment, given the patient's sex

2018 BMJ Best Practice

9. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. Full Text available with Trip Pro

Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries (...) abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required.

2018 Cochrane

10. Complex endovascular aneurysm repair for juxta-renal or thoraco-abdominal aortic aneurysm: Advice Statement

Complex endovascular aneurysm repair for juxta-renal or thoraco-abdominal aortic aneurysm: Advice Statement File name: 20171208 Complex EVAR AS v3.0.docx0 Version: 3.0 Date: 26 April 2018 Produced by: Page: 1 Review date: Advice Statement 006/18 May 2018 What is the clinical and cost- effectiveness of complex endovascular aneurysm repair in patients with juxta-renal or thoraco-abdominal aortic aneurysm compared with open surgical repair and how should these technologies be delivered (...) -abdominal aortic aneurysm (TAAA) service is currently underway, and will address issues regarding service provision. NHSScotland is required to consider Scottish Health Technology Group (SHTG) advice. Why is SHTG looking at this topic? Complex endovascular aneurysm repair techniques are high cost procedures and there was perceived to be uncertainty in their clinical and cost-effectiveness. There is variation in the use of these procedures between NHS boards and it is not clear which model of delivery

2018 SHTG Advice Statements

11. Participation in bowel screening among men attending abdominal aortic aneurysm screening. Full Text available with Trip Pro

Participation in bowel screening among men attending abdominal aortic aneurysm screening. Uptake of population-based screening for colorectal cancer in Scotland is around 55 per cent. Abdominal aortic aneurysm (AAA) screening has recently been introduced for men aged 65 years and the reported uptake is 78 per cent. The aim was to determine the impact of a brief intervention on bowel screening in men who attended AAA screening, but previously failed to complete bowel screening.Men invited (...) for AAA screening between September 2015 and March 2016 within NHS Tayside were included. Attendees who had not responded to their latest bowel screening invitation were seen by a colorectal cancer clinical nurse specialist. Reasons for not completing the faecal occult blood test (FOBT) were recorded; brief information on colorectal cancer screening was communicated, and participants were offered a further invitation to complete a FOBT. Those who responded positively were sent a further FOBT from

2018 British Journal of Surgery

14. Endovascular aneurysm sealing for abdominal aortic aneurysm

Endovascular aneurysm sealing for abdominal aortic aneurysm Endovascular aneurysm sealing for abdominal aortic aneurysm | Guidance | NICE Endovascular aneurysm sealing for abdominal aortic aneurysm Interventional procedures guidance [IPG547] Published date: February 2016 Guidance March 2019: We have withdrawn the guidance because the CE mark for the Nellix Endovascular Aneurysm Sealing (EVAS) System has been withdrawn. Endologix is recalling unused stock. The MHRA recommends (see MDA/2019/002

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

15. Abdominal Aortic Aneurysm Follow-up (Without Repair)

Abdominal Aortic Aneurysm Follow-up (Without Repair) New 2018 ACR Appropriateness Criteria ® 1 AAA Follow-up (Without Repair) American College of Radiology ACR Appropriateness Criteria ® Abdominal Aortic Aneurysm Follow-up (Without Repair) Variant 1: Asymptomatic abdominal aortic aneurysm surveillance (without repair). Procedure Appropriateness Category Relative Radiation Level US duplex Doppler aorta abdomen Usually Appropriate O CTA abdomen and pelvis with IV contrast Usually Appropriate (...) contrast May Be Appropriate O MRI abdomen and pelvis without IV contrast May Be Appropriate (Disagreement) O Aortography abdomen Usually Not Appropriate ??? Radiography chest abdomen pelvis Usually Not Appropriate ??? ACR Appropriateness Criteria ® 2 AAA Follow-up (Without Repair) ABDOMINAL AORTIC ANEURYSM FOLLOW-UP (WITHOUT REPAIR) Expert Panel on Vascular Imaging: Michael Collard, MD, MA a ; Patrick D. Sutphin, MD, PhD b ; Sanjeeva P. Kalva, MD c ; Bill S. Majdalany, MD d ; Jeremy D. Collins, MD e

2019 American College of Radiology

16. Abdominal Aortic Aneurysm: Screening

results from a large United Kingdom abdominal aortic aneurysm screening center in the context of optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme protocols. J Vasc Surg . 2016;63(2):301-4. 5. Choke E, Vijaynagar B, Thompson J, Nasim A, Bown MJ, Sayers RD. Changing epidemiology of abdominal aortic aneurysms in England and Wales: older and more benign? Circulation . 2012;125(13):1617-25. 6. Anjum A, Powell JT. Is the incidence of abdominal aortic aneurysm declining (...) Abdominal Aortic Aneurysm: Screening Recommendation | United States Preventive Services Taskforce Toggle navigation Main navigation Main navigation Recommendation Men aged 65 to 75 years who have ever smoked The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked. B Men aged 65 to 75 years who have never smoked The USPSTF recommends that clinicians selectively offer screening for AAA with ultrasonography

2019 U.S. Preventive Services Task Force

17. Recommendations on screening for abdominal aortic aneurysm in primary care

Recommendations on screening for abdominal aortic aneurysm in primary care © 2017 Joule Inc. or its licensors CMAJ | SEPTEMBER 11, 2017 | VOLUME 189 | ISSUE 36 E1137 A n abdominal aortic aneurysm (AAA) results from a weaken- ing in a section of the aortic wall in the abdomen, which bulges because of pressure from blood flow to form an aneurysm. 1 The aneurysm may grow and eventually rupture, caus- ing death from hemorrhage. 1 It is estimated that each year, 20?000 Canadians receive a diagnosis (...) -abdominal-aortic-aneurism/protocol/ (accessed 2017 Jan. 16). 24. Ali MU, Fitzpatrick-Lewis D, Raina P, et al. Screening for abdominal aortic aneurysm: updated GRADE tables. Hamilton (ON): Evidence Review and Syn- thesis Centre, McMaster University; 2017. Available: http://canadiantaskforce. ca/guidelines/published-guidelines/abdominal-aortic-aneurysm/ (accessed on 2017 May 14). 25. Ali MU, Fitzpatrick-Lewis D, Raina P, et al. Absolute effects for harms out- comes; one-time AAA screening in men

2017 CPG Infobase

18. Pharmacological treatment of vascular risk factors for reducing mortality and cardiovascular events in patients with abdominal aortic aneurysm. Full Text available with Trip Pro

Pharmacological treatment of vascular risk factors for reducing mortality and cardiovascular events in patients with abdominal aortic aneurysm. Pharmacological prophylaxis has been proven to reduce the risk of cardiovascular events in individuals with atherosclerotic occlusive arterial disease. However, the role of prophylaxis in individuals with abdominal aortic aneurysm (AAA) remains unclear. Several studies have shown that despite successful repair, those people with AAA have a poorer rate (...) in people with abdominal aortic aneurysm (AAA).For this update the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (14 April 2016). In addition, the CIS searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 3) and trials registries (14 April 2016) and We also searched the reference lists of relevant articles.Randomised controlled trials in which people with AAA were randomly allocated to one prophylactic treatment versus

2017 Cochrane

19. Laparoscopic surgery for elective abdominal aortic aneurysm repair. Full Text available with Trip Pro

Laparoscopic surgery for elective abdominal aortic aneurysm repair. Abdominal aortic aneurysm (AAA) is an abnormal dilatation of the infradiaphragmatic aorta that is equal to or greater than 30 mm or a local dilatation of equal to or greater than 50% compared to the expected normal diameter of the artery. AAAs rarely occur in individuals under 50 years of age, but thereafter the prevalence dramatically increases with age, with men at a six-fold greater risk of developing an AAA than women (...) . Prevalence of AAA has been reported to range from 1.3% in women aged 65 to 80 years to between 4% and 7.7% in men aged 65 to 80 years.There is evidence that the risk of rupture increases as the aneurysm diameter increases from 50 mm to 60 mm. People with AAAs over 55 mm in diameter are therefore generally referred for consideration of repair, as the risk of rupture exceeds the risk of repair. The traditional treatment for AAA is open surgical repair (OSR) which involves a large abdominal incision

2017 Cochrane

20. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm Full Text available with Trip Pro

approach for patients requiring OSR of an inflammatory aneurysm, a horseshoe kidney, or an aortic aneurysm in the presence of a hostile abdomen. Level of recommendation 1 (Strong) Quality of evidence C (Low) We suggest a retroperitoneal exposure or a transperitoneal approach with a transverse abdominal incision for patients with significant pulmonary disease requiring OSR. Level of recommendation 2 (Weak) Quality of evidence C (Low) We recommend a thrombin inhibitor, such as bivalirudin or argatroban (...) ., and Mahmood, A. Outcome of open versus endovascular abdominal aortic aneurysm repair in obese patients: a systemic review and meta-analysis. Int Angiol . 2015 ; 34 : 9–15 | Open vs endovascular repair (obese patients) • EVAR had lower 30-day postoperative mortality and fewer early postoperative complications (MI, chest infection, renal failure, wound infection); risks of postoperative bowel ischemia and stroke were similar (low) Rayet, 2008 16 x 16 Rayt, H.S., Sutton, A.J., London, N.J., Sayers, R.D

2018 Society for Vascular Surgery

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