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Abdominal Aortic Aneurysm

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6621. Treatment of an early type II endoleak causing hemorrhage after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. (PubMed)

Treatment of an early type II endoleak causing hemorrhage after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. We report a case of ruptured abdominal aortic aneurysm emergently treated by endovascular aneurysm repair (EVAR) that developed a primary type II endoleak leading to persistent blood loss and retroperitoneal hematoma increase. Coil embolization resolved this. Although to our knowledge there are no recommendations regarding this, our report suggests that early type (...) II endoleaks occurring after emergency EVAR for ruptured AAA should be treated when it is associated with blood extravasation outside the aneurysm sac.

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2007 Journal of Vascular Surgery

6622. The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm endoprosthesis. (PubMed)

The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm endoprosthesis. Endovascular abdominal aortic aneurysm repair (EVAR) with the original-permeability Excluder (W.L. Gore & Associates, Flagstaff, Ariz) has been associated with postoperative sac expansion in the absence of endoleak. In these cases, we have performed an endovascular revision, relining the original endograft with another (...) Excluder, in an effort to arrest sac expansion by reducing permeability. We have studied these cases to determine the effect of relining on aneurysm expansion.Patients who demonstrated sac expansion (>or=5 mm diameter, >or=5% three-dimensional volume) after EVAR with the original Excluder were evaluated. Between 1999 and 2004, the original-permeability endoprosthesis was used in 97 patients who underwent EVAR for asymptomatic abdominal aortic aneurysm (AAA). Sac expansion occurred in 24 patients

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2007 Journal of Vascular Surgery

6623. Evaluation of pressure transmission and intra-aneurysmal contents after endovascular repair using the Trivascular Enovus expanded polytetrafluoroethylene stent graft in a canine model of abdominal aortic aneurysm. (PubMed)

Evaluation of pressure transmission and intra-aneurysmal contents after endovascular repair using the Trivascular Enovus expanded polytetrafluoroethylene stent graft in a canine model of abdominal aortic aneurysm. Endotension has been defined as persistently increased pressure within the excluded sac of an abdominal aortic aneurysm (AAA) resulting in increasing aneurysm size after endovascular repair in the absence of endoleak. Devices that use expanded polytetrafluoroethylene (ePTFE) have been (...) . The stent graft was then deployed to exclude the aneurysm via distal aortic access. Comparison was made among three distinct stent grafts: the Trivascular Enovus (nonporous ePTFE; four animals), the original Gore Excluder (porous ePTFE; five animals), and the Medtronic AneuRx (Dacron; four animals). Daily systemic and intra-AAA pressures were measured for 4 weeks. Intra-aneurysmal pressures were indexed to simultaneously measured systemic pressures. After 4 weeks, the aorta, the prosthetic aneurysm

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2007 Journal of Vascular Surgery

6624. Endovascular abdominal aortic aneurysm repair in patients with common iliac artery aneurysms--Initial experience with the Zenith bifurcated iliac side branch device. (PubMed)

Endovascular abdominal aortic aneurysm repair in patients with common iliac artery aneurysms--Initial experience with the Zenith bifurcated iliac side branch device. To present our initial experience with the Zenith bifurcated iliac side branch device that preserves internal iliac artery flow whilst excluding aorto-iliac aneurysms.Between November 2005 and October 2006, data was prospectively collected on 8 patients in whom this device was used; 2 aorto-bi-iliac aneurysms, 3 aorto-uni-iliac (...) aneurysms, 1 solitary common iliac aneurysm, 1 distal type 1 endoleak, and 1 internal iliac aneurysm.No mortality or major complications resulted from use of this device. The median fluoroscopy time was 53 minutes (range 38 to 105) and a median of 102 g of iodine (range 84 to 130) as contrast were used. One patient required a blood transfusion and only one of the eight side branches occluded. There has been no endoleak related to the device in the median follow-up period of 6 months (1 to 14 months

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2007 Journal of Vascular Surgery

6625. Aortic necks of ruptured abdominal aneurysms dilate more than asymptomatic aneurysms after endovascular repair. (PubMed)

Aortic necks of ruptured abdominal aneurysms dilate more than asymptomatic aneurysms after endovascular repair. Endovascular repair of abdominal aortic aneurysm (AAA) is increasingly used. We evaluated if a difference exists in the rate of change of the aortic neck diameter between non-ruptured and ruptured AAAs after endovascular aneurysm repair (EVAR).Details of patients undergoing elective (group I) and emergency (group II) EVAR using Talent stents between October 1999 and September 2005 (...) were reviewed. Top neck diameters were prospectively recorded on the hospital database from computed tomography scans preoperatively and at 1, 3, 12, and 24 months postoperatively. The aortic neck diameter rate of change was calculated for each group.Endovascular repair was performed on 110 elective and 41 emergency patients, of which 100 (80 male) elective and 29 (26 male) emergency patients were included in this analysis. Mean age was similar in each group. Stents were oversized by 20.9% +/- 13.6

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2006 Journal of Vascular Surgery

6626. External validation of the Glasgow Aneurysm Score to predict outcome in elective open abdominal aortic aneurysm repair. (PubMed)

External validation of the Glasgow Aneurysm Score to predict outcome in elective open abdominal aortic aneurysm repair. Selecting patients based on their risk profiles could improve the outcome after elective surgery of an abdominal aortic aneurysm (AAA). The Glasgow Aneurysm Score (GAS) is a scoring system developed to determine such risk profiles. In other settings, the GAS has proved to have a predictive value for the postoperative outcome. The aim of this study was to investigate whether (...) cutoff value for the GAS was determined at 77. All the deceased patients (100%) and 63.3% of those who had a major complication had a risk score of >or=77. Of all examined risk factors, suprarenal clamping during surgery was predictive of in-hospital mortality (8.3%, P = .017). For major morbidity, three risk factors, all of which are components of the GAS, were predictive: age (P = .046), cardiac disease (P = .032), and renal disease (P = .041).The Glasgow Aneurysm Score has a predictive value

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2006 Journal of Vascular Surgery

6627. Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. (PubMed)

Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. The endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) with a bilateral common iliac artery aneurysm (CIAA) often requires exclusion of the bilateral hypogastric artery (HA), which can be associated with pelvic ischemic complications such as erectile dysfunction and buttock claudication. This study assessed the effect of HA

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2006 Journal of Vascular Surgery

6628. Predictors of outcome after abdominal aortic aneurysm rupture: Edinburgh Ruptured Aneurysm Score. (PubMed)

Predictors of outcome after abdominal aortic aneurysm rupture: Edinburgh Ruptured Aneurysm Score. Many surgeons adopt a selective policy of intervention for a ruptured abdominal aortic aneurysm (AAA). This study aimed to develop an objective method of identifying patients suitable for attempted repair.Consecutive patients selected for attempted repair of ruptured AAA over a 31-month period (January 2000 to July 2002) were entered into an observational study. Altogether, 53 preoperative

2007 World Journal of Surgery

6629. Compliance of abdominal aortic aneurysms evaluated by tissue Doppler imaging: correlation with aneurysm size. (PubMed)

Compliance of abdominal aortic aneurysms evaluated by tissue Doppler imaging: correlation with aneurysm size. Several studies have shown that an increase in abdominal aortic aneurysm (AAA) growth rate occurs when the diameter reaches 40 to 50 mm. AAA expansion is related to remodeling of the parietal extracellular matrix. The parietal mechanisms involved in this critical phase of sudden increase remain unexplained. Analysis of AAA wall movements and determination of AAA compliance may provide

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2005 Journal of Vascular Surgery

6630. Endovascular aneurysm repair: Treatment of choice for abdominal aortic aneurysm coincident with horseshoe kidney? Three case reports and review of literature. (PubMed)

Endovascular aneurysm repair: Treatment of choice for abdominal aortic aneurysm coincident with horseshoe kidney? Three case reports and review of literature. There is still controversy as to which surgical method is the most suitable for repair of abdominal aortic aneurysm with concomitant horseshoe kidney (AAA-HSK). We report three cases of AAA-HSK treated with endovascular aneurysm repair. In one of these patients we sacrificed the accessory renal artery by applying coils before (...) the operation. Renal infarction, hypertension, or elevated serum creatinine level was not observed in any of our patients. If the blood supply to the kidneys is taken into consideration, endovascular aneurysm repair is our preferred surgical method for repair of AAA-HSK when anatomic conditions are suitable for stent-graft application and kidney function is normal.

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2004 Journal of Vascular Surgery

6631. To what extent has endovascular aneurysm repair influenced abdominal aortic aneurysm management in the state of Illinois? (PubMed)

To what extent has endovascular aneurysm repair influenced abdominal aortic aneurysm management in the state of Illinois? This study was performed using population-based data to determine the changing trends in the techniques for abdominal aortic aneurysm (AAA) repair in the state of Illinois during the past 9 years and to examine the extent to which endovascular aneurysm repair (EVAR) has influenced overall AAA management.All records of patients who underwent AAA repair (1995 to 2003 inclusive (...) % for elective and 15% for ruptured AAA). The average age was 71.4 +/- 7.9 years, and 76% were men. For elective cases, open repair was performed in 86% and EVAR in 14%; and for ruptured cases, open repair in 97% and EVAR in 3%. Elective EVAR was associated with lower in-hospital mortality compared with open repair regardless of age. No differences were observed with age after either type of repair for a ruptured aneurysm. Men had a lower in-hospital mortality compared with women for open repair of both

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2005 Journal of Vascular Surgery

6632. Serum C-reactive protein level is associated with abdominal aortic aneurysm size and may be produced by aneurysmal tissue. (PubMed)

Serum C-reactive protein level is associated with abdominal aortic aneurysm size and may be produced by aneurysmal tissue. Abdominal aortic aneurysms (AAA) are characterized by extensive transmural inflammation and C-reactive protein (CRP) has emerged as an independent risk factor for the development of cardiovascular disease. Therefore, we evaluated a possible association between serum CRP and aneurysm dimension in patients with asymptomatic AAA. Furthermore, the possibility of CRP production (...) by aneurysmal tissue has been examined.Serum CRP was determined highly sensitive (hsCRP) and aneurysmal size was measured in 39 patients with AAA. The presence of CRP mRNA was assessed in the aneurysmal tissue of 16 patients. Mean (SD) hsCRP was 3.23 (2.96) mg/L. After log-transformation, hsCRP correlated significantly with aneurysmal size (r=0.477, P=0.002). When the patients were divided into 3 equally sized groups according to hsCRP level, aortic diameter increased from lowest to upper hsCRP-tertile (49

2003 Circulation

6633. Commentary. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomized controlled trial. (PubMed)

Commentary. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomized controlled trial. 16628343 2006 07 20 2007 05 13 1531-0035 18 1 2006 Mar Perspectives in vascular surgery and endovascular therapy Perspect Vasc Surg Endovasc Ther Commentary. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomized controlled trial. 74-6 Rutherford Robert B RB rbruth@aol.com eng Comment

2006 Perspectives in Vascular Surgery and Endovascular Therapy Controlled trial quality: uncertain

6634. Commentary. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomized controlled trial. (PubMed)

Commentary. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomized controlled trial. 16628344 2006 07 20 2007 05 13 1531-0035 18 1 2006 Mar Perspectives in vascular surgery and endovascular therapy Perspect Vasc Surg Endovasc Ther Commentary. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomized controlled trial. 76-7 Rutherford Robert B RB

2006 Perspectives in Vascular Surgery and Endovascular Therapy Controlled trial quality: uncertain

6635. High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. (PubMed)

High-risk and low-risk screening for abdominal aortic aneurysm both reduce aneurysm-related mortality. A stratified analysis from a single-centre randomised screening trial. Cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are both associated with abdominal aortic aneurysms (AAA). The aim of this study was therefore to analyse whether screening for AAA could be restricted to men with such diseases (high risk group).Before the date of randomisation of a population

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2007 European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Controlled trial quality: uncertain

6636. The Amsterdam Acute Aneurysm Trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms. (PubMed)

The Amsterdam Acute Aneurysm Trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms. To evaluate anatomical suitability and application rate for endovascular repair of patients with a ruptured abdominal aortic aneurysm (RAAA).The Amsterdam Acute Aneurysm trial is a multicenter randomised trial comparing open with endovascular treatment in patients with a RAAA (International Standard Randomized Controlled Trial Number (ISRCTN) 66212637). Between (...) April 2004 and January 2006, all consecutive patients with clinical suspicion of a RAAA at presentation were assessed prospectively. Anatomical suitability for endovascular repair was based on use of an aorto-uni-iliac endovascular graft and assessed in patients with a proven aortic rupture on CT angiography (CTA).In 128/256 patients, presenting with clinical suspicion of a ruptured aneurysm, RAAA was diagnosed. 105 patients were brought to a trial center and CTA confirmed RAAA in 83 patients. In 38

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2007 European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Controlled trial quality: uncertain

6637. Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. (PubMed)

%), and abdominal aorta (26%). This study was limited in detail to 811 patients who had ascending and ascending and aortic arch replacement for aneurysm. These patients were divided into 3 subgroups: (1) 524 patients with no distal disease; (2) 135 patients with distal disease treated by subtotal replacement in 82 and total replacement in 53; and (3) 152 patients with distal disease not treated. The 5-year survival rate from the time of first operation, including early death from operation was 75% in group 1 (...) Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. The life expectancy of patients with aortic aneurysm is significantly prolonged by graft replacement therapy. Regardless, a significant predictor of late death is complications of either residual aortic aneurysmal disease or the development of additional aortic aneurysm. This paper reviews

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1990 Annals of Surgery

6638. Health service costs and quality of life for early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. UK Small Aneurysm Trial Participants. (PubMed)

Health service costs and quality of life for early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. UK Small Aneurysm Trial Participants. Uncertainty surrounds the best approach to management of patients with symptomless abdominal aortic aneurysms of 4.0-5.5 cm in diameter. The UK Small Aneurysm Trial showed that surveillance and early prophylactic elective surgical repair had similar survival benefits. We compared the impact on health service costs (...) for early surgery than for ultrasonographic surveillance for small aortic aneurysms. Early surgery is, however, associated with improvement in some features of health-related quality of life that should be taken into account with the finding that early surgical repair gives no significant survival advantage over surveillance.

1998 Lancet

6639. Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. (PubMed)

Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants. Early elective surgery may prevent rupture of abdominal aortic aneurysms, but mortality is 5-6%. The risk of rupture seems to be low for aneurysms smaller than 5 cm. We investigated whether prophylactic open surgery decreased long-term mortality risks for small aneurysms.We randomly assigned 1090 patients (...) aged 60-76 years, with symptomless abdominal aortic aneurysms 4.0-5.5 cm in diameter to undergo early elective open surgery (n=563) or ultrasonographic surveillance (n=527). Patients were followed up for a mean of 4.6 years. If the diameter of aneurysms in the surveillance group exceeded 5.5 cm, surgical repair was recommended. The primary endpoint was death. Mortality analyses were done by intention to treat.The two groups had similar cardiovascular risk factors at baseline. 93% of patients

1998 Lancet Controlled trial quality: predicted high

6640. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. (PubMed)

The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Opposing views have been published on the importance of ultrasound screening for abdominal aortic aneurysms. The Multicentre Aneurysm Screening Study was designed to assess whether or not such screening is beneficial.A population-based sample of men (n=67800) aged 65-74 years was enrolled, and each individual randomly allocated to either (...) receive an invitation for an abdominal ultrasound scan (invited group, n=33839) or not (control group, n=33961). Men in whom abdominal aortic aneurysms (> or =3 cm in diameter) were detected were followed-up with repeat ultrasound scans for a mean of 4.1 years. Surgery was considered on specific criteria (diameter > or =5.5 cm, expansion > or =1 cm per year, symptoms). Mortality data were obtained from the Office of National Statistics, and an intention-to-treat analysis was based on cause of death

2002 Lancet Controlled trial quality: predicted high

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