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Abdominal Aortic Aneurysm

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6681. Outcome and quality of life in patients treated for abdominal aortic aneurysms: a single center experience. Full Text available with Trip Pro

Outcome and quality of life in patients treated for abdominal aortic aneurysms: a single center experience. Durability of protection and long-term quality of life (QoL) are critical outcome parameters of abdominal aortic aneurysm (AAA) repair. The aim of the present study was to compare results of endovascular and open aneurysm repair (EVAR and OR) with adjusted standard populations, including stratification for urgency of presentation.Retrospective analysis of prospectively collected data

2008 World Journal of Surgery

6682. Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the Ancure stent graft. Full Text available with Trip Pro

Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the Ancure stent graft. We report a case of aortoduodenal fistula 5 years after uncomplicated endovascular abdominal aortic aneurysm repair. The diagnosis was confirmed by abdominal computed tomography scan and esophagogastroduodenoscopy. The patient was successfully treated with primary duodenal repair, removal of the infected graft, in situ placement of a bifurcated graft, and omental interposition. Review (...) of the literature identifies this as one of very few documented aortoduodenal fistulas after endovascular aneurysm repair. Fistulization occurred despite accurate stent graft placement without migration, endoleak, or aortic sac size enlargement on annual postoperative imaging studies.

2007 Journal of Vascular Surgery

6683. Optimizing compliance, efficiency, and safety during surveillance of small abdominal aortic aneurysms. Full Text available with Trip Pro

Optimizing compliance, efficiency, and safety during surveillance of small abdominal aortic aneurysms. Outcome data documenting safety for observation of small abdominal aortic aneurysms (AAA 4.0 to 5.4 cm) are lacking outside of large clinical trials but requires near perfect patient compliance. This study describes a clinical pathway for AAA surveillance using a prospective database utilizing a nurse practitioner oversight to provide efficient use of clinic visits while maintaining a high (...) to >5.4 cm (n = 219) or expansion by >1cm/yr (n = 6). One hundred six patients currently remain in surveillance. A single AAA rupture resulting in death occurred during surveillance (0.3%) and perioperative mortality (<60 days) was 0.9% in patients needing intervention for AAA growth. Cumulative aneurysm-related mortality was 0.9% for patients compliant with the AAA surveillance pathway.Use of a prospectively-maintained surveillance database managed by a non-physician provider with a reliance

2007 Journal of Vascular Surgery

6684. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. Full Text available with Trip Pro

Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. Type 2 endoleak occurs in up to 20% of patients after endovascular aneurysm repair (EVAR), but its long-term significance is debated. We reviewed our experience to evaluate late outcomes associated with type 2 endoleak.During the interval January 1994 to December 2005, 873 patients underwent EVAR. Computed tomography (CT) scan assessment was performed < or =1 month (...) of the operation and at least annually thereafter. Sequential 6-month CT scan follow-up was adopted for those patients with persistent type 2 endoleaks, and reintervention was limited to those with sac enlargement >5 mm. Study end points included overall survival, aneurysm sac growth, reintervention rate, conversion to open repair, and abdominal aortic aneurysm (AAA) rupture. Preoperative variables and anatomic factors potentially associated with these endpoints were assessed using multivariate analysis.We

2007 Journal of Vascular Surgery

6685. Objective scoring systems of medical risk: a clinical tool for selecting patients for open or endovascular abdominal aortic aneurysm repair. Full Text available with Trip Pro

Objective scoring systems of medical risk: a clinical tool for selecting patients for open or endovascular abdominal aortic aneurysm repair. Objective scoring systems have been developed for risk stratification of open infrarenal aneurysm repair. To date, none have been applied for the selection of patients who would most benefit from either an open or an endovascular approach. This study assessed the utility of comorbidity-based objective scoring systems for defining subgroups of patients who (...) might most benefit from open or endovascular aneurysm repair.A retrospective database review was performed for the period January 1999 to December 2004 to identify patients who had undergone elective open aneurysm repair (open repair) or elective endovascular aneurysm repair (EVAR). Validation of the Glasgow Aneurysm Score (GAS), the Modified Leiden Score (M-LS), and the Modified Comorbidity Severity Score (M-CSS) was performed for perioperative mortality risk in the open repair group. GAS, M-LS

2007 Journal of Vascular Surgery

6686. Elevated tissue plasminogen activator in patients with screening-detected abdominal aortic aneurysm. Full Text available with Trip Pro

Elevated tissue plasminogen activator in patients with screening-detected abdominal aortic aneurysm. A population-based case-control study with historical and current data was conducted in a population with a high prevalence of disease to explore the hypothesis that the fibrinolytic system may be involved in the early pathogenesis of abdominal aortic aneurysm (AAA).Forty-two patients found to have AAA at population-based screening were compared with 100 controls matched for age and sex. Mass

2007 Journal of Vascular Surgery

6687. Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. Full Text available with Trip Pro

Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. The study was conducted to demonstrate improved survival (30-day mortality) after the introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms (rAAA). Numerous authors have successfully demonstrated reduced mortality in patients with rAAA using endovascular techniques. Comparison of endovascular aneurysm repair (EVAR) with open

2007 Journal of Vascular Surgery

6688. Outcomes of original and low-permeability Gore Excluder endoprosthesis for endovascular abdominal aortic aneurysm repair. Full Text available with Trip Pro

Outcomes of original and low-permeability Gore Excluder endoprosthesis for endovascular abdominal aortic aneurysm repair. Because of concern about the percentage of enlarging abdominal aortic aneurysms (AAAs) after endovascular repair with the Excluder device (W.L. Gore & Assoc, Inc, Sunnyvale, Calif), the graft material was modified to reduce its permeability and released for commercial use in mid-2004. We studied all AAA repairs with Excluder endografts performed at our institution, including (...) -Whitney U test for unpaired samples.Preoperative and postoperative anatomy was similar in the two groups, including AAA diameter (OP, 5.6 +/- 1 cm; LP, 5.8 +/- 2 cm; P = .3), aortic neck length (OP, 21 +/- 1 mm; LP, 22 +/- 2 mm; P = .9), postoperative aortic seal zone (OP, 18 +/- 1 mm; LP, 16 +/- 1 mm, P > .1) and iliac seal zone (OP, 33 +/- 1 mm, LP 31 +/- 1 mm, P = .2). The rate of sac shrinkage differed significantly. Orthogonal diameter measurements showed a significant difference in the rate

2007 Journal of Vascular Surgery

6689. Elective treatment of abdominal aortic aneurysm with endovascular or open repair: the first decade. Full Text available with Trip Pro

Elective treatment of abdominal aortic aneurysm with endovascular or open repair: the first decade. The development of endovascular aneurysm repair (EVAR) as an alternative to open repair of abdominal aortic aneurysms (AAA) has led to an increasing number of patients being treated by this less-invasive technique. It was anticipated that EVAR would reduce the operative mortality and morbidity compared with open repair. This study examined the initial 10-year experience in one center when both (...) techniques were available to determine if there were advantages to one technique or the other, putting the results into the perspective of routine clinical care of patients with infrarenal AAA.From June 1996 to May 2005, 677 patients underwent elective repair of their infrarenal AAA, of which 417 were treated with open repair and 260 by EVAR. Demographic and aneurysm-specific data, comorbidities, operative morbidity, mortality, and late outcome were analyzed.Open repair patients were 2 years younger (71

2007 Journal of Vascular Surgery

6690. Intraobserver and interobserver variability of 64-row computed tomography abdominal aortic aneurysm neck measurements. Full Text available with Trip Pro

Intraobserver and interobserver variability of 64-row computed tomography abdominal aortic aneurysm neck measurements. Integrity of the abdominal aortic aneurysm (AAA) neck is crucial for the long-term success of endovascular AAA repair (EVAR). However, suitable tools for reliable assessment of changes in small aortic volumes are lacking. The purpose of this study was to assess the intraobserver and interobserver variability of software-enhanced 64-row computed tomographic angiography (CTA) AAA (...) dedicated software. Variability was calculated as 1.96 SD of the mean arithmetic difference according to Bland and Altman. Two-sided and paired t tests were used to compare measurements. P values <.05 were considered to indicate statistical significance.Intraobserver agreement was excellent for dedicated aneurysmal neck volumetry, with mean differences of less than 1 mL (P > .05), whereas it was poor for transverse aortic neck diameter measurements (P < .05). However, interobserver variability

2007 Journal of Vascular Surgery

6691. Patient-reported quality of life after abdominal aortic aneurysm surgery: a prospective comparison of endovascular and open repair. Full Text available with Trip Pro

Patient-reported quality of life after abdominal aortic aneurysm surgery: a prospective comparison of endovascular and open repair. This study evaluated and compared changes over time in health-related quality of life reported by patients with infrarenal abdominal aortic aneurysm (AAA) undergoing elective endovascular (EVAR) and open aneurysm (OR) repair.A prospective, nonrandomized cohort of 76 patients (62 men, 14 women; age range, 42 to 89 years) undergoing elective, infrarenal AAA repair

2006 Journal of Vascular Surgery

6692. Salvage of failed prior endovascular abdominal aortic aneurysm repair with fenestrated endovascular stent grafts. Full Text available with Trip Pro

Salvage of failed prior endovascular abdominal aortic aneurysm repair with fenestrated endovascular stent grafts. Three patients with type I proximal endoleak after previous endovascular abdominal aortic aneurysm (AAA) repair were treated with fenestrated endovascular stent grafts. Six renal arteries, three superior mesenteric arteries, and one coeliac axis were targeted for incorporation by graft fenestration. The fenestration-renal ostium interface was secured with balloon-expandable stents

2006 Journal of Vascular Surgery

6693. Challenges and opportunities in abdominal aortic aneurysm research. Full Text available with Trip Pro

Challenges and opportunities in abdominal aortic aneurysm research. Abdominal Aortic Aneurysms (AAAs) are associated with advanced age, male gender, cigarette smoking, atherosclerosis, hypertension, and genetic predisposition. Basic research studies have led to a better understanding of aneurysm disease over the past two decades. There has also been a growing appreciation that fundamental knowledge regarding the process of aneurysmal degeneration is still somewhat limited. Opportunities (...) in research include: 1) the investigation of potential new mechanism-based pharmacologic interventions; 2) identify the genetic basis for an inherited predisposition; 3) develop and refine noninvasive approaches for the early detection; 4) examine potential novel surgical approaches and design new biomaterials; and 5) initiate and promote awareness programs for diagnosis and treatment of aortic aneurysms. The optimal approach to addressing these issues will require integrative, multidisciplinary research

2007 Journal of Vascular Surgery

6694. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures. Full Text available with Trip Pro

Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures. Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking.A review of the English language (...) literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable.We identified

2007 Journal of Vascular Surgery

6695. Impaired Fas-induced apoptosis of T lymphocytes in patients with abdominal aortic aneurysms. Full Text available with Trip Pro

Impaired Fas-induced apoptosis of T lymphocytes in patients with abdominal aortic aneurysms. Homeostasis of the immune system is maintained by apoptotic elimination of potentially pathogenic autoreactive lymphocytes. Emerging evidence shows that Fas-mediated apoptosis is impaired in activated lymphocytes from patients with autoimmune disease. The aim of this work was to assess apoptosis mediated by the cell death receptor Fas in peripheral T lymphocytes from patients with abdominal aortic (...) aneurysms (AAA).The apoptotic pathway was triggered by anti-Fas monoclonal antibodies in cultured and activated peripheral T-cell lines from 20 AAA patients with control groups of 15 patients with aortic atherosclerotic occlusive disease (AOD) and 25 healthy individuals. Cell survival and death (apoptosis) rate were assessed.Cross-linkage of Fas receptor exerted a strong apoptotic response on T cells from AOD patients and healthy controls, but a much less pronounced effect on T cells from AAA patients

2007 Journal of Vascular Surgery

6696. The impact of gender on presentation, therapy, and mortality of abdominal aortic aneurysm in the United States, 2001-2004. Full Text available with Trip Pro

The impact of gender on presentation, therapy, and mortality of abdominal aortic aneurysm in the United States, 2001-2004. The elective repair of abdominal aortic aneurysms (AAA) may decrease a patient's risk of rupture and confers a significantly lower in-hospital mortality rate than emergency repair. Previous works have shown that AAA rupture rates are higher in women compared to men, and that women have higher associated in-hospital mortality rates. This study was performed to evaluate (...) , currently, to what extent patient gender influences presentation and treatment of AAA and the associated outcomes in the United States.The Nationwide Inpatient Sample was used, with pertinent ICD-9 codes, to identify all patient-discharges that occurred with the primary diagnosis of intact (iAAA) or ruptured/dissecting (rAAA) abdominal aortic aneurysms between the years 2001 and 2004. Univariate and multiple logistic regression analyses of variables were performed.An estimated 220,403 AAA patient

2007 Journal of Vascular Surgery

6697. Low vitamin B6, and not plasma homocysteine concentration, as risk factor for abdominal aortic aneurysm: a retrospective case-control study. Full Text available with Trip Pro

Low vitamin B6, and not plasma homocysteine concentration, as risk factor for abdominal aortic aneurysm: a retrospective case-control study. Hyperhomocysteinemia has been associated with vascular disease in many epidemiologic studies, but only a few have reported on the relation between hyperhomocysteinemia and aneurysms of the abdominal aorta (AAAs). Although these studies showed higher homocysteine concentrations in patients with AAA than in controls, little attention had been given

2007 Journal of Vascular Surgery

6698. The role of human leukocyte antigen genes in the formation of abdominal aortic aneurysms. Full Text available with Trip Pro

The role of human leukocyte antigen genes in the formation of abdominal aortic aneurysms. Increasing evidence suggests an autoimmune component to abdominal aortic aneurysm (AAA) formation. This study was conducted to determine if a difference exists in human leukocyte antigen (HLA) allele distribution between patients with AAA and population controls, and between patients with small and large AAA.Patients with known AAA attending the vascular unit were consented for recruitment. HLA-A, HLA-B (...) and HLA-DR was determined by polymerase chain reaction and sequence-specific oligonucleotide probes. The distribution of these alleles in the Northern Ireland general population was obtained from the histocompatibility and immunogenetics database. The chi(2) test was used for statistical analysis with Bonferroni correction.A total of 241 AAA patients were recruited, with a wide range of aneurysm size. In class I, the most frequent allele families were HLA-A*02 and *01 and HLA-B*07, *08, and *44

2007 Journal of Vascular Surgery

6699. The pro-inflammatory and chemotactic cytokine microenvironment of the abdominal aortic aneurysm wall: a protein array study. Full Text available with Trip Pro

The pro-inflammatory and chemotactic cytokine microenvironment of the abdominal aortic aneurysm wall: a protein array study. Cytokines are inflammatory mediators implicated in abdominal aortic aneurysm (AAA) pathogenesis. The cytokine expression profile of the AAA is poorly defined and has focused on the expression of pro-inflammatory cytokines, at the expense of chemokines and growth factors. This study aims to investigate the cytokine expression profile of the established AAA wall.Cytokine (...) protein expression was measured in homogenized human aortic tissue (10 AAAs and 9 nonaneurysmal controls) using a 42-cytokine antibody-based protein array. Data were quantified using densitometric analysis and statistically analyzed using a Mann-Whitney U test.A significant difference in cytokine expression between AAA and control samples was found in 15 of 42 cytokines. Several pro-inflammatory cytokines were upregulated within the AAA compared with the control: interleukin (IL)-6 (P = .001), IL

2007 Journal of Vascular Surgery

6700. A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. Full Text available with Trip Pro

A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. To retrospectively compare a single center's immediate and mid-term outcomes of ruptured abdominal aortic aneurysm open and endovascular repair (EVAR) for two patient groups-hemodynamically stable and unstable patients-in the same time period.Patients presenting at our center with confirmed rupture of an abdominal aortic aneurysm between (...) %), and for open repair it was 10% (unstable, 9%; stable, 15%). We recorded a 27% severe complication rate for EVAR patients (unstable, 40%; stable, 17%), and for patients treated with open repair, it was 33% (unstable, 35%; stable, 29%). Our overall EVAR eligibility rate was 52%, and our overall EVAR treatment rate was 27%.Our study's overall results for EVAR remain encouraging when compared with those of conventional repair, but large randomized trials are required to confirm the efficacy of the procedure.

2006 Journal of Vascular Surgery

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