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Abdominal Aortic Aneurysm

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6701. Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: clinical outcomes with 1-year follow-up. Full Text available with Trip Pro

Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: clinical outcomes with 1-year follow-up. To compare the clinical outcomes of treatment after endovascular repair and open surgery in patients with ruptured infrarenal abdominal aortic aneurysms (AAAs), including 1-year follow-up.All consecutive conscious patients with ruptured infrarenal AAAs who presented to our tertiary care teaching hospital between January 1, 2001, and December 31, 2005, were (...) ). During 1-year follow-up, two patients initially treated with endovascular repair died as a result of non-aneurysm-related causes; no death occurred in the open surgery group. Complications during 1-year follow-up were 1 (5%) of 20 for endovascular repair and 4 (16%) of 25 for open surgery (P = .36).On the basis of our study with a highly selected population, the mortality and complication rates after endovascular repair may be similar compared with those after open surgery in patients treated

2006 Journal of Vascular Surgery

6702. Long-term outcome and reintervention after endovascular abdominal aortic aneurysm repair using the Zenith stent graft. Full Text available with Trip Pro

Long-term outcome and reintervention after endovascular abdominal aortic aneurysm repair using the Zenith stent graft. To assess the long-term performance of the bifurcated Zenith stent graft.A total of 325 patients (300 men and 25 women) underwent elective endovascular abdominal aortic aneurysm repair with bifurcated Zenith stent grafts between October 1998 and December 2005. Follow-up included routine contrast-enhanced computed tomography and multiview abdominal radiographs at 1, 6, and 12 (...) %) of these patients died from causes related to malfunction of the stent graft: one each from aneurysm rupture, stent-graft infection, and infection of a femoral-femoral bypass graft placed after limb occlusion. Nineteen additional patients (5.8%) required treatment for type II endoleak, for a total reintervention rate of 8.6%.Late failures of Zenith stent-graft attachment, structure, or function are rare. In the absence of known endoleak, routine follow-up imaging plays a limited role in the identification

2007 Journal of Vascular Surgery

6703. Concomitant detection of systemic atherosclerotic disease while screening for abdominal aortic aneurysm. (Abstract)

Concomitant detection of systemic atherosclerotic disease while screening for abdominal aortic aneurysm. Although population screening for abdominal aortic aneurysm (AAA) has/had a significant impact on disease-specific mortality, coexisting systemic atherosclerosis represents the major impediment to improved longevity. We examined the feasibility and yield of full cardiovascular assessment concomitant with screening for AAA detection.A total of 1032 asymptomatic men over the age of 50 years (...) cardiac disease.Overall, we detected an AAA>3 cm in 30 men (2.9%). Unaddressed obesity, smoking, hypertension, impaired glucose metabolism, and hypercholesterolemia were commonly identified in individuals both with and without an AAA, being notably frequent in those>60 years without an AAA. The 10-year risk of IHD and CHD in those>60 years was similar regardless of whether an AAA was present. Doppler screening for significant carotid stenosis had detection rates similar to those for aortic US scanning

2006 World Journal of Surgery

6704. Endovascular techniques for the treatment of ruptured abdominal aortic aneurysms: 7-year intention-to-treat results. (Abstract)

Endovascular techniques for the treatment of ruptured abdominal aortic aneurysms: 7-year intention-to-treat results. The purpose of this single-institution study was to describe our 7-year intention-to-treat results, obtained with the use of endovascular techniques for the treatment of ruptured abdominal aortic aneurysms (rAAA).From October 1998 until March 2005, a total of 28 patients were admitted or transferred to our department with an rAAA. They were all treated according to a management

2006 World Journal of Surgery

6705. Biomechanical properties of ruptured versus electively repaired abdominal aortic aneurysm wall tissue. Full Text available with Trip Pro

Biomechanical properties of ruptured versus electively repaired abdominal aortic aneurysm wall tissue. The purpose of this study was to evaluate and compare the biomechanical properties of abdominal aortic aneurysm (AAA) wall tissue from patients who experienced AAA rupture with that of those who received elective repair.Rectangular, circumferentially oriented AAA wall specimens (approximately 2.5 cm x 7 mm) were obtained fresh from the operating room from patients undergoing surgical repair (...) < .05) and a significant positive correlation with the tissue maximum tangential modulus (R = 0.76; P < .05).Our data suggest that AAA rupture is associated with aortic wall weakening, but not with wall stiffening. A widely accepted indicator for risk of aneurysm rupture is the maximum transverse diameter. Our results suggest that AAA wall strength, in large aneurysms, is not related to the maximum transverse diameter. Rather, wall thickness or stiffness may be a better predictor of rupture

2006 Journal of Vascular Surgery

6706. Adjunctive primary stenting of Zenith endograft limbs during endovascular abdominal aortic aneurysm repair: implications for limb patency. Full Text available with Trip Pro

Adjunctive primary stenting of Zenith endograft limbs during endovascular abdominal aortic aneurysm repair: implications for limb patency. Endograft limb occlusion is an infrequent but serious complication of endovascular abdominal aortic aneurysm (AAA) repair. The insertion of additional stents within the endograft limb may prevent future occlusion. This study evaluates limb patency with and without adjunctive stenting of endograft limbs at the time of endovascular AAA repair.We performed (...) a retrospective review of 248 patients who underwent endovascular abdominal aortic aneurysm repair with the Zenith AAA endovascular graft between 1999 and 2004. Among these patients, two groups were identified: 64 patients with adjunctive stents placed in 85 limbs and 184 patients without additional bare stent placement in endograft limbs at the time of endovascular AAA repair.Women comprised 23% of stented and 11% of unstented patients (P = .02). The mean length of follow-up in the stented and unstented

2006 Journal of Vascular Surgery

6707. Laparoscopy-assisted abdominal aortic aneurysm repair: early and middle-term results of a consecutive series of 122 cases. Full Text available with Trip Pro

consecutive nonurgent AAAs were treated at our institution. Of these, 122 (20.2%) were treated by HALS. Exclusion criteria for HALS were hostile abdomen (previous major abdominal or aortic surgery), bilateral diffuse common iliac and/or hypogastric aneurysms, massive aortoiliac calcifications, and severe cardiac (ejection fraction <35%) and respiratory (P(O2) <60 mm Hg or carbon dioxide >50 mm Hg) insufficiency. Juxtarenal and proximal iliac aneurysms were not a contraindication, nor was obesity. In all (...) Laparoscopy-assisted abdominal aortic aneurysm repair: early and middle-term results of a consecutive series of 122 cases. Endoaneurysmorrhaphy with intraluminal graft placement, described by Creech, is the gold standard for abdominal aortic aneurysm (AAA) repair. Endovascular aneurysm repair has gained popularity for its minimal invasiveness and satisfying short-term results, but there are still many concerns about the long-term success of the procedure. Since 1998, laparoscopic surgery has

2006 Journal of Vascular Surgery

6708. Successful endovascular repair of a ruptured abdominal aortic aneurysm in a patient with unfavorable anatomy. Full Text available with Trip Pro

Successful endovascular repair of a ruptured abdominal aortic aneurysm in a patient with unfavorable anatomy. Endovascular repair of an abdominal aortic aneurysm (AAA) offers hope of improved outcomes in patients presenting with acute rupture. However, a high proportion of such patients have unfavorable proximal neck anatomy and are not suitable for treatment with conventional endografts. Fenestrated endografts overcome the problem of a short proximal neck, but at present their deployment

2006 Journal of Vascular Surgery

6709. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. Full Text available with Trip Pro

Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. The purpose of this study was to evaluate the need for secondary interventions after endovascular abdominal aortic aneurysm repair with current stent-grafts.Studied were data from 2846 patients treated from December 1999 until December 2004. The data were recorded from the EUROSTAR registry. The only patients studied were those with a follow-up of at least 12 months (...) ) compared with patients without a secondary intervention.Although the incidence of secondary interventions after endovascular aneurysm repair has substantially decreased in recent years, continuing need for surveillance for device-related complications remains necessary.

2006 Journal of Vascular Surgery

6710. Endovascular repair of Salmonella-infected abdominal aortic aneurysms: a word of caution. Full Text available with Trip Pro

Endovascular repair of Salmonella-infected abdominal aortic aneurysms: a word of caution. Over the last several years, treatment modalities have changed for infected aortic aneurysms. Surgical treatment has undergone a paradigm shift from débridement and extra-anatomic bypass to direct reconstruction to, most recently, endovascular repair. Although many reports of endovascular repair of such aneurysms are favorable, the following two cases highlight some of the concerns with endografts

2006 Journal of Vascular Surgery

6711. Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms. Full Text available with Trip Pro

Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms. Among various methods to achieve rapid occlusion of the aorta during endovascular repair for ruptured abdominal aortic aneurysm, particular emphasis is placed on two techniques that have been incorporated into our endovascular repair practice. The sheath-over-balloon technique (the Loan SOB technique) facilitates hemodynamic stability by transfemoral endovascular placement of an aortic occlusion (...) balloon catheter to the infrarenal abdominal aorta. The balloon-ahead-of-graft technique (the Hornsby BAG technique) allows suprarenal hemodynamic control using a stent-graft system with a built-in balloon. The two techniques are simple, quick, and effective in achieving hemodynamic stability.

2006 Journal of Vascular Surgery

6712. Increasing incidence of ruptured abdominal aortic aneurysm: a population-based study. Full Text available with Trip Pro

Increasing incidence of ruptured abdominal aortic aneurysm: a population-based study. The aim of the present population-based study was to assess the trends of age- and gender-specific incidence of ruptured abdominal aortic aneurysm (rAAA).Patients with rAAA from the city of Malmö, Sweden, were studied between 2000 and 2004. An analysis of trends of incidence and mortality of rAAA in Malmö was possible because of a previous population-based study on patients with rAAA between 1971 and 1986

2006 Journal of Vascular Surgery

6713. Tetraplegia after elective abdominal aortic aneurysm repair. Full Text available with Trip Pro

Tetraplegia after elective abdominal aortic aneurysm repair. Spinal cord ischemia after elective infrarenal aortic aneurysm repair is extremely rare, and documented cases that are described are of paraplegia. This case of tetraplegia occurred in a 64-year-old man with disabling claudication after an aortobifemoral graft repair for occlusive disease associated with a 5-cm infrarenal aneurysm. Magnetic resonance imaging supported lower cervical spinal cord ischemia, an unusual area for ischemia (...) during aortic clamping since this area is usually most resistant. Because the lower thoracic and upper lumbar region, typically T8, is more susceptible to ischemia due to the variable collateral spinal cord circulation, the level of clamping was unlikely to be responsible. Other causes are considered. It was likely to be multifactorial and illustrates the need for great attention to detail in perioperative management and patient consent.

2006 Journal of Vascular Surgery

6714. Endovascular abdominal aortic aneurysm repair: long-term outcome measures in patients at high-risk for open surgery. Full Text available with Trip Pro

Endovascular abdominal aortic aneurysm repair: long-term outcome measures in patients at high-risk for open surgery. The study was conducted to determine the outcome in the United States after endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs) in patients at high-risk for open surgery by using independently audited, high-compliance, chart-verified data sets, and to compare those results with open surgery.High-risk was defined to match a recent European trial (EVAR2 (...) ) and included age of > or =60 years with aneurysm size of > or =5.5 cm, plus at least one cardiac, pulmonary, or renal comorbidity. Data from five multicenter investigational device exemption clinical trials leading to Food and Drug Administration (FDA) approval were analyzed. Of 2216 EVAR patients, 565 met the high-risk criteria. Of 342 surgical controls (OPEN), 61 met high-risk criteria. Primary outcome comparisons included AAA-related death, all-cause death, and aneurysm rupture. Secondary measures were

2006 Journal of Vascular Surgery

6715. Endograft treatment of ruptured abdominal aortic aneurysms using the Talent aortouniiliac system: an international multicenter study. Full Text available with Trip Pro

Endograft treatment of ruptured abdominal aortic aneurysms using the Talent aortouniiliac system: an international multicenter study. To understand the potential of endovascular aneurysm repair (EVAR) in patients presenting with a ruptured abdominal aortic aneurysm (rAAA), the proportion in whom this procedure was applicable was assessed. Mortality and morbidity was also determined in patients treated with emergency EVAR (eEVAR) when anatomic and hemodynamic conditions allowed (ie (...) , in the entire cohort with patients receiving endovascular and open repair combined). In addition, a comparison was made between the treatment group with eEVAR and open repair.Between February 2003 and September 2004, 10 participating institutions enrolled a representative sample of 100 consecutive patients in whom eEVAR was considered. Patients in the New Endograft treatment in Ruptured abdominal aortic Aneurysm (ERA) trial were offered eEVAR or open repair in accordance with their clinical condition

2006 Journal of Vascular Surgery

6716. Activated coagulation during open and endovascular abdominal aortic aneurysm repair. Full Text available with Trip Pro

Activated coagulation during open and endovascular abdominal aortic aneurysm repair. The study was conducted to determine activation of coagulation in patients undergoing open and endovascular infrarenal abdominal aortic aneurysm repair (EVAR).In a prospective, comparative study, 30 consecutive patients undergoing open repair (n = 15) or EVAR (n = 15) were investigated. Blood samples to determine fibrinopeptide A, fibrin monomer, thrombin-antithrombin complex, and D-dimer were taken up to 5

2006 Journal of Vascular Surgery

6717. Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. Full Text available with Trip Pro

Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. In our transition from elective abdominal aortic aneurysm (AAA) to emergent ruptured AAA (r-AAA) repair with endovascular techniques, we recognized that the availability of endovascularly trained staff in the operating rooms and emergency departments, and adequate equipment were the limiting factors. To this end, we established a multidisciplinary protocol (...) patients (18%) needed supraceliac aortic occlusion balloon, and six (15%) needed aortouniiliac stent-grafts. The mean blood loss was 455 mL (range, 115 to 1100 mL). Two patients each (5%) developed myocardial infarction, renal failure, and ischemic colitis, seven (18%) developed abdominal compartment syndrome, and seven (18%) died. Over a mean follow-up of 17 months, three patients with endovascular r-AAA repair required four secondary procedures.The early results show that emergent endovascular

2006 Journal of Vascular Surgery

6718. An intention-to-treat by endovascular repair policy may reduce overall mortality in ruptured abdominal aortic aneurysm. Full Text available with Trip Pro

An intention-to-treat by endovascular repair policy may reduce overall mortality in ruptured abdominal aortic aneurysm. The use of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) has been restricted to a small number of specialized units on a selected group of patients. The aim of this study is to assess if the overall mortality in these patients with ruptured AAA may be reduced in a unit where all patients with ruptured AAA are considered first for EVAR.During (...) a 24-month period beginning in July 2002, 51 patients admitted with ruptured AAA were considered for EVAR as the treatment of choice and comprised the study group. EVAR was performed in 17 patients. Open repair was performed in 34 patients: 13 patients had hemodynamic instability and 16 patients had an unsuitable aortic neck anatomy. The study group was compared with a historical control group of 41 patients with ruptured AAA who were treated by open repair from July 2000 to June 2002.Mortality

2006 Journal of Vascular Surgery

6719. Decreased incidence of left common iliac vein compression in patients with abdominal aortic aneurysms. Full Text available with Trip Pro

Decreased incidence of left common iliac vein compression in patients with abdominal aortic aneurysms. Compression of the left common iliac vein (LCIV) by the right common iliac artery is an anatomic variant that may increase the risk for LCIV thrombosis. The incidence of LCIV compression in patients with abdominal aortic aneurysms (AAA) is unknown, however. The aim of this descriptive anatomic study was to determine (1) the incidence of LCIV compression in patients with and without AAA and (2

2006 Journal of Vascular Surgery

6720. Outcomes of endovascular treatment of ruptured abdominal aortic aneurysms. Full Text available with Trip Pro

Outcomes of endovascular treatment of ruptured abdominal aortic aneurysms. The successful application of endovascular techniques for the elective repair of abdominal aortic aneurysms (AAAs) has stimulated a strong interest in their possible use in dealing with a long-standing surgical challenge: the ruptured abdominal aortic aneurysm (RAAA). The use of a conventional open procedure to repair ruptured aneurysms is associated with a high operative mortality of 45% to 50%. In this study, we (...) evaluated the current frequency of endovascular repair of RAAAs in four large states and the impact of this technique on patient outcome.We examined discharge data sets from 2000 through 2003 from the four states of California, Florida, New Jersey, and New York, whose combined population represents almost a third of the United States population. Proportions and trends were analyzed by chi2 analysis and continuous variables by the Student's t test.We found that since the year 2000, endovascular repair

2006 Journal of Vascular Surgery

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