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Abdominal Aortic Aneurysm

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121. Stent graft types for endovascular repair of abdominal aortic aneurysms. (Abstract)

Stent graft types for endovascular repair of abdominal aortic aneurysms. The UK prevalence of abdominal aortic aneurysm (AAA) is estimated at 4.9% in over 65-year olds. Progressive and unpredictable enlargement can lead to rupture. Endovascular repair of AAAs involves a stent graft system being introduced via the femoral artery and manipulated within the aorta under radiological guidance. Following endograft deployment, a seal is formed at the proximal and distal landing zones to exclude (...) comparisons of the performance of different stent graft types. Therefore, this review cannot recommend guidance to clinicians in their selection of stent graft types. High quality randomised controlled trials evaluating stent graft types in abdominal endovascular aneurysm repair are required.

2013 Cochrane

122. Primary care screening for abdominal aortic aneurysm: a systematic evidence review for the US Preventive Services Task Force

for abdominal aortic aneurysm (AAA) screening for men aged 65 years or older was associated with decreased AAA rupture and mortality, but no difference in all-cause mortality. The authors' conclusions largely follow from the presented evidence and appear to be reliable for older Caucasian men. Authors' objectives To assess the benefits and harms of programmes to screen for abdominal aortic aneurysm (AAA) and treat small aneurysms, and to determine the screening yield for population subgroups. Searching (...) Primary care screening for abdominal aortic aneurysm: a systematic evidence review for the US Preventive Services Task Force Primary care screening for abdominal aortic aneurysm: a systematic evidence review for the US Preventive Services Task Force Primary care screening for abdominal aortic aneurysm: a systematic evidence review for the US Preventive Services Task Force Guirguis-Blake JM, Beil TL, Sun X, Senger CA, Whitlock EP CRD summary This review concluded that one-time invitation

2014 DARE.

123. Upper gastrointestinal hemorrhage and thoracic aortic aneurysm rupture as presenting signs of Behçet disease: A case report. Full Text available with Trip Pro

Upper gastrointestinal hemorrhage and thoracic aortic aneurysm rupture as presenting signs of Behçet disease: A case report. Behçet disease (BD) is an autoimmune disorder characterized by oral aphthosis, genital aphthosis, ocular lesions, and arthritis. However, other fatal complications are often misdiagnosed, which implies that the early diagnosis of the disease is important for a good prognosis.A 51-year-old man complained of hematemesis for 5 hours and syncope once.BD as demonstrated (...) by esophageal ulcer and aortic aneurysm rupture.Surgeries were conducted to repair the thoracic aortic aneurysm, proton-pump inhibitor was used to reduce acid secretion, antibiotics were applied for anti-infective therapy, and immunosuppressor was administered to control the injuries of BD.The patient was discharged and his medication dosage was reduced gradually until the minimum maintenance dose. In the follow-ups, the gastric ulcer and vascular aneurysm were not found.We presented a rare case of BD

2019 Medicine

124. Design of The PReferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) Trial. (Abstract)

Design of The PReferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) Trial. For patients with abdominal aortic aneurysm, randomized trials have found endovascular AAA repair (EVAR) is associated with lower perioperative morbidity and mortality than open surgical repair (OSR). However, OSR has fewer long-term aneurysm-related complications such as endoleak or late rupture. Patients treated with EVAR and OSR have similar survival rates within two years following (...) surgery, and OSR does not require intensive surveillance. Few have examined if patient preferences are aligned with the type of treatment they receive for their AAA. While many assume that patients may universally prefer the less invasive nature of EVAR, our preliminary work suggests that patients who value the lower risk of late complications may prefer OSR. In this study, called The PReferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) trial, we describe a cluster

2019 Annals of vascular surgery Controlled trial quality: uncertain

125. Efficacy of Unibody Bifurcated Endovascular Stent-Graft Repair in the Treatment of Abdominal Aortic Aneurysm. Full Text available with Trip Pro

Efficacy of Unibody Bifurcated Endovascular Stent-Graft Repair in the Treatment of Abdominal Aortic Aneurysm. To compare the clinical efficacy of unibody bifurcated endovascular stent-graft repair versus conventional open surgery for abdominal aortic aneurysm (AAA).Interventional study.Department of Vascular Surgery, Gansu Province People's Hospital, China, from January 2015 to December 2016.A total of 80 patients with AAA were randomly divided into Group A and Group B, with 40 cases in each (...) , respectively). The survival rate of patients in Group B at 6 months, 12 months and 24 months after operation was higher than that of Group A (p=0.002, 0.002 and 0.005, respectively).Unibody bifurcated endovascular stent-graft repair for abdominal aortic aneurysm has advantages of short operation time, little trauma, short recovery time, high safety and efficacy compared with the conventional open surgery.

2019 Journal of the College of Physicians and Surgeons--Pakistan : JCPSP Controlled trial quality: uncertain

126. Adherence to Prescribed Drugs Among 65-74 Year Old Men Diagnosed with Abdominal Aortic Aneurysm or Peripheral Arterial Disease in a Screening Trial: A VIVA Substudy. Full Text available with Trip Pro

Adherence to Prescribed Drugs Among 65-74 Year Old Men Diagnosed with Abdominal Aortic Aneurysm or Peripheral Arterial Disease in a Screening Trial: A VIVA Substudy. Adherence to antiplatelet and statin therapy in participants diagnosed with abdominal aortic aneurysm (AAA) or peripheral arterial disease (PAD) was examined in a vascular screening trial.This was a population based cohort study. The study population consisted of 65-74 year old men diagnosed with AAA or PAD in the Viborg Vascular

2019 European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Controlled trial quality: uncertain

127. Smooth muscle-specific LKB1 deletion exaggerates angiotensin II-induced abdominal aortic aneurysm in mice. (Abstract)

Smooth muscle-specific LKB1 deletion exaggerates angiotensin II-induced abdominal aortic aneurysm in mice. Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease without an effective pharmaceutical treatment. Liver kinase B1 (LKB1), a tumor suppressor, is a central regulator of cell polarity and energy homeostasis. However, the role of LKB1 in the development of AAA has not been explored. In this study, mice with knockout of smooth muscle-specific LKB1 (LKB1SMKO) were generated (...) by cross-breeding LKB1flox/flox mice with SM22-CreERT2 transgenic mice and induced in adult mice by tamoxifen treatment. LKB1 deficiency increased the expression of matrix metalloproteinase 2 (MMP-2), which was inhibited by LKB1 overexpression. Mechanistically, LKB1 could bind to the MMP-2 transcription factor, specificity protein 1 (Sp1), thereby reducing the binding of Sp1 to the MMP-2 promoter to inhibit MMP-2 expression. LKB1 expression was significantly reduced in abdominal aortas of the mouse AAA

2019 Journal of Molecular and Cellular Cardiology

128. LncRNA H19 promotes vascular inflammation and abdominal aortic aneurysm formation by functioning as a competing endogenous RNA. Full Text available with Trip Pro

LncRNA H19 promotes vascular inflammation and abdominal aortic aneurysm formation by functioning as a competing endogenous RNA. Abdominal aortic aneurysm (AAA) is accepted as a chronic vascular inflammatory disease. However, how the inflammatory response is regulated during AAA formation is not fully understood. This study was undertaken to determine whether the long noncoding RNA (lncRNA) H19 (H19) promotes AAA formation by enhancing aortic inflammation. qRT-PCR detected the upregulation (...) infiltration. H19 suppression resulted in the opposite effects. A rescue experiment indicated that IL-6 neutralization significantly mitigated the aortic inflammation and AAA formation evoked by H19 overexpression. Luciferase reporter assays and ex vivo experiments using VSMCs and macrophages confirmed that H19 induced aneurysm formation in part via endogenous competition with the let-7a microRNA to induce the transcription of its target gene, IL-6. This mechanism was further validated by in vivo

2019 Journal of Molecular and Cellular Cardiology

129. The 10-year outcomes of a regional abdominal aortic aneurysm screening program. Full Text available with Trip Pro

The 10-year outcomes of a regional abdominal aortic aneurysm screening program. In 2007, Medicare established ultrasound screening guidelines to identify patients at risk for abdominal aortic aneurysm (AAA). The purpose of this study was to evaluate AAA diagnosis rates and compliance with screening during 10 years (2007-2016) of the Screen for Abdominal Aortic Aneurysms Very Efficiently Act implementation within a regional health care system.A retrospective chart review of all patients screened (...) patients using screening criteria improved significantly from 61.7% in 2007 to 92.4% in 2016 (P < .01). The overall compliance rate since implementation of the screening program during the past 10 years is 81.3%.The overall 10-year rate of AAA diagnosis is 6.3%. There are more smaller aneurysms (3.0-4.4 cm) detected and fewer large AAAs ≥5.5 cm in the last 5 years compared with the first 5 years of the screening program. The overall AAA-related mortality rate of all screened patients is 0.03

2019 Journal of Vascular Surgery

130. Intraoperative Unfractionated Heparin Unresponsiveness During Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm Following Administration of Andexanet Alfa for the Reversal of Rivaroxaban. (Abstract)

fibrillation managed with rivaroxaban presented with severe right-sided flank pain radiating to the left side of his abdomen. Computed tomography-angiography on arrival demonstrated a left retroperitoneal hematoma and a suspected ruptured abdominal aortic aneurysm. He received andexanet alfa to reverse rivaroxaban prior to an emergent endovascular aneurysm repair. During surgery, he received a total of 14,000 units (167 units/kg) of UFH with minimal changes in activated clotting time (132-144 sec; baseline (...) Intraoperative Unfractionated Heparin Unresponsiveness During Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm Following Administration of Andexanet Alfa for the Reversal of Rivaroxaban. The authors describe a case of unfractionated heparin (UFH) unresponsiveness in the operating room secondary to reversal of rivaroxaban with coagulation factor Xa (recombinant) inactivated-zhzo (andexanet alfa). A 70-year-old man with a known 4.5- to 5.0-cm abdominal aortic aneurysm and atrial

2019 Pharmacotherapy

131. Smooth muscle-specific Gsα deletion exaggerates angiotensin II-induced abdominal aortic aneurysm formation in mice in vivo. Full Text available with Trip Pro

Smooth muscle-specific Gsα deletion exaggerates angiotensin II-induced abdominal aortic aneurysm formation in mice in vivo. Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease without an effective pharmaceutical treatment. Genetic studies have proved the involvement of smooth muscle phenotype switch in the development of AAA. The alpha subunit of the heterotrimeric G stimulatory protein (Gsα) mediates receptor-stimulated production of cyclic adenosine monophosphate (cAMP (...) uridylate-rich elements of the 3' untranslated region of Krüppel-like factor 4 (KLF4) mRNA, thereby increasing the stability of KLF4. Moreover, genetic knockdown of HuR or KLF4 rescued the phenotype switch in Gsα-deficient smooth muscle cells. Furthermore, with acute infusion of angiotensin II, the incidence of AAA was markedly higher in ApoE-/-/GsαSMKO than ApoE-/-/Gsαflox/flox mice and induced increased elastic lamina degradation and aortic expansion. Finally, the levels of Gsα and SM α-actin were

2019 Journal of Molecular and Cellular Cardiology

132. Differences in patient selection and outcomes based on abdominal aortic aneurysm diameter thresholds in the Vascular Quality Initiative. Full Text available with Trip Pro

Differences in patient selection and outcomes based on abdominal aortic aneurysm diameter thresholds in the Vascular Quality Initiative. Randomized trials have shown no benefit for repair of small abdominal aortic aneurysms (AAAs), although repair of small AAAs is widely practiced. It has also been suggested that repair of large-diameter AAAs may incur worse outcomes. We sought to examine differences in patient selection, operative outcomes, and survival after elective endovascular aneurysm (...) categories (small, 0.4%; medium, 0.9%; large, 1.6%; P < .001). EVAR for large AAAs had the highest rates of multiple medical complications, including myocardial infarction (P < .001), respiratory complications (P = .001), and renal complications (P < .001). In contrast, EVAR for small AAAs had the lowest rates of type I endoleak at completion and reoperation during index hospitalization, shortest operative times, and shortest hospital length of stay (P < .001 for all). Aneurysm diameter was associated

2019 Journal of Vascular Surgery

133. Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms. Full Text available with Trip Pro

Variation in center-level frailty burden and the impact of frailty on long-term survival in patients undergoing elective repair for abdominal aortic aneurysms. Frailty is increasingly recognized as a key determinant in predicting postoperative outcomes. Centers that see more frail patients may not be captured in risk adjustment, potentially accounting for poorer outcomes in hospital comparisons. We aimed to (1) determine the effect of frailty on long-term mortality in patients undergoing (...) elective abdominal aortic aneurysm (AAA) repair and (2) evaluate the variability in frailty burden among centers in the Vascular Quality Initiative (VQI) database.Patients undergoing elective open and endovascular AAA repair (2003-2017) were identified, and those with complete data on component variables of the VQI-derived Risk Analysis Index (VQI-RAI) and centers with ≥10 AAA repairs were included. VQI-RAI characteristics are sex, age, body mass index, renal failure, congestive heart failure, dyspnea

2019 Journal of Vascular Surgery

134. The effect of ticagrelor on growth of small abdominal aortic aneurysms - a randomized controlled trial. (Abstract)

The effect of ticagrelor on growth of small abdominal aortic aneurysms - a randomized controlled trial. To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small AAAs.In this multi-center randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naïve patients with AAA and with a maximum aortic diameter 35-49 mm were included. The primary outcome was mean reduction in log-transformed AAA volume

2019 Cardiovascular Research Controlled trial quality: predicted high

135. Female sex hormones and risk of incident abdominal aortic aneurysm in Norwegian women. (Abstract)

Female sex hormones and risk of incident abdominal aortic aneurysm in Norwegian women. The delayed development of abdominal aortic aneurysm (AAA) in women compared with men might be secondary to a protective effect from endogenous estrogens. The role of postmenopausal hormone therapy remains unclear. The aim of the present study was to evaluate the effect of female sex hormones compared with other risk factors associated with AAA through a long-term study of a large female cohort.The present

2019 Journal of Vascular Surgery

136. Suprarenal fixation is associated with worse midterm renal function after endovascular abdominal aortic aneurysm repair compared with infrarenal fixation. (Abstract)

Suprarenal fixation is associated with worse midterm renal function after endovascular abdominal aortic aneurysm repair compared with infrarenal fixation. Several reports have indicated that suprarenal (SR) fixation may impair renal function after endovascular abdominal aortic aneurysm repair (EVAR). However, most were short-term or at most, 1-year observational studies; therefore, the midterm effects on renal function remain unclear. This study aimed to identify predictors of midterm renal (...) dysfunction after EVAR and compare renal outcomes in patients after EVAR with SR and infrarenal (IR) fixation.A total of 467 patients who underwent EVAR of nonruptured IR abdominal aortic aneurysm between 2007 and 2014 were reviewed in a prospectively collected database. Patients on hemodialysis at baseline were excluded. Among the remaining patients, those with 3-year laboratory testing were included in this study. Patients who developed acute kidney injury were excluded from the late renal function

2019 Journal of Vascular Surgery

137. Assessing trends, morbidity, and mortality in ruptured abdominal aortic aneurysm repair with nine years of data from the National Surgical Quality Improvement Program. (Abstract)

Assessing trends, morbidity, and mortality in ruptured abdominal aortic aneurysm repair with nine years of data from the National Surgical Quality Improvement Program. The American College of Surgeons' National Quality Improvement Program (NSQIP) database can be used to assess trends and outcomes of ruptured abdominal aortic aneurysm (rAAA) repair. The purpose of this study is to examine the morbidity and mortality for ruptured endovascular (rEVAR) and ruptured open (rOPEN) aneurysm repair (...) compared with elective endovascular (EVAR) and elective open (OPEN) aneurysm repair.Ruptured and nonruptured abdominal aortic aneurysms were identified from the NSQIP database between 2008 and 2016. Data regarding demographics and comorbidities, 30-day mortality, and postoperative complications were collected for rEVAR, rOPEN, EVAR, and OPEN cases.There were 43,105 AAAs, 34,177 (79.28%) EVARs, and 8928 (20.71%) OPENs. There were 3806 rAAAs, 1843 (48.42%) rEVARs, and 1963 (51.58%) rOPENs. The incidence

2019 Journal of Vascular Surgery

138. Transabdominal open abdominal aortic aneurysm repair is associated with higher rates of late reintervention and readmission compared with the retroperitoneal approach. Full Text available with Trip Pro

Transabdominal open abdominal aortic aneurysm repair is associated with higher rates of late reintervention and readmission compared with the retroperitoneal approach. Limited data exist comparing the transabdominal and retroperitoneal approaches to open abdominal aortic aneurysm (AAA) repair, especially late mortality and laparotomy-related reinterventions and readmissions. Therefore, we compared long-term rates of mortality, reintervention, and readmission after open AAA repair through (...) a transabdominal compared with a retroperitoneal approach.We identified all patients in the Vascular Quality Initiative (VQI) undergoing open AAA repair from 2003 to 2015. Patients with rupture or supraceliac clamp were excluded. We used the VQI linkage to Medicare to ascertain rates of long-term outcomes, including rates of AAA-related and laparotomy-related (ie, hernia, bowel obstruction) reinterventions and readmissions. We used multivariable Cox regression to account for differences in comorbidities

2019 Journal of Vascular Surgery

139. Health gains, costs and cost-effectiveness of a population-based screening programme for abdominal aortic aneurysms. (Abstract)

Health gains, costs and cost-effectiveness of a population-based screening programme for abdominal aortic aneurysms. Abdominal aortic aneurysm (AAA) rupture carries a high fatality rate. AAAs can be detected before rupture by abdominal ultrasound imaging, allowing elective repair. Population-based screening for AAA in older men reduces AAA-related mortality by about 40 per cent. The UK began an AAA screening programme offering one-off scans to men aged 65 years in 2009. Sweden has a similar (...) programme. Currently, there is no AAA screening programme in New Zealand. This cost-utility analysis aimed to assess the cost-effectiveness of a UK-style screening programme in the New Zealand setting.The analysis compared a formal AAA screening programme (one-off abdominal ultrasound imaging for about 20 000 men aged 65 years in 2011) with no systematic screening. A Markov macrosimulation model was adapted to estimate the health gains (in quality-adjusted life-years, QALYs), health system costs

2019 British Journal of Surgery

140. Locoregional anesthesia is associated with lower 30-day mortality than general anesthesia in patients undergoing endovascular repair of ruptured abdominal aortic aneurysm. (Abstract)

Locoregional anesthesia is associated with lower 30-day mortality than general anesthesia in patients undergoing endovascular repair of ruptured abdominal aortic aneurysm. The objective of this study was to compare 30-day postoperative mortality for patients undergoing endovascular repair of ruptured abdominal aortic aneurysm (rAAA) using locoregional vs general anesthesia. Unlike the open approach, endovascular repair of rAAA can be performed using either locoregional or general anesthesia. We

2019 Journal of Vascular Surgery

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