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Abdominal Aortic Aneurysm

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121. Open Versus Fenestrated Endovascular Repair of Complex Abdominal Aortic Aneurysms. (PubMed)

Open Versus Fenestrated Endovascular Repair of Complex Abdominal Aortic Aneurysms. To compare outcomes of fenestrated (FEVAR) and open repairs of complex abdominal aortic aneurysms (cAAA).FEVAR has emerged as an alternative to open surgery for treating cAAA, but direct comparisons are limited.We studied all repairs of intact or symptomatic cAAA in the Vascular Quality Initiative between 2012 and 2018, excluding chimney/snorkels and any devices implanted under Investigational Device Exemption (...) studies. We compared open repairs, commercially available FEVAR devices and physician-modified endografts (PMEG) using inverse probability weighting. As a secondary analysis, we compared PMEG separately.We identified 3253 cAAA repairs: 2125 open (65%), 877 FEVAR (27%), and 251 PMEG (8%). Patients undergoing FEVAR were older, with larger aneurysms, and more comorbidities. Propensity-weighted perioperative mortality was similar between open repair and FEVAR (4.7% vs 3.3%, respectively, P = 0.17

2019 Annals of Surgery

122. Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair. (PubMed)

Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair. The effect of sarcopenia based on the total psoas muscle area (TPMA) on CT is inconclusive in patients undergoing abdominal aortic aneurysm (AAA) intervention. The aim of this prospective cohort study was to evaluate morphometric sarcopenia as a method of risk stratification in patients undergoing elective AAA intervention.TPMA was measured on preintervention CT images of patients undergoing (...) elective endovascular aneurysm repair (EVAR) or open aneurysm repair. Mortality was assessed in relation to preintervention TPMA using Cox regression analysis, with calculation of hazard ratios at 30 days, 1 year and 4 years. Postintervention morbidity was evaluated in terms of postintervention care, duration of hospital stay and 30-day readmission. Changes in TPMA on surveillance EVAR imaging were also evaluated.In total, 382 patient images acquired between March 2008 and December 2016 were analysed

2019 British Journal of Surgery

123. Caloric Restriction Exacerbates Angiotensin II-Induced Abdominal Aortic Aneurysm in the Absence of p53. (PubMed)

Caloric Restriction Exacerbates Angiotensin II-Induced Abdominal Aortic Aneurysm in the Absence of p53. p53-dependent vascular smooth muscle cell senescence is a key pathological process of abdominal aortic aneurysm (AAA). Caloric restriction (CR) is a nonpharmacological intervention that prevents AAA formation. However, whether p53 is indispensable to the protective role of CR remains unknown. In this study, we investigated the necessity of p53 in the beneficial role of CR in AAA formation (...) and the underlying mechanisms. We subjected p53+/+ and p53-/- mice to 12 weeks of CR and then examined the incidence of Ang II (angiotensin II)-induced AAA formation. We found that both CR and p53 knockout reduced Ang II-induced AAA formation; however, CR markedly increased the incidence of AAA formation and exacerbated aortic elastin degradation in p53-/- mice, accompanied by increased vascular senescence, reactive oxygen species generation, and reduced energy production. Analysis of mitochondrial respiratory

2019 Hypertension

124. Anemia and postoperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms. (PubMed)

Anemia and postoperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms. Anemia is associated with increased cardiac adverse events during the early postoperative period because of high physiologic stress and increased cardiac demand. The aim of this study was to assess the surgical outcomes and prognostic implications of anemia in patients undergoing repair of intact abdominal aortic aneurysms (AAAs).A retrospective analysis of all patients who underwent open (...) aortic repair (OAR) or endovascular aneurysm repair (EVAR) in the Vascular Quality Initiative database (2008-2017) was performed. Patients with preoperative polycythemia, patients with ruptured aneurysms, and patients transfused with >4 units of packed red blood cells were excluded. Hemoglobin levels were categorized into three groups: moderate-severe anemia (<10 g/dL), mild anemia (10-12 g/dL in women and 10-13 g/dL in men), and no anemia (>12 g/dL in women and >13 g/dL in men). Multivariate

2019 Journal of Vascular Surgery

125. Safety of Men with Small and Medium Abdominal Aortic Aneurysms Under Surveillance in the National Health Service Screening Programme. (PubMed)

Safety of Men with Small and Medium Abdominal Aortic Aneurysms Under Surveillance in the National Health Service Screening Programme. Population screening for abdominal aortic aneurysm (AAA) has commenced in several countries, and has been shown to reduce AAA-related mortality by up to 50%. Most men who screen positive have an AAA <5.5 cm in diameter, the referral threshold for treatment, and are entered into an ultrasound surveillance program. This study aimed to determine the risk of ruptured

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2019 Circulation

126. African Americans are less likely to have elective endovascular repair of abdominal aortic aneurysms. (PubMed)

African Americans are less likely to have elective endovascular repair of abdominal aortic aneurysms. Recently published Society for Vascular Surgery guidelines recommend endovascular aneurysm repair (EVAR) for both elective and emergent treatment of abdominal aortic aneurysm in patients with suitable anatomy. Racial disparities in health care are well known. The aim of this study was to stratify the patients undergoing EVAR on the basis of their racial differences and to determine

2019 Journal of Vascular Surgery

127. Acute Inflammatory Responses to Exercise in Patients with Abdominal Aortic Aneurysm. (PubMed)

Acute Inflammatory Responses to Exercise in Patients with Abdominal Aortic Aneurysm. Inflammation and extracellular matrix degeneration contribute to abdominal aortic aneurysm (AAA) development. We aimed to assess the effect of exercise intensity on circulating biomarkers of inflammation and extracellular matrix degeneration in patients with AAA and healthy older adults.Twenty patients with AAA (74 ± 6 yr) and 20 healthy males (72 ± 5 yr) completed moderate-intensity cycling at 40% peak power

2019 Medicine and science in sports and exercise

128. Effects of acute exercise on endothelial function in patients with abdominal aortic aneurysm. (PubMed)

Effects of acute exercise on endothelial function in patients with abdominal aortic aneurysm. Endothelial dysfunction is observed in patients with abdominal aortic aneurysm (AAA), who have increased risk of cardiovascular events and mortality. This study aimed to assess the acute effects of moderate- and higher-intensity exercise on endothelial function, as assessed by flow-mediated dilation (FMD), in AAA patients (74 ± 6 yr old, n = 22) and healthy adults (72 ± 5 yr old, n = 22). Participants (...) and healthy adults. Our findings provide evidence that regular exercise may improve vascular function in AAA patients, as it does in healthy adults. Improved FMD after moderate-intensity exercise may provide short-term benefit. Whether the decrease in FMD after higher-intensity exercise represents an additional risk and/or a greater stimulus for vascular adaptation remains to be elucidated. NEW & NOTEWORTHY Abdominal aortic aneurysm patients have vascular dysfunction. We observed a short-term increase

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2019 American journal of physiology. Heart and circulatory physiology

129. Metformin treatment does not affect the risk of ruptured abdominal aortic aneurysms

Metformin treatment does not affect the risk of ruptured abdominal aortic aneurysms Diabetes counteracts formation and rupture of abdominal aortic aneurysms, possibly through arterial matrix accumulation. Use of metformin, on the other hand, reduces arterial accumulation of matrix molecules. Consequently, we hypothesized that metformin treatment may reverse the protective role of diabetes on the development and course of aneurysms, that is, that metformin would be associated with aneurysm (...) rupture among individuals with diabetes.Using nationwide Danish registry data, we performed a nested case-control study on the association between long-term use of metformin and ruptured abdominal aortic aneurysm (RAAA). The source population was defined as all individuals in Denmark with diabetes. Cases were all individuals within the source population who were hospitalized with a primary diagnosis of RAAA. For each case, 10 controls matched by age and sex were randomly selected from the source

2017 EvidenceUpdates

130. Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm-Polish population analysis. (PubMed)

Short- and long-term survival after open versus endovascular repair of abdominal aortic aneurysm-Polish population analysis. The aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR).Retrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer.In the National Health

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2018 PLoS ONE

131. External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair

External validation of a 5-year survival prediction model after elective abdominal aortic aneurysm repair The benefit of prophylactic repair of abdominal aortic aneurysms (AAAs) is based on the risk of rupture exceeding the risk of death from other comorbidities. The purpose of this study was to validate a 5-year survival prediction model for patients undergoing elective repair of asymptomatic AAA <6.5 cm to assist in optimal selection of patients.All patients undergoing elective repair

2017 EvidenceUpdates

132. Comparative clinical effectiveness and cost effectiveness of endovascular strategy <i>v</i> open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial. (PubMed)

Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial. Objective To assess the three year clinical outcomes and cost effectiveness of a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair for patients with suspected ruptured abdominal aortic aneurysm.Design Randomised controlled trial.Setting 30 (...) was >90% at all levels of willingness to pay for a QALY gain.Conclusions At three years, compared with open repair, an endovascular strategy for suspected ruptured abdominal aortic aneurysm was associated with a survival advantage, a gain in QALYs, similar levels of reintervention, and reduced costs, and this strategy was cost effective. These findings support the increasing use of an endovascular strategy, with wider availability of emergency endovascular repair.Trial registration Current Controlled

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2017 BMJ

133. Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial

Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial The aim of the study was to compare long-term total and aneurysm-related mortality in physically frail patients with abdominal aortic aneurysm (AAA) randomized to either early endovascular aneurysm repair (EVAR) or no-intervention.EVAR-2 remains the sole randomized trial to identify whether EVAR reduces mortality in patients (...) physically ineligible for open repair.Between September 1999 and August 2004, 404 patients from 33 centers in the United Kingdom aged ≥60 years with AAA >5.5 cm in diameter were randomized 1:1 using computer-generated sequences of randomly permuted blocks stratified by center to receive either EVAR (197) or no-intervention (207). The primary analysis compared total and aneurysm-related deaths in groups until June 30, 2015 (mean, 12.0 yrs; maximum 14.1 yrs).Mean follow-up until death or censoring was 4.2

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2017 EvidenceUpdates

134. Transforming growth factor β neutralization finely tunes macrophage phenotype in elastase-induced abdominal aortic aneurysm and is associated with an increase of arginase 1 expression in the aorta. (PubMed)

Transforming growth factor β neutralization finely tunes macrophage phenotype in elastase-induced abdominal aortic aneurysm and is associated with an increase of arginase 1 expression in the aorta. Macrophages play a critical role in the initiation and progression of abdominal aortic aneurysm (AAA) and are classically distinguished into M1 "proinflammatory" and M2 "anti-inflammatory" macrophages. Topical application of elastase associated with transforming growth factor β (TGF-β) systemic (...) macrophage phenotype in elastase-induced AAA and leads to an increase in ARG1 gene and protein expression in the aortic wall. Even if further studies are required to elucidate its role in AAA development, ARG1 could represent a new prognostic or therapeutic target in aneurysmal disease.Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

2019 Journal of Vascular Surgery

135. Cost-effectiveness analysis of endovascular versus open repair of abdominal aortic aneurysm in a high-volume center. (PubMed)

Cost-effectiveness analysis of endovascular versus open repair of abdominal aortic aneurysm in a high-volume center. Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is the standard treatment for anatomically suitable patients. EVAR has been associated with a lower perioperative morbidity and mortality compared with open surgical repair (OSR) at the expense of increased reinterventions and costs. We aimed to compare the outcomes of EVAR and OSR for elective AAA repair

2019 Journal of Vascular Surgery

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

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

137. Washington State abdominal aortic aneurysm-related mortality shows a steady decline between 1996 and 2016. (PubMed)

Washington State abdominal aortic aneurysm-related mortality shows a steady decline between 1996 and 2016. Management of abdominal aortic aneurysms (AAA) has undergone considerable advances over the last two decades. Our aim was to evaluate AAA-related mortality trends in Washington State over a 21-year period and to assess variation in AAA-related mortality by sex, race, and county over the same time period. We hypothesized that a significant decrease in AAA-related mortality in Washington

2019 Journal of Vascular Surgery

138. Increasing surgeon volume correlates with patient survival following open abdominal aortic aneurysm repair. (PubMed)

Increasing surgeon volume correlates with patient survival following open abdominal aortic aneurysm repair. The annual number of open abdominal aortic aneurysm (AAA) repairs has decreased dramatically over the last decade, making the search for physician case volume thresholds more important. The purpose of this study was to identify a minimum threshold for annual surgeon case volume in open AAA repair.The New York Statewide Planning and Research Cooperative System inpatient database was used

2019 Journal of Vascular Surgery

139. Variation in the elective management of small abdominal aortic aneurysms and physician practice patterns. (PubMed)

Variation in the elective management of small abdominal aortic aneurysms and physician practice patterns. Recent vascular societal guidelines have recommended an abdominal aortic aneurysm (AAA) size threshold for elective intervention; however, limited data have documented how well these AAA diameter benchmarks are being met. The objective of this study was to analyze variation in management of AAAs based on diameter and to determine the physician's rationale for intervention on small AAAs (...) in relation to recommended treatment guidelines.A retrospective review of a statewide vascular surgery registry of all elective endovascular or open surgical AAA repairs from January 2012 to January 2016 was performed. Patients were dichotomized on the basis of aortic diameter at time of intervention into either guideline size AAAs or small AAAs, which were defined as <5.5 cm in men, <5.0 cm in women, or with growth <1.0 cm/y. An internal review was conducted of all small AAAs to determine the physician's

2019 Journal of Vascular Surgery

140. Man With Sudden Paralysis: Insidious Spinal Cord Infarction due to a Non-Ruptured Abdominal Aortic Aneurysm. (PubMed)

Man With Sudden Paralysis: Insidious Spinal Cord Infarction due to a Non-Ruptured Abdominal Aortic Aneurysm. Acute infarctions of the spinal cord are rare events characterized by sudden paralysis or sensory deficits below the level of injury. Etiologies include spinal cord trauma, vascular injury, arterial dissection, thromboembolic disease, chronic inflammatory conditions, or mass effect on the spinal cord.A 63-year-old male presented to the emergency department with sudden-onset bilateral leg (...) numbness and weakness. His physical examination was notable for decreased light touch and temperature sensation and bilateral lower-extremity paresis. Initial magnetic resonance imaging (MRI) of his spine did not show cord injuries. Computed tomography angiography of his chest, abdomen, and pelvis demonstrated a 7.5-cm non-ruptured infrarenal abdominal aortic aneurysm (AAA) extending into bilateral iliac arteries. The patient was diagnosed with clinical spinal cord infarction secondary

2019 Journal of Emergency Medicine

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