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Abdominal Aortic Aneurysm

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141. Long-term Reintervention After Endovascular Abdominal Aortic Aneurysm Repair. (Abstract)

Long-term Reintervention After Endovascular Abdominal Aortic Aneurysm Repair. To describe the long-term reintervention rate after endovascular abdominal aortic aneurysm repair (EVR), and identify factors predicting reintervention.EVR is the most common method of aneurysm repair in America, and reintervention after EVR is common. Clinical factors predicting reintervention have not been described in large datasets with long-term follow-up.We studied patients who underwent EVR using the Vascular (...) %, and the 10-year rate was 33%. Five factors predicted reintervention: operative time ≥3.0 hours, aneurysm diameter ≥6.0 cm, an iliac artery aneurysm ≥2.0 cm, emergency surgery, and a history of prior aortic surgery. Patients with no risk factors had a 3-year reintervention rate of 12%, and 10-year rate of 26% (n = 7310). Patients with multiple risk factors, such as prior aortic surgery and emergent surgery, had a 3-year reintervention rate 72%, (n = 32). Modifiable factors including EVR graft manufacturer

2019 Annals of Surgery

142. Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays. (Abstract)

Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays. We sought to assess whether sex-related differences in timely repair of ruptured abdominal aortic aneurysm (rAAA) were associated with excess risk of early mortality in women.rAAA is a surgical emergency and timeliness of intervention affects outcomes. A door-to-intervention time of <90 minutes is recommended.All rAAA repairs in the Vascular Quality Initiative from 2003 to 2017 were

2019 Annals of Surgery

143. Optimizing Surveillance and Re-intervention Strategy Following Elective Endovascular Repair of Abdominal Aortic Aneurysms. (Abstract)

Optimizing Surveillance and Re-intervention Strategy Following Elective Endovascular Repair of Abdominal Aortic Aneurysms. EVAR for abdominal aortic aneurysm has an initial survival advantage over OR, but more frequent complications increase costs and long-term aneurysm-related mortality. Randomized controlled trials of EVAR versus OR have shown EVAR is not cost-effective over a patient's lifetime. However, in the EVAR-1 trial, postoperative surveillance may have been sub-optimal (...) with observed EVAR-1 outcomes, modeling full adherence to the EVAR-1 scan protocol reduced abdominal aortic aneurysm (AAA) deaths by 3% and increased elective re-interventions by 44%. European Society re-intervention guidelines provided the most clinically effective strategy, with an 8% reduction in AAA deaths, but a 52% increase in elective re-interventions. The cheapest and most cost-effective strategy used lifetime annual ultrasound in primary care with confirmatory computed tomography if necessary

2019 Annals of Surgery

144. Saccular Abdominal Aortic Aneurysms: Patient Characteristics, Clinical Presentation, Treatment, and Outcomes in the Netherlands. (Abstract)

Saccular Abdominal Aortic Aneurysms: Patient Characteristics, Clinical Presentation, Treatment, and Outcomes in the Netherlands. The aim of this was to analyze differences between saccular-shaped abdominal aortic aneurysms (SaAAAs) and fusiform abdominal aortic aneurysms (FuAAAs) regarding patient characteristics, treatment, and outcome, to advise a threshold for intervention for SaAAAs.Based on the assumption that SaAAAs are more prone to rupture, guidelines suggest early elective treatment (...) . However, little is known about the natural history of SaAAAs and the threshold for intervention is not substantiated.Observational study including primary repairs of degenerative AAAs in the Netherlands between 2016 and 2018 in which the shape was registered, registered in the Dutch Surgical Aneurysm Audit (DSAA). Patients were stratified by urgency of surgery; elective versus acute (symptomatic/ruptured). Patient characteristics, treatment, and outcome were compared between SaAAAs and FuAAAs.A total

2019 Annals of Surgery

145. Systematic review and meta-analysis of the association between intraluminal thrombus volume and abdominal aortic aneurysm rupture. (Abstract)

Systematic review and meta-analysis of the association between intraluminal thrombus volume and abdominal aortic aneurysm rupture. Intraluminal thrombus (ILT) is present in most abdominal aortic aneurysms (AAAs), although its role in AAA progression is controversial.A literature search was performed to identify studies that investigated the association between ILT volume and AAA rupture. A study assessment tool was developed to assess the methodologic quality of included studies. A meta (...) -analysis was conducted using an inverse variance-weighted random-effects model to compare the ILT volume in ruptured and asymptomatic intact AAAs. Leave-one-out sensitivity analyses were conducted to assess the robustness of the findings. A subanalysis was performed including studies in which patients with asymptomatic intact and ruptured AAAs were matched for aortic diameter. Interstudy heterogeneity was assessed using the I2 statistic.Eight studies involving 672 patients were included

2019 Journal of Vascular Surgery

146. Giant abdominal aortic aneurysm of uncommon etiology due to Behçet disease. (Abstract)

Giant abdominal aortic aneurysm of uncommon etiology due to Behçet disease. Behçet disease is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as with ocular involvement. Vascular involvement can occur in up to 50% of affected patients. Arterial aneurysms are often multiple and are characterized by a saccular configuration with increased risk of unexpected rupture, thrombosis, and aneurysm recurrence. Here we report a case of giant infrarenal abdominal (...) aortic aneurysm in a 34-year-old man with Behçet disease who underwent aneurysmorrhaphy and aortobifemoral bypass.Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

2019 Journal of Vascular Surgery

147. Outcomes of open repair of postdissection abdominal aortic aneurysms. (Abstract)

Outcomes of open repair of postdissection abdominal aortic aneurysms. Evidence to guide management of postdissection abdominal aortic aneurysms (PDAAA) is lacking. This study describes the outcomes of open repair of PDAAA.A retrospective cohort study was conducted of all consecutive patients treated with open repair for PDAAA after a Stanford type A or type B thoracic aortic dissection between January 2006 and December 2017 in two vascular referral centers. Preceding type B dissection treatment (...) survival was 95.5% after 1 year and 88.6% after 2 years.Open repair of PDAAA can be performed with a low mortality rate and an acceptable complication rate, comparable with elective open repair of abdominal aortic aneurysms without dissection.Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

2019 Journal of Vascular Surgery

148. Patient information sources when facing repair of abdominal aortic aneurysm. (Abstract)

Patient information sources when facing repair of abdominal aortic aneurysm. Shared medical decision making is most important when there are competing options for repair such as in treatment of abdominal aortic aneurysm (AAA). We sought to understand the sources of patients' pre-existing knowledge about AAA to better inform treating physicians about patients' needs for preoperative counseling.We performed a multicenter survey of patients facing AAA repair at 20 Veterans Affairs hospitals across (...) by anyone. Slightly less than one-half of patients reported that they did not receive any information about open surgical aneurysm repair and endovascular aortic aneurysm repair (41% and 37%, respectively). Few patients indicated using the internet as their main source of information about open surgical aneurysm repair and endovascular aortic aneurysm repair (10% and 11%, respectively).Patients are commonly referred for AAA repair having little to no information regarding AAA pathology or repair options

2019 Journal of Vascular Surgery

149. Sex differences in perioperative outcomes after complex abdominal aortic aneurysm repair. (Abstract)

Sex differences in perioperative outcomes after complex abdominal aortic aneurysm repair. Female sex is associated with worse outcomes after infrarenal abdominal aortic aneurysm (AAA) repair. However, the impact of female sex on complex AAA repair is poorly characterized. Therefore, we compared outcomes between female and male patients after open and endovascular treatment of complex AAA.We identified all patients who underwent complex aneurysm repair between 2011 and 2017 in the American (...) College of Surgeons National Surgical Quality Improvement Program targeted vascular module. Complex repairs were defined as those for juxtarenal, pararenal, or suprarenal aneurysms. We compared rates of perioperative adverse events between female and male patients stratified by open AAA repair and endovascular aneurysm repair (EVAR). We calculated propensity scores and used inverse probability-weighted logistic regression to identify independent associations between female sex and our outcomes.We

2019 Journal of Vascular Surgery

150. The population prevalence of undetected abdominal aortic aneurysm in New Zealand Māori. (Abstract)

The population prevalence of undetected abdominal aortic aneurysm in New Zealand Māori. The prevalence of abdominal aortic aneurysm (AAA) in Polynesian populations such as the New Zealand Māori has not been characterized. We measured this in a large population-based sample.A cross-sectional population-based prevalence study was conducted as part of an AAA screening pilot; 2467 Māori men aged 54 to 74 years and 1526 women aged 65 to 74 years registered with a primary care practice in Auckland (...) (New Zealand) were invited to be screened by abdominal ultrasound between June 2016 and March 2018. Patients with pre-existing AAA disease and those with terminal conditions or circumstances that would make them unlikely to benefit from screening were excluded. The prevalence rate of AAA in Māori women was calculated with a cutoff definition of 27 mm as well as with the normal 30-mm definition (used in men). A log-binomial regression model estimated the prevalence rate at exactly 65 years

2019 Journal of Vascular Surgery

151. Hospital resource use and costs among abdominal aortic aneurysm repair patients admitted to the intensive care unit. (Abstract)

Hospital resource use and costs among abdominal aortic aneurysm repair patients admitted to the intensive care unit. Abdominal aortic aneurysm (AAA) repair is associated with significant morbidity and mortality. As a result, many of these patients are monitored postoperatively in the intensive care unit (ICU). However, little is known about resource utilization and costs associated with ICU admission in this population. We sought to evaluate predictors of total costs among patients admitted

2019 Journal of Vascular Surgery

152. Long-term outcomes comparing endovascular and open abdominal aortic aneurysm repair in octogenarians. (Abstract)

Long-term outcomes comparing endovascular and open abdominal aortic aneurysm repair in octogenarians. Patients older than 80 years have significantly lower early mortality with endovascular aneurysm repair (EVAR) compared with open repair for abdominal aortic aneurysms (AAAs), but long-term results remain poorly studied. We analyzed the results of both emergent and elective AAA repair in patients aged 80 years or older who had at least 5 years of follow-up.Retrospective review (...) likely to be male and open repair patients were more likely to have larger aneurysms. Compared with open repair, elective early postoperative mortality was significantly lower for EVAR patients (1% vs 14%; P < .001). Overall mean life expectancy was 5.9 years (EVAR, 5.8 years; open repair, 5.8 years; P = .98). The 1-year survival was significantly higher for EVAR (92.9%) than for open repair (84.1%; P = .02). The 2-year survival (EVAR, 83.4%; open repair, 74.6%; P = .07) and 5-year survival (EVAR

2019 Journal of Vascular Surgery

153. The decline of open abdominal aortic aneurysm surgery among individual training programs and vascular surgery trainees. (Abstract)

The decline of open abdominal aortic aneurysm surgery among individual training programs and vascular surgery trainees. In the past decade, treatment of abdominal aortic aneurysm (AAA) has dramatically shifted from open repair to an endovascular approach. The decreasing number of open AAA repairs (OAR) has raised concerns regarding future vascular surgeons' competence to perform this complex and high-risk procedure. Prior work has documented decreasing open aortic volume among surgical (...) residents. However, these studies report average national case volume with a limited understanding of the variation in OAR exposure among training programs and trainees. We sought to evaluate the current open AAA repair trends among individual accredited vascular surgery training programs and vascular surgery residents to better evaluate trainees' exposure to OAR.We identified elderly Medicare beneficiaries undergoing OAR and endovascular aneurysm repair (EVAR) between 2010 and 2014. Accredited vascular

2019 Journal of Vascular Surgery

154. Incidence of stent graft failure from type IIIB endoleak in contemporary endovascular abdominal aortic aneurysm repair. (Abstract)

Incidence of stent graft failure from type IIIB endoleak in contemporary endovascular abdominal aortic aneurysm repair. Type IIIB endoleak from material failure can lead to aneurysmal sac enlargement and latent rupture after endovascular repair of abdominal aortic aneurysm. Long-term durability of the endovascular stent graft is largely unknown, and the complication rate from device failure due to material fatigue may be underappreciated. In addition, even with advancement in imaging techniques (...) , recognition of type IIIB endoleak can be challenging, which can lead to delay in intervention.A review of the literature was performed in PubMed and Google Scholar, yielding 23 articles with 46 case reports of type IIIB endoleak from various Food and Drug Administration-approved stent grafts after endovascular repair of infrarenal abdominal aortic aneurysm.The most common location of type IIIB endoleak occurred in the main body (34.8%), followed by the area of the flow divider (32.6%). Sac growth

2019 Journal of Vascular Surgery

155. Five-year reintervention after endovascular abdominal aortic aneurysm repair in the Vascular Quality Initiative. (Abstract)

Five-year reintervention after endovascular abdominal aortic aneurysm repair in the Vascular Quality Initiative. Patients who undergo endovascular abdominal aortic aneurysm repair (EVR) remain at risk for reintervention and rupture. We sought to define the 5-year rate of reintervention and rupture after EVR in the Vascular Quality Initiative (VQI).We identified all patients in the VQI who underwent EVR from 2003 to 2015. We linked patients in the VQI to Medicare claims for long-term outcomes (...) . We stratified patients on baseline clinical and procedural characteristics to identify those at risk for reintervention. Our primary outcomes were 5-year rates of reintervention and late aneurysm rupture after EVR. We assessed these with Kaplan-Meier survival estimation.We studied 12,911 patients who underwent EVR. The mean age was 75.5 years, 79.9% were male, 3.9% were black, and 89.1% of operations were performed electively. The 5-year rate of reintervention for the entire cohort was 21

2019 Journal of Vascular Surgery

156. Preservation of pelvic perfusion with iliac branch devices does not decrease ischemic colitis compared with hypogastric embolization in endovascular abdominal aortic aneurysm repair. (Abstract)

Preservation of pelvic perfusion with iliac branch devices does not decrease ischemic colitis compared with hypogastric embolization in endovascular abdominal aortic aneurysm repair. Ischemic colitis is a rare but devastating complication of endovascular repair of infrarenal abdominal aortic aneurysms. Although it is rare (0.9%) in standard endovascular aneurysm repair (EVAR), the incidence increases to 2% to 3% in EVAR with hypogastric artery embolization (HAE). This study investigated whether (...) preservation of pelvic perfusion with iliac branch devices (IBDs) decreases the incidence of ischemic colitis.We used the targeted EVAR module in the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing EVAR of infrarenal abdominal aortic aneurysm from 2012 to 2017. The cohort was further stratified into average-risk and high-risk groups. Average-risk patients were those who underwent elective repair for sizes of the aneurysms, whereas high

2019 Journal of Vascular Surgery

157. Outcomes after ruptured abdominal aortic aneurysm repair in the era of centralized care. (Abstract)

Outcomes after ruptured abdominal aortic aneurysm repair in the era of centralized care. Little is known about the relationship between case volume and patient outcomes of those treated for ruptured abdominal aortic aneurysm (rAAA) after either endovascular aneurysm repair (EVAR) or open aneurysm repair (OAR). This study evaluated the impact of hospital case volume on outcomes after rAAA.Patients with rAAA were identified in the Society for Vascular Surgery Vascular Quality Initiative database (...) from 2003 to 2017, excluding patients from years in which a limited number of hospitals were included (2003-2009, 2017). Patients were stratified according to type of aneurysm repair and further stratified according to aortic surgical volume of the treating facility. Univariate and multivariable analyses were performed.Between 2010 and 2016, of 2895 patients who presented emergently with rAAA, 1246 underwent ruptured OAR (rOAR) and 1649 underwent ruptured EVAR (rEVAR). Before adjustment

2019 Journal of Vascular Surgery

158. Design and protocol of a comprehensive multicentre biobank for abdominal aortic aneurysms. Full Text available with Trip Pro

Design and protocol of a comprehensive multicentre biobank for abdominal aortic aneurysms. The pathophysiology and natural course of abdominal aortic aneurysms (AAAs) are insufficiently understood. In order to improve our understanding, it is imperative to carry out longitudinal research that combines biomarkers with clinical and imaging data measured over multiple time points. Therefore, a multicentre biobank, databank and imagebank has been established in the Netherlands: the 'Pearl Abdominal (...) Aortic Aneurysm' (AAA bank).The AAA bank is a prospective multicentre observational biobank, databank and imagebank of patients with an AAA. It is embedded within the framework of the Parelsnoer Institute, which facilitates uniform biobanking in all university medical centres (UMCs) in the Netherlands. The AAA bank has been initiated by the two UMCs of Amsterdam UMC and by Leiden University Medical Center. Participants will be followed during AAA follow-up. Clinical data are collected every patient

2019 BMJ open

159. Retrospective review of abdominal aortic aneurysm deaths in New Zealand: what proportion of deaths is potentially preventable by a screening programme in the contemporary setting? Full Text available with Trip Pro

Retrospective review of abdominal aortic aneurysm deaths in New Zealand: what proportion of deaths is potentially preventable by a screening programme in the contemporary setting? To describe the proportions of people dying from abdominal aortic aneurysm (AAA) who might have benefited from a formal screening programme for AAA.Retrospective cross-sectional review of deaths.All AAA deaths registered in New Zealand from 2010 to 2014 in the absence of a national AAA screening programme.Known (...) history of AAA prior to the acute event leading to AAA death, prognosis limiting comorbidities, history of prior abdominal imaging and a validated multimorbidity measure (M3-index scores).1094 AAA deaths were registered in the 5 years between 2010 and 2014 in New Zealand. Prior to the acute AAA event resulting in death, 31.3% of the cohort had a known AAA diagnosis, and 10.9% had a previous AAA procedure. On average, the AAA diagnosis was known 3.7 years prior to death. At least 77% of the people

2019 BMJ open

160. 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

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