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Abdominal Aortic Aneurysm

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

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

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

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

143. Meta-analysis of the growth rates of abdominal aortic aneurysm in the Chinese population. Full Text available with Trip Pro

Meta-analysis of the growth rates of abdominal aortic aneurysm in the Chinese population. Several studies on the growth rates of abdominal aortic aneurysm (AAA) in Chinese population have been conducted; however, this issue remains unclear. The aim of this study is to systematically review published data of the AAA growth rates among people in China.We conducted a comprehensive search of multiple databases to identify all studies of AAA growth in the Chinese population from inception until June (...) ). Finally, meta-regression showed a strong trend of linear relationship between AAA growth rate and aneurysm diameter.The growth rates of AAA in the Chinese population increase with AAA enlargement and appear to range from 0.18 cm/year in the smallest AAAs to 0.75 cm/year when the diameter exceeds 6 cm. However, based on current studies, it is difficult to estimate the accurate average AAA growth rate in Chinese patients. More large-scale, high-quality studies are required to achieve that. Overall, AAA

2019 BMC Cardiovascular Disorders

144. Response to letter about "Lack of an effective drug for abdominal aortic aneurysm". (Abstract)

Response to letter about "Lack of an effective drug for abdominal aortic aneurysm". We agree there was substantial heterogeneity in the design of the past abdominal aortic aneurysm (AAA) drug trials, particularly those testing antibiotics. While Yu et al. have focused on I2 , it should be noted that this describes the dispersion of effect sizes and does not completely describe the heterogeneity between studies. The included antibiotic trials had many methodological variations, such as different

2019 Journal of internal medicine

145. Lack of an effective drug therapy for abdominal aortic aneurysm. Full Text available with Trip Pro

Lack of an effective drug therapy for abdominal aortic aneurysm. Abdominal aortic aneurysm (AAA) rupture is a common cause of death in adults. Current AAA treatment is by open surgical or endovascular aneurysm repair. Rodent model and human epidemiology, and genetic and observational studies over the last few decades have highlighted the potential of a number of drug therapies, including medications that lower blood pressure, correct dyslipidaemia, or inhibit thrombosis, inflammation or matrix

2019 Journal of internal medicine

146. Deep vein thrombosis secondary to abdominal aortic aneurysm: A case report. Full Text available with Trip Pro

Deep vein thrombosis secondary to abdominal aortic aneurysm: A case report. Abdominal aortic aneurysm is an extremely rare cause of deep vein thrombosis. Here we report an elderly gentleman who presented with deep vein thrombosis and was found to have concomitant abdominal aortic aneurysm upon ultrasonographic screening. It illustrates the possibility of such an aetiology, and the importance of screening for such aneurysms in a select patient population before heparinization.A 73-year-old Asian (...) in the high-risk group for deep vein thrombosis. Serum D-dimer was subsequently found to be elevated at 926 nanograms/milliliter (ng/ml). Compression ultrasonography revealed a thrombus in the left deep femoral vein, confirming the diagnosis of deep vein thrombosis. The ultrasonographic evaluation was extended to the abdominal aorta due to the patient's high risk of abdominal aortic aneurysm, and a 7-cm aneurysm was indeed found. Further computed tomography and magnetic resonance imaging localized

2019 Medicine

147. 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

148. 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

149. 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

150. 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

151. 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

152. Nationwide Study of Ruptured Abdominal Aortic Aneurysms During Twenty Years (1994-2013). (Abstract)

Nationwide Study of Ruptured Abdominal Aortic Aneurysms During Twenty Years (1994-2013). To analyze the epidemiology of ruptured abdominal aortic aneurysms (RAAA) in Sweden over 20 years, and assess the effect of endovascular repair (EVAR) on surgical treatment rate and outcome.All Swedish citizens >50 years with RAAA 1994 to 2013 were extracted from 3 national (Cause of Death, Patient, and Vascular Surgical) registries. Incidence, proportion repaired, surgical techniques, and 90-day mortality

2019 Annals of Surgery

153. 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

154. Optimizing Surveillance and Re-intervention Strategy Following Elective Endovascular Repair of Abdominal Aortic Aneurysms. Full Text available with Trip Pro

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

155. 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

156. 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

157. 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

158. 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

159. 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

160. 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 (...) associated with significantly elevated reintervention rates (black, 31% vs white, 20% [log-rank, P < .001]; aneurysm size 6.0 cm or greater, 27% vs all others, <20% [log-rank, P < .001]). There were no significant associations between age or gender and the 5-year rate of reintervention.More than one in five Medicare patients undergo reintervention within 5 years after EVR in the VQI; late rupture remains low at 3%. Black patients, those with large aneurysms, and those who undergo EVR urgently

2019 Journal of Vascular Surgery

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