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Aortic Rupture

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1. Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT

Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT Journals Library An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation or try

2018 NIHR HTA programme

2. Endovascular aortic repair (EVAR) surgery more beneficial for ruptured abdominal aortic aneurysms than open repair

Endovascular aortic repair (EVAR) surgery more beneficial for ruptured abdominal aortic aneurysms than open repair EVAR surgery more beneficial for ruptured abdominal aortic aneurysms than open repair Discover Portal Discover Portal Endovascular aortic repair (EVAR) surgery more beneficial for ruptured abdominal aortic aneurysms than open repair Published on 28 August 2018 doi: EVAR surgery to repair a ruptured abdominal aortic aneurysm had a slightly better survival rate after three years than (...) open repair surgery. The survival benefit in this trial wasn’t apparent 30 days after surgery, but those having EVAR did recover more quickly and went home sooner. This NIHR-funded study also found that EVAR is likely to be more cost-effective. An abdominal aortic aneurysm is a swelling in the main artery that runs from the heart through the abdomen. If it bursts, there is catastrophic bleeding. The traditional treatment is urgent open surgery to repair the rupture. EVAR is a less invasive strategy

2019 NIHR Dissemination Centre

3. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. (PubMed)

Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries (...) of shock in patients with ruptured abdominal aortic aneurysms.Two review authors independently assessed identified studies for potential inclusion in the review. We used standard methodological procedures in accordance with the Cochrane Handbook for Systematic Review of Interventions.We identified no RCTs that met the inclusion criteria.We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured

2018 Cochrane

5. Endovascular treatment for ruptured abdominal aortic aneurysm. (PubMed)

Endovascular treatment for ruptured abdominal aortic aneurysm. An abdominal aortic aneurysm (AAA) (pathological enlargement of the aorta) is a condition that can occur as a person ages. It is most commonly seen in men older than 65 years of age. Progressive aneurysm enlargement can lead to rupture and massive internal bleeding, which is fatal unless timely repair can be achieved. Despite improvements in perioperative care, mortality remains high (approximately 50%) after conventional open (...) surgical repair. Endovascular aneurysm repair (EVAR), a minimally invasive technique, has been shown to reduce early morbidity and mortality as compared to conventional open surgery for planned AAA repair. More recently emergency endovascular aneurysm repair (eEVAR) has been used successfully to treat ruptured abdominal aortic aneurysm (RAAA), proving that it is feasible in select patients; however, it is unclear if eEVAR will lead to significant improvements in outcomes for these patients or if indeed

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2017 Cochrane

6. Intravenous heparin during ruptured abdominal aortic aneurysmal repair. (PubMed)

Intravenous heparin during ruptured abdominal aortic aneurysmal repair. There have been enormous advances in the screening, diagnosis, intervention and overall prognosis of abdominal aortic aneurysms (AAAs) in the last decade, but despite these, ruptured AAAs (rAAAs) still cause around 3500 to 6000 deaths in England and Wales each year. Open repair remains standard treatment for rAAA in most centres but increasingly endovascular aneurysm repair (EVAR) is being adopted. This has a 30-day (...) has been demonstrated in elective repairs.The primary objective was to assess the effect of intravenous heparin on all-cause mortality in ruptured abdominal aortic aneurysm (rAAA) management in people undergoing an emergency repair.The secondary objectives were to assess the effect of intravenous heparin in rAAA management on the incidence of general arterial disease, for example, cardiovascular, cerebral, pulmonary and renal pathologies, in people undergoing emergency repair.The Cochrane Vascular

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2016 Cochrane

7. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. (PubMed)

Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries (...) searched the Specialised Register (April 2016) and the Cochrane Register of Studies (CENTRAL (2016, Issue 3)). Clinical trials databases were searched (April 2016) for details of ongoing or unpublished studies.We sought all published and unpublished randomised controlled trial (RCTs) that compared controlled hypotension and normotensive resuscitation strategies for the management of shock in patients with ruptured abdominal aortic aneurysms.Two review authors independently assessed identified studies

2016 Cochrane

8. No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms

No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms Discover Portal Discover Portal No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms Published on 3 May 2016 doi: Open and keyhole surgery for repairing a ruptured abdominal aortic aneurysm show similar rates of death at three (...) on the research. Why was this study needed? Small abdominal aortic aneurysms don’t usually pose a serious threat to health, but there is a risk larger aneurysms can rupture. They are most common in men over 65 years. The evidence suggests that aneurysms expand at an average rate of 0.3 to 0.4 cm each year. The risk of rupture for aneurysms less than 4 cm across is less than 0.5% per year, but can rise to above 30% for aneurysms above 8 cm in diameter. Ruptured abdominal aortic aneurysms are one of the most

2019 NIHR Dissemination Centre

9. A prognostic review and meta-analysis of the outcomes of open and endovascular ruptured abdominal aortic aneurysm repair in patients with hostile versus friendly aortic anatomy

A prognostic review and meta-analysis of the outcomes of open and endovascular ruptured abdominal aortic aneurysm repair in patients with hostile versus friendly aortic anatomy Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability

2019 PROSPERO

10. Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm

Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm The aim of this study was to develop a 48-h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care.Data from patients in the IMPROVE (Immediate Management (...) of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C-statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based

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2019 EvidenceUpdates

11. Accuracy evaluations of three ruptured abdominal aortic aneurysm mortality risk scores using an independent dataset

Accuracy evaluations of three ruptured abdominal aortic aneurysm mortality risk scores using an independent dataset To date, no single scoring system for predicting 30-day mortality in patients with ruptured abdominal aortic aneurysms (rAAAs) has been endorsed by any vascular society or proven to definitively predict treatment futility. Three recently developed scoring systems for predicting 30-day mortality in patients with rAAA have been validated by their respective institutional data (...) under the receiver operating characteristic (AUC) curves.Complete data from 38 patients was used for accuracy evaluation. The AUCs for the Dutch Aneurysm Score, Harborview Medical Center score, and Vascular Surgery Group of New England (VSGNE) score were 0.762, 0.792, and 0.860, respectively, for all patients. When evaluating 30-day mortality for patients undergoing ruptured endovascular aneurysm repair, the scores were 0.802, 0.893, and 0.927, respectively. The difference between scores did

2019 EvidenceUpdates

12. Sex differences in repair rates and outcomes of patients with ruptured abdominal aortic aneurysm

Sex differences in repair rates and outcomes of patients with ruptured abdominal aortic aneurysm Data are conflicting on sex differences in ruptured abdominal aortic aneurysm (rAAA) repair rates and outcomes have rarely been addressed. The aim of this study was to investigate differences in the management and outcome of rAAA in men and women, and to describe time trends over a 15-year interval.Data on patients with rAAA were extracted from the Swedish National Patient Registry and the Cause (...) of Death Registry for the interval 2001-2015. The study included patients with rAAA whether or not they were admitted to any hospital in Sweden. A propensity score-matched model was used to determine sex differences in repair type and outcome after rupture. Time trends for rAAA events and mortality were investigated.Some 10 724 patients were identified. A higher percentage of men were admitted to hospital (79·8 versus 77·5 per cent; P = 0·011). Of those admitted, a higher percentage of men than women

2019 EvidenceUpdates

13. No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms

No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms Discover Portal Discover Portal No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms Published on 3 May 2016 doi: Open and keyhole surgery for repairing a ruptured abdominal aortic aneurysm show similar rates of death at three (...) on the research. Why was this study needed? Small abdominal aortic aneurysms don’t usually pose a serious threat to health, but there is a risk larger aneurysms can rupture. They are most common in men over 65 years. The evidence suggests that aneurysms expand at an average rate of 0.3 to 0.4 cm each year. The risk of rupture for aneurysms less than 4 cm across is less than 0.5% per year, but can rise to above 30% for aneurysms above 8 cm in diameter. Ruptured abdominal aortic aneurysms are one of the most

2018 NIHR Dissemination Centre

14. A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease. (PubMed)

A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease. In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs.All patients admitted to an emergency department in Stockholm and Gotland, a region with a population of 2.1 million, between 2009-2013 with a CT-verified rupture (n = 192) were (...) . Aortic size index (ASI) was similar between men and women (4.1 ± 3.1 cm/m2 vs 3.8 ± 1.0 cm/m2). Fourteen percent of all patients ruptured at Dmax ≤ 60 mm, and a higher proportion of women compared to men ruptured at Dmax ≤ 60 mm: 27% (12/45) vs. 10% (15/147), p = 0.005. Also, a higher proportion of patients with a chronic obstructive pulmonary disease ruptured at Dmax ≤ 60 mm (34.6% vs 14.6%, p = 0.026). Supra-renal aortic size index (14.0, IQR 13.3-15.3 vs 12.8, IQR = 11.4-14.0) and peak wall

2019 PLoS ONE

15. Predicting risk of rupture and rupture-preventing reinterventions following endovascular abdominal aortic aneurysm repair. (PubMed)

Predicting risk of rupture and rupture-preventing reinterventions following endovascular abdominal aortic aneurysm repair. Clinical and imaging surveillance practices following endovascular aneurysm repair (EVAR) for intact abdominal aortic aneurysm (AAA) vary considerably and compliance with recommended lifelong surveillance is poor. The aim of this study was to develop a dynamic prognostic model to enable stratification of patients at risk of future secondary aortic rupture or the need (...) for intervention to prevent rupture (rupture-preventing reintervention) to enable the development of personalized surveillance intervals.Baseline data and repeat measurements of postoperative aneurysm sac diameter from the EVAR-1 and EVAR-2 trials were used to develop the model, with external validation in a cohort from a single-centre vascular database. Longitudinal mixed-effects models were fitted to trajectories of sac diameter, and model-predicted sac diameter and rate of growth were used in prognostic Cox

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2018 British Journal of Surgery

16. Systematic review and meta-analysis of the risk of bowel ischemia after ruptured abdominal aortic aneurysm repair

Systematic review and meta-analysis of the risk of bowel ischemia after ruptured abdominal aortic aneurysm repair Outcomes after repair of ruptured abdominal aortic aneurysm (RAAA) have improved in the last decade. It is unknown whether this has resulted in a reduction of postoperative bowel ischemia (BI). The primary objective was to determine BI prevalence after RAAA repair. Secondary objectives were to determine its major sequelae and differences between open repair (OR) and endovascular

2018 EvidenceUpdates

17. Renin-angiotensin system blockade does not attenuate abdominal aortic aneurysm growth, rupture rate, or perioperative mortality after elective repair

Renin-angiotensin system blockade does not attenuate abdominal aortic aneurysm growth, rupture rate, or perioperative mortality after elective repair The objective of this study was to summarize the literature regarding the effects of renin-angiotensin system blockade (RASB) using angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) on human abdominal aortic aneurysm (AAA) growth, rupture, and perioperative mortality.We conducted a systematic review (...) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our review protocol was registered at the International Prospective Register of Systematic Reviews (CRD42016054082). We searched the Cochrane Central Register of Controlled Trials database, MEDLINE, and Embase from inception to 2017 for studies examining the effects of ACEi or ARB treatment on AAA growth, rupture, or perioperative mortality. Review, abstraction, and quality assessment were conducted

2018 EvidenceUpdates

18. Endovascular treatment for ruptured abdominal aortic aneurysm. (PubMed)

Endovascular treatment for ruptured abdominal aortic aneurysm. An abdominal aortic aneurysm (AAA) (pathological enlargement of the aorta) can develop in both men and women as they grow older. It is most commonly seen in men over the age of 65 years. Progressive aneurysm enlargement can lead to rupture and massive internal bleeding, a fatal event unless timely repair can be achieved. Despite improvements in perioperative care, mortality remains high (approximately 50%) after conventional open (...) surgical repair. A newer minimally invasive technique, endovascular aneurysm repair (EVAR), has been shown to reduce early morbidity and mortality as compared to conventional open surgery for planned AAA repair. Emergency endovascular aneurysm repair (eEVAR) has been used successfully to treat ruptured abdominal aortic aneurysm (RAAA), proving that it is feasible in selected patients. However, it is not yet known if eEVAR will lead to significant improvements in outcomes for these patients or indeed

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2014 Cochrane

19. Current challenges in open versus endovascular repair of ruptured thoracic aortic aneurysm

Current challenges in open versus endovascular repair of ruptured thoracic aortic aneurysm A ruptured thoracic aortic aneurysm is considered a surgical emergency; it is often fatal if it is not identified and managed immediately. Since the recognition of this clinical entity, open surgical repair has been the "gold standard" method of management. However, open surgical repair is associated with high morbidity and mortality rates. Among high-risk patients and as an alternative, thoracic (...) endovascular repairs have since transpired, aiming to reduce the morbidity and mortality rates associated with open repair in a number of patients. The results of both treatment options are debatable, yet there is not a full concurrence on the advantages of endovascular repair in comparison to open repair as the gold standard method of managing such emergency cases, particularly ruptures involving the ascending and aortic arch. This literature review aimed to examine current literature evidence for the use

2018 EvidenceUpdates

20. SmgGDS Prevents Thoracic Aortic Aneurysm Formation and Rupture by Phenotypic Preservation of Aortic Smooth Muscle Cells. (PubMed)

SmgGDS Prevents Thoracic Aortic Aneurysm Formation and Rupture by Phenotypic Preservation of Aortic Smooth Muscle Cells. Thoracic aortic aneurysm (TAA) and dissection are fatal diseases that cause aortic rupture and sudden death. The small GTP-binding protein GDP dissociation stimulator (SmgGDS) is a crucial mediator of the pleiotropic effects of statins. Previous studies revealed that reduced force generation in aortic smooth muscle cells (AoSMCs) causes TAA and thoracic aortic dissection.To (...) examine the role of SmgGDS in TAA formation, we used an angiotensin II (1000 ng·min-1·kg-1, 4 weeks)-induced TAA model.We found that 33% of Apoe-/- SmgGDS+/- mice died suddenly as a result of TAA rupture, whereas there was no TAA rupture in Apoe-/- control mice. In contrast, there was no significant difference in the ratio of abdominal aortic aneurysm rupture between the 2 genotypes. We performed ultrasound imaging every week to follow up the serial changes in aortic diameters. The diameter

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2018 Circulation

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