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Aortic Rupture

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1. 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

2. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Hybrid Repair for Ruptured Thoracic Aortic Aneurysm: Frozen Elephant Trunk Technique with Thoracic Endovascular Aortic Repair (PubMed)

Hybrid Repair for Ruptured Thoracic Aortic Aneurysm: Frozen Elephant Trunk Technique with Thoracic Endovascular Aortic Repair We present a case of ruptured thoracic aortic aneurysm (TAA) with type B aortic dissection in which hybrid repair, namely, the frozen elephant trunk (FET) technique with thoracic endovascular aortic repair (TEVAR), was performed. The TAA extended to the proximal descending aorta at the level of the pulmonary trunk bifurcation. We thus employed the FET technique

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2018 Annals of vascular diseases

19. Management of acute aortic dissection and thoracic aortic rupture (PubMed)

Management of acute aortic dissection and thoracic aortic rupture Both acute aortic dissection and ruptured aortic aneurysm are leading causes of death in cardiovascular disease. These life-threatening conditions have recently been categorized as acute aortic syndrome. This review describes the etiology, clinical presentation, and therapeutic options for acute aortic syndrome including acute aortic dissection and ruptured aortic aneurysm.Several diagnostic tools for detecting these critical (...) conditions have been developed including computed tomography, ultrasonography, magnetic resonance imaging, and laboratory tests. Early and accurate diagnosis is most important to determine appropriate treatment. Initial treatment for these conditions should be aimed at controlling pain and the hemodynamic state with further treatment based on the imaging diagnosis and hematological assessment. Surgical outcomes after acute aortic syndrome are improving gradually; however, mortality remains high. Recently

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2018 Journal of intensive care

20. Thoracic Endovascular Aortic Repair through Cardiac Apex in the Setting of Thoracic Aortic Rupture. (PubMed)

Thoracic Endovascular Aortic Repair through Cardiac Apex in the Setting of Thoracic Aortic Rupture. Treatment of thoracic aortic rupture poses a substantial challenge for the aortic surgeon. The advent of thoracic endovascular aortic repair (TEVAR) revolutionized the treatment of this heterogeneous group of diseases. Some patients suitable for TEVAR, however, present severe peripheral vascular diseases that can prevent standard retrograde delivery of the stent graft through the femoral artery (...) . In this report, we present a case series of 5 patients with thoracic aortic rupture successfully treated with cardiac transapical TEVAR.Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

2018 Annals of Thoracic Surgery

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