OBJECTIVE:The aim of this study was to investigate the effects of ruptured aneurysm on morbidity and mortality in patients with ischemic colitis (IC) and resection following infrarenal abdominal aortic aneurysms (AAA) surgery.METHODS:Between January 2012 and December 2016, patients who underwent resection for ischemic colitis in our clinic were retrospectively reviewed. Data on the ruptured condition of the aneurysm, the emergency or elective form of aneurysm surgery, treatment method for the aneurysm (EVAR-open) were obtained. The patients were compared and divided into two groups as those with ruptured aneurysm and those without.RESULTS:A total of 275 infrarenal AAA cases were treated by the cardiovascular surgery clinic between January 2012 and December 2016. Fourteen patients (5%) developed ischemic colitis requiring resection. Four (1.8%) patients with EVAR and 10 (17.5%) patients with open surgery were operated because of IC. No statistically significant difference was observed between the two groups in terms of demographic data and surgical procedures. The intergroup comparison did not reveal any statistically significant difference among gastrointestinal (GIS) symptoms, the time period until surgery, the involved colon segment, and the surgical procedures performed. The mortality rate in ruptured AAA group was 83.3%, while it was 62.5% in the non-ruptured AAA group. In spite of the fact that the mortality rate was high in the ruptured group, it was not statistically significant (p=0.393).CONCLUSION:IC is a complication of AAA surgery with a high mortality rate. Rupture in abdominal aortic aneurysm increasing mortality in IC patients. This complication with a high mortality rate following open AAA surgery should be noted by surgeons and we believe that the liberal utilization of laparotomy and early intervention in suspected cases will decrease mortality rates.
Introduction The aim of this study is to compare postoperative outcomes and follow-up of two different modifications facilitating surgical technique of frozen elephant trunk (FET) procedure for complex thoracic aortic diseases - zone 0 (fixation with total arch debranching) and zone 3 (fixation with islet-shape arch repair). Methods From May 2012 to December 2018, data were collected from 139 patients who had been treated with FET procedure for complex thoracic aortic diseases. According to Ishimaru arch map, patients with proximal anastomotic site of hybrid graft at zone 0 and zone 3 were grouped as Group A (n=58, 41.7%) and Group B (n=81, 58.3%), respectively. Mean age of study population was 54.7±11.4 years, and 111 patients were male (79.9%). Results In-hospital mortality was observed in 20 (14.4%) patients (n=12, acute type A aortic dissection, and n=4, previous aortic dissection surgery). There was no significant difference between both groups in terms of in-hospital mortality. Four patients from Group A and three patients from Group B had permanent neurological deficit ( P =0.32). Three patients from both groups had transient spinal cord ischemia ( P =0.334). Although mean total perfusion time was longer in Group A, duration of visceral ischemia, when compared with Group B, was shorter ( P <0.001). Five-year survival rate was 82.8% in Group A and 81.5% in Group B ( P =0.876). Conclusion FET procedure is a feasible repair technique in the treatment of complex aortic diseases, providing satisfactory early results. Because of its advantageous aspects, zone 0 fixation with debranching is the preferred technique in our clinic.
ObjectiveThis study aims to compare open surgical and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms in terms of their effects on quality of life, using Short Form-36 (SF-36).MethodsA total of 133 consecutive patients who underwent EVAR or open surgical repair for infra-renal abdominal aorta aneurysm between January 2009 and June 2014 were included in the study. Twenty-six (19.5%) patients died during follow-up and were excluded from the analysis. Overall, 107 patients, 39 (36.4%) in the open repair group, and 68 (63.6%) in the EVAR group, completed all follow-up visits and study assessments. Quality of life assessments using SF-36 were performed before surgery and at post-operative months 1, 6, and 12.ResultsThe mean duration of follow-up was 29.55±19.95 months. At one month, both physical and mental domains of the quality of life assessments favored EVAR, while the two surgical approaches did not differ significantly at or after six months postoperatively.ConclusionDespite anatomical advantages and acceptable mid-phase mortality in patients with high- or medium-risk for open surgery, EVAR did not exhibit a quality of life superiority over open surgery in terms of physical function and patient comfort at or after postoperative six months.
Aim: Nowadays, usage of hybrid techniques in complex aortic diseases, especially in the high risk patient group for conventional surgery, enables us to cope with the challenges posed in major surgery and reduce complications. In this study, we evaluate our early results in patients who underwent Frozen Elephant Trunk procedure using e-Vita Open stent grafts for complex aortic disease.Methodology: A total of 61 patients (mean age 56 ±11.5, 50 patients (81.9%) were male) who underwent E-vita Open Plus repair between January 2013 and October 201, with the diagnosis of either acute / chronic type I aortic dissection, acute / chronic type III aortic dissection, or thoracic aortic aneurysm were analyzed retrospectively. 21 patients (34.4%) had acute / chronic type I aortic dissection, 22 (36.0%) had acute / chronic type III aortic dissection, 11 (18.0%) had thoracic aortic aneurysm and 7 (11.4%) had residual type I aortic dissection.Results: Arterial cannulation sites were right subclavian artery in 57 patients (93.4%), brachiocephalic artery in 2 patients (3.2%) and ascending aorta in 2 patients (3.2%). The mean times for antegrade cerebral perfusion and cardiopulmonary bypass were 80 minutes (range 52-167) and 178 minutes (range 105-350) respectively. First 30-day mortality rate was 7 (11.4%). In terms of neurological deficit, 2 patients (3.2%) had paraplegia, 3 (4.9%) had major stroke/coma and one (1.6%) had right hemiplegia. Patients with paraplegia and hemiplegia recovered completely and were free of any neurological deficits during discharge. Conclusion:Frozen elephant trunk procedure is a good alternative method which makes the techniques of surgical repair more feasible in the treatment of complex aortic diseases and enables us to use the combination of surgery and endovascular techniques to reduce complications.Key words: Aortic dissection, complex repair, frozen elephant trunk, early results Abstract
Background: The aim of this study was to compare postoperative outcomes of percutaneous access and femoral cutdown methods for elective bifurcated endovascular abdominal aortic aneurysm repair. Methods: Between November 2013 and September 2020, a total of 152 patient (135 males, 17 females; mean age: 70.6±6, range, 57 to 87 years) who underwent endovascular repair due to infrarenal abdominal aortic aneurysm were retrospectively analyzed. According to femoral access type, the patients were grouped into two groups as the total percutaneous femoral access and open cutdown femoral access endovascular repair. Intra- and postoperative data were compared, including operative time, amount of contrast media, bleeding requiring transfusion, return to the operating room, access vessel complications, wound complications, and overall length of hospital stay. Results: Eighty-seven (57.2%) femoral cutdown access repair and 65 (42.8%) percutaneous femoral access repair cases were evaluated in the study. The two groups were comparable in terms of demographic and clinical characteristics (p>0.05), except for chronic obstructive pulmonary disease which was more frequent in the percutaneous access group (p=0.014). After adjustment, age, diabetes mellitus, chronic obstructive pulmonary disease, and obesity were not predictive of percutaneous access failure. Percutaneous femoral access was observed as the only preventing factor for wound infection (odds ratio=0.166, 95% confidence interval: 0.036-0.756; p=0.021). Conclusion: Although femoral access preference does not affect mortality and re-intervention rates, percutaneous endovascular repair reduces operation time, hospital stay, and wound site complications compared to femoral artery exposures.
Introduction:The aim of this study is to determine the prevalence of acute kidney injury after endovascular repair of an abdominal aortic aneurysm and examine the risk factors.Patients and Methods: Patients who underwent endovascular repair of abdominal aortic aneurysms between November 2013 and March 2019 were examined retrospectively. We have excluded the patients who had ruptured abdominal aortic aneurysms and were undergoing emergency repair and those who underwent endovascular procedures, such as renal or iliac stenting, in addition to endovascular repair. Other than procedural exclusion criteria, patients dependent on dialysis, those having acute kidney injury and those with missing data were not included in the study. The acute kidney injury was diagnosed in patients according to Kidney Disease: Improving Global Outcomes definition.Results: Out of 185 patients who underwent elective endovascular repair of abdominal aortic aneurysms, 167 patients were included in this study. There was no in-hospital mortality or requirement of reintervention. An acute kidney injury developed in 23 (13.8%) patients and 6 (3.3%) of these patients needed hemodialysis. The preoperative renal functions of patients who needed hemodialysis after the endovascular repair were significantly impaired than those who did not need hemodialysis [p< 0.001;]. Conclusion:With new acute kidney injury definitions, the frequency of endovascular aneurysm repair-related acute kidney injury is much higher than expected. If acute kidney damage has developed after an endovascular repair, it is permanent and patients should be closely monitored for renal function.
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