Mortality and morbidity were higher in women than men undergoing EVAR. Multivariate analysis showed that the increased risk of mortality was related to women presenting more emergently, more debilitated (recent weight loss and functional dependence), and requiring iliac or brachial exposure. After adjustment for multiple preoperative and operative factors, women remained at significantly higher risk for the development of a broad range of complications and increased length of stay.

Rupture of thoracic aneurysm, acute type B dissection, blunt thoracic trauma, and penetrating aortic ulcer can present with a similar clinical profile of thoracic aortic rupture. We report a meta-analysis of comparative studies evaluating endoluminal graft versus open repair of these lesions as well as the early experience from our institution. We searched the following databases for reports of endovascular versus open repair of acute descending thoracic aortic rupture: Medline/PubMed, OVID, EMBASE, CINAHL, ClinicalTrials.gov, the Cochrane central register of controlled trials and the Cochrane database of systematic reviews. We used the random-effects model to calculate the odds ratio (OR) and 95% confidence intervals (CI) for mortality, paraplegia/paraparesis and stroke rates. Also, the medical records of the patients treated in our institution with this technique from 2000 to 2008 were reviewed. Demographics, comorbidities and operative procedure information were retrieved. Outcomes examined were mortality, paraplegia and stroke. Meta-analysis indicates that endoluminal graft repair is accompanied by lower procedure related mortality (OR 0.46, 95% CI 0.26-0.78, p=0.005) and paraplegia rates (OR 0.23, 95% CI 0.08-0.65, p=0.005), as compared to open repair. There was no difference in stroke rate between the two methods (OR 0.86, 95% CI 0.26-2.8, p=0.8). We have treated 13 patients with endoluminal stent-grafts. No conversion to open repair was necessary. Stroke rate was 15%, no patient died as a result of the stent-graft placement, one patient died as a result of massive head injury (overall 30-day mortality: 7.5%). There were no spinal cord ischemic complications. Our experience and meta-analysis indicate that thoracic endograft repair has low mortality and spinal cord complication rates for treatment of acute thoracic aortic rupture. If this method proves to be durable, it could replace open repair as the treatment of choice for these critically ill patients.

The analysis indicates that catheter-based treatments and traditional venous stripping with high ligation have similar long-term results. Establishing preoperative criteria for each method may improve outcomes but presently neither technique appears to confer an advantage in terms of mid- to long-term freedom from recurrent symptoms.

No abstract

No abstract

number of surgeries on patients age 80ϩ with CI has increased, rate per capita decreased by 14%, compared to a 20% decline in other age groups. The incidence of significant comorbidities has substantially increased; for claudicants: diabetes by 19%, HTP 30%, COPD 40%, CAD 21% and renal 230%; for patients with CI: HTP, COPD, and CAD incidence was higher (23%, 32%, 8% respectively) but diabetics decreased by 6%. Cardiac, respiratory and infection complications after amputation have increased by 29%, 28% and 10%. For LER, respiratory complications increased 9% but cardiac and infection complications actually decreased (8 and 27%) Similar trends were observed for patients with combined LER and amputation. Length of stay (LOS) declined significantly in all groups with an overall decrease of 30% (pϽ.05).Conclusion: Despite the fact that patients, whether treated for claudication or CI, are sicker, older and have more complications, the rate of major amputations and LOS has significantly decreased due presumably to widespread and successful use of endo LER and/or to earlier interventions driven by the safety of endo LER.Purpose: To introduce an algorithm which has been successful in minimizing complications related to the use of percutaneous closure devices.

Methods: 178 consecutive EVARs had concurrent CardioMEMS EndoSure® implantation during Jan. 2007 -Dec. 2008. Post-operative intrasac pressure was measured at every office visit. Ratios of sac to systemic pressures were recorded as mean (MPI) and pulse (PPI) pressure indexes. CT scans were obtained at every 6 months or anytime an endoleak was suspected. Aneurysm sac volume was quantitated after constructed by volume rendering of CTA.Results: Technical success of EndoSure implantation was 98% (175/178). No sensor malfunctioned after successful implantation. Mean follow-up was 12.5 months (range 1 -24 months). In EVAR without endoleak (143/175), sac pressure decreased progressively and remained plateaued (MPI Ͻ 0.5, PPI Ͻ 0.5) for 24 months. There was a strong correlation (r ϭ 0.87) between diminishing sac pressure and shrinking sac size. Thirty-two endoleaks developed (18.5%). Five type I endoleaks (3%) were discovered by sac pressure elevation (MPI Ͼ 0.5) and pulsatile waveform (PPI Ͼ 0.5) (Positive Predictive Value 100%). Twenty-seven type II endoleaks or endotensions (15.5%) were suspected with variant MPI elevation (Ͼ 0.5) but normal PPI (Ͻ 0.5)(PPV 100%). Endoleaks with markedly elevated sac pressure (MPI Ͼ 1.0) were followed by sac volume expansion.Conclusions: EVAR can be surveillanced safely by sac pressure monitoring up to 2 years. The type of endoleak can be predicted based on the character of sac pressure elevation. Suspected endoleak should be further examined by CTA with sac volume quantitation. Consistent sac pressure elevation with sac volume expansion warrants aggressive intervention. Summary of sac pressure and volume change during EVAR surveillance N ϭ 175 MPI PPI Sac volume No endoleak 143 Ͻ 0.5 Ͻ 0.5 Decrease Type I endoleak 5 Ͼ 0.5 Ͼ 0.5 Same or increase Type II endoleak 25 Ͼ 0.5 Ͻ 0.5 Increase if MPI Ͼ 1.0 Endotension 2 Ͼ 0.5 Ͻ 0.5 Increase if MPI Ͼ 1.0 Background: The mortality of ruptured abdominal aortic aneurysm (rAAA) repair is currently 40-50%. Reports indicate that endovascular repair (EVAR) is feasible for rAAA and may offer potential benefits over open repair. We examined the NSQIP database to compare 30-day multicentre outcomes for EVAR vs. open rAAA repair. Methods: Patients that underwent rAAA repair in the NSQIP database from 2005 to 2007 were identified through a combination of CPT codes and ICD-9 diagnoses. Preoperative comorbidities, operative duration and transfusion, and 30 day outcomes were evaluated using T-tests. Results: 76.8% of patients underwent open repair as shown: