Comparison of EVAR and open repair in patients with small abdominal aortic aneurysms: Can we predict results of the PIVOTAL trial?

Lall, Purandath; Gloviczki, Péter; Agarwal, Gautam; Duncan, Audra A.; Kalra, Manju; Hoskin, Tanya L.; Oderich, Gustavo S.; Bower, Thomas C.

doi:10.1016/j.jvs.2008.07.085

Cited by 15 publications

(8 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this international registry of 4392 patients, the patients with large AAAs ($6.5 cm) after EVAR had the highest rate of all-cause and aneurysm-related death and late aneurysm rupture. 11 Outcome of patients with small (<5.5 cm) AAAs was excellent, similar to data reported by us 10 and others. 12,13 A review of long-term results of a prospective multicenter investigational device exemption clinical trial of EVAR found that patients with large AAAs ($6.0 cm) had a shorter life expectancy and a higher risk of rupture, surgical conversion, and aneurysm-related death compared with patients with smaller AAAs (<5.0 cm).…”

supporting

confidence: 86%

“…3 The current size threshold to recommend OR for asymptomatic AAAs in men has been established at 5.5 cm. [5][6][7][8][9] On the basis of two randomized controlled trials and evidence from single-institutional data, 10 this size has also been accepted as a threshold for EVAR. A report from the European Collaborators on Stent/graft Techniques for aortic Aneurysm Repair (EUROSTAR) registry, published in 2004, first called attention to the size of AAA as a factor predicting late outcome after EVAR.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Huang

Gloviczki

Duncan

et al. 2017

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

Maximal aortic diameter is associated with long-term outcomes after elective EVAR. Patients with large AAAs (≥6.0 cm) have higher all-cause mortality, complication, and reintervention rates after EVAR than those with smaller aneurysms. We continue to recommend that AAAs be repaired when they reach 5.5 cm as recommended by the guidelines of the Society for Vascular Surgery. On the basis of our data, EVAR should be considered even in high-risk patients with a maximal aortic diameter between 5.5 and 6.0 cm because surgical risk with aneurysm size above 6.0 cm will increase significantly.

show abstract

supporting

confidence: 86%

mentioning

confidence: 99%

Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Huang

Gloviczki

Duncan

et al. 2017

Journal of Vascular Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lall et al found a correlation between survival, age, and aneurysm size, but there were only three deaths and 32 patients in the EVAR arm following multivariate analysis. 18 In our 2008 risk assessment model 30-day survival was mainly predicted by age and aneurysm size, whereas aneurysm size, age, ASA status, and creatinine all contributed significantly to 3 and 5-year survival. 6e8 Respiratory fitness and calcification were not analysed in 2008, so it is interesting to find that they do contribute to the 1-year survival model.…”

Section: Discussionmentioning

confidence: 69%

Predictors of 1-Year Survival After Endovascular Aneurysm Repair

Fitridge

Boult

Loryn

et al. 2016

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

show abstract

“…A presentation at a recent meeting of the European Society of Vascular Surgery reported that at 3 years, early elective EVAR did not reduce mortality for patients with 40–54mm AAAs 114. Longer term results are awaited 115,116. Recently, it has been suggested that delaying surgery does not alter the anatomical suitability for EVAR 117.…”

Section: 0 Current Diagnosis Of Aaamentioning

confidence: 99%

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

Moxon

Parr²,

Emeto³

et al. 2010

Current Problems in Cardiology

125

148

View full text Add to dashboard Cite

Abdominal aortic aneurysm (AAA) remains an important cause of morbidity and mortality in elderly men, and prevalence is predicted to increase in parallel with a global ageing population. AAA is commonly asymptomatic, and in the absence of routine screening, diagnosis is usually incidental when imaging to assess unrelated medical complaints. In the absence of approved diagnostic and prognostic markers, AAAs are monitored conservatively via medical imaging until aortic diameter approaches 50-55mm and surgical repair is performed. There is currently significant interest in identifying molecular markers of diagnostic and prognostic value for AAA. Here we outline the current guidelines for AAA management, and discuss modern scientific techniques currently employed to identify improved diagnostic and prognostic markers. KeywordsAbdominal aortic aneurysm; diagnosis; prognosis; biomarker INTRODUCTIONAn abdominal aortic aneurysm (AAA) is a dilation of the infra-renal aorta, which appears to result from chronic weakening of the arterial wall, increasing the risk of fatal rupture.1 -3 AAA is also associated with an increased risk of other major cardiovascular events in aneurysmal patients. For example the UK small aneurysm trial (UKSAT), demonstrated that only 16% of deaths in patients with 40-55mm AAAs was related to AAA repair or rupture while ~50% were due to other cardiovascular causes (mainly myocardial infarction and stroke).4 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access AAA pathologyMacroscopically, an AAA can be considered a dilatation of the infrarenal aorta, giving rise to a permanent vessel diameter >30mm (typical abdominal aortic diameter ranges from 15 to 25mm). 23-27 AAA vessel dilation is commonly progressive, and is often accompanied by the formation of a laminated, non-occlusive, intraluminal thrombus.28 -29 Thrombus size and location varies between patients, and the arterial wall may be partially or completely covered by the thrombus ( Figure 1A and B). 30 The thrombus remains in permanent contact with circulating blood and is continually remodeled, 31,32 and thrombus size increases in parallel with aortic dilation. Due to constant remodeling the thrombus is a laminated structure comprising a red blood cell-rich luminal layer in contact with the flowing blood, progressing to a brown fibrinolysed layer at the aortic wall. 29 Localised hypoxia has been demonstrated in regions of the aorta covered by the thrombus and this has been suggested to contribute to physiological stresses within the arterial wall. 33 Similar to other vascular dise...

show abstract

Comparison of EVAR and open repair in patients with small abdominal aortic aneurysms: Can we predict results of the PIVOTAL trial?

Abstract: For repair of small AAAs, results of EVAR vs OR are not different at 5 years at a tertiary institution. Multicenter studies confirmed OR were not superior to observation in these patients. We predict the PIVOTAL study will conclude EVAR is not superior to observation.

Cited by 15 publications

References 22 publications

Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Maximal aortic diameter affects outcome after endovascular repair of abdominal aortic aneurysms

Predictors of 1-Year Survival After Endovascular Aneurysm Repair

Diagnosis and Monitoring of Abdominal Aortic Aneurysm: Current Status and Future Prospects

Contact Info

Product

Resources

About