Early outcomes of endovascular versus open abdominal aortic aneurysm repair in the National Surgical Quality Improvement Program–Private Sector (NSQIP–PS)

Hua, Hong; Cambria, Richard P.; Chuang, Sung Kiang; Stoner, Michael C.; Kwolek, Christopher J.; Rowell, Katherine S.; Khuri, Shukri F.; Henderson, William G.; Brewster, David C.; Abbott, William M.

doi:10.1016/j.jvs.2004.12.048

Cited by 140 publications

(96 citation statements)

References 34 publications

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“…17) Acute renal failure requiring hemodialysis has been reported to complicate the course of 0.5% to 2% of patients undergoing elective AAA repair, with associated in-hospital mortality ranging from 25% to 66%. 15,[18][19][20][21][22][23][24][25][26] Contrary to that report, our findings demonstrated that at 7 day after the operation, the incidence of a 10% or greater increase in serum Cr over the preoperative level was 10.9%, which was significantly lower in comparison to the previous report. Anatomical suitability for EVAR aortic neck diameter of 18-28 mm, neck length ≥15 mm, neck angulation <60, iliac diameter of 7.5-20 mm, length of iliac sealing zone ≥10 mm Fig.…”

Section: Discussioncontrasting

confidence: 99%

Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

Guntani

Okadome

Kawakubo

et al. 2012

Annals of Vascular Diseases

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Objective: Chronic renal insufficiency may be a relative contraindication to endovascular aneurysm repair (EVAR) for the use of contrast enhanced mediums. It is thought that more contrast enhanced media are needed in patients who are not anatomically suitable for EVAR, because of procedural difficulties. We reviewed a 2 year EVAR experience at our institution to determine whether the procedure and use of contrast enhanced mediums has any deleterious effect on renal function in patients with pre-existing chronic renal insufficiency. Materials and Methods: EVAR was performed in 46 patients with pre-existing chronic renal insufficiency without hemodialysis. Patients were retrospectively assigned to two groups on the basis of their preoperative creatinine clearance levels. Furthermore, patients were assigned to two other groups on the basis of anatomical suitability for EVAR. The absolute change in the serum creatinine (Cr) level was reviewed in the each renal insufficiency group between the preoperative and post-operative time periods. Results: No increase in the serum Cr level was noted, and no patient required temporary or permanent hemodialysis, in any of the groups. Conclusions: EVAR with contrast agents can be accomplished in patients with chronic renal insufficiency without hemodialysis; therefore,elevated Cr levels maynot be a contraindication in EVAR.

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Section: Discussioncontrasting

confidence: 99%

Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

Guntani

Okadome

Kawakubo

et al. 2012

Annals of Vascular Diseases

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“…[1][2][3][4][5][6][7] The results of the present study are in agreement with those of meta-analyses 2,7 comparing outcomes of patients undergoing EVAR and open repair for AAA. These data have not demonstrated the longterm survival benefit of EVAR over open repair for AAA.…”

Section: Discussionsupporting

confidence: 91%

“…Our grey The short-term mortality had varied definitions among studies. [1][2][3][4][5][6][7]12,13 Dangas et al 12 reported 30-day mortality data and did not include in-hospital mortality, whereas two large scale studies of RCT, DREAM and OVER 12,13 , used a combination of 30-day and in-hospital mortality. Contrary to previous study results, our present study showed similar short-term mortality between EVAR and open repair; the disparity from DREAM trial 6,12 could be due to the limited number of patients we studied.…”

Section: Discussionmentioning

confidence: 99%

“…One study showed a 9.8% reoperation rate among 543 EVAR cases, compared with 5.8% of 539 open repairs during 4 years. 4 Another study compared 444 EVAR with 437 open repair outcomes during a mean 1.8-year follow-up and found essentially equivalent rates of reintervention. 13 The reoperation rate for patients undergoing open repair in our study was 6.8% (9/133), and no patients in EVAR group underwent reoperation, which was in line with the literature 3,13 ; thus, the long-term benefit of EVAR for AAA was questioned.…”

Section: Discussionmentioning

confidence: 99%

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Grey Relational Analysis of Benefit of Surgical Management for Abdominal Aortic Aneurysm

Wang

Ren

Qian

et al. 2014

International Surgery

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Patients in the open repair group required larger volumes of intraoperative blood transfusion than those in EVAR (P , 0.001), and they had more of a trend of cardiac failure after surgery than those in the EVAR group. The operative mortality was similar in both groups. On follow-up, the all-cause mortality and the rates of ischemic legs within 5 years had no significant differences between the 2 procedures (P . 1-7 These trials showed that EVAR is superior to open surgery in terms of operative mortality in the short term, and there were no differences in mortality or aneurysm-related mortality in the long term. However, any possible longterm benefit from EVAR versus open surgical repair for abdominal aortic aneurysm (AAA) has not been proven, 2 and the data of long-term mortality rate after repair surgery are limited. It is necessary to study this issue to get a clear answer.

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“…10,11) These studies suggest that a transperitoneal approach for vascular surgery in patients with previous abdominal surgery may increase the risk of encountering a localized abscess during the dissection of adhesions, resulting in postoperative panperitonitis or graft infection. Endovascular treatment may be a promising alternative to aneurysm repair in patients with previous abdominal surgery because endovascular repair has significantly improved outcomes in patients with abdominal aortic aneurysms 12,13) and can be a first-line treatment for common iliac artery aneurysms. 14) However, internal iliac artery occlusion during endovascular aneurysm repair has been reported to result in impotence and buttock claudication caused by decreased penile and gluteal blood flow.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Retroperitoneal Approach to Repairing a Ruptured Right Iliac Artery Aneurysm in a Patient who has Undergone Transperitoneal Abdominal Surgery

Yamamoto

Fukuhiro

Yamaura

et al. 2011

ATCS

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An 84-year-old woman with a history of surgery for cholangiocarcinoma presented to Akita University Hospital with severe right lower abdominal pain, respiratory distress, and hypotension. Computed tomography scanning revealed a ruptured right common iliac artery aneurysm with a massive right retroperitoneal hematoma and a right internal iliac artery aneurysm. Under the bilateral retroperitoneal approach, we preformed an in-situ repair of an aneurysm rupture from the aorta to the left common and right external iliac arteries using a bifurcated knitted Dacron graft, and then we ligated the right internal iliac artery. The postoperative course of the patient was uneventful. The patient was discharged from hospital 52 days after surgery. In conclusion, a bilateral retroperitoneal approach may be a safe and useful strategy for in-situ repair of a right iliac artery aneurysm rupture in patients with peritoneal adhesions after transperitoneal abdominal surgery.

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Early outcomes of endovascular versus open abdominal aortic aneurysm repair in the National Surgical Quality Improvement Program–Private Sector (NSQIP–PS)

Cited by 140 publications

References 34 publications

Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

Clinical Results of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Renal Insufficiency without Hemodialysis

Grey Relational Analysis of Benefit of Surgical Management for Abdominal Aortic Aneurysm

Bilateral Retroperitoneal Approach to Repairing a Ruptured Right Iliac Artery Aneurysm in a Patient who has Undergone Transperitoneal Abdominal Surgery

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