Editor's Choice – Endovascular vs. Open Repair for Abdominal Aortic Aneurysm: Systematic Review and Meta-analysis of Updated Peri-operative and Long Term Data of Randomised Controlled Trials

Antoniou, George Α.; Antoniou, Stavros A.; Torella, Francesco

doi:10.1016/j.ejvs.2019.11.030

Cited by 164 publications

(75 citation statements)

References 36 publications

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“…Lastly, recent meta-studies (e.g. [8,9]) on the long term outcomes of EVAR versus OSR could not detect any differences with regards to the all-cause mortality or even concluded in favor of OSR.…”

Section: Introductionmentioning

confidence: 94%

Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study

et al. 2020

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We present a data-informed, highly personalized, probabilistic approach for the quantification of abdominal aortic aneurysm (AAA) rupture risk. Our novel framework builds upon a comprehensive database of tensile test results that were carried out on 305 AAA tissue samples from 139 patients, as well as corresponding non-invasively and clinically accessible patient-specific data. Based on this, a multivariate regression model is created to obtain a probabilistic description of personalized vessel wall properties associated with a prospective AAA patient. We formulate a probabilistic rupture risk index that consistently incorporates the available statistical information and generalizes existing approaches. For the efficient evaluation of this index, a flexible Kriging-based surrogate model with an active training process is proposed. In a case-control study, the methodology is applied on a total of 36 retrospective, diameter matched asymptomatic (group 1, n = 18) and known symptomatic/ruptured (group 2, n = 18) cohort of AAA patients. Finally, we show its efficacy to discriminate between the two groups and demonstrate competitive performance in comparison to existing deterministic and probabilistic biomechanical indices.

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Section: Introductionmentioning

confidence: 94%

Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study

et al. 2020

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“…This finding is also discussed in a recent meta-analysis of seven randomized trials on iAAA repair confirming the increase in aneurysm-related mortality over time in the EVAR group. 45 Further research regarding the optimal interval, imaging and duration of follow-up after EVAR is needed according to the Society for Vascular Surgery guidelines. 1 Post-OSR rupture.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

A population-based study of post-endovascular aortic repair rupture during 15 years

Andersson

Talvitie

Benson

et al. 2021

Journal of Vascular Surgery

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Objective: The devastating event of a ruptured abdominal aortic aneurysm (rAAA) in patients who have survived a previous AAA repair, either elective or urgent, is a feared and quite uncommon event. It has been suggested to partly explain the loss of the early survival benefit for endovascular aortic repair (EVAR) vs open surgical repair (OSR). The main objective of this study was to report the national incidence rate, risk factors and outcome of post-EVAR ruptures. Secondarily, the national incidence rate of ruptures after OSR (post-OSR ruptures) was investigated.Methods: We conducted a nationwide, population-based, retrospective cohort study using the inpatient and outpatient entries for all patients >40 years of age, receiving their first (index) surgical procedure for AAA, from 2001 to 2015. Only patients surviving their index procedure were included. The primary outcome was rAAA, registered after discharge from the index procedure (EVAR or OSR), identified in the Swedish National Patient Registry and the Cause of Death Registry.Results: In total, 14,859 patients survived their primary (index) AAA procedure. There were 6470 EVAR procedures, 5893 for intact AAA (iAAA) and 577 for rAAA. Of the 6470 EVAR patients, 86 cases of post-EVAR rupture were identified, corresponding with a cumulative incidence of 1.3% over a mean follow-up time of 3.9 years. The incidence rate was 3.4 (95% confidence interval [CI], 2.7-4.2)/1000 person-years. The independent risk factors identified for post-EVAR rupture were rAAA at index surgery HR 2.4 (95% CI, 1.4-4.1, p 0.002) and age (hazard ratio, 1.1; 95% CI, 1.0-1.1; P < .001). Freedom from post-EVAR rupture was 99%, 98%, and 96% at 3, 5, and 10 years, respectively. Total and postoperative mortality after post-EVAR rupture were 42% and 17% (30 days), 45% and 22% (90 days), and 53% and 33% (1 year). The incidence rate of post-OSR rupture was 0.9/1000 person-years (95% CI, 0.7-1.2).Conclusions: Post-EVAR rupture is a rare complication that can occur at any time after the index EVAR procedure. This finding may have implications for the discussion of limited follow-up programs and for the choice of procedure in patients with an AAA with a long life expectancy. An rAAA as the indication for the index surgery and age were identified as risk factors for post-EVAR rupture. The mortality associated with post-EVAR rupture is high, but lower than that of primary rAAA. The much lower risk of post-OSR rupture was confirmed, but must not be neglected as a possible late complication.

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“…Nonetheless, aneurysm related mortality after eight years is higher in patients that underwent endovascular aneurysm repair compared with open surgery. 49 Currently available pharmacological treatment strategies are aimed at reducing AAA risk factors, but no prescription medication is yet approved to prevent the incidence or growth of AAA. As stated in the European Society for Vascular Surgery clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms, there is a global request for further research into medical treatment to slow AAA growth.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Gene Expression of Human Perivascular Adipose Tissue in Abdominal Aortic Aneurysms

Meekel

Dias-Neto

Bogunovic

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSA multicentre study was conducted to assess inflammatory gene expression in perivascular adipose tissue (PVAT) of patients with abdominal aortic aneurysm (AAA) and healthy controls. PVAT from AAA patients and healthy aortic smooth muscle cells stimulated with this adipose deposit both showed increased proinflammatory and decreased anti-inflammatory gene expression. These findings suggest that inflammation of PVAT and thereby the aortic wall contributes to AAA pathophysiology. The pathway of inflammatory induction could reveal new therapeutic targets for both prevention and conservative treatment of AAA.Objective: Perivascular adipose tissue (PVAT) contributes to vascular homeostasis and is increasingly linked to vascular pathology. PVAT density and volume were associated with abdominal aortic aneurysm (AAA) presence and dimensions on imaging. However, mechanisms underlying the role of PVAT in AAA have not been clarified. This study aimed to explore differences in PVAT from AAA using gene expression and functional tests. Methods: Human aortic PVAT and control subcutaneous adipose tissue were collected during open AAA surgery. Gene analyses and functional tests were performed. The control group consisted of healthy aorta from non-living renal transplant donors. Gene expression tests were performed to study genes potentially involved in various inflammatory processes and AAA related genes. Live PVAT and subcutaneous adipose tissue (SAT) from AAA were used for ex vivo co-culture with smooth muscle cells (SMCs) retrieved from non-pathological aortas. Results: Adipose tissue was harvested from 27 AAA patients (n [gene expression] ¼ 22, n [functional tests] ¼ 5) and five control patients. An increased inflammatory gene expression of PTPRC (p ¼ .008), CXCL8 (p ¼ .033), LCK (p ¼ .003), CCL5 (p ¼ .004) and an increase in extracellular matrix breakdown marker MMP9 (p ¼ .016) were found in AAA compared with controls. Also, there was a decreased anti-inflammatory gene expression of PPARG in AAA compared with controls (p ¼ .040). SMC co-cultures from non-pathological aortas with PVAT from AAA showed increased MMP9 (p ¼ .033) and SMTN (p ¼ .008) expression and SAT increased SMTN expression in these SMC. Conclusion:The data revealed that PVAT from AAA shows an increased pro-inflammatory and matrix metallopeptidase gene expression and decreased anti-inflammatory gene expression. Furthermore, increased expression of genes involved in aneurysm formation was found in healthy SMC co-culture with PVAT of AAA patients. Therefore, PVAT from AAA might contribute to inflammation of the adjacent aortic wall and thereby plays a possible role in AAA pathophysiology. These proposed pathways of inflammatory induction could reveal new therapeutic targets in AAA treatment.

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Editor's Choice – Endovascular vs. Open Repair for Abdominal Aortic Aneurysm: Systematic Review and Meta-analysis of Updated Peri-operative and Long Term Data of Randomised Controlled Trials

Abstract: Conclusion: Compared with open surgery, EVAR results in a better outcome during the first six months but carries an increased risk of aneurysm related mortality after eight years.

Cited by 164 publications

References 36 publications

Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study

Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study

A population-based study of post-endovascular aortic repair rupture during 15 years

Inflammatory Gene Expression of Human Perivascular Adipose Tissue in Abdominal Aortic Aneurysms

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