Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair

Mehta, Manish; Byrne, John; Darling, R. Clement; Paty, Philip S.K.; Roddy, Sean P.; Kreienberg, Paul B.; Taggert, John B.; Feustel, Paul J.

doi:10.1016/j.jvs.2012.09.003

Cited by 128 publications

(93 citation statements)

References 32 publications

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“…EVAR has expanded access to repair because ruptures may have been prevented, particularly for oldest patients, and life expectancy may have been prolonged meaningfully (3). These patients in previous studies were older men and had higher rates of hypertension and COPD; they were more likely to undergo elective EVAR rather than emergent EVAR and were comparable with the patients in our present report (7,8,12). A history of hypertension strongly predicted survival of EVAR (8,13).…”

Section: Discussionsupporting

confidence: 84%

“…Our current practice indicates that many patients with a clinical diagnosis of a rupture are transferred from smaller hospitals and are increasingly managed in vascular units. A previous report showed that 59% were transferred from an outside facility and 41% were direct admissions (8). In our study, 36% (9/25) of patients were transferred from local hospitals without surgical service to our hospital.…”

Section: Discussionmentioning

confidence: 43%

“…The lowest systolic blood pressure was strongly and independently associated with 30-d mortality (16). Hemodynamically unstable patients had a 21.7-40% chance of requiring aortic occlusion balloons during the procedures (8,15,17).…”

Section: Discussionmentioning

confidence: 99%

“…Scholarly articles report that the population most likely to show decreased incidence of AAA are those who might have benefited most from lower smoking rates and increased overall penetrance of statins (1,3,7). However, it is crucial to consider, first, that the use of endovascular repair for rAAA increased from 13% in 2002 to 73% in 2013; and second, that the demographic trend has been moving toward an increasing incidence and prevalence of cardiovascular disease in elderly men (4,8). In some reports, the mean age was 70-75 years, with over 78-90% of the patients being men (7,(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital

Lee¹,

Chang

Huang

et al. 2016

J. Thorac. Dis.

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Background: The purpose of this study was to compare the outcomes of elective endovascular abdominal aortic aneurysm repair (EVAR) and ruptured abdominal aortic aneurysm (rAAA) in patients at a district general hospital.Methods: A retrospective clinical study was conducted using data on 16 patients with elective abdominal aortic aneurysm (AAA) and nine patients with consecutive rAAA treated with EVAR from January 2010 to December 2014 in a district general hospital in Taiwan.Results: The preoperative characteristics of the two groups are listed. Thirty-six percent (9/25) of the patients were referred from other hospitals that did not offer surgical services. The percentage of patients with rAAA that were transferred from other hospitals was 55.5% (5/9). The stay durations in the intensive care unit for elective EVAR cases were shorter than those for emergent EVAR (

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital

Lee¹,

Chang

Huang

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…Compared with open repair, EVAR may offer significant survival benefits in elective surgery patients aged over 80 years (risk ratio 3.87, 95% CI 3.19-4.68) and a lower prevalence of complications [22,23]. A large randomised controlled trial (the IMPROVE trial) comparing EVAR and open repair for ruptured AAA is currently recruiting participants in the UK, and is due to report in 2014/15 [24].…”

Section: Emergency Abdominal Aortic Aneurysm Repairmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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Recent risk factors for open surgical mortality in patients with ruptured abdominal aortic aneurysm

Uchida

Akita

et al. 2014

Acute Medicine & Surgery

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Aim:We examined recent relevant prognostic factors for the outcome of open surgical treatment of ruptured abdominal aortic aneurysm.Methods: Between 2006 and 2012, 35 patients received emergency open surgical treatment for ruptured abdominal aortic aneurysm at our institute. We reviewed ambulance activity logs and clinical records of 34 infrarenal ruptured abdominal aortic aneurysm patients retrospectively. Univariate and multivariate logistic regression analyses were carried out to identify risk factors for surgical outcomes.Results: Eight patients died during surgery or within a few hours following surgery completion. Through univariate analysis, body mass index, serum lactate level, arterial blood pH, base excess, platelet count, prothrombin time-international normalized ratio, activated partial thromboplastin time, type of ruptured aneurysm, response to i.v. fluid resuscitation within 2,000 mL in the initial therapy, and volume of blood loss during surgery were detected to be significant variants. Multivariate logistic regression analysis revealed the patients who were hemodynamically stabilized after primary volume loading had a 13.2 times higher possibility of survival. Body mass index, high serum lactate level, and volume of blood loss were also found to be independent risk factors of mortality. Conclusion:The risk factors of open surgical ruptured abdominal aortic aneurysm repair, body mass index, lactate level, volume of intraoperative blood loss, and response to initial 2,000 mL fluid resuscitation were correlated to survival.

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Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair

Cited by 128 publications

References 32 publications

Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital

Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Recent risk factors for open surgical mortality in patients with ruptured abdominal aortic aneurysm

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