Importance of early repair of isolated abdominal aortic dissecting aneurysm

Flores, Jorge; Kunihara, Takashi; Shiiya, Norihiko; Yoshimoto, Kimihiro; Matsuzaki, Kei; Nakamura, Michitaka; Okamoto, Fumiyuki; Nakanishi, Koji; Matano, J; Yamada, Akira; Maruyama, Ryushi; Sakai, Keisuke; Yasuda, Keishu

doi:10.1024/0301-1526.34.2.118

Cited by 5 publications

(10 citation statements)

References 18 publications

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“…Ten studies reported different treatment strategies, including conservative treatment, ENDO and OS 3,7,8,10,13,15e18,26 ; six studies only reported ENDO 9,14,19e21,25 and one study only reported OS. 11 The details of the main characteristics of included studies are summarised in Tables 1 and 2.…”

Section: Resultsmentioning

confidence: 99%

“…During follow up, other than two deaths before treatment and 35 deaths in the Kang et al 13 study with non-separated data, 21 deaths The overall 91% of IAADs were spontaneous, which is comparable to previous studies reporting dissection types (66.7e100%). 3,7,9,11,14,18,19,21,25,26 Hypertension, smoking, and hyperlipidaemia were the most common concomitant risk factors of IAAD, which could induce endothelial damage and a persistent inflammatory response to stimulate formation of atherosclerosis and spontaneous aortic dissection. 27,28 Therefore, all patients with IAAD should be advised on basic lifestyle interventions, including hypertension control, smoking cessation, and a decrease of salt and fat in diet.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

Yang

Han

Zhao

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis meta-analysis presents the pooled quantitative evidence of basic profiles, initial treatment strategies, and clinical outcomes in patients with isolated abdominal aortic dissection. Major findings suggest that appropriate initial treatment strategies can obtain acceptable clinical outcomes, with a 30 day mortality of 3%, a long term mortality of 8%, and a re-intervention rate of 8%. Endovascular repair or open surgery is necessary if patients match certain indications for intervention. Regular imaging surveillance should be provided for all patients, especially those treated conservatively, who appear to be most at risk of second intervention.Objective: To present the pooled quantitative evidence of basic profiles, initial treatment strategies, and clinical outcomes in patients with isolated abdominal aortic dissection (IAAD). Methods: A comprehensive systematic review and meta-analysis was performed of all available studies reporting IAAD, retrieved from the MEDLINE, Embase, and Cochrane Databases. The logistic normal random effect model was fitted using the generalised linear mixed model with random intercepts to calculate the pooled proportion estimates.Results: Seventeen studies with 482 patients were included in this meta-analysis. Male smokers with hyperlipidaemia and hypertension were the most prominent basic profile. IAADs were predominantly spontaneous and infrarenal, and roughly half were acute and symptomatic. Approximately 67% [95% confidence interval (CI) 42e86%] of patients were managed initially conservatively. In the overall population, the 30 day all cause mortality was 3% (95% CI 1e5%) and the long term mortality during follow up was 8% (95% CI 5e14%). Re-intervention during follow up occurred in 8% (95% CI 5e15%) of patients. In the subgroup analysis, patients with conservative treatment had a 30 day mortality of 1% (95% CI 0e8%), a long term mortality of 5% (95% CI 1e29%), and a re-intervention rate of 18% (95% CI 10e29%). Patients with open surgery had a 30 day mortality of 9% (95% CI 0e82%), a long term mortality of 12% (95% CI 4e31%), and a re-intervention rate of 9% (95% CI 1e44%). Patients with endovascular repair had a 30 day mortality of 2% (95% CI 0e10%), a long term mortality of 5% (95% CI 2e13%), a re-intervention rate of 6% (95% CI 3e 13%), and a persistent endoleak rate of 4% (95% CI 2e10%). Conclusion: Appropriate initial treatment strategies can be used to obtain acceptable clinical outcomes in patients with IAAD. Invasive intervention is necessary if patients match certain indications for intervention. Regular imaging surveillance should be provided for all patients, especially those treated conservatively.

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Section: Resultsmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

Yang

Han

Zhao

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…7 Generally, however, dissecting AAAs are more clinically evident than their non-dissecting counterparts because of their rapid evolution, although the presenting symptoms may initially be heterogeneous and non-specific. 8 Although the natural history and management of this combined pathology is poorly understood, the presence of both aneurysmal disease and aortic dissection is associated with a significant risk of vessel rupture due to loss of integrity of the aortic wall and increased wall tension. Although debate exists about when these patients should be offered intervention, a review of the literature appears to favour early surgical repair 9 and probably at an aneurysm size of just 3 cm, considerably below the usual 'cut-off' of 5.5 cm.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous aortic dissection within an infrarenal AAA

et al. 2012

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“…14,21,22) This tendency is due to a decrease in elastin in the aortic wall from the chest to the abdomen. 20) However, in the abdominal aorta unlike the thoracic aorta, changes in the media such as cystic medial necrosis rarely occur, and the presence of PAU may be closely associated with the development of abdominal aortic dissection. The onset of this dissection is often acute with symptoms such as abdominal and low back pain, but some cases are asymptomatic and incidentally detected.…”

Section: Resultsmentioning

confidence: 99%

Abdominal Aortic Disease Caused by Penetrating Atherosclerotic Ulcers

Satô

Imai

Sakamoto

et al. 2012

Annals of Vascular Diseases

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Objective: Penetrating atherosclerotic ulcer (PAU) of the aorta is defined as an atherosclerotic lesion with ulceration of the aortic intima and media and rupture of the internal elastic lamina. PAU induced aortic dissection, aortic rupture, and secular aortic aneurysm and typically occurs in elderly hypertensive patients with severe atherosclerosis. Although it has been reported that atherosclerosis similarly occurs in the abdominal aorta, its natural history and treatment are still unclear. This study investigated the clinical features, natural history, and treatment of PAU of the abdominal aorta.

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Importance of early repair of isolated abdominal aortic dissecting aneurysm

Cited by 5 publications

References 18 publications

Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

Spontaneous aortic dissection within an infrarenal AAA

Abdominal Aortic Disease Caused by Penetrating Atherosclerotic Ulcers

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