Probability of rupture of an abdominal aortic aneurysm after an unrelated operative procedure: A prospective study

Durham, Samuel J.; Steed, David L.; Moosa, Hans H.; Makaroun, Michel S.; Webster, Marshall W.

doi:10.1016/0741-5214(91)90217-i

Cited by 43 publications

(16 citation statements)

References 17 publications

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“…However, Cohen et al 254 examined this question in rats, and found no evidence of increased aortic collagenase activity, and a prospective clinical study on this topic by Durham and colleagues found no evidence of this phenomenon. 255 It seems reasonable to conclude that the risk of AAA rupture is not increased by such unrelated surgeries, and that a period of four to six weeks should be allowed to enable a satisfactory recovery to occur prior to elective AAA repair. Certainly this should be modified if the aneurysm is symptomatic, large, or other worrisome features are identified on CT scan.…”

Section: Level Of Recommendation: Strong Quality Of Evidence: Highmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

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625

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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Section: Level Of Recommendation: Strong Quality Of Evidence: Highmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

Self Cite

625

520

View full text Add to dashboard Cite

show abstract

“…[14][15][16][17][18][19][20] Similarly, when dealing with AAA-associated gastric cancer in low-risk patients, concomitant subtotal or total gastrectomy can safely be performed in combination with open AAA repair. 11 However, to our knowledge there have not been any reports describing either a concomitant subtotal or total gastrectomy in a high-risk patient with AAA.…”

Section: Discussionmentioning

confidence: 90%

“…If the two procedures are performed separately with a tumor resection performed fi rst, treatment of the AAA must be delayed by at least 1 month, which may precipitate perioperative aneurysm rupture. 10,11 If AAA repair is performed and tumor resection is delayed, there is risk for interim spread of local and metastatic disease. 12,13 If the procedures are performed simultaneously, the risk of the surgery increases due to both the greater risk of bacterial graft contamination, higher blood loss, and possible stress on the patient due to a longer duration of surgery.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous total gastrectomy and endovascular repair of an abdominal aortic aneurysm: Report of a case

et al. 2011

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We herein present the case of a 66-year-old man with both gastric cancer and an infrarenal abdominal aneurysm. The patient's medical history included bladder cancer, chronic renal failure, and ischemic heart disease. We performed a simultaneous endovascular aneurysm repair (EVAR) and total gastrectomy. Following the procedure, the patient remained in the intensive care unit for 3 days. Oral feeding was resumed on postoperative day 7, and the patient was discharged from the hospital on postoperative day 13 with no complications. Despite the patient's medical problems and higher operative risk, he tolerated simultaneous EVAR and total gastrectomy, and had a good outcome after undergoing these simultaneous procedures.

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“…The risk of rupture of the aneurysm after surgery for nonvascular disease has been reported only for abdominal procedures and it has been related not only to the degree of exposure of the aneurysm and its size, but also to possible indirect mechanisms such as activation of collagenase and metalloproteinase. 18,19 An endovascular repair has radically modifi ed abdominal aortic aneurysm treatment, especially for patients in poor general health and with a high anesthesiology risk (ASA 3-4). It is much less invasive and more advantageous than an open repair in the short term but it has a 41% complication rate at a 4-year follow-up, 20 with a mean of 20% of the patients who experience endoleaks, 3% endotension, and with a rupture risk per year of 1%.…”

Section: Discussionmentioning

confidence: 99%

Concomitant pulmonary carcinoma and abdominal aortic aneurysm: Therapeutic strategies

et al. 2008

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An endovascular exclusion of the aneurysm may therefore be proposed in order to achieve a concomitant treatment of both diseases. Such an approach excludes complications due to a postoperative rupture of the aneurysm when a pulmonary resection would be first performed; moreover, it does not delay the performance of a pulmonary resection when treatment of the aneurysm is considered to have priority.

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Probability of rupture of an abdominal aortic aneurysm after an unrelated operative procedure: A prospective study

Cited by 43 publications

References 17 publications

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Simultaneous total gastrectomy and endovascular repair of an abdominal aortic aneurysm: Report of a case

Concomitant pulmonary carcinoma and abdominal aortic aneurysm: Therapeutic strategies

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