Surgical management of abdominal aortic aneurysm

Yeung, B. Kwok Fai; Pearce, William H.

doi:10.1177/1358836x0000500308

Cited by 7 publications

(14 citation statements)

References 57 publications

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“…[22][23][24][25] According to the literature, depending on the size of the cycles with classic elective AAA repairs, mortality ranges from 1.8 to 5% 26 to even 9.6%. [27][28][29][30] In our study, we have found nonsignificant differences in 30-day mortality (0 vs. 1, p ¼ ns). We may assume that we were actually underpowered to estimate the differences in such rare outcome.…”

Section: Discussioncontrasting

confidence: 62%

Restrictive versus Standard Fluid Regimen in Elective Minilaparotomy Abdominal Aortic Repair—Prospective Randomized Controlled Trial

Piljić¹,

Petričević

Piljić

et al. 2015

Thorac cardiovasc Surg

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Objective Elective minilaparotomy abdominal aortic aneurysm (AAA) repair is associated with a significant number of complications involving respiratory, cardiovascular, gastrointestinal, and central nervous systems, with mortality ranging up to 5%. In our study, we tested the hypothesis that intra- and postoperative intravenous restrictive fluid regimen reduces postoperative morbidity and mortality, and improves the outcome of minilaparotomy AAA repair. Methods From March 2009 to July 2013, 60 patients operated due to AAA were included in a prospective randomized controlled trial (RCT). About the administration of fluid during the operation and in the early postoperative period, all the patients were randomized into two groups: the group of standard fluid administration (S-group, 30 patients) and the group of reduced fluid administration (R-group, 30 patients). The verification of the treatment success was measured by the length of intensive care unit (ICU) stay, duration of hospitalization after the procedure, as well as the number and type of postoperative complications and mortality. This prospective RCT was registered in a publicly accessible database ClinicalTrials.gov with unique Identifier ID: NTC01939652. Results Total fluid administration and administration of blood products were significantly lower in R-group as compared with S-group (2,445.5 mL vs. 3308.7 mL, p = 0.004). Though the number of nonlethal complications was significantly lower in R-group (2 vs. 9 patients, p = 0.042), the difference in lethal complications remained nonsignificant (0 vs. 1 patient, p = ns). The average ICU stay (1.2 vs. 1.97 days, p = 0.003) and duration of postoperative hospital stay (4.33 vs. 6.20 days, p = 0.035 for R-group and S-group, respectively) were found to be significantly shorter in R-group. Conclusion Intra- and postoperative restrictive intravenous fluid regimen in patients undergoing minilaparotomy AAA repair significantly reduces postoperative morbidity, and shortens ICU and overall hospital stay. Even though incidence of lethal complication was lower in R-group, the difference did not reach statistical significance. Therefore, we may assume that this study was probably underpowered to estimate the differences in mortality between R- and S-groups. Further multicentric, sufficiently powered RCTs are needed to confirm these findings and to clarify effect of restrictive fluid management on mortality.

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Section: Discussioncontrasting

confidence: 62%

Restrictive versus Standard Fluid Regimen in Elective Minilaparotomy Abdominal Aortic Repair—Prospective Randomized Controlled Trial

Piljić¹,

Petričević

Piljić

et al. 2015

Thorac cardiovasc Surg

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“…AAA is a very malignant disease characterized by a high incidence of mortality (70%) after rupture. [ 9 ] A sudden severe pain may indicate peritoneal or retroperitoneal rupture. A growing tumor could result in compression of adjacent organs such as duodenum, the proximal jejunum and ureter, which was observed in our patient who developed hydronephrosis due to an oppression.…”

Section: Discussionmentioning

confidence: 99%

Marfan syndrome combined with huge abdominal aortic aneurysm size of 20 × 11 cm

Zhang

Chi²,

Jiang³

et al. 2018

Medicine

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Rationale:Abdominal aortic aneurysm is one of the most common aneurisms. Patients presenting with secondary back pain should be given prompt medical attention. Herein, a rare case of a giant abdominal aortic aneurysm that was successfully treated with surgery is described.Patient concerns:A 33-year-old Chinese male suffered from Marfan syndrome combined with giant abdominal aortic aneurysm, and presented with back pain, fever, nausea, vomiting, abdominal distention, and constipation. After undergoing numerous tests, the patient underwent an abdominal aortic aneurysm resection coupled with artificial graft bypass. The patient's recovery was smooth, and he was discharged 14 days after the operation in stable condition.Diagnosis:Abdominal aortic aneurysm.Interventions:The patient underwent a surgery involving mass resection and artificial graft bypass.Outcome:The patient was discharged 14 days after surgery in stable condition.Lessons:Giant abdominal aortic aneurysms are rarely seen, and aneurysmectomy associated with prosthetic vascular graft repair is an effective and standard treatment for such aneurysms.

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“…An aneurysm is the local dilation of the lumen of a vessel by 50% compared to the proximal, unaffected segment. In practice, the abdominal aortic aneurysm is diagnosed when its diameter is at least 30 mm, measured from the internal to external vessel outline (1)(2)(3)(4)(5)(6)(7). The normal diameter of aorta in the subrenal segment is 1.66-2.16 cm in women and 1.99-2.39 in men (8,9).…”

Section: Introductionmentioning

confidence: 99%