Total laparoscopic infrarenal aortic aneurysm repair: Preliminary results

Coggia, Marc; Javerliat, Isabelle; Centa, Isabelle Di; Colacchio, Giovanni; Cerceau, Pierre; Kitzis, M; Goëau-Brissonnière, Olivier

doi:10.1016/j.jvs.2004.06.037

Cited by 66 publications

(77 citation statements)

References 22 publications

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“…In their series, Creech endoaneurysmorrhaphy was performed through an 8-11 cm periumbilical incision after a laparoscopic dissection. Coggia et al 19 described total laparoscopic infrarenal AAA repair. In their series, although most patients rapidly returned to a fully functional status, the 30-day mortality was 6.7%.…”

Section: Discussionmentioning

confidence: 99%

A Shorter Skin Incision Technique for the Repair of Infrarenal Abdominal Aortic Aneurysms

et al. 2007

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Section: Discussionmentioning

confidence: 99%

A Shorter Skin Incision Technique for the Repair of Infrarenal Abdominal Aortic Aneurysms

et al. 2007

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“…Laparoscopic AAA repair is similar in principle to open AAA repair but performed using laparoscopy rather than a laparotomy; it has not been widely adopted because of the difficulty and frequency of complications. 31 Although there are inevitable variations, 32 the mortality following open elective AAA repair is generally accepted as being approximately 5% with some evidence that the 30-day mortality rate is falling. 33,34 In addition to this mortality risk, there is a significant risk of major medical morbidity and laparotomy-related complications.…”

Section: Open or Endovascular Repairmentioning

confidence: 99%

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Grant

Sperrin

Carlson

et al. 2015

Health Technology Assessment

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BackgroundAbdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities.ObjectiveTo develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice.Data sourcesThe UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases.MethodsA combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit.ResultsThe analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty.LimitationsLack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation.ConclusionsThe ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Videoscopic approach is confined to centres with a specific expertise in laparoscopic AAA repair (10,46,47). However laparoscopic surgery of AAA is performed in some vascular surgery centers in the world with relatively low perioperative complications and mortality rates comparable with EVAR (46,47,48).…”

Section: Laparoscopic Approach and Robots Techniquementioning

confidence: 99%

Endovascular Aneurysm Repair or Open Aneurysm Repair for the Treatment of Abdominal Aortic Aneurysm – The Latest Update

Kulig¹,

Lewandowski²,

Ziaja³

et al. 2016

Polish Journal of Surgery

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Total laparoscopic infrarenal aortic aneurysm repair: Preliminary results

Cited by 66 publications

References 22 publications

A Shorter Skin Incision Technique for the Repair of Infrarenal Abdominal Aortic Aneurysms

A Shorter Skin Incision Technique for the Repair of Infrarenal Abdominal Aortic Aneurysms

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Endovascular Aneurysm Repair or Open Aneurysm Repair for the Treatment of Abdominal Aortic Aneurysm – The Latest Update

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