Two decades of abdominal aortic aneurysm repair: Have we made any progress?

Heller, Jennifer; Weinberg, Alan; Arons, Ray; Krishnasastry, Kambhampaty; Lyon, Ross T.; Deitch, Jonathan; Schulick, Andrew H.; Bush, Harry L.; Kent, K. Craig

doi:10.1067/mva.2000.111691

Cited by 217 publications

(149 citation statements)

References 12 publications

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“…Operative mortality was higher in women than in men (overall OR for EVAR 2·51, 95% CI 1·72-3·69 vs OR for open repair 1·50, 1·33-1·69). The results were dominated by a 20-year review from the USA with 81 384 women 35 and contained few data for patients who underwent EVAR. By contrast, we focused on 30-day mortality only in studies published since Jan 1, 2009, which included more data for EVAR.…”

Section: Schermerhorn Et Al (2012) 30mentioning

confidence: 99%

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

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1 ArticlesMorphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis Pinar Ulug, Michael J Sweeting, Regula S von Allmen, Simon G Thompson, Janet T Powell, on behalf of the SWAN collaborators* Summary Background Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000.Methods In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the NewcastleOttawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227.Findings Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0·44, 95% CI 0·32-0·62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2·27, 95% CI 1·21-4·23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2·3%) than in men (1·4%; OR 1·67, 95% CI 1·38-2·04). The overall estimate for open repair also was higher in women (5·4%) than in men (2·8%; OR 1·76, 95% CI 1·35-2·30).Interpretation Compared with men, a smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative...

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Section: Schermerhorn Et Al (2012) 30mentioning

confidence: 99%

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

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“…Yapılan çalışmalarda son iki dekadda ameliyat sırası bakımda sağlanan ilerlemelere karşın rüptüre AAA'ya ilişkin acil cerrahi girişimin mortalite oranının %45-50 arasında değiştiği bildirilmiştir. [14][15][16][17] Son yıllarda AAA'nın tedavisinde endovasküler aortik anevrizma tamiri (EVAR) artmıştır. Dahası Bulut ve Demirağ [18] yaptıkları çalışmada, uygun anatomili ve açık cerrahi ile yüksek ameliyat sırası mortalite ve morbidite beklenen hastalarda EVAR'ın doğru bir tedavi yöntemi olduğu ve EVAR veya açık cerrahi ile tedavi edilenlerin kısa ve orta dönem yaşam kaliteleri karşılaştırıldığında, EVAR'la tedavi edilenlerin yaşam kalitelerinin daha iyi olduğunun izlendiği bildirilmiştir.…”

Section: Discussionunclassified

Emergency surgical treatment of a ruptured abdominal aortic aneurysm: a 10-year experience in diagnosis and treatment

Halıcı¹

2014

Turk Gogus Kalp Dama

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Amaç: Bu çalışmada, rüptüre abdominal aort anevrizmasında gerçekleştirilen acil ameliyatlara ilişkin sonuçlar bildirildi.Ça lış m apla nı:Şubat 2001 -Şubat 2011 tarihleri arasında acil servise başvuran ve rüptüre abdominal aort anevrizması nedeni ile acil ameliyata alınan 20 hasta (1 kadın, 19 erkek, ort. yaş 64.9±9.4 yıl; dağılım 50-77 yıl) retrospektif olarak incelendi. Hastaların birine (%5) kombine sol torakotomi + median laparotomi yapılırken, diğerlerine sadece median laporotomi yapıl-dı. Heparinizasyon sonrasında aorta kros klemp uygulandı. Kros klemp uygulanamayan hastalarda (n=3) endoklemp olarak Foley sonda ile oklüzyon sağlanmak suretiyle proksimal kanama kontrolü yapıldı. Hastaların altısına (%30) anevrizmektomi + aortobifemoral baypas, 10'una (%50) anevrizmektomi + aortobiiliyak baypas, ikisine (%10) anevrizmektomi + abdominal aorta greft interpozisyonu, birine (%5) eksploratif laparatomi ve birine (%5) toraks + batın eksplorasyonu yapıldı. Ameliyatta kullanılan greft materyalleri politetrafloretilen (PTFE) pantolon greft (%80) ve Dacron tüp greft (%10) idi. Bul gu lar:Ameliyat sonrası erken dönemde bir hastada (%5) iskemik kolit, dört hastada (%20) uzamış entübasyon (>72 saat), bir hastada (%5) yara yeri enfeksiyonu, iki hastada (%10) aritmi ve bir hastada (%5) dissemine intravasküler koagülasyon gözlendi. Hastaların yoğun bakım ünitesinde ve hastanede kalış süreleri sırasıyla, 3.8±2.1 gün ve 8.5±3.4 gün olarak saptandı. Toplam dört hastada (%20) mortalite gözlendi.So nuç:Rüptüre abdominal aort anevrizması varlığının erken tanısı-nın ve aorta kros klemp için uygun olmayan hastalarda Foley sonda ile endoklemp veya intraaortik balon oklüzyonu uygulamasının acil ameliyatın başarısını artırabileceğini düşünmekteyiz.Anah tar söz cük ler: Karın ağrısı; acil ameliyat; rüptüre abdominal aort anevrizması.Background: This study aims to report the results of emergency operations of ruptured abdominal aortic aneurysm.

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“…Significant post-operative morbidity was seen in 5/17 (29%) of group 1 and 7/48 (15%) of Group 2, (p = 0.27). The significant morbidities included myocardial ischaemia (5), pneumonia (5), acute kidney injury (3), acute lower limb ischaemia (3), colonic ischaemia (2) and burst abdomen (1). All three patients with acute kidney injury required temporary dialysis and recovered completely between 14-25 days.…”

Section: Resultsmentioning

confidence: 99%

“…Most 'high volume' centers report an operative mortality rate of less than 5% for elective repair and 30%-50% for emergency repair. [1][2][3] There is also a severe dearth of published data on the operative outcomes of AAA in the developing world with limited resources.…”

Section: Introductionmentioning

confidence: 99%

Open Repair of Infra Renal Abdominal Aortic Aneurysms: A Single Center Experience from the Developing World

Gunawansa

Goonerathne

Cassim

et al. 2011

Annals of Vascular Diseases

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Two decades of abdominal aortic aneurysm repair: Have we made any progress?

Cited by 217 publications

References 12 publications

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Emergency surgical treatment of a ruptured abdominal aortic aneurysm: a 10-year experience in diagnosis and treatment

Open Repair of Infra Renal Abdominal Aortic Aneurysms: A Single Center Experience from the Developing World

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