Endovascular Treatment of Acute Abdominal Aortic Aneurysm with a Bifurcated Stentgraft

Department of Surgery, University of Groningen, Groningen, Groningen, Netherlands
European Journal of Vascular and Endovascular Surgery (Impact Factor: 2.49). 06/2005; 29(5):510-5. DOI: 10.1016/j.ejvs.2005.01.007
Source: PubMed


To analyse the results of emergency endovascular aneurysm repair (eEVAR) for acute abdominal aortic aneurysms (AAA), in comparison to open repair, and to evaluate suitability and application rate.
All patients treated for an acute AAA between January 1998 and August 2004 were included. The primary outcome measure was in-hospital mortality. Secondary outcome measures were procedure time, intra-operative blood loss, transfusion requirement, intensive care unit, and hospital length of stay. Suitability and application rate for eEVAR were assessed in a subgroup of patients, from January 2003.
A total of 253 patients were treated. eEVAR was performed in 40 patients, 5 (13%) died in-hospital. Open repair was performed in 213 patients, 64 (30%) died in-hospital. Secondary outcome measures were all significantly improved in the eEVAR subgroup. From January 2003, 56 patients were treated. Of the 44 (79%) patients who were evaluated for eEVAR, 16 (36%) patients were anatomically suitable. Eventually, 15 out of the 56 (27%) patients were treated by eEVAR.
The results of eEVAR in a selected group of patients are promising, but suitability and application rate were low.

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    • "Reported results of reduced early mortality after EVAR for the treatment of a ruptured AAA compared to open surgery seems conclusive (table 1). However, the currently available, mainly observational, studies are small and add considerable heterogeneity and methodological limitations (Yilmaz et al., 2002; Reichart et al., 2003; Resch et al., 2003; Lee et al., 2004; Alsac et al., 2005; Brandt et al., 2005; Castelli et al., 2005; Hechelhammer et al., 2005; Kapma et al., 2005; Larzon et al., 2005; Vaddineni et al., 2005; Arya et al., 2006; Coppi et al., 2006; Franks et al., 2006; Hinchliffe et al., 2006; Peppelenbosch et al., 2006; Visser et al., 2006; Acosta et al., 2007; Ockert et al., 2007). Heterogeneity is signified by the broad range in percentages of patients treated with EVAR (15-50%) and in percentage of haemodynamical unstable patients (33-73% in the eEVAR group). "
    Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch, 06/2011; , ISBN: 978-953-307-524-2
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    ABSTRACT: Background The natural history of abdominal aortic aneurysms (AAAs) is marked by progressive expansion and final rupture, which results in considerable morbidity and mortality as well as significant costs to family and soci-ety. 1 This is the reason why AAAs should be treated and, accordingly, the postoperative rupture rate should be the most important end point for evaluation of treat-ment effectiveness. We researched 10 years of experience with endovascular aneurysm repair (EVAR)—1,064 consecutive infrarenal AAAs with a post-EVAR rupture rate of only 0.5%, which is much lower than the reported post-EVAR rupture rate of 1.6 to 10%. 2,3 Frank Veith asked, "Post-EVAR rupture rate can be as low as 0.5%; is that the result of treating more small AAAs? Maybe they need no treatment at all?" To answer the above question, we reviewed our data and the related references. Methods Data for 1,064 consecutive infrarenal patients with AAA with EVAR performed within 10 years, ending May 2005, were analyzed retrospectively. Mean follow-up was 33 months (range 0.2 to 88 months). All patients received commercially available, CE-approved devices. The 11 different grafts included Ancure® (Guidant-EVT, Menlo Park, CA), AneuRX® (Medtronic Sunrise, FL), Chuter® (Meadox, NJ), Endofit® (Le Maitre, Burlington, MA), Powerlink (Endologix®, Irvine, CA), Excluder® (W.L. Gore & Associates, Flagstaff, AZ), Fortron® (Cordis, Miami, FL), Lifepath® (Edwards, Irvine, CA), Talent® (Medtronic, Sunrise, FL), Vanguard/Mintec® (Boston Scientific, Natick, MA), and Zenith® (Cook, Bloomington, IN). Nine hundred sixteen (86.1%) patients received an endograft of bifurcated configuration, and 148 (13.9%) patients received a tube endograft. To evaluate the influ-ence of size on the outcome of EVAR, the study cohort was subdivided into two groups according to the pre-operative aneurysm diameter: small AAA group (EVARsmall), with an aneurysm diameter < 5 cm; and big AAA group (EVARbig), with an aneurysm diame-ter ? 5 cm. Inclusion criteria included all the consecutive 1,064 AAAs treated with EVAR, including ruptured AAAs managed by EVAR. Baseline data including age, gender, comorbidities, and smoking history; anatomic aspects; and operative details such as bleeding amount, opera-tive time length, primary endoleak, and conversion were recorded (Table 1). Findings at the follow-up visits, which involved clinical examination and computed tomography (CT), angiography, or magnetic resonance angiography, were recorded on data forms and kept in the data room. Follow-up visits were scheduled at 14 days, 12 months, and annually thereafter. Deaths that occurred within 30 days of the initial procedure were recorded as a perioperative death, and those after 30 days as a late death. Mean AAA diameter (cm) 4.9 4.3 5.8 AAA = abdominal aortic aneurysm; COPD = chronic obstructive pulmonary disease.
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    ABSTRACT: We are motivated by the need to derive simple control-oriented models of complex systems. Briefly, complex systems are a collection of systems that are not approximable (arbitrarily closely) by a finitely parameterized collection of systems. The study of system identification for such classes of systems has received considerable attention in the past few years. In this paper a new formulation of the system identification problem, which balances between the set-membership and probabilistic approaches is presented. The salient feature of the formulation is that we distinguish between the two principal sources of error encountered in the input-output data-noise and unmodeled dynamics. Unmodeled dynamics arise from the fact that the finitely parameterized model that we seek does not truly characterize the real system. Therefore, unmodeled dynamics are “modeled” as the residual error between the parametric model and the real system. This viewpoint leads to a decomposition between the parametric model class and unmodeled dynamics. In contrast noise is modeled so that it is uncorrelated (in a deterministic or a stochastic sense) from the input. The identification problem deals with obtaining the appropriate finite parametric model from input-output data. The identification problem is studied for several different norms including l<sub>1</sub> and H<sub>∞</sub>. One of the chief outcomes is a new notion of a persistent input and showing that there are both deterministic and stochastic inputs which meet the new criterion
    Decision and Control, 1997., Proceedings of the 36th IEEE Conference on; 01/1998
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