Endovascular Treatment of Acute Abdominal Aortic Aneurysm with a Bifurcated Stentgraft
ABSTRACT 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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ABSTRACT: Background Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA. Methods We conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital. Results Twelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P<0.001). Advancing age was associated with increasing mortality (hazard ratio 1.05 [95% confidence interval 1.01–1.09]) per year for patients who received operative repair, with a 67%, 76%, and 100% 5-year mortality rate in the 34 patients aged <70 years, 59 patients aged 70–79 years, and 12 octogenarians, respectively; 30-day rAAA-related mortality was also associated with increasing age (21%, 30%, and 61%, respectively; P=0.008). Conclusion The 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.Clinical Interventions in Aging 10/2014; 9:1721-32. DOI:10.2147/CIA.S64718 · 1.82 Impact Factor
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ABSTRACT: Objectives and design The aim of this work was to assess absorbed radiation doses in selected organs and to estimate cancer and mortality risks in patients undergoing abdominal stent-graft implantation, as a function of age, gender, and anatomical parameters of patients' aneurysms and arteries. Materials and methods 297 patients (266 males and 31 females) underwent endovascular aortic aneurysm repair (EVAR) with abdominal stent-graft implantation. Kerma–area products Gy-cm2 for all implanted patients were collected retrospectively. Entrance surface air kerma (ESAK), doses absorbed by selected organs, and cancer/mortality risks were estimated using Monte Carlo simulation methods (CALDose_X software). Results The highest radiation doses were deposited in the skin, gallbladder wall, and colon wall. The highest average cancer risk was found for the youngest group of patients (<60 years old; 1:275) and the lowest for the oldest (>70 years old, 1:735). The radiation-induced risk of cancer mortality (mortality risk) was about 40% lower than radiation-induced cancer occurrence risk. Aneurysm neck angulations >45° had a significant impact on ESAK, as well as increasing cancer and mortality risks. Conclusions The main factors increasing cancer risk are young age and aneurysm neck angulations >45°, which determines the difficulty of proper stent-graft placement. However, the radiation risk associated with the stent-graft implantation procedure is relatively low, and EVAR should not be avoided.European Journal of Vascular and Endovascular Surgery 07/2014; 48(1). DOI:10.1016/j.ejvs.2014.03.014 · 3.07 Impact Factor