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Moulakakis KG, Lazaris AM, Georgiadis GS, Kakkos S, Papavasileiou VG, Antonopoulos CN, Papapetrou A, Katsikas V, Klonaris C, Geroulakos G. A Greek Multicentre Study Assessing the Outcome of Late Rupture After Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2024; 67:756-764. [PMID: 38154499 DOI: 10.1016/j.ejvs.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/02/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Late rupture after endovascular aortic aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA) is an increasing complication associated with a high mortality rate. This study aimed to analyse the causes and outcomes in patients with AAA rupture after EVAR. METHODS A multi-institutional Greek study of late ruptures after EVAR between 2008 - 2022 was performed. Primary outcomes were intra-operative and in hospital death. RESULTS A total of 70 patients presented with late rupture after EVAR (proportion of ruptured EVARs among all EVARs, 0.6%; 69 males; mean age 77.2 ± 6.7 years). The mean time interval between EVAR and late rupture was 72.3 months (range 6 - 180 months). In all cases the cause of rupture was the presence of an endoleak (type I, 73%) with sac enlargement. Moreover, 34% of subjects with rupture after EVAR had been lost to follow up and 32% underwent a secondary intervention. Additionally, 57 patients (81%) were treated by conversion to open surgical repair (COSR) and the remainder by endovascular correction of endoleak (ECE). Eleven intra-operative deaths (16%) were recorded. The overall in hospital mortality rate was 41% (23% ECE vs. 46% COSR; p = .21). Of the patients who presented as initially haemodynamically stable, 23% died during hospitalisation, while the respective mortality rate for patients who presented as unstable was 78% (odds ratio [OR] 11.8, 95% confidence interval [CI] 3.6 - 39.1; p < .001). Multivariable logistic regression analysis revealed that severity of haemodynamic shock was the most significant risk factor for intra-operative (OR 7.15, 95% CI 1.58 - 32.40; p = .010) and in hospital death (OR 9.53, 95% CI 2.79 - 32.58; p < .001). CONCLUSION These data underline the devastating prognosis of late rupture after EVAR. Haemodynamic status at presentation was an important predictive factor for death both in the ECE and COSR groups. Rigorous follow up and prompt evaluation of an unstable patient in case of rupture after EVAR is recommended.
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Affiliation(s)
- Konstantinos G Moulakakis
- Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | - Andreas M Lazaris
- Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stavros Kakkos
- Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | | | - Constantine N Antonopoulos
- Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Papapetrou
- Hellenic Vascular Registry (HEVAR); Vascular Surgery Clinic, K.A.T. General Hospital, Athens, Greece
| | - Vasilios Katsikas
- Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, Gennimatas General Hospital of Athens, Athens, Greece
| | - Chris Klonaris
- Hellenic Vascular Registry (HEVAR); 2nd Department of Vascular Surgery, National and Kapodistrian University of Athens, Laiko Hospital, Athens, Greece
| | - George Geroulakos
- Hellenic Vascular Registry (HEVAR); Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Sweeting MJ, Balm R, Desgranges P, Ulug P, Powell JT. Individual-patient meta-analysis of three randomized trials comparing endovascular versus open repair for ruptured abdominal aortic aneurysm. Br J Surg 2015; 102:1229-39. [PMID: 26104471 PMCID: PMC4744980 DOI: 10.1002/bjs.9852] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/04/2015] [Accepted: 04/08/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The benefits of endovascular repair of ruptured abdominal aortic aneurysm remain controversial, without any strong evidence about advantages in specific subgroups. METHODS An individual-patient data meta-analysis of three recent randomized trials of endovascular versus open repair of abdominal aortic aneurysm was conducted according to a prespecified analysis plan, reporting on results to 90 days after the index event. RESULTS The trials included a total of 836 patients. The mortality rate across the three trials was 31.3 per cent for patients randomized to endovascular repair/strategy and 34.0 per cent for those randomized to open repair at 30 days (pooled odds ratio 0.88, 95 per cent c.i. 0.66 to 1.18), and 34.3 and 38.0 per cent respectively at 90 days (pooled odds ratio 0.85, 0.64 to 1.13). There was no evidence of significant heterogeneity in the odds ratios between trials. Mean(s.d.) aneurysm diameter was 8.2(1.9) cm and the overall in-hospital mortality rate was 34.8 per cent. There was no significant effect modification with age or Hardman index, but there was indication of an early benefit from an endovascular strategy for women. Discharge from the primary hospital was faster after endovascular repair (hazard ratio 1.24, 95 per cent c.i. 1.04 to 1.47). For open repair, 30-day mortality diminished with increasing aneurysm neck length (adjusted odds ratio 0.69 (95 per cent c.i. 0.53 to 0.89) per 15 mm), but aortic diameter was not associated with mortality for either type of repair. CONCLUSION Survival to 90 days following an endovascular or open repair strategy is similar for all patients and for the restricted population anatomically suitable for endovascular repair. Women may benefit more from an endovascular strategy than men and patients are, on average, discharged sooner after endovascular repair.
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Affiliation(s)
- M J Sweeting
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - R Balm
- Department of Vascular Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - P Desgranges
- Vascular Surgery Unit, Hospital Henri Mondor, Créteil, France
| | - P Ulug
- Vascular Surgery Research Group, Imperial College, Charing Cross Hospital, London, UK
| | - J T Powell
- Vascular Surgery Research Group, Imperial College, Charing Cross Hospital, London, UK
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von Meijenfeldt G, Ultee K, Eefting D, Hoeks S, ten Raa S, Rouwet E, Hendriks J, Verhagen H, Bastos Goncalves F. Differences in Mortality, Risk Factors, and Complications After Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2014; 47:479-86. [DOI: 10.1016/j.ejvs.2014.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
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Ambler G, Twine C, Shak J, Rollins K, Varty K, Coughlin P, Hayes P, Boyle J. Survival Following Ruptured Abdominal Aortic Aneurysm Before and During the IMPROVE Trial: A Single-centre Series. Eur J Vasc Endovasc Surg 2014; 47:388-93. [DOI: 10.1016/j.ejvs.2014.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Karthikesalingam A, Holt PJ, Vidal-Diez A, Ozdemir BA, Poloniecki JD, Hinchliffe RJ, Thompson MM. Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Lancet 2014; 383:963-9. [PMID: 24629298 DOI: 10.1016/s0140-6736(14)60109-4] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The outcome of patients with ruptured abdominal aortic aneurysm (rAAA) varies by country. Study of practice differences might allow the formulation of pathways to improve care. METHODS We compared data from the Hospital Episode Statistics for England and the Nationwide Inpatient Sample for the USA for patients admitted to hospital with rAAA from 2005 to 2010. Primary outcomes were in-hospital mortality, mortality after intervention, and decision to follow non-corrective treatment. In-hospital mortality and the rate of non-corrective treatment were analysed by binary logistic regression for each health-care system, after adjustment for age, sex, year, and Charlson comorbidity index. FINDINGS The study included 11,799 patients with rAAA in England and 23,838 patients with rAAA in the USA. In-hospital mortality was lower in the USA than in England (53·05% [95% CI 51·26-54·85] vs 65·90%; p<0·0001). Intervention (open or endovascular repair) was offered to a greater proportion of cases in the USA than in England (19,174 [80·43%] vs 6897 [58·45%]; p<0·0001) and endovascular repair was more common in the USA than in England (4003 [20·88%] vs 589 [8·54%]; p<0·0001). Postintervention mortality was similar in both countries (41·77% for England and 41·65% for USA). These observations persisted in age-matched and sex-matched comparisons. In both countries, reduced mortality was associated with increased use of endovascular repair, increased hospital caseload (volume) for rAAA, high hospital bed capacity, hospitals with teaching status, and admission on a weekday. INTERPRETATION In-hospital survival from rAAA, intervention rates, and uptake of endovascular repair are lower in England than in the USA. In England and the USA, the lowest mortality for rAAA was seen in teaching hospitals with larger bed capacities and doing a greater proportion of cases with endovascular repair. These common factors suggest strategies for improving outcomes for patients with rAAA. FUNDING None.
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Affiliation(s)
| | - Peter J Holt
- St George's Vascular Institute, St George's, University of London, London, UK.
| | - Alberto Vidal-Diez
- St George's Vascular Institute, St George's, University of London, London, UK
| | - Baris A Ozdemir
- St George's Vascular Institute, St George's, University of London, London, UK
| | - Jan D Poloniecki
- St George's Vascular Institute, St George's, University of London, London, UK
| | - Robert J Hinchliffe
- St George's Vascular Institute, St George's, University of London, London, UK
| | - Matthew M Thompson
- St George's Vascular Institute, St George's, University of London, London, UK
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Edwards ST, Schermerhorn ML, O'Malley AJ, Bensley RP, Hurks R, Cotterill P, Landon BE. Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. J Vasc Surg 2014; 59:575-82. [PMID: 24342064 PMCID: PMC4454372 DOI: 10.1016/j.jvs.2013.08.093] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. METHODS We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. RESULTS Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P < .001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P < .001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P < .001; all surgical complications, 4.4% vs 9.1%; P < .001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%. CONCLUSIONS EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade.
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Affiliation(s)
- Samuel T Edwards
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | - A James O'Malley
- Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - Rodney P Bensley
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Rob Hurks
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Bruce E Landon
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Health Care Policy, Harvard Medical School, Boston, Mass.
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Affiliation(s)
- Frank Vandy
- Cardiovascular Center, University of Michigan, Ann Arbor, USA
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Hinchliffe RJ, Powell JT. Improving the outcomes from ruptured abdominal aortic aneurysm: interdisciplinary best practice guidelines. Ann R Coll Surg Engl 2013; 95:96-7. [PMID: 23484988 PMCID: PMC4098596 DOI: 10.1308/003588413x13511609956778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK.
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Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms With the Endurant Device. Ann Vasc Surg 2013; 27:162-7. [DOI: 10.1016/j.avsg.2012.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 03/14/2012] [Accepted: 04/11/2012] [Indexed: 12/20/2022]
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Gawenda M, Brunkwall J. Ruptured abdominal aortic aneurysm: the state of play. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012. [PMID: 23181137 DOI: 10.3238/arztebl.2012.0727] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ruptured abdominal aortic aneurysm (rAAA) remains a challenging problem: 2,410 cases were treated in Germany in 2010. Ruptured abdominal aortic aneurysm should be suspected in patients over age 50 who complain of pain in the abdomen or back and in whom examination reveals a pulsatile abdominal mass. The incidence of hospitalization for rAAA is 12 per 100,000 persons over age 65 per year (statistics for Germany, 2010), and rAAA carries an overall mortality of 80%. METHODS The current state of knowledge of rAAA was surveyed in a selective review of pertinent literature retrieved by an electronic search in the PubMed, Web of Science, and Cochrane Library databases with the keywords "abdominal aortic aneurysm," "ruptured," "open repair," and "endovascular." Publications in English or German up to and including March 2012 were considered, among them the Clinical Practice Guidelines of the European Society for Vascular Surgery (1). RESULTS AND CONCLUSIONS Recent reports show that the treatment of rAAA is still fraught with high mortality and high perioperative morbidity. Improvement is needed. It would be advisable for the care of rAAA to be centralized in specialized vascular centers implementing defined treatment pathways. Systematic screening, too, would be beneficial. An increasing number of reports suggest that endovascular treatment with stent prostheses improves outcomes; more definitive evidence on this matter will come from prospective, randomized trials that are now in progress.
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Hinchliffe RJ, Ribbons T, Ulug P, Powell JT. Transfer of patients with ruptured abdominal aortic aneurysm from general hospitals to specialist vascular centres: results of a Delphi consensus study. Emerg Med J 2012; 30:483-6. [PMID: 22761515 PMCID: PMC3664393 DOI: 10.1136/emermed-2012-201239] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aim To explore areas of consensus and disagreement concerning the interhospital transfer of patients with a clinical diagnosis of ruptured abdominal aortic aneurysm. Methods A three-round Delphi questionnaire approach was used among vascular and endovascular surgery and emergency medicine specialists to explore patient characteristics and clinical management issues for emergency interhospital transfer. Analysis is based on 38 responses to rounds 2 and 3 (19 vascular surgeons, 6 interventional radiologists, 13 emergency care specialists) with agreement reported when 70% of respondents were in agreement. Results Initially there was agreement that transfer patients should be <85 years of age, either alert or with fluctuating consciousness, with moderate or minimal systemic disease, needing no/some help with daily living. Round 3 clarified that patients requiring inotropes and those institutionalised for mental infirmity should be transferred. Those with cardiac arrest in current episode should not be transferred. There was no agreement as to whether those institutionalised with physical infirmities, unconscious/intubated patients or those with severe systemic disease should be transferred. Speed was accepted as important, with agreement for specialty trainees to arrange transfer if consultants were not on site. Consultant–consultant discussion was recommended for patients with severe systemic disease. CT confirmation of diagnosis was considered unnecessary before transfer but ultrasound assessment was desirable, and transfers should not be delayed by waiting for specific tests. There was no agreement about blood tests and ECG before transfer or whether blood should accompany the patient being transferred. There was no agreement as to whether specific staff/facilities needed to be in place at the specialist hospital. A systolic blood pressure ≥70 mm Hg was sufficient for transfer without the need for intravenous fluids unless deterioration occurred. Conclusions There is broad agreement about the type of patient who should be eligible for transfer but disagreements about patient management before and during transfer remain.
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Affiliation(s)
- Robert J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
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Saqib N, Park SC, Park T, Rhee RY, Chaer RA, Makaroun MS, Cho JS. Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair. J Vasc Surg 2012; 56:614-9. [PMID: 22572008 DOI: 10.1016/j.jvs.2012.01.081] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/29/2011] [Accepted: 01/03/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endovascular repair of ruptured abdominal aortic aneurysm (rAAA) is being increasingly performed despite lack of good evidence for its superiority. Other reported studies suffer from patient selection and publication bias with limited follow-up. This study is a single-center propensity score comparing early and midterm outcomes between open surgical repair (OSR) and endovascular repair of rAAA (REVAR). METHODS A retrospective review from January 2001 to November 2010 identified 312 patients who underwent rAAA repairs. Thirty-one patients with antecedent AAA repair and three with incomplete records were excluded, leaving 37 REVARs and 241 OSRs. Propensity score-based matching for sex, age, preoperative hemodynamic status, surgeon's annual AAA volume, and preoperative cardiopulmonary resuscitation was performed in a 1:3 ratio to compare outcomes. Thirty-seven REVARs were matched with 111 OSRs. Late survival was estimated by Kaplan-Meier methods. RESULTS Operative time and blood replacement were higher with OSR. Overall complication rates were similar (54% REVAR vs 66% OSR; P = .23), except for higher incidences of tracheostomies (21% vs 3%; P = .015), myocardial infarction (38% vs 18%; P = .036), and acute tubular necrosis (47% vs 21%; P = .009) with OSR. Operative mortality rates were similar (22% REVAR vs 32% OSR), with an odds ratio of 0.63 for REVAR (95% confidence interval = [0.24, 1.48]; P = .40). No differences in the incidences for secondary interventions for aneurysm- or graft-related complications were noted (22% REVAR vs 22% OSR; P = .99). Kaplan-Meier estimates of 1-, 2-, and 3-year survival rates were also similar (50%, 50%, 42% REVAR vs 54%, 52%, 47% OSR; P = .66). CONCLUSIONS REVAR for rAAA does not seem to conclusively confer either acute or late survival advantages. Routine use of REVAR should be deferred until prospective, randomized trial data become available.
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Affiliation(s)
- Naveed Saqib
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa 15213, USA
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Mid-term Outcomes following Emergency Endovascular Aortic Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2012; 43:382-5. [DOI: 10.1016/j.ejvs.2011.12.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 12/20/2011] [Indexed: 11/17/2022]
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Mandawat A, Mandawat A, Sosa JA, Muhs BE, Indes JE. Endovascular Repair Is Associated With Superior Clinical Outcomes in Patients Transferred for Treatment of Ruptured Abdominal Aortic Aneurysms. J Endovasc Ther 2012; 19:88-95. [DOI: 10.1583/11-3651.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Comments regarding ‘EVAR Suitability is not a Predictor for Early and Midterm Mortality after Open Ruptured AAA Repair’. Eur J Vasc Endovasc Surg 2011; 41:652-3. [DOI: 10.1016/j.ejvs.2011.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 02/14/2011] [Indexed: 11/15/2022]
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Powell J, Hinchliffe R. Part One: For the Motion. Eur J Vasc Endovasc Surg 2010; 40:421-4. [DOI: 10.1016/j.ejvs.2010.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 06/07/2010] [Indexed: 11/28/2022]
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Veith FJ, Powell JT, Hinchliffe RJ. Is a randomized trial necessary to determine whether endovascular repair is the preferred management strategy in patients with ruptured abdominal aortic aneurysms? J Vasc Surg 2010; 52:1087-93. [DOI: 10.1016/j.jvs.2010.05.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 05/26/2010] [Accepted: 05/26/2010] [Indexed: 01/26/2023]
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Perrott S, Puckridge P, Foreman R, Russell D, Spark J. Anatomical Suitability For Endovascular AAA Repair May Affect Outcomes following Rupture. Eur J Vasc Endovasc Surg 2010; 40:186-90. [DOI: 10.1016/j.ejvs.2010.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 04/04/2010] [Indexed: 10/19/2022]
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Chagpar RB, Harris JR, Lawlor DK, DeRose G, Forbes TL. Early Mortality Following Endovascular Versus Open Repair of Ruptured Abdominal Aortic Aneurysms. Vasc Endovascular Surg 2010; 44:645-9. [DOI: 10.1177/1538574410376603] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine whether endovascular repair (EVAR) offers a survival advantage over open repair (OAR) with ruptured abdominal aortic aneurysms (RAAA). Methods: Retrospective analysis of RAAA patients treated between 2003 and 2008. Univariate and multivariate analyses were performed. Results: 167 patients presented with RAAA (OAR = 135, 80.8%, EVAR = 32, 19.2%). On univariate analysis, EVAR was associated with a decreased mortality relative to OAR, (15.6% vs 43.7%, P = .004). Patients who survived were younger (P < .0005), had a higher blood pressure (P < .0005), level of consciousness (P < .0005), and hemoglobin (P = .018), and a lower urea (P = .005) and international normalized ratio (INR; P = .001). On multivariate analysis, type of repair remained an independent predictor of 30-day mortality (OR: 0.121; 95% CI: 0.021-0.682, P = .017). Conclusion: Controlling for preoperative factors, EVAR is an independent predictor of lower 30 day mortality relative to open repair after RAAA. This supports the wider use of endovascular repair in all patients with RAAA.
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Affiliation(s)
- Ryaz B. Chagpar
- Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, ON, Canada
| | - Jeremy R. Harris
- Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, ON, Canada
| | - D. Kirk Lawlor
- Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, ON, Canada
| | - Guy DeRose
- Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, ON, Canada
| | - Thomas L. Forbes
- Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, ON, Canada,
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Jim J, Sanchez LA. Abdominal Aortic Aneurysms: Endovascular Repair. ACTA ACUST UNITED AC 2010; 77:238-49. [DOI: 10.1002/msj.20180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Endovascular repair of ruptured abdominal aortic aneurysm in a Jehovah's Witness without blood transfusion. Int J Surg 2010; 8:79-80. [DOI: 10.1016/j.ijsu.2009.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 10/01/2009] [Indexed: 11/22/2022]
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Holt PJ, Hinchliffe RJ, Thompson MM. Commentary: Population-Based Outcomes From Administrative Datasets:Shedding Light on the Potential of Endovascular Repair to Reduce Mortality From Ruptured AAA. J Endovasc Ther 2009; 16:565-6. [DOI: 10.1583/09-2743c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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