Association Between Type of Anaesthesia and Clinical Outcome in Patients Undergoing Endovascular Repair of Thoraco-Abdominal Aortic Aneurysms by Fenestrated and Branched Endografts

A bibliometric analysis of abdominal aortic aneurysm (2014-2024)

Background

Abdominal aortic aneurysm (AAA) is a localized bulge of the abdominal aorta, which mainly manifests as a pulsatile mass in the abdomen. Once an abdominal aortic aneurysm ruptures, the patient's life is seriously endangered. Surgery is the preferred treatment for abdominal aortic aneurysm. At present, there has been no comprehensive review of the current status of abdominal aortic aneurysm research. Therefore, this study aimed to identify global trends in abdominal aortic aneurysm research over the last 10 years through bibliometric analysis and to inform clinical practice, research funding allocation, and decision-making.

Methods

We downloaded research articles and reviews on abdominal aortic aneurysm from 1 January 2014, to 1 March 2024, from the Web of Science core collection. CiteSpace (version 6.2.1), RStudio and VOSviewer (version 1.6.18) were used for visual analysis of regional distribution, institutions, authors, keywords and other information.

Results

The number of documents on abdominal aortic aneurysm research increased continuously and has stabilized in recent years. A total of 9,905 publications from 67 countries were published from 1 January 2014, to 1 March 2024. A total of 2,142 (29.52%) studies were from the United States, 1,293 (13.05%) were from China, and 919 (9.28%) were from the United Kingdom. A total of 205 studies were conducted at Stanford University, 172 were conducted at Harvard Medical School, and 165 were conducted at the Mayo Clinic. The top three coauthorship authors were Schermerhorn, Marc L (114); Golledge, Jonathan (102); and De Vries, Jean Paul P.M. (74). The most cocited reference was Chaikof EL, 2018, J Vasc Surg, v67, p. 2; the most cocited journal was the Journal of Vascular Surgery; and the most cocited author was Lederle, FA. "Abdominal aortic aneurysm" was the most frequently used author keyword (2,492). Twenty-five references with strong citation bursts were identified by "CiteSpace". "Artificial intelligence", "clinical outcomes" and "bridging stent" were the primary keywords of emerging research hotspots.

Conclusion

This is the first bibliometric study to comprehensively summarize the research trends in abdominal aortic aneurysm research. This information can help us to identify the current research hotspots and directions. This study will provide extensive help for future research.

Total Aortic Arch Repair With Double-Fenestrated Physician-Modified Endograft Under Local Anesthesia And Sedation: A Prospective Study

CLINICAL IMPACT

The outcomes of local anesthesia and sedation (also referred to as monitored anesthesia care) in endovascular aortic arch repair are not well-studied or widely reported. This study aims to demonstrate the feasibility and safety of this approach using physician-modified endografts for total aortic arch repair and showing it is a promising alternative to general anesthesia. Only a few exclusion criteria necessitate performing the procedure under general anesthesia and no conversions to general anesthesia were required.

Sedation versus general anesthesia on all-cause mortality in patients undergoing percutaneous procedures: a systematic review and meta-analysis

BACKGROUND

The comparison between sedation and general anesthesia (GA) in terms of all-cause mortality remains a subject of ongoing debate. The primary objective of our study was to investigate the impact of GA and sedation on all-cause mortality in order to provide clarity on this controversial topic.

METHODS

A systematic review and meta-analysis were conducted, incorporating cohort studies and RCTs about postoperative all-cause mortality. Comprehensive searches were performed in the PubMed, EMBASE, and Cochrane Library databases, with the search period extending until February 28, 2023. Two independent reviewers extracted the relevant information, including the number of deaths, survivals, and risk effect values at various time points following surgery, and these data were subsequently pooled and analyzed using a random effects model.

RESULTS

A total of 58 studies were included in the analysis, with a majority focusing on endovascular surgery. The findings of our analysis indicated that, overall, and in most subgroup analyses, sedation exhibited superiority over GA in terms of in-hospital and 30-day mortality. However, no significant difference was observed in subgroup analyses specific to cerebrovascular surgery. About 90-day mortality, the majority of studies centered around cerebrovascular surgery. Although the overall pooled results showed a difference between sedation and GA, no distinction was observed between the pooled ORs and the subgroup analyses based on RCTs and matched cohort studies. For one-year all-cause mortality, all included studies focused on cardiac and macrovascular surgery. No difference was found between the HRs and the results derived from RCTs and matched cohort studies.

CONCLUSIONS

The results suggested a potential superiority of sedation over GA, particularly in the context of cardiac and macrovascular surgery, mitigating the risk of in-hospital and 30-day death. However, for the longer postoperative periods, this difference remains uncertain.

TRIAL REGISTRATION

PROSPERO CRD42023399151; registered 24 February 2023.

In-hospital cost-effectiveness analysis of open versus staged fenestrated/branched endovascular elective repair of thoracoabdominal aneurysms

OBJECTIVE

To compare costs and effectiveness of elective open (OR) versus fenestrated/branched endovascular (ER) repair of thoracoabdominal aneurysms (TAAA) in a high-volume center.

METHODS

This single-center retrospective observational study (PRO-ENDO TAAA Study, NCT05266781) was designed as part of a larger Health Technology Assessment analysis. All electively treated TAAAs between 2013 and 2021 were analyzed and propensity-matched. Endpoints were clinical success, major adverse events (MAE), hospital direct costs, and freedom from all causes and aneurysm-related mortality and reinterventions. Risk factors and outcomes were homogeneously classified according to the Society of Vascular Surgery reporting standards. Cost-effectiveness value (CEV) and Incremental Cost-Effectiveness Ratio (ICER) were calculated, considering the absence of MAEs as a measure of effectiveness.

RESULTS

Propensity matching identified 102 pairs of patients out of 789 TAAAs. Mortality, MAE, permanent spinal cord ischemia rates, respiratory complications, cardiac complications, and renal injury were higher for OR (13% vs 5%, p=.048; 60% vs 17%, p<.001; 10% vs 3%, p=.045; 91% vs 18%, p<.001; 16% vs 6%, p=.024; 27% vs 6%, p<.001; respectively). Access complication rate (6% vs 27%; p<.001) was higher in the ER group. Intensive Care Unit stay was longer (p<.001) for OR and ER patients were discharged home more frequently (3% vs 94%; p<.001). No differences in mid-term endpoints were observed at 2 years. Despite ER reducing all the hospital cost items (-42% to -88%, p<.001), the higher expenses (p<.001) of the endovascular devices increased the overall cost of ER by 80%. CEV for ER was favorable to OR (56 365 vs 64 903 €/patient) with an ICER of 48 409 € per MAE saved.

CONCLUSIONS

ER of TAAA reduces perioperative mortality and morbidity compared to OR, with no differences in reinterventions and survival rates at midterm follow-up. Despite the expenses for endovascular grafts, ER resulted more cost-effective in preventing MAEs.