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Song Q, Guo Y, Huo Z, Wang M, Sun X, Zhou Z, Cong B, Dong D, Gao P, Wu X. Analysis of high-risk factors and mortality prediction of ruptured abdominal aortic aneurysm. Ann Vasc Surg 2024:S0890-5096(24)00443-6. [PMID: 39025223 DOI: 10.1016/j.avsg.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Ruptured abdominal aortic aneurysms (RAAAs) are among the most dangerous emergencies in vascular surgery, with a high death rate and numerous risk factors influencing perioperative death. Therefore, identifying the critical risk factors for RAAAs is crucial to increasing their survival rate. Our aim was to identify those risk factors from a wide range of parameters. METHODS Retrospective analysis of hospitalised RAAA patients treated at this center between May 2004 and January 2023. After comparing the preoperative data of patients who survived and those who died, high-risk characteristics influencing the perioperative care of RAAA patients were identified, and logistic regression analysis was carried out. The mean follow-up time was 45.34 months. RESULTS During the study period, a total of 155 patients (average age 67.4±71.93 years, 123 (78.85%)males, 32 (20.51%)females) were enrolled. The patients participating in the group were divided into survival group (n = 123) and death group (n = 27). The main differences included hemodynamic instability (51.9% vs 28.5%; P=0.019), sudden cardiac arrest (14.8% vs 1.6%; P=0.010), deterioration of consciousness (40.7% vs 17.1%; P=0.007), renal impairment (22.2% vs 2.4%; P=0.001), chronic kidney disease (18.5% vs3.2%; P=0.010). There is also a history of cancer (Ca) (18.5% vs 4.1%; P=0.021). Risk factors for Endovascular aneurysm repair (EVAR) include diastolic blood pressure ≤ 50 mmHg (36.4% vs 8.0%; P=0.025), renal function impairment (18.2% vs 0; P=0.015), and chronic kidney disease (27.3% vs 4.0%; P=0.028). Risk factors for open surgical repair (OSR) include diastolic blood pressure ≤ 50 mmHg (40.0% vs 6.3%; P=0.014). Finally, the above statistically significant factors were analyzed by Logistic regression analysis, and it was found that diastolic blood pressure ≤ 50mmHg, cardiac arrest, renal function damage and Ca history were independent risk factors. We followed 123 individuals and 14 were lost to follow-up, with an overall survival rate of 43.8%. CONCLUSION Hemodynamics, which includes shock, blood pressure, cardiac arrest, deterioration of consciousness, and other conditions, are the primary risk factors for the perioperative death of a ruptured abdominal aortic aneurysm. Simultaneously, diastolic blood pressure ≤50mmHg was found to be associated with risk factors for OSR, whereas renal function impairment, chronic renal illness, and diastolic blood pressure ≤50mmHg were associated with risk for EVAR.
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Affiliation(s)
- Qingpeng Song
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Yifan Guo
- Shandong University, Jinan, Shandong, 250100, China
| | - Zhengkun Huo
- Shandong University, Jinan, Shandong, 250100, China
| | - Maohua Wang
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Xiaofan Sun
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Zhengtong Zhou
- Institute of Medical Genomics, Biomedical Sciences College & Shandong Medicinal Biotechnology Centre, First Affiliated Hospital of Shandong First Medical University/Shandong Province Qianfoshan Hospital, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, China
| | - Bi Cong
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Dianning Dong
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Peixian Gao
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Xuejun Wu
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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Wang R, Yuan T, Kan Y, Yue J, Chen B, Dong Z, Guo D, Si Y, Fu W. Long-term outcomes following exclusive use of endovascular aortic repair for ruptured infrarenal abdominal aortic aneurysms. Chin Med J (Engl) 2023; 136:1876-1878. [PMID: 37218072 PMCID: PMC10406057 DOI: 10.1097/cm9.0000000000002534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 05/24/2023] Open
Affiliation(s)
- Ruihan Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Jianing Yue
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Bin Chen
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Yi Si
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Vascular Surgery Institute of Fudan University, Shanghai 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai 200032, China
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Dakis K, Nana P, Kouvelos G, Behrendt CA, Kölbel T, Giannoukas A, Spanos K. Treatment of Aortocaval Fistula Secondary to Abdominal Aortic Aneurysm: A Systematic Review. Ann Vasc Surg 2023; 90:204-217. [PMID: 36496094 DOI: 10.1016/j.avsg.2022.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Aortocaval fistula (ACF) secondary to an abdominal aortic aneurysm is a rare complication, inadvertently caused by a rupture into the inferior vena cava. Different treatment modalities have been applied toward the repair of such lesions, including open surgical and endovascular repair. The aim of this study was to report on ACF treatment and to analyze its early and mid-term outcomes. METHODS A systematic search of the English medical literature published between 2000 and 2022 was undertaken, using PubMed, SCOPUS, and CENTRAL databases as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. A study protocol was registered in PROSPERO (CRD42022329058). Studies reporting on primary ACF outcomes following open surgical or endovascular repair were included. The ROBINS-I tool was applied for risk of bias assessment. Outcomes included technical success, 30-day and mid-term survival, endoleak following endovascular repair, and reintervention rates. RESULTS In total, 110 case studies, incorporating 196 patients (mean age; 66.2 years, males 96%) were included. Open surgical repair was applied in 78% (153/196). From the available data, technical success rate for each modality was 99% (152/153) and 100% (43/43), respectively. Open and endovascular repair demonstrated 87.5% (126/144) and 97.6% (42/43) 30-day survival, respectively, while mid-term survival was 86% (74/86) and 95.2% (20/21), respectively (medial follow-up: 14 months [1-54 months]). Endoleaks were reported in 19 endovascular cases (39.5%). Type II endoleak was the most frequent with a rate at 32.5% (14/43). Reintervention rates were 2.5% (4/151) and 35.7% (15/42) for open and endovascular repair, respectively. CONCLUSIONS Only few case studies were published on the treatment of this rare condition, while almost all invasive procedures were performed in males. Management of ACF repair with both open and endovascular approach was associated with excellent technical success rate and acceptable early and mid-term survival outcomes. Reintervention remained an issue for patients who were managed endovascularly.
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Affiliation(s)
- Konstantinos Dakis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - Petroula Nana
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christian-Alexander Behrendt
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Athanasios Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
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Ali T, Stather PW. Rupture Post-Endovascular Aneurysm Repair: Are We Missing the Signs? Eur J Vasc Endovasc Surg 2022; 64:175. [PMID: 35599135 DOI: 10.1016/j.ejvs.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Tariq Ali
- Department of Interventional Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK
| | - Philip W Stather
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich, UK.
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Bozzani A, Arici V, Ticozzelli G, Franciscone MM, Sterpetti AV, Ragni F. Sudden Rupture of Abdominal Aortic Aneurysm in COVID19 Patients. J Endovasc Ther 2022; 30:296-301. [PMID: 35098775 PMCID: PMC10051004 DOI: 10.1177/15266028221075221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: The purpose of the paper is to report the clinical outcomes of 4 patients with ruptured abdominal aortic aneurysm (AAA) during (3 patients) or immediately after (1 patient) moderate-severe SARS-CoV-2 infection. We discuss COVID-19-related mechanisms which could impact AAA rupture. Patients and Methods: During the period of the pandemic (March 2020—May 2021), we performed surgery in 18 patients with ruptured AAA. Four patients were affected by moderate or severe SARS-CoV-2 infection (in 3 patients the rupture occurred during the infection and in 1 patient 3. months after discharge from the hospital). Two patients underwent open repair and 2 endovascular surgery. Results: No postoperative mortality and no major complication occurred. Rapid growth of the AAA in comparison with a previous Duplex scan was evident in all 4 patients. Conclusions: Family doctors and vascular surgeons should be aware about the possibility of AAA degeneration in patients with moderate-severe COVID19 infection. The risk is increased by steroid therapy which is essential in more advanced stages of the infection. In this clinical setting, endovascular repair is a valid choice.
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Affiliation(s)
- Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Arici
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mila Maria Franciscone
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Franco Ragni
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Sunoqrot H, Silverberg D, Hater H, Abu Rmeileh A, Halak M. A novel technique for the treatment of a ruptured para-anastomotic thoracic aortic aneurysm in the presence of a chronic abdominal aortic dissection. J Vasc Surg Cases Innov Tech 2021; 7:350-353. [PMID: 34095640 PMCID: PMC8163864 DOI: 10.1016/j.jvscit.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/19/2021] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 69-year-old woman with Marfan syndrome and a history of multiple thoracic aortic surgeries and a coexisting dissection of her abdominal aorta. She had presented with a ruptured para-anastomotic thoracic aortic aneurysm due to an infected graft. She was treated with two parallel Nellix endografts that were placed in the true and false lumens. The surrounding endobags were inflated with a polymer that completely sealed the ruptured aorta and preserved blood flow to the visceral arteries. Postoperative imaging showed complete exclusion of the aneurysm with patency of all aortic branches and no evidence of endoleak.
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Affiliation(s)
- Hakam Sunoqrot
- Department of Vascular Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv, Israel
| | - Daniel Silverberg
- Department of Vascular Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv, Israel
| | - Haitam Hater
- Department of Vascular Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv, Israel
| | - Ahmad Abu Rmeileh
- Department of Vascular Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv, Israel
| | - Moshe Halak
- Department of Vascular Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv, Israel
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