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Kontopodis N, Kehagias E, Chronis C, Nasis N, Tsetis D, Ioannou CV. Technical challenges during emergent endovascular aneurysm repair with the ALTO system. Expert Rev Med Devices 2024; 21:269-275. [PMID: 38571391 DOI: 10.1080/17434440.2024.2339416] [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: 01/05/2024] [Accepted: 04/02/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Ruptured abdominal aortic aneurysms (AAAs) pose an immediate threat for patient's life and endovascular repair (EVAR) is currently the preferred treatment modality in the presence of suitable anatomy. This is determined based on the requirements of each endograft as described in the instructions for use (IFU). The new ALTO system (Endologix, Irvin, CA, U.S.A.), can accommodate a great range of anatomies such as short necks and/or narrow access, but its unique design requires specific technical modifications during treatment of ruptured AAAs. AREAS COVERED The standard double balloon technique has long been described and it is used to provide circulatory support during EVAR for ruptured AAA. While this technique is straightforward with the use of endografts with a traditional design, this would not be the case if one uses the ALTO system. In that case specific maneuvers would be required to treat AAA patients in an acute setting. EXPERT OPINION The ALTO system although being able to treat AAAs with adverse anatomy, it may not be appropriate during treatment of ruptured AAA patients with profound hemodynamic instability. A careful evaluation of the individual's patient anatomy and hemodynamic condition is mandatory in order to decide the best endograft for each case.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete, Heraklion, Crete, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Heraklion, Crete, Greece
| | - Christos Chronis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos Nasis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete, Heraklion, Crete, Greece
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Hansted AK, Møller MH, Møller AM, Burcharth J, Thorup SS, Vester-Andersen M. Risk prediction models in emergency surgery: Protocol for a scoping review. Acta Anaesthesiol Scand 2024; 68:579-581. [PMID: 38317635 DOI: 10.1111/aas.14383] [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: 01/07/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Risk prediction models are used for many purposes in emergency surgery, including critical care triage and benchmarking. Several risk prediction models have been developed, and some are used for purposes other than those for which they were developed. We aim to provide an overview of the existing literature on risk prediction models used in emergency surgery and highlight knowledge gaps. METHODS We will conduct a scoping review on risk prediction models used for patients undergoing emergency surgery in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We will search Medline, EMBASE, and the Cochrane Library and include all study designs. We aim to answer the following questions: (1) What risk prediction models are used in emergency surgery? (2) Which variables are used in these models? (3) Which surgical specialties are the models used for? (4) Have the models been externally validated? (5) Where have the models been externally validated? (6) What purposes were the models developed for? (7) What are the strengths and limitations of the included models? We will summarize the results descriptively. The certainty of evidence will be evaluated using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. CONCLUSION The outlined scoping review will summarize the existing literature on risk prediction models used in emergency surgery and highlight knowledge gaps.
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Affiliation(s)
- Anna K Hansted
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Morten H Møller
- Department of Intensive Care 4131, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ann M Møller
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Burcharth
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Sofie S Thorup
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Morten Vester-Andersen
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anaesthesiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Berchiolli R, Troisi N, Bertagna G, D’Oria M, Mezzetto L, Malquori V, Artini V, Motta D, Grosso L, Grando B, Badalamenti G, Calvagna C, Mastrorilli D, Veraldi GF, Adami D, Lepidi S. Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score). J Clin Med 2024; 13:1384. [PMID: 38592197 PMCID: PMC10934212 DOI: 10.3390/jcm13051384] [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: 12/18/2023] [Revised: 01/30/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Several mortality risk scores have been developed to predict mortality in ruptured abdominal aortic aneurysms (rAAAs), but none focused on intraoperative factors. The aim of this study is to identify intraoperative variables affecting in-hospital mortality after open repair and develop a novel prognostic risk score. (2) Methods: The analysis of a retrospectively maintained dataset identified patients who underwent open repair for rAAA from January 2007 to October 2023 in three Italian tertiary referral centers. Multinomial logistic regression was used to calculate the association between intraoperative variables and perioperative mortality. Independent intraoperative factors were used to create a prognostic score. (3) Results: In total, 316 patients with a mean age of 77.3 (SD ± 8.5) were included. In-hospital mortality rate was 30.7%. Hemoperitoneum (p < 0.001), suprarenal clamping (p = 0.001), and operation times of >240 min (p = 0.008) were negative predictors of perioperative mortality, while the patency of at least one hypogastric artery had a protective role (p = 0.008). Numerical values were assigned to each variable based on the respective odds ratio to create a risk stratification for in-hospital mortality. (4) Conclusions: rAAA represents a major cause of mortality. Intraoperative variables are essential to estimate patients' risk in surgically treated patients. A prognostic risk score based on these factors alone may be useful to predict in-hospital mortality after open repair.
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Affiliation(s)
- Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (N.T.); (G.B.); (V.M.); (V.A.); (D.M.); (D.A.)
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (N.T.); (G.B.); (V.M.); (V.A.); (D.M.); (D.A.)
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (N.T.); (G.B.); (V.M.); (V.A.); (D.M.); (D.A.)
| | - Mario D’Oria
- Vascular and Endovascular Surgery Unit, Cardio-Thoraco-Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy; (B.G.); (G.B.); (C.C.); (S.L.)
| | - Luca Mezzetto
- Unit of Vascular Surgery, Department of Cardio-Thoraco-Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, 37134 Verona, Italy; (L.M.); (L.G.); (D.M.); (G.F.V.)
| | - Vittorio Malquori
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (N.T.); (G.B.); (V.M.); (V.A.); (D.M.); (D.A.)
| | - Valerio Artini
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (N.T.); (G.B.); (V.M.); (V.A.); (D.M.); (D.A.)
| | - Duilio Motta
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (N.T.); (G.B.); (V.M.); (V.A.); (D.M.); (D.A.)
| | - Lorenzo Grosso
- Unit of Vascular Surgery, Department of Cardio-Thoraco-Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, 37134 Verona, Italy; (L.M.); (L.G.); (D.M.); (G.F.V.)
| | - Beatrice Grando
- Vascular and Endovascular Surgery Unit, Cardio-Thoraco-Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy; (B.G.); (G.B.); (C.C.); (S.L.)
| | - Giovanni Badalamenti
- Vascular and Endovascular Surgery Unit, Cardio-Thoraco-Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy; (B.G.); (G.B.); (C.C.); (S.L.)
| | - Cristiano Calvagna
- Vascular and Endovascular Surgery Unit, Cardio-Thoraco-Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy; (B.G.); (G.B.); (C.C.); (S.L.)
| | - Davide Mastrorilli
- Unit of Vascular Surgery, Department of Cardio-Thoraco-Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, 37134 Verona, Italy; (L.M.); (L.G.); (D.M.); (G.F.V.)
| | - Gian Franco Veraldi
- Unit of Vascular Surgery, Department of Cardio-Thoraco-Vascular Surgery, University Hospital and Trust of Verona, University of Verona School of Medicine, 37134 Verona, Italy; (L.M.); (L.G.); (D.M.); (G.F.V.)
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (R.B.); (N.T.); (G.B.); (V.M.); (V.A.); (D.M.); (D.A.)
| | - Sandro Lepidi
- Vascular and Endovascular Surgery Unit, Cardio-Thoraco-Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy; (B.G.); (G.B.); (C.C.); (S.L.)
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Scali ST, Stone DH. Modern management of ruptured abdominal aortic aneurysm. Front Cardiovasc Med 2023; 10:1323465. [PMID: 38149264 PMCID: PMC10749949 DOI: 10.3389/fcvm.2023.1323465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
Ruptured abdominal aortic aneurysms (rAAA) remain one of the most clinically challenging and technically complex emergencies in contemporary vascular surgery practice. Over the past 30 years, a variety of changes surrounding the treatment of rAAA have evolved including improvements in diagnosis, development of coordinated referral networks to transfer patients more efficiently to higher volume centers, deliberate de-escalation of pre-hospital resuscitation, modification of patient and procedure selection, implementation of clinical pathways, as well as enhanced awareness of certain high-impact postoperative complications. Despite these advances, current postoperative outcomes remain sobering since morbidity and mortality rates ranging from 25%-50% persist among modern published series. Some of the most impactful variation in rAAA management has been fostered by the rapid proliferation of endovascular repair (EVAR) along with service alignment at selected centers to improve timely revascularization. Indeed, clinical care pathways and emergency response networks are now increasingly utilized which has led to improved outcomes contemporaneously. Moreover, evolution in pre- and post-operative physiologic resuscitation has also contributed to observed improvements in rAAA outcomes. Due to different developments in care provision over time, the purpose of this review is to describe the modern management of rAAA, while providing historical perspectives on patient, procedure and systems-based practice elements that have evolved care delivery paradigms in this complex group of patients.
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Affiliation(s)
- Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States
| | - David H. Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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