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Gormley S, Mao J, Sedrakyan A, Beck AW, Mani K, Beiles B, Szeberin Z, Venermo M, Cassar K, Khashram M. The association of ruptured abdominal aortic aneurysm diameter with mortality in the International Consortium of Vascular Registries. J Vasc Surg 2024; 79:748-754.e2. [PMID: 38013041 DOI: 10.1016/j.jvs.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The mortality after ruptured abdominal aortic aneurysm (rAAA) repair is high, despite improvements in perioperative care, centralization of emergency vascular surgical services, and the introduction of endovascular aneurysm repair (EVAR). The diameter of intact AAA has been shown to be a predictor of short- and long-term survival. The aim of this study was to analyze the impact of AAA diameter on mortality for rAAA repair using contemporary data collected from the International Consortium of Vascular Registries and compare outcomes by sex and the type of repair patients received. METHODS Prospective registry data on repair of rAAA from seven countries were collected from 2010 to 2016. The primary outcome was perioperative mortality after EVAR and open surgical repair (OSR). Data were stratified by type of repair and sex. Logistic regression models were used to estimate odds ratio (OR) for the association between AAA diameter and perioperative mortality and the association between type of repair and mortality. Multivariable logistic regression models were used to adjust for differences in patient characteristics. RESULTS The study population consisted of 6428 patients with a mean age ranging from 70.2 to 75.4 years; the mean AAA diameter was 7.7 ± 1.8 cm. Females had a significantly smaller AAA diameter at presentation compared with males (6.9 ± 1.6 cm vs 7.9 ± 1.8 cm; P < .001). who underwent OSR had larger AAA diameters compared with those who underwent EVAR (P < .001). Females who underwent repair were significantly older (P < .001). Males were more likely to have cardiac disease, diabetes mellitus, and renal impairment. Overall, AAA diameter was a predictor of mortality in univariate and multivariate analysis. When analyzing EVAR and OSR separately, the impact of AAA diameter per cm increase on mortality was apparent in both males and females undergoing EVAR, but not OSR (EVAR: male OR, 1.09 [95% confidence interval, 1.03-1.16] and EVAR: female OR, 1.17 [95% confidence interval, 1.02-1.35]). The early mortality rate for males and females who underwent EVAR was 18.9% and 25.9% (P < .001), respectively. The corresponding mortality for males and females who underwent OSR was 30.2% and 38.6% (P < .001), respectively. CONCLUSIONS In these real-world international data, there is a significant association between rAAA diameters and early mortality in males and females. This association was more evident in patients undergoing EVAR, but not shown in OSR. Despite improvements in overall AAA repair outcomes, the risk of mortality after rAAA repair is consistently higher for females.
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Affiliation(s)
- Sinead Gormley
- Department of Surgery, University of Auckland, Auckland, NZ; Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, NZ
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Barry Beiles
- Australasian Vascular Audit, Australia & New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kevin Cassar
- Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, NZ; Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, NZ.
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Pherwani AD, Johal AS, Cromwell DA, Boyle JR, Szeberin Z, Venermo M, Beiles B, Khashram M, Lattmann T, Altreuther ME, Laxdal E, Behrendt CA, Mani K, Budtz-Lilly J. Outcomes Following Intact and Ruptured Aneurysm Repair across Nations: Analysis of International Registry Data from the VASCUNET Collaboration 2014 - 2019. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00178-3. [PMID: 38382695 DOI: 10.1016/j.ejvs.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To determine the peri-operative mortality rate for intact and ruptured abdominal aortic aneurysm (AAA) repair in 10 countries and to compare practice and outcomes over a six year period by age, sex, and geographic location. METHODS This VASCUNET study used prospectively collected data from vascular registries in 10 countries on primary repair of intact and ruptured AAAs undertaken between January 2014 and December 2019. The primary outcome was peri-operative death (30 day or in hospital). Logistic regression models were used to estimate the association between peri-operative death, patient characteristics, and type of procedure. Factors associated with the use of endovascular aortic aneurysm repair (EVAR) were also evaluated. RESULTS The analysis included 50 642 intact and 9 453 ruptured AAA repairs. The proportion of EVARs for intact repairs increased from 63.4% in 2014 to 67.3% in 2016 before falling to 62.3% in 2019 (p < .001), but practice varied between countries. EVAR procedures were more common among older patients (p < .001) and men (p < .001). Overall peri-operative mortality after intact AAA repair was 1.4% (95% confidence interval [CI] 1.3 - 1.5%) and did not change over time. Mortality rates were stable within countries. Among ruptured AAA repairs, the proportion of EVARs increased from 23.7% in 2014 to 35.2% in 2019 (p < .001). The average aortic diameter was 7.8 cm for men and 7.0 cm for women (p < .001). The overall peri-operative mortality rate was 31.3% (95% CI 30.4 - 32.2%); the rates were 36.0% (95% CI 34.9 - 37.2%) for open repair and 19.7% (95% CI 18.2 - 21.3%) for EVAR. This difference and shift to EVAR reduced peri-operative mortality from 32.6% (in 2014) to 28.7% (in 2019). CONCLUSION The international practice of intact AAA repair was associated with low mortality rates in registry reported data. There remains variation in the use of EVAR for intact AAAs across countries. Overall peri-operative mortality remains high after ruptured AAA, but an increased use of EVAR has reduced rates over time.
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Affiliation(s)
- Arun D Pherwani
- Keele University School of Medicine, Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
| | - Amundeep S Johal
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK. http://www.twitter.com/vsqip
| | | | - Jonathan R Boyle
- Cambridge University Hospitals NHS Trust and Department of Surgery, University of Cambridge, Cambridge, UK. http://www.twitter.com/Jonnyboyle1
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. http://www.twitter.com/VenerMa
| | - Barry Beiles
- Australasian Vascular Audit, Australian and New Zealand Society for Vascular Surgery, Melbourne, Australia
| | - Manar Khashram
- University of Auckland, Waikato Hospital, Hamilton, New Zealand. http://www.twitter.com/ManarKhashram
| | - Thomas Lattmann
- Swissvasc Registry, Clinic for Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland. http://www.twitter.com/LattmannThomas
| | - Martin E Altreuther
- Section of Vascular Surgery, Department of Surgery, St Olavs Hospital, and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elin Laxdal
- Department of Vascular Surgery, Landspitalinn University Hospital, Reykjavik, Iceland
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany. http://www.twitter.com/VASCevidence
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. http://www.twitter.com/KevinMani7
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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3
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Moffatt C, Bath J, Rogers RT, Colglazier JJ, Braet DJ, Coleman DM, Scali ST, Back MR, Magee GA, Plotkin A, Dueppers P, Zimmermann A, Afifi RO, Khan S, Zarkowsky D, Dyba G, Soult MC, Mani K, Wanhainen A, Setacci C, Lenti M, Kabbani LS, Weaver MR, Bissacco D, Trimarchi S, Stoecker JB, Wang GJ, Szeberin Z, Pomozi E, Gelabert HA, Tish S, Hoel AW, Cortolillo NS, Spangler EL, Passman MA, De Caridi G, Benedetto F, Zhou W, Abuhakmeh Y, Newton DH, Liu CM, Tinelli G, Tshomba Y, Katoh A, Siada SS, Khashram M, Gormley S, Mullins JR, Schmittling ZC, Maldonado TS, Politano AD, Rynio P, Kazimierczak A, Gombert A, Jalaie H, Spath P, Gallitto E, Czerny M, Berger T, Davies MG, Stilo F, Montelione N, Mezzetto L, Veraldi GF, D'Oria M, Lepidi S, Lawrence P, Woo K. International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum. Ann Vasc Surg 2023; 95:23-31. [PMID: 37236537 DOI: 10.1016/j.avsg.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch. METHODS Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions. RESULTS 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change. CONCLUSIONS In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
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Affiliation(s)
- Clare Moffatt
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Jonathan Bath
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Richard T Rogers
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Drew J Braet
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Dawn M Coleman
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Salvatore T Scali
- Division of Vascular and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Martin R Back
- Division of Vascular and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Gregory A Magee
- Division of Vascular and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Anastasia Plotkin
- Division of Vascular and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Philip Dueppers
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Rana O Afifi
- Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Sophia Khan
- Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Devin Zarkowsky
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Gregory Dyba
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Michael C Soult
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Carlo Setacci
- Division of Vascular and Endovascular Surgery, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Massimo Lenti
- Division of Vascular and Endovascular Surgery, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Loay S Kabbani
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI
| | - Mitchell R Weaver
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI
| | - Daniele Bissacco
- Department of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Department of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jordan B Stoecker
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Eniko Pomozi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Hugh A Gelabert
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shahed Tish
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Andrew W Hoel
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nicholas S Cortolillo
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily L Spangler
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Marc A Passman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Giovanni De Caridi
- Division of Vascular Surgery, Department of Medical Sciences and Morpho-Functional-Imaging, University of Messina, Messina, Italy
| | - Filippo Benedetto
- Division of Vascular Surgery, Department of Medical Sciences and Morpho-Functional-Imaging, University of Messina, Messina, Italy
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Yousef Abuhakmeh
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Daniel H Newton
- Division of Vascular Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Christopher M Liu
- Division of Vascular Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Airi Katoh
- Department of Surgery, University of California San Francisco at Fresno, Fresno, CA
| | - Sammy S Siada
- Department of Surgery, University of California San Francisco at Fresno, Fresno, CA
| | - Manar Khashram
- Department of Surgery, University of Auckland, Waikato, New Zealand
| | - Sinead Gormley
- Department of Surgery, University of Auckland, Waikato, New Zealand
| | - John R Mullins
- Division of Vascular Surgery, Department of Surgery, CoxHealth, Springfield, MO
| | | | - Thomas S Maldonado
- Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Amani D Politano
- Division of Vascular Surgery, Department of Surgery, Oregon Health and Sciences University, Portland, OR
| | - Pawel Rynio
- Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
| | | | - Alexander Gombert
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Houman Jalaie
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Paolo Spath
- Department of Vascular Surgery, University of Bologna, DIMES, Bologna, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, University of Bologna, DIMES, Bologna, Italy
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Clinic for Cardiovascular Surgery, University Clinic Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Tim Berger
- University Heart Center Freiburg-Bad Krozingen, Clinic for Cardiovascular Surgery, University Clinic Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, Long School of Medicine, UT Health San Antonio, San Antonio, TX
| | - Francesco Stilo
- Operative Research Unit of Vascular Surgery, Department of Medicine and Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Nunzio Montelione
- Operative Research Unit of Vascular Surgery, Department of Medicine and Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Luca Mezzetto
- Division of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Gian Franco Veraldi
- Division of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Peter Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Karen Woo
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
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4
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Koeckerling D, Raguindin PF, Kastrati L, Bernhard S, Barker J, Quiroga Centeno AC, Raeisi-Dehkordi H, Khatami F, Niehot C, Lejay A, Szeberin Z, Behrendt CA, Nordanstig J, Muka T, Baumgartner I. Endovascular revascularization strategies for aortoiliac and femoropopliteal artery disease: a meta-analysis. Eur Heart J 2023; 44:935-950. [PMID: 36721954 PMCID: PMC10011342 DOI: 10.1093/eurheartj/ehac722] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/24/2022] [Accepted: 11/22/2022] [Indexed: 02/02/2023] Open
Abstract
AIMS Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy. METHODS AND RESULTS Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints. CONCLUSION Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
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Affiliation(s)
- David Koeckerling
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Swiss Paraplegic Research, Guido A. Zäch Str. 1, 6207 Nottwil, Switzerland.,Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse, 36002 Lucerne, Switzerland
| | - Lum Kastrati
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Joseph Barker
- Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicestershire LE1 7RH, UK
| | | | - Hamidreza Raeisi-Dehkordi
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Farnaz Khatami
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Community Medicine Department, Tehran University of Medical Sciences, PourSina St., Tehran 1417613151, Iran
| | - Christa Niehot
- Literature Searches Support, 3314SC Dordrecht, the Netherlands
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, 4 rue Kirschleger, 67085 Strasbourg, France
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, XII. Városmajor u. 68., 1122 Budapest, Hungary
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Alphonsstraße 14, 22043 Hamburg, Germany
| | - Joakim Nordanstig
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.,Epistudia, 3011 Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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5
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Sörelius K, Wyss TR, Adam D, Beck AW, Berard X, Budtz-Lilly J, Chakfé N, Clough R, Czerny M, D'Oria M, Dang M, di Summa PG, Eldrup N, Fourneau I, Heinola I, Hosaka A, Hsu RB, Huang YK, Jutidamrongphan W, Kan CD, Kölbel T, Lau C, Lawaetz M, Mani K, Moulakakis K, Oderich GS, Resch T, Schmidli J, Sedivy P, Shirasu T, Suwannanon R, Szeberin Z, Touma J, van den Berg JC, Veger H, Wanhainen A, Weiss S. Editor's Choice - Infective Native Aortic Aneurysms: A Delphi Consensus Document on Terminology, Definition, Classification, Diagnosis, and Reporting Standards. Eur J Vasc Endovasc Surg 2023; 65:323-329. [PMID: 36470311 DOI: 10.1016/j.ejvs.2022.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 12/09/2022]
Abstract
OBJECTIVE There is no consensus regarding the terminology, definition, classification, diagnostic criteria, and algorithm, or reporting standards for the disease of infective native aortic aneurysm (INAA), previously known as mycotic aneurysm. The aim of this study was to establish this by performing a consensus study. METHODS The Delphi methodology was used. Thirty-seven international experts were invited via mail to participate. Four two week Delphi rounds were performed, using an online questionnaire, initially with 22 statements and nine reporting items. The panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements revised, and results presented in iterative rounds. Consensus was defined as ≥ 75% of the panel selecting "strongly agree" or "agree" on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha coefficient > .80. RESULTS All 38 panellists completed all four rounds, resulting in 100% participation and agreement that this study was necessary, and the term INAA was agreed to be optimal. Three more statements were added based on the results and comments of the panel, resulting in a final 25 statements and nine reporting items. All 25 statements reached an agreement of ≥ 87%, and all nine reporting items reached an agreement of 100%. The Cronbach's alpha increased for each consecutive round (round 1 = .84, round 2 = .87, round 3 = .90, and round 4 = .92). Thus, consensus was reached for all statements and reporting items. CONCLUSION This Delphi study established the first consensus document on INAA regarding terminology, definition, classification, diagnostic criteria, and algorithm, as well as reporting standards. The results of this study create essential conditions for scientific research on this disease. The presented consensus will need future amendments in accordance with newly acquired knowledge.
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Affiliation(s)
- Karl Sörelius
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas R Wyss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Kantonsspital Winterthur, Department of Interventional Radiology and Vascular Surgery, Winterthur, Switzerland
| | - Donald Adam
- University Hospitals Birmingham, Birmingham, UK
| | - Adam W Beck
- University of Alabama at Birmingham, Division of Vascular Surgery and Endovascular Therapy, Birmingham, AL, United States
| | - Xavier Berard
- Vascular and General Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France, and GEPROMED Strasbourg, France
| | - Rachel Clough
- School of Biomedical Engineering and Imaging Science, King's College London, London UK, and Department of Vascular Surgery, Imperial Healthcare NHS Foundation Trust, London, UK
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre Freiburg University, Freiburg, Germany
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Italy
| | - Michael Dang
- Haga Teaching Hospital, The Hague, The Netherlands
| | - Pietro G di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ivika Heinola
- Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Akihiro Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | | | | | - Warissara Jutidamrongphan
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chung-Dann Kan
- College of Medicine, National Cheng-Kung University and National Cheng-Kung University Hospital, Taiwan
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Hospital Eppendorf, Hamburg, Germany
| | | | - Martin Lawaetz
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | | | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Timothy Resch
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jürg Schmidli
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Petr Sedivy
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Takuro Shirasu
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan
| | - Ruedeekorn Suwannanon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Joseph Touma
- Vascular Surgery Department, Henri Mondor University Hospital, Creteil, France
| | - Jos C van den Berg
- Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland; Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hugo Veger
- Haga Teaching Hospital, The Hague, The Netherlands
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Salome Weiss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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DeCarlo C, Woo K, van Petersen AS, Geelkerken RH, Chen AJ, Yeh SL, Kim GY, Henke PK, Tracci MC, Schneck MB, Grotemeyer D, Meyer B, DeMartino RR, Wilkins PB, Iranmanesh S, Rastogi V, Aulivola B, Korepta LM, Shutze WP, Jett KG, Sorber R, Abularrage CJ, Long GW, Bove PG, Davies MG, Miserlis D, Shih M, Yi J, Gupta R, Loa J, Robinson DA, Gombert A, Doukas P, de Caridi G, Benedetto F, Wittgen CM, Smeds MR, Sumpio BE, Harris S, Szeberin Z, Pomozi E, Stilo F, Montelione N, Mouawad NJ, Lawrence P, Dua A. Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort. J Vasc Surg 2023; 77:567-577.e2. [PMID: 36306935 DOI: 10.1016/j.jvs.2022.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prior research on median arcuate ligament syndrome has been limited to institutional case series, making the optimal approach to median arcuate ligament release (MALR) and resulting outcomes unclear. In the present study, we compared the outcomes of different approaches to MALR and determined the predictors of long-term treatment failure. METHODS The Vascular Low Frequency Disease Consortium is an international, multi-institutional research consortium. Data on open, laparoscopic, and robotic MALR performed from 2000 to 2020 were gathered. The primary outcome was treatment failure, defined as no improvement in median arcuate ligament syndrome symptoms after MALR or symptom recurrence between MALR and the last clinical follow-up. RESULTS For 516 patients treated at 24 institutions, open, laparoscopic, and robotic MALR had been performed in 227 (44.0%), 235 (45.5%), and 54 (10.5%) patients, respectively. Perioperative complications (ileus, cardiac, and wound complications; readmissions; unplanned procedures) occurred in 19.2% (open, 30.0%; laparoscopic, 8.9%; robotic, 18.5%; P < .001). The median follow-up was 1.59 years (interquartile range, 0.38-4.35 years). For the 488 patients with follow-up data available, 287 (58.8%) had had full relief, 119 (24.4%) had had partial relief, and 82 (16.8%) had derived no benefit from MALR. The 1- and 3-year freedom from treatment failure for the overall cohort was 63.8% (95% confidence interval [CI], 59.0%-68.3%) and 51.9% (95% CI, 46.1%-57.3%), respectively. The factors associated with an increased hazard of treatment failure on multivariable analysis included robotic MALR (hazard ratio [HR], 1.73; 95% CI, 1.16-2.59; P = .007), a history of gastroparesis (HR, 1.83; 95% CI, 1.09-3.09; P = .023), abdominal cancer (HR, 10.3; 95% CI, 3.06-34.6; P < .001), dysphagia and/or odynophagia (HR, 2.44; 95% CI, 1.27-4.69; P = .008), no relief from a celiac plexus block (HR, 2.18; 95% CI, 1.00-4.72; P = .049), and an increasing number of preoperative pain locations (HR, 1.12 per location; 95% CI, 1.00-1.25; P = .042). The factors associated with a lower hazard included increasing age (HR, 0.99 per increasing year; 95% CI, 0.98-1.0; P = .012) and an increasing number of preoperative diagnostic gastrointestinal studies (HR, 0.84 per study; 95% CI, 0.74-0.96; P = .012) Open and laparoscopic MALR resulted in similar long-term freedom from treatment failure. No radiographic parameters were associated with differences in treatment failure. CONCLUSIONS No difference was found in long-term failure after open vs laparoscopic MALR; however, open release was associated with higher perioperative morbidity. These results support the use of a preoperative celiac plexus block to aid in patient selection. Operative candidates for MALR should be counseled regarding the factors associated with treatment failure and the relatively high overall rate of treatment failure.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, Netherlands
| | - Alina J Chen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Savannah L Yeh
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Gloria Y Kim
- Division of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Peter K Henke
- Division of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Matthew B Schneck
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Dirk Grotemeyer
- Department of Vascular Surgery, Hôpitaux Robert Schuman - Hopital Kirchberg, Luxembourg, MN
| | - Bernd Meyer
- Department of Vascular Surgery, Hôpitaux Robert Schuman - Hopital Kirchberg, Luxembourg, MN
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Parvathi B Wilkins
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Sina Iranmanesh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Vinamr Rastogi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Bernadette Aulivola
- Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL
| | - Lindsey M Korepta
- Division of Vascular and Endovascular Surgery, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL
| | - William P Shutze
- Division of Vascular Surgery, Department of Surgery, The Heart Hospital Plano, Plano, TX
| | - Kimble G Jett
- Division of Vascular Surgery, Department of Surgery, The Heart Hospital Plano, Plano, TX
| | - Rebecca Sorber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Christopher J Abularrage
- Division of Vascular and Endovascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Graham W Long
- Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Paul G Bove
- Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX
| | - Dimitrios Miserlis
- Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeniann Yi
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Ryan Gupta
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Jacky Loa
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David A Robinson
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alexander Gombert
- Department of Vascular Surgery, European Vascular Center Aachen Maastricht, RWTH, University Hospital Aachen, Aachen, Germany
| | - Panagiotis Doukas
- Department of Vascular Surgery, European Vascular Center Aachen Maastricht, RWTH, University Hospital Aachen, Aachen, Germany
| | - Giovanni de Caridi
- Division of Vascular and Endovascular Surgery, Department of Biomorf, University of Messina, Messina, Italy
| | - Filippo Benedetto
- Division of Vascular and Endovascular Surgery, Department of Biomorf, University of Messina, Messina, Italy
| | - Catherine M Wittgen
- Division of Vascular Surgery, Department of Surgery, St. Louis University, St. Louis, MO
| | - Matthew R Smeds
- Division of Vascular Surgery, Department of Surgery, St. Louis University, St. Louis, MO
| | - Bauer E Sumpio
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Sean Harris
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Enikő Pomozi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Francesco Stilo
- Division of Vascular Surgery, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Nunzio Montelione
- Division of Vascular Surgery, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Nicolas J Mouawad
- Division of Vascular and Endovascular Surgery, Department of Surgery, McLaren Health System, Bay City, MI
| | - Peter Lawrence
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
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Kolossváry E, Ferenci T, Kováts T, Sótonyi P, Szeberin Z, Nemes B, Dósa E, Farkas K, Járai Z. High Level of Unwarranted Clinical Variation in the Use of Lower Extremity Revascularisation Procedures in Hungary (2013–2017). J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nooromid M, De Martino R, Squizzato F, Benedetto F, De Caridi G, Chou EL, Conrad MF, Pantoja J, Abularrage C, Sorber R, Garcia-Ortega DY, Luna-Ortiz K, Eichler C, Zarkowsky D, Chia M, Kalluri A, Cohnert T, Szeberin Z, Grotemeyer D, Shalhub S, Fagg D, Jackson MJ, Charlton-Ouw K, Gombert A, Jacobs M, Boyd A, Motaganahalli R, Uceda D, Woo K, Eskandari MK. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: A multicenter experience. Eur J Vasc Endovasc Surg 2022. [DOI: 10.1016/j.ejvs.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Janko MR, Hubbard G, Back M, Shah SK, Pomozi E, Szeberin Z, DeMartino R, Wang LJ, Crofts S, Belkin M, Davila VJ, Lemmon GW, Wang SK, Czerny M, Kreibich M, Humphries MD, Shutze W, Joh JH, Cho S, Behrendt CA, Setacci C, Hacker RI, Sobreira ML, Yoshida WB, D'Oria M, Lepidi S, Chiesa R, Kahlberg A, Go MR, Rizzo AN, Black JH, Magee GA, Elsayed R, Baril DT, Beck AW, McFarland GE, Gavali H, Wanhainen A, Kashyap VS, Stoecker JB, Wang GJ, Zhou W, Fujimura N, Obara H, Wishy AM, Bose S, Smeds M, Liang P, Schermerhorn M, Conrad MF, Hsu JH, Patel R, Lee JT, Liapis CD, Moulakakis KG, Farber MA, Motta F, Ricco JB, Bath J, Coselli JS, Aziz F, Coleman DM, Davis FM, Fatima J, Irshad A, Shalhub S, Kakkos S, Zhang Q, Lawrence PF, Woo K, Chung J. In-situ Bypass Is Associated with Superior Infection-free Survival Compared to Extra-Anatomic Bypass for the Management of Secondary Aortic Graft Infections Without Enteric Involvement. J Vasc Surg 2022; 76:546-555.e3. [PMID: 35470015 DOI: 10.1016/j.jvs.2022.03.869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. METHODS A retrospective, multi-institutional study of AGI from 2002-2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. RESULTS 241 patients at 34 institutions from 7 countries presented with AGI during the study period (median age 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%) and 66 endografts (27%) and 3 unknown (2%). 172 (71%) of the patients underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (NAIS) (24%), and cryopreserved allograft (41%). 69 patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier (KM) estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB versus EAB, there was a significant difference in KM estimated infection-free survival (2910 days, IQR 391, 3771 versus 180 days, IQR 27, 3750 days; p<0.001). There were otherwise no significant differences in presentation, comorbidities, nor perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (HR 2.4, 95% CI 1.6-3.6; p<0.001), polymicrobial infection (HR 2.2, 95% CI 1.4-3.5; p=0.001), MRSA infection (HR 1.7, 95% CI 1.1-2.7; p=0.02), as well as the protective effect of omental/muscle flap coverage (HR 0.59, 95% CI 0.37-0.92; p=0.02). CONCLUSIONS After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two-and-half fold higher re-infection/mortality compared to ISB. Omental and/or muscle flap coverage of the repair appear protective.
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Affiliation(s)
- Matthew R Janko
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Grant Hubbard
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Martin Back
- Division of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Samir K Shah
- Division of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Eniko Pomozi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Linda J Wang
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Sarah Crofts
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Michael Belkin
- Department of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor J Davila
- Division of Vascular Surgery, Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Gary W Lemmon
- Division of Vascular Surgery, Department of Surgery, Indiana University, Indianapolis, IN
| | - Shihuan K Wang
- Division of Vascular Surgery, Department of Surgery, Indiana University, Indianapolis, IN
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany
| | - Misty D Humphries
- Division of Vascular Surgery, Department of Surgery, UC Davis Health, Sacramento, CA
| | - William Shutze
- Texas Vascular Associates, The Heart Hospital Plano, Plano, TX
| | - Jin Hyun Joh
- Division of Vascular Surgery, Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Sungsin Cho
- GermanVasc Research Group, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- GermanVasc Research Group, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carlo Setacci
- Department of Vascular and Endovascular Surgery, University of Siena, Sienna, Italy
| | - Robert I Hacker
- Division of Vascular Surgery, Surgical Arts of St. Louis, Bridgeton, MO
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, Botucatu School of Medicine, Paulista State University, São Paulo, Brazil
| | - Winston Bonetti Yoshida
- Department of Surgery and Orthopedics, Botucatu School of Medicine, Paulista State University, São Paulo, Brazil
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Kahlberg
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Michael R Go
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Anthony N Rizzo
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Ramsey Elsayed
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Donald T Baril
- Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Graeme E McFarland
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Hamid Gavali
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jordan B Stoecker
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Naoki Fujimura
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Andrew M Wishy
- Division of Vascular and Endovascular Surgery, Brooke Army Medical Center, San Antonio, TX
| | - Saideep Bose
- Division of Vascular Surgery, Department of Surgery, Saint Louis University, St Louis, MO
| | - Matthew Smeds
- Division of Vascular Surgery, Department of Surgery, Saint Louis University, St Louis, MO
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mark F Conrad
- Division of Vascular Surgery, St Elizabeth's Hospital, Brighton, MA
| | - Jeffrey H Hsu
- Division of Vascular Surgery, Kaiser Permanente, Fontana, CA
| | - Rhusheet Patel
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jason T Lee
- Division of Vascular Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Christos D Liapis
- Department of Vascular Surgery, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Fernando Motta
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University of Poitiers Medical School, Poitiers, France
| | - Jonathan Bath
- Cardiovascular Surgical Clinics, University of Missouri, Columbia, MO
| | - Joseph S Coselli
- Division of Vascular Surgery, Penn State Health Heart and Vascular Institute, Hershey, PA
| | - Faisal Aziz
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Dawn M Coleman
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Frank M Davis
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Javairiah Fatima
- Cardiovascular Center at Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Ali Irshad
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Stavros Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Qianzi Zhang
- Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Peter F Lawrence
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jayer Chung
- Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
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10
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Kolossváry E, Ferenci T, Kováts T, Sótonyi P, Szeberin Z, Nemes B, Dósa E, Farkas K, Járai Z. High level of unwarranted clinical variation in the utilisation of lower extremity revascularisation procedures in Hungary (2013–2017). Eur J Vasc Endovasc Surg 2022; 63:874-882. [DOI: 10.1016/j.ejvs.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022]
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11
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Mansilha A, Viddal B, Krievins D, McLain D, Petkov D, Adili F, DE Borst G, Oszkinis G, Fourneau I, Cvjetko I, Kakisis J, Maeso J, Scott J, Tijunaitis K, Cassar K, Velicka L, Gasparini M, Widmer M, Gargiulo M, Ionac M, Chakfé N, Staffa R, Suominen V, Szeberin Z. European training requirements in vascular surgery. INT ANGIOL 2022; 41:91-104. [PMID: 35138075 DOI: 10.23736/s0392-9590.22.04841-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Armando Mansilha
- UEMS Section and Board of Vascular Surgery, Faculty of Medicine, University of Porto, Porto, Portugal -
| | - Beate Viddal
- UEMS Section and Board of Vascular Surgery, Norway
| | | | | | | | - Farzin Adili
- UEMS Section and Board of Vascular Surgery, Germany
| | - Gert DE Borst
- UEMS Section and Board of Vascular Surgery, the Netherlands
| | | | | | - Ivan Cvjetko
- UEMS Section and Board of Vascular Surgery, Croatia
| | - John Kakisis
- UEMS Section and Board of Vascular Surgery, Greece
| | - Jordi Maeso
- UEMS Section and Board of Vascular Surgery, Spain
| | | | | | - Kevin Cassar
- UEMS Section and Board of Vascular Surgery, Malta
| | - Linas Velicka
- UEMS Section and Board of Vascular Surgery, Lithuania
| | | | | | | | - Mihai Ionac
- UEMS Section and Board of Vascular Surgery, Romania
| | - Nabil Chakfé
- UEMS Section and Board of Vascular Surgery, France
| | - Robert Staffa
- UEMS Section and Board of Vascular Surgery, Czech Republic
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12
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Corte AD, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D'Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D'Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'. Eur J Cardiothorac Surg 2021; 60:724-725. [PMID: 34378028 PMCID: PMC8385948 DOI: 10.1093/ejcts/ezab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitaly A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching, Hospital, Varese, Italy
| | - Ilenia D'Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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13
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Nooromid M, De Martino R, Squizzato F, Benedetto F, De Caridi G, Chou EL, Conrad MF, Pantoja J, Abularrage C, Sorber R, Garcia-Ortega DY, Luna-Ortiz K, Eichler C, Zarkowsky D, Chia M, Kalluri A, Cohnert T, Szeberin Z, Grotemeyer D, Shalhub S, Fagg D, Jackson MJ, Charlton-Ouw K, Gombert A, Jacobs M, Boyd A, Motaganahalli R, Uceda D, Woo K, Eskandari MK. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. J Vasc Surg Venous Lymphat Disord 2021; 10:617-625. [PMID: 34271247 DOI: 10.1016/j.jvsv.2021.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Primary leiomyosarcoma of the inferior vena cava (IVC) is best managed with surgical resection when technically feasible. However, consensus is lacking regarding the best choice of conduit and reconstruction technique. The aim of the present multicenter study was to perform a comprehensive assessment through the VLFDC (Vascular Low Frequency Disease Consortium) to determine the most effective method for caval reconstruction after resection of primary leiomyosarcoma of the IVC. METHODS A multicenter, standardized database review of patients who had undergone surgical resection and reconstruction of the IVC for primary leiomyosarcoma from 2007 to 2017 was performed. The demographics, periprocedural details, and postoperative outcomes were analyzed. RESULTS A total of 92 patients (60 women and 32 men), with a mean age of 60.1 years (range, 30-88 years) were treated. Metastatic disease was present in 22%. The tumor location was below the renal veins in 49 (53%), between the renal and hepatic veins in 52 (57%), and above the hepatic veins in 13 patients (14%). The conduits used for reconstruction included ringed polytetrafluoroethylene (PTFE; n = 80), nonringed PTFE (n = 1), Dacron (n = 1), autogenous vein (n = 1), bovine pericardium (n = 4), and cryopreserved tissue (n = 5). Complete R0 resection was accomplished in 73 patients (79%). In-hospital mortality was 2%, with a median length of stay of 8 days. The primary patency of PTFE reconstructed IVCs was 97% and 92% at 1 and 5 years, respectively, compared with 73% at 1 and 5 years for the non-PTFE reconstructed IVCs. The overall 1-, 3-, and 5-year survival for the entire cohort were 94%, 86%, and 65%, respectively CONCLUSIONS: The findings from our multi-institutional study have demonstrated that complete en bloc resection of IVC leiomyosarcoma with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. A ringed PTFE graft was the most commonly used conduit for caval reconstruction, yielding excellent long-term primary patency.
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Affiliation(s)
- Michael Nooromid
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Randall De Martino
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Francesco Squizzato
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Filippo Benedetto
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Giovanni De Caridi
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Elizabeth L Chou
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Joe Pantoja
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Christopher Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Rebecca Sorber
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Dorian Yarih Garcia-Ortega
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Kuauhyama Luna-Ortiz
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Charles Eichler
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Devin Zarkowsky
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Matthew Chia
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Aravind Kalluri
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tina Cohnert
- Department of Vascular Surgery, Graz Medical University, Graz, Austria
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Dirk Grotemeyer
- Department of Vascular Surgery, Hopitaux Robert Schuman, Hopital Kirchberg, Luxembourg City, Luxembourg
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Damen Fagg
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Mark J Jackson
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kristofer Charlton-Ouw
- Department of Clinical Sciences, University of Houston College of Medicine and Gulf Coast Vascular, HCA Houston Healthcare, Gulf Coast Division, Houston, Tex
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - April Boyd
- Division of Vascular Surgery, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Raghu Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Domingo Uceda
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Mark K Eskandari
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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14
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Della Corte A, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions. Eur J Cardiothorac Surg 2021; 59:1096-1102. [PMID: 33394040 PMCID: PMC7799089 DOI: 10.1093/ejcts/ezaa452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures. METHODS Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared. RESULTS No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89-1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76-0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (-40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02). CONCLUSIONS There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality.
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Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitali A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Ilenia D Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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15
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Boyle JR, Mao J, Beck AW, Venermo M, Sedrakyan A, Behrendt CA, Szeberin Z, Eldrup N, Schermerhorn M, Beiles B, Thomson I, Cassar K, Altreuther M, Debus S, Johal AS, Waton S, Scali ST, Cromwell DA, Mani K. Editor's Choice - Variation in Intact Abdominal Aortic Aneurysm Repair Outcomes by Country: Analysis of International Consortium of Vascular Registries 2010 - 2016. Eur J Vasc Endovasc Surg 2021; 62:16-24. [PMID: 34144883 DOI: 10.1016/j.ejvs.2021.03.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Outcomes for intact abdominal aortic aneurysm (AAA) repair vary over time and by healthcare system, country, and surgeon. The aim of this study was to analyse peri-operative mortality for intact AAA repair in 11 countries over time and compare outcomes by gender, age, and geographical location. METHODS Prospective data on primary repair of intact AAA were collected from 11 countries through the International Consortium of Vascular Registries (ICVR) and analysed for two time periods, 2010 - 2013 and 2014 - 2016. The primary outcome was peri-operative mortality after endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Multivariable logistic regression models were used to adjust for differences in patient characteristics. RESULTS A total of 103 715 patients were included. The percentage of patients undergoing EVAR increased from 63.6% to 71.2% (p < .001) over the study period. This proportion varied by country from 35% in Hungary to 81% in the United States. Overall peri-operative mortality decreased from 2.1% to 1.6 % (p < .001). Mortality also declined significantly over time for both OSR 4.2% to 3.6 % (p = .002) and EVAR 1.0% to 0.7% (p = .002). Mortality was significantly higher for female than male patients (3.0% vs. 1.6% p < .001). The percentage of patients > 80 years old undergoing AAA repair remained constant at 23.6% (p = .91). Peri-operative mortality was higher for patients > 80 years than for those < 80 years old (2.7% vs. 1.6% p < .001). Forty-six per cent (n = 275) of all EVAR deaths occurred in the over 80s. CONCLUSION The proportion of AAA repairs performed using EVAR has increased over time. Peri-operative mortality continues to decline for both OSR and EVAR. Outcomes however were significantly worse for both women and those aged over 80, so efforts should be focused on these patient groups to further reduce elective AAA mortality rates.
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Affiliation(s)
- Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust & Department of Surgery, University of Cambridge, Cambridge, UK.
| | - Jialin Mao
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Marc Schermerhorn
- Division of Vascular Surgery and Endovascular Therapy, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Barry Beiles
- Australasian Vascular Audit, Australasian Society for Vascular Surgery, Melbourne, Australia
| | - Ian Thomson
- Department of Surgery, University of Otago, Dunedin, New Zealand
| | - Kevin Cassar
- Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Malta
| | - Martin Altreuther
- Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Sebastian Debus
- Department of Vascular Medicine, Working Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Amundeep S Johal
- The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom
| | - Sam Waton
- The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom
| | - Salvatore T Scali
- University of Florida College of Medicine, Division of Vascular Surgery & Endovascular Therapy, Gainesville, FL, USA
| | - David A Cromwell
- The Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, United Kingdom
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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16
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Scali S, Beck A, Sedrakyan A, Mao J, Behrendt CA, Boyle J, Venermo M, Faizer R, Schermerhorn M, Beiles B, Szeberin Z, Eldrup N, Thomson I, Cassar K, Altreuther M, Debus S, Johal A, Bjorck M, Cronenwett J, Mani K. Optimal Threshold for the Volume–Outcome Relationship After Open AAA Repair in the Endovascular Era: Analysis of the International Consortium of Vascular Registries. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Gonçalves FB, Kakkos SK, Kolh P, Tulamo R, de Ceniga MV, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Corrigendum to 'Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections' [European Journal of Vascular & Endovascular Surgery 59/3 (2020) 339-384]. Eur J Vasc Endovasc Surg 2020; 60:958. [PMID: 32958384 DOI: 10.1016/j.ejvs.2020.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Grima M, Behrendt CA, Vidal-Diez A, Altreuther M, Björck M, Boyle J, Eldrup N, Karthikesalingam A, Khashram M, Loftus I, Schermerhorn M, Setacci C, Szeberin Z, Debus S, Venermo M, Holt P, Mani K. Assessment of Correlation Between Mean Size of Infrarenal Abdominal Aortic Aneurysm at Time of Intact Repair Against Repair and Rupture Rate in Nine Countries. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Czerny M, Eggebrecht H, Rousseau H, Mouroz PR, Janosi RA, Lescan M, Schlensak C, Böckler D, Ante M, Weijde EV, Heijmen R, Eckstein HH, Reutersberg B, Trimarchi S, Schmidli J, Wyss T, Frey R, Makaloski V, Brunkwall J, Mylonas S, Szeberin Z, Klocker J, Gottardi R, Schusterova I, Morlock J, Berger T, Beyersdorf F, Rylski B. Distal Stent Graft-Induced New Entry After TEVAR or FET: Insights Into a New Disease From EuREC. Ann Thorac Surg 2020; 110:1494-1500. [PMID: 32283085 DOI: 10.1016/j.athoracsur.2020.02.079] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/10/2020] [Accepted: 02/04/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The study sought to learn about incidence and reasons for distal stent graft-induced new entry (dSINE) after thoracic endovascular aortic repair (TEVAR) or after frozen elephant trunk (FET) implantation, and develop prevention algorithms. METHODS In an analysis of an international multicenter registry (EuREC [European Registry of Endovascular Aortic Repair Complications] registry), we found 69 dSINE patients of 1430 (4.8%) TEVAR patients with type B aortic dissection and 6 dSINE patients of 100 (6%) patients after the FET procedure for aortic dissection with secondary morphological comparison. RESULTS The underlying aortic pathology was acute type B aortic dissection in 33 (44%) patients, subacute or chronic type B aortic dissection in 34 (45%) patients, acute type A aortic dissection in 3 patients and remaining dissection after type A repair in 3 (8%) patients, and acute type B intramural hematoma in 2 (3%) patients. dSINE occurred in 4.4% of patients in the acute setting and in 4.9% of patients in the subacute or chronic setting after TEVAR. After the FET procedure, dSINE occurred in 5.3% of patients in the acute setting and in 6.5% of patients in the chronic setting. The interval between TEVAR or FET and the diagnosis of dSINE was 489 ± 681 days. Follow-up after dSINE was 1340 ± 1151 days, and 4 (5%) patients developed recurrence of dSINE. Morphological analysis between patients after TEVAR with and without dSINE showed a smaller true lumen diameter, a more accentuated oval true lumen morphology, and a higher degree of stent graft oversizing in patients who developed dSINE. CONCLUSIONS dSINE after TEVAR or FET is not rare and occurs with similar incidence after acute and chronic aortic dissection (early and late). Avoiding oversizing in the acute and chronic settings as well as carefully selecting patients for TEVAR in postdissection aneurysmal formation will aid in reducing the incidence of dSINE to a minimum.
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Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany.
| | | | - Herve Rousseau
- Department of Radiology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Paul Revel Mouroz
- Department of Radiology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Rolf-Alexander Janosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Mario Lescan
- Department of Cardiothoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Cardiothoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany
| | - Dittmar Böckler
- Department of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Marius Ante
- Department of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Emma Vdr Weijde
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Germany
| | - Robin Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Germany
| | - Hans Henning Eckstein
- Munich Aortic Centre, Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich Germany
| | - Benedikt Reutersberg
- Munich Aortic Centre, Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich Germany
| | - Santi Trimarchi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Wyss
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Romina Frey
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Vladimir Makaloski
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Josef Klocker
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Gottardi
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Julia Morlock
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
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20
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 256] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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21
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Budtz-Lilly JW, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Bjorck M, Loftus I, Mani K. The Impact of Centralization and Endovascular Aortic Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Banga P, Varga A, Bayerle P, Miháy Z, Kovats T, Szeberin Z, Sótonyi P. Contralateral Carotid Occlusion With Sufficient Circle of Willis is not Associated With A Higher Incidence of Neurologic Events During Carotid Endarterectomy Without Shunting. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Budtz-Lilly JW, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Bjorck M, Loftus I, Mani K. Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over Nine Years. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Hellgren T, Beiles B, Venermo M, Settembre N, Szeberin Z, Thomson I, Espada CL, Becker D, Mani K. Outcome of Thoracic Endovascular Aortic Repair in 8 Countries – Report from an International Registry Collaboration. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Scali S, Beck A, Sedrakyan A, Mao J, Venermo M, Faizer R, Schermerhorn M, Beiles B, Szeberin Z, Eldrup N, Thomson I, Cassar K, Altreuther M, Behrendt C, Debus S, Boyle J, Björck M, Johal A, Cronenwett J, Mani K. Hospital Volume Effects on Abdominal Aortic Aneurysm Repair Mortality – An International Registry-based Analysis. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Behrendt CA, Sigvant B, Szeberin Z, Beiles B, Eldrup N, Thomson I, Venermo M, Altreuther M, Menyhei G, Nordanstig J, Clarke M, Rieß H, Björck M, Debus E. International Variations in Amputation Practice: A VASCUNET Report. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Budtz-Lilly J, Björck M, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Khashram M, Loftus I, Mani K. Editor's Choice - The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries. Eur J Vasc Endovasc Surg 2018; 56:181-188. [PMID: 29482972 DOI: 10.1016/j.ejvs.2018.01.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Current management of ruptured abdominal aortic aneurysms (RAAA) varies among centres and countries, particularly in the degree of implementation of endovascular aneurysm repair (EVAR) and levels of vascular surgery centralisation. This study assesses these variations and the impact they have on outcomes. MATERIALS AND METHODS RAAA repairs from vascular surgical registries in 11 countries, 2010-2013, were investigated. Data were analysed overall, per country, per treatment modality (EVAR or open aortic repair [OAR]), centre volume (quintiles IV), and whether centres were predominantly EVAR (≥50% of RAAA performed with EVAR [EVAR(p)]) or predominantly OAR [OAR(p)]. Primary outcome was peri-operative mortality. Data are presented as either mean values or percentages with 95% CI within parentheses, and compared with chi-square tests, as well as with adjusted OR. RESULTS There were 9273 patients included. Mean age was 74.7 (74.5-74.9) years, and 82.7% of patients were men (81.9-83.6). Mean AAA diameter at rupture was 7.6 cm (7.5-7.6). Of these aneurysms, 10.7% (10.0-11.4) were less than 5.5 cm. EVAR was performed in 23.1% (22.3-24.0). There were 6817 procedures performed in OAR(p) centres and 1217 performed in EVAR(p) centres. Overall peri-operative mortality was 28.8% (27.9-29.8). Peri-operative mortality for OAR was 32.1% (31.0-33.2) and for EVAR 17.9% (16.3-19.6), p < .001, and the adjusted OR was 0.38 (0.31-0.47), p < .001. The peri-operative mortality was 23.0% in EVAR(p) centres (20.6-25.4), 29.7% in OAR(p) centres (28.6-30.8), p < .001; adjusted OR = 0.60 (0.46-0.78), p < .001. Peri-operative mortality was lower in the highest volume centres (QI > 22 repairs per year), 23.3% (21.2-25.4) than in QII-V, 30.0% (28.9-31.1), p < .001. Peri-operative mortality after OAR was lower in high volume centres compared with the other centres, 25.3% (23.0-27.6) and 34.0% (32.7-35.4), respectively, p < .001. There was no significant difference in peri-operative mortality after EVAR between centres based on volume. CONCLUSIONS Peri-operative mortality is lower in centres with a primary EVAR approach or with high case volume. Most repairs, however, are still performed in low volume centres and in centres with a primary OAR strategy. Reorganisation of acute vascular surgical services may improve outcomes of RAAA repair.
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Affiliation(s)
- Jacob Budtz-Lilly
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Martin Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sebastian Debus
- Department of Vascular Medicine, University Heart Centre Hamburg - Eppendorf, Hamburg, Germany
| | | | - Martin Altreuther
- Department of Vascular Surgery, St Olavs Hospital, Trondheim, Norway
| | - Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Nikolaj Eldrup
- Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Gudmundur Danielsson
- National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland
| | - Ian Thomson
- Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand
| | - Pius Wigger
- Department of Cardiovascular Surgery, Kantonsspital Winterthur, Switzerland
| | - Manar Khashram
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Ian Loftus
- Department of Vascular Surgery, St George's University of London, London, UK
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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Budtz-Lilly J, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Björck M, Loftus I, Mani K. Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Budtz-Lilly J, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Björck M, Loftus I, Mani K. Editor's Choice – Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years. Eur J Vasc Endovasc Surg 2017; 54:13-20. [DOI: 10.1016/j.ejvs.2017.03.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/02/2017] [Indexed: 01/01/2023]
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Beck AW, Sedrakyan A, Mao J, Venermo M, Faizer R, Debus S, Behrendt CA, Scali S, Altreuther M, Schermerhorn M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Björck M, Cronenwett JL, Mani K. Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries. Circulation 2016; 134:1948-1958. [PMID: 27784712 PMCID: PMC5147037 DOI: 10.1161/circulationaha.116.024870] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/29/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND This project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery. METHODS Registry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries. RESULTS Among 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries. CONCLUSIONS Despite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.
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Affiliation(s)
- Adam W Beck
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.).
| | - Art Sedrakyan
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Jialin Mao
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Maarit Venermo
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Rumi Faizer
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Sebastian Debus
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Christian-Alexander Behrendt
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Salvatore Scali
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Martin Altreuther
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Marc Schermerhorn
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Barry Beiles
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Zoltan Szeberin
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Nikolaj Eldrup
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Gudmundur Danielsson
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Ian Thomson
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Pius Wigger
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Martin Björck
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Jack L Cronenwett
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
| | - Kevin Mani
- From Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham (A.W.B.); Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (A.S., J.M.); Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland (M.V.); Division of Vascular Surgery, University of Minnesota, Minneapolis (R.F.); Department of Vascular Medicine, University Heart Center Hamburg-Eppendorf, Hamburg, Germany (S.D., C.-A.B.); Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville (S.S.); Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (M.A.); Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Australian and New Zealand Society for Vascular Surgery, East Melbourne, Australia (B.B.); Department of Vascular Surgery, Semmelweis University, Budapest, Hungary (Z.S.); Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (N.E.); National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland (G.D.); Department of Vascular Surgery, Dunedin School of Medicine, Dunedin Hospital, Dunedin, New Zealand (I.T.);Department of Cardiovascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland (P.W.); Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden (M.B., K.M.); and Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.L.C.)
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Affiliation(s)
- Z Szeberin
- Department of Vascular Surgery, Cardiovascular Centre, Semmelweis University, Budapest, Hungary.
| | - C Csobay-Novák
- Department of Vascular Surgery, Cardiovascular Centre, Semmelweis University, Budapest, Hungary
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Laine M, Björck M, Beiles B, Altreuter M, Szeberin Z, Thompson I, Debus S, Mani K, Menyhei G, Venermo M. Internal Iliac Aneurysms have a Low Risk of Rupture under 4 cm: A Multicentre Study. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Szeberin Z, Dósa E, Fehérvári M, Csobay-Novák C, Pintér N, Entz L. Early and Long-term Outcome after Open Surgical Suprarenal Aortic Fenestration in Patients with Complicated Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2015; 50:44-50. [DOI: 10.1016/j.ejvs.2014.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 12/22/2014] [Indexed: 12/14/2022]
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Mitchell D, Venermo M, Mani K, Bjorck M, Troeng T, Debus S, Szeberin Z, Hansen A, Beiles B, Setacci C, Bergqvist D, Menyhei G, Heller G, Danielsson G, Loftus I, Thomson I, Vogt K, Jensen L, Altreuther M, Eldrup N, Wigger P, Moreno-Carriles R, Lees T. Quality Improvement in Vascular Surgery: The Role of Comparative Audit and Vascunet. Eur J Vasc Endovasc Surg 2015; 49:1-3. [DOI: 10.1016/j.ejvs.2014.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gősi G, Nádasy GL, Raffai G, Fehér E, Szeberin Z, Monos E, Acsády G. Regional differences in statistical geometry of endothelial dense granules in human extremity veins. Phlebology 2014; 30:481-5. [PMID: 25121560 DOI: 10.1177/0268355514547715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Leg and arm human veins are exposed to different gravitational stresses. We investigated if there is difference in the amount and geometry of secretory vesicles in their endothelium. METHODS Superficial small vein segments were removed during vascular operations for electromicroscopic analysis. Vesicular area/total endothelial cross-sectional area was determined by computer-based morphometry. Long and short axes of granule cross sections were measured by image analyzing software. RESULTS Vesicular density in all samples was 2.26 ± 0.34%. There was no significant difference between the vesicular densities of upper extremity and leg. The shape of the vesicles was more frequently elongated in leg than in arm sections (p < 0.01). CONCLUSIONS The density of the vesicles does not depend on vascular region or orthostatic load. Ellipticity of these granules is significantly different in areas exposed to different gravitational stresses. This might contribute to the differences of thrombotic and hemodynamic properties of leg and upper body veins.
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Affiliation(s)
- G Gősi
- Department of Vascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - G L Nádasy
- Clinical Experimental Research Department and Department of Human Physiology, Semmelweis University, Budapest, Hungary
| | - G Raffai
- Clinical Experimental Research Department and Department of Human Physiology, Semmelweis University, Budapest, Hungary
| | - E Fehér
- Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary
| | - Z Szeberin
- Department of Vascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - E Monos
- Clinical Experimental Research Department and Department of Human Physiology, Semmelweis University, Budapest, Hungary
| | - G Acsády
- Department of Vascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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36
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Fehérvári M, Krepuska M, Széplaki G, Apor A, Sótonyi P, Prohászka Z, Acsády G, Szeberin Z. The level of complement C3 is associated with the severity of atherosclerosis but not with arterial calcification in peripheral artery disease. INT ANGIOL 2014; 33:35-41. [PMID: 24452084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Recent evidences show correlations between atherosclerosis and the serum level of third component of complement (C3). However, there is less data on the connection of C3 and the severity of atherosclerosis. The aim of our study was to evaluate the association of serum C3 levels with atherosclerosis and arterial calcification in patients with chronic lower extremity atherosclerosis. METHODS In a single centre cross-sectional study 103 patients and 109 healthy controls were examined. Sera were analyzed for C3. To identify the severity of atherosclerosis and calcification, ankle-brachial Doppler index, angiographic Bollinger score, arterial calcification score and carotid intima-media thickness was determined. RESULTS Serum level of C3 was significantly higher in the lower extremity atherosclerosis group than in healthy patients (P=0.00004). In the patient group, serum level of C3, C4 was significantly and inversely associated with ABI (r=-0.246, P=0.014), (r=-0.259, P=0.011). C3 inversely correlates with Bollinger score (r= -0.357, P=0.028). Among our patients no correlation was found between C3 levels and CS (P=0.672, r=-0.046) or between C3 levels and carotid IMT (r=0.104, P=0.351). The serum levels of different complement components were associated with C-reactive protein, Hba1c, peptide-C and insulin. CONCLUSION Our results suggest that C3 serum levels are associated with ABI and angiographic parameters of atherosclerosis, but do not relate to the severity of calcification.
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Affiliation(s)
- M Fehérvári
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary -
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Tóth Á, Kispál G, Ungvári E, Violka M, Szeberin Z, Pászti J, Molnár K, Gacs M, Füzi M. First Report of Heterogeneously Vancomycin-IntermediateStaphylococcus aureus(hVISA) Causing Fatal Infection in Hungary. J Chemother 2013; 20:655-6. [DOI: 10.1179/joc.2008.20.5.655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Csobay-Novák C, Sótonyi P, Krepuska M, Zima E, Szilágyi N, Tóth S, Szeberin Z, Acsády G, Merkely B, Tekes K. Decreased plasma nociceptin/orphanin FQ levels after acute coronary syndromes. Acta Physiol Hung 2012; 99:99-110. [PMID: 22849833 DOI: 10.1556/aphysiol.99.2012.2.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
Foregoing researches made on the N/OFQ system brought up a possible role for this system in cardiovascular regulation. In this study we examined how N/OFQ levels of the blood plasma changed in acute cardiovascular diseases. Three cardiac patient groups were created: enzyme positive acute coronary syndrome (EPACS, n = 10), enzyme negative ACS (ENACS, n = 7) and ischemic heart disease (IHD, n = 11). We compared the patients to healthy control subjects (n = 31). We found significantly lower N/OFQ levels in the EPACS [6.86 (6.21-7.38) pg/ml], ENACS [6.97 (6.87-7.01) pg/ml and IHD groups [7.58 (7.23-8.20) pg/ml] compared to the control group [8.86 (7.27-9.83) pg/ml]. A significant correlation was detected between N/OFQ and white blood cell count (WBC), platelet count (PLT), creatine kinase (CK), glutamate oxaloacetate transaminase (GOT) and cholesterol levels in the EPACS group.Decreased plasma N/OFQ is closely associated with the presence of acute cardiovascular disease, and the severity of symptoms has a significant negative correlation with the N/OFQ levels. We believe that the rate of N/OFQ depression is in association with the level of ischemic stress and the following inflammatory response. Further investigations are needed to clarify the relevance and elucidate the exact effects of the ischemic stress on the N/OFQ system.
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Szeberin Z, Fehérvári M, Krepuska M, Apor A, Rimely E, Sarkadi H, Széplaki G, Prohászka Z, Kalabay L, Acsády G. Serum fetuin-A levels inversely correlate with the severity of arterial calcification in patients with chronic lower extremity atherosclerosis without renal disease. INT ANGIOL 2011; 30:474-50. [PMID: 21804488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Fetuin-A is a hepatic glycoprotein that inhibits extraosseous calcification. Lower serum fetuin-A concentration was associated with severe arterial calcification in patients with end stage renal disease. We evaluated the association of serum fetuin-A levels and the severity of atherosclerosis in patients with peripheral vascular disease having normal renal function. METHODS In this cross-sectional study among 93 chronic atherosclerotic patients with lower extremity vascular disease, systemic atherosclerosis and calcification was assessed by ultrasound (carotid intima-media thickness/IMT/, calcification at the abdominal aorta, carotid and femoral bifurcations, aortic and mitral valves) and angiography (Bollinger score). Standard serum markers of inflammation, diabetes, renal function, ankle-brachial indexes and traditional risk factors for atherosclerosis were noted and Fontaine classification was applied for the severity of symptoms. RESULTS The patients mean (SD) age was 59.95 (7.61) years, 78% were men, 35% had diabetes. Serum fetuin-A level showed significant negative correlation with ultrasound calcification score (P=0.018, r=-0.257) and Bollinger angiographic score (P=0.035, r=-0.347). Fetuin-A did not correlate with IMT or Fontaine classification. Fetuin-A also showed significant correlation with albumin, transferrin and hemoglobin A1c (r=0.287, 0.305 and 0.219, respectively at P<0.05). Logistic regression analysis confirmed the association between fetuin-A and calcification score (OR: 3.03, CI: 1.05-8.7), P=0.039) independent of traditional risk factors. CONCLUSION Our data show that serum fetuin-A levels inversely correlate with the severity of atherosclerosis in nonuremic patients with symptomatic chronic lower limb ischemia. These data support a putative protective role for fetuin-A in the development of arterial calcification.
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Affiliation(s)
- Z Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary.
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Bíró G, Szeberin Z, Nemes A, Acsády G. Cryopreserved homograft and autologous deep vein replacement for infrarenal aorto and iliaco-femoral graft infection: early and late results. J Cardiovasc Surg (Torino) 2011; 52:169-176. [PMID: 21464818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of the study was to evaluate the early and late results of aortic replacement using cryopreserved homografts and autologous deep veins for infected infrarenal prosthetic reconstructions and the influence of type of bacteria on the mortality. METHODS Thirty-three patients were treated from 30 March 1994 to 01 September 2008 for aorto-femoral or iliaco-femoral graft infections with homografts (HG:19) or autologous deep veins (DV:14). The diagnosis was based on physical signs, bacteriological tests and computed tomography(CT) scans. We obtain cryopreserved homografts from our non-profit vessel bank, deep veins were harvested before the arterial reconstruction. Patients were followed by clinical examination and ultrasound. RESULTS The infections occurred 47.78 ± 20 months after the primary operations; 45% of the infections were caused by Gram-negative bacteria. Treatment indications included seven aortoduodenal fistula (21.2%) and six septic para-anastomotic bleedings (18.2%). There were six in-hospital deaths (18.2%). All the deceased patients had Gram-negative bacteria in cultures and pluribacterial infections. No patient died with single staphylococcus, streptococcus or MRSA infection. At three years freedom from reinfection was 100% in DV group and 82% (CI:0.56-0.92) in the homograft group. Survival after three years was 71% (CI:0.48-0.88) in HG group and 79% (CI:0.49-0.94) in DV group. The difference is not significant. CONCLUSION For infrarenal graft infection homograft replacement or deep vein implantation is durable method and eradicate late reinfection. The in-hospital mortality is significantly higher in patients with aortoduodenal fistulas with Gram-negative organisms regardless of the conduit used for aortic replacement.
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Affiliation(s)
- G Bíró
- Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary.
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Molnár AA, Apor A, Kristóf V, Nádasy GL, Szeberin Z, Monos E, Acsády G, Préda I, Bérczi V. Generalized alterations in the biomechanical properties of large veins in non-thrombotic thrombophilic young patients. INT ANGIOL 2008; 27:247-252. [PMID: 18506128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM In young, post-thrombotic patients, venous distensibility is decreased not only in the affected lower limb, but also in the contralateral limb and in the jugular vein when compared to age-matched control subjects. In the present study, we investigated venous wall mechanical properties in young, asymptomatic thrombophilic patients. METHODS Eleven young (24+/-0.4 years) control subjects and 9 age-matched patients (21.1+/-1.8 years) with proven thrombophilic molecular defects, but without any signs or history of previous deep vein thrombosis, were compared. Anterolateral and mediolateral diameters of the common femoral, axillary and internal jugular veins were measured by ultrasonography in situ. Pressure alterations were induced by altering body positions and by pressure-controlled Valsalva tests. Distensibility was calculated from diameter and pressure changes. RESULTS In thrombophilic patients, resting diameter of both the common femoral and of internal jugular veins at low transmural pressure was larger than those for the control subjects. Distensibility, however, was significantly less when high pressures were applied. Alterations in diameter of the axillary vein were minimal. CONCLUSION Our measurements suggest that there are generalized changes in venous mechanical properties in thrombophilic patients even before the appearance of thrombotic processes. These biomechanical alterations of the venous wall and/or surrounding connective tissue are similar to those found in connection with aging and in post-thrombotic patients. The pathological mechanisms behind these processes are unknown.
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Affiliation(s)
- A A Molnár
- Cardiovascular Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
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Szeberin Z, Bíró G, Sótonyi P, Soós P, Százados M, Arkossy O, Berta K, Acsády G. The role of autologous antebrachial arteriovenous fistula in the strategy of access planning for chronic uremic patients on hemodialysis. MINERVA UROL NEFROL 2007; 59:231-6. [PMID: 17912220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
AIM The number of arteriovenous (AV) fistula creation increases worldwide. Haemodialysis is more effective, patients live longer, and they need more access operations. The optimal strategy for the order and sequence of the different type and localization of AV fistulas remains obscure. Based on internationally acclaimed guidelines, autogenous access should be performed whenever possible and the first operation of choice is the radiocephalic fistula at the wrist, the second type is the elbow fistula. The area between the standard exposures means also good access area and its usage is not emphasized properly. Our aim was to study the short and long-term the results of autologous forearm fistulas. METHODS Between 1997 and 2005 we performed 1018 AV shunts in an academic tertiary care centre. Ninety-seven autologous antebrachial AV shunts were performed. The average follow-up time was 31.3 months. We examined the patency rate and its connection with different variables such as diabetes mellitus, acute or chronic operative situations, indications for surgery, diameter and quality of the vein. RESULTS The primary patency rates were 93%, 79.5% and 61.2% at the end of years 1, 2 and 6, respectively. The patency rate was not significantly affected by any of the examined variables mentioned above. CONCLUSION The patency rate of the autologous antebrachial AV shunt is comparable to the wrist and elbow fistulas, so our results support the practice of performing fistula at this atypical localization. Proximal autologous fistulas and prosthetic graft implantation could be postponed, this way valuable time could be saved for the uremic patients.
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Affiliation(s)
- Z Szeberin
- Department of Cardiovascular Surgery, Semmelweis University, Budapest, Hungary.
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Szabó GV, Laczkó A, Szeberin Z, Windisch M, Százados M, Kristóf V, Acsády G. [Anatomical and extra-anatomical reconstructions in aorto-iliac occlusive diseases]. Magy Seb 2001; 54 Suppl:60-2. [PMID: 11816150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE In the case of the aorto-iliac arteries occlusion there are two different operative reconstructive possibilities. As an anatomical reconstruction the open desobliteration of the iliaca arteries, the retrograde half-closed desobliteration or the aorto/ilio-femoral bypasses can be mentioned. As an extraanatomical solution ilio/femoro-femoral crossover bypass can be implanted. We compared the results of these two types of operations. PROCEDURE Between 1 January 1998 and 31 December 1999 at the Cardiovascular Surgical Department of the Semmelweis University Budapest 239 primary, reconstructive operations were done because of the iliac arteries occlusion. We made 175 anatomical and 64 extraanatomical operations. We controlled the results of this operation in this retrospective study. RESULTS Since the operation 12 patients died, most of them because of cardial reasons. Hundred sixty seven survival patients could be involved in the study. There was no significant difference regarding the age and the Fontaine stadium of the patients in the two groups. Two-third of the patients underwent anatomical, the others extraanatomical operations. The patency rate in the anatomical group was 92.8%, with the extraanatomical patients 90%. In the view of the postoperative function after the anatomical reconstruction the claudication distance was longer. There were two limb amputations, one of them because of distal progression of the atherosclerosis, in the other case the reason was reocclusion of the graft. DISCUSSION In this study we examined patients who underwent an operation about 3 years ago. The preoperative stadium of the two non-selected groups was similar. The postoperative patency rate was quite similar, but the postoperative function after the anatomical reconstruction was significantly better. In our opinion the results of the two different types of the reconstruction used by proper indication were the similarly satisfactory.
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Affiliation(s)
- G V Szabó
- Semmelweis Egyetem Altalános Orvostudományi Kar, Er- és Szívsebészeti Klinika, 1122 Budapest, Városmajor utca 68.
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Bíró G, Szabó A, Szeberin Z, Nemes A. [Cryopreserved homografts in arterial reconstructions]. Magy Seb 2001; 54 Suppl:63-7. [PMID: 11816151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The use of cryopreserved homologous vessels (CHV) in arterial reconstructions is indicated in cases when no suitable autologous material is available and the use of prosthetic grafts is contraindicated. In the presentations authors overview their 4 years' experiences with homografts in case of aneurysms and lower limb obliterative arterial disease. Forty four CHV grafts were implanted in 41 patients from May 1997 to May 2001. Following explantation and preparation the grafts are treated in a special preservation solution containing 10% DMSO, antibiotic and antimycotic drugs. Using a cryostat the graft packages get deep frozen and are stored in fluid nitrogen, therefore these grafts are available even after years. Donor and patient data are recorded and processed following strict bacteriological examination. No postoperative immunosuppression therapy was administered. Twenty six greater saphenous veins, 12 superficial femoral arteries, 2 iliac arteries, 3 aortic bifurcations and one thoracic aorta segment were used as graft material--24 grafts were implanted in femoro-crural, 7 in distal femoro-popliteal, 2 in proximal femoro-popliteal, 2 in ilio-femoral, 2 in femoro-femoral crossover, one in aorto-femoral, 3 in bifemoral and one in aorto-aortic position. Successful redo surgery was performed in case of graft occlusion in 6 cases, 11 limbs were amputated because of failed thrombectomy. One patient underwent surgery due to a pseudoaneurysm at the diaphysis of a femoro-crural graft, this case is presented in details. The three year graft and limb patency were 23% and 64% subsequently following infrainguinal reconstructions, graft reocclusion occurred in 17 cases, 11 limbs were amputated. Eight patients died in 30 days following CHV implantations, the causes of death were septic bleeding in 4 cases, acute myocardial infarction in 2 cases and cardiorespiratory insufficiency in 2 cases. According to the authors' results and to the literature based on well defined indication use of cryopreserved homologues vessels are a good choice for vascular reconstruction in cases, when implantation of biologic material is essential for restoring circulation.
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Affiliation(s)
- G Bíró
- Semmelweis Egyetem Altalános Orvostudományi Kar, Er- és Szívsebészeti Klinika, 1122 Budapest, Városmajor utca 68.
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Acsády G, Laczkó A, Szabó A, Szabó G, Szeberin Z, Gálfy I, Turbók E, Nemes A. [Treatment options for complications in vascular surgery]. Magy Seb 2001; 54 Suppl:75-80. [PMID: 11816153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The authors processed the patients' data of the last 10 years and present their experience in treating septic complications in the field of vascular surgery. They analyzed the therapeutic possibilities and reviewed the literature. They suggest the following treatment alternatives for the infection related complications, that they consider the best options these days: 1. Identification of the causative agent by microbiologic methods and determination of the antibiotic susceptibility. 2. In the cases of occluded grafts it is recommended to remove the whole graft and to apply a suction-irrigation drainage. 3. In the cases of patent grafts: (a) If the infections starts in the immediate postoperative period it is suggested to spare the graft, open the wound, perform debridement and apply a suction-irrigation drainage. (b) Late suppurations, confined to the trunk of the graft without affecting the anastomoses, requires extensive debridement and lavage, and the graft could be left in place. (c) Anastomosis infection calls for graft removal, in situ reconstruction and suction-irrigation drainage in one setting. (d) Extraanatomic bypass is indicated when culture proves bacteria producing extraprotease enzymes because in these cases the incidence of repetitive septic bleedings are significantly higher, so in situ reconstructions are not recommended.
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Affiliation(s)
- G Acsády
- Semmelweis Egyetem Altalános Orvostudományi Kar, Er- és Szívsebészeti Klinika, 1122 Budapest, Városmajor utca 68.
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Laczkó A, Szabó GV, Szeberin Z, Nemes B, Bobek I, Kristóf V, Selmeci L, Acsády G. [Thrombolytic therapy as pretreatment before vascular operations and radiologic interventions]. Magy Seb 2001; 54 Suppl:69-73. [PMID: 11816152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The authors describe their 60 cases of thrombolysis with steptokinase (SK). Thrombolysis was required in 55 patients because of arterial, while in 5 patients because of venous side thrombosis. The 73% of the patients with arterial occlusion where thrombolysis was applied belonged Fountain stage IV, while 27% to Fountain stage III. Graft occlusion occurred in 60% of all cases and the acute or subacute thrombosis of the native vessels required thrombolysis in 40%. The thrombolysis alone was sufficient in 26 patients, while it was completed with PTA in 9, with PTA and implantation of stent in 1 and with vascular surgical procedure in 10 cases. Reconstruction surgery was the final solution in 4 patients, for whom the thrombolysis was inadequate. Amputation was unavoidable in 8 cases. The thrombolysis therapy was successful in 77% in our experience. The high number of hemorrhagic complications was due to the bleeding of puncture hole. It needed surgical suture in 10 cases.
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Affiliation(s)
- A Laczkó
- Semmelweis Egyetem Altalános Orvostudományi Kar, Er- és Szívsebészeti Klinika, 1122 Budapest, Városmajor utca 68.
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Szeberin Z, Nemes B, Nemes A. [Ruptured aneurysm of the common hepatic artery]. Magy Seb 2000; 53:70-2. [PMID: 11299623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The rupture of aneurysm of the common hepatic artery is a rare disease with high mortality. Differential diagnosis and surgical treatment is difficult, which is often worsened by the condition of the seriously ill patient and the lack of time. The authors report a successfully treated case summarizing the diagnostic and therapeutic options and point out the recent changes in etiology.
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Affiliation(s)
- Z Szeberin
- Semmelweis Egyetem Budapest Altalános Orvostudományi Kar Er- és Szívsebészeti Klinika
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Szeberin Z, Pápay J, Bíró G, Nemes A. [Primary leiomyosarcoma of vascular origin in the groin causing lower extremity venous compression]. Magy Seb 2000; 53:21-3. [PMID: 11299587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A soft tissue tumor causing left lower extremity swelling in a 43 years old female was detected in the left inguinal region and resection was performed at the Department of Cardiovascular Surgery of Semmelweis University of Medicine, Budapest. Histologic examination revealed primary leiomyosarcoma of vascular origin. On the base of this case attention is called to this rare disease, which has poor prognosis. Early diagnosis and complete resection plays key role in the treatment of leiomyosarcoma and may improve survival.
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Affiliation(s)
- Z Szeberin
- Semmelweis Orvostudományi Egyetem Er- és Szívsebészeti Klinika
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Sepa G, Dzsinich C, Szabó A, Nemes A, Szeberin Z. [Popliteal artery entrapment syndrome]. Magy Seb 2000; 53:17-20. [PMID: 11299586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Popliteal Artery Entrapment Syndrome (PAES) is an uncommon congenital anomaly. It arises due to compression of the popliteal artery by tendomuscular structures often combined with an anomalous position of the artery. Mostly young men are suffering of this disease. There are four common variations of this anomaly. We report on a 14 year old patient who had an acute 24 hours duration right leg ischemia caused by PAES. Using a posterior approach to the popliteal artery, following division of the accessory slip of gastrocnemius muscle we performed an arteriotomy and a floating thrombus was removed. The artery was reconstructed by direct continuous suture. One year postoperatively the boy has no complaints, peripheral pulse is palpable.
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Affiliation(s)
- G Sepa
- Semmelweis Orvostudományi Egyetem Er- és Szívsebészeti Klinika
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Regöly-Mérei J, Ihász M, Szeberin Z, Sándor J, Máté M. Biliary tract complications in laparoscopic cholecystectomy. A multicenter study of 148 biliary tract injuries in 26,440 operations. Surg Endosc 1998; 12:294-300. [PMID: 9543516 DOI: 10.1007/s004649900657] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The higher risk of biliary tract injury is considered the most significant disadvantage of laparoscopic cholecystectomy. METHODS A national multicenter retrospective study was performed to determine the frequency, etiology, and treatment of biliary tract injuries between January 1, 1991, and December 31, 1994. Follow-up was by questionnaire. RESULTS Some 148 biliary tract complications were observed during 26,440 laparoscopic cholecystectomies. There was no significant correlation found between the number of LCs performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage, but in the 2nd year of practice, the incidence of both complications decreased. In institutes with more conversions, more cases of bile leakage were also observed. A significant positive relationship was found between biliary tract injuries and postoperative bile leaks. There was no significant relationship between usage of intravenous and intraoperative cholangiography and ERCP. In univariant analysis of the type of injury, the primary treatment modality did not affect the outcome of injury or entail the necessity of reoperation. Obscure anatomy leads to significantly more main bile duct injuries. According to multivariant analysis, the outcome is significantly influenced unfavorably by the necessity of repeated interventions and advanced age. CONCLUSIONS The definitely higher risk of bile duct injury mentioned in early studies was not confirmed.
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Affiliation(s)
- J Regöly-Mérei
- 3rd Surgical Department, Semmelweis Medical University, Budapest, Hungary
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