Aortic Aneurysm Repair Research Articles

Long-Term Outcomes After Open Repair for Ruptured Abdominal Aortic Aneurysm

BackgroundEarly mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population.MethodsThis is a population-based, observational long-term follow-up (beyond 30-day mortality) study of patients surgically treated for rAAA from 2000 through 2014. Long-term survival was analysed using Kaplan–Meier estimates and compared to the general population by analyses of relative survival.ResultsOut of 178 patients operated for rAAA, 95 patients (55%) either died in the perioperative period, were referred from other hospitals or were lost to follow-up (two patients). Altogether 83 patients were eligible for long-term outcomes: 72 men and 11 women. Estimated median crude survival time was 6.5 years [95% confidence interval (CI) 4.8–8.2]. Men had a median survival of 7.3 years (95% CI 5.1–9.4) versus 5.4 years in females (95% CI 3.5–7.3) (P = 0.082). Reinterventions during follow-up occurred in 31 (37%). Relative survival demonstrated a slightly higher risk of death in the rAAA population compared to the general age- and gender-matched population. Age, but not comorbidities, had a significant influence on long-term survival.ConclusionFor survivors beyond 30 days after surgery for rAAA, long-term survival compares well to that of an age- and sex-matched population. A high frequency of cardiovascular comorbidities did not seem to affect long-term survival.

The Clinical Utility and Assessment of Renal Biomarkers in Acute Kidney Injury After Abdominal Endovascular Aneurysm Repair. A Systematic Review.

The widespread adoption of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) is due to the obvious advantages of the procedure compared to the traditional open repair. However, these advantages have to be weighed against the increased risk of renal dysfunction with EVAR. The evaluation of the perioperative renal function after EVAR has been hampered by the lack of sensitive and specific biochemical markers of acute kidney injury (AKI). The purpose of this study was to summarize all novel renal biomarkers and to evaluate their clinical utility for the assessment of the kidney function after EVAR. A systematic review of the current literature, as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, was performed to identify relevant studies with novel renal biomarkers and EVAR. Pubmed and Scopus databases were systemically searched. Studies reporting on thoracic endovascular aortic repair (TEVAR), case reports, case series, letters to the editor, and systematic reviews were excluded. Neutrophil-Gelatinase-Associated Lipocalin, Cystatin C, Liver-type fatty-acid-binding protein were the most common among the eligible studies while Interleukin-18, Retinol binding protein, N-acetyle-b-D-glucosaminidase and microalbumin have a sparse appearance in the literature. These biomarkers have been assessed in plasma as well as urine samples with each sample material having its own advantages and drawbacks. Which of these biomarkers has the most potential for assessing postoperative renal failure after EVAR, remains to be proved. The few studies presented in the literature show the potential clinical utility of these biomarkers, but larger studies with longer follow-up are required to determine the precise relationship between these biomarkers and postoperative acute kidney injury.

Clinical Application of the Medyria TrackCath System in Endovascular Repair of Abdominal Aortic Aneurysms (AAA)

Clinical Application of the Medyria TrackCath System in Endovascular Repair of Abdominal Aortic Aneurysms (AAA)

Endovascular Relining Therapy of Peri Graft Seroma After Open Repair of Abdominal Aortic Aneurysm with Polytetrafluoroethylene Graft; Report of a long-term follow-up Case

Peri-Graft Seroma (PGS) is a sterile, serous fluid collection confined around a prosthetic vascular graft in the original aneurysm sac...

Outcomes of aortic aneurysm surgery in England: a nationwide cohort study using hospital admissions data from 2002 to 2015

BackgroundThe United Kingdom aortic aneurysms (AA) services have undergone reconfiguration to improve outcomes. The National Health Service collects data on all hospital admissions in England. The complex administrative datasets generated have the potential to be used to monitor activity and outcomes, however, there are challenges in using these data as they are primarily collected for administrative purposes. The aim of this study was to develop standardised algorithms with the support of a clinical consensus group to identify all AA activity, classify the AA management into clinically meaningful case mix groups and define outcome measures that could be used to compare outcomes among AA service providers.MethodsIn-patient data about aortic aneurysm (AA) admissions from the 2002/03 to 2014/15 were acquired. A stepwise approach, with input from a clinical consensus group, was used to identify relevant cases. The data is primarily coded into episodes, these were amalgamated to identify admissions; admissions were linked to understand patient pathways and index admissions. Cases were then divided into case-mix groups based upon examination of individually sampled and aggregate data. Consistent measures of outcome were developed, including length of stay, complications within the index admission, post-operative mortality and re-admission.ResultsSeveral issues were identified in the dataset including potential conflict in identifying emergency and elective cases and potential confusion if an inappropriate admission definition is used. Ninety six thousand seven hundred thirty-five patients were identified using the algorithms developed in this study to extract AA cases from Hospital episode statistics. From 2002 to 2015, 83,968 patients (87% of all cases identified) underwent repair for AA and 12,767 patients (13% of all cases identified) died in hospital without any AA repair. Six thousand three hundred twenty-nine patients (7.5%) had repair for complex AA and 77,639 (92.5%) had repair for infra-renal AA.ConclusionThe proposed methods define homogeneous clinical groups and outcomes by combining administrative codes in the data. These methodologically robust methods can help examine outcomes associated with previous and current service provisions and aid future reconfiguration of aortic aneurysm surgery services.

Endograft Limb Compression at Aortic Bifurcation and Risk of Limb Thrombosis Following Endovascular Abdominal Aortic Aneurism Repair (EVAR)

Endograft Limb Compression at Aortic Bifurcation and Risk of Limb Thrombosis Following Endovascular Abdominal Aortic Aneurism Repair (EVAR)

Abdominal Compartment Syndrome after Surgery for Abdominal Aortic Aneurysm: Subgroups, Risk Factors, and Outcome

Objectives Abdominal compartment syndrome (ACS) is a serious complication after abdominal aortic aneurysm (AAA) repair. The aim was to investigate outcome among subgroups and factors associated with outcome, with emphasis on the duration of intra-abdominal hypertension before treatment. Methods Since 2008, ACS and decompressive laparotomy (DL) after AAA repair are registered prospectively in the Swedish vascular registry (Swedvasc). Registry data and case records were reviewed. Subgroups were defined by main pathophysiological finding at DL, timing of DL after AAA repair, and treatment modality. Results During 2008–2015, 120 of 8765 patients undergoing surgery for infrarenal AAA developed post-operative ACS (1.4%). Eighty-three followed ruptured AAA (rAAA); 45 open surgical repairs (OSR) and 38 endovascular (EVAR), and thirty-seven after intact AAA (iAAA); 30 OSR and seven EVAR. The main pathophysiological findings at DL were bowel ischaemia in 27 (23.3%), post-operative bleeding in 34 (29.3%), and general oedema in 55 (47.4%). DL was performed 48 hours in 29 patients (25.2%). The overall 90 day mortality was 50.0%, neither different depending on main pathophysiological finding, nor on the timing of DL. In multivariable regression analysis, age was a predictor of mortality (p = .017), while duration of intra-abdominal hypertension (IAH) prior to DL predicted the need for renal replacement therapy (RRT) (p = .033). DL was performed earlier after EVAR compared with OSR in rAAA (p Conclusions Mortality in ACS was high, irrespective of the main pathophysiological finding and timing of DL. The duration of IAH prior to DL predicted the need for RRT. DL was performed earlier after EVAR than after OSR for rAAA, underlining the importance of monitoring IAP after EVAR for rAAA.

AAA 11. Outcomes After Aortic Aneurysm Repair in Patients With History of Cancer With a Nationwide Data Set Analysis

AAA 11. Outcomes After Aortic Aneurysm Repair in Patients With History of Cancer With a Nationwide Data Set Analysis

2D-shear wave elastography in the prediction of type II endoleaks after endovascular aneurysm repair

Purpose To evaluate the usefulness of 2D-shear wave elastography (2D-SWE) in the prediction of type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA). Material and methods Twenty-nine patients underwent EVAR for AAA, and 2D-SWE was performed after EVAR. Follow-up contrast-enhanced CT and ultrasonography were performed to evaluate endoleaks in all patients. The median follow-up period was 12 months (range, 3–12 months). Patients were divided into two groups: one with an endoleak (endoleak group) and another without it (control group). We compared the elasticity index (EI) of intraluminal thrombus (ITL) and fresh thrombus (FT) between the two groups. Results Type II endoleaks were confirmed in five of the 29 patients (endoleak group), and there were no endoleaks in the other 24 (control group). ILT was observed in 21 patients of the control group and in all patients of the endoleak group. There was a difference only in EI of ILT; the mean EI (± standard deviation) of ILT was 89 ± 16 kPA in the control group and 113 ± 25 kPA in the endoleak group (p=.037). Conclusions High EI of ILT may predict the occurrence of type II endoleaks after EVAR of AAA.

Long Term Outcomes of Iliac Artery Aneurysm (IAA) and Abdominal Aortic Aneurysm (AAA) Repair with Endovascular Procedures at the Parkview Heart Institute

Background: Favorable characteristics of the minimally invasive endovascular aneurysm repair (EVAR), such as a reduced recovery time, have led physicians and patients alike to elect for this procedure over open repair. Longitudinal study on endovascular repair has raised concerns regarding an increased rate of late failure leading to rupture and overall higher rates of re-intervention for patients.
 Objective: This project compares the outcomes of endovascular stent graft repairs of AAA and IAA at Parkview Heart Institute over a certain time span.
 Methods & Design: This study is a retrospective review of patients (N=89) with AAA/IAA repair since 2014. The EPIC online medical record is the main tool in data extraction while statistical analysis was conducted via Microsoft Excel (p = 0.05).
 Results: Males, ages 51-75 y.o., White population, non-Hispanics, and BMI rating of 1-30 were observed to have more AAAs. A significant decrease in length of stay over historical averages was observed with at most 1-3 days and minimal complications. Most causes for re-interventions were due to endo-leaks. More than 60% of patients with AAA and EVAR have a significant past medical history of smoking, hypertension, and chronic obstructive pulmonary disease. Finally, most pre- and post-operative aneurysms sizes are within 41-60 mm in diameter.
 Conclusion and Potential Impact: This study analyzed 89 patients that experienced AAA instead of IAA. Certain populations, such as being male, ages 51-75 y.o., White population, non-Hispanics, and BMI rating of 1-30 with past medical history characteristics are frequent in patients with EVAR. The procedure has minimal complications in comparison to open abdominal surgery, and this study will add to the literature by aiding physicians’ determination of the best course of action for treating patients with AAA/IAA.

2723 Abdominal Aortic Aneurysm: An Uncommon Cause of Gastric Outlet Obstruction

INTRODUCTION: Gastric outlet obstruction is a highly uncommon presentation for abdominal aortic aneurysm. CASE DESCRIPTION/METHODS: A 65 year old male with past medical history of AAA, HCV treated with Harvoni, GERD with gastritis, and HTN presented with intractable nausea and non-bloody, bilious vomiting for 6 hours associated with sudden onset generalized abdominal pain. Patient reports that he had been having regular bowel movements and passing flatus in the days leading up to presentation. GERD had been previously well-controlled with a PPI. Physical exam revealed a 5 cm pulsating mass in the epigastrium. CTA demonstrated gross distension of both the stomach and the proximal duodenum. The abdominal aortic aneurysm measured 5.2 cm by 4.2 cm and extended over 10 cm in length; an increasingly large false lumen was also noted. There was no other obstructing lesion appreciated on CT, either intra- or extra-luminal. The enlarging aortic aneurysm impinged upon and caused the obstruction of the distal duodenum. DISCUSSION: An expanding abdominal aortic aneurysm can compress the duodenum against the mesenteric artery or abdominal wall, causing gastric outlet obstruction; this obstruction leads to patients presenting with nausea and vomiting. Aortoduodenal syndrome was first described in 1905 by Osler. There are a few dozen case reports of aortoduodenal syndrome in the literature. Any patients presenting with protracted vomiting and pulsatile abdominal mass should raise suspicion for aortoduodenal syndrome. Abdominal tenderness and distension are not common findings in this syndrome. CT is required to rule out an alternative cause of duodenal obstruction; diagnosis may be confirmed with upper GI series with contrast or upper endoscopy. Patient should be initially optimized with gastric decompression, fluid resuscitation, and electrolyte correction before preceding to definitive treatment. Previously, gastric bypass was the general treatment prior to the introduction of surgical aortic repair. Aortic aneurysm repair is the mainstay of therapy with endovascular repair becoming increasingly common.

Delay in Endovascular Aneurysm Repair for Symptomatic Abdominal Aortic Aneurysm up to Five Days Does Not Impact Morbidity or Mortality

Delay in Endovascular Aneurysm Repair for Symptomatic Abdominal Aortic Aneurysm up to Five Days Does Not Impact Morbidity or Mortality

Anesthetic Management of Abdominal Aortic Aneurysm Repair in a Patient With Tuberous Sclerosis Complex

Tuberous sclerosis complex, also known as Bourneville disease, is an autosomal dominant, progressive neurocutaneous disorder with variable presentation and multisystem involvement. It is characterized by the development of benign tumors in multiple organs and tissues in the body, with the majority of patients having neurological involvement. We report a 19-year-old adolescent, with tuberous sclerosis and advanced systemic involvement of the disease, presenting for surgical repair of an abdominal aortic aneurysm. The etiology and presentation of TS are discussed and its multisystem organ involvement is reviewed with emphasis on the anesthetic implications of the disease. J Med Cases. 2019;10(7):198-202 doi: https://doi.org/10.14740/jmc3326

Two cases of asymptomatic axillary artery occlusion difficult to diagnose preoperatively: pitfalls and its solution in endovascular therapy when approaching from the upper extremity

BackgroundApproaching from the left brachial artery is an important access route in endovascular therapy for complicated aortic and peripheral artery cases.Here, we report two cases of a poor access route from the left brachial artery because of asymptomatic axillary artery occlusion (AAO), despite no preoperative upper arm blood pressure laterality, a normal ankle brachial pressure index, and absence of occlusion of the subclavian artery on CT scan.Case 1Seventy-six-year-old female. We planned endovascular aneurysm repair (EVAR) for para-renal abdominal aortic aneurysm using the snorkel technique in the renal artery, but we failed to pass through the left subclavian artery when approaching from the left brachial artery because of AAO.Case 2Seventy-three-year-old female. We planned zone 2 thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysm and embolization of the left subclavian artery via the left brachial artery, but we failed to pass through the left subclavian artery because of AAO, and therefore, we simply covered the orifice of the left subclavian artery using a stent graft without embolization.ConclusionsThe presence of an asymptomatic AAO may alter the treatment plan but may be difficult to diagnose preoperatively. In those cases in which a brachial or radial artery access is planned, contrast medium should be injected from the contralateral upper extremity during preoperative enhanced CT since the absence of halation of the ipsilateral subclavian/axillary vein provides improved visualization of the AAO which may lead to a better preoperative strategy including the choice of the side of upper extremity access.

Options to achieve proximal sealing zone during endovascular repair of abdominal aortic aneurysm and correlated classification.

Since its first development, endovascular aortic aneurysmal repair (EVAR) has largely evolved, and several types of endografts are currently available including bifurcated grafts with supra or infra-renal fixation, fenestrated (FEVAR). Technical advances have led to propose EVAR in patients with challenging anatomy and the indications for using endografts mainly depend on patients’ vascular anatomical characteristics and on the instructions for use. Even if the minimal requirements for standard commercially available endografts have been defined, there is a lack of consensus to help surgeons to choose the most appropriate approach. Here, we propose a four-class abdominal aortic aneurysm (AAA) categorization based on the morphology and the length of the necks considered as landing zones as well as markers of potential evolution of the AAA. This pragmatic classification may help to clarify the decision-making process for selecting the most appropriate endovascular device to treat AAA in accordance with the anatomy and the foreseeable evolution and delayed complication risk to anticipate vascular outcome.

Plasma CCN2 is independently related to subsequent need for abdominal aorta aneurysm repair

The objective of this study was to determine if plasma CCN2 is associated with abdominal aorta aneurysm (AAA), and future need for AAA repair, and further to assess the potential clinical value of CCN2 in predicting disease outcome. CCN2 was quantified in plasma samples obtained from a cohort of 679 men aged 65–74 at initial ultrasound screening for AAA in the Viborg Vascular (VIVA) screening trial. Plasma CCN2 was correlated with need for future surgical repair in the whole study population (HR = 1.457 (1.081–1.962), p = .013) and in the AAA group alone (HR = 1.431 (1.064–1.926), p = .018), yet the predictive value (CCN2 > 0 and <0 of 0.52 and 0.55, respectively) disqualified its use in clinically relevant AAA repair prediction. In conclusion, CCN2 is independently related to subsequent need for AAA repair, but has negligible predictive power for clinical use.

Mini open stent grafting with half sternotomy for aortic arch aneurysm

BackgroundOpen stent grafting is an alternative of graft replacement and thoracic endovascular aortic repair for aortic arch aneurysm. We have performed open stent grafting with half sternotomy (mini-OSG) to reduce in-hospital stay and recovery time of patients and herein report seven cases of mini-OSG for aortic aneurysm and dissection.Case presentationThe patients’ mean age was 66 years. Cardiopulmonary bypass was performed conventionally, and an open stent graft was inserted via an aortotomy on the aortic arch during circulatory arrest. No mortality occurred. The mean operation time was 387 min, and the mean blood loss was 587 ml. The patients were weaned from the ventilator 7.1 h postoperatively. No pseudoaneurysm or endoleakage was observed during the 2- to 20-month follow-up.ConclusionsMini-OSG might be less invasive, although further studies and intensive follow-up are needed.

Elective Endovascular vs. Open Repair of AAA: Long-Term Follow-Up

In a previously published, randomized U.S. trial of elective repair of abdominal aortic aneurysm (AAA) that involved nearly 900 patients, 30-day

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

BackgroundUnintentional renal artery occlusion after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm remains one of the most unfavorable complications. Renal salvage options include percutaneous transluminal renal artery angioplasty (PTRA) and open hepatosplenorenal bypass. However, the usefulness of kidney autotransplantation (AutoTx) remains unclear.Case presentationA 76-year-old woman with a right solitary kidney attributable to a left renal thromboembolism had previously undergone EVAR with a stent graft for an infrarenal aortic aneurysm, which led to ostial occlusion of the right renal artery. In addition, she had undergone PTRA and stenting. Two days before admission, she developed leg edema and hypertension, leading her to visit the hospital. Her serum creatinine level was 2.4 (baseline, 1.0) mg/dL. Acute kidney injury due to renal artery in-stent restenosis was suspected; re-angioplasty was attempted on day 2 of hospitalization, but was unsuccessful. Her renal function did not improve and anuria persisted; thus, hemodialysis was initiated on the same day. The right kidney size (8.6 cm) was preserved relative to her body size, with only mild cortical atrophy. Doppler ultrasonography and mercaptoacetyltriglycine scintigraphy revealed minimal but significant perfusion of the right kidney. Therefore, we considered that kidney perfusion was sustained and renal function could be reversed. On day 25 of hospitalization, right kidney AutoTx to the right iliac fossa was performed to reestablish adequate renal perfusion and reverse the need for dialysis. Soon after the procedure, the patient started passing urine. Her renal function improved; her serum creatinine level decreased to 1.0 mg/dL on day 33 of hospitalization. Hemodialysis was discontinued after the surgery. Zero-hour kidney biopsy showed only mild tubular injury, with neither tubular necrosis nor glomerular abnormalities.ConclusionsKidney AutoTx can be performed for patients with renal artery in-stent occlusion after unsuccessful PTRA who previously underwent EVAR. Our case showed successful recovery of renal function nearly 1 month after renal artery occlusion, indicating that revascularization should be considered even if it is delayed, as the kidney might be perfused through collateral circulation.

Tu1706 – Early Endoscopic Evaluation Associated with Shorter Time to Colectomy and Lower Mortality Following Ruptured Abdominal Aortic Aneurism Repair Complicated by Colon Ischemia, a Nationwide Analysis

Tu1706 – Early Endoscopic Evaluation Associated with Shorter Time to Colectomy and Lower Mortality Following Ruptured Abdominal Aortic Aneurism Repair Complicated by Colon Ischemia, a Nationwide Analysis