Aortic Emergencies Research Articles

ThP8.10 - Diagnostic accuracy of aortic dissection detection risk score and D-dimer to rule out aortic emergencies in the emergency department – outcomes from a multicentre study

Abstract Background Acute aortic syndromes (AAS) are rare but potentially fatal vascular emergencies affecting the aorta, including aortic dissection, penetrating aortic ulcers, intramural haematoma and occasionally aortic aneurysm rupture. The variety of presentations can make it difficult to decide which patients should have definitive computerised tomography aortogram (CTA) imaging. This study aims to evaluate the diagnostic accuracy of the aortic dissection detection risk score (ADD-RS) combined with D-dimer to rule out AAS in the emergency department. Methods This retrospective cohort study involved two centres. Results of patients who had CTAs between 1st March 2020 – 31st March 2022 were reviewed. Patient data including demographics and laboratory results were logged from day of presentation. Results A total of 435 CTAs were requested. Patients with diagnosis of AAS had higher mean total ADD-RS (1.6 vs 1.0, P<0.05) and higher mean D-dimer (8,836 vs 1,462ng/mL, P<0.05). The use of ADD-RS≤1/normal D-dimer had sensitivity of 100.0% and specificity of 27.9%. Negative predictive value (NPV) was 100%. In this cohort, there were no false negatives. Conclusion This study appears to support the implementation of a new guideline in these departments that incorporates ADD-RS and D-dimer to aid deciding next steps for suspected AAS. In this cohort ADD-RS ≤1 and negative D-dimer (<500ng/mL) had high sensitivity, and low failure rate and could have prevented at least 70 and up to 229 patients from receiving unnecessary radiation. The results suggest that in low-risk patients, with ADD-RS≤1/negative D-dimer, AAS can be safely ruled out. New guidelines could prevent patients receiving unnecessary radiation, contrast induced nephropathy and reduce burden of stretched emergency departments.

Consensus statement on the interhospital transfer of patients with acute aortic syndrome: TRAVERSING Delphi study

BackgroundStandardisation of referral pathways and the transfer of patients with acute aortic syndromes (AAS) to regional centres are recommended by NHS England in the Acute Aortic Dissection Toolkit. The aim...

Temporal trends in mortality of aortic dissection and rupture in the UK, Japan, the USA and Canada

ObjectiveAortic dissection and aortic aneurysm rupture are aortic emergencies and their clinical outcomes have improved over the past two decades; however, whether this has translated into lower mortality across countries...

Unveiling the Intricacies of Acute Aortic Syndromes through Imaging: A Case Series

Acute Aortic Syndrome (AAS) comprises of three distinct pathological conditions: Aortic Dissection (AD), Penetrating Atherosclerotic Ulcer (PAU), and Intramural Haematoma (IMH). Although AAS and its emergencies are not common occurrences, they are considered highly dangerous and potentially fatal. Clinically, differentiating between the various types of aortic syndromes can be challenging. The prognosis of these conditions significantly depends on speedy and precise analysis. Therefore, present study emphasised the critical role of radiology in the diagnosis of AASs, with Contrast-Enhanced Computed Tomography (CECT) being the quickest and most consistent imaging modality. In this case series, four cases of AASs are presented, comprising three cases of AD and a case of PAU in a patient with infrarenal aortic occlusion. Notably, one of the dissection cases was accompanied by renal ischaemia. Recognising acute aortic emergencies promptly is essential for saving lives.

Clinical Characteristics and Outcomes of Aortic Arch Emergencies: Takayasu Disease, Fibromuscular Dysplasia, and Aortic Arch Pathologies: A Retrospective Study and Review of the Literature.

In this study, 82 (1.07%) consecutive patients with NA-AAPs (including 38 TAKs, 26 FMDs, and 18 other AAPs) out of 7645 patients who underwent endovascular treatment (EVT) for the aortic arch and its side-branch diseases at a single institution between 2002 and 2022 were retrospectively reviewed. The recorded demographic, biochemical, diagnostic, operative, and postoperative factors were reviewed, and the functional outcomes were determined during follow-up. A systematic review of the literature was also performed. The study group comprised 65 (79.3%) female and 17 (21.7%) male subjects with a mean age of 46.1 ± 14.9 years. Overall, 62 (75.6%) patients were diagnosed with either cerebral ischemia symptoms or aortic arch dissection on admission. The EVT was feasible in 59 (72%) patients, whereas 23 (28%) patients were referred for medical treatment. In EVT patients, severe periprocedural complications occurred in two (3.39%) patients, including one periprocedural death and one cerebral hyperperfusion syndrome. During a median follow-up period of 64 months, cardiovascular events occurred in 24 (29.6%) patients (5 deaths, 13 ISs, and 6 myocardial infarctions). Repeated EVT for the index lesion was performed in 21/59 (35.6%) patients, including 19/33 (57.6%) in TAK and 2/13 (15.4%) in FMD. In the AAP group, one patient required additional stent-graft implantation for progressing dissection to the iliac arteries at 12 months. A baseline white blood count (odds ratio [HR]: 1.25, 95% confidence interval [CI]: 1.11-1.39; p < 0.001) was the only independent prognostic factor for recurrent stenosis, while a baseline hemoglobin level (HR: 0.73, 95%CI: 0.59-0.89; p = 0.002) and coronary involvement (HR: 4.11, 95%CI: 1.74-9.71; p = 0.001) were independently associated with a risk of major cardiac and cerebral events according to the multivariate Cox proportional hazards regression analysis. This study showed that AAPs should not be neglected in clinical settings, as it can be a life-threatening condition requiring a multidisciplinary approach. The knowledge of prognostic risk factors for adverse outcomes may improve surveillance in this group of patients.

An automated screening model for aortic emergencies using convolutional neural networks and cropped computed tomography angiography images of the aorta.

Patients with aortic emergencies, such as aortic dissection and rupture, are at risk of rapid deterioration, necessitating prompt diagnosis. This study introduces a novel automated screening model for computed tomography angiography (CTA) of patients with aortic emergencies, utilizing deep convolutional neural network (DCNN) algorithms. Our model (Model A) initially predicted the positions of the aorta in the original axial CTA images and extracted the sections containing the aorta from these images. Subsequently, it predicted whether the cropped images showed aortic lesions. To compare the predictive performance of Model A in identifying aortic emergencies, we also developed Model B, which directly predicted the presence or absence of aortic lesions in the original images. Ultimately, these models categorized patients based on the presence or absence of aortic emergencies, as determined by the number of consecutive images expected to show the lesion. The models were trained with 216 CTA scans and tested with 220 CTA scans. Model A demonstrated a higher area under the curve (AUC) for patient-level classification of aortic emergencies than Model B (0.995; 95% confidence interval [CI], 0.990-1.000 vs. 0.972; 95% CI, 0.950-0.994, respectively; p = 0.013). Among patients with aortic emergencies, the AUC of Model A for patient-level classification of aortic emergencies involving the ascending aorta was 0.971 (95% CI, 0.931-1.000). The model utilizing DCNNs and cropped CTA images of the aorta effectively screened CTA scans of patients with aortic emergencies. This study would help develop a computer-aided triage system for CT scans, prioritizing the reading for patients requiring urgent care and ultimately promoting rapid responses to patients with aortic emergencies.

Benchmarking a Center of Excellence in Vascular Surgery: Using Acute Physiology and Chronic Health Evaluation II to Validate Outcomes in a Tertiary Care Institute.

The Society of Vascular Surgery (SVS) has made it a top priority to implement verification of vascular "centers of excellence". Our institutional aortic network was established in 2008 in order to standardize care of patients with suspected acute aortic pathology. The implementation and success of this program has been previously reported. We sought to use our experience as a benchmark for which to develop prognostic modeling to quantify clinical status upon admission and help predict outcomes. Our objective was to validate the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system using a cohort of aortic emergencies transferred by an organized transfer network. This was a retrospective, single institution review of patients transferred through an institutional aortic network for acute aortic pathology from 2017-2018. Demographics, comorbidities, aortic diagnosis, APACHE II score, as well as 30-day mortality were recorded. Associations with 30-day mortality were evaluated using two-sample t-tests, ANOVA models, Pearson chi-square tests and Fisher exact tests. Receiver operating characteristic (ROC) curves were fit overall and by pathology to predict 30-day mortality by Apache II total score. There were 395 consecutive transfers were identified. The mean age was 64.7years. Diagnoses included Type A Dissection (n = 134), Type B (n = 81), Aortic Aneurysm (n = 122), and PAU/IMH (n = 27). Mean APACHE II score on arrival was 12. Overall there were 53 deaths (13.4%) in the cohort. Patients that died had significantly higher Apache II total scores (11.3 vs 16.5, P < .001). The area under the receiver operator characteristic (ROC) curve (AUC) was .66 for the full cohort, indicating a poor clinical prediction test. APACHE II score is a poor predictor of 30-day mortality in a large transfer network accepting all aortic emergencies. The authors believe further refining a prognostic model for diverse population will not only help in predicting outcomes but to objectively quantify illness severity in order to have a basis for comparison among institutions and verification of "centers of excellence".

Houston Methodist Ruptured Abdominal Aortic Aneurysm Guidelines.

Ruptured abdominal aortic aneurysm (RAAA) is an acute aortic condition that requires emergent intervention and appropriate continuity of care to optimize patient outcomes. We describe the standardized RAAA protocol at the Houston Methodist Hospital Acute Aortic Treatment Center, developed to navigate critical patient transfer periods safely and efficiently, make crucial decisions about surgical intervention, and clearly communicate these plans with other care team providers. Our workflow is organized into five phases: prehospital, preoperative, intraoperative, postoperative, and post-discharge. We identify the transfer center, anesthesia, operating room nursing staff, surgeons, and intensive care unit as key entities of our acute aortic pathology care team. This systematic protocol for the management of acute aortic emergencies such as RAAA identifies critical decision points, potential complications at each stage, and recommendations for best practice.

Abstract 9976: Contrasting Mortality Trends of Aortic Emergency: Dissection and Rupture in the UK, Japan, USA, and Canada

Introduction: Aortic dissection and aneurysm rupture are aortic emergencies. Surgical outcomes and interventional procedures have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question. Hypothesis: We hypothesized that given improved surgical mortality, there will be improvement in mortality from aortic dissection and rupture in the UK, Japan, USA, and Canada. Methods: We analyzed the WHO mortality database to determine trends in mortality from aortic dissection and rupture in 4 countries from 2000 to 2019. Crude mortality rate and age-standardized mortality rate per 100,000 persons were calculated, and annual percentage change was estimated using joinpoint regression. Results: In 2019, crude and age-standardized mortality rates from aortic dissection were 2.15 and 1.04 in UK, 8.67 and 2.66 in Japan, 1.21 and 0.76 in USA, and 1.30 and 0.67 in Canada, respectively. In 2019, crude and age-standardized mortality rates from aortic rupture were 4.86 and 1.80 in UK, 5.22 and 1.16 in Japan, 1.04 and 0.52 in USA, and 1.99 and 0.81 in Canada, respectively. There was a significantly decreasing trend in age-standardized mortality from aortic aneurysm rupture in all 4 countries over the study period, and a decreasing trend in age-standardized mortality from aortic dissection in the UK over the study period, in USA until 2010, and in Canada until 2012. There was a significantly increasing trend in mortality from aortic dissection in Japan over the study period, in the USA after 2010, and in Canada after 2012. Joinpoint regression identified significant changes in the trends from decreasing to increasing in USA and Canada. In sensitivity analyses stratified by sex, similar trends were observed. Conclusions: Trends in mortality from aortic aneurysm rupture are decreasing, however, mortality from aortic dissection is increasing in Japan, USA, and Canada. Further study to explain these trends is warranted.

Inequalities in accessing quality healthcare, does insurance play a role? retrospective analysis of aortic emergencies from national inpatient sample 2019

Abstract Background Aortic emergencies, dissection and rupture, are rare but catastrophic entities, with the cornerstone to survival being prompt diagnosis and treatment. Insurance status often limits access to healthcare, and our study aims to determine if it plays a role in the outcomes of aortic emergencies. Method A retrospective analysis of the 2019 Nationwide Inpatient Sample was conducted to identify hospitalization (Age ≥18 &amp; non-elective) with aortic dissection and ruptured aortic aneurysms using ICD-10 codes. Discharge-level weight analysis was used to produce a national estimate. Variables were screened with univariate regression, and intermediate and co-linear variables were screened-out before a multivariable regression analysis model was built and performed to calculate the odds ratio. Results A total of 19,685 (0.06%) hospitalizations are identified for aortic emergencies (14965 dissections &amp; 4720 ruptured aneurysms). The mean age was 58.56, 62.7% were males, and ethnic distribution was 65.1% white, 19.5% blacks, 7.6% Hispanics, and others. 11.4% of the hospitalizations underwent diagnostic imaging with either CTA/MRA/TEE/Aortography within 24 hours. Hypotension/shock was present in 32% of these hospitalizations and was a risk factor for mortality OR 3.21 (p&amp;lt;0.00), increasing LOS by an average of 5.1 days and resource utilization by 156,000$. Another risk factor for mortality was stroke/TIA (OR-1.76, p&amp;lt;0.00), increasing LOS and resource utilization by 3.1 days and 80,662$, respectively. 3220 hospitalizations (16.4%) did not survive the course, and the mortality rate in uninsured, Medicare, and Medicaid was 17%, 20%,9% compared with 12% in privately insured. On crude analysis, uninsured and medicare patients appeared to have higher odds of mortality [OR 1.50, p&amp;lt;0.04, and OR 1.83 p-value &amp;lt;0.002 respectively], however upon adjusting for confounders, only uninsured patients showed statistically significant difference (OR 2.13, p&amp;lt;0.002). Similar results were corroborated on analyzing hospitalizations for aortic dissection; however, insurance status did not influence mortality in a ruptured aneurysm. When comparing hospitalization of median household income of ≥79,000$ with household of median income of 59,000–78,999 $, 46,000–58,999 $ and &amp;lt;46,000$ had higher odds of mortality (OR-1.38, p&amp;lt;0.04), (OR-1.44, p&amp;lt;0.02) and (OR-1.44, p&amp;lt;0.03) respectively. Of all the insurance types, a statistically significant difference compared with private insurance, Medicaid on average, had 2.8 more days and incurred an additional 62,912$ in resource utilization (p&amp;lt;0.00). Conclusion Inequalities in accessing healthcare, median household income, and insurance status are risk factors for mortality in aortic emergencies. Efforts are needed to bridge the gap in this particular facet of social determinants of health to find a sustainable and equitable solution for quality healthcare for aall regardless of their insurance status. Funding Acknowledgement Type of funding sources: None.

上腕動脈からREBOAを留置して救命した大動脈緊急症の2治療例(Two cases of aortic emergencies treated by placement of a resuscitative endovascular balloon occlusion of the aorta through the left brachial artery)

要旨Resuscitative endovascular balloon occlusion of the aorta（REBOA）は，出血性ショックの一時的血流制御のため，とくに外傷で用いられる。迅速性より大腿動脈アクセスが多いが，上腕動脈アクセスも可能である。当院は初療室に自走式CTと透視装置を備えるhybrid emergency roomを有する。大動脈緊急症に対し，上腕動脈からREBOAを留置しステントグラフトで救命した2例を経験した。症例1：70代男性。ワゴン車乗車中の事故で，ショック状態で搬送された。CTで腹部大動脈損傷があり，REBOAを右大腿動脈からzone 3に留置し初期蘇生を行った。コイル塞栓時の干渉を防ぐため，またステントグラフト手技中の循環安定のため，REBOAを左上腕動脈から入れ替えた。ステントグラフトで止血を得た。迅速な血流制御後，安全な根治術のため，アクセス変更は有用である。症例2：60代男性。外出中の背部痛で，ショック状態で搬送された。CTで腹部大動脈瘤破裂がみられた。右大腿動脈からではガイドワイヤーが瘤を越えず，左上腕動脈からREBOAをzone 1に留置しステントグラフトで止血を得た。動脈や病変部の形状により，大腿動脈アクセスが難しい場合，上腕動脈アクセスは有用である。症例に応じたREBOAのアクセスサイトの変更は，有効な戦略の一つである。

Imaging Paradigms in Nontraumatic Aortic Emergencies.

Aortic cause of acute chest pain or abdominal pain can be easily overlooked. Unceasing wariness is required for timely diagnosis and prompt treatment. In such cases, cross-sectional imaging can detect the type of aortic involvement, its site, extent, complications, and could help clinicians decide on a management method and prognosticate the condition. This pictorial illustration represents a spectrum of life-threatening conditions involving the aorta in a non-traumatic setting.

Evolution of the management of ruptured abdominal aortic aneurisms before and after the implementation of a “S.O.S Aorta” program dedicated to aortic emergencies

The objective of this work was to evaluate the results of the treatment of ruptured aneurysms of the abdominal aorta (rAAA) and the demographic trends of the patients following the implementation of “S.O.S Aorta”, a pre and in-hospital organized care system dedicated to aortic urgencies.

Misdiagnosis of Thoracic Aortic Emergencies Occurs Frequently Among Transfers to Aortic Referral Centers: An Analysis of Over 3700 Patients.

BackgroundAcute aortic syndromes may be prone to misdiagnosis by nonreferral aortic centers with less diagnostic experience. We evaluated regional variability in these misdiagnosis trends among patients transferred to different regional quaternary care centers with presumed acute aortic syndromes.Methods and ResultsTwo institutional aortic center databases were retrospectively reviewed for emergency transfers in patients diagnosed with acute aortic dissection, intramural hematoma, penetrating aortic ulcer, thoracic aortic aneurysm, or aortic pseudoaneurysm between 2008 and 2020. Transferring diagnoses versus actual diagnoses were reviewed using physician notes and radiology reports. Misdiagnoses were confirmed by a board‐certified cardiothoracic surgeon. A total of 3772 inpatient transfers were identified, of which 1762 patients were classified as emergency transfers. The mean age was 64 years (58% male). Patients were transferred from 203 medical centers by ground (51%) or air (49%). Differences in transfer diagnosis and actual diagnosis were identified in 188 (10.7%) patients. Of those, incorrect classification of Type A versus B dissections was identified among 23%, and 30% of patients with a referring diagnosis of an acute aortic dissection did not have one. In addition, 14% transferred for contained/impending rupture did not have signs of rupture. All misdiagnoses were secondary to misinterpretation of imaging, with motion artifacts (n=32, 17%) and postsurgical changes (n=44, 23%) being common sources of diagnostic error.ConclusionsMisdiagnosis of acute aortic syndromes commonly occurred in patients transferred to 2 separate large aortic referral centers. Although diagnostic accuracy may be improving, there are opportunities for improved physician awareness through standardized web‐based imaging education.

MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management-A Reappraisal.

Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.

Management of acute aortic syndromes from initial presentation to definitive treatment.

Acute aortic syndromes comprise a spectrum of diseases including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcers. Early diagnosis, rapid intervention, and multidisciplinary team care are vital to efficiently manage time-sensitive aortic emergencies, mobilize appropriate resources, and optimize clinical outcomes. This comprehensive review outlines the multidisciplinary team approach from initial presentation to definitive interventional treatment and post-operative care. Acute aortic syndromes can be life-threatening and require prompt diagnosis and aggressive initiation of blood pressure and pain control to prevent subsequent complications. Early time to diagnosis and intervention are associated with improved outcomes. A multidisciplinary team can help promptly diagnose and manage aortic syndromes.

Nanoparticle-Assisted Diagnosis and Treatment for Abdominal Aortic Aneurysm.

An abdominal aortic aneurysm (AAA) is a localized dilatation of the aorta related to the regional weakening of the wall structure, resulting in substantial morbidity and mortality with the aortic ruptures as complications. Ruptured AAA is a dramatic catastrophe, and aortic emergencies constitute one of the leading causes of acute death in older adults. AAA management has been centered on surgical repair of larger aneurysms to mitigate the risks of rupture, and curative early diagnosis and effective pharmacological treatments for this condition are still lacking. Nanoscience provided a possibility of more targeted imaging and drug delivery system. Multifunctional nanoparticles (NPs) may be modified with ligands or biomembranes to target agents' delivery to the lesion site, thus reducing systemic toxicity. Furthermore, NPs can improve drug solubility, circulation time, bioavailability, and efficacy after systemic administration. The varied judiciously engineered nano-biomaterials can exist stably in the blood vessels for a long time without being taken up by cells. Here, in this review, we focused on the NP application in the imaging and treatment of AAA. We hope to make an overview of NP-assisted diagnoses and therapy in AAA and discussed the potential of NP-assisted treatment.

P132 TRAVERSING: Transfer of thoracic Aortic Vascular Emergencies to Regional Specialist Institutes Group

IntroductionThe incidence of Acute Aortic Syndrome (AAS) is rising. The Department of Health is considering a supra regional tier of centralisation for complex aortic care. No standardised pathway exists to guide the transfer of patients with AAS, despite increasing evidence from coroners and the Healthcare Safety Investigation Board of delayed transfers and miscommunication costing lives. This study aims to deliver a pathway for the safe transfer of patients with suspected AAS to a specialist aortic centre through multidisciplinary Delphi consensus.MethodsThe researchers will create an interdisciplinary Steering Group to oversee the study, which will identify appropriate stakeholders for inclusion in the Delphi process. A systematic review will be performed to summarise existing evidence and highlight gaps in knowledge where consensus is required. The Steering Group will create, circulate and interpret the Delphi questionnaire. The outcomes will also enable determination of criteria for audit that should become the standard for ensuring a safe and efficient process for patient transfer to a complex aortic centre.ResultsResults will provide inter-disciplinary guidance to healthcare professionals for early management and transfer of patients with suspected AAS, and prevent unnecessary transfer, thereby improving outcomes, ensuring equity of access to specialist aortic care for patients. Results will also provide audit standards through which future improvements can be realised.ConclusionThis study is reliant upon collaboration between multidisciplinary healthcare providers, qualitative researchers and patients. Its success will streamline emergency pathways in the management of AAS, saving lives and resources, with inbuilt mechanisms for continuous review and improvement.

Outcomes of emergency endovascular versus open repair for abdominal aortic aneurysm rupture.

PurposeRuptured abdominal aortic aneurysm (rAAA) is one of the most common aortic emergencies in vascular surgery and is associated with high operative mortality and morbidity rates despite recent treatment advances. We evaluated operative mortality risks for the outcomes of emergency endovascular aneurysm repair (eEVAR) vs. open repair in rAAA.MethodsTwenty patients underwent eEVAR (n = 12) or open repair (n = 8) for rAAA between 2016 and 2020. We adopted the EVAR first strategy since 2018. Primary endpoints included in-hospital mortality and 1-year survival. The outcome variables were analyzed with Fisher exact, Mann-Whitney test, and linear by linear association. The Kaplan-Meier method was used to estimate survival.ResultsThere were 13 males (65.0%) and the median age of the study cohort was 78.0 years (range, 49–88 years). In-hospital mortality occurred in 7 patients (35.0%); 5 (50.0%) in the early period and 2 (20.0%) in the later period of this series. According to the procedure type, 4 (50.0%) and 3 (25.0%) in-hospital mortalities occurred in the open repair and eEVAR patients, respectively. In 6 patients (50.0%), eEVAR was performed on unfavorable anatomy. The 1-year survival of eEVAR vs. open repair group was 75% ± 12.5% and 50% ± 17.7%, respectively. On univariate analysis, preoperative high-risk indices, postoperative acute renal failure requiring dialysis, pulmonary complications, and prolonged mechanical ventilation were associated with higher operative mortality.ConclusionThe current data showed relatively superior outcomes with eEVAR vs. open repair for rAAA, even in some patients with unfavorable anatomy supporting the feasibility, efficacy, and safety of EVAR first strategy.

"Turn downs" in aortic emergencies: Reassurance or uncertainty?

"Turn-down" rate has been reported to have a significant influence on outcomes, and being turned down for an operation is associated with significant short-term mortality risk. A study examining the impact of the pandemic on the "turn-down" rates of acute aortic syndromes in the United Kingdom reported an overall "turn-down" rate of 7.3% in the early part of the pandemic. This review examines the significance of "turn-downs" in this setting and scrutinizes the adequacy of reporting this complex variable.