Undergoing Open Abdominal Aortic Aneurysm Research Articles

Prognostic Value of the Pre-Procedural Six Minute Walk Test in Patients Undergoing Open Abdominal Aortic Aneurysm Repair – A Prospective Observational Study

Objective: Open surgery for aortic aneurysm is associated with significant morbidity and mortality. Preoperative functional status is one of the key predictors of adverse outcomes in the postoperative period. This study investigated the role of 6-min walk test (6MWT) in predicting the outcomes after open surgery in abdominal aortic aneurysm (AAA). Methods: A prospective cohort study was conducted in patients scheduled to undergo open repair of AAA. The preoperative 6-min walk distance (6MWD) was calculated for patients, followed by postoperative monitoring of all patients who underwent surgery. Walking performance was classified with 300 m as a cutoff, and patients were divided into two groups with 6MWD- <300 m and >300 m. The results of 6MWT were analyzed with respect to cardiopulmonary complications, intensive care unit (ICU) stay, ventilatory or inotropic support, length of hospital stay, and mortality. Results: A total of 52 patients were included in the study, and 49 patients were able to complete the 6MWT. The patients with <300 m 6MWD had a longer stay in the ICU and an increased duration of ventilatory and inotropic support (P < 0.001). The <300-m group had an increased incidence of cardiopulmonary complications (47%, P = 0.001). The <300-m group had a higher duration of hospital stay (10.6 vs. 8.4 days; P = 0.01). All the patients who died in the perioperative period had a 6MWD <300 m (n = 3, P = 0.03). The 6MWD was the only strong predictor of adverse outcomes in the cohort. Conclusion: 6MWT can be safely performed in patients with AAA. A low walking distance correlates directly with increased perioperative morbidity and length of hospital stay. A distance of <300 m in patients with aortic aneurysm is predictive of perioperative morbidity and mortality.

Impact of Frailty on Outcomes in Patients Undergoing Open Abdominal Aortic Aneurysm Repair

Frailty is a global state that does not relate directly to comorbidities and is prevalent among patients with vascular disease. The Clinical Frailty Scale (CFS) is a rapid assessment tool to identify vulnerable and frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to independently predict mortality and morbidity after elective open abdominal aortic aneurysm (AAA) repair. We retrospectively reviewed our institutional National Vascular Registry (NVR) data to identify all patients who underwent an elective open juxta or infrarenal AAA repair between January 2014 and December 2018. The NVR data set included preoperative risk factors, imaging findings, intraprocedural variables, and postprocedural outcomes. A total of 184 patients were assessed using the CFS before they underwent elective open AAA repair. Among 26 (14%) individuals categorized as vulnerable using the CFS, there was no significant difference in age or preoperative cardiac and respiratory testing compared with nonfrail patients. However, vulnerable patients were significantly more likely to have a longer length of stay (12.2days vs. 8.8days, P-value 0.044), suffer from respiratory complications (35% vs. 15%, P-value 0.022) and renal failure (23% vs. 6%, P-value 0.013), or die (23% vs. 2%, P-value 0.0003). The regression analysis identified a vulnerable frailty score to be the only significant predictor of mortality (odds ratio=36.7, P<0.001), all other factors were not shown to be independent predictors. The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective open AAA repair and can be used to predict mortality and morbidity after surgery.

Translation of a Vascular-Specific Cardiac Risk Stratification Tool into Practice for Patients Undergoing Open Abdominal Aortic Aneurysm Repair

Translation of a Vascular-Specific Cardiac Risk Stratification Tool into Practice for Patients Undergoing Open Abdominal Aortic Aneurysm Repair

Variation in Transfusion Practices and the Association With Perioperative Adverse Events in Patients Undergoing Open Abdominal Aortic Aneurysm Repair and Lower Extremity Arterial Bypass in the Vascular Quality Initiative

Variation in Transfusion Practices and the Association With Perioperative Adverse Events in Patients Undergoing Open Abdominal Aortic Aneurysm Repair and Lower Extremity Arterial Bypass in the Vascular Quality Initiative

Variation in Transfusion Practices and the Association with Perioperative Adverse Events in Patients Undergoing Open Abdominal Aortic Aneurysm Repair and Lower Extremity Arterial Bypass in the Vascular Quality Initiative

Blood transfusions are associated with adverse events. We examined perioperative transfusion practices and associated complications following open vascular procedures nationwide in the Vascular Quality Initiative (VQI). Adults undergoing open abdominal aortic aneurysm repair (OAR) and lower extremity arterial bypass (Bypass) within VQI (2003-2016) were identified. All emergent cases, patients with preoperative hemoglobin <7g/dL, preoperative hospitalization >1day, or a return to operating room during the index hospitalization were excluded. Units of red blood cells transfused were the primary outcome. Secondary outcomes were postoperative myocardial infarction (MI) and death. Patient, center, and procedural factors were evaluated. Multivariable mixed effects negative binomial regression and multivariable logistic regression were performed. We identified 24,131 procedures (OAR 3885, 16.1%; Bypass 20,246, 83.9%) among 22,532 patients (10.1% had >1 procedure). Overall, 37.5% of OAR and 19.5% of Bypass were transfused. Transfusion rates varied across estimated blood loss quartiles and across various preoperative hemoglobin levels. The overall rate of postoperative MI and death was 4.0% and 1.8% for OAR, and 2.2% and 0.7% for Bypass, respectively. In univariate and multivariable analysis, transfusions were associated with an increased risk of postoperative MI and death. A mixed effects negative binomial model demonstrated variation in transfusions across centers (P<0.001). Female gender and preoperative anemia were significantly associated with transfusions. Blood transfusions are variable across centers in VQI. Transfusions are associated with a higher postoperative MI and death after OAR and Bypass. Efforts to reduce transfusion may focus on center variability, gender, and preoperative anemia.

Variation in Transfusion Practices and Their Associations with Perioperative Adverse Events in Patients Undergoing Open Abdominal Aortic Aneurysm Repair and Lower Extremity Arterial Bypass in the Vascular Quality Initiative (VQI)

Blood transfusions are associated with adverse events. We examined perioperative transfusion practices and associated complications following open vascular procedures nationwide in the Vascular Quality Initiative (VQI).

The Impact of Exposure Technique on Perioperative Complications in Patients Undergoing Open Abdominal Aortic Aneurysm Repair

The Impact of Exposure Technique on Perioperative Complications in Patients Undergoing Open Abdominal Aortic Aneurysm Repair

PC32. The Impact of Exposure Technique on Perioperative Complications in Patients Undergoing Open Abdominal Aortic Aneurysm Repair

PC32. The Impact of Exposure Technique on Perioperative Complications in Patients Undergoing Open Abdominal Aortic Aneurysm Repair

Acute Kidney Injury in Patients Undergoing Open Abdominal Aortic Aneurysm Repair: A Pilot Observational Trial.

Acute kidney injury (AKI) is a frequent complication after open repair of abdominal aortic aneurysms (AAA). Little research has been done to determine whether intraoperative hemodynamic events may precipitate AKI. Novel biomarkers also may aid in the earlier diagnosis of AKI. A pilot prospective observational trial. A single tertiary academic medical center. Participants were 40 adult patients undergoing open repair of infrarenal AAA. Intraoperative hemodynamic monitoring of heart rate, mean arterial pressure, central venous pressure, and cardiac index was performed on a continuous basis. Blood samples were obtained at baseline and at 24 hours postoperatively for inflammatory biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL). AKI occurred in 20% of patients (8 of 40). Hypotension, including duration (defined as the length of time mean arterial pressure was<65 mmHg) and magnitude (the area under the curve of a mean arterial pressure<65 mmHg), was the only factor associated with postoperative AKI. Urinary NGAL at the conclusion of surgery had excellent ability to predict the development of AKI (area under the curve 0.84, 95% confidence interval = 0.70-0.97). The cytokines pentraxin 3 (PTX3), interleukin-1 receptor antagonist (IL1-RA), macrophage chemotactic protein (MCP), suppressor of tumorigenicity 2 (ST-2), and interleukin-10 (IL-10) also had good ability to predict the development of AKI in the immediate postoperative period. AKI occurs frequently in patients undergoing open repair of AAA. Intraoperative hypotension was the only factor that predicted the development of subsequent AKI. Urinary NGAL and several novel inflammatory biomarkers demonstrated good ability to predict its development. Novel biomarkers also may aid in the early diagnosis of AKI.

Intraoperative Use of Cell Saver on Patients Undergoing Open Abdominal Aortic Aneurysm Surgical Repair: A Greek Hospital Experience

Perioperative use of a cell saver device can serve as a cost-beneficial alternative to the transfusion method, especially in countries where the cost of a single unit of blood is high. The purpose of this study, conducted in a Greek hospital, was to calculate the cost benefit of using a cell saver device to salvage intraoperative blood during open surgical abdominal aortic aneurysm repair or open aortofemoral bypass for occlusive disease. This retrospective study measured the amounts of salvaged blood and reinfused blood encountered during the procedure and then calculated the cost benefit of cell saver use. With the cost of a unit of blood purchased in Greece about €450 ($585), the blood units salvaged and reinfused were calculated at a mean cost benefit of €754 ($980) per case.

Accuracy of Cardiac Risk Prediction Models in Patients Undergoing Open Abdominal Aortic Aneurysm Repair or Lower Extremity Bypass

Accuracy of Cardiac Risk Prediction Models in Patients Undergoing Open Abdominal Aortic Aneurysm Repair or Lower Extremity Bypass

Cytokine and Fibrinogen Response in Patients Undergoing Open Abdominal Aortic Aneurysm Surgery

Objectivesto assess whether open abdominal aortic aneurysm (AAA) surgery influences cytokines and fibrinogen.Methodstwenty-three consecutive patients operated on for AAA were compared to 11 operated controls and 20 age-matched controls. Cubital blood was sampled pre-, intra- and postoperatively and femoral blood also sampled intraoperatively.Resultspreoperatively, interleukin (Il)-6 was elevated in AAA patients. During aortic clamping, Il-6, Il-10 and monocyte chemoattractant protein-1 (MCP-1) increased significantly (p<0.001,p<0.01 andp<0.05 respectively) while soluble interleukin-2 receptor (sIl-2R) and fibrinogen decreased significantly (p<0.001 for both). After aortic declamping, Il-6, Il-10 and MCP-1 had further significant increases compared with levels during aortic clamping while sIl-2R had a further non-significant and fibrinogen a significant decrease (p<0.05 in cubital andp<0.001 in femoral blood). One week postoperatively Il-6, Il-10 and MCP-1 had all decreased but were still significantly elevated compared with baseline values while sIl-2R and fibrinogen showed an increase in comparison with baseline (p<0.001 for both). Intraoperative levels of Il-6 and Il-10 showed a significant co-variation with the magnitude of operative trauma.Conclusionsthese data indicate that open AAA surgery induces a profound inflammatory and coagulative response which persists at one week postoperatively.