Hybrid Thoracoabdominal Aortic Aneurysm Repair: Concomitant Visceral Revascularization and Endovascular Aneurysm Exclusion
Thoracoabdominal aortic aneurysms (TAAA) remain a formidable surgical challenge, with conventional open repair associated with significant rates of mortality and morbidity. Furthermore, many of these patients are elderly with significant comorbidities and may not be candidates for repair. Consequently, the availability of a “hybrid” option, including open visceral debranching with concomitant endovascular aneurysm exclusion, may have advantages in these high-risk patients, including the potential to offer therapy to those ineligible for conventional repair. Our technique for hybrid TAAA repair is performed by means of midline laparotomy. A commercially manufactured custom multibranched Dacron graft is used to sequentially bypass, in extranatomic manner, the left renal artery, superior ......
POSTED 03/11/2010 at 12:09 PM --
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Primary aorto-enteric fistula: A rare complication of abdominal aortic aneurysm
Thomson V S, Gopinath K G, Joseph E, Joseph GJournal of Postgraduate Medicine 2009 55(4):267-269A 70-year-old lady presented with recurrent gastrointestinal bleeding and septicemia caused by multiple enteric pathogens. She was diagnosed to have primary aorto-enteric fistula (PAEF) complicating abdominal aortic aneurysm. Endovascular aneurysm repair was carried out that arrested gastrointestinal bleeding, but despite prolonged antibiotic therapy the patient died a month later of probable sepsis. PAEF refers to abnormal communication between the aorta and the intestine resulting from disease at either site; this rare condition should be suspected in patients with abdominal aortic aneurysm who present with unexplained life-threatening gastrointestinal bleeding. Computerized tomography is the ......
POSTED 03/09/2010 at 10:15 AM --
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Endoluminal abdominal aortic aneurysm repair: the latest advances in prevention of distal endograft migration and type 1 endoleak.
Authors: Ghouri M, Krajcer Z
Endovascular abdominal aortic aneurysm repair (EVAR) is an attractive alternative to open surgical repair. Distal endograft migration and type 1 endoleak are recognized to be the 2 main complications of EVAR. First-generation endografts had a stronger propensity for distal migration, modular component separation, thrombosis, and loss of structural integrity. Substantial progress has been made in recent years with 2nd- and 3rd-generation devices to prevent these complications. Some of the most common predictors of endograft failure are angulated and short infrarenal necks, large-diameter necks, and thrombus in the aneurysmal sac. The purpose of this study is to describe and review our experience in using innovative techniques and a newer generation of endogr......
POSTED 03/06/2010 at 05:20 PM --
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Fenestrated Stent Grafting for Short-necked and Juxtarenal Abdominal Aortic Aneurysm: An 8-Year Single-centre Experience.
CONCLUSIONS: Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm appears safe and effective on the longer term. Renal function deterioration, however, is a major concern.
PMID: 20202868 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)...
POSTED 03/01/2010 at 06:00 PM --
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Delayed permanent paraplegia after endovascular repair of abdominal aortic aneurysm
We report the first case of significantly delayed permanent paraplegia after endovascular abdominal aortic aneurysmorrhaphy. (Source: Journal of Vascular Surgery)...
POSTED 02/28/2010 at 06:00 PM --
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Outcome Following Endovascular vs. Open Repair of Abdominal Aortic Aneurysm: A Randomized Trial
Conclusion: Perioperative mortality is lower for endovascular than open AAA repair. There is no significant difference in all cause-mortality at 2 years. Summary: Previous randomized trials of open vs endovascular aneurysm repair have shown reduced perioperative mortality, hospital stay, and intensive care unit days in the endovascularly treated patients. In randomized trials conducted in Europe, at 2 years the early survival advantage of the endovascular patients was lost, while the relative effects of endovascular and open repair on quality of life and erectile function remain unclear. This study was conducted in 881 veterans aged >49 years drawn from 42 Department of Veterans Affairs Medical Centers. To be eligible for the trial, the patient had to have had an abdominal aortic aneurysm......
POSTED 02/28/2010 at 06:00 PM --
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Regarding “SVS practice guidelines for the care of patients with an abdominal aortic aneurym: Executive summary”
In the executive summary of the new Society for Vascular Surgery (SVS) practice guidelines for abdominal aortic aneurysm (AAA), Chaikof et al state, in reference to the United Kingdom Small Aneurysm Trial (UKSAT) and Aneurysm Detection and Management (ADAM) trials, that “a trend towards a beneficial effect of early surgery was observed in both studies in the younger patient and for those with larger aneurysms.” This is incorrect; in Table 2 of the ADAM trial report, the relative risks for the youngest patients (age 50-59) and for the largest AAA (5.0-5.4 cm) are each given as 1.02, representing a slight trend favoring surveillance. The authors then state that “Young healthy patients, and especially women, with AAA between 5.0 and 5.4 cm may benefit from early repair.” ADAM patients......
POSTED 02/28/2010 at 06:00 PM --
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Incidence and prediction of permanent neurological deficits after cardiac surgery -- are the existing models of prediction truly global? [Original articles]
Conclusion: PND after cardiac operation is associated with a high mortality and poor prognosis. The incidence of PND varies depending on the procedure. Predictive models of neurological injury post-cardiac surgery should be more centre-specific. (Source: European Journal of Cardio-Thoracic Surgery)...
POSTED 02/26/2010 at 04:01 PM --
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Screened individuals' preferences in the delivery of abdominal aortic aneurysm repair
This study aimed to determine preferences for service attributes in a population screened for abdominal aortic aneurysm.A questionnaire was designed to encompass various aspects of service provision. Questions were calibrated against the time an individual was willing to travel to access specific attributes. Subjects attending an aneurysm screening programme were asked to complete a questionnaire before their screening ultrasound scan. Statistical analysis was through pairwise analysis of the median travel times with the signed rank test. The Wilcoxon rank sum, analysed by the Kruskal-Wallis test, was used to compare preference ratings.A total of 262 individuals were asked to complete the questionnaire; the response rate was 98·5 per cent. Approximately 92 per cent of individuals stated a......
POSTED 02/17/2010 at 06:00 PM --
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Screened individuals' preferences in the delivery of abdominal aortic aneurysm repair.
CONCLUSION:: Patients attending aneurysm screening were willing to travel beyond their nearest hospital to access a service with better outcomes, higher surgical volumes and endovascular surgery. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
PMID: 20169573 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)...
POSTED 02/17/2010 at 06:00 PM --
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AAA Stent-Grafts: Past Problems and Future Prospects.
Authors: Desai M, Eaton-Evans J, Hillery C, Bakhshi R, You Z, Lu J, Hamilton G, Seifalian AM
Endovascular aneurysm repair (EVAR) has quickly gained popularity for infrarenal abdominal aortic aneurysm repair during the last two decades. The improvement of available EVAR devices is critical for the advancement of patient care in vascular surgery. Problems are still associated with the grafts, many of which can necessitate the conversion of the patient to open repair, or even result in rupture of the aneurysm. This review attempts to address these problems, by highlighting why they occur and what the failings of the currently available stent grafts are, respectively. In addition, the review gives critical appraisal as to the novel methods required for dealing with these problems and ident......
POSTED 02/16/2010 at 06:00 PM --
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Racial and Ethnic Differences in the Use of High-Volume Hospitals and Surgeons [Original Article]
Conclusions Minority patients in New York City are doubly disadvantaged in their surgical care; they are substantially less likely to use both high-volume hospitals and surgeons for procedures with an established volume-mortality association. Better information is needed about which providers minority patients have access to and how they select them. (Source: Archives of Surgery)...
POSTED 02/15/2010 at 02:50 PM --
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Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm
This study examined the population outcome of ruptured abdominal aortic aneurysm (rAAA) in England, the role of endovascular repair (EVAR), and the relationship between outcome and hospital workload.Data were retrieved from Hospital Episode Statistics between 1 April 2003 and 31 March 2008. Propensity scoring was used to compare the outcomes of stratified patients undergoing EVAR and open repair. The relationship between workload and outcome was determined.Some 3725 urgent and 4414 rAAA repairs were included. Mortality rates were 21·3 per cent for urgent repair and 46·3 per cent for rAAA repair. EVAR was employed for 16·3 and 7·6 per cent of urgent and rAAA repairs respectively. EVAR was associated with significantly reduced mortality for urgent repair (odds ratio (OR) 0·531, 95 per c......
POSTED 02/11/2010 at 06:00 PM --
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Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm.
CONCLUSION:: EVAR offered a survival advantage over open repair for non-elective aneurysm procedures. Services for the treatment of rAAA should incorporate access to EVAR and would benefit from being based in units with a high elective caseload. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
PMID: 20155793 [PubMed - as supplied by publisher] (Source: The British Journal of Surgery)...
POSTED 02/11/2010 at 06:00 PM --
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Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm [Letters]
(Source: JAMA)...
POSTED 02/09/2010 at 02:50 PM --
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Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm [Letters]
(Source: JAMA)...
POSTED 02/09/2010 at 02:50 PM --
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Comparing Endovascular and Open Repair of Abdominal Aortic Aneurysm--Reply [Letters]
(Source: JAMA)...
POSTED 02/09/2010 at 02:50 PM --
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Catheter-delivered Transducer-tipped Ultrasound Thrombolysis of a Chronically Occluded Aortic Stentgraft Limb
We describe a unique case of successful treatment of a chronically occluded stentgraft limb after EVAR with catheter-delivered transducer-tipped US thrombolysis. (Source: EJVES Extra)...
POSTED 02/07/2010 at 06:00 PM --
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Lithium Does Not Protect Against Spinal Cord Ischemia-Reperfusion Injury in Rabbits
This study was aimed to evaluate the effect of lithium on SCIRI in rabbits. (Source: Annals of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Endovascular repair of ruptured thoracic aortic aneurysms is associated with high perioperative mortality and morbidity
Conclusions: The endovascular treatment of ruptured thoracic aortic aneurysms is associated with a high perioperative mortality and morbidity as well as poor midterm survival. Renal insufficency proved to be an independent risk factor for perioperative death. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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