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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Invited commentary
Management of right renal artery reconstruction during complex aortic aneurysm repair, particularly through a flank or thoracoabdominal exposure, can be challenging and may require orificial endarterectomy for stenotic lesions as well as incorporation of the right renal artery into the suture line as a button, most commonly in conjunction with the superior mesenteric and celiac arteries. The use of intraoperative balloon-expandable stents (BESs) in the visceral arteries during open thoracoabdominal aneurysm repair was first described in 2004 by Lemaire et al, who reported 93 patients. In that study, however, only 9% of the patients had postoperative imaging. In the current study, Patel et al describe their technique and midterm results in 67 patients who underwent BES placement into the ri......
POSTED 01/31/2010 at 06:00 PM --
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Secondary Intervention After Endovascular Abdominal Aortic Aneurysm Repair
Conclusion: Secondary interventions are common after endovascular aneurysm repair but do not adversely affect aneurysm related death or overall actuarial 5-year survival. Summary: A substantial number of secondary interventions are performed in patients who have undergone endovascular aneurysm repair (EVAR). Rates of secondary intervention range from 10% to 18%, with most problems addressed with endovascular procedures. The authors sought to determine the indications for secondary interventions after EVAR in their institution and the effect of these interventions on long-term survival. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Endovascular Repair of Thoracoabdominal Aortic Aneurysms
Objectives: To evaluate the early outcomes following thoracoabdominal aortic aneurysm (TAAA) repair utilising fenestrated and branched endografts. Design and materials and methods: A prospective analysis of all patients undergoing endovascular repair of TAAA in a single academic centre. All patients were deemed unfit for open surgical repair. Customised endografts were designed using CT data reconstructed on 3D workstations. Post-operatively all patients were evaluated radiologically at hospital discharge, at 6, 12, 18 and 24months, and annually thereafter. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Outcomes of Symptomatic Abdominal Aortic Aneurysm Repair: A Multicenter Review from the Vascular Surgery Study Group of Northern New England (VSGNNE)
Objective: Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (AAA) repair has been reported to be 6% to 30% during the past 25 years. We sought to describe the contemporary outcomes of patients undergoing repair of symptomatic AAA using a multicenter, regional database. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Volume Outcome Relationship for Endovascular Aortic Aneurysm Repair and Open Abdominal Aortic Aneurysm Repair in United States Medicare Patients
Introduction: Mortality after open abdominal aortic aneurysm (AAA) repair is inversely proportional to procedure volume. It is unclear if this is true for endovascular AAA repair (EVAR) or if EVAR volume predicts outcome with open repair or vice versa. This will become important as centers shift volume to EVAR. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Accuracy of Cardiac Risk Prediction Models in Patients Undergoing Open Abdominal Aortic Aneurysm Repair or Lower Extremity Bypass
Objective: The Revised Cardiac Risk Index (RCRI) is a widely used model for predicting cardiac events after noncardiac surgery. We tested the accuracy of the RCRI in vascular surgery patients compared with a specific model developed from these patients. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Preoperative Statin Therapy Is Associated with Improved Outcomes and Lower Resource Utilization in Patients Undergoing Open or Endovascular Aortic Aneurysm Repair
This study hypothesized that preoperative statin therapy would have a protective effect on patients undergoing elective abdominal aortic aneurysm (AAA) repair owing to the pleiotropic effect of these agents. (Source: Journal of Vascular Surgery)...
POSTED 01/31/2010 at 06:00 PM --
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Morphometric analysis of anatomic variables affecting endovascular stent design in patients undergoing elective and emergency repair of endovascular abdominal aortic aneurysm.
CONCLUSION: Significant anatomic differences between elective and emergency patients will require hospitals to stock separate endovascular devices to treat abdominal aortic aneurysms in both groups.
PMID: 20100409 [PubMed - in process] (Source: Canadian Journal of Surgery)...
POSTED 01/29/2010 at 12:14 AM --
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Pulmonary Sequestration Supplied by Giant Aneurysmal Aortic Branch [CASE REPORTS]
We report a case of an intralobar sequestration supplied by a 13-cm aneurysmal vessel originating from the abdominal aorta. The malformation was discovered during a roentgenogram investigation of an abdominal infrarenal aneurysm. During the endovascular repair of the abdominal aneurysm, the giant feeding vessel of the pulmonary sequestration was embolized. Two days later the patient underwent an uneventful resection of the malformation en bloc with the right lower lobe through a standard right thoracotomy. (Source: The Annals of Thoracic Surgery)...
POSTED 01/27/2010 at 01:27 PM --
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Improved Cannulation: Technique for Thoracoabdominal Aortic Aneurysm Repair [CORRESPONDENCE]
(Source: The Annals of Thoracic Surgery)...
POSTED 01/27/2010 at 01:27 PM --
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Type B Aortic Dissections: Risk Factors and Outcome of Medical and Surgical Management
Conclusion: Early mortality for type B dissections has been shown to be 10-15% which is consistent with the findings in this study. The low mortality in the surgical group is likely a reflection of the small sample size though the results are encouraging. We are using TEVAR for intervening on complicated type B dissections with malperfusion to improve short term outcomes. We look forward to reporting the long term outcomes of these patients. (Source: Journal of Surgical Research)...
POSTED 01/25/2010 at 10:42 AM --
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Composite Quality Measures for Abdominal Aortic Surgery: Moving Beyond Hospital Volume
Background: The Leapfrog Group, a consortium of healthcare purchasers, reports quality rankings on major surgery from hospitals nationwide. The Leapfrog Group uses a “Survival Predictor”, a composite measure, to generate rankings of surgical quality. We assessed whether this composite measure discriminates differences in quality between hospitals better than hospital volume alone. Methods: Data from the Leapfrog Hospital Survey (2008) from all hospitals performing elective abdominal aortic aneurysm repairs (N=623) was obtained. Leapfrog ranks hospitals using the “Survival Predictor”, a composite measure that incorporates both mortality and hospital volume. The composite measure is calculated by combining the mortality rate with the mortality expected given the hospitals volume usin......
POSTED 01/25/2010 at 10:41 AM --
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Hospital Quality Rankings in Vascular Surgery: The Impact of Adjusting for Reliability
Conclusions: Adjusting mortality for reliability reduces statistical noise and provides more stable estimates of hospital quality. This technique should be standard for reporting relative hospital quality. (Source: Journal of Surgical Research)...
POSTED 01/25/2010 at 10:41 AM --
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Emergency Endovascular Repair for Ruptured Abdominal Aortic Aneurysms Results in Improved Outcomes
Conclusion: Historically, the literature has demonstrated a mortality of around 48% in patients with rAAA that reach the hospital. Our study found a statistically significant reduction in mortality by nearly half. In addition, a reduction in ICU stay, total hospital stay, and blood loss were demonstrated in comparison to the traditional open AAA repair. These data support the use of emergency EVAR in patients with rAAA that meet the standard criteria for EVAR. (Source: Journal of Surgical Research)...
POSTED 01/25/2010 at 10:41 AM --
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Investigation of Reduced Permeability Expanded Polytetrafluoroethylene Graft Material for Endovascular Aortic Aneurysm Repair Using a Canine Model
Conclusion: The new low permeable Gore ePTFE graft significantly reduced the intra-aneurysmal pressure as compared to the original Gore graft. These pressure readings were eqivalent to the low porosity, commercially available dacron stent grafts. This correlates with clinical data indicating decreased sac size and no progression in sac expansion in the abscence of an endoleak. (Source: Journal of Surgical Research)...
POSTED 01/25/2010 at 10:41 AM --
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Is CT Scan Useful for the Diagnosis Bowel Ischemia in Cardiac Surgical Patients?
Conclusions: Laparotomy is a late complication in cardiac surgical patients. The 30-day mortality rate reported here is lower than the rate reported in a previous large retrospective study of cardiac surgery patients with GIC, and most patients will survive hospitalization. CT scan was less sensitive and specific for the diagnosis of bowel ischemia. (Source: Journal of Surgical Research)...
POSTED 01/25/2010 at 10:40 AM --
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Increased Phosphorylated Extracellular Signal-Regulated Kinase (ERK) in Abdominal Aortic Aneurysms in a Rodent Model and in Humans
Conclusions. These data document increased phosphorylated ERK in a rodent AAA model, as well as in human AAAs compared with control tissue. These data support the role of ERK in modulating the inflammatory and extracellular matrix remodeling environment that occurs during AAA formation. (Source: Journal of Surgical Research)...
POSTED 01/25/2010 at 10:40 AM --
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Unexpectedly difficult intubation caused by subglottic stenosis in Wegener’s granulomatosis
Abstract A 76-year-old woman was scheduled to undergo abdominal aortic repair for progressive abdominal aortic aneurysm. After inducing
general anesthesia, the 7.5-mm internal diameter (ID) tracheal tube could not be advanced below the level of the vocal cords
because of resistance, and intubation was re-attempted several times using smaller tubes. An otolaryngologist was consulted
and subglottic stenosis of unknown origin was suggested. The aortic repair was cancelled and tracheostomy was performed instead.
She was diagnosed with Wegener’s granulomatosis 46 days after the operation because she developed symptoms of renal dysfunction,
hemoptysis, gastrointestinal bleeding, and presence of anti-neutrophil cytoplasmic autoantibodies (c-ANCA). The patient was
treated w......
POSTED 01/22/2010 at 04:09 AM --
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Abdominal Aortic Aneurysm Repair in Obese Patients: Improved Outcome After Endovascular Treatment Compared With Open Surgery
Conclusions: We observed improved short-term outcomes among obese AAA patients after EVAR compared to open repair. Endovascular repair may be preferable in obese patients with AAA. (Source: Vascular and Endovascular Surgery)...
POSTED 01/20/2010 at 06:05 AM --
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