Current Status and Perspectives on Pharmacologic Therapy for Abdominal Aortic Aneurysm.
Current Status and Perspectives on Pharmacologic Therapy for Abdominal Aortic Aneurysm. Curr Drug Targets. 2017 Dec 27;: Authors: Yoshimura K, Morikage N, Nishino-Fujimoto S, Furutani A, Shirasawa B, Hamano K Abstract Abdominal aortic aneurysm (AAA), a common disease involving the segmental expansion and rupture of the aorta, has a high mortality rate. Therapeutic options for AAA are currently limited to surgical repair to prevent catastrophic rupture. Non-surgical approaches, particularly pharmacotherapy, are lacking for the treatment of AAA. Here, we review both basic and clinical studies and discuss the current challenges to developing medical therapy that reduces AAA progression. Studies using animal models of AAA progression and human AAA explant cultures have identified several potential targets for preventing AAA growth. However, no clinical studies have convincingly confirmed the efficacy of any pharmacologic treatment against the growth of AAA. Thus, there is as yet no strong recommendation regarding pharmacotherapy to reduce the risk of AAA progression and rupture. This review identifies concerns that need to be addressed for the field to progress and discusses the challenges that must be overcome in order to develop effective pharmacotherapy to reduce AAA progression in the future. PMID: 29284386 [PubMed - as supplied by publisher]
We appreciate the interest of Dr Kakkos and colleagues in our recent article comparing crossed and standard limb configurations in endovascular abdominal aortic repair (EVAR).1 As discussed previously, the performance of the stent graft configuration can be affected by the device type, and further investigation of other devices is needed. Regarding this issue, we are delighted to receive the comments from Dr Kakkos and colleagues sharing their valuable experience in stent graft configuration of the Gore Excluder device.
As a result of a significant risk of rupture with increasing infrarenal abdominal aortic aneurysm (AAA) diameter, current guidelines recommend consideration of elective repair in patients whose AAA is ≥ 5.5 cm (with a suggested lower threshold for female patients), symptomatic, or growing by> 1 cm/year.1 Pre-operative assessment of cardiopulmonary fitness, including respiratory function, is of paramount importance and all patients should have their respiratory disease assessed/optimised before surgery.
Previously, reports have shown that women experience a higher mortality rate than men after elective open (OAR) and endovascular (EVAR) repair of abdominal aortic aneurysm (AAA). With recent improvements in overall AAA repair outcomes, this study aimed to identify whether sex specific disparity has been ameliorated by modern practice, and to define sex specific differences in peri- and post-operative complications and pre-operative status; factors which may contribute to poor outcome.
Diagn Interv Radiol. 2021 Jul;27(4):570-572. doi: 10.5152/dir.2021.20369.ABSTRACTType III endoleak is an uncommon but life-threatening complication of endovascular aortic repair, and such leaks at certain sites can be challenging to treat through an endovascular route. A 77-year-old man presented with severe abdominal pain and was found to have an abdominal aortic aneurysm with contained rupture due to an unfavorably cited type IIIb endoleak. He was successfully treated with an endovascular approach using bilateral iliac limb proximal extension combined with embolization of endoleak sac, endoleak site and the feeding reces...
AbstractThe reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture...
Accurate and contemporary prognostic risk prediction is essential to inform clinical decision-making surrounding abdominal aortic aneurysm (AAA) care. Therefore, we validated and compared three different in-hospital mortality risk scores in one administrative and two quality improvement registries.
In a recent analysis, we discovered lower mortality after open abdominal aortic aneurysm repair (OAAA) in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) database when compared to previously published reports of other national registries. Understanding differentials in these registries is essential for their utility since such datasets increasingly inform clinical guidelines and health policy.
In this study Esryd and colleagues identified risk factors associated with the development of abdominal compartment syndrome (ACS) following endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA).1 Patients treated by EVAR for rAAA between 2008 and 2015 were identified in the Swedish vascular registry (Swedvasc) and patients that developed ACS were compared with matched controls that did not. After multivariable logistic regression multiple red blood cell transfusions remained the sole statistically significant risk factor for the development of ACS.
CONCLUSIONS: Use of IOCM vs LOCM in patients at high risk of AKI undergoing EVAR procedures was associated with a lower risk of MARCE. As prevention of AKI or cardiovascular events after EVAR procedures may lead to reduced morbidity and mortality, this finding may have important clinical implications and should be confirmed through randomized controlled clinical studies.PMID:34280892