Dutch Experience with Evas Relining after Failure of Open or Endovascular AAA Treatment
The objective of the current study is to describe the Dutch experience with relining a failed open or endovascular AAA with EVAS.
Existing data regarding endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) are conflicting in their findings. The purpose of this paper was to determine the long-term outcomes of EVAR vs open surgical repair (OSR) for treatment of rAAA.
ConclusionsAlthough endovascular procedures for repairing juxtarenal AAAs, such as fenestrated EVAR, have been developed, surgical repair is the standard treatment for juxtarenal AAAs. Morbidity and mortality due to open surgery were not higher in the juxtarenal AAA group than in the infrarenal AAA group. Therefore, need for suprarenal clamp should not preclude OSR and also there is continued need for training in surgical exposure of juxtarenal AAA and OSR.
Local market competition has been previously associated with more aggressive surgical decision making. For example, more local competition for organs is associated with acceptance of lower quality kidney offers in transplant surgery. We hypothesized that market competition would be associated with size of abdominal aortic aneurysm (AAA) at time of elective endovascular aneurysm repair (EVAR).
We read with interest Mr Armon's letter and we agree with his notion that the pendulum may have already swung too far in some instances in favour of endovascular aneurysm repair (EVAR). We're all witnessing irrational use of EVAR and subsequent bad outcomes related to poor patient/anatomy selection. However, this cannot justify abandonment of EVAR. This is a good reason to initiate measures for the appropriateness of care, and to monitor and inform users of their poor anatomy selection or outcomes (outliers amongst their peers) through the existing quality initiatives (e.g.
In their editorial on the (unpublished) National Institute of Clinical Excellence (NICE) abdominal aortic aneurysm (AAA) guidelines, Liapis et al. argue that these swing the pendulum too far in favour of open surgery,1 but in doing so fail to acknowledge that the balance may already have swung too far in favour of endovascular aneurysm repair (EVAR).
CONCLUSIONS: Most patients eligible for AAA repair present with baseline erectile and sexual dysfunction. Laparoscopic AAA repair provides no onset of erectile or sexual dysfunction but a global improvement after surgery. Ejaculation troubles are frequent and persistent at 1 year. However, EVAR treatment, doesn't allow recovering of sexual function at 1 year. LEVEL OF EVIDENCE: 4. PMID: 31959570 [PubMed - as supplied by publisher]
ConclusionsStriking differences in the relative numbers of unruptured AAA repairs and in the population characteristics in various districts of the country point to the possibility of different health needs in the regions and variations in standards of care.
CONCLUSIONS: Striking differences in the relative numbers of unruptured AAA repairs and in the population characteristics in various districts of the country point to the possibility of different health needs in the regions and variations in standards of care. PMID: 31978695 [PubMed - as supplied by publisher]
Trials for endovascular aneurysm repair (EVAR) report lower perioperative mortality and morbidity, but also higher costs compared with open repair. However, few studies have examined the subsequent cost of follow-up evaluations and interventions. Therefore, we present the index and 5-year follow-up costs of EVAR from the Endurant Stent Graft System Post Approval Study.
Authors: Borioni R, Guarnera G, Fratticci L, Tesori MC, Paciotti C, Cotticelli V, Garofalo M Abstract AIM: The purpose of this study was to examine the influence of aneurysm size on early outcome in women undergoing abdominal aortic aneurysm (AAA) repair, with suggestion of lowered threshold for intervention. PATIENTS AND METHODS: Retrospective cohort study on the early outcome of 25 females undergoing elective endovascular (EVAR) and open AAA repair, compared to 340 males from 2005 to 2017. The study was focused on 30-days mortality (primary endpoint) and incidence of non fatal major adverse events - MAE (seco...