Short Term and Long Term Outcomes After Endovascular or Open Repair for Ruptured Infrarenal Abdominal Aortic Aneurysms in the Vascular Quality Initiative
Repair of ruptured infrarenal abdominal aortic aneurysms (rAAA) has shifted from open surgical (OAR) to endovascular (EVAR) over the last decade. However, the long term impact of EVAR vs. OAR for rAAA has not been well described.
Mycotic aneurysms of the abdominal aorta (MAAA) can be treated by open repair (OR) or endovascular aneurysm repair (EVAR). This nationwide study provides an overview of the situation of MAAA treatment in The Netherlands in 2016.
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).
There is heterogeneity in practice with limited data to guide for access type when treating ruptured abdominal aortic aneurysms (rAAA) with EVAR. Our study ’s objective was to evaluate access type in rAAA and its associated outcomes.
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In their editorial on the (unpublished) National Institute of Clinical Excellence (NICE) abdominal aortic aneurysm (AAA) guidelines, Liapis et al.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.