Meta-Analysis and Meta-Regression Analysis of Outcomes of Endovascular and Open Repair for Ruptured Abdominal Aortic Aneurysm.

Meta-Analysis and Meta-Regression Analysis of Outcomes of Endovascular and Open Repair for Ruptured Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg. 2020 Jan 11;: Authors: Kontopodis N, Galanakis N, Antoniou SA, Tsetis D, Ioannou CV, Veith FJ, Powell JT, Antoniou GA Abstract OBJECTIVES: The aim was to assess peri-operative mortality of endovascular aneurysm repair (EVAR) vs. open repair for ruptured abdominal aortic aneurysm (AAA) and to investigate whether outcomes have improved over the years and whether there is an association between institutional caseload and peri-operative mortality. METHODS: Electronic information sources (MEDLINE, EMBASE, CINAHL and CENTRAL) were searched up to August 2019. A systematic review was carried out according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a registered protocol (CRD42018106084). Studies were selected that reported peri-operative mortality of EVAR for ruptured AAA. A proportion meta-analysis was conducted, and summary estimates of odds ratios (ORs) and 95% confidence intervals (CIs) for EVAR vs. open surgical repair were obtained using random effects models. Mixed effects regression models were developed to investigate outcome changes over time and with institutional caseload. RESULTS: One hundred and thirty-six studies were included in quantitative synthesis reporting a total of 267 259 patients (EVAR 58 273; open surgery 208 9...
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research

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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.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
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.
Source: World Journal of Surgery - Category: Surgery Source Type: research
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).
Source: Annals of Vascular Surgery - Category: Surgery Authors: Source Type: research
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.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Tags: Correspondence Source Type: research
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).
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Tags: Correspondence Source Type: research
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]
Source: Progres en Urologie - Category: Urology & Nephrology Tags: Prog Urol Source Type: research
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.
Source: Advances in Medical Sciences - Category: Biomedical Science Source Type: research
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]
Source: Advances in Medical Sciences - Category: Biomedical Science Authors: Tags: Adv Med Sci Source Type: research
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.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
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...
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
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