Response to “Re. Proposed NICE Abdominal Aortic Aneurysm Repair Guidelines: Swinging the Pendulum too Far?”

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

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Patients who undergo endovascular aneurysm repair (EVAR) often require reintervention after the index repair. The long-term rate of reintervention and how this has changed with newer device technology are poorly understood. Therefore, we performed a systematic review and meta-analysis of the available literature to determine long-term freedom from reintervention after EVAR and the change in reintervention rates over time.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
The few randomized trials comparing endovascular with open surgical repair of ruptured abdominal aortic aneurysm (rAAA) were poorly designed and heavily criticized. The short-term and midterm survival advantages of endovascular repair remain unclear. We sought to compare the two treatment modalities using a propensity-matched analysis in a real-world setting.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
The objective of this study was to report the 5-year outcomes of the Food and Drug Administration investigational device exemption clinical trial of endovascular aneurysm repair (EVAR) with the Ovation stent graft (Endologix, Irvine, Calif) for elective treatment of abdominal aortic aneurysm (AAA).
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
Posthospital syndrome (PHS) is an acquired, transient period of health vulnerability after a hospital admission for acute illness. It is characterized by physiologic deconditioning secondary to stressors from disruption in circadian rhythm, depletion of nutritional and physiologic reserve as well as the pain and discomfort associated with hospitalization. PHS is reported as an independent risk factor for readmission and adverse postoperative outcomes. The aim of this study is to investigate whether preoperative hospitalization affects outcomes of elective endovascular repair of abdominal aortic aneurysm (EVAR).
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
Abstract BACKGROUND: The aim is to define the prevalence, the evolution and the clinical relevance of the intraprosthetic thrombus deposit (IPT) after endovascular abdominal aortic repair (EVAR). METHODS: Patients treated with EVAR from 2009 to 2017 for abdominal aortic aneurysm were retrospectively considered. Patients with at least one post-operative computed tomography angiography (CTA) performed after a 3-month follow-up were included. Post-operative medical therapy (antiplatelet and/or oral anticoagulant) were recorded. Aorto-iliac anatomical characteristics were measured on pre-operative CTA, while stru...
Source: The Journal of Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: J Cardiovasc Surg (Torino) Source Type: research
Popliteal artery aneurysm (PAA) carries a risk of sudden thromboembolism resulting in acute limb ischaemia (ALI). Since 2010, all 65 years old men in Region Sk åne are invited for abdominal aortic aneurysm (AAA) screening, and subsequently for PAA if AAA is detected.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
The present study evaluates aneurysmal sac remodeling and the loss of intercostal arteries after the first step of staged treatment of thoraco-abdominal aortic aneurysms (TAAA). The purpose of this approach is to keep the aneurysmal sac temporarily perfused in order to induce progressive thrombosis of the aneurysm while simultaneously allowing the spinal cord to establish adequate perfusion thereby promoting the development of collateral circulation.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
Endovascular aortic aneurysm repair (EVAR) is associated with the risk of late complications and mandates follow up. This retrospective study assessed post-EVAR complications in a two centre cohort. The study evaluated the rate of complications presenting with symptoms vs. those detected by imaging follow up. Additionally, the agreement between DUS and CTA in detecting complications was assessed in patients with both.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Tags: Observational Study Source Type: research
CONCLUSION: Approximately a quarter of the patients developed complications, the majority of which were asymptomatic, underlining the importance of adequate surveillance. There was good agreement between CTA and DUS in detecting complications. Clinically significant complications related to inadequate seal were missed by DUS, suggesting that CTA still plays an important role in EVAR surveillance. PMID: 32209282 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
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.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Selected abstracts from the march issue of the european journal of vascular and endovascular surgery Source Type: research
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