Endovascular repair of ruptured abdominal aortic aneurysm is superior to open repair: Propensity-matched analysis in the Vascular Quality Initiative
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.
The study by Baderkhan et al.1 is a retrospective analysis of prospectively recorded data of patients having had endovascular abdominal aortic aneurysm repair (EVAR) between 1998 and 2012 at two Swedish centres. The authors reached two conclusions after analysing the cohorts compliant and not compliant with a post-EVAR su rveillance protocol. The compliant protocol required early post-EVAR computed tomographic angiography (CTA) imaging and annual follow up imaging with CTA and/or duplex ultrasound (DUS).
We present a case of ruptured abdominal aortic aneurysm with an aortocaval fistula that was successfully treated with percutaneous endovascular aneurysm repair under local anaesthesia. Despite a persistent type 2 endoleak the aneurysm sack shrank from 8.4cm to 4.8cm in 12 months. The presence of an aortocaval fistula may have depressurised the aneurysm, resulting in less bleeding retroperitoneally and may have promoted rapid shrinkage of the sac despite the presence of a persistent type 2 endoleak. PMID: 32436721 [PubMed - as supplied by publisher]
A ruptured abdominal aortic aneurysm (rAAA) remains one of the most challenging, morbid, and mortal conditions that confronts a vascular surgeon. A number of patient-, surgeon-, and systems-based factors determine whether the optimal approach to care for these challenging patients is endovascular aneurysm repair (EVAR) or open surgical repair (OSR). In this issue of the Journal, Salata et al1 compare the short- and long-term results of EVAR and OSR for rAAA in Ontario between 2003 and 2016. They demonstrate that EVAR is associated with significant benefit in 30-day mortality and a reduction in major adverse cardiac events.
To investigate the effect of hostile aortic anatomy on the outcomes of endovascular and open repair for ruptured abdominal aortic aneurysm (AAA).
Type II endoleaks (T2ELs) are the most common type of endoleaks after endovascular abdominal aortic aneurysm repair (EVAR). The iliolumbar artery arising from the hypogastric artery is often a major source of T2ELs, and transarterial embolization of the iliolumbar artery via the hypogastric artery is sometimes performed to interrupt sac expansion during follow-up. Considering the equivocal results regarding an association between hypogastric embolization and T2ELs in previous studies, this topic has re-emerged after the advent of iliac branch devices.
CONCLUSIONS: EVAR using TREO device seems to be safe and effective treatment for unselected patients suffering AAA. Particularly this device seems to be suitable as workhorse device in a single center with skillness between open and endovascular techniques. PMID: 32401472 [PubMed - as supplied by publisher]
Authors: Martinelli O, Di Girolamo A, Irace L, Baratta F, Gossetti B, Gattuso R Abstract BACKGROUND: Postimplantation syndrome (PIS) is a systemic inflammatory response occurring in early phase after abdominal aortic aneurysm (AAA) endovascular repair (EVAR). PIS can also occur after endovascular aneurysm sealing (EVAS) with Nellix system which prevent new onset of mural thrombus inside. Aim was to compare the incidence of PIS after EVAS and EVAR in order to evaluate the possible role of the new-onset thrombus inside the aneurysmal sac. Secondary aims were to assess the effect of AFX (Endologix) endoskeleton compar...
The aim of this report is to discuss emergent repair for complex aortic diseases in patients affected by novel coronavirus pneumonia (COVID-19), describing a case of ruptured pararenal aortic aneurysm.A COVID-19, eighty-years-old man was admitted for ruptured aneurysm of the pararenal aorta and hemorrhagic shock. Endovascular repair was chosen and a proximal extension of the previous abdominal endograft was performed with parallel stents in the right renal artery and the superior mesenteric artery.
Conflicting evidence exists regarding the comparative effects of endovascular abdominal aortic aneurysm repair (EVAR) with and without suprarenal fixation. We compare outcomes in patients treated by EVAR with baseline normal, moderate and severe chronic kidney disease.
We report a patient that presented with acute abdominal pain during the COVID-19 pandemic. His workup revealed rupture of a 5.8 cm abdominal aortic aneurysm. He presented with fever, cough, and shortness of breath and radiologic evidence of COVID-19 infection. After careful consideration, he underwent successful endovascular repair under local anesthesia with good short-term results.