Endovascular and open surgical repair of abdominal aortic aneurysms: A comparative analysis of western and Chinese studies.
Endovascular and open surgical repair of abdominal aortic aneurysms: A comparative analysis of western and Chinese studies. Rev Cardiovasc Med. 2020 Mar 30;21(1):75-92 Authors: Shi F, He Y, Wang S, Jia F, Ji C, Zhang J, Liu X, Han Y Abstract Abdominal aortic aneurysms (AAA) are life-threatening serious conditions that require effective and quick management. Although it is generally acknowledged that patients with AAA obtain the greatest benefit from endovascular repair (EVAR) compared to open surgical repair (OSR), there are few comparisons between the surgical approaches in Western versus Chinese patients. We aimed to perform a meta-analysis of studies in which EVAR was compared with OSR in the management of abdominal aortic aneurysms. We searched the Western literature through PubMed, OVID and Web of Science from 1991 until December 2018 and the Chinese-language literature from 1998 until December 2018. We pooled the results in January 2019 based on standardized inclusion and exclusion criteria and analyzed them using a conventional meta-analysis. Forty-five English papers with 31,074 AAA patients and twenty-one Chinese studies with 1,405 patients were included in this study. Chinese subjects were more likely to undergo endovascular repair than Western subjects (44.5% versus 41.5%, P = 0.012). The 30-day post-discharge mortality rate in Western studies was significantly lower for EVAR than for OSR (odds ratio (OR) = 0.481, P
The objective of this study was to propose a new decision-making method for emergency surgeries, endovascular aortic repair (EVAR) or open repair (OR) for rAAA based on Fitzgerald classification using preoperative CT images.
Branched endovascular repair (BEVAR) is well established in the treatment of thoraco-abdominal aortic aneurysms (TAAA). Despite high technical success rates, the literature reports considerable re-intervention rates associated with the bridging stent grafts (BrSG). One of the most challenging complications is BrSG migration from the target vessel (type Ic endoleak according to newer classification). An endovascular technique to address seal failure due to BrSG migration that can be applied to any dislocated BrSG is demonstrated.
ConclusionOur results suggest that the use of the NMOC-3WAY catheter® for the injection of 2% lidocaine into the urethra does not reduce the incidence of CRBD immediately after EVAR. However, it may reduce moderate or severe CRBD that may lead to postoperative distress and agitation.
Anatomical variations of the renal arteries may complicate endovascular repair of infrarenal abdominal aortic aneurysms (AAA). Occlusion of renal branches may be necessary to seal the aneurysm sac efficiently. Depending on the size of the affected renal arteries and the supplied parenchyma, this can lead to loss of renal function.Iliac branch devices (IBDs) have been created in order to preserve the internal iliac artery in aortoiliac or isolated iliac aneurysms; however, IBDs have the potential to maintain patency of other arteries as well.
To identify candidates undergoing elective endovascular aneurysm repair (EVAR) of asymptomatic infrarenal abdominal aortic aneurysm who are eligible for early ( ≤6 hours) hospital discharge or to have EVAR performed in free-standing ambulatory surgery centers.
Three out of four patients with infrarenal abdominal aortic aneurysm (AAA) are now treated with endovascular aneurysm repair (EVAR). The incidence of secondary procedures and surgical conversions is increasing for a population theoretically unfit for open surgery. The indications and outcomes of late open surgical conversions (LOC) after EVAR in a high volume tertiary vascular unit are reported.
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.
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.