Psoas muscle area as a predictor of mortality and morbidity following endovascular aneurysm repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

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Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair

British Journal of Surgery ◽

10.1002/bjs.11074 ◽

2019 ◽

Vol 106 (4) ◽

pp. 367-374 ◽

Cited By ~ 12

Author(s):

M. A. Waduud ◽

B. Wood ◽

P. Keleabetswe ◽

J. Manning ◽

E. Linton ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Psoas Muscle ◽

Abdominal Aortic Aneurysm Repair ◽

Muscle Area ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair ◽

Elective Abdominal Aortic Aneurysm

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Predictors of All-Cause Mortality after Endovascular Aneurysm Repair: Assessing the Role of Psoas Muscle Cross-Sectional Area

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.04.032 ◽

2019 ◽

Vol 30 (12) ◽

pp. 1972-1979 ◽

Cited By ~ 4

Author(s):

Timothy C. Huber ◽

Nicole Keefe ◽

James Patrie ◽

Margaret C. Tracci ◽

Daniel Sheeran ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Psoas Muscle ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

All Cause Mortality ◽

Aneurysm Repair ◽

Muscle Cross Sectional Area

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Impact of the Type of Anesthesia on Outcome after Elective Endovascular Aortic Aneurysm Repair: Literature Review

Vascular ◽

10.2310/6670.2008.00053 ◽

2008 ◽

Vol 16 (6) ◽

pp. 340-345 ◽

Cited By ~ 17

Author(s):

Umar Sadat ◽

David G. Cooper ◽

Jonathan H. Gillard ◽

Stewart R. Walsh ◽

Paul D. Hayes

Keyword(s):

Hospital Stay ◽

General Anesthesia ◽

Endovascular Aneurysm Repair ◽

Postoperative Mortality ◽

Postoperative Outcomes ◽

Mortality And Morbidity ◽

Icu Stay ◽

Locoregional Anesthesia ◽

Aneurysm Repair ◽

The Impact

The type of anesthesia used during aneurysm repair affects postoperative outcomes for the patient. Although endovascular aneurysm repair (EVAR) appears to improve surgical outcomes, by convention, general anesthesia remains predominantly used. The aim of this study was to compare the impact of the type of anesthesia (ie, locoregional versus general anesthesia) on the outcomes following EVAR. A literature search was carried out using the PubMed search engine to find relevant published articles that compared locoregional and general anesthesia in patients undergoing EVAR. The review of the selected studies showed that although patients in the locoregional group were less medically fit compared with those in the general anesthesia group, there was a reduction in the cardiovascular support required during and after the surgery, postoperative hospital stay, intensive care unit (ICU) stay, and postoperative mortality and morbidity. Although there is no level 1 evidence for or against locoregional anesthesia in EVAR, conventionally, EVAR has been performed under general anesthesia. But this is rooted in tradition rather than evidence. This review suggests that locoregional anesthesia can improve postoperative outcomes following EVAR by reducing hospital stay, ICU stay, mortality, and morbidity, although other factors may also have some influence.

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Loco-regional versus general anaesthesia for elective endovascular aneurysm repair – results of a cohort study and a meta-analysis

VASA ◽

10.1024/0301-1526/a000688 ◽

2018 ◽

Vol 47 (3) ◽

pp. 209-217 ◽

Cited By ~ 8

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Kelvin Adasonla ◽

Stavros A. Antoniou ◽

Janet Barrie ◽

...

Keyword(s):

Hospital Stay ◽

General Anaesthesia ◽

Meta Analysis ◽

Group Analysis ◽

Endovascular Aneurysm Repair ◽

Anaesthetic Techniques ◽

Perioperative Mortality ◽

Level Of Evidence ◽

Mortality And Morbidity ◽

Aneurysm Repair

Abstract. Background: The aim of this study was to investigate whether patients undergoing elective endovascular aneurysm repair (EVAR) with loco-regional anaesthetic techniques have better outcomes than those treated with general anaesthesia (GA). Patients and methods: We retrospectively evaluated outcomes of EVAR performed with regional anaesthesia (RA) or GA over a five-year period. Furthermore, we searched electronic bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) to identify studies comparing different anaesthetic methods in EVAR. We defined perioperative mortality and morbidity as well as length of hospital stay (LOS) as the primary outcome measures. Pooled effect estimates were calculated using fixed-effect or random-effects models. Results are reported as the odds ratio (OR) or mean difference (MD) and 95 % confidence interval (CI). Results: Three hundred and fifty-five patients underwent standard EVAR over the study period (RA, 215 patients; GA 140 patients). Patients in both groups had comparable baseline demographics and clinical characteristics. Perioperative mortality was significantly lower in the RA group (0.5 % vs. 4.3 %, P = 0.017). No difference was found in perioperative morbidity (P = 0.370), LOS (P = 0.146), postoperative destination (P = 0.799), reoperation (P = 0.355) or readmission within 30 days (P = 0.846). Meta-analysis of data on 15,472 patients from 15 observational studies found a significantly lower perioperative mortality (OR 0.70, 95 % CI 0.52–0.95, P = 0.02) and morbidity (OR 0.73, 95 % CI 0.55–0.96, P = 0.02) in patients treated with loco-regional anaesthetic techniques compared to those treated with GA. Our sub-group analysis demonstrated that both local anaesthesia (LA) (P = 0.003) and RA (P < 0.0001) were associated with a significantly shorter LOS compared to GA. Conclusions: Local and/or regional anaesthetic techniques may be advantageous over GA in elective EVAR, as indicated by reduced perioperative mortality and morbidity and a shorter hospital stay. Considering the current level of evidence, LA or RA should be considered in selected patients. Further clinical research is required to provide high level evidence on the optimal anaesthetic technique in EVAR.

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