Experiences in the Surgical Management of Abdominal Aortic Aneurysms

1968 ◽  
Vol 13 (12) ◽  
pp. 416-424 ◽  
Author(s):  
D. W. Short ◽  
W. A. Mackey
Keyword(s):  
Mortality Rate ◽  
Bronchial Carcinoma ◽  
Abdominal Aortic Aneurysms ◽  
Well Being ◽  
Aortic Aneurysms ◽  
Rapid Expansion ◽  
Abdominal Aneurysm ◽  
Abdominal Aortic ◽  
Operative Complications ◽  
Overall Mortality

From 1954 until 1967, a total of 52 patients with abdominal aortic aneurysms were referred to the University Surgical Unit and in 44 instances the aneurysm was resected. Nine patients (including one who had the aneurysm resected at a later date) were either rejected for surgery on general grounds or were explored but did not have the aneurysm resected. These cases are discussed. Out of the 44 cases undergoing aneurysmectomy, 11 died during the operation or in the first week after the operation, giving an overall mortality rate of 25 per cent. There were 13 asymptomatic aneurysms with no deaths, 16 aneurysms with symptoms indicating rapid expansion of the aneurysm with 2 deaths (mortality rate of 12.5%) and 15 aneurysms which had ruptured with 9 deaths (mortality rate of 60%). The main operative complications were haemorrhage, cardiac arrest and peripheral arterial thrombosis. Post-operative complications were respiratory insufficiency, renal insufficiency or failure, bowel ischaemia, wound infection and wound dehiscence. Of the 44 patients operated upon, 33 survived operation and left the hospital alive. Three patients have been lost to follow-up and there were 9 known late deaths due to suture-line rupture (2), coronary artery thrombosis (1), renal failure (1), pneumonia (2), embolism (1), bronchial carcinoma (1). Twenty-one patients are still alive having survived the operation for periods ranging from 6 months to 9 years. Atherosclerotic aortic aneurysms occur in elderly patients with other evidence of advanced systemic atherosclerosis. Nevertheless, these aneurysms are specifically dangerous and in the absence of surgical treatment the majority of the patients may be expected to die from rupture of the aneurysm. At the present time, in good circumstances, resection of an unruptured aortic abdominal aneurysm has an overall mortality rate of less than 10 per cent but, should surgery be deferred until the aneurysm has ruptured, the operative mortality rate is 50 per cent or more. Patients surviving operation can expect a very satisfactory restoration of physical well-being.

Abdominal aortic aneurysm screening programme

2019 ◽  
Vol 13 (9) ◽  
pp. 430-434
Author(s):  
Ian Peate
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Screening Programme ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Ultrasound Scan ◽  
Abdominal Aneurysm ◽  
Abdominal Aortic ◽  
The Uk

This is the second article in a series of articles regarding screening programmes. In this article, an overview of the abdominal aorta is provided. The article also considers the abdominal aortic aneurysm screening programme. Aortic abdominal aneurysm is described. The majority of abdominal aortic aneurysms are asymptomatic; however, if there are any symptoms, these are explained. All four UK countries offer men aged 65 years and over a screening opportunity using an ultrasound scan, the fundamental aspects of abdominal aortic aneurysm screening programmes is offered. It is emphasised that screening is not mandatory in the UK; the man has a right to decline the invitation to attend any screening programme.

Flow-Induced Wall Pressure Under Average Resting Hemodynamic Conditions for Patient-Specific Abdominal Aortic Aneurysms

2002 ◽  
Author(s):  
Ender A. Finol ◽  
Shoreh Hajiloo ◽  
Keyvan Keyhani ◽  
David A. Vorp ◽  
Cristina H. Amon
Keyword(s):  
Imaging Techniques ◽  
Abdominal Aortic Aneurysms ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Mortality And Morbidity ◽  
Abdominal Aortic ◽  
Lethal Event ◽  
Overall Mortality

Abdominal Aortic Aneurysms (AAAs) are characterized by a continuous dilation of the infrarenal segment of the abdominal aorta. Despite significant improvements in surgical procedures and imaging techniques, the mortality and morbidity rates associated with untreated ruptured AAAs are still outrageously high. AAA disease is a health risk of significant importance since this kind of aneurysm is mostly asymptomatic until its rupture, which is frequently a lethal event with an overall mortality rate in the 80% to 90% range. From a purely biomechanical viewpoint, aneurysm rupture is a phenomenon that occurs when the mechanical stress acting on the dilating inner wall exceeds its failure strength. Since the internal mechanical forces are maintained by the dynamic action of blood flowing in the aorta, the quantification of the hemodynamics of AAAs is essential for the characterization of their biomechanical environment.

The use of heparin in patients with ruptured abdominal aortic aneurysms

Vascular ◽  
2012 ◽  
Vol 20 (2) ◽  
pp. 61-64 ◽  
Author(s):  
A P Graham ◽  
E Fitzgerald O'Connor ◽  
R J Hinchliffe ◽  
I M Loftus ◽  
M M Thompson ◽  
...  
Keyword(s):  
Open Repair ◽  
Abdominal Aortic Aneurysms ◽  
Outcome Data ◽  
Multiple Organ ◽  
Aortic Aneurysms ◽  
Cochrane Library ◽  
Abdominal Aneurysm ◽  
Heparin Administration ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms

The use of systemic heparin in patients with ruptured abdominal aortic aneurysms (rAAAs) remains a contentious issue with no clear guidelines. This review reports the current understanding, at a molecular and clinical level, of the possible benefits and risks of heparin in emergency aneurysm repair (both open and endovascular). MEDLINE, EMBASE, AMED, SCOPUS, CINAHL and Cochrane Library were searched for all articles containing the keywords ‘rupture’, ‘abdominal’, ‘aneurysm’ and ‘heparin’. Current experience, indications and outcomes were analyzed. Articles were searched for both endovascular and open repair of AAAs. A total of eight studies were included for analysis in the systematic review. Of these, only one paper focused specifically on heparin use in open repair of ruptures and suggested a benefit. Of the remaining seven, two were self-reporting retrospective studies assessing individual surgeons’ practice, one was a case report and the remaining four included mention of heparin use but with no outcome data. The evidence available suggests that a pro-coagulable state exists in rAAAs. This may be responsible for the morbidity and mortality postprocedure, which arises predominantly from multiple organ failure and cardiac compromise rather than outright hemorrhage. This diathesis may respond well to heparin administration, suggesting that heparin administration in ruptured aneurysms is appropriate.

Mortality after endovascular treatment of infrarenal abdominal aortic aneurysms – the newer the better?

VASA ◽  
2018 ◽  
Vol 47 (3) ◽  
pp. 187-196 ◽  
Author(s):  
Aspasia Tzani ◽  
Ilias P. Doulamis ◽  
Ioannis Katsaros ◽  
Eirini Martinou ◽  
Dimitrios Schizas ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Endovascular Treatment ◽  
Abdominal Aortic Aneurysms ◽  
Mortality Rates ◽  
Aortic Aneurysms ◽  
Late Mortality ◽  
Ruptured Aneurysms ◽  
Abdominal Aortic ◽  
Perioperative Bleeding

Abstract. Although endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) presents a delicate alternative treatment for abdominal aortic aneurysms (AAA) with lower perioperative mortality, its long-term efficacy remains a matter of concern. The purpose of this study was to evaluate the currently reported mortality evidence after EVAR and to examine the possible effect of aneurysm status and the study period on mortality rates. The PubMed and Cochrane bibliographical databases were thoroughly searched for studies reporting on more than 1 000 patients with non-ruptured or ruptured infrarenal AAA, treated with EVAR from August 1991 to September 2016. A total of 10 910 titles/abstracts were retrieved and 121 studies were deemed relevant. Twenty-six studies met the inclusion criteria and reported on 354 500 patients with a mean age of 74.6 years. Almost all of the studies referred to elective EVAR and the mean aneurysm size was 5.58 cm. The most common early complication for elective EVAR was perioperative bleeding (1.9 %), whereas hospital-acquired pneumonia was a major concern in urgent EVAR (28.5 %). Conversion rate to open surgery was 1.2 %. The 30-day all-cause mortality rate was 4.84 % (1.7 % for non- ruptured aneurysms, 33.8 % for ruptured aneurysms).The overall all-cause late mortality in a mean follow-up period of 23.8 months was 19.1 %. The aneurysm-related late mortality rate was 3.4 %. With respect to the time period of patient enrollment, studies reporting on patients recruited before 2006 were found to face more secondary complications and higher late mortality rates than patients enrolled after 2005.The endovascular treatment of large and anatomically suitable infrarenal AAA in selected patients remains a safe alternative to open repair. Our findings demonstrate that newer studies show better long-term outcomes than the older ones, proposing a possible improvement of EVAR techniques and perioperative care and providing encouraging evidence for a wider application of EVAR.

Mortality in endovascular and open abdominal aneurysm repair – trends in Germany

VASA ◽  
2018 ◽  
Vol 47 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Olga von Beckerath ◽  
Sebastian Schrader ◽  
Marcus Katoh ◽  
Bernd Luther ◽  
Frans Santosa ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aneurysm ◽  
General Increase ◽  
Death Rates ◽  
National Statistics ◽  
Abdominal Aortic ◽  
Open Aortic Repair ◽  
Males And Females ◽  
Aneurysm Repair

Abstract. Background: We analysed trends in mortality of endovascular (EVAR) and open aortic repair (OAR) in patients hospitalized for abdominal aortic aneurysms (AAA) in Germany from 2005 to 2015. Patients and methods: We used national statistics published by the Federal Statistical Office in Germany to calculate mortality rate of patients hospitalized with ruptured (rAAA, n = 2,448 in 2005, n = 2,180 in 2015) and non-ruptured (iAAA, n = 11,626 in 2005, n = 14,205 in 2015) AAA. Results: Considering only those who were treated with EVAR or OAR, treatment rates of iAAA with EVAR increased to 78.2 % in males and 72.6 % in females in 2015 and treatment rates of rAAA to 36.9 % and 40.7 %, respectively. In cases with iAAA, death rates associated with EVAR decreased in males from 2.1 to 1.1 % (p = 0.0005) in the period from 2005 to 2015 but not in females (1.8 % in 2005 and 2.3 % in 2015, p = 0.8511). Similar trends are seen in cases with rAAA (males 30.1 % and 24 %, p = 0.1034, females 36.4 to 37.3 %, p = 0.8511). Death rates associated with OAR increased in males from 4.7 % in 2005 to 5.7 % in 2015 (p = 0.0103) and tended to increase in females from 6.8 to 8.2 % (p = 0.1476). In cases of rAAA, there were no changes. EVAR treatment rates increased in cases with iAAA in both genders with age, as well as in males with rAAA, but not in females. OAR associated death rates increased with age in rAAA (from around 30 % in the sixth/seventh decade of life to almost 80 % in cases with patients over the age of 90) and in iAAA (from 1.1 to 20 %). Conclusions: The general increase in EVAR procedures in males and females hospitalized for rAAA and iAAA went along with a decrease in in-hospital mortality in males treated with EVAR for iAAA only and an increasing mortality in males treated with OAR for iAAA.

Assessment of the criteria for elective surgery in screen-detected abdominal aortic aneurysms

2005 ◽  
Vol 12 (3) ◽  
pp. 150-154 ◽  
Author(s):  
R Alan P Scott ◽  
Lois G Kim ◽  
Hilary A Ashton ◽  
Keyword(s):  
Direct Evidence ◽  
Elective Surgery ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Rapid Expansion ◽  
Aortic Diameter ◽  
Abdominal Aortic ◽  
Screening Study ◽  
Accepted Practice

Objectives: Apart from aortic diameter, two other widely used criteria for considering surgery in screen-detected abdominal aortic aneurysms (AAAs) - annual aortic expansion ≥1.0 cm and presence of symptoms attributable to the AAA 0 are based on accepted practice and AAA expansion rates, rather than direct evidence. The Multi-centre Aneurysm Screening Study (MASS) enables assessment of their contribution to this risk reduction. Methods: MASS employs three criteria for referral for considering elective open surgery: maximum aortic diameter ≥5.5 cm, rapid aortic expansion (≥1.0 cm/year), and/or the presence of symptoms attributable to the AAA. Data from MASS are used to examine the value of these criteria in practice. Results: No patients were referred for symptoms alone. Of those referred for rapid expansion, 88% were returned to surveillance, compared with only 12% of those referred for diameter ≥5.5 cm at initial scan, and 34% of those referred for diameter ≥5.5 cm at a follow-up scan. Return to surveillance following referral for rapid expansion was strongly associated with aortic diameter (age-adjusted odds ratio for return 0.89 per mm, 95% confidence interval 0.79-1.00). Of those 5.0-5.4 cm at the time of referral for rapid expansion who were returned, 31% reached 5.5 cm during a median post-referral follow-up of 0.9 years. Among those referred for expansion, the rupture rate was only 8 per 1000 person-years of follow-up prior to reaching 5.5 cm. Conclusions: A single criterion for considering elective surgery is recommended in screen-detected AAA, based on a maximum aortic diameter of ≥5.5 cm. This criterion detects the majority of those at risk from rupture, and is simple to assess.

scholarly journals Effects of hospital preference for endovascular repair on postoperative mortality after elective abdominal aortic aneurysm repair: analysis of the Dutch Surgical Aneurysm Audit

BJS Open ◽  
2021 ◽  
Vol 5 (3) ◽  
Author(s):  
N Lijftogt ◽  
A C Vahl ◽  
E G Karthaus ◽  
E M van der Willik ◽  
S Amodio ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Endovascular Aneurysm Repair ◽  
Postoperative Mortality ◽  
Aortic Aneurysms ◽  
Vascular Surgeon ◽  
Median Percentage ◽  
Abdominal Aortic ◽  
Elective Repair ◽  
Aneurysm Repair ◽  
Overall Mortality

Abstract Background Increased use of endovascular aneurysm repair (EVAR) and reduced open surgical repair (OSR), has decreased postoperative mortality after elective repair of abdominal aortic aneurysms (AAAs). The choice between EVAR or OSR depends on aneurysm anatomy, and the experience and preference of the vascular surgeon, and therefore differs between hospitals. The aim of this study was to investigate the current mortality risk difference (RD) between EVAR and OSR, and the effect of hospital preference for EVAR on overall mortality. Methods Primary elective infrarenal or juxtarenal aneurysm repairs registered in the Dutch Surgical Aneurysm Audit (2013–2017) were analysed. First, mortality in hospitals with a higher preference for EVAR (high-EVAR group) was compared with that in hospitals with a lower EVAR preference (low-EVAR group), divided by the median percentage of EVAR. Second, the mortality RD between EVAR and OSR was determined by unadjusted and adjusted linear regression and propensity-score (PS) analysis and then by instrumental-variable (IV) analysis, adjusting for unobserved confounders; percentage EVAR by hospital was used as the IV. Results A total of 11 997 patients were included. The median hospital rate of EVAR was 76.6 per cent. The overall mortality RD between high- and low-EVAR hospitals was 0.1 (95 per cent −0.5 to 0.4) per cent. The OSR mortality rate was significantly higher among high-EVAR hospitals than low-EVAR hospitals: 7.3 versus 4.0 per cent (RD 3.3 (1.4 to 5.3) per cent). The EVAR mortality rate was also higher in high-EVAR hospitals: 0.9 versus 0.7 per cent (RD 0.2 (−0.0 to 0.6) per cent). The RD following unadjusted, adjusted, and PS analysis was 4.2 (3.7 to 4.8), 4.4 (3.8 to 5.0), and 4.7 (4.1 to 5.3) per cent in favour of EVAR over OSR. However, the RD after IV analysis was not significant: 1.3 (−0.9 to 3.6) per cent. Conclusion Even though EVAR has a lower mortality rate than OSR, the overall effect is offset by the high mortality rate after OSR in hospitals with a strong focus on EVAR.

Conservative management of type 1A endoleaks at completion angiogram in endovascular repair of infra-renal abdominal aortic aneurysms with current generation stent grafts

Vascular ◽  
2018 ◽  
Vol 27 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Abdul Aziz Qazi ◽  
Arash Jaberi ◽  
Oleg Mironov ◽  
Jamil Addas ◽  
Emmad Qazi ◽  
...  
Keyword(s):  
Treatment Approach ◽  
Abdominal Aortic Aneurysms ◽  
Spontaneous Resolution ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Abdominal Aneurysm ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Completion Angiography

Purpose Proximal type 1A endoleaks on completion intra-operative angiography are not infrequently seen following endovascular abdominal aneurysm repair (EVAR). The natural course of these leaks is not well established. We sought to determine the rate of spontaneous resolution and a conservative treatment approach to these endoleaks. Methods All cases involving endovascular repairs of infra-renal abdominal aortic aneurysms resulting in proximal type 1A endoleak on final intra-operative completion angiography were retrospectively reviewed from 1 April 2010 and 30 March 2015. Demographic, pre and post-procedural imaging, and clinical outcomes were reviewed. Summarizing descriptive statistics are reported. Results Of the 337 patients who underwent an EVAR, 24 patients (7.1%) had a proximal type 1A endoleak on final intra-operative angiography. Twenty-two of 24 patients (92%) with proximal type 1A endoleaks had spontaneous resolution on follow-up imaging without any intervention, while two (8%) patients had a persistent endoleak. One of these patients required intervention. The median follow-up for patients with resolved endoleaks was 2.5 years vs. 4 and 6 years, respectively, for patients that did not resolve spontaneously. Conclusion A conservative approach may be used in the management of patients with proximal type 1A endoleaks on completion angiography once maximum proximal seal was achieved intra-operatively as the vast majority of these leaks spontaneously seal.

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