Sigmoid Ischemia and the Inflammatory Response following Endovascular Abdominal Aortic Aneurysm Repair

2000 ◽  
Vol 7 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Nabil M. Elmarasy ◽  
Chee V. Soong ◽  
Stuart R. Walker ◽  
Jan A. Macierewicz ◽  
Syed W. Yusuf ◽  
...  
Keyword(s):  
Plasma Concentrations ◽  
Abdominal Aortic Aneurysm Repair ◽  
Bowel Ischemia ◽  
Aortic Aneurysms ◽  
Necrosis Factor Alpha ◽  
Abdominal Aortic ◽  
Tnf Α ◽  
Group A ◽  
Aneurysm Repair ◽  
Aneurysm Diameter

Purpose: To assess the relationship between sigmoid colonic perfusion, endotoxemia, and cytokine generation in patients undergoing elective open repair (OR) or endovascular repair (EVR) of infrarenal abdominal aortic aneurysms (AAA). Methods: Ten patients (9 males; average age 67.6 ± 2.5 years, mean aneurysm diameter 6.9 ± 0.6 cm) undergoing OR were compared to 10 patients (all males; average age 70.3 ± 2.6 years, mean aneurysm diameter 6.5 ± 0.5 cm) whose repair was performed using the EVR technique. The partial pressure of the carbon dioxide gap (Pco2gap = tissue Pco2 — arterial Pco2) of the sigmoid colonic mucosa was measured using a silicone tonometer to evaluate bowel perfusion. Blood samples were collected into pyrogen-free heparinized tubes for quantification of plasma concentrations of endotoxin, tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6) before, during, and after aortic repair. Results: Patients in the OR group had a significantly greater increase in Pco2gap, suggesting a greater degree of bowel ischemia compared to the EVR group. This was associated with significantly greater postoperative concentrations of endotoxin, TNF-α, and IL-6 in the OR group. A significant correlation was found between Pco2gap, IL-6, and postoperative core temperature. Conclusions: The results suggest that the degree of bowel ischemia, endotoxemia, and cytokine generation following elective infrarenal AAA reconstruction may be reduced if the endovascular technique is used instead of conventional surgery.

Efficacy and safety of doxycycline for the management of small abdominal aortic aneurysms- a meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
D Rocha Castellanos ◽  
A Lopez Mendez ◽  
M Fernando Perez Paz ◽  
S Pothuru ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Abdominal Aortic Aneurysms ◽  
Abdominal Aortic Aneurysm Repair ◽  
Mean Difference ◽  
Aortic Aneurysms ◽  
Efficacy And Safety ◽  
Funding Sources ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
Aneurysm Repair

Abstract Funding Acknowledgements Type of funding sources: None. Background- Patients with small Abdominal Aortic Aneurysms are managed with surveillance as there is currently insufficient evidence to recommend surgical aneurysm repair. Hence, there is a dire need and interest in pharmacotherapy like tetracycline antibiotics to reduce the need for aneurysm repair. Purpose- To determine the efficacy and safety of doxycycline in the management of small abdominal aortic aneurysms. Methods- Electronic databases (PubMed, Scopus, Embase, Cochrane) were searched until 25th November 2020.The primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to Abdominal aortic aneurysm repair in each group. Results- A total of three studies with 572 participants (Doxycycline = 290; Placebo = 282 ) were included in our analysis. Average follow up was a period of 18 months. For AAA expansion, the combined results demonstrated a statistically significant mean difference in expansion rates favoring the placebo groups over the intervention (WMD-0.75, 95%CI 0.12-1.38; p = 0.02;I2 = 0%) There was no statistically significant difference in the efficacy and safety of doxycycline as opposed to placebo groups for referral to AAA surgery (OR 1.01, 95%CI 0.61-1.69; p = 0.96, I2 = 0%) and all-cause mortality(OR 0.51; 95%CI 0.18-1.43; p = 0.20, I2 =0%) Conclusion- Amongst patients with small abdominal aortic aneurysms, doxycycline did not significantly reduce aneurysm growth. Abstract Figure. A) AAA expansion B)Surgery C)Mortality

scholarly journals Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

2014 ◽  
Vol 13 (4) ◽  
pp. 318-324
Author(s):  
Rodrigo Gibin Jaldin ◽  
Marcone Lima Sobreira ◽  
Regina Moura ◽  
Matheus Bertanha ◽  
Jamil Víctor de Oliveira Mariaúba ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Arterial Access ◽  
Abdominal Aortic ◽  
First Choice ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

Use of Zenith TX2 endografts in endovascular abdominal aortic aneurysm repair for large-diameter aortic necks

Vascular ◽  
2012 ◽  
Vol 20 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Jeffrey Jim ◽  
Andres Fajardo ◽  
Patrick J Geraghty ◽  
Luis A Sanchez
Keyword(s):  
Endovascular Treatment ◽  
Large Diameter ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Preoperative Imaging ◽  
Abdominal Aortic ◽  
Elective Repair ◽  
Cook Medical ◽  
Aneurysm Repair ◽  
Aortic Cuff

The purpose of this case report is to describe the use of thoracic endografts in endovascular repair of abdominal aortic aneurysms (AAAs) with large-diameter aortic necks. We present four patients who underwent elective repair of AAAs. Preoperative imaging demonstrated all to have large aortic necks (35–37 mm) precluding treatment with standard abdominal aortic devices. All underwent endovascular treatment, which included the use of a Zenith TX2 endograft (Cook Medical Incorporated, Bloomington, IN, USA) as a proximal aortic cuff. There was 100% technical success. One patient developed gastrointestinal bleeding and a myocardial infarction. All were subsequently discharged home. On follow-up, there was one aneurysm-related death at three months. The remaining three patients are alive at a mean of 25.7 months after their operation. In conclusion, large proximal aortic necks preclude endovascular treatment with standard abdominal endograft components. The use of a thoracic endograft as a proximal aortic cuff is a feasible technique for patients unable to tolerate open aortic reconstruction.

scholarly journals Incidence of and risk factors for bowel ischemia after abdominal aortic aneurysm repair

2016 ◽  
Vol 64 (5) ◽  
pp. 1384-1391 ◽  
Author(s):  
Klaas H.J. Ultee ◽  
Sara L. Zettervall ◽  
Peter A. Soden ◽  
Jeremy Darling ◽  
Daniel J. Bertges ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Abdominal Aortic Aneurysm Repair ◽  
Bowel Ischemia ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Delayed Paraplegia Following Infrarenal Abdominal Aortic Endograft Placement: Case Report and Literature Review

Vascular ◽  
2004 ◽  
Vol 12 (2) ◽  
pp. 130-135 ◽  
Author(s):  
Daniel L. Fortes ◽  
B. Zane Atkins ◽  
Andy C. Chiou
Keyword(s):  
Open Repair ◽  
Spinal Cord Ischemia ◽  
Abdominal Aortic Aneurysm Repair ◽  
Careful Consideration ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Made In

The treatment of abdominal aortic aneurysms (AAAs) has changed over the past 12 years, with increased numbers of endovascular procedures being performed. Early morbidity is decreased following endovascular abdominal aortic aneurysm repair (EVAR) compared with open repair, and long-term studies of EVAR have focused on freedom from death, rupture, and conversion to open repair. Other less commonly encountered complications of EVAR are rarely reported. For instance, spinal cord ischemia (SCI) is a devastating complication infrequently seen after open AAA repair. This report discusses a case of delayed paraplegia after EVAR and reviews the pertinent literature. The incidence of SCI after EVAR is similar to open repair, but the mechanisms may be different. Atheroembolization and occlusion of pelvic inflow appear to be the predominant etiologies for SCI after EVAR. Careful consideration of the potential for SCI should be made in elderly patients undergoing EVAR, particularly if difficult arterial anatomy is present.

Does the diameter of abdominal aortic aneurysm influence late survival following abdominal aortic aneurysm repair? A systematic review and meta-analysis

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 658-667 ◽  
Author(s):  
Manar Khashram ◽  
Phil N Hider ◽  
Jonathan A Williman ◽  
Gregory T Jones ◽  
Justin A Roake
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysm Repair ◽  
Hazard Ratio ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Aneurysm Diameter ◽  
Late Survival

Background Studies reporting the influence of preoperative abdominal aortic aneurysm diameter on late survival following abdominal aortic aneurysm repair have not been consistent. Aim: To report the influence of abdominal aortic aneurysm diameter on overall long-term survival following abdominal aortic aneurysm repair. Methods Embase, Medline and the Cochrane electronic databases were searched to identify articles reporting the influence of abdominal aortic aneurysm diameter on late survival following open aneurysm repair and endovascular aneurysm repair published up to April 2015. Data were extracted from multivariate analysis; estimated risks were expressed as hazard ratio. Results A total of 2167 titles/abstracts were retrieved, of which 76 studies were fully assessed; 19 studies reporting on 22,104 patients were included. Preoperative larger abdominal aortic aneurysm size was associated with a worse survival compared to smaller aneurysms with a pooled hazard ratio of 1.14 (95% CI: 1.09–1.18), per 1 cm increase in abdominal aortic aneurysm diameter. Subgroup analysis of the different types of repair was performed and the hazard ratio (95% CI), for open aneurysm repair and endovascular aneurysm repair were 1.08 (1.03–1.12) and 1.20 (1.15–1.25), respectively, per 1 cm increase. There was a significant difference between the groups p < 0.02. Conclusions This meta-analysis suggests that preoperative large abdominal aortic aneurysm independently influences overall late survival following abdominal aortic aneurysm repair, and this association was greater in abdominal aortic aneurysm repaired with endovascular aneurysm repair.

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