scholarly journals Validation of abdominal aortic aneurysm repair codes in Ontario administrative data

2018 ◽  
Vol 41 (3) ◽  
pp. E148-E155 ◽  
Author(s):  
Konrad Salata ◽  
Mohamad A Hussain ◽  
Charles De Mestral ◽  
Elisa Greco ◽  
Muhammad Mamdani ◽  
...  
Keyword(s):  
Administrative Data ◽  
Retrospective Chart Review ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Discharge Abstract Database ◽  
Ontario Health Insurance Plan ◽  
Predictive Values ◽  
Abdominal Aortic ◽  
Degree Of Certainty

Purpose: To determine the positive predictive values (PPV) of Ontario administrative data codes for the identification of open (OSR) and endovascular (EVAR) repairs of elective (eAAA) and ruptured (rAAA) abdominal aortic aneurysms. Methods: We randomly identified 319 eAAA and rAAA repairs at two Toronto hospitals between April 2003 and March 2015, using administrative health data in Ontario, Canada. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes I71.3 and I71.4, were used to identify rAAA and eAAA patients, respectively. A blinded retrospective chart review was conducted and served as the gold standard comparator. Re-abstracted records were compared to Canadian Classification of Health Interventions (CCI) and Ontario Health Insurance Plan (OHIP) codes in the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) and OHIP databases. We calculated the PPV and 95% confidence intervals (95% CI) of individual and combined procedure and billing codes for elective and ruptured OSR and EVAR (eOSR, eEVAR, rOSR, and rEVAR). Results: Permutation of codes allowed identification of eOSR with 95% PPV (95% CI 88, 98), eEVAR with 96% PPV (95% CI 90, 99), rOSR with 87% PPV (95% CI 79, 93) and rEVAR with 91% PPV (95% CI 59, 100). Conclusions: Diagnostic, procedure and billing code combinations allow identification of eOSR, eEVAR, rOSR and rEVAR patients in Ontario administrative data with a high degree of certainty.

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.

Mortality for Open Abdominal Aortic Aneurysm Repair before and after Endovascular Aortic Repair (EVAR)

2019 ◽  
Vol 85 (12) ◽  
pp. 1341-1344
Author(s):  
Alex D. Ammar
Keyword(s):  
Tertiary Care ◽  
Study Groups ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Inhospital Mortality ◽  
Vascular Surgeon ◽  
Care Community ◽  
Aortic Repair ◽  
Abdominal Aortic

The purpose of this study was to determine whether endovascular aortic repair (EVAR) has impacted inhospital mortality for patients undergoing open repair (OR). From 1982 through 2016, 1572 repairs were performed for abdominal aortic aneurysms (AAAs). Both ORs and EVARs were performed by the author at two large, tertiary-care, community-based hospitals. In Period I (1982–1999, n = 863), all AAA repairs were performed open. In Period II (2000–2016; n = 709), repairs were performed both by ORs and EVARs. Demographics were similar between study groups. Mortality for elective repairs in Periods I and II were as follows: I = 1.2 per cent (open, n = 9/756) versus II = 1.7 per cent (open, n = 4/241) versus II = 1.2 per cent (EVAR, n = 5/420). Mortality for patients with ruptured AAAs in Periods I and II were as follows: I = 31.8 per cent (open, n = 34/107) versus II = 32 per cent (open, n = 8/25) versus II = 13 per cent (EVAR, n = 3/23). The results of this study demonstrate that the introduction of EVARs has not negatively impacted the inhospital mortality for elective ORs or emergent AAAs for one vascular surgeon who completed training before EVARs became available.

Mykotisches Aneurysma der infrarenalen Aorta

VASA ◽  
2003 ◽  
Vol 32 (4) ◽  
pp. 218-220 ◽  
Author(s):  
Papadimitriou ◽  
Tachtsi ◽  
Koutsias ◽  
Pitoulias ◽  
Mpompoti
Keyword(s):  
Relevant Literature ◽  
Aortic Aneurysms ◽  
Ex Situ ◽  
Infrarenal Aorta ◽  
Autologous Vein ◽  
Abdominal Aortic ◽  
Mycotic Aneurysms ◽  
Post Traumatic

The mycotic aneurysms of the infrarenal aorta (MAIA) are extremely rare and the associated morbidity and mortality is very high. The classification of infected aneurysms considers four types: a) true mycotic aneurysms, b) secondary mycotic aneurysms due to bacterial arteritis, c) infected preexisting abdominal aortic aneurysms and d) post-traumatic infected false aneurysms. The prognosis of true MAIA’s is better than the other forms of infected aneurysms. The standard treatment includes the resection of the aneurysm and infectious surrounding tissues and the restoration of the flow using ex situ (axillobifemoral) bypass or in situ replacement with autologous vein or a rifampicine-bonded graft. We present a case of mycotic aneurysm of the infrarenal aorta and a brief discussion of the alternative treatments from the relevant literature.

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.

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.

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.

scholarly journals Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Joshua K Kays ◽  
Tiffany W Liang ◽  
Teresa A Zimmers ◽  
Daniel P Milgrom ◽  
Hamzah Abduljabar ◽  
...  
Keyword(s):  
Survival Data ◽  
Univariate Analysis ◽  
Fold Increase ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
High Risk Population ◽  
Term Survival ◽  
Risk Of Death ◽  
Abdominal Aortic ◽  
The Impact

Abstract Background: Repair of abdominal aortic aneurysms (AAA) decreases the incidence of rupture and death. In cancer patients, sarcopenia has been associated with increased surgical complications and mortality. The impact of sarcopenia on survival after AAA repair has yet to be described.    Methods: Patient demographic, laboratory, body composition measurements and survival data were obtained from patients undergoing AAA repair at the Indiana University medical campus over a 5-year period. Univariate and multivariate analyses were performed to identify factors associated with overall survival. Results: Overall, 58.2% presented with sarcopenia. Sarcopenic patients were older (71.8±8.3 versus 66.8±8.1 years; p<0.001), had lower body mass index (BMI) (26.3±5.2 versus 31.5±5.9 kg/m2; p<0.001), higher rates of myosteatosis (84.4% versus 52.%; p<0.001), greater AAA diameter (60.6±14.0 versus 57.8±11.7 mm; p=0.016), higher Charlson Comorbidity Index (CCI) (32.3% versus 25.1% ³6; p=0.034), and increased rates of rupture (8.2% versus 3.8%; p=0.047). Sarcopenic and nonsarcopenic patients had no difference in 30-day morbidity (8.5% versus 8.5%; p=0.991) or mortality (3.7% versus 0.9%; p=0.07). Univariate analysis demonstrated age, sarcopenia, myosteatosis, CCI, and BMI to be associated with long-term survival. There was no correlation between BMI and sarcopenia. Both sarcopenia and myosteatosis resulted in decreased one-, three-, and five-year survivals compared to their counterparts. On multivariate analysis sarcopenia is independently associated with survival, conferring a 1.6-fold increase in death (p=0.04). The combination of sarcopenia plus myosteatosis doubled the risk of death compared to sarcopenia alone. Conclusions: This is the first study to demonstrate that over half of all patients undergoing AAA repair are sarcopenic, a condition associated with increased mortality. Sarcopenia with myosteatosis is associated with double the mortality of sarcopenia alone. CT scan, but not BMI, accurately identifies sarcopenia and myosteatosis. Defining the mechanisms through which sarcopenia contributes to late death after AAA repair is critical to developing novel interventions that may improve survival in this high risk population. 

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