Concomitant Radical Cystectomy and Infrarenal Aortic Aneurysm Repair with Cryopreserved Aortic Allograft: A Case Report

In localized muscle invasive bladder cancer (MIBC), the gold standard treatment is radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND), associated with cisplatin-based neoadjuvant chemotherapy, whereas first-line treatment for metastatic patients is cisplatin-based chemotherapy. In men with an abdominal aortic aneurysm (AAA), elective repair is recommended when its diameter is >5.5 cm, while cryopreserved arterial allografts (CAA) offer resistance to infection. A patient with simultaneous metastatic MIBC, associated with left hydronephrosis, and infrarenal AAA of 49 mm diameter was evaluated in an interdisciplinary study. Concomitant surgery was opted for; first, the AAA repair with CAA implantation was practiced, followed by retroperitoneal and common iliac lymphadenectomy. Thereafter, RC and PLND were conducted, and a Wallace-1 ileal conduit and a stoma were constructed. Chest and abdomen contrast-enhanced CT at 2 months showed the onset of two osteolytic lesions on the left ilium. At oncological re-evaluation the patient was deemed cisplatin-fit.

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Endovascular Abdominal Aortic Aneurysm Repair through a Persistent Sciatic Artery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000188 ◽

2015 ◽

Vol 10 (5) ◽

pp. 354-356

Author(s):

Rajesh Ramanathan ◽

Michelle L. DesChamplain ◽

Derek R. Brinster

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Femoral Artery ◽

Arterial System ◽

Persistent Sciatic Artery ◽

Infrarenal Aortic Aneurysm ◽

Open Operation ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Conventional access for endovascular infrarenal aortic aneurysm repair is through the femoral artery. In rare circumstances, an anomalous persistent sciatic artery may replace the femoral arterial system as the main blood supply of the lower extremity. We report the case of a 64-year-old woman with a rapidly expanding infrarenal abdominal aortic aneurysm. Preoperative computed tomography revealed a right persistent sciatic artery with an ipsilateral atrophic femoral artery. Her aortic aneurysm was successfully repaired using an endovascular approach with access through the right persistent sciatic artery and contralateral femoral artery. A persistent sciatic artery can be used as an access for endovascular treatment of an infrarenal aortic aneurysm. This technique can be extrapolated to the treatment of distal or contralateral aneurysms, precluding the need for open operation.

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Perioperative Outcomes for Abdominal Aortic Aneurysm Repair Based on Aneurysm Diameter

Vascular and Endovascular Surgery ◽

10.1177/1538574420909635 ◽

2020 ◽

Vol 54 (4) ◽

pp. 341-347

Author(s):

Christopher Ramos ◽

Amit Pujari ◽

Ravi R. Rajani ◽

Guillermo A. Escobar ◽

Brian G. Rubin ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Perioperative Outcomes ◽

Improvement Program ◽

Asymptomatic Patients ◽

Abdominal Aortic ◽

Elective Repair ◽

Aneurysm Repair ◽

Aneurysm Diameter

Background: Guidelines from the Society for Vascular Surgery recommend elective repair in asymptomatic patients with an abdominal aortic aneurysm (AAA) only if their diameter is greater than or equal to 5.5 cm, yet smaller ones are routinely repaired. This study aims to evaluate perioperative outcomes based on aneurysm size at the time of repair. Methods: Male patients who underwent elective endovascular aneurysm repair (EVAR) or open abdominal aneurysm repair (OAAR) repair of an infrarenal AAA were abstracted from 2011 to 2015 Targeted National Surgical Quality Improvement Program (NSQIP) database. Patients with symptoms or with aneurysmal extension into the visceral or iliac vessels were excluded. Outcomes of open versus endovascular repair were reported, with multivariate analyses to identify factors associated with the decision to repair AAA ≤5.4 cm. Results: A total of 2115 (90.9%) patients underwent EVAR, while 213 (9.1%) underwent OAAR. The mean diameter in patients who underwent OAAR was 6.1 cm (interquartile range [IQR]: 5.2-6.1 cm) versus 5.7 cm (IQR: 5.2-6.0 cm) for EVAR. However, in 42.5% of EVAR and 32.8% of OAAR patients, the diameter of the AAA was 5.4 cm or less. The group undergoing repair of AAA ≤5.4 cm was younger compared to the larger AAA group (71.9 vs 73.9 years; P < .0001). Patients older than 80 years were less likely to have a repair of AAA measuring ≤5.4 cm (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.30-0.65). Additionally, patients who underwent EVAR were more likely to have AAA measuring ≤5.4 cm repaired compared to those who underwent OAAR (OR = 1.62, 95% CI = 1.19-2.21). There were no differences in perioperative morbidity or mortality between the groups. Conclusion: There were no differences in perioperative outcomes after AAA repair, independent of aneurysm diameter. We found a higher likelihood of repairing AAA ≤5.4 cm in younger patients who were more likely to have been repaired with EVAR. Patients older than 80 years were less likely to undergo small AAA repair.

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Elective endovascular vs. open repair for abdominal aortic aneurysm in octogenarians

Vascular ◽

10.1177/1708538115594967 ◽

2016 ◽

Vol 24 (4) ◽

pp. 348-354 ◽

Cited By ~ 5

Author(s):

Koichi Morisaki ◽

Takuya Matsumoto ◽

Yutaka Matsubara ◽

Kentaro Inoue ◽

Yukihiko Aoyagi ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Operative Mortality ◽

Open Repair ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Elective Repair ◽

Aneurysm Repair ◽

Repair Group

Purpose The purpose of this study was to investigate the operative mortality and short-term and midterm outcomes of treatment of abdominal aortic aneurysm in Japanese patients over 80 years of age. Methods Between January 2007 and December 2011, 207 patients underwent elective repair of infrarenal abdominal aortic aneurysms. Comorbidities, operative morbidity and mortality, midterm outcomes were analyzed retrospectively. Results The average age (endovascular aneurysm repair, 84.4 ± 0.3; open, 82.8 ± 0.3, P < 0.01) and the percentage of hostile abdomen (endovascular aneurysm repair, 22.2%; open repair, 11.1%, P < 0.05) were higher in the endovascular aneurysm repair group. Percentage of outside IFU was higher in open repair (endovascular aneurysm repair, 38.5%; open repair, 63.3%, P < 0.01). The cardiac complication (endovascular aneurysm repair, 0%; open repair, 5.6%, P < 0.01) and length of postoperative hospital stay (endovascular aneurysm repair, 10.3 ± 0.8 days; open, 18.6 ± 1.6 days, P < 0.05) were significantly lower in the endovascular aneurysm repair group. There were no differences in operative mortality (endovascular aneurysm repair, 0%; open, 1.1%, P = 0.43) and the aneurysm-related death was not observed. The rate of secondary interventions (EVAR, 5.1%; open repair, 0%, P < 0.01) and midterm mortality rate were much higher in the endovascular aneurysm repair group. Conclusions Endovascular aneurysm repair is less invasive than open repair and useful for treating abdominal aortic aneurysm in octogenarians; however, open repair can be acceptable treatment in the inappropriate case treated by endovascular aneurysm repair.

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Impairment of erectile function after elective repair of abdominal aortic aneurysm

Vascular ◽

10.1177/1708538115577290 ◽

2015 ◽

Vol 24 (1) ◽

pp. 37-43 ◽

Cited By ~ 5

Author(s):

P Majd ◽

W Ahmad ◽

Th Luebke ◽

M Gawenda ◽

J Brunkwall

Keyword(s):

Abdominal Aortic Aneurysm ◽

Erectile Dysfunction ◽

Aortic Aneurysm ◽

Erectile Function ◽

Open Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic ◽

Elective Repair ◽

Significant Difference ◽

Aneurysm Repair

The purpose of the present study was to compare the functional change of erectile dysfunction after endovascular repair (EVAR) and open repair (OR) of abdominal aortic aneurysm. Between April 2009 and December 2011, male patients admitted for elective treatment of an asymptomatic infrarenal abdominal aortic aneurysm were included. The erectile function was evaluated by using a validated KEED questionnaire. All patients filled out the questionnaire preoperatively and postoperatively after one year. The number of patients with an increase of erectile dysfunction was 8 (26.6%) to 16 (53.3%) in open repair group vs. 30 (42.6%) to 40 (58.8%) in endovascular aneurysm repair. There was no statistically significant difference between open repair and endovascular aneurysm repair groups in order of new incidence of erectile dysfunction ( p = 0.412). The study showed an increase in the mean value of Erectile Dysfunction -Score postoperatively in both the groups as well. The present study showed an increase of erectile dysfunction postoperatively, but the difference between the two groups was not statistically significant.

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Development of a scoring system to estimate mortality in abdominal aortic aneurysms management

Vascular ◽

10.1177/1708538114563825 ◽

2014 ◽

Vol 23 (6) ◽

pp. 586-591 ◽

Cited By ~ 7

Author(s):

Anahita Dua ◽

Mohammed M Algodi ◽

Courtney Furlough ◽

Hunter Ray ◽

Sapan S Desai

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Nationwide Inpatient Sample ◽

Abdominal Aortic Aneurysm Repair ◽

Inpatient Mortality ◽

Risk Of Mortality ◽

Abdominal Aortic ◽

Elective Repair ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Introduction This study aimed to define risk factors associated with inpatient mortality in patients undergoing elective repair for unruptured abdominal aortic aneurysm and utilize these factors to create a scoring system to estimate risk of mortality. Methods A retrospective analysis was completed using the Nationwide Inpatient Sample from 1998 to 2011. Patients who underwent elective abdominal aortic aneurysm repair were identified using ICD-9 codes. Demographics, comorbidities, length of stay, insurance status, and mortality were recorded. Statistically significant variables were identified using a multivariate analysis, and a discriminant analysis was used to identify factors predictive of inpatient mortality. Results Over a 14-year period, 28,448 patients underwent elective repair of an unruptured abdominal aortic aneurysm. Independent variables associated with inpatient mortality included: age >60, female gender, congestive heart failure, peripheral artery disease, renal failure, malnutrition, and hypercoagulability. Endovascular aneurysm repair was protective against inpatient mortality. The area under the curve for the discriminant function was 0.83 (95% CI, 0.81–0.85) and successfully classified 87.9% of patients within the Nationwide Inpatient Sample (25,006/28,448 patients). Conclusion Seven factors that predict an increased risk of mortality and one factor that decreased the risk of mortality were identified. Preoperative risk factor mitigation may improve mortality following elective abdominal aortic aneurysm repair.

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Zenith Cook limb type IIIB endoleak causing aneurysm rupture five years after EVAR

Vascular ◽

10.1177/1708538114546714 ◽

2014 ◽

Vol 23 (3) ◽

pp. 319-321 ◽

Cited By ~ 10

Author(s):

Peter Mezes ◽

Morad Sallam ◽

Athanasios Diamantopoulos ◽

Peter Taylor ◽

Irfan Ahmed

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Aneurysm Rupture ◽

Graft Material ◽

Infrarenal Aortic Aneurysm ◽

Type Iiib ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Type III endoleaks are rare late complications of endovascular abdominal aortic aneurysm repair. The aneurysm sac is pressurised either through disconnection of modular components (type IIIA) or a defect in the graft fabric (type IIIB). We report the endovascular treatment of a ruptured infrarenal aortic aneurysm five years after elective endovascular abdominal aortic aneurysm repair caused by a type IIIB endoleak secondary to probable graft material erosion of the contralateral limb. This is the first report of a late aneurysm rupture caused by fabric defect in a Cook Zenith limb. The case highlights the potential serious consequences of minimal migration of the device and the importance of landing the proximal fixation in healthy aorta.

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Survival following abdominal aortic aneurysm repair in North Queensland is not associated with remoteness of place of residence

PLoS ONE ◽

10.1371/journal.pone.0241802 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241802

Author(s):

Jonathan Golledge ◽

Aaron Drovandi ◽

Ramesh Velu ◽

Frank Quigley ◽

Joseph Moxon

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Hazard Analysis ◽

Abdominal Aortic Aneurysm Repair ◽

Place Of Residence ◽

Clinical Events ◽

Abdominal Aortic ◽

Elective Repair ◽

Aneurysm Repair ◽

Related Mortality

Objective To assess whether survival and clinical events following elective abdominal aortic aneurysm (AAA) repair were associated with remoteness of residence in North Queensland, Australia. Methods This retrospective cohort study included participants undergoing elective AAA repair between February 2002 and April 2020 at two hospitals in Townsville, North Queensland, Australia. Outcomes were all-cause survival and AAA-related events, defined as requirement for repeat AAA repair or AAA-related mortality. Remoteness of participant’s place of residence was assessed by the Modified Monash Model classifications and estimated distance from the participants’ home to the tertiary vascular centre. Cox proportional hazard analysis examined the association of remoteness with outcome. Results The study included 526 participants undergoing elective repair by open (n = 204) or endovascular (n = 322) surgery. Fifty-four (10.2%) participants had a place of residence at a remote or very remote location. Participants' were followed for a median of 5.2 (inter-quartile range 2.5–8.3) years, during which time there were 252 (47.9%) deaths. Survival was not associated with either measure of remoteness. Fifty (9.5%) participants had at least one AAA-related event, including 30 (5.7%) that underwent at least one repeat AAA surgery and 23 (4.4%) that had AAA-related mortality. AAA-related events were more common in participants resident in the most remote areas (adjusted hazard ratio 2.83, 95% confidence intervals 1.40, 5.70) but not associated with distance from the participants’ residence to the tertiary vascular centre Conclusions The current study found that participants living in more remote locations were more likely to have AAA-related events but had no increased mortality following AAA surgery. The findings emphasize the need for careful follow-up after AAA surgery. Further studies are needed to examine the generalisability of the findings.

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