Operative results for high-risk abdominal aortic aneurysms in elective surgery. Analysis of preoperative risk factors influenced operative mortality and our operative management.

To identify patient risk factors for nonhome discharge (NHD) for home-dwelling older patients undergoing surgery, we performed a retrospective cohort study of patients aged ≥65 years undergoing elective surgery between 2014 and 2016 using the geriatric research file from the National Surgical Quality Improvement Program (NSQIP). Multivariable logistic regression examined the association between preoperative demographics, comorbidities, and functional status and NHD to determine which factors are most strongly predictive of NHD. Risk of NHD was higher among those of age >85 years, age 75 to 85 years, Black race, with body mass index (BMI) >30, dyspnea with exertion or at rest, partially or totally dependent in activities of daily living (ADLs), preoperative steroid use, preoperative wound infection, use of a mobility aid, fall within 3 months, or living alone at home without support. NHDs were statistically more likely among orthopedic, neurosurgery, or cardiac surgery interventions. Understanding individual patient’s risks and setting expectations for likely postoperative course is integral to appropriate preoperative counseling and preoperative optimization.

Download Full-text

Presence of NGAL/MMP-9 complexes in human abdominal aortic aneurysms

Thrombosis and Haemostasis ◽

10.1160/th06-11-0638 ◽

2007 ◽

Vol 98 (08) ◽

pp. 427-433 ◽

Cited By ~ 64

Author(s):

Chaoyong Zhu ◽

Angela Silveira ◽

Anne-Louise Hemdahl ◽

Anders Hamsten ◽

Ulf Hedin ◽

...

Keyword(s):

Elective Surgery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Intraluminal Thrombus ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Reducing Conditions ◽

Aneurysm Wall ◽

Abdominal Aortic ◽

Aneurysm Growth ◽

Neutrophil Gelatinase

SummaryIt has been suggested that the intraluminal thrombus of abdominal aortic aneurysms (AAAs) predisposes for AAA enlargement and rupture.The growth of theAAA is dependent on proteolytic degradation of elastin. Here, we analysed whether the neutrophil gelatinase-associated lipocalin (NGAL) is expressed within the thrombus and the aneurysm wall. NGAL can bind to metalloproteinase- 9 (MMP-9) and inhibit its degradation,thereby preserving enzymatic activity. Biopsies were obtained from thrombus- free and thrombus-covered aneurysm wall and the intraluminal thrombus from patients undergoing elective surgery for AAA. Immunohistochemistry and real-time PCR were used to study NGAL and MMP-9 expression. Immunoprecipitation, gel zymography,Western blot and ELISA were used to detect and quantify NGAL/MMP-9 complexes. NGAL was detected in the thrombus, the interface between the thrombus and the underlying wall and in the wall itself.Double staining showed that neutrophils are the major source of NGAL expression. Immunoprecipitation of MMP-9 with antibody against NGAL showed that complexes of NGAL and active MMP-9 were present in thrombus, the interface fluid and the aneurysm wall.Western blot analyses using non-reducing conditions and gel zymography demonstrated that high-molecular-weight complexes of NGAL/MMP-9 were present within the different regions.The concentration of the NGAL/MMP-9 complex was highest in the luminal part of the thrombus. In conclusion, NGAL in complex with activated MMP-9 is present in AAA wall and thrombus. Neutrophil-derived NGAL could enhance the proteolytic activity associated with AAA, but the importance of this mechanism for aneurysm growth remains to be shown.

Download Full-text

Implicit Discount Rates of Vascular Surgeons in the Management of Abdominal Aortic Aneurysms

Medical Decision Making ◽

10.1177/0272989x9801800206 ◽

1998 ◽

Vol 18 (2) ◽

pp. 168-177 ◽

Cited By ~ 15

Author(s):

Ulrika Enemark ◽

Carl H. Lyttkens ◽

Thomas Troëng ◽

Henrik Weibull ◽

Jonas Ranstam

Keyword(s):

Watchful Waiting ◽

Elective Surgery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Time Preferences ◽

Empirical Literature ◽

Discount Rates ◽

Abdominal Aortic ◽

Life Saving ◽

District Hospitals

A growing empirical literature has investigated attitudes towards discounting of health benefits with regard to social choices of life-saving and health-improving measures and individuals' time preferences for the management of their own health. In this study, the authors elicited the time preferences of vascular surgeons in the context of management of small abdominal aortic aneurysms, for which the choice between early elective surgery and watchful waiting is not straightforward. They interviewed 25 of a random sample of 30 Swedish vascular surgeons. Considerable variation in the time preferences was found in the choices between watchful waiting and surgical intervention among the otherwise very homogeneous group of surgeons. The discount rates derived ranged from 5.3% to 19.4%. The median discount rate (10.4%) is similar to those usually reported for social choices concerning life-saving measures. The surgeons who were employed in university hospitals had higher discount rates than did their colleagues in county and district hospitals.

Download Full-text

RISK FACTORS FOR TYPE II ENDOLEAKS AFTER ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSMS

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2007.04378.x ◽

2008 ◽

Vol 78 (1-2) ◽

pp. 61-63 ◽

Cited By ~ 22

Author(s):

Ranjana Warrier ◽

Robert Miller ◽

Rick Bond ◽

Ian K. Robertson ◽

Peter Hewitt ◽

...

Keyword(s):

Risk Factors ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Type Ii ◽

Abdominal Aortic

Download Full-text

The similarities and differences among patients with abdominal aortic aneurysms referred to a tertiary hospital and found at necropsy

Vascular ◽

10.1177/1708538114552095 ◽

2014 ◽

Vol 23 (4) ◽

pp. 411-418 ◽

Cited By ~ 5

Author(s):

Erasmo S da Silva ◽

Vitor C Gornati ◽

Ivan B Casella ◽

Ricardo Aun ◽

Andre EV Estenssoro ◽

...

Keyword(s):

Risk Factors ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Protective Factor ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Transverse Diameter ◽

Abdominal Aortic ◽

Tertiary Center

Objective To analyze the characteristics of patients with abdominal aortic aneurysms referred to a tertiary center and to compare with individuals with abdominal aortic aneurysm found at necropsy. Methods We have retrospectively analyzed the medical records of 556 patients with abdominal aortic aneurysm and 102 cases abdominal aortic aneurysm found at necropsy. Results At univariated analysis, hypertension, tobacco use and maximum diameter were significant risk factors for symptomatic aneurysm, while diabetes tended to be a protective factor for rupture. By logistic regression analysis, the largest transverse diameter was the only one significantly associated with abdominal aortic aneurysm rupture ( p < .0001, odds ratio 1.7, 95% confidence interval 1.481–1.951). Intact abdominal aortic aneurysm found at necropsy showed similarities with outpatients in relation to abdominal aortic aneurysm diameter and risk factors. Conclusion Intact abdominal aortic aneurysm at necropsy and at outpatients setting showed similarities that confirmed that abdominal aortic aneurysm repair is less offered to women, and they died more frequently with intact abdominal aortic aneurysm from other causes.

Download Full-text