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EVAR risk score

Chien Yi M Png, Rami O Tadros, Peter L Faries, Marielle R Torres, Sung Yup Kim, Robert Lookstein, Ageliki G Vouyouka, Michael L Marin
BACKGROUND: This study aims to investigate the relationship of increased age on post-endovascular aneurysm repair (EVAR) outcomes. METHODS: A total of 1,380 of 1,853 consecutive patients who underwent EVAR between 1992 and 2012 met our inclusion criteria and were reviewed. Five hundred of the 1,380 patients had computed tomography angiography data to characterize anatomic differences. Age <70 years and ≥70 years were compared. RESULTS: Older patients had higher Glasgow Aneurysm Scores (85...
August 2016: Annals of Vascular Surgery
Caitlin W Hicks, Joseph K Canner, Isibor Arhuidese, Tammam Obeid, James H Black, Mahmoud B Malas
IMPORTANCE: Patient- and hospital-level factors affecting outcomes after open and endovascular abdominal aortic aneurysm (AAA) repair are each well described separately, but not together. OBJECTIVE: To describe the association of patient- and hospital-level factors with in-hospital mortality after elective AAA repair. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of the Nationwide Inpatient Sample database (January 2007-December 2011)...
September 1, 2016: JAMA Surgery
Anuj Mahajan, Marcus Barber, Todd Cumbie, Giovanni Filardo, William P Shutze, Danielle M Sass, William Shutze
BACKGROUND: Hostile anatomic characteristics in patients undergoing endovascular abdominal aortic aneurysm repair (EVAR) and the placement of endografts not in concordance with the specific device anatomic guidelines (or instructions for use [IFU]) have shown decreased technical success of the procedure. But these factors have never been evaluated in regard to patient postoperative survival. We sought to assess the association between survival and (1) aneurysm anatomy and characteristics and (2) implantation in compliance with manufacturer's anatomic IFU guidelines in patients undergoing endovascular aortic aneurysm repair...
July 2016: Annals of Vascular Surgery
Martijn L Dijkstra, Steven M M van Sterkenburg, Jan-Willem Lardenoye, Clark J Zeebregts, Michel M P J Reijnen
PURPOSE: To evaluate the outcome and survival of patients with extensive comorbid conditions after endovascular aneurysm repair (EVAR) and objectify which of 2 medical comorbidity classifications is more accurate in predicting adverse outcomes. METHODS: All 1263 patients (mean age 73.1 years; 1129 men) treated using the Endurant Stent Graft system and entered in the prospective global postmarketing ENGAGE registry ( identifier NCT00870051) were grouped using the American Society of Anesthesiologists (ASA) classification and the Society for Vascular Surgery/American Association for Vascular Surgery (SVS/AAVS) medical comorbidity grading system...
August 2016: Journal of Endovascular Therapy
J J Siracuse, M L Schermerhorn, A J Meltzer, M H Eslami, J A Kalish, D Rybin, G Doros, A Farber
BACKGROUND: In randomized trials endovascular aortic aneurysm repair (EVAR) has been shown to have superior perioperative outcomes compared with open aneurysm repair (OAR). However, outcomes in patients at low risk of complications are unclear and many surgeons still prefer OAR in this cohort. The objective was to analyse perioperative and longer-term outcomes of OAR and EVAR in this low-risk group of patients. METHODS: All elective infrarenal EVARs and OARs in the Vascular Study Group of New England database were reviewed from 2003 to 2014...
July 2016: British Journal of Surgery
Albeir Y Mousa, Joseph Bozzay, Mike Broce, Michael Yacoub, Patrick A Stone, Aravinda Najundappa, Mark C Bates, Ali F AbuRahma
OBJECTIVE: The purpose of this study was to identify significant predictors of long-term mortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS: We included all cases with elective EVAR based on a national data set from the Society for Vascular Surgery Patient Safety Organization. Clinical and anatomic variables were analyzed with a Kaplan-Meier and Cox-regression model to determine predictors of mortality and develop a score equation to categorize patients into low, medium, and high long-term mortality risk...
May 2016: Vascular and Endovascular Surgery
Fábio Hüsemann Menezes, Bárbara Ferrarezi, Moisés Amâncio de Souza, Susyanne Lavor Cosme, Giovani José Dal Poggetto Molinari
INTRODUCTION: Endovascular repair (EVAR) of abdominal aortic aneurysm has become the standard of care due to a lower 30-day mortality, a lower morbidity, shorter hospital stay and a quicker recovery. The role of open repair (OR) and to whom this type of operation should be offered is subject to discussion. OBJECTIVE: To present a single center experience on the repair of abdominal aortic aneurysm, comparing the results of open and endovascular repairs. METHODS: Retrospective cross-sectional observational study including 286 patients submitted to OR and 91 patients submitted to EVAR...
February 2016: Brazilian Journal of Cardiovascular Surgery
P De Rango, G Simonte, A Manzone, E Cieri, G Parlani, L Farchioni, M Lenti, F Verzini
OBJECTIVE/BACKGROUND: A consistent number of elderly patients with ruptured abdominal aortic aneurysms (rAAAs) are deemed unfit for repair and excluded from any treatment. The objective of this study was to examine the impact on survival of endovascular repair and open surgery with restricted turndown in acute AAA repair. METHODS: A prospective database for patients treated for rAAA was established. None of the patients admitted alive with rAAA were denied treatment...
June 2016: European Journal of Vascular and Endovascular Surgery
Jorg Lucas de Bruin, Alan Karthikesalingam, Peter J Holt, Monique Prinssen, Matt M Thompson, Jan D Blankensteijn
BACKGROUND: Identifying patients at risk for aneurysm rupture and sac expansion after open and endovascular abdominal aortic aneurysm (AAA) repair (EVAR) may help to attenuate this risk by intensifying follow-up and early detection of problems. The goal of this study was to validate the St George's Vascular Institute (SGVI) score to identify patients at risk for a secondary intervention after elective aneurysm repair. METHODS: A post hoc on-treatment analysis of a randomized trial comparing open AAA repair and EVAR was performed...
June 2016: Journal of Vascular Surgery
Akihiro Hosaka, Masaaki Kato, Manabu Motoki, Hiroko Sugai, Nobukazu Okubo
Atheromatous degeneration of the aorta is considered to be a risk factor for postoperative embolic complications after endovascular treatment, and is associated with a high incidence of vascular events in the long term. We devised a method to quantify the shagginess of the aorta using contrast-enhanced computed tomography (CT) images. This study examined the method's validity and prognostic usefulness in patients undergoing elective endovascular abdominal aortic aneurysm repair (EVAR). We retrospectively investigated 427 patients who underwent elective EVAR between 2007 and 2013...
March 2016: Medicine (Baltimore)
Rong Zeng, Wei Ye, Bao Liu, Leng Ni, Changwei Liu, Yongjun Li, Yuehong Zheng, Xiaojun Song, Jiang Shao, Yuexin Chen, Yu Chen, Zhili Liu
OBJECTIVE: To determine risk factors of overt/non-overt disseminated intravascular coagulation (DIC) in abdominal aortic aneurysm (AAA) patients undergoing endovascular aneurysm repair (EVAR). METHODS: In a retrospective study, 117 patients undergoing selective EVAR for AAA were investigated for overt/non-overt DIC from June 1st 2013 to December 31 2014. The following parameters were reviewed: D-dimer, Platelet count, fibrinogen and prothrombin time (PT) at before operation and 1, 2, and 7 days after operation...
July 14, 2015: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Khurram Rasheed, John P Cullen, Matthew J Seaman, Susan Messing, Jennifer L Ellis, Roan J Glocker, Adam J Doyle, Michael C Stoner
BACKGROUND: Potential cost effectiveness of endovascular aneurysm repair (EVAR) compared with open aortic repair (OAR) is offset by the use of intraoperative adjuncts (components) or late reinterventions. Anatomic severity grade (ASG) can be used preoperatively to assess abdominal aortic aneurysms, and provide a quantitative measure of anatomic complexity. The hypothesis of this study is that ASG is directly related to the use of intraoperative adjuncts and cost of aortic repair. METHODS: Patients who undergo elective OAR and EVAR for abdominal aortic aneurysms were identified over a consecutive 3-year period...
March 2016: Journal of Vascular Surgery
M Khashram, J A Williman, P N Hider, G T Jones, J A Roake
BACKGROUND: Predicting long-term survival following repair is essential to clinical decision making when offering abdominal aortic aneurysm (AAA) treatment. A systematic review and a meta-analysis of pre-operative non-modifiable prognostic risk factors influencing patient survival following elective open AAA repair (OAR) and endovascular aneurysm repair (EVAR) was performed. METHODS: MEDLINE, Embase and Cochrane electronic databases were searched to identify all relevant articles reporting risk factors influencing long-term survival (≥1 year) following OAR and EVAR, published up to April 2015...
February 2016: European Journal of Vascular and Endovascular Surgery
Paolo Biagi, Gianmarco de Donato, Carlo Setacci
Endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA) is the preferred first treatment option in case of patients with advanced age and/or fit anatomy owing to shorter length of in hospital staying, less complications or laparotomy-related re-interventions, and lower initial costs. Although it is a less-invasive intervention, EVAR entails a risk similar to that of open aortic procedures for medical comorbidities, and a perioperative clinical evaluation is mandatory to minimize the early and late cardiovascular risk...
April 2016: Minerva Cardioangiologica
Michele Piazza, Francesco Squizzato, Marco Zavatta, Mirko Menegolo, Joseph J Ricotta, Sandro Lepidi, Franco Grego, Michele Antonello
OBJECTIVE: The aim of this study was to evaluate outcomes of intraoperative aneurysm sac embolization during endovascular aneurysm repair (EVAR) in patients considered at risk for type II endoleak (EII), using a sac volume-dependent dose of fibrin glue and coils. METHODS: Between January 2012 and December 2014, 126 patients underwent EVAR. Based on preoperative computed tomography evaluation of anatomic criteria, 107 patients (85%) were defined as at risk for EII and assigned to randomization for standard EVAR (group A; n = 55, 44%) or EVAR with intraoperative sac embolization (group B; n = 52, 42%); the remaining 19 patients (15%) were defined as at low risk for EII and excluded from the randomization (group C)...
January 2016: Journal of Vascular Surgery
J Hunter Mehaffey, Damien J LaPar, Margret C Tracci, Kenneth J Cherry, John A Kern, Gilbert R Upchurch
OBJECTIVE: Endovascular aneurysm repair (EVAR) is a commonly performed vascular operation. Yet, postoperative length of stay (LOS) varies greatly, even within institutions. The present study reviewed the morbidity, mortality, and the financial effect of increased LOS to establish modifiable factors associated with prolonged hospital LOS, with the goal of improving quality. METHODS: The Society for Vascular Surgery Vascular Quality Initiative database was used to identify all patients undergoing primary, elective EVAR at a single institution between January 1, 2011, and May 28, 2014...
December 2015: Journal of Vascular Surgery
Sebastian DiDato, Alik Farber, Denis Rybin, Jeffrey A Kalish, Mohammad H Eslami, Carla C Moreira, Nishant K Shah, Jeffrey J Siracuse
OBJECTIVE: Although the effect of trainee involvement has been evaluated across different specialties, their effects on perioperative outcomes after abdominal aortic aneurysm (AAA) repair have not been examined. Our goal was to examine the association between resident and fellow intraoperative participation with perioperative outcomes of endovascular AAA repair (EVAR), open infrarenal AAA repair (OIAR), and open juxtarenal AAA repair (OJAR). METHODS: The American College of Surgeons National Surgical Quality Improvement Program data set (2005-2012) was queried to identify all patients who underwent EVAR, OIAR, or OJAR...
January 2016: Journal of Vascular Surgery
Lucas R Beffa, Gregory F Petroski, Robin L Kruse, Todd R Vogel
Although many trials have evaluated abdominal aortic aneurysm (AAA) repair, the impact of these procedures on the functional status of frail elderly patients is not well-described. The effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and comorbidities were evaluated for their impact on functional trajectories after discharge. Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for OAR and EVAR. A functional score (range, 0-28; higher scores indicate greater impairment) was calculated before and after interventions...
September 2015: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
Chang-Lie Zhang, Zhi-Hong Song, Fan Wang
To explore the efficacy of endovascular aneurysm repair (EVAR) compared with traditional open surgical repair (OSR) in the treatment of middle/high-risk patients with abdominal aortic aneurysm (AAA). With a retrospective method, we analyzed the clinical data of 57 patients with middle/high-risk AAA admitted to Linyi People's Hospital Affiliated to Shandong University from January 2010 to January 2014. Twenty-eight of the 57 patients received EVAR and 29 others received OSR. Statistical analysis was conducted by the design of spreadsheet according to preoperative, intraoperative, perioperative, and postoperative follow-up relevant information...
January 2016: American Journal of Therapeutics
G K Ambler, P A Coughlin, P D Hayes, K Varty, M S Gohel, J R Boyle
INTRODUCTION: Acute kidney injury (AKI) following ruptured abdominal aortic aneurysm (rAAA) repair is common and multifactorial. A standard definition of AKI after endovascular repair (EVAR), the Aneurysm Renal Injury Score (ARISe), has been proposed to facilitate standardised reporting and thus improve understanding of this issue. METHODS: Data were collected retrospectively on AKI in a prospectively maintained database of all patients treated for rAAA in a single tertiary referral centre since the availability of routine out of hours emergency EVAR...
October 2015: European Journal of Vascular and Endovascular Surgery
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