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EVAR risk score

Masayuki Sugimoto, Akio Koyama, Kiyoaki Niimi, Akio Kodama, Hiroshi Banno, Kimihiro Komori
BACKGROUND: Although recent guidelines recommend EVAR for robust younger patients, we have been limiting our indication to older patients or those who are physically frail. This study compares long-term outcomes of our series of abdominal aortic aneurysms (AAA) treated with endovascular repair (ER) and open surgery (OS), using propensity-score matching. METHODS: Between June 2007 and October 2014, 819 patients with infrarenal AAA underwent elective repair at our institution...
April 5, 2017: Annals of Vascular Surgery
L R de Souza, G S Oderich, M A Farber, S Haulon, P V Banga, A H Pereira, P Gloviczki, S C Textor, F Jia
OBJECTIVE/BACKGROUND: Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined. METHODS: Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR...
March 10, 2017: European Journal of Vascular and Endovascular Surgery
Donald G Harris, Ilynn Bulatao, Connor P Oates, Richa Kalsi, Charles B Drucker, Nandakumar Menon, Tanya R Flohr, Robert S Crawford
OBJECTIVE: Endovascular aneurysm repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status to EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR...
March 1, 2017: Journal of Vascular Surgery
N Lijftogt, A C Vahl, E D Wilschut, B H P Elsman, S Amodio, E W van Zwet, V J Leijdekkers, M W J M Wouters, J F Hamming
OBJECTIVE/BACKGROUND: The Dutch Surgical Aneurysm Audit (DSAA) is mandatory for all patients with primary abdominal aortic aneurysms (AAAs) in the Netherlands. The aims are to present the observed outcomes of AAA surgery against the predicted outcomes by means of V-POSSUM (Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity). Adjusted mortality was calculated by the original and re-estimated V(physiology)-POSSUM for hospital comparisons. METHODS: All patients operated on from January 2013 to December 2014 were included for analysis...
February 28, 2017: European Journal of Vascular and Endovascular Surgery
Caitlin W Hicks, Devin S Zarkowsky, Ian C Bostock, David H Stone, James H Black, Jens Eldrup-Jorgensen, Philip P Goodney, Mahmoud B Malas
BACKGROUND: Society for Vascular Surgery practice guidelines recommend 1- and 12-month follow-up with computed tomography imaging for the year after endovascular aneurysm repair (EVAR). We describe the incidence, risk factors, and outcomes of EVAR patients who are lost to follow-up (LTF). METHODS: All patients undergoing elective EVAR in the Vascular Quality Initiative (VQI) data set (January 2003-December 2015) were stratified according to long-term follow-up method (in-person vs phone call vs LTF)...
February 16, 2017: Journal of Vascular Surgery
Vicente A Sala-Almonacil, José M Zaragozá-García, Mauricio Ramírez-Montoya, Vicente Molina-Nácher, Inmaculada Martínez-Perelló, Francisco J Gómez-Palonés
BACKGROUND: Many patients with complex abdominal aortic aneurysms are unfit for open repair. New endovascular technologies and bailout techniques are being used for managing those complex anatomies. The purpose of this study is to compare the results obtained with advanced endovascular aneurysm repair techniques (fenestrated and chimney endografts) to those obtained with open repair for the treatment of complex abdominal aortic aneurysms not anatomically suitable for standard endovascular exclusion (infrarenal neck <10 mm, juxtarenal, suprarenal and Crawford's type IV thoracoabdominal aneurysms)...
January 27, 2017: Journal of Cardiovascular Surgery
Karl Sörelius, Anders Wanhainen, Mia Furebring, Martin Björck, Peter Gillgren, Kevin Mani
BACKGROUND: No reliable comparative data exist between open repair (OR) and endovascular aneurysm repair (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR and EVAR for MAAA in a population-based cohort. METHODS: All patients treated for MAAAs in Sweden between 1994 and 2014 were identified in the Swedish vascular registry. The primary aim was to assess survival after MAAA with OR and EVAR. Secondary aims were analyses of the rate of recurrent infections and reoperations, and time trends in surgical treatment...
December 6, 2016: Circulation
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
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