No abstract

AAA overall could make screening less cost effective than previously estimated. Bottom line is some things are improving but despite the falling incidence of rAAA, it is still quite common with 3.2 deaths per 100,000 people annually.

Purpose This study aims to evaluate the safety and efficacy of novel approaches to type 2 endoleak access for the purpose of embolization using ethylene-vinyl-alcohol copolymer (EVOH) in patients with abdominal aortic aneurysm (AAA) sac expansion post endovascular abdominal aortic repair (EVAR). Methods A retrospective review of 43 consecutive patients (mean age = 80.2 ± 6.7 years) who underwent 52 embolization procedures for type 2 endoleaks using EVOH was performed at a single institution. Catheterization of the endoleaks was achieved using the transarterial (TA) and direct translumbar approaches (DTL), in addition to the novel direct transabdominal (DTA) and perigraft (PG) approaches. Endpoints included technical success of endoleak catheterization, technical success of endoleak embolization, endoleak persistence, endoleak recurrence, AAA sac area change, and adverse events. Results The TA, DTL, DTA, and PG approaches were used 25, 2, 14, and 19 times respectively, including nine procedures where a combination of approaches was used. The technical success rate of endoleak embolization was 98%. Five patients developed recurrent type 2 endoleaks, while five patients developed a type 1 endoleak. The persistent endoleak rate at a mean initial follow-up of 3 months was 34%. At a mean follow-up of 18 months, 58% of patients demonstrated absence of an endoleak, and 71% showed freedom from AAA sac enlargement. No major adverse events were recorded. Conclusion The DTA and PG approaches were safe and effective in this cohort of patients undergoing embolization of type 2 endoleaks with EVOH.

characterize the breadth of assistance provided during urgent consultations at a single tertiary academic center.Methods: We queried our institutional billing department during a 15-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) and identified unanticipated urgent vascular surgery intraoperative consultations from all surgical services. Patients' demographics and comorbidities were recorded along with the consulting services, type of index operation, reasons for vascular consultation, anatomic regions intervened on, vascular interventions performed, and outcomes achieved.Results: A total of 366 true emergency intraoperative consultations were identified. Patients were 51% male, with an average age of 57 years and body mass index of 28.4 kg/m 2 . Subspecialties assisted were most commonly surgical oncology (n114 [31%]), cardiac surgery (n ¼ 76 [21%]), and orthopedics (n ¼ 39 [11%]; Table). Index cases were elective/nonurgent (n ¼ 280 [76.7%]), urgent (n ¼ 24 [6.6%]), and emergent (n ¼ 61 [16.7%]), with a majority involving tumor resection (n ¼ 193 [53.2%]). The primary reason for vascular consultation was revascularization (n ¼ 169 [47.4%]), control of bleeding (n ¼ 120 [33.4%]), assistance with dissection/exposure (n ¼ 40 [11.1%]), embolic protection (n ¼ 25 [7.0%]), and other (n ¼ 4 [1.1%]). The primary blood vessel and anatomic field of intervention were categorized (Fig).A majority of cases (n ¼ 233 [61.3%]) involved preservation of blood flow, including primary arterial repair (n ¼ 157 [43.1%]), patch angioplasty (n ¼ 70 [19.2%]), bypass (n ¼ 50 [13.7%]), and thrombectomy (n ¼ 33 [9.1%]).Postoperative length of stay was 14 days, with 30-day and 1-year mortality of 7.7% and 27.0%.Conclusions: Vascular surgeons are called on to provide urgent open surgical consultations for a wide variety of specialties over wide-ranging anatomic regions employing a variety of skills and techniques. This study testifies to the essential services supplied to hospitals and our surgical colleagues as well as the broad skills and training necessary for modern vascular surgeons.