Assessing trends, morbidity, and mortality in ruptured abdominal aortic aneurysm repair with 9 years of data from the National Surgical Quality Improvement Program

Melillo, Atlee; Trani, Jose; Gaughan, John; Carpenter, Jeffrey P.; Lombardi, Joseph V.

doi:10.1016/j.jvs.2019.04.462

Cited by 23 publications

(9 citation statements)

References 26 publications

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“…Data from the American College of Surgeons' National Quality Improvement Program database showed that for all rAAAs with hypotension, OSR had increased mortality compared with EVAR (p < .0004). 33 It is possible that the higher mortality with OSR was due to selection bias where patients with hypotension or more complex aneurysms are more likely to undergo OSR. Despite the widespread use of endovascular technology in elective cases, EVAR was used only in 11% of all emergency cases, or one EVAR to 7.5 OSR cases.…”

Section: Discussionmentioning

confidence: 99%

“…This suggests that although surgeons became increasingly comfortable using EVAR in a controlled setting, this does not translate directly into emergency use. 33 The offer of EVAR in the emergency setting comes with a greater complexity that involves not only the surgeon's expertise but also the availability of a wide range of endograft sizes and ancillary material on the shelf, a suitable operation room, and an autonomous team to plan and perform the case, all during 24 h a day and seven days a week. Efforts to accommodate the increase of EVAR for rAAA in Portugal, including vascular training focused on EVAR on hypotensive patients and the use of resuscitative endovascular balloon occlusion of the aorta may contribute to a further gain in rAAA mortality in the future.…”

Section: Discussionmentioning

confidence: 99%

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Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000–2015)

Dias-Neto¹,

Castro‐Ferreira²,

Mani³

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThe overall mortality of ruptured abdominal aortic aneurysm (rAAA) depends both on disease prevalence and mortality before and after hospital admission. In this article, the mortality related to rAAA was studied in Portugal based on national registries. Admission, repair, and mortality due to rAAA seem to have reached a peak and recently have been decreasing (2010e2015). At the same time, there was a gradual increased adoption of endovascular repair for ruptures. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.Objective: Ruptured abdominal aortic aneurysm (rAAA) is a lethal condition that requires acute repair to prevent death. This analysis aims to assess the nationwide trends in rAAA admission, repair and mortality in a country, Portugal, without national screening for AAA. Methods: rAAA registered in the hospital administrative database of the National Health Service and all nationally registered deaths due to rAAA based on death certificate data were analysed. Three time periods (2000e2004, 2005e2009, and 2010e2015) were compared in patients ! 50 years old to assess the variations over time. Results: A total of 2 275 patients !50 years old with rAAA were identified in the two databases from 2000 to 2015. The age standardised incidence of rAAA was 2.78 AE 0.24/100 000/year in 2000e2004, 3.17 AE 0.39/100 000/year in 2005e2009 and 3.21 AE 0.28/100 000/year in 2010e2015 (p < .001). When comparing the time periods 2000e2004 to 2005e2009, the age standardised rate of admission (n ¼ 1460) increased from 1.57 AE 0.25/100 000/year to 2.24 AE 0.32/100 000/year (p < .001). The operative mortality rates decreased during this time period (from 55.3 AE 4.7% to 48.8 AE 4.7%, p < .001). In 2010e2015, the age standardised rate of admissions due to rAAA decreased (1.98 AE 0.22/100 000/year). Operative mortality remained stable (48.9 AE 6.2%). The rate of patient deaths outside the hospital decreased from the first to the second period (1.21 AE 0.10/100 000/year and 0.93 AE 0.29/100 000/year, respectively) but later increased (1.14 AE 0.22/100 000/year). This resulted in a higher overall rAAA related mortality in Portugal in the third period (2.20 AE 0.18/100 000/year, 2.21 AE 0.27/100 000/year and 2.26 AE 0.26/100 000/year in 2000e2004, 2005e2009, and 2010e2015, respectively, p < .001). Conclusion: Overall, the incidence of rAAA in Portugal has been stable over the past 10 years. The rates of admission, repair, and death due to rAAA repair seem to have reached an inflection point and are now decreasing. Mortality outside the hospital remains a matter of concern, warranting further planning of streamlined transfer networks and vascular surgical departments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000–2015)

Dias-Neto¹,

Castro‐Ferreira²,

Mani³

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…Patients with ruptured AAAs that survive to surgery have a mortality of approximately 30%. 3 There are currently no medical treatments recommended in clinical practice to abrogate aneurysm growth and reduce the risk of rupture. 4 The pathophysiology of aortic aneurysm and dissection is complex.…”

Section: Introductionmentioning

confidence: 99%

Adventitial recruitment of Lyve-1− macrophages drives aortic aneurysm in an angiotensin-2-based murine model

Ulndreaj

Chen

et al. 2021

Clinical Science

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Objective: Aortic macrophage accumulation is characteristic of the pathogenesis of abdominal aortic aneurysm (AAA) but the mechanisms of macrophage accumulation and their phenotype are poorly understood. Lyve-1+ resident aortic macrophages independently self-renew and are functionally distinct from monocyte-derived macrophages recruited during inflammation. We hypothesized that Lyve-1+ and Lyve-1- macrophages differentially contribute to aortic aneurysm. Approach and Results: Angiotensin-2 and beta-aminopropionitrile (AT2/BAPN) were administered to induce AAA in C57BL/6J mice. Using immunohistochemistry, we demonstrated primarily adventitial accumulation of aortic macrophages, and in association with areas of elastin fragmentation and aortic dissection. Compared to controls, AAA was associated with a relative percent depletion of Lyve-1+ resident aortic macrophages and accumulation of Lyve-1- macrophages. Using CD45.1/CD45.2 parabiosis, we demonstrated aortic macrophage recruitment in AAA. Depletion of aortic macrophages in CCR2-/- mice was associated with reduced aortic dilatation indicating the functional role of recruitment from the bone marrow. Depletion of aortic macrophages using anti- Macrophage Colony Stimulating Factor 1 Receptor (MCSF1R)-neutralizing antibody reduced the incidence of AAA. Conditional depletion of Lyve-1+ aortic macrophages was achieved by generating Lyve-1 wt/cre Csf1rfl/fl mice. Selective depletion of Lyve-1+ aortic macrophages had no protective effects following AT2/BAPN administration and resulted in increased aortic dilatation in the suprarenal aorta. Conclusions: Aortic macrophage accumulation in AAA derives from adventitial recruitment of Lyve-1- macrophages, with relative percent depletion of Lyve-1+ macrophages. Selective targeting of macrophage subtypes represents a potential novel therapeutic avenue for the medical treatment of AAA.

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“…[1][2][3][4] Although centralization of care and the adoption of endovascular aneurysm repair (EVAR) treatment strategies have improved survival after rAAA repair, the treatment of rAAAs is resource intensive, and mortality has remained high. [5][6][7][8][9][10][11][12][13][14][15][16] The existence of an accurate preoperative risk stratification tool, which could predict who might benefit from surgery, would, therefore, not only help guide clinicians and patients in decision-making, but would also allow for the appropriate allocation of healthcare resources.…”

Section: Discussionmentioning

confidence: 99%

Preoperative risk score accuracy confirmed in a modern ruptured abdominal aortic aneurysm experience

Hemingway

French

Caps

et al. 2021

Journal of Vascular Surgery

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Assessing trends, morbidity, and mortality in ruptured abdominal aortic aneurysm repair with 9 years of data from the National Surgical Quality Improvement Program

Cited by 23 publications

References 26 publications

Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000–2015)

Nationwide Analysis of Ruptured Abdominal Aortic Aneurysm in Portugal (2000–2015)

Adventitial recruitment of Lyve-1− macrophages drives aortic aneurysm in an angiotensin-2-based murine model

Preoperative risk score accuracy confirmed in a modern ruptured abdominal aortic aneurysm experience

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