Emergency Non-ruptured Abdominal Aortic Aneurysm

Haug, Erik Skaaheim; Romundstad, Pål Richard; Aadahl, Petter; Myhre, Hans O.

doi:10.1016/j.ejvs.2004.09.013

Cited by 23 publications

(20 citation statements)

References 23 publications

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“…Many series have demonstrated a significantly higher operative mortality for patients with symptomatic but unruptured AAA who undergo emergent open repair. [248][249][250] For example, Sullivan et al noted a fivefold increase in mortality (26% vs 5.1%) for patients with symptomatic aneurysms undergoing emergency operation in contrast to elective repair. 249 Similarly, Haug and co-workers observed a mortality rate of 18% in patients with symptomatic AAA who underwent surgical repair within 24 hours versus 4.2% for those with semi-elective repair following emergency admission or patients having elective surgery.…”

Section: Level Of Recommendationmentioning

confidence: 95%

“…249 Similarly, Haug and co-workers observed a mortality rate of 18% in patients with symptomatic AAA who underwent surgical repair within 24 hours versus 4.2% for those with semi-elective repair following emergency admission or patients having elective surgery. 248 In the Mayo Clinic series, no deaths from rupture occurred among those patients whose operation was delayed. 251 The reason for such differences in outcome are multifactorial, but include the fact that truly emergency surgical repair is often carried out in less favorable circumstances without the usual surgical and anesthesia personnel or at times outside the typical workday.…”

Section: Level Of Recommendationmentioning

confidence: 98%

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The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

636

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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Section: Level Of Recommendationmentioning

confidence: 95%

Section: Level Of Recommendationmentioning

confidence: 98%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

636

520

View full text Add to dashboard Cite

show abstract

“…Symptomatic cases were defined as acutely symptomatic aneurysms resulting in the need for emergency medical attention. These normally present as acute severe pain in the abdomen, back, or flank not obviously attributable to another cause and without evidence of aneurysm rupture on imaging . No strict aortic diameter was required for inclusion, but all cases did have aortic diameters of greater than 5.0 cm.…”

Section: Methodsmentioning

confidence: 99%

Population‐Based Study of Incidence of Acute Abdominal Aortic Aneurysms With Projected Impact of Screening Strategy

Howard

Banerjee

Fairhead

et al. 2015

JAHA

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BackgroundCurrent abdominal aortic aneurysm (AAA) screening in men age 65 might have limited impact on overall AAA death rates if incidence is moving to older ages. Up-to-date population-based studies of age-specific incidence, risk factors, and outcome of acute AAA are needed to inform screening policy.Methods and ResultsIn a prospective, population-based study (Oxfordshire, UK, 2002–2014), the incidence and outcome of acute AAA events were determined. Based on population projections and current incidence trends, the impact of screening strategies in the UK was estimated. Over the 12-year period, 103 incident acute AAA events occurred in the study population of 92 728. Incidence/100 000/year was 55 in men ages 65 to 74 years, but increased to 112 at 75 to 85 and 298 at ≥85, with 66.0% of all events occurring at age ≥75 years. Incidence at ages 65 to 74 was highest in male smokers (274), with 96.4% of events in men <75 years occurring in ever-smokers. Extrapolating rates to the UK population, using trial evidence of screening efficacy, the current UK screening program would prevent 5.6% of aneurysm-related deaths (315 200 scans/year: 1426/death prevented, 121/year-of-life saved). Screening only male smokers age 65 and then all men at age 75 would prevent 21.1% of deaths (247 900 scans/year; 297/death prevented, 34/year-of-life saved). By 2030, 91.0% of deaths will occur at age ≥75, 61.6% at ≥85, and 28.6% in women.ConclusionsGiven that two thirds of acute AAA occurred at ≥75 years of age, screening older age groups should be considered. Screening nonsmokers at age 65 is likely to have very little impact on AAA event rates.

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“…arterial hypertension (5 of them), hypercholesterolemia (4), cardiomyopathy and diabetes mellitus type II (3), pulmonary disease and stroke (2), myocardial infarction, colon cancer, depression and benign prostatic hyperplasia (1). Four of them were smokers.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with infrarenal AAA (abdominal aortic aneurysms) are often separated into three groups: elective or asymptomatic patients, patients with ruptured aneurysm and symptomatic or emergency patients without rupture [1][2][3]. The sAAA (symptomatic abdominal aortic aneurysm) refers to any of numerous symptoms that are associated with the aneurysm.…”

Section: Introduction mentioning

confidence: 99%

Endovascular Repair of Symptomatic (Non-ruptured) Abdominal Aortic Aneurysm in the University Hospital Centre Split

Penović¹,

Cambj-Sapunar²,

Batinić³

et al. 2018

JPP

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The aim of this study is overview of endovascular sAAA (symptomatic abdominal aortic aneurysm) treatment in the University Hospital Centre Split. The sAAA refers to a number of symptoms associated with aneurysm. EVAR (endovascular aortic repair) is increasingly used as an alternative to an open method that carries a number of advantages. Between January 2016 and February 2017, eight patients were admitted to the University Hospital Centre Split due to sAAA, following clinical and diagnostic treatment by a team of vascular surgeons and emergency radiologists, and ultimately treated with EVAR. Two patients had femoral endarterectomy. One patient had fistula of the right external iliac artery with left common iliac vein. After EVAR with embolization of the right internal iliac artery, the fistula was resolved. Also, one patient had occluded left external iliac artery and femoral-femoral bypass graft was made. After the procedure, two patients had endoleak of type II. Perioperative mortality was zero. On control examinations, all patients were with good general condition and without complications. A prompt diagnosis of sAAA and good team working will result of emergency endovascular procedure and resolve the risk for abdominal aortic aneurysm rupture.

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Emergency Non-ruptured Abdominal Aortic Aneurysm

Cited by 23 publications

References 23 publications

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Population‐Based Study of Incidence of Acute Abdominal Aortic Aneurysms With Projected Impact of Screening Strategy

Endovascular Repair of Symptomatic (Non-ruptured) Abdominal Aortic Aneurysm in the University Hospital Centre Split

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