Endovascular treatment for ruptured abdominal aortic aneurysm

Badger, Stephen A.; Bedenis, Rachel; Blair, Paul; Ellis, Peter; Kee, Frank; Harkin, Denis W.

doi:10.1002/14651858.cd005261.pub3

Cited by 42 publications

(31 citation statements)

References 57 publications

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“…45 ). This study, another prospective randomized studies (AJAX, IMPROVE) and meta-analysis showed no difference in perioperative mortality [45][46][47][48][49] . Perioperative mortality is 20-50% (ref.…”

Section: Treatment Of Ruptured Aneurysmssupporting

confidence: 50%

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Acute aorta, overview of acute CT findings and endovascular treatment options

Černá¹,

Köcher²,

Thomas³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Acute aortic pathologies include acute aortic syndrome (aortic dissection, intramural hematoma, penetrating aortic ulcer), impending rupture, aortic aneurysm rupture and aortic trauma. Acute aortic syndrome, aortic aneurysm rupture and aortic trauma are life-threatening conditions requiring prompt diagnosis and treatment. The basic imaging modality for "acute aorta" is CT angiography with typical findings for these aortic pathologies. Based on the CT, it is possible to classify aortic diseases and anatomical classifications are essential for the planning of treatment. Currently, endovascular treatment is the method of choice for acute diseases of the descending thoracic aorta and is increasingly indicated for patients with ruptured abdominal aortic aneurysms.

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Section: Treatment Of Ruptured Aneurysmssupporting

confidence: 50%

“…Perioperative mortality is 20-50% (ref. 48,49 ). The results of above mentioned studies AJAX and IMPROVE have recently been questioned on methodological errors and it is stated that the results of endovascular treatment of RAAA could have been better compared with surgical repair.…”

Section: Treatment Of Ruptured Aneurysmsmentioning

confidence: 99%

Acute aorta, overview of acute CT findings and endovascular treatment options

Černá¹,

Köcher²,

Thomas³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Post hoc analysis of REDOXS data suggested that the presence of multi-organ failure that included renal dysfunction at study entry was most strongly associated with the mortality signal with GLN administration (51). However, the current GLND trial differs from the REDOX trial in that it was conducted exclusively in post-operative SICU patients, excluded those in shock or with significant renal/hepatic dysfunction at entry, and provided a lower, more conventional GLN dose (50, 52), in conjunction with complete PN ± EN support, with GLN-PN started several days after ICU admission in resuscitated patients. Given several decades of published RCTs and numerous meta-analyses suggesting the clinical and metabolic benefits of GLN-supplemented PN (6–12, 16–20, 32–36), it remains unclear why we were unable to observe a signal of benefit in this or recent RCTs of GLN-supplemented PN (24–25).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Glutamine-supplemented Parenteral Nutrition in Surgical ICU Patients

et al. 2016

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Objective To determine whether glutamine (GLN)-supplemented parenteral nutrition (PN) improves clinical outcomes in surgical ICU (SICU) patients. Summary Background Data GLN requirements may increase with critical illness. GLN-supplemented PN may improve clinical outcomes in SICU patients, but data in patient subgroups are limited. Methods A parallel-group, multicenter, double blind, randomized, controlled clinical trial in adults after gastrointestinal, vascular, or cardiac surgery who required PN and SICU care. Subjects were without significant renal or hepatic failure or shock at entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids (AA) and energy at 1.3 × estimated basal energy expenditure]. Controls (n = 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75) received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally replacing AA in control PN (GLN-PN). Enteral nutrition (EN) was advanced and PN weaned as indicated. Hospital mortality and infections were primary endpoints. Results Baseline characteristics, days on study PN and daily energy and amino acid/protein intakes via PN and EN were similar between groups. There were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the STD-PN group and (17.3%; difference, −2.6%; 95% confidence interval −14.6 to 9.3%; P = 0.66). The 6-month cumulative all-cause mortality was 31.4% in the GLN-PN group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups, respectively (P= 0.73). Other clinical outcomes and adverse events were similar. Conclusions PN supplemented with GLN dipeptide was safe but did not alter clinical outcomes among SICU patients.

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“…The studies conducted in Europe did not reveal significant difference between EVAR and OAR used for the treatment of ruptured AAA in the shortterm outcomes (31,33,35). Moreover, for the patients undergoing elective operations of AAA and emergency procedure for the ruptured AAA relatively low rate of perioperative mortality and well long-term survival were reported for both methods of treatment (31,33,35,42,43,45). In view of technical difficulties in videoscopic approach with a long learning curve and high cost of robotic system, EVAR or OAR remain routine methods used for AAA repair in the world.…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Badger at al. no relevant advantages in shortterm outcomes for endovascular repair of the ruptured AAA were revealed and the perioperative mortality was comparable for the both methods, with odds ratio 0.91 (95% confidence interval 0.67 to 1.22, p = 0.52) (33). In the study conducted in the Netherlands, the investigators evaluated the same parameters in the patients with the ruptured AAA but the analysis included also long-term outcomes.…”

Section: In Europementioning

confidence: 99%