Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms with Hostile Aortic Neck Anatomy

Broos, Pieter P.H.L.; Mannetje, Yannick W. ‘t; Cuypers, P.H.; Sambeek, Marc R.H.M. van; Teijink, Joep A.W.

doi:10.1016/j.ejvs.2015.04.017

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…When considering emergency EVAR only, single centre studies from experienced units document good results even in rAAA patients with hostile aortic neck anatomy. [471][472][473][474] When patients are grouped based on aortic anatomy and whether EVAR is performed inside or outside the IFU, increased long-term mortality and complications after EVAR for rAAAs are associated with hostile aneurysm anatomy. 475…”

Section: Intra-abdominal Hypertension (Iah) and Acsmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Wanhainen¹,

Verzini²,

Herzeele³

et al. 2019

European Journal of Vascular and Endovascular Surgery

1,962

1,522

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Section: Intra-abdominal Hypertension (Iah) and Acsmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Wanhainen¹,

Verzini²,

Herzeele³

et al. 2019

European Journal of Vascular and Endovascular Surgery

1,962

1,522

View full text Add to dashboard Cite

“…Three studies examined patients who underwent EVAR for ruptured AAA, 21,23,24 and another five studies examined patients who had open surgery. 16e18,20,25 An additional study included both patients with EVAR and open surgery and reported separate outcome data for the two groups.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Only two studies 21,24 reporting 60 patients with hostile and 83 with friendly anatomy provided data on this outcome. Two studies 21,24 reported on technical success of treatment for ruptured AAA (39 patients with hostile anatomy and 30 patients with friendly anatomy). The difference in technical success was not significant in patients with hostile vs. friendly aortic anatomy (OR 0.14, 95% CI 0.01e3.07, p ¼ .21) (Fig.…”

Section: Effects Of Interventionsmentioning

confidence: 99%

“…5D) with evidence of substantial statistical heterogeneity (p ¼ .06, I 2 ¼ 72%). Only 60 patients with hostile and 83 with friendly anatomy reported by two studies 21,24 were included in this meta-analysis. Data on the length of hospital stay were reported in five studies 17e20,23 (total of 402 patients with hostile anatomy and 198 with friendly anatomy).…”

Section: Effects Of Interventionsmentioning

confidence: 99%

“…Broos 2015 21 Powell 2015 6 EVAR Heterogeneity: Tau 2 = 0.12; Chi 2 = 3.69, df = 3 (p = .30); I 2 = 19% Test for overall effect: Z = 0.89 (p = .37)…”

Section: Evarmentioning

confidence: 99%

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Systematic Review and Meta-Analysis of Outcomes of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Hostile vs. Friendly Aortic Anatomy

Kontopodis

Tavlas

Ioannou

et al. 2020

European Journal of Vascular and Endovascular Surgery

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Observational data from national and international registries have shown that endovascular repair carries a lower peri-operative mortality risk than open repair for ruptured abdominal aortic aneurysm (AAA). Patient selection may explain the superiority of endovascular aneurysm repair (EVAR), with hostile aortic anatomy being a confounding factor. This study is a meta-analysis of outcomes in patients with hostile vs. friendly aortic anatomy treated for ruptured AAA. It was found that patients with hostile aortic anatomy undergoing EVAR have higher peri-operative mortality and lower overall survival. No significant differences in mortality were found for patients treated by open repair.Objective: To investigate the effect of hostile aortic anatomy on the outcomes of endovascular and open repair for ruptured abdominal aortic aneurysm (AAA). Methods: Electronic bibliographic sources (MEDLINE, EMBASE, CENTRAL) were searched using a combination of thesaurus and free text terms to identify studies comparing treatment outcomes of ruptured AAA in patients with hostile vs. friendly aortic anatomy. A systematic review was conducted that conformed to the PRISMA guidelines using a registered protocol (CRD42019127307). The primary outcomes were peri-operative mortality, freedom from aneurysm related mortality, and overall survival. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) and 95% confidence interval (CI). A time to event data metaanalysis was conducted using the inverse variance method and the results were reported as summary hazard ratio (HR) and associated 95% CI. Subgroup analysis for type of treatment (endovascular aneurysm repair [EVAR] or open repair) was undertaken. Random effects models of meta-analysis were developed. Results: Ten observational studies were included reporting a total of 1284 patients (748 with hostile anatomy and 536 with friendly anatomy). Patients with hostile anatomy had a higher peri-operative mortality than patients with friendly anatomy (OR 1.73, 95% CI 1.13e2.66; p ¼ .01). Subgroup analysis showed a significant difference in perioperative mortality in favour of friendly anatomy in patients treated by EVAR (OR 1.76, 95% CI 1.01e3.08; p ¼ .05), but not in those treated by open repair (OR 1.37, 95% CI 0.83e2.27; p ¼ .22). Patients with hostile anatomy treated by EVAR had a significantly higher hazard of death in follow up than patients with friendly aortic anatomy (HR 2.01, 95% CI 1.18e3.44, p ¼ .01), whereas for open surgical repair, the survival was similar in patients with hostile and those with friendly aortic anatomy (HR 0.90, 95% CI 0.61e1.32, p ¼ .58). Conclusion: Hostile aortic anatomy is associated with increased mortality in patients with ruptured AAA treated by EVAR.

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Contemporary Management of Ruptured Infrarenal Abdominal Aortic Aneurysms

Schneck

Farivar

2021

Curr Surg Rep

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Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms with Hostile Aortic Neck Anatomy

Abstract: Emergency EVAR provides excellent results for treatment of RAAA patients with both FNA and HNA. EVAR in RAAAs with HNA is technically feasible and safe in experienced endovascular centres. Article history.

Cited by 19 publications

References 25 publications

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Systematic Review and Meta-Analysis of Outcomes of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Hostile vs. Friendly Aortic Anatomy

Contemporary Management of Ruptured Infrarenal Abdominal Aortic Aneurysms

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