Epidemiology of endovascular and open repair for abdominal aortic aneurysms in the United States from 2004 to 2015 and implications for screening

Dansey, Kirsten; Varkevisser, Rens R.B.; Swerdlow, Nicholas J.; Li, Chun; Guerre, Livia E.V.M. de; Liang, Patric; Marcaccio, Christina L.; O’Donnell, Thomas F.X.; Carroll, Brett J.; Schermerhorn, Marc L.

doi:10.1016/j.jvs.2021.01.044

Cited by 66 publications

(26 citation statements)

References 45 publications

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“…The adjusted HR comparing the primary outcome between those treated with unibody devices vs non-unibody devices was 1.06 (95% CI, 0.98-1.14 were treated endovascularly. 3 The primary benefits of this treatment modality compared with open surgery include lower risks of periprocedural events and inhospital mortality. This has been demonstrated in several randomized trials comparing outcomes after aortic stent grafts with open surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Since the time of initial endograft approval, the use of these devices has grown steadily, with current implantation rates far surpassing those of open surgery. 3 This expansion in endovascular aneurysm repair (EVAR) for AAA has not been without issue. Although advances in endograft design have allowed their use in more complex lesions, these devices may develop endoleaks (defined as blood flow into the aneurysm sac), which occurs in 20% to 25% of patients undergoing EVAR.…”

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confidence: 99%

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Comparison of Unibody and Non-Unibody Endografts for Abdominal Aortic Aneurysm Repair in Medicare Beneficiaries: The SAFE-AAA Study

et al. 2023

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BACKGROUND: Concerns have been raised about the long-term performance of aortic stent grafts for the treatment of abdominal aortic aneurysms, in particular, unibody stent grafts (eg, Endologix AFX AAA stent grafts). Only limited data sets are available to evaluate the long-term risks related to these devices. The SAFE-AAA Study was designed with the Food and Drug Administration to provide a longitudinal assessment of the safety of unibody aortic stent grafts among Medicare beneficiaries. METHODS: The SAFE-AAA Study was a prespecified, retrospective cohort study evaluating whether unibody aortic stent grafts are noninferior to non-unibody stent grafts with respect to the composite primary outcome of aortic reintervention, rupture, and mortality. Procedures were evaluated from August 1, 2011, through December 31, 2017. The primary end point was evaluated through December 31, 2019. Inverse probability weighting was used to account for imbalances in observed characteristics. Sensitivity analyses were used to evaluate the effect of unmeasured confounding, including the falsification end points of heart failure, stroke, and pneumonia. A prespecified subgroup includes patients treated from February 22, 2016, through December 31, 2017, corresponding to the market release of the most contemporary unibody endograft (Endologix AFX2 AAA stent graft). RESULTS: Of 87 163 patients who underwent aortic stent grafting at 2146 US hospitals, 11 903 (13.7%) received a unibody device. The average age was 77.0±6.7 years, 21.1% were female, 93.5% were White, 90.8% had hypertension, and 35.8% used tobacco. The primary end point occurred in 73.4% of unibody device-treated patients versus 65.0% of non-unibody device–treated patients (hazard ratio, 1.19 [95% CI, 1.15–1.22]; noninferior P value of 1.00; median follow-up, 3.4 years). Falsification end points were negligibly different between groups. In a contemporary subgroup of procedures, the cumulative incidence of the primary end point was 37.5% of unibody device–treated patients and 32.7% of non-unibody device–treated patients (hazard ratio, 1.06 [95% CI, 0.98–1.14]). CONCLUSIONS: In the SAFE-AAA Study, unibody endografts failed to meet noninferiority compared with non-unibody endografts with respect to aortic reintervention, rupture, and mortality. These data support the urgency of instituting a prospective longitudinal surveillance program for monitoring safety events related to aortic stent grafts.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Comparison of Unibody and Non-Unibody Endografts for Abdominal Aortic Aneurysm Repair in Medicare Beneficiaries: The SAFE-AAA Study

et al. 2023

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“…5,6 In a large study from the National Inpatient Sample, 10 603 of 25 777 patients with ruptured AAA (24%) were <65 years of age. 5 Notably, in patients <65 years, data are lacking on the mortality benefit of AAA screening.…”

Section: Aneurysmsmentioning

confidence: 99%

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Isselbacher¹,

Preventza²,

Black³

et al. 2022

Circulation

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747

410

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Aim: The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). Methods: A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.

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“…In clinic, AAA is defined as a maximum abdominal aortic diameter at least 1.5 times larger than the expected normal value [ 3 ]. For now, open or endovascular surgical repair is useless for most small AAA, and the specific medicine against AAA remains undeveloped [ 4 ]. Nowadays, AAA can be identified at early stage as a result of imaging and screening programs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Effect and Mechanism of Si-Miao-Yong-An Decoction on Abdominal Aortic Aneurysm Based on Mice Experiment and Bioinformatics Analysis

Zhang

Huangfu

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. Abdominal aortic aneurysm (AAA) is a fatal disease characterized by high morbidity and mortality in old population. Globally, effective drugs for AAA are still limited. Si-Miao-Yong-An decoction (SMYAD), a traditional Chinese medicine (TCM) formula with a high medical value, was reported to be successfully used in an old AAA patient. Thus, we reason that SMYAD may serve as a potential anti-AAA regime. Objective. The exact effects and detailed mechanisms of SMYAD on AAA were explored by using the experimental study and bioinformatics analysis. Methods. Firstly, C57BL/6N mice induced by Bap and Ang II were utilized to reproduce the AAA model, and the effects of SMYAD were systematically assessed according to histology, immunohistochemistry, and enzyme-linked immunosorbent assay (ELISA). Then, network pharmacology was applied to identify the biological processes, pathways, and hub targets of SMYAD against AAA; moreover, molecular docking was utilized to identify the binding ability and action targets. Results. In an animal experiment, SMYAD was found to effectively alleviate the degree of pathological expansion of abdominal aorta and reduce the incidence of Bap/Ang II-induced AAA, along with reducing the damage to elastic lamella, attenuating infiltration of macrophage, and lowering the circulating IL-6 level corresponding to the animal study, and network pharmacology revealed the detailed mechanisms of SMYAD on AAA that were related to pathways of inflammatory response, defense response, apoptotic, cell migration and adhesion, and reactive oxygen species metabolic process. Then, seven targets, IL-6, TNF, HSP90AA1, RELA, PTGS2, ESR1, and MMP9, were identified as hub targets of SMYAD against AAA. Furthermore, molecular docking verification revealed that the active compounds of SMYAD had good binding ability and clear binding site with core targets related to AAA formation. Conclusion. SMYAD can suppress AAA development through multicompound, multitarget, and multipathway, which provides a research direction for further study.

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Epidemiology of endovascular and open repair for abdominal aortic aneurysms in the United States from 2004 to 2015 and implications for screening

Cited by 66 publications

References 45 publications

Comparison of Unibody and Non-Unibody Endografts for Abdominal Aortic Aneurysm Repair in Medicare Beneficiaries: The SAFE-AAA Study

Comparison of Unibody and Non-Unibody Endografts for Abdominal Aortic Aneurysm Repair in Medicare Beneficiaries: The SAFE-AAA Study

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Exploring the Effect and Mechanism of Si-Miao-Yong-An Decoction on Abdominal Aortic Aneurysm Based on Mice Experiment and Bioinformatics Analysis

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