Evolution of Practices in Treatment of Abdominal Aortic Aneurysm in France between 2006 and 2015

Mont, Lucie Salomon du; Rinckenbach, Simon; Besch, Guillaume; Steinmetz, Éric; Kretz, Benjamin

doi:10.1016/j.avsg.2018.12.063

Cited by 7 publications

(3 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Concordantly, there was a reciprocal increase in the operative complexity of OARs, which was consistent with prior studies. 40,41 In addition, it is important to highlight that ≈40% of elective EVAR procedures were performed in patients with AAA diameters below the currently endorsed diameter treatment thresholds. Although alternative indications such as saccular morphology or rapid expansion may account for a percentage of real-world off guideline repairs, these numbers have been historically documented to be a dramatic outlier (eg, a 2-6-fold higher rate in the United States) relative to other international registries 6 and thus would fail to account for our observation.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends and Outcomes of Abdominal Aortic Aneurysm Care in the United States

Gilmore,

Scali,

D’Oria

et al. 2024

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

BACKGROUND: Endovascular aortic aneurysm repair (EVAR) has had a dynamic impact on abdominal aortic aneurysm (AAA) care, often supplanting open AAA repair (OAR). Accordingly, US AAA management is often highlighted by disparities in patient selection and guideline compliance. The purpose of this analysis was to define secular trends in AAA care. METHODS: The Society for Vascular Surgery Vascular Quality Initiative was queried for all EVARs and OARs (2011–2021). End points included procedure utilization, change in mortality, patient risk profile, Society for Vascular Surgery-endorsed diameter compliance, off-label EVAR use, cross-clamp location, blood loss, in-hospital complications, and post-EVAR surveillance missingness. Linear regression was used without risk adjustment for all end points except for mortality and complications, for which logistic regression with risk adjustment was used. RESULTS: In all, 66 609 EVARs (elective, 85% [n=55 805] and nonelective, 15% [n=9976]) and 13 818 OARs (elective, 70% [n=9706] and nonelective, 30% [n=4081]) were analyzed. Elective EVAR:OAR ratios were increased (0.2 per year [95% CI, 0.01–0.32]), while nonelective ratios were unchanged. Elective diameter threshold noncompliance decreased for OAR (24%→17%; P =0.01) but not EVAR (mean, 37%). Low-risk patients increasingly underwent elective repairs (EVAR, +0.4%per year [95% CI, 0.2–0.6]; OAR, +0.6 points per year [95% CI, 0.2–1.0]). Off-label EVAR frequency was unchanged (mean, 39%) but intraoperative complications decreased (0.5% per year [95% CI, 0.2–0.9]). OAR complexity increased reflecting greater suprarenal cross-clamp rates (0.4% per year [95% CI, 0.1–0.8]) and blood loss (33 mL/y [95% CI, 19–47]). In-hospital complications decreased for elective (0.7% per year [95% CI, 0.4–0.9]) and nonelective EVAR (1.7% per year [95% CI, 1.1–2.3]) but not OAR (mean, 42%). A 30-day mortality was unchanged for both elective OAR (mean, 4%) and EVAR (mean, 1%). Among nonelective OARs, an increase in both 30-day (0.8% per year [95% CI, 0.1–1.5]) and 1-year mortality (0.8% per year [95% CI, 0.3–1.6]) was observed. Postoperative EVAR surveillance acquisition decreased (67%→49%), while 1-year mortality among patients without imaging was 4-fold greater (9.2% versus imaging, 2.0%; odds ratio, 4.1 [95% CI, 3.8–4.3]; P <0.0001). CONCLUSIONS: There has been an increase in EVAR and a corresponding reduction in OAR across the United States, despite established concerns surrounding guideline adherence, reintervention, follow-up, and cost. Although EVAR morbidity has declined, OAR complication rates remain unchanged and unexpectedly high. Opportunities remain for improving AAA care delivery, patient and procedure selection, guideline compliance, and surveillance.

show abstract

Section: Discussionmentioning

confidence: 99%

Temporal Trends and Outcomes of Abdominal Aortic Aneurysm Care in the United States

Gilmore,

Scali,

D’Oria

et al. 2024

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…For instance, this shift was observed in Sweden, Italy, and the United Kingdom in 2009, followed by France and Spain in 2010. 6,[13][14][15] New Zealand noted a similar transition in 2011, five years after Australia. 16 Additionally, Japan and Finland joined this trend in 2013.…”

mentioning

confidence: 91%

Trends in AAA Repair in Australia Over Twenty Years

Anthony,

Gillies,

Goh

2024

VHRM

View full text Add to dashboard Cite

Background The advent of endovascular techniques has revolutionised the treatment of abdominal aortic aneurysms (AAA). Many countries have seen a transition from open AAA repair (OAR) to endovascular AAA repair (EVAR) over the past 25 years. The only study done in Australia that describes this change was done in the private sector. Majority of healthcare in Australia is delivered through the public, universal healthcare system. The aim of this study was to evaluate the trends in AAA repair in the Australian public sector over the past two decades. Methods The Australian Institute of Health and Welfare (AIHW) Procedures Data Cubes from the National Hospitals Data Collection was used to extract data pertaining to AAA repairs from 2000 to 2021. Population data from the Australian Bureau of Statistics was used to calculate incidence of each type of repair per 100,000 population. Results There were 65,529 AAA repairs performed in the Australian public sector from 2000 to 2021. EVARs accounted for 64.4% (42,205) and OARs accounted for 35.6% (23, 324) of them. EVAR surpassed OAR as the preferred method of AAA repair in 2006. This trend was observed in both males and females and across all age groups. Conclusion There was a consistent and steady transition from OAR to EVAR over the 21 year period with EVAR surpassing OAR as the preferred method of AAA repair relatively early in Australia compared to other countries. Further research that investigates medium- and long-term outcomes of newer stent grafts is needed to further ascertain the continued viability and effectiveness of this trend in AAA treatment.

show abstract

“…[ 1 ] Endovascular techniques are considered less invasive and are preferred in two thirds of cases. [ 2 , 3 ] Endovascular aneurysm repair (EVAR) can be performed with infrarenal or suprarenal fixation (SR fixation). The choice depends the operators usual habits, the angulation ,and the length of the neck of the aneurysm.…”

Section: Introductionmentioning

confidence: 99%

To assess hemodynamic disturbances to the ostia of the renal arteries generated by the implantation of EVAR with a suprarenal fixation

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction: The treatment of abdominal aortic aneurysm (AAA) is increasingly performed via endovascular aneurysm repair (EVAR). Different types of fixation are possible with EVAR, i.e., below (infrarenal fixation) or above (suprarenal fixation) the renal arteries. Hemodynamic alterations in renal arterial flow with suprarenal (SR) fixation remain to be demonstrated. The IFIXEAR (Impact of Supra-renal Fixation of EVAR on Hemodynamics of Renal Arteries) study is designed to assess the hemodynamic effects at the ostia of at least 1 renal artery, generated immediately post-surgery by the implantation of an aortic stent with SR fixation. Methods: IFIXEAR is a prospective, 2 center study. Every patient undergoing elective EVAR with SR fixation is eligible for inclusion. Patients with previous hemodynamic disturbances to the ostia of 1 of the renal arteries are not eligible. All patients undergo echocardiography and renal arteries duplex ultrasound within a month before surgery, and at 1 and 12 months after surgery. The primary endpoint is hemodynamic disturbance, defined as a peak systolic velocity greater than 120 cm/second, at the ostia of 1 of the renal arteries in the immediate postoperative period. Ethics and dissemination: The study was approved by the Ethics Committee “Comité de Protection des Personnes Ouest V” under the number 18/019-2 on April 20, 2018. All patients provide written informed consent before inclusion. The University Hospital of Besancon is the trial sponsor. Results of the study will be submitted for publication in a peer-reviewed international medical journal. Registration: The trial is registered with ClinicalTrials.gov (Identifier: NCT03594786, principal investigator: Dr Patricia Costa, Registered on April 24, 2018).

show abstract

Evolution of Practices in Treatment of Abdominal Aortic Aneurysm in France between 2006 and 2015

Cited by 7 publications

References 31 publications

Temporal Trends and Outcomes of Abdominal Aortic Aneurysm Care in the United States

Temporal Trends and Outcomes of Abdominal Aortic Aneurysm Care in the United States

Trends in AAA Repair in Australia Over Twenty Years

To assess hemodynamic disturbances to the ostia of the renal arteries generated by the implantation of EVAR with a suprarenal fixation

Contact Info

Product

Resources

About