How Many Patients with Infrarenal Aneurysms are Candidates for Endovascular Repair? The Northern California Experience

Arko, Frank R.; Filis, Konstantinos; Seidel, Scott A.; Gonzalez, Jim; Lengle, Steve J.; Webb, Ron; Rhee, John; Zarins, Christopher K.

doi:10.1177/152660280401100104

Cited by 76 publications

(22 citation statements)

References 20 publications

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“…The data from our systematic review do not suggest that the proportion of women morphologically suitable for EVAR has improved since earlier this century. 6,7 However, the operative mortality in both men and women has fallen substantially since a 2010 systematic review, 9 particularly for open repair; although 30-day operative mortality remains almost twice as high in women as in men. Some of the reduction in operative mortality in women might have come at the expense of the high proportion of women (a third) who are assigned to a non-intervention policy; although, the literature on non-intervention policy remains sparse.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 However, data from the large Medicare database in the USA suggest that this relative difference in 30-day mortality between EVAR and open repair is observed for both men and women, even though the absolute mortality was higher in women than men. 8 An earlier systematic review, 9 including studies published by July, 2009, showed that for elective open repairs the operative mortality (30 day or in-hospital) was 7·6% for women versus 5·1% for men.…”

Section: Introductionmentioning

confidence: 99%

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Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

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1 ArticlesMorphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis Pinar Ulug, Michael J Sweeting, Regula S von Allmen, Simon G Thompson, Janet T Powell, on behalf of the SWAN collaborators* Summary Background Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000.Methods In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the NewcastleOttawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227.Findings Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0·44, 95% CI 0·32-0·62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2·27, 95% CI 1·21-4·23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2·3%) than in men (1·4%; OR 1·67, 95% CI 1·38-2·04). The overall estimate for open repair also was higher in women (5·4%) than in men (2·8%; OR 1·76, 95% CI 1·35-2·30).Interpretation Compared with men, a smaller proportion of women are eligible for EVAR, a higher proportion of women are not offered intervention, and operative...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Ulug¹,

Sweeting²,

vonAllmen³

et al. 2017

Journal of Vascular Surgery

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“…7 Furthermore, a high percentage of them have severe comorbidities precluding traditional open repair. [8][9][10] Thus, the unmet medical needs to preserve the endovascular management of complex aortic aneurysms urged clinicians and manufactures to develop SGs with fenestrations (holes) or scallops (gaps or valleys in the upper graft fabric margin) to access visceral arteries, called fenestrated SGs, simply to allow extension of the sealing zone indefinitely, limited only by the desire to limit the number of visceral vessels incorporated into the repair.…”

mentioning

confidence: 99%

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

et al. 2016

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The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).

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“…The proximal neck is the segment of aorta above the aneurysm sac. An unfavourable neck anatomy, based on its diameter, length, angulation, morphology, and presence of calcification and mural thrombus, is the most frequent cause of exclusion from EVAR [12]. a) Length: To achieve a good seal and decrease proximal migration and type I endoleak rates, a length of at least 15-mm for infrarenal stent-graft fixation or 10-mm for transrenal stent-graft fixation, with barbs, hooks, or uncovered suprarenal stents, is recommended [13].…”

Section: ) Proximal Neck Of the Aneurysmmentioning

confidence: 99%

Deploying swarm intelligence in medical imaging identifying metastasis, micro‐calcifications and brain image segmentation

al-Rifaie

Aber²,

Hemanth

2015

IET syst. biol.

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Abstract-This paper proposes an umbrella deployment of swarm intelligence algorithm such as Stochastic Diffusion Search for medical imaging applications. After summarising the results of some previous work which shows how the algorithm assists in the identification of metastasis in bone scans and microcalcifications on mammographs, for the first time, the use of the algorithm in assessing the CT images of aorta is demonstrated along with its performance in detecting the nasogastric tube in chest X-ray. The swarm intelligence algorithm presented in this paper is adapted to address these particular tasks and its functionality is investigated by running the swarms on sample CT images and X-rays whose status have been determined by senior radiologists. Additionally, a hybrid swarm intelligence-Learning Vector Quantisation (LVQ) approach is proposed in the context of Magnetic Resonance (MR) brain image segmentation. The Particle Swarm Optimisation (PSO) is used to train the LVQ which eliminates the iterationdependent nature of LVQ. The proposed methodology is used to detect the tumor regions in the abnormal MR brain images.

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How Many Patients with Infrarenal Aneurysms are Candidates for Endovascular Repair? The Northern California Experience

Cited by 76 publications

References 20 publications

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

Deploying swarm intelligence in medical imaging identifying metastasis, micro‐calcifications and brain image segmentation

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