Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair

Carpenter, Jeffrey P.; Baum, Richard A.; Barker, Clyde F.; Golden, Michael A.; Mitchell, Mark E.; Velázquez, Omaida C.; Fairman, Ronald M.

doi:10.1067/mva.2001.120037

Cited by 282 publications

(235 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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“…Unfortunately, EVAR has technical limitations caused by the present stent-graft system construction and the indication depends on AAA morphology. Not all AAAs could be endovascularly treated [21][22][23] . That is why all questions in preoperative decision as to the type of treatment are connected with the patient risk and AAA morphology.…”

Section: Discussionmentioning

confidence: 99%

“…Open surgery was indicated in 115 patients (n = 38 %), 128 patients (n = 43 %) were treated endovascularly [16][17][18][19][20] . Indication for elective treatment and the way of repair were determined according to patients' life expectancy, condition (ASA classification) and AAA morphlogy analyses 7,8,[21][22][23] ( Fig. 2).…”

Section: Methodsmentioning

confidence: 99%

Aaa Elective Treatment Indication Tactics in Evar Era

Utíkal¹,

Köcher²,

Koutná³

et al. 2004

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…A retrospective analysis of 307 patients showed that up to 34 % of patients do not meet the anatomical requirements for EVAR, with 47 % of those being due to an insufficient diameter of the iliac arteries and 10 % due to high torsion of the pelvic axis [36]. The diameter of the common iliac artery should be at least 2 mm smaller than the prosthesis diameter to achieve adequate anchoring through moderate oversizing.…”

Section: Iliac Arteriesmentioning

confidence: 99%

Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms: Standards, Technical Options and Advanced Indications

Ketelsen

Thomas

Schmehl

et al. 2014

Fortschr Röntgenstr

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Since the introduction of endovascular aneurysm repair (EVAR) in 1991, the endovascular therapy with newest stent grafts has assumed a prominent role in the clinical management of abdominal aortic aneurysms (AAA) with a superior perioperative mortality of EVAR and an equivalent mid-term outcome, compared to open surgery. Newest techniques using chimney or periscope grafts and customized fenestrated and branched stent grafts allow the endovascular treatment of complex pararenal AAA. This article reviews EVAR in the treatment of AAA, evidence based results and advanced indication by newest interventional techniques and technical developments. Key Points: ??EVAR has become standard treatment of abdominal aortic aneurysm with equivalent results to open surgery. ??Technical advancements and the introduction of newest stent grafts continually expand the indication of EVAR. ??Chimney- and periscope grafts as well as custom-made prothesis systems allow endovascular treatment of complex para- and suprarenal aneurysms. Citation Format: ??Ketelsen D, Thomas C, Schmehl J et?al. Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms: Standards, Technical Options and Advanced Indications. Fortschr R?ntgenstr 2014; 186: 337???347

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Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair

Cited by 282 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

Aaa Elective Treatment Indication Tactics in Evar Era

Endovascular Aneurysm Repair of Abdominal Aortic Aneurysms: Standards, Technical Options and Advanced Indications

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