Management of Postoperative Complications Following Endovascular Aortic Aneurysm Repair

Qrareya, Mohammad; Zuhaili, Bara

doi:10.1016/j.suc.2021.05.020

Cited by 8 publications

(6 citation statements)

References 46 publications

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“…Nonetheless, the vast majority of complications were minor ( n = 103, 31.9%), and the associated mortality was estimated as null (0.6%). Nowadays, EVAR has been established as a minimally invasive and gold-standard care for high-risk patients due to the more favorable early postoperative outcome [ 21 , 22 , 23 ]. In the United States, EVAR accounts for almost 50% of all AAA repairs [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, EVAR has been established as a minimally invasive and gold-standard care for high-risk patients due to the more favorable early postoperative outcome [ 21 , 22 , 23 ]. In the United States, EVAR accounts for almost 50% of all AAA repairs [ 23 ]. However, the reported rate of major or minor postoperative complications following EVAR may range from 0 to 40%; hence, our morbidity rate should not be considered surprising [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although cumulative data have shown that the safety profile of EVAR is improving, many challenges seem poised to arise in the future, and conflicting data still exist due to the utilization of EVAR in everyday clinical practice [ 9 ]. Of note, increased postoperative morbidity has been associated with worse long-term prognosis and mortality rates following the aforementioned invasive procedure [ 9 , 10 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

Ntalouka,

Nana,

Brotis

et al. 2023

JCM

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Background: We evaluated the 30-day postoperative outcome after elective endovascular aneurysm repair (EVAR) and the possible predictors for the 30-day postoperative outcome. Materials: Demographics, medical history, laboratory values, intensive care unit (ICU) admission and 30-day complications classified as major (major adverse cardiovascular events (MACEs), acute kidney injury (AKI) and death of any cause) and minor (postimplantation syndrome (PIS), postoperative delirium (POD), urinary tract infection (UTI) and technical graft failure) were documented (March 2016 to February 2019). Results: We included 322 patients. The majority were managed under general anesthesia (83%) with femoral cutdown (98.1%). Overall, 121 (37.5%) complications, mostly minor (n = 103, 31.9%), were recorded. In total, 11 patients (3.4%) developed MACEs, 5 (1.6%) experienced AKI and 2 (0.6%) died in the ICU. Moreover, 77 patients (23.9%) suffered from PIS, 11 from POD, 11 from UTI and 4 from technical graft failure. The multivariate logistic regression analysis revealed that aneurysm diameter (p = 0.01) and past smoking (p = 0.003) were predictors for complications. PAD was an independent predictor of MACEs (p = 0.003), preoperative neutrophil to lymphocyte ratio (NLR) of AKI (p = 0.003) and past smoking of PIS (p = 0.008), respectively. Conclusions: Our study showed that the 30-day morbidity after EVAR exceeded 35%. However, the majority of complications were minor, and the associated mortality was low. Aneurysm diameter and past smoking were independent predictors for postoperative outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

Ntalouka,

Nana,

Brotis

et al. 2023

JCM

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“…Randomized control trials comparing EVAR and open repair have suggested superior short-term survival with EVAR [ 60 , 61 ]; however, recent data have cast doubt on the long-term advantages of EVAR [ 62 ]. Although patients receiving EVAR are spared the ischemic insult of aortic cross-clamping and have less perioperative hemorrhage [ 63 ], the potential nephrotoxicity of intravenous contrast media must be considered [ 64 ]. In addition, as in the case of aortic surgery, manipulation of the abdominal aorta may lead to the disruption of lipid-laden plaques and subsequent embolization into the renal vasculature.…”

Section: Renal Complicationsmentioning

confidence: 99%

Postoperative Intensive Care Management of Aortic Repair

Paulis

Arlotta

Calabrese

et al. 2022

JPM

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Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved in recent years, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy. The intensive care physician must be aware that aortic repair surgery has an impact on every organ system, and the importance of early recognition of organ failure cannot be overemphasized.

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“…Endoleaks are the most common complications associated with EVAR, with an incidence of up to 30% [71]. In the late postoperative period, there is a global consensus about the treatment of type I or III endoleaks when feasible.…”

mentioning

confidence: 99%

The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

Troisi,

Bertagna,

Torri

et al. 2023

JCM

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Background: despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment. Methods: we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms’ incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies. Results: the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention. Conclusions: RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk–benefit assessment may improve outcomes.

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Management of Postoperative Complications Following Endovascular Aortic Aneurysm Repair

Cited by 8 publications

References 46 publications

Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

Postoperative Intensive Care Management of Aortic Repair

The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

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