Open Repair of AAA in a High Volume Center

Davidović, Lazar; Maksic, Milanko; Končar, Igor; Ilić, Nikola; Dragaš, Marko; Fatić, Nikola; Marković, Miroslav; Banzić, Igor; Mutavdžic, Perica

doi:10.1007/s00268-016-3788-3

Cited by 21 publications

(12 citation statements)

References 60 publications

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“…þ e e 5 (33) Nakamura (2009) 41 Caseecontrol e e þ e e NA NA e e e þ ? þ þ e 4 (31) Davidovic (2017) 42 Cohort þ e þ e e e ? e e e þ e þ e e 4 (27) Sharma (2006) 43 Caseecontrol e e e e e ?…”

Section: Included Studiesunclassified

Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review

Wesselink

Kappen

Torn

et al. 2018

British Journal of Anaesthesia

576

454

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The reported associations suggest that organ injury might occur when mean arterial pressure decreases <80 mm Hg for ≥10 min, and that this risk increases with blood pressures becoming progressively lower. Given the retrospective observational design of the studies reviewed, reflected by large variability in patient characteristics, hypotension definitions and outcomes, solid conclusions on which blood pressures under which circumstances are truly too low cannot be drawn. We provide recommendations for the design of future studies. CLINICAL REGISTRATION NUMBER: (PROSPERO ID). CRD42013005171.

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Section: Included Studiesunclassified

Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review

Wesselink

Kappen

Torn

et al. 2018

British Journal of Anaesthesia

576

454

View full text Add to dashboard Cite

show abstract

“…After 2003, EVAR became the treatment of choice for AAA, replacing OPEN as the most common surgical intervention for AAA repair. 33 Recently, Davidovic et al 34 showed that short-term mortality after OPEN surgical repair of AAA in high-volume centers with highly experienced anesthesiologic and surgical teams might be very low. Furthermore, in the same study, 34 OPEN improved clinical outcomes in patients with a hostile abdomen, unsuitable anatomy, or young patients.…”

Section: Discussionmentioning

confidence: 99%

“…33 Recently, Davidovic et al 34 showed that short-term mortality after OPEN surgical repair of AAA in high-volume centers with highly experienced anesthesiologic and surgical teams might be very low. Furthermore, in the same study, 34 OPEN improved clinical outcomes in patients with a hostile abdomen, unsuitable anatomy, or young patients. However, this study 34 did not directly compare clinical outcomes with EVAR, as it only included patients undergoing OPEN.…”

Section: Discussionmentioning

confidence: 99%

Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification

et al. 2019

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Objectives Abdominal aortic aneurysms are conventionally treated by open repair surgery. While endovascular aortic repair improves survival in high-risk patients, younger patients (40–65 years) potentially at lower risk with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair usually have poorer post-operative outcomes and require longer term follow-up. In this study, clinical data on younger patients were analyzed to investigate whether endovascular aortic repair leads to poorer short- and long-term outcomes. Methods This was a systematic review and meta-analysis of articles comparing clinical outcomes in patients aged 40–65 years undergoing open repair or endovascular aortic repair and published between 2000 and 2017. In-hospital mortality, long-term mortality, and post-operative complication data were retrieved from eligible studies and clinical outcomes were compared. Twenty-one retrospective cohort analyses were included, accounting for 250,837 patients (149,051 endovascular aortic repair; 101,786 open repair). Risk ratios were pooled using the DerSimonian and Laird random effects model. All statistical analyses were performed in Review Manager 5.3. Results Younger patients with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair had a significantly reduced 30-day mortality (odds ratio (OR) = 0.40, 95% confidence intervals (CI) 0.28–0.57; p < 0.00001), long-term mortality (OR = 0.37, 95% CI 0.17–0.82; p = 0.01), incidence of reintervention (OR = 0.47, 95% CI 0.34–0.66; p < 0.0001), and incidence of renal failure (OR = 1.58, 95% CI 1.37–1.82; p < 0.00001). Conclusions Endovascular aortic repair may improve short- and long-term survival and reduce post-operative complications in younger patients with asymptomatic abdominal aortic aneurysms.

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“…The traditional approach is represented by the open surgical repair-a longitudinal abdominal incision is performed; abdominal organs are eviscerated and aneurysmectomy is performed with subsequent aortic reconstruction. [5,6] In addition to this approach, a less invasive endovascular treatment has been proposed. Over the years, endovascular aneurysm repair (EVAR) has become the first treatment of choice in patients with suitable anatomy [7][8][9].…”

Section: Introduction Abdominal Aortic Aneurysm Definition and Treatment Optionsmentioning

confidence: 99%

The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

et al. 2021

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An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta that progressively grows until it ruptures. Treatment is typically recommended when the diameter is more than 5 cm. The EVAR (Endovascular aneurysm repair) is a minimally invasive procedure that involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. For years, stent grafts’ essential design was based on metallic stent frames to support the fabric. More recently, a polymer-based technology has been proposed as an alternative method to seal AAA. This review underlines the two platforms that are based on a polymer technology: (1) the polymer-filled endobags, also known as Endovascular Aneurysm Sealing (EVAS) with Nellix stent graft; and (2) the O-ring EVAR polymer-based proximal neck sealing device, also known as an Ovation stent graft. Polymer characteristics for this particular aim, clinical applications, and durability results are hereby summarized and commented critically. The technique of inflating endobags filled with polymer to exclude the aneurysmal sac was not successful due to the lack of an adequate proximal fixation. The platform that used polymer to create a circumferential sealing of the aneurysmal neck has proven safe and effective.

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Open Repair of AAA in a High Volume Center

Abstract: Early mortality after open repair of AAA in high volume center might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy.

Cited by 21 publications

References 60 publications

Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review

Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review

Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification

The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

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