Outcomes of EVAR with the endurant stent-graft system in patients with infrarenal ruptured abdominal aortic aneurysms: Is hostile anatomy a challenging factor?

Küçükay, Fahrettin; Karan, Adnan; Simsek, Erdal; Özdemir, Mustafa; Ökten, Sarper; Ulus, A. Tulga

doi:10.1016/j.ejrad.2015.07.018

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…When considering emergency EVAR only, single centre studies from experienced units document good results even in rAAA patients with hostile aortic neck anatomy. [471][472][473][474] When patients are grouped based on aortic anatomy and whether EVAR is performed inside or outside the IFU, increased long-term mortality and complications after EVAR for rAAAs are associated with hostile aneurysm anatomy. 475…”

Section: Intra-abdominal Hypertension (Iah) and Acsmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Wanhainen¹,

Verzini²,

Herzeele³

et al. 2019

European Journal of Vascular and Endovascular Surgery

1,959

1,522

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Section: Intra-abdominal Hypertension (Iah) and Acsmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Wanhainen¹,

Verzini²,

Herzeele³

et al. 2019

European Journal of Vascular and Endovascular Surgery

1,959

1,522

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“…21 Kucukay et al found no significant difference in major complications, persistent endoleak and secondary intervention. 23 Similarly, the IMPROVE trial investigators found no significant differences in graft related reintervention between patients with hostile vs. friendly aortic anatomy. 22 A significant statistical heterogeneity was noted among the studies reporting open AAA repair but not among those reporting EVAR.…”

Section: Discussionmentioning

confidence: 97%

“…Three studies examined patients who underwent EVAR for ruptured AAA, 21,23,24 and another five studies examined patients who had open surgery. 16e18,20,25 An additional study included both patients with EVAR and open surgery and reported separate outcome data for the two groups.…”

Section: Description Of Studiesmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Outcomes of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Hostile vs. Friendly Aortic Anatomy

Kontopodis

Tavlas

Ioannou

et al. 2020

European Journal of Vascular and Endovascular Surgery

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Observational data from national and international registries have shown that endovascular repair carries a lower peri-operative mortality risk than open repair for ruptured abdominal aortic aneurysm (AAA). Patient selection may explain the superiority of endovascular aneurysm repair (EVAR), with hostile aortic anatomy being a confounding factor. This study is a meta-analysis of outcomes in patients with hostile vs. friendly aortic anatomy treated for ruptured AAA. It was found that patients with hostile aortic anatomy undergoing EVAR have higher peri-operative mortality and lower overall survival. No significant differences in mortality were found for patients treated by open repair.Objective: To investigate the effect of hostile aortic anatomy on the outcomes of endovascular and open repair for ruptured abdominal aortic aneurysm (AAA). Methods: Electronic bibliographic sources (MEDLINE, EMBASE, CENTRAL) were searched using a combination of thesaurus and free text terms to identify studies comparing treatment outcomes of ruptured AAA in patients with hostile vs. friendly aortic anatomy. A systematic review was conducted that conformed to the PRISMA guidelines using a registered protocol (CRD42019127307). The primary outcomes were peri-operative mortality, freedom from aneurysm related mortality, and overall survival. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) and 95% confidence interval (CI). A time to event data metaanalysis was conducted using the inverse variance method and the results were reported as summary hazard ratio (HR) and associated 95% CI. Subgroup analysis for type of treatment (endovascular aneurysm repair [EVAR] or open repair) was undertaken. Random effects models of meta-analysis were developed. Results: Ten observational studies were included reporting a total of 1284 patients (748 with hostile anatomy and 536 with friendly anatomy). Patients with hostile anatomy had a higher peri-operative mortality than patients with friendly anatomy (OR 1.73, 95% CI 1.13e2.66; p ¼ .01). Subgroup analysis showed a significant difference in perioperative mortality in favour of friendly anatomy in patients treated by EVAR (OR 1.76, 95% CI 1.01e3.08; p ¼ .05), but not in those treated by open repair (OR 1.37, 95% CI 0.83e2.27; p ¼ .22). Patients with hostile anatomy treated by EVAR had a significantly higher hazard of death in follow up than patients with friendly aortic anatomy (HR 2.01, 95% CI 1.18e3.44, p ¼ .01), whereas for open surgical repair, the survival was similar in patients with hostile and those with friendly aortic anatomy (HR 0.90, 95% CI 0.61e1.32, p ¼ .58). Conclusion: Hostile aortic anatomy is associated with increased mortality in patients with ruptured AAA treated by EVAR.

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Systematic review and meta-analysis of the risk of bowel ischemia after ruptured abdominal aortic aneurysm repair

Jalalzadeh

Leeuwen

Indrakusuma

et al. 2018

Journal of Vascular Surgery

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Outcomes of EVAR with the endurant stent-graft system in patients with infrarenal ruptured abdominal aortic aneurysms: Is hostile anatomy a challenging factor?

Cited by 3 publications

References 27 publications

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Systematic Review and Meta-Analysis of Outcomes of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Hostile vs. Friendly Aortic Anatomy

Systematic review and meta-analysis of the risk of bowel ischemia after ruptured abdominal aortic aneurysm repair

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