Regionalization of Emergent Vascular Surgery for Patients With Ruptured AAA Improves Outcomes

Abstract

participants. Resident-specific spatio-temporal pollution concentration models, incorporating community specific measurements, agency monitoring data, and geographical predictors, estimated concentrations of PM [2][3][4][5] and NO x between 1999 and 2012. The primary aim was to examine the association between progression of coronary artery calcium and mean carotid artery intima-media thickness in long term exposure to ambient air pollutant concentrations (PM [2][3][4][5] , NO x , and black carbon) between examinations and within the 6 metropolitan areas adjusting for baseline age, sex, ethnicity, socio-economic characteristics, cardiovascular risk factors, site, and CT scanner technology. 4).Comment: PM 2-5 air pollutant particles are particles less than 2.5 mm in diameter, commonly referred to as fine particles and believed to pose the greatest health risk from air pollution because their small size allows them to be inhaled deeply. Primary sources are motor vehicles, power plants, wood burning, and some industrial processes. In this study the authors adjusted for outdoor concentrations of PM 2-5 particles according to time spent indoors and infiltration of particles into the home. However, full characterization of time-location patterns in indoor exposures is difficult and a potential weakness of the study. Nevertheless, the data suggests an accrued relationship between acceleration of atherosclerosis and ambient air pollution, particularly air pollution particles generated by human activity. Pregnancy and the Risk of Aortic Dissection or Conclusion:There is an elevated risk of aortic rupture or dissection during pregnancy and in the postpartum period.Summary: There is an increased risk of vascular events during pregnancy and several months into the postpartum period; particularly venous thromboembolism, myocardial infarction and stroke (Kamel H et al, N Engl J Med 2014;370:1307-15). There have also been case reports that suggest pregnancy may trigger aortic dissection or rupture (Kinney TD et al, Am J Med Sci 1945; 210:725-32). Aortic complications in pregnancy have been described with Marfan syndrome, Loeys-Dietz syndrome, type 4 Ehlers-Danlos syndrome, Turner syndrome and bicuspid aortic valves. Other than case series, however, there are few population based data to support an association between pregnancy and aortic complications. The authors decided to better assess the relationship between pregnancy and aortic complications by performing a cohortcrossover analysis in a large population-based sample of patients. They utilized data from all emergency department visits and acute care hospitalizations in non-Federal healthcare facilities in California, Florida and New York. Included patients included women $12 years of age with labor and delivery or an aborted pregnancy outcome between 2005 and 2013. Primary outcome of this study was a composite of aortic dissection or rupture. Based on the timing of the reported aortic complications during pregnancy the authors defined a period of risk as 6 months befor...

The Weekend Effect in AAA Repair

“…Several centers have published their experience with regionalization, streamlining of treatment protocols, and the subsequent improvement in perioperative outcomes. [18][19][20][21][22][23] Our data demonstrate that while these efforts, and others, are associated with improvements in some areas, significant gaps remain.…”

Editor's Choice – Short Term and Long Term Outcomes After Endovascular or Open Repair for Ruptured Infrarenal Abdominal Aortic Aneurysms in the Vascular Quality Initiative

“…However, broad adoption of a centralised EVAR first approach for the treatment of rAAA requires massive systemic changes, and the question of which patients with rAAA may wait to be transported to a centre that can offer both open and endovascular repair remains unclear. Indeed, despite the increasing evidence that regionalisation of emergency vascular surgery for patients with rAAA improves outcomes, 34 many rAAA repairs are still being performed in low volume centres and/or those offering a primary OAR strategy. 35 Therefore, future work is needed to improve regionalisation and standardisation of acute aortic care.…”

The Relationship Between Operative Volume and Peri-operative Mortality After Non-elective Aortic Aneurysm Repair in Australia

“…Although Australia has not, several overseas hospital networks have implemented regional referral protocols for rAAA services with favourable results, providing a model for the feasibility of inter-facility transfer. 24,25 When there is a strong suspicion of aneurysm rupture, first referral pathways from the field may see a greater proportion of rAAA access vascular surgery at a high volume hospital within the suggested 90 min framework. Australia currently has no system in place to cater for direct transfer to regional "hubs"; however, there is a pre-existing model for ST elevation myocardial infarction, where ambulance personnel transport patients directly to larger, coronary angioplasty equipped hospitals.…”