Simultaneous total gastrectomy and endovascular repair of an abdominal aortic aneurysm: Report of a case

Yoshinaga, Keiji; Yoshida, Rika; Guntani, Atsushi; Matsumoto, Takuya; Saeki, Hiroshi; Morita, Masaru; Emi, Yasunori; Kakeji, Yoshihiro; Tsujitani, Shunichi; Maehara, Yoshihiko

doi:10.1007/s00595-010-4322-0

Cited by 7 publications

(3 citation statements)

References 30 publications

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“…The coexistence of AAA or AAD and gastrointestinal tumor is uncommon but may be increasing in incidence with an aging population. The management of this clinical situation remains a therapeutic dilemma, as evidenced by the disparity in published case reports, series, and recommendations [1, 9–11]. Many variables in the decision-making process should be considered, including surgeon's experience and preference, local medical level, aneurysm or dissection size, and type and stage of cancer [12, 13].…”

Section: Discussionmentioning

confidence: 99%

Synchronous Gastrointestinal Tumor and Abdominal Aortic Aneurysm or Dissection Treated with Endovascular Aneurysm Repair Followed by Tumor Resection

Zhang

Liu

et al. 2019

Gastroenterology Research and Practice

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Objective To evaluate the strategy in the management of patients with synchronous gastrointestinal tumor and abdominal aortic aneurysm (AAA) or abdominal aortic dissection (AAD) undergoing endovascular repair followed by tumor resection. Materials and Methods Five patients with synchronous gastrointestinal tumor and AAA or AAD were treated by endovascular repair followed by tumor resection. Clinical data were retrospectively analyzed with respect to the management strategy, safety, and outcome. Results Endovascular repair was technically successful in all patients. All the stents were well positioned and well patent, and the AAA (n = 3) or AAD (n = 2) were correctly excluded without endoleaks. After endovascular repair, all patients underwent resection of gastrointestinal tumor. No late mortality or major complications related to the two procedures were observed in the subsequent follow-up. Conclusion Our results demonstrate that EVAR could significantly shorten the delay between AAA and gastrointestinal procedure with an excellent postoperative outcome. If the anatomical criteria are satisfied, EVAR followed by tumor resection might be an effective treatment for concomitant AAA and gastrointestinal tumor.

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Section: Discussionmentioning

confidence: 99%

Synchronous Gastrointestinal Tumor and Abdominal Aortic Aneurysm or Dissection Treated with Endovascular Aneurysm Repair Followed by Tumor Resection

Zhang

Liu

et al. 2019

Gastroenterology Research and Practice

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“…AAA resection and gastrectomy as singlestage surgery is a very extensive procedure and would often be over-limit for the patient. The risk of graft infection is minimal in the synchronous procedure [31][32][33]. If EVAR cannot be performed for some reason, and we have to choose two-stage surgery, it is possible to use retroperitoneal access for AAA resection (either in the first or second stage).…”

Section: Tumors Of the Stomachmentioning

confidence: 99%

Abdominal Aortic Aneurysm and Malignancies

Moláček¹,

Houdek²,

Novák³

et al. 2019

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice

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Concomitant AAA and abdominal malignancy are always very complicated conditions requiring early management of both pathologies. This is undoubtedly a dilemma for a surgeon who cannot currently rely on any large randomized trials or mandatory guidelines. When making decisions, a surgeon most often relies on personal experience, the experience of his/her center and/or limited literary guidelines and recommendations. Efforts should be aimed at achieving a consensual multidisciplinary decision about which pathology requires "more acute" management. The decision-making process is easier if one of the pathologies is life-threatening, and such pathology should be managed first. In most cases, however, AAA is asymptomatic and a malignancy is found randomly, as a secondary finding during the follow-up of AAA patients, or vice versa, AAA is found randomly during the staging of cancer patients. In these cases, the therapeutic algorithm already admits several possible variants. Endovascular repair of AAA (EVAR) resulted in an absolute change in the management of these patients. EVAR can be used in simultaneous or stage procedures with minimal time delay. Also, surgical open resection is an option (simultaneously or staged). It is necessary to know the advantages and risks of all approaches.

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“…Currently, the number of patients undergoing EVAR exceeds that of patients undergoing open surgery (OS). Furthermore, EVAR has been increasingly indicated for extremely old patients in whom elective surgery was abandoned, those with severe heart or respiratory dysfunction, 1 , 2 ) and cancer-bearing patients 3 ) because of its low-level invasiveness. Initially, EVAR was expected to reduce health expenditure because of a short hospital stay and low incidence of complications, but the rate of reduction does not exceed the high device price.…”

Section: Introductionmentioning

confidence: 99%

A Cost-Utility Analysis of Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

Takayama

2017

Annals of Vascular Diseases

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Objective: To assess medical economic adequacy of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).Methods: Cost-utility analysis. A total of 21 patients with AAA treated at Ibaraki Prefectural Central Hospital in 2014 were divided into non-ruptured EVAR (Group E) and open surgery (OS) (Group O), and ruptured OS (Group R) groups, and hospital costs were aggregated with a medical accounting system. Mid-level hospital costs were estimated by a diagnosis-procedure-combination analysis system. Incremental life years were extrapolated from the results of randomized controlled trials in the UK (EVAR Trial 1 and 2), a life table, and the Pancreas Cancer Registry in Japan. Quality-adjusted life years (QALY) were estimated under the assumption of a certain quality weight.Results: Incremental cost-effectiveness ratio (ICER) of EVAR compared with the OS was calculated to be 31.0 million yen/QALY, which is economically inadequate. ICER of EVAR compared with conservative treatment was inadequate in some subgroups of extremely old patients and in patients operated for far-advanced cancer.Conclusion: EVAR is inadequate with respect to medical economics as a substitute for OS for patients in whom both procedures are available. The indication for EVAR in patients ineligible for OS should be different from that for surgery in usual patients with AAA. (This is a translation of J Jpn Coll Angiol 2016; 56: 123–130.)

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Simultaneous total gastrectomy and endovascular repair of an abdominal aortic aneurysm: Report of a case

Cited by 7 publications

References 30 publications

Synchronous Gastrointestinal Tumor and Abdominal Aortic Aneurysm or Dissection Treated with Endovascular Aneurysm Repair Followed by Tumor Resection

Synchronous Gastrointestinal Tumor and Abdominal Aortic Aneurysm or Dissection Treated with Endovascular Aneurysm Repair Followed by Tumor Resection

Abdominal Aortic Aneurysm and Malignancies

A Cost-Utility Analysis of Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

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