Trends in Treatment of Ruptured Abdominal Aortic Aneurysm: Impact of Endovascular Repair and Implications for Future Care

Park, Brian D.; Azefor, Nchang M.; Huang, Chun‐Chieh; Ricotta, John J.

doi:10.1016/j.jamcollsurg.2012.12.028

Cited by 68 publications

(33 citation statements)

References 27 publications

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“…The use of EVAR for rAAAs has increased in the United States, especially in urban areas, likely because EVAR is associated with reduced mortality and a reduced complication rate compared to OSR [38], [42]. However, there are conflicting data on the efficacy and outcomes of EVAR in patients with rAAAs due to wide variations in trial design.…”

Section: Discussionmentioning

confidence: 99%

Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

Qin

Chen

2014

PLoS ONE

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ObjectivesTo systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs) who underwent endovascular aneurysm repair (EVAR) to patients who underwent open surgical repair (OSR).MethodsThe Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay.ResultsA total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies) with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001). rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from −2.00 to −19.10 days, with the overall estimate being −5.25 days (95% CI = −9.23 to −1.26, P = 0.010). There was no publication bias and sensitivity analysis showed good reliability.ConclusionsEVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

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Section: Discussionmentioning

confidence: 99%

Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

Qin

Chen

2014

PLoS ONE

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“…1 Recent data from the Nationwide Inpatient Sample that included 21,206 patients with ruptured AAA from 2005 to 2009 found that endovascular aneurysm repair (EVAR) performed in 3796 patients was associated with a still high although somewhat reduced in-hospital mortality of 27%. 2 To prevent rupture, OR used to be the "gold standard," with excellent long-term results. 3 With the advent of EVAR, 4 its use in the United States has risen from 5.2% in 2000 to 74% in 2010.…”

mentioning

confidence: 99%

Outcome after open and endovascular repairs of abdominal aortic aneurysms in matched cohorts using propensity score modeling

Huang

Gloviczki

Oderich

et al. 2015

Journal of Vascular Surgery

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In this retrospective propensity score-matched study, early mortality was similarly low after both EVAR and OR, significantly different from all except one large randomized controlled trial. EVAR had fewer early complications, but it was associated with late all-cause mortality and reinterventions and had a small but definite risk of late rupture. Significantly increased mortality at 5 years was no longer observed when operations were performed after 2005. High risk, advanced age, cancer history, and AAA size predicted late all-cause mortality. This study failed to confirm early or late survival benefit for EVAR vs OR. Improved surveillance, longer follow-up, and analysis of factors affecting late death in prospective studies are warranted.

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“…The incidence of inguinal hernia in patients scheduled for aortic aneurysm repair has been as high as 41% in some series, with 2.3-fold increased risk of inguinal hernia when compared with patients undergoing surgery for aortoiliac occlusive disease [1, 5–7]. In addition, the frequency of endovascular aneurysm repair (EVAR) for the treatment of unruptured and even ruptured aortic aneurysms has sharply increased [2]. EVAR frequently involves femoral artery cutdown for device access.…”

Section: Discussionmentioning

confidence: 99%

“…aneurysmal degeneration of the aorta) with inguinal hernias is likely to increase the frequency with which surgeons must perform herniorraphy in reoperative groins [1, 2]. This situation is further complicated when a vascular graft has been placed and passes through the field required for hernia repair.…”

Section: Introductionmentioning

confidence: 99%

Repair of a bowel-containing, scrotal hernia with incarceration contributed by femorofemoral bypass graft

2017

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The rising use of endovascular techniques utilizing femoral artery access may increase the frequency with which surgeons face the challenge of hernia repair in reoperative groins—which may or may not include a vascular graft. We present a case where a vascular graft contributed to an acute presentation and complicated dissection, and review the literature. A 67-year-old man who had undergone prior endovascular aneurysm repair via open bilateral femoral artery access and concomitant prosthetic femorofemoral bypass, presented with an incarcerated, scrotal inguinal hernia. The graft with its associated fibrosis contributed to the incarceration by compressing the inguinal ring. Repair was undertaken via an open, anterior approach with tension-free, Lichtenstein herniorraphy after releasing graft-associated fibrosis. Repair of groin hernias in this complex setting requires careful surgical planning, preparation for potential vascular reconstruction and meticulous technique to avoid bowel injury in the face of a vascular conduit and mesh.

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Trends in Treatment of Ruptured Abdominal Aortic Aneurysm: Impact of Endovascular Repair and Implications for Future Care

Cited by 68 publications

References 27 publications

Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

Outcome after open and endovascular repairs of abdominal aortic aneurysms in matched cohorts using propensity score modeling

Repair of a bowel-containing, scrotal hernia with incarceration contributed by femorofemoral bypass graft

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