Tags

Type your tag names separated by a space and hit enter

Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment.
J Vasc Surg. 2009 Mar; 49(3):582-8.JV

Abstract

OBJECTIVE

A retrospective analysis of immediate outcomes following aneurysm rupture (rAAA) in two groups: patients previously treated at our center with primary endovascular repair (EVAR) and patients without previous EVAR for abdominal aortic aneurysms (AAA) in an 8-year period.

METHODS

Fourteen patients with a confirmed rAAA identified throughout the follow-up period following primary EVAR repair at our center (from a population of 820 AAA treated at our center in election) were retrospectively compared with 155 patients without previous EVAR in the same time period, from the introduction of an intention-to-treat protocol with EVAR for rAAA in January 1999. Primary study outcomes included 30-day mortality and severe systemic complications following rAAA correction with both open and EVAR treatments.

RESULTS

In the 14 patients secondary interventions were necessary throughout follow-up prior to rupture in 43% (6/14). The mean time to rupture was 50.23 months (9-113). The mean increase in maximum aneurysmal diameter at rupture was 18.39 mm. Type of endoleaks observed at rupture: 35.7% I proximal, 35.7% III contralateral stump disconnection, 14.3% I distal, 14.3% III midgraft tear: treatment at rupture included five EVAR corrections with aortouniiliac endografts, four EVAR corrections with extensions, and five surgical conversions. Thirty-day mortality between the two groups, 28.5% (patients with prior EVAR) 38.7% (patients without prior EVAR), and severe systemic complications, 50% vs 37.6%, were not found to be statistically significant. Hemodynamic instability, 36% (patients with prior EVAR) 63% (patients without prior EVAR), was found to be an independent predictor of 30-day mortality (P < .0001), whereas severe systemic complications, 50% vs 33.5%, did not influence the same outcome (P = .852).

CONCLUSIONS

In terms of mortality, it would be logical to expect a protection from the endograft in patients with previous EVAR. A trend seems to confirm this assumption, but no statistical significance was found, which may be due to the small population size.

Authors+Show Affiliations

University of Modena and Reggio nell'emilia, Modena, Italy. g.coppi@ausl.mo.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19135841

Citation

Coppi, Gioacchino, et al. "Treatment of Ruptured Abdominal Aortic Aneurysm After Endovascular Abdominal Aortic Repair: a Comparison With Patients Without Prior Treatment." Journal of Vascular Surgery, vol. 49, no. 3, 2009, pp. 582-8.
Coppi G, Gennai S, Saitta G, et al. Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment. J Vasc Surg. 2009;49(3):582-8.
Coppi, G., Gennai, S., Saitta, G., Silingardi, R., & Tasselli, S. (2009). Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment. Journal of Vascular Surgery, 49(3), 582-8. https://doi.org/10.1016/j.jvs.2008.10.032
Coppi G, et al. Treatment of Ruptured Abdominal Aortic Aneurysm After Endovascular Abdominal Aortic Repair: a Comparison With Patients Without Prior Treatment. J Vasc Surg. 2009;49(3):582-8. PubMed PMID: 19135841.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment. AU - Coppi,Gioacchino, AU - Gennai,Stefano, AU - Saitta,Giuseppe, AU - Silingardi,Roberto, AU - Tasselli,Sebastiano, Y1 - 2009/01/09/ PY - 2008/07/17/received PY - 2008/10/07/revised PY - 2008/10/11/accepted PY - 2009/1/13/entrez PY - 2009/1/13/pubmed PY - 2009/3/20/medline SP - 582 EP - 8 JF - Journal of vascular surgery JO - J Vasc Surg VL - 49 IS - 3 N2 - OBJECTIVE: A retrospective analysis of immediate outcomes following aneurysm rupture (rAAA) in two groups: patients previously treated at our center with primary endovascular repair (EVAR) and patients without previous EVAR for abdominal aortic aneurysms (AAA) in an 8-year period. METHODS: Fourteen patients with a confirmed rAAA identified throughout the follow-up period following primary EVAR repair at our center (from a population of 820 AAA treated at our center in election) were retrospectively compared with 155 patients without previous EVAR in the same time period, from the introduction of an intention-to-treat protocol with EVAR for rAAA in January 1999. Primary study outcomes included 30-day mortality and severe systemic complications following rAAA correction with both open and EVAR treatments. RESULTS: In the 14 patients secondary interventions were necessary throughout follow-up prior to rupture in 43% (6/14). The mean time to rupture was 50.23 months (9-113). The mean increase in maximum aneurysmal diameter at rupture was 18.39 mm. Type of endoleaks observed at rupture: 35.7% I proximal, 35.7% III contralateral stump disconnection, 14.3% I distal, 14.3% III midgraft tear: treatment at rupture included five EVAR corrections with aortouniiliac endografts, four EVAR corrections with extensions, and five surgical conversions. Thirty-day mortality between the two groups, 28.5% (patients with prior EVAR) 38.7% (patients without prior EVAR), and severe systemic complications, 50% vs 37.6%, were not found to be statistically significant. Hemodynamic instability, 36% (patients with prior EVAR) 63% (patients without prior EVAR), was found to be an independent predictor of 30-day mortality (P < .0001), whereas severe systemic complications, 50% vs 33.5%, did not influence the same outcome (P = .852). CONCLUSIONS: In terms of mortality, it would be logical to expect a protection from the endograft in patients with previous EVAR. A trend seems to confirm this assumption, but no statistical significance was found, which may be due to the small population size. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/19135841/Treatment_of_ruptured_abdominal_aortic_aneurysm_after_endovascular_abdominal_aortic_repair:_A_comparison_with_patients_without_prior_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(08)01802-8 DB - PRIME DP - Unbound Medicine ER -