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The impact of hemodynamic status on outcomes of endovascular abdominal aortic aneurysm repair for rupture.
J Vasc Surg. 2013 May; 57(5):1255-60.JV

Abstract

OBJECTIVE

To date, there are no published reports comparing hemodynamically (Hd)-stable and Hd-unstable patients with ruptured abdominal aortic aneurysms (r-AAAs) undergoing endovascular aneurysm repair (EVAR). This study evaluates outcomes of EVAR for r-AAA based on patient's Hd status

METHODS

From 2002 to 2011, 136 patients with r-AAAs underwent EVAR and were categorized into two groups based on systolic blood pressure (SBP) measurements before EVAR: 92 (68%) Hd-stable (SBP ≥ 80 mm Hg) and 44 (32%) Hd-unstable (SBP <80 mm Hg for >10 minutes). All data were prospectively entered in a database and retrospectively analyzed. Outcomes included 30-day mortality, postoperative complications, the need for secondary reinterventions, and midterm mortality. The effect of potential predictors on 30-day mortality was assessed by χ(2) and logistic regression.

RESULTS

Of the 136 r-AAA patients with EVAR, the Hd-stable and Hd-unstable groups had similar comorbidities (coronary artery disease, 63% vs 59%; hypertension, 72% vs 75%; chronic obstructive pulmonary disease, 21% vs 26%; and chronic renal insufficiency, 18% vs 18%), mean AAA maximum diameter (6.6 vs 6.4 cm), need for on-the-table conversion to open surgical repair (3% vs 7%), and incidences of nonfatal complications (43% vs 38%) and secondary interventions (23% vs 25%). Preoperative computed tomography scan was available in significantly fewer Hd-unstable patients (64% vs 100%; P < .05). Compared with Hd-stable patients, the Hd-unstable patients had a significantly higher intraoperative need for aortic occlusion balloon (40% vs 6%; P < .05), mean estimated blood loss (744 vs 363 mL; P < .05), incidence of developing abdominal compartment syndrome (ACS; 29% vs 4%; P < .01), and death (33% vs 18%; P < .05). ACS was a significant predictor of death; death in all r-EVAR with ACS was significantly higher compared with all r-EVAR without ACS (10 of 17 [59%] vs 22 of 119 [18%]; P < .01).

CONCLUSIONS

EVAR for r-AAA is feasible in Hd-stable and Hd-unstable patients, with a comparable incidence of conversion to open surgical repair, nonfatal complications, and secondary interventions. Hd-stable patients have reduced mortality at 30 days, whereas Hd-unstable patients require intraoperative aortic occlusion balloon more frequently, and have an increased risk for developing ACS and death.

Authors+Show Affiliations

Vascular Group, PLLC, The Institute for Vascular Health and Disease, Albany Medical College, The Center for Vascular Awareness, Inc, Albany, NY 12208, USA. mehtam@albanyvascular.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23388393

Citation

Mehta, Manish, et al. "The Impact of Hemodynamic Status On Outcomes of Endovascular Abdominal Aortic Aneurysm Repair for Rupture." Journal of Vascular Surgery, vol. 57, no. 5, 2013, pp. 1255-60.
Mehta M, Paty PS, Byrne J, et al. The impact of hemodynamic status on outcomes of endovascular abdominal aortic aneurysm repair for rupture. J Vasc Surg. 2013;57(5):1255-60.
Mehta, M., Paty, P. S., Byrne, J., Roddy, S. P., Taggert, J. B., Sternbach, Y., Ozsvath, K. J., & Darling, R. C. (2013). The impact of hemodynamic status on outcomes of endovascular abdominal aortic aneurysm repair for rupture. Journal of Vascular Surgery, 57(5), 1255-60. https://doi.org/10.1016/j.jvs.2012.11.042
Mehta M, et al. The Impact of Hemodynamic Status On Outcomes of Endovascular Abdominal Aortic Aneurysm Repair for Rupture. J Vasc Surg. 2013;57(5):1255-60. PubMed PMID: 23388393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of hemodynamic status on outcomes of endovascular abdominal aortic aneurysm repair for rupture. AU - Mehta,Manish, AU - Paty,Philip S K, AU - Byrne,John, AU - Roddy,Sean P, AU - Taggert,John B, AU - Sternbach,Yaron, AU - Ozsvath,Kathleen J, AU - Darling,R Clement,3rd Y1 - 2013/02/04/ PY - 2012/06/18/received PY - 2012/11/05/revised PY - 2012/11/06/accepted PY - 2013/2/8/entrez PY - 2013/2/8/pubmed PY - 2013/6/19/medline SP - 1255 EP - 60 JF - Journal of vascular surgery JO - J Vasc Surg VL - 57 IS - 5 N2 - OBJECTIVE: To date, there are no published reports comparing hemodynamically (Hd)-stable and Hd-unstable patients with ruptured abdominal aortic aneurysms (r-AAAs) undergoing endovascular aneurysm repair (EVAR). This study evaluates outcomes of EVAR for r-AAA based on patient's Hd status METHODS: From 2002 to 2011, 136 patients with r-AAAs underwent EVAR and were categorized into two groups based on systolic blood pressure (SBP) measurements before EVAR: 92 (68%) Hd-stable (SBP ≥ 80 mm Hg) and 44 (32%) Hd-unstable (SBP <80 mm Hg for >10 minutes). All data were prospectively entered in a database and retrospectively analyzed. Outcomes included 30-day mortality, postoperative complications, the need for secondary reinterventions, and midterm mortality. The effect of potential predictors on 30-day mortality was assessed by χ(2) and logistic regression. RESULTS: Of the 136 r-AAA patients with EVAR, the Hd-stable and Hd-unstable groups had similar comorbidities (coronary artery disease, 63% vs 59%; hypertension, 72% vs 75%; chronic obstructive pulmonary disease, 21% vs 26%; and chronic renal insufficiency, 18% vs 18%), mean AAA maximum diameter (6.6 vs 6.4 cm), need for on-the-table conversion to open surgical repair (3% vs 7%), and incidences of nonfatal complications (43% vs 38%) and secondary interventions (23% vs 25%). Preoperative computed tomography scan was available in significantly fewer Hd-unstable patients (64% vs 100%; P < .05). Compared with Hd-stable patients, the Hd-unstable patients had a significantly higher intraoperative need for aortic occlusion balloon (40% vs 6%; P < .05), mean estimated blood loss (744 vs 363 mL; P < .05), incidence of developing abdominal compartment syndrome (ACS; 29% vs 4%; P < .01), and death (33% vs 18%; P < .05). ACS was a significant predictor of death; death in all r-EVAR with ACS was significantly higher compared with all r-EVAR without ACS (10 of 17 [59%] vs 22 of 119 [18%]; P < .01). CONCLUSIONS: EVAR for r-AAA is feasible in Hd-stable and Hd-unstable patients, with a comparable incidence of conversion to open surgical repair, nonfatal complications, and secondary interventions. Hd-stable patients have reduced mortality at 30 days, whereas Hd-unstable patients require intraoperative aortic occlusion balloon more frequently, and have an increased risk for developing ACS and death. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23388393/The_impact_of_hemodynamic_status_on_outcomes_of_endovascular_abdominal_aortic_aneurysm_repair_for_rupture_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(12)02434-2 DB - PRIME DP - Unbound Medicine ER -