Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: Clinical outcomes with 1-year follow-up

ObjectiveTo compare the clinical outcomes of treatment after endovascular repair and open surgery in patients with ruptured infrarenal abdominal aortic aneurysms (AAAs), including 1-year follow-up.MethodsAll consecutive conscious patients with ruptured infrarenal AAAs who presented to our tertiary care teaching hospital between January 1, 2001, and December 31, 2005, were included in this study (n = 55). Twenty-six patients underwent endovascular repair, and 29 patients underwent open surgery. Patients who were hemodynamically too unstable to undergo a computed tomography angiography scan were excluded. Outcomes evaluated were intraoperative mortality, 30-day mortality, systemic complications, complications necessitating surgical intervention, and mortality and complications during 1-year follow-up. The statistical tests we used were the Student t test, χ2 test, Fisher exact test, and Mann-Whitney U test (two sided; α = .05).ResultsThirty-day mortality was 8 (31%) of 26 patients who underwent endovascular repair and 9 (31%) of 29 patients who underwent open surgery (P = .98). Systemic complications and complications necessitating surgical intervention during the initial hospital stay were similar in both treatment groups (8/26 [31%] and 5/26 [19%] for endovascular repair, respectively, and 9/29 [31%] and 8/29 [28%] for open surgery, respectively; P > .40). During 1-year follow-up, two patients initially treated with endovascular repair died as a result of non–aneurysm-related causes; no death occurred in the open surgery group. Complications during 1-year follow-up were 1 (5%) of 20 for endovascular repair and 4 (16%) of 25 for open surgery (P = .36).ConclusionsOn the basis of our study with a highly selected population, the mortality and complication rates after endovascular repair may be similar compared with those after open surgery in patients treated for ruptured infrarenal AAAs

Value of risk scores in the decision to palliate patients with ruptured abdominal aortic aneurysm

Background: The aim of this study was to develop a 48-h mortality risk score, which included morphology data, for patients with ruptured abdominal aortic aneurysm presenting to an emergency department, and to assess its predictive accuracy and clinical effectiveness in triaging patients to immediate aneurysm repair, transfer or palliative care. Methods: Data from patients in the IMPROVE (Immediate Management of the Patient With Ruptured Aneurysm: Open Versus Endovascular Repair) randomized trial were used to develop the risk score. Variables considered included age, sex, haemodynamic markers and aortic morphology. Backwards selection was used to identify relevant predictors. Predictive performance was assessed using calibration plots and the C-statistic. Validation of the newly developed and other previously published scores was conducted in four external populations. The net benefit of treating patients based on a risk threshold compared with treating none was quantified. Results: Data from 536 patients in the IMPROVE trial were included. The final variables retained were age, sex, haemoglobin level, serum creatinine level, systolic BP, aortic neck length and angle, and acute myocardial ischaemia. The discrimination of the score for 48-h mortality in the IMPROVE data was reasonable (C-statistic 0·710, 95 per cent c.i. 0·659 to 0·760), but varied in external populations (from 0·652 to 0·761). The new score outperformed other published risk scores in some, but not all, populations. An 8 (95 per cent c.i. 5 to 11) per cent improvement in the C-statistic was estimated compared with using age alone. Conclusion: The assessed risk scores did not have sufficient accuracy to enable potentially life-saving decisions to be made regarding intervention. Focus should therefore shift to offering repair to more patients and reducing non-intervention rates, while respecting the wishes of the patient and family

Stent-assisted, balloon-induced intimal disruption and relamination of aortic dissection in patients with Marfan syndrome: Midterm outcomes and aortic remodeling.

International audienc

A French comparative monocentric study of stent-grafts for abdominal aortic aneurysms

BACKGROUND: Endovascular treatment of abdominal aortic aneurysms (AAA) has become more common and is expected to fit best for high risk patients even if it displays an increased number of secondary reintervention when compared to open surgery. METHODS: Cohort study of 311 consecutive patients with AAAs treated by endovascular repair from 2004 to 2015 in a single University Hospital were analyzed and included in the study. We computed Kaplan-Meier life tables to estimate all-cause survival at 30 days and 1 year as well as to estimate rate of endovascular and global (endovascular + surgical) reintervention, incidence of endoleaks and of aneurysm progression at 1 month, 3 months, 6 months and 1 year. Patients were observed from the date of intervention. RESULTS: Sixty-eight patients were lost to follow-up. No statistically significant differences emerged from the comparison of 30 days mortality between the 6 endograft groups (overall rate 1.7%, P=0.787). No significant differences of mean aneurysm diameter reduction recorded within 1 year from intervention were observed between the groups. Overall diameter stability, regression and progression occurred in 82.5%, 12.5% and 4.5%, respectively. Cook device displayed the highest incidence of type I endoleak within the 1st postoperative year (11.5% vs. 2.4%; HR=3.75, 95% CI: 0.95-14.73, P=0.059) while Gore and Anaconda devices of type II endoleaks within the same period (49.5% vs. 26.0%; HR=1.79, 95% CI: 0.95-3.40, P=0.073). Endovascular aneurysm repair treatment failed in 16 patients (5.1%) who were thus converted to open surgery. CONCLUSIONS: Gore and Cook devices resulted those with the highest incidence of type II endoleaks and of global reintervention while AFX resulted the device with the lowest incidence of both the events mentioned. In conclusion, regular follow-up of patients is mandatory for the effectiveness of endovascular treatment and to detect early complications and when EVAR fails, open surgical repair is still a reasonable surgical alternative

Deciphering the stromal and hematopoietic cell network of the adventitia from non-aneurysmal and aneurysmal human aorta

10.1371/journal.pone.0089983PLoS ONE92e8998

Predicting the effect on pulse wave reflection of different endovascular repair techniques in abdominal aortic aneurysm using 1D patient-specific models

Abdominal aortic aneurysm (AAA) is a pathological dilation of the abdominal aorta, generally distal to the renal arteries. In relation to this, minimally invasive endovascular aortic repair has become a common technique, and great efforts have been made to characterize surgical outcome in terms of endograft displacement, leakages, aneurysm sac enlargement or other post-operative complication. Recently, two novel devices (AFX and Nellix sealing device) were developed to surpass these complications, but there is no work accounting for the effects they may have on the pressure waveform. In this study, we address the problem of generating a patient-specific 1D model of an aortic aneurysm, and compute the impact that these devices can have on pressure, in terms of wave reflection. As a result, we found both endovascular repair devices decrease the reflected wave transient time by one order of magnitude, and that the Nellix device shows increased reflected wave amplitude at proximal abdominal aorta and at renal artery level compared to AFX (33 % and 75 % increase in amplitude ratio compared to a non-diseased aorta, respectively). Due to the importance that pressure at renal site and pulse waveform have on the overall cardiovascular physiology, the validity of these results should be carefully studied in order to develop a patient-specific tool for medical planning of interventions.Fil: Casciaro, Mariano Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaFil: Alfonso, M. A.. Universidad Tecnológica Nacional; ArgentinaFil: Craiem, Damian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina. Hopital Europeen Georges Pompidou; Francia. Inserm; FranciaFil: Alsac, J. M.. Hopital Europeen Georges Pompidou; Francia. Inserm; FranciaFil: El-Batti, S.. Hopital Europeen Georges Pompidou; Francia. Inserm; FranciaFil: Armentano, Ricardo Luis. Universidad Tecnológica Nacional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentin

Kinematics of the local universe : XII. 21-cm line measurements of 586 galaxies with the new Nançay receiver

International audienceThis paper presents 586 new 21-cm neutral hydrogen line measurements carried out with the FORT receiver of the meridian transit Nançay radiotelescope in the period July 2000-March 2003. This observational programme is part of a larger project aiming at collecting an exhaustive and magnitude-complete HI extragalactic catalogue for Tully-Fisher applications. It is associated with the building of the MIGALE spectroscopic archive and database.