Factors affecting early results after elective open repair of abdominal aortic aneurysms

Uvod. Cilj ovog rada je prikaz faktora koji utiču na rane rezltate otvorenog hirurškog lečenja (OHL) aneurizmi abdominalne aorte (AAA). Metod. Istraživanje je sprovedeno u vidu prospektivne studije na 450 pacijenata podvrgnutih elektivnom OHL AAA na Klinici za vaskularnu i endovaskularnu hirurgiju KCS u Beogradu u period januar 2013-septembr 2014 godine. Rezultati. Smrtni ishod zabeležen je kod sedam (1.55%) bolesnika u prvih 30 postoperativnih dana. Uzroci smrtnog ishoda bili su: nekontrolisano krvarenje-1; akutni infarkt miokarda-1; ishemijski kolitis-2, MOFS-2, sepsa-1. Koronarna bolest (OR:3.89; CI:0.85-17.7; p=0.0058), postoperativni akutni infarkt miokarda (OR:29.9; CI:2.56- 334.95; p=0.0053), hronična bubrežna slabost (OR: 7.5; CI 1.35-8.5; p=0.0073), ishemijski kolitis (OR:88.2; CI:4.77-1629.69; p=0.0026), okluzija obe hipogastrične arterije uz nemogućnost da se bar jedna prezervira (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoralna rekonstrukcija (OR:9.06; CI:1.76-46.49; p=0.016), značajno perioperativni krvarenje (>2 litra) (OR:7.32; CI:1.31-10.79; p=0.0001), “hostilni” abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatorna aneurizma (OR: 13.99; CI:2.88-65.09; p=0.0002), supracelijačno klemovanje aorte (OR:18.7; CI:3.8- 90.6; p=0.0003), prolongirano klemovanje aorte (>60 minuta) (OR:14.25; CI:2.75-64.5; p=0.0003), intraoperativna hipotenzija (OR:6.61; CI:0.71-61.07; p=0.0545), prolongirana operacija (>240 minuta) (OR:8.66; CI:0.91-81.56; p=0.0585) i kompletna dehiscencija laparotomne rane (OR:44.1; CI:3.39-572.78; p=0.0396) povećavaju 30 dnevni mortalitet.Zaključak: Rani moratlitet nakon OHL AAA u centrima sa velikim iskustvom koji imaju dobro obučene multidisciplinarne timove, može biti veoma nizak. Takozvano centralizovano OHL može biti adekvatna solucija za pacijetne sa nepovoljnom anatomijom, odnosno za mladje, nerizične pacijenta sa dugom životnom prognozom.To assess results of open repair (OR) of AAA in a single high volume centre. Methods. We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for vascular and endovascular surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. Results. Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1,acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound -1. Coronary artery disease (OR:3.89; CI:0.85-17.7; p=0.0058), postoperative acute myoardial infarction (OR:29.9; CI:2.56-334.95; p=0.0053), chronic renal failure (OR: 7.5; CI 1.35-8.5; p=0.0073), colonic necrosis (OR:88.2; CI:4.77-1629.69; p=0.0026), occlusion of the both hypogastric arteries an the inability to preserve at least one hypogastric artery (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoral reconstruction (OR:9.06; CI:1.76-46.49; p=0.016), significant perioperative blleding (>2 liters) (OR:7.32; CI:1.31-10.79; p=0.0001), hostile abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatory aneurysm (OR: 13.99; CI:2.88-65.09; p=0.0002), supraceliac aortic cross clamping (OR:18.7; CI:3.8-90.6; p=0.0003), prolonged aortic cross clamping (>60 minutes) (OR:14.25; CI:2.75-64.5; p=0.0003), the intraoperative hypotension (OR:6.61; CI:0.71-61.07; p=0.0545), the prolonged operation (>240 minutes) (OR:8.66; CI:0.91-81.56; p=0.0585) and complete dehiscention of the laparotomy (OR:44.1; CI:3.39-572.78; p=0.0396) increased the 30 day mortality in our study. Conclusions. Early mortality after open repair of AAA in high volume centre might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy

Appearance of femoropopliteal segment aneurysms in patients with abdominal aortic aneurysm

Background/Aim. To promote better treatment outcome, as well as economic benefit it is very important to find out patients with simultaneous occurrence of both aortic and arterial aneurysms. The aim of this prospective study was to determine the frequency and factors affecting femoropopliteal (F-P) segment aneurysms appearance in patients with abdominal aortic aneurysms (AAA). Methods. This study included 70 patients who had underwent elective or urgent surgery of AAA from January 1, 2006 to December 31, 2007. After ultrasonographic examination of F-P segment, all the patients were divided into two groups - those with adjunctive F-P segment aneurysm (n = 20) and the group of 50 patients with no adjunctive F-P segment aneurysm. In both groups demographic characteristics (gender, age), risk factors (diabetes mellitus, elevated serum levels of cholesterol and triglycerides, arterial hypertension, smoking, obesity) and cardiovascular comorbidity (cerebrovascular desease, ischemic heart desease) were investigated. Results. Twenty (28.57%) patients who had been operated on because of AAA, had adjunctive aneurysmal desease of F-P segment. Diabetes was no statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (χ2 = 0.04; DF = 1; p > 0.05). Also, in both groups there was no statistically significant difference in gender structure (χ2 = 2. 05; DF = 2; p > 0.05), age (χ2 = 5. 46; DF = 1; p > 0.05), total cholesterol level (χ2 = 0.89; DF = 1; p > 0.05) and triglyceride (χ2 = 0.89; DF = 1; p > 0.05) levels, the presence of arterial hypertension (χ2 = 1.38; DF = 2; p > 0.05), smoking (χ2 = 1.74; DF = 1; p > 0.05), obesity (χ2 = 1.76; DF = 1; p > 0.05) and presence of cerebrovascular desease (χ2 = 2.34; DF = 1; p > 0.05). Conversly, ischemic heart desease was statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (χ2 = 5.45; DF = 1; p < 0.05). Conclusion. Twenty patients, beside AAA, had adjunctive F-P segment aneurysm. The results of this study suggest the necessity of preforming ultrasonographic examination of F-P segment in all patients with proven AAA

Factors affecting early results after elective open repair of abdominal aortic aneurysms

Uvod. Cilj ovog rada je prikaz faktora koji utiču na rane rezltate otvorenog hirurškog lečenja (OHL) aneurizmi abdominalne aorte (AAA). Metod. Istraživanje je sprovedeno u vidu prospektivne studije na 450 pacijenata podvrgnutih elektivnom OHL AAA na Klinici za vaskularnu i endovaskularnu hirurgiju KCS u Beogradu u period januar 2013-septembr 2014 godine. Rezultati. Smrtni ishod zabeležen je kod sedam (1.55%) bolesnika u prvih 30 postoperativnih dana. Uzroci smrtnog ishoda bili su: nekontrolisano krvarenje-1; akutni infarkt miokarda-1; ishemijski kolitis-2, MOFS-2, sepsa-1. Koronarna bolest (OR:3.89; CI:0.85-17.7; p=0.0058), postoperativni akutni infarkt miokarda (OR:29.9; CI:2.56- 334.95; p=0.0053), hronična bubrežna slabost (OR: 7.5; CI 1.35-8.5; p=0.0073), ishemijski kolitis (OR:88.2; CI:4.77-1629.69; p=0.0026), okluzija obe hipogastrične arterije uz nemogućnost da se bar jedna prezervira (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoralna rekonstrukcija (OR:9.06; CI:1.76-46.49; p=0.016), značajno perioperativni krvarenje (>2 litra) (OR:7.32; CI:1.31-10.79; p=0.0001), “hostilni” abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatorna aneurizma (OR: 13.99; CI:2.88-65.09; p=0.0002), supracelijačno klemovanje aorte (OR:18.7; CI:3.8- 90.6; p=0.0003), prolongirano klemovanje aorte (>60 minuta) (OR:14.25; CI:2.75-64.5; p=0.0003), intraoperativna hipotenzija (OR:6.61; CI:0.71-61.07; p=0.0545), prolongirana operacija (>240 minuta) (OR:8.66; CI:0.91-81.56; p=0.0585) i kompletna dehiscencija laparotomne rane (OR:44.1; CI:3.39-572.78; p=0.0396) povećavaju 30 dnevni mortalitet.Zaključak: Rani moratlitet nakon OHL AAA u centrima sa velikim iskustvom koji imaju dobro obučene multidisciplinarne timove, može biti veoma nizak. Takozvano centralizovano OHL može biti adekvatna solucija za pacijetne sa nepovoljnom anatomijom, odnosno za mladje, nerizične pacijenta sa dugom životnom prognozom.To assess results of open repair (OR) of AAA in a single high volume centre. Methods. We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for vascular and endovascular surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. Results. Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1,acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound -1. Coronary artery disease (OR:3.89; CI:0.85-17.7; p=0.0058), postoperative acute myoardial infarction (OR:29.9; CI:2.56-334.95; p=0.0053), chronic renal failure (OR: 7.5; CI 1.35-8.5; p=0.0073), colonic necrosis (OR:88.2; CI:4.77-1629.69; p=0.0026), occlusion of the both hypogastric arteries an the inability to preserve at least one hypogastric artery (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoral reconstruction (OR:9.06; CI:1.76-46.49; p=0.016), significant perioperative blleding (>2 liters) (OR:7.32; CI:1.31-10.79; p=0.0001), hostile abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatory aneurysm (OR: 13.99; CI:2.88-65.09; p=0.0002), supraceliac aortic cross clamping (OR:18.7; CI:3.8-90.6; p=0.0003), prolonged aortic cross clamping (>60 minutes) (OR:14.25; CI:2.75-64.5; p=0.0003), the intraoperative hypotension (OR:6.61; CI:0.71-61.07; p=0.0545), the prolonged operation (>240 minutes) (OR:8.66; CI:0.91-81.56; p=0.0585) and complete dehiscention of the laparotomy (OR:44.1; CI:3.39-572.78; p=0.0396) increased the 30 day mortality in our study. Conclusions. Early mortality after open repair of AAA in high volume centre might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy

Factors affecting early results after elective open repair of abdominal aortic aneurysms

Uvod. Cilj ovog rada je prikaz faktora koji utiču na rane rezltate otvorenog hirurškog lečenja (OHL) aneurizmi abdominalne aorte (AAA). Metod. Istraživanje je sprovedeno u vidu prospektivne studije na 450 pacijenata podvrgnutih elektivnom OHL AAA na Klinici za vaskularnu i endovaskularnu hirurgiju KCS u Beogradu u period januar 2013-septembr 2014 godine. Rezultati. Smrtni ishod zabeležen je kod sedam (1.55%) bolesnika u prvih 30 postoperativnih dana. Uzroci smrtnog ishoda bili su: nekontrolisano krvarenje-1; akutni infarkt miokarda-1; ishemijski kolitis-2, MOFS-2, sepsa-1. Koronarna bolest (OR:3.89; CI:0.85-17.7; p=0.0058), postoperativni akutni infarkt miokarda (OR:29.9; CI:2.56- 334.95; p=0.0053), hronična bubrežna slabost (OR: 7.5; CI 1.35-8.5; p=0.0073), ishemijski kolitis (OR:88.2; CI:4.77-1629.69; p=0.0026), okluzija obe hipogastrične arterije uz nemogućnost da se bar jedna prezervira (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoralna rekonstrukcija (OR:9.06; CI:1.76-46.49; p=0.016), značajno perioperativni krvarenje (>2 litra) (OR:7.32; CI:1.31-10.79; p=0.0001), “hostilni” abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatorna aneurizma (OR: 13.99; CI:2.88-65.09; p=0.0002), supracelijačno klemovanje aorte (OR:18.7; CI:3.8- 90.6; p=0.0003), prolongirano klemovanje aorte (>60 minuta) (OR:14.25; CI:2.75-64.5; p=0.0003), intraoperativna hipotenzija (OR:6.61; CI:0.71-61.07; p=0.0545), prolongirana operacija (>240 minuta) (OR:8.66; CI:0.91-81.56; p=0.0585) i kompletna dehiscencija laparotomne rane (OR:44.1; CI:3.39-572.78; p=0.0396) povećavaju 30 dnevni mortalitet.Zaključak: Rani moratlitet nakon OHL AAA u centrima sa velikim iskustvom koji imaju dobro obučene multidisciplinarne timove, može biti veoma nizak. Takozvano centralizovano OHL može biti adekvatna solucija za pacijetne sa nepovoljnom anatomijom, odnosno za mladje, nerizične pacijenta sa dugom životnom prognozom.To assess results of open repair (OR) of AAA in a single high volume centre. Methods. We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for vascular and endovascular surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. Results. Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1,acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound -1. Coronary artery disease (OR:3.89; CI:0.85-17.7; p=0.0058), postoperative acute myoardial infarction (OR:29.9; CI:2.56-334.95; p=0.0053), chronic renal failure (OR: 7.5; CI 1.35-8.5; p=0.0073), colonic necrosis (OR:88.2; CI:4.77-1629.69; p=0.0026), occlusion of the both hypogastric arteries an the inability to preserve at least one hypogastric artery (OR:17.4; CI:1.99-178.33; p=0.0230), aorto bifemoral reconstruction (OR:9.06; CI:1.76-46.49; p=0.016), significant perioperative blleding (>2 liters) (OR:7.32; CI:1.31-10.79; p=0.0001), hostile abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatory aneurysm (OR: 13.99; CI:2.88-65.09; p=0.0002), supraceliac aortic cross clamping (OR:18.7; CI:3.8-90.6; p=0.0003), prolonged aortic cross clamping (>60 minutes) (OR:14.25; CI:2.75-64.5; p=0.0003), the intraoperative hypotension (OR:6.61; CI:0.71-61.07; p=0.0545), the prolonged operation (>240 minutes) (OR:8.66; CI:0.91-81.56; p=0.0585) and complete dehiscention of the laparotomy (OR:44.1; CI:3.39-572.78; p=0.0396) increased the 30 day mortality in our study. Conclusions. Early mortality after open repair of AAA in high volume centre might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy