A systematic review of the current status of interventions for type II endoleak after EVAR for abdominal aortic aneurysms

Objective: To study the mid- and long-term outcomes of type II endoleak treatment after EVAR and the technical aspects of different techniques to exclude endoleaks which different embolic agents. Methods: A systematic review was performed using the approach recommended by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for meta-analyses of interventional studies. The comprehensive search was conducted using the following database: MEDLINE, EMBASE, and the Cochrane Library. Patient characteristic, intervention approaches, embolic agents, and results at mid and long term follow up were studied. Results: A total of 6 studies corresponding to a total of 141 patients fulfilled the inclusion criteria with a mean age of 73–78.6 years and a mean duration of follow up varying from 25 to 42 months. There were different techniques for embolization used (translumbar, transarterial, and transcaval approach) with various types of embolic agents. In all studies, the indication for embolization of the type II endoleaks was sac enlargement of more than 5 mm. A wide range of technical success rate was reported regardless of the intervention strategy being used (17,6%–100%). The overall technical success rate of all studies was 62%. Conclusion: This systematic review shows that there is a wide variety of techniques to exclude a persistent type II endoleak. Different kinds of embolic agents have be used. Due to a lack of peer reviewed data on longterm follow-up, it was not possible to come to recommendations what treatment would be the best for a durable exclusion of a persistent type II endoleak after an initially successful EVAR. There remains an urgent need for proper executed studies, either randomized or with close observation in relation to longer follow-up

Structured Multidisciplinary Approach to Ruptured Abdominal Aortic Aneurysm: Impact on Mortality and Complications in a 13-Year Cohort

Objective: To evaluate the impact of a comprehensive multidisciplinary protocol on 30-day survival in ruptured abdominal aortic aneurysm (rAAA) patients and to identify factors influencing outcomes. Materials and Methods: We conducted a retrospective study comparing outcomes before and after implementation a multidisciplinary protocol for rAAA management at Siriraj Hospital. The study included 182 patients (pre-protocol: n=99, Jan 2010-Dec 2017; post-protocol: n=83, Jan 2018-Mar 2023). Primary outcome was 30-day overall survival, with secondary outcomes including factors influencing survival, need for aortic balloon occlusion, operative parameters, length of stay, and complications. Results: The 30-day mortality rate significantly decreased from 16.2% pre-protocol to 6.0% post-protocol (p=0.037). Kaplan-Meier analysis showed improved 30-day survival in the post-protocol group (94.0% vs 83.8%, p=0.034). However, while protocol implementation was associated with a non-significant reduction in mortality hazard (adjusted HR 0.509, 95% CI 0.175-1.478, p=0.213), multivariable analysis identified cardiac arrest (aHR 8.180, p<0.001) and unfit patient status (aHR 6.420, p=0.003) as independent predictors of mortality. The post-protocol group had significantly reduced myocardial ischemia (7.2% vs 21.2%, p=0.015) and septicemia (1.2% vs 20.2%, p<0.001), with no significant differences in operative parameters or length of stay. Conclusion: Implementation of a multidisciplinary protocol for rAAA management was associated with improved 30-day survival and reduced postoperative complications, supporting the use of structured protocols in rAAA management

Determining Perioperative Mortality in Patients with Ruptured Abdominal Aortic Aneurysm: Insights from a Retrospective Cohort Study

Objective: This retrospective cohort study analyzed factors determining perioperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA) undergoing open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Materials and Methods: 147 rAAA patients who underwent OSR (n=37) or EVAR (n=110) between 2000 and 2017 were included. Demographic data, intraoperative details, and perioperative complications were assessed. Logistic regression analysis identified factors associated with perioperative mortality. The primary endpoint was perioperative mortality rate, and the secondary endpoint focused on factors determining 30-day mortality. Results: Overall perioperative mortality was 19.04% (28/147), with 8.1% (3/37) for OSR and 22.7% (25/110) for EVAR (p=0.139). The non-survived group had more unfit patients (82.1% vs. 47.9%, p=0.002), higher preoperative serum creatinine levels (1.8±1.74 vs. 1.4±5.89, p=0.011), and higher rates of aortic balloon usage (64.3% vs. 22.7%, p80 years (adjusted odds ratio [aOR] 9.785, p=0.003), unfit patient status (aOR 3.35, p=0.028), aortic balloon usage (aOR 5.54, p=0.036), postoperative myocardial infarction (aOR 13.995, p<0.001), postoperative congestive heart failure (aOR 15.22, p=0.038), and abdominal compartment syndrome (aOR 23.397, p<0.001) as independent predictors of 30-day mortality. Conclusion: No significant difference in perioperative mortality was found between OSR and EVAR in rAAA patients. Several independent factors predicting 30-day mortality were identified, providing valuable insights for clinicians in predicting outcomes and improving patient care in rAAA cases

Determining Perioperative Mortality in Patients with Ruptured Abdominal Aortic Aneurysm: Insights from a Retrospective Cohort Study

Objective: Analyzing factors determining perioperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA) undergoing open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Materials and Methods: Inclusion of 147 consecutive rAAA patients who underwent OSR (n=37) or EVAR (n=110) between 2000 and 2017. Assessment of patients' demographic data, intraoperative details, and perioperative complications. Investigation of comparative outcomes between OSR and EVAR. Employing logistic regression analysis to identify factors associated with perioperative mortality. Results: Perioperative mortality rate of 19.04% (28/147), with 8.1% (3/37) for OSR and 22.7% (25/110) for EVAR (p=0.139). Higher prevalence of unfit patients in the non-survived group (82.1% vs. 47.9%, p=0.002). Non-survived group had significantly higher preoperative serum creatinine levels (1.8 ± 1.74 vs. 1.4 ± 5.89, p=0.011). Intraoperatively, non-survived group had higher rates of aortic balloon usage and cardiac arrest (64.3% vs. 22.7% and 28.6% vs. 3.4%, p 80 years old, unfit patient status, aortic balloon usage, postoperative myocardial infarction, postoperative congestive heart failure, and abdominal compartment syndrome as independent predictors of 30-day mortality. Conclusions: No significant difference in perioperative mortality between OSR and EVAR in rAAA patients. Independent predictors of 30-day mortality include age > 80 years old, unfit patient status, aortic balloon usage, postoperative myocardial infarction, congestive heart failure, and abdominal compartment syndrome. Valuable insights for clinicians in predicting outcomes and improving patient care in rAAA cases

Comparison of early and intermediate-term outcomes between hybrid arch debranching and total arch replacement: A systematic review and meta-analysis of propensity-matched studies.

ObjectivesTo systematically review propensity score-matched studies comparing hybrid arch repair (HAR) with total arch replacement (TAR) for aortic arch pathologies, summarizing early outcomes and intermediate-term results.MethodsWe searched PubMed, Embase, the Cochrane Library, and Google Scholar to April 2024. The primary outcome was in-hospital mortality, evaluated by a random-effects model to calculate the odds ratio (OR). Time-to-event outcomes were synthesized as hazard ratios (HR) using inverse variance method.ResultsEight studies comprising 860 patients were included. There was no significant difference in in-hospital mortality between HAR and TAR groups (OR 0.66; 95% CI 0.33-1.31; p = 0.240). HAR was associated with a lower incidence of renal failure (OR 0.51; 95% CI 0.30-0.88; p = 0.020). In the isolated type A aortic dissection (ITAAD) subgroup, HAR showed a non-significant trend toward lower in-hospital mortality (OR 0.66; 95% CI 0.33-1.31, p = 0.24). In mixed degeneration-dissection (MDAD), TAR showed a non-significant trend toward lower risk of permanent neurological dysfunction (PND) (OR 2.84; 95% CI 0.89-9.10; p = 0.080) and a significantly lower three-year re-interventions rate (HR 2.99; 95% CI 1.48-6.04; p ConclusionsHAR was associated with a lower risk of renal failure. In ITAAD, HAR showed a trend toward lower in-hospital mortality, whereas in MDAD cohorts, TAR showed a significantly lower three-year re-intervention rate. These findings should be interpreted with caution given the small number of studies and underlying heterogeneity. Further observational studies or randomized trials are warranted