Abstract:
BACKGROUND:Thoracoabdominal aortic aneurysm (TAAA) repairs are technically challenging. The advent of endovascular aneurysm repair in combination with visceral/renal artery bypasses has allowed for hybrid endovascular repair of these aneurysms. The purpose of this study was to evaluate whether outcomes were affected by the number of visceral/renal artery reconstructions, conduit, or gender. METHODS:All patients who underwent visceral/renal bypass associated with an endovascular aortic aneurysm repair were prospectively studied in a vascular registry and retrospectively reviewed between the years 2004 and 2009. Patients undergoing standard open TAAA repair and those with aortic arch branch vessel reconstructions associated with thoracic endovascular repair were excluded from this analysis. Patients were segregated into two groups on the basis of number of vessels bypassed. Group 1 (n = 9) consisted of patients who required one or two bypasses, whereas group 2 (n = 15) consisted of patients who required three or four bypasses. RESULTS:A total of 64 TAAA repairs were performed. In all, 22 patients with hybrid repair and aortic arch vessel reconstructions and 18 patients with open TAAA repair were excluded from this analysis. A total of 24 (38%) patients with hybrid endovascular repair were evaluated in this study. The 30-day mortality was found to be 12.5% (3/24) and the incidence of spinal cord ischemia was 8.3% (2/24). Preoperative comorbidities and American Society of Anesthesia (ASA) scores were reported to be similar between the two groups. As compared with group 2, patients in group 1 were reported to be younger (69.7 ± 10.6 vs. 76.0 ± 5.7 years [p = 0.074]), had less blood loss (1,200 ± 1,088 mL vs. 3,119 ± 2,188 mL, [p = 0.06]), required fewer blood transfusions (5.33 ± 2.31 vs. 9.09 ± 7.06 units packed red blood cells (PRBC) [p = 0.39]), and had a shorter length of stay (11.4 ± 5.6 vs. 21.9 ± 15.1 days, [p = 0.090]). There was no difference in 30-day mortality rates between the two groups. The incidence of perioperative morbidity, including bowel ischemia (11%[1/9] vs. 27% [4/15], [p = 0.39]), myocardial infarction (11% [1/9] vs. 13% [2/15], [p = 0.88]), wound infection (0% vs. 27% [4/15], [p = 0.09]), and pneumonia (11% [1/9] vs. 40% [6/15], [p = 0.14]) was found to be less in group 1 than group 2, but this difference was not significant. Patients with three or four bypasses had a significantly greater requirement for a skilled nursing facility or a rehabilitation facility after discharge (79% [11/14] vs. 29% [2/7], p = 0.026). There were no statistically significant differences in postoperative outcomes when comparing choice of conduit (autogenous or prosthetic) or gender. Results from the Cox-proportional hazards regression showed that bowel ischemia was the only postoperative complication associated with decreased survival (p = 0.037, confidence interval [0.1328-4.3075]). CONCLUSIONS:Hybrid aortic aneurysm repair carries a significant risk of patient morbidity with an acceptable mortality for patients considered to be at a high risk for standard thoracoabdominal repair. In patients requiring fewer visceral/renal reconstructions, there is a trend toward fewer postoperative complications and a significantly shorter length of stay. Moreover, there is a significantly lower need for skilled nursing facility requirements after discharge from the hospital. Bowel ischemia is associated with significantly worse outcome and better attempts at avoiding this complication and aggressive management is indicated.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Smith TA,Gatens S,Andres M,Modrall JG,Clagett GP,Arko FRdoi
10.1016/j.avsg.2010.06.004subject
Has Abstractpub_date
2011-01-01 00:00:00pages
64-70issue
1eissn
0890-5096issn
1615-5947pii
S0890-5096(10)00297-9journal_volume
25pub_type
杂志文章abstract:BACKGROUND:Unintentional renal artery occlusion after endovascular aortic aneurysm repair (EVAR) is an uncommon phenomenon. The sequelae from this specific complication are severe; consequently, the topic of renal artery coverage is a pertinent issue. We present a case series of patients undergoing EVAR with unintentio...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2012.02.018
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:This study is to investigate the causes, treatment methods, and preventive measures of retrograde type A aortic dissection (RAAD) complicating thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). METHODS:From January 2005 to December 2013, 360 TBAD patients receiving TEVAR were e...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.09.028
更新日期:2016-04-01 00:00:00
abstract::We describe the technique using high-volume three-dimensional coils to "augment" an insufficient stent-graft landing zone. This was performed to preserve hypogastric artery perfusion in the case of common iliac artery aneurysm which resides next to the internal iliac artery. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.03.191
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:To evaluate the effectiveness and patient satisfaction with the use of oxybutynin for treating axillary hyperhidrosis in a large series of patients. METHODS:One hundred two patients with axillary hyperhidrosis were treated with oxybutynin. During the first week, patients received 2.5 mg of oxybutynin once a...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.06.007
更新日期:2011-11-01 00:00:00
abstract::The objective of this study was to compare magnetic resonance angiography (MRA), contrast arteriography (CA), and duplex arteriography (DA) for defining anatomic features relevant to performing lower extremity revascularizations. From March 1, 2001 to August 1, 2001, 33 consecutive inpatients with chronic lower extrem...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-004-0039-0
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to review our experiences treating peripheral artery disease (PAD) by common femoral artery endarterectomy (CFE) with and without endovascular therapy (EVT), and to describe the role of CFE in the endovascular era. METHODS:We retrospectively reviewed a contemporary series of 38...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.05.005
更新日期:2015-11-01 00:00:00
abstract::Small-sized vessels can represent a contraindication to standard endovascular aortic repair (EVAR), and more specifically, aortoiliac deformities resulting from poliomyelitis may add an adjunctive challenge for total endovascular repair. Herein we report a case of a 62-year-old man with a 55 mm abdominal aortic aneury...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.07.019
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Primary closure (PC) and patch angioplasty (PA) during carotid endarterectomy (CEA) have been disputed in many studies. Some studies announced that PC is associated with a higher restenosis rate. The aim of this study was to evaluate the outcomes of PC and PA using propensity score matching (PSM). METHODS:B...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.11.011
更新日期:2020-01-01 00:00:00
abstract::This study is based on a unique registry of 632 patients who underwent great saphenous vein (GSV) stripping and liberal use of subfascial endoscopic perforator vein surgery (SEPS) for minimal to severe lower limb venous insufficiency. Clinical examinations and color-coded duplex scanning were performed on a randomly s...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-003-0032-z
更新日期:2003-09-01 00:00:00
abstract::In this retrospective study, we reviewed the records of 62 patients who were treated at a tertiary care community teaching hospital between 1977 and 1987 for major arterial injury caused by blunt trauma. Nearly half (45%, 28/62) of the injuries were to the thoracic aorta, 24% (15/62) were to arteries of the head and n...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/S0890-5096(06)60158-1
更新日期:1989-10-01 00:00:00
abstract:BACKGROUND:We investigated the outcome of vein stenting placement for chronic proximal venous outflow obstruction (PVOO) in a predominantly Asian-American cohort to improve patient selection, enhance technical approach, and better define quality measurements of this emerging vascular intervention. METHODS:A total of 4...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.01.018
更新日期:2020-07-01 00:00:00
abstract::Existing animal models do not replicate all aspects of abdominal aortic aneurysms (AAAs), including the rupture mechanisms. From histopathological analyses conducted in humans, it has been found that the vasa vasorum of the AAA wall is the starting point of circulatory failure and that bulging and dilatation of the ab...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2019.08.082
更新日期:2020-02-01 00:00:00
abstract::Fifty-eight patients underwent lower limb amputation for arterial disease over a 30-month period. Mean age of the patients was 72 years. Cardiopulmonary and metabolic risk factors were present in the majority of the patients. Postoperative one-year and three-year mortality rates were 24, 40, and 76%, respectively. Con...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02009459
更新日期:1990-05-01 00:00:00
abstract::Between October 1990 and June 2001, 121 patients underwent surgery for thoracoabdominal aortic aneurysm (TAAA)-99 procedures were elective and 22 were for ruptured aneurysms. Between October 1990 and September 1997, the clamp-and-go technique was used for all aneurysms (43 patients), and from October 1997, clamp-and-g...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-001-0181-x
更新日期:2002-09-01 00:00:00
abstract::The aim of this article is to describe a new open surgical technique for revascularization of renal arteries. Several interventions for surgical revascularization of renal arteries have been proposed. We suggest to perform an alternative technique if the described inflow vessels are not suitable because of severe athe...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.03.051
更新日期:2015-08-01 00:00:00
abstract::Carotidynia is a term that is best defined by neck pain associated with tenderness over the carotid artery. The differential diagnosis of this entity is broad and includes vascular disorders such as carotid dissection, aneurysm, occlusion, and arteritis. We describe the first reported case of carotidynia caused by sep...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/s10016-001-0402-3
更新日期:2003-03-01 00:00:00
abstract::Infections involving the aorta are associated with high rates of morbidity and mortality, and their management is complex. Saturating Dacron grafts in rifampin (60 mg/mL) inhibits the growth of organisms commonly found to be involved in both primary aortic infections and aortoenteric fistulas. Open repair and replacem...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2013.10.006
更新日期:2014-04-01 00:00:00
abstract::Synovial hemangioma is a rare benign vascular malformation. We report a case of chronic swelling in the left knee of a 7-year-old boy. An intra-articular tumor of synovial origin could was detected after a magnetic resonance imaging scan. Surgical excision of the mass associated with partial synovectomy was carried ou...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2012.08.019
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:This report examines the effects of regional versus general anesthesia for infrainguinal bypass procedures performed in the treatment of critical limb ischemia (CLI). METHODS:Nonemergent infrainguinal bypass procedures for CLI (defined as rest pain or tissue loss) were identified using the 2005 to 2008 Amer...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.04.006
更新日期:2013-02-01 00:00:00
abstract::Percutaneous endovenous techniques, such as radiofrequency ablation (RFA), have become the preferred method for treatment for varicose veins associated with great saphenous vein (GSV) insufficiency. Reports have shown safety and efficacy of these techniques with relatively few complications. Deep venous thrombosis aft...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.07.005
更新日期:2010-11-01 00:00:00
abstract::Iliac arterial disease, unfavorable anatomy, and prior stenting all pose challenges to access in endovascular abdominal aortic repair (EVAR) and thoracic aortic repair (TEVAR). Iliac access injury during T/EVAR may lead to rupture, dissection, thrombosis, or distal ischemia. Some have advocated iliac stent prior to T/...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.06.157
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS:Patients who underwent surgery for acute limb ischemia...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.06.002
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:The aim of this study is to present midterm results of thoracic endovascular aortic repair (TEVAR) using scalloped or fenestrated custom-made endovascular grafts (CMEGs) in aortic arch Zones 0 and 1. METHODS:A retrospective review of prospectively collected data involving consecutive patients with aortic ar...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.06.009
更新日期:2020-11-01 00:00:00
abstract::Percutaneous renal artery revascularization for hypertension and renal dysfunction is now common, and there is an increasing realization that renal artery intervention can be associated with parenchymal injury. The frequency, cause, and outcomes of acute functional injury associated with renal intervention are poorly ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.06.006
更新日期:2008-11-01 00:00:00
abstract::With the development of endovascular aneurysm repair, abdominal aortic aneurysms with short infrarenal necks (< or =10 mm, AAASN) are considered juxtarenal aneurysms. Minimally invasive treatment consists of hybrid procedures or fenestrated endografts. We present our experience with direct aortic repair for AAASN perf...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.09.005
更新日期:2009-01-01 00:00:00
abstract::The adductor canal compression syndrome is one of the several rare nontraumatic causes of arterial occlusions, which may lead to critical ischemia of the lower limb. We report the case of a 46-year-old athletic woman, who suffered from activity-related paresthesia and sharp pain in the left upper and lower leg for 2 y...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2016.05.134
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:To propose a protocol for the routine clinical use of duplex ultrasound (DUS) assessment after transcarotid artery revascularization (TCAR) procedures, with its specific point of vascular access, based on DUS data from routine clinical practice. METHODS:DUS data were retrospectively collected at 2 centers f...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.09.065
更新日期:2020-11-24 00:00:00
abstract::The risk of intraoperative open conversion during endovascular aortic repair (EVAR) still remains a main issue, albeit in a small percentage of cases. Open conversion can be extremely demanding and risky in relation to the type of the stent graft implanted and can be somehow challenging even for the most experienced v...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2015.04.062
更新日期:2015-10-01 00:00:00
abstract::Aortic wall tension was determined in 40 patients to assess its predictive value in abdominal aortic aneurysm (AAA) rupture. A 3-year retrospective analysis of 243 patients with ruptured AAAs and 45 patients with intact AAAs was conducted. The 288 patient sample was limited to the 40 patients with an abdominal CT scan...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169910027
更新日期:2000-03-01 00:00:00
abstract::Antithrombin is a potent inhibitor of the coagulation cascade exerting its primary effects on activated factors X, IX and II. It is the mechanism by which heparin and low-molecular weight heparin cause anti-coagulation. Deficiency of antithrombin presents as a hypercoagulable state, and may result in unexplained deep ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2009.07.028
更新日期:2010-04-01 00:00:00