Abstract:
BACKGROUND:The best strategy in the treatment for ruptured abdominal aortic aneurysm (RAAA) is an ongoing matter of debate. Differently from several retrospective studies, recent randomized controlled trials (RCTs) failed to demonstrate the superiority of endovascular repair (EVAR) over open repair (OPEN). The aim of the present study was to compare 30-day mortality of EVAR and OPEN in RAAA according to different study designs through a systematic review and meta-analysis. METHODS:A systematic literature search of all series comparing the outcome of EVAR and OPEN in RAAA was performed. Studies on symptomatic aneurysms without frank ruptures were excluded. The analyses evaluated the effect of the study design on EVAR versus OPEN 30-day mortality. The pooled mortality risk was expressed as odds ratio (OR) with a 95% confidence interval (CI) by random effect model. RESULTS:Four different study designs were evaluated. 1) Patients allocation in EVAR or OPEN was "unbiased" (3 studies, 2 RCTs): there was no superiority treatment in EVAR versus OPEN (OR, 1.58; 95% CI, 0.82-3.06; P = 0.17). 2) Patients submitted to EVAR were compared with a historical OPEN group (2 studies): no difference between EVAR and OPEN (OR, 3.55; 95% CI, 0.47-26.62; P = 0.22). 3) EVAR was the preferential treatment and OPEN was confined to patients with unsuitable anatomy for endovascular procedures (18 studies): in this type of study OPEN had a higher risk of 30-day mortality (OR, 2.18; 95% CI, 1.61-2.96; P < 0.00001). 4) The 30-day mortality after EVAR introduction in centers using both EVAR and OPEN was compared with the only OPEN treatment (7 studies): the latter had higher mortality compared with the protocol with both EVAR and OPEN options (OR, 2.26; 95% CI, 1.41-3.63; P = 0.0007). CONCLUSIONS:Only few studies are available to compare EVAR and OPEN in an "unbiased" cohort, with no significant differences between the 2 treatments. However, after the introduction of EVAR and OPEN protocols, the overall mortality for RAAA was reduced compared with the only OPEN option, suggesting a beneficial effect of EVAR in selected cases.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Pini R,Faggioli G,Longhi M,Mauro R,Freyrie A,Gargiulo M,Gallitto E,Mascoli C,Stella Adoi
10.1016/j.avsg.2014.03.017subject
Has Abstractpub_date
2014-08-01 00:00:00pages
1568-80issue
6eissn
0890-5096issn
1615-5947pii
S0890-5096(14)00184-8journal_volume
28pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Mentoring relationships have been encouraged for medical students interested in surgical specialties. We investigated the role of mentoring relationships of integrated vascular surgery residents, while in medical school. We hypothesized that mentoring relationships between medical students and vascular surge...
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abstract:BACKGROUND:Radiation-induced necrosis and arteriopathy are well-known iatrogenic pathologic entities. However, radiation-induced rupture of the superficial femoral artery is an exceptional life-threatening event. REPORT:We hereby report a case of radiation-induced rupture of the superficial femoral artery that was suc...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.12.034
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abstract::Bronchial artery aneurysms (BAA) are a rarely noted. Asymptomatic cases of BAA are very rare. Most patients are correctly diagnosed only after BAA ruptures. The conventional treatment includes aneurysm resection through thoracotomy or transcatheter arterial embolization. In the present report, we describe a case of an...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2013.12.021
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abstract::Omental artery aneurysms are a unique subset of splanchnic artery aneurysms that are associated with intraperitoneal hemorrhage and high mortality rates. Detecting omental artery aneurysms prior to rupture is especially challenging; as such there are limited data surrounding unruptured aneurysms. Various methods of tr...
journal_title:Annals of vascular surgery
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abstract::Pseudoaneurysms of the lingual artery are extremely rare and are commonly iatrogenic in nature or less frequently a result of blunt or penetrating trauma. Traditionally, these vascular abnormalities have been repaired with open or endovascular techniques. Although ultrasound-guided percutaneous thrombin injection has ...
journal_title:Annals of vascular surgery
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doi:10.1016/j.avsg.2013.10.013
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abstract:BACKGROUND:The Vascular Quality of Life Questionnaire (VascuQoL-6) was proposed to evaluate specific quality of life of peripheral artery disease (PAD) patients. However, there is no Brazilian-Portuguese version available, blunting its use in Brazilian patients. The objective of the study was to analyze the psychometri...
journal_title:Annals of vascular surgery
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abstract:BACKGROUND:Dynamic compliance (Cd) of the adult thoracic ascending and arch aorta has had limited in vivo evaluation in patients with aortic disease. This study evaluates aortic compliance using intravascular ultrasound (IVUS) across a range of thoracic aortic diseases. METHODS:Seventy-nine patients undergoing thoraci...
journal_title:Annals of vascular surgery
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abstract::Venous thoracic outlet syndrome (V-TOS) and associated subclavian vein thrombosis (SVT) result in significant patient morbidity and can be difficult to manage. Previous studies have suggested that both mechanical compressive factors and pathological alterations in patient coagulation may contribute to the development ...
journal_title:Annals of vascular surgery
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abstract:BACKGROUND:Sex-related differences in outcomes have been identified in patients with peripheral artery disease (PAD). We hypothesized that women with PAD would have equivalent inpatient mortality with men after vascular intervention. METHODS:Patients with a primary diagnosis of critical limb ischemia (CLI) or lifestyl...
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journal_title:Annals of vascular surgery
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abstract:BACKGROUND:Endovascular repair is associated with better 30-day outcomes than open surgical repair for patients with infrarenal aortic aneurysms. In patients with complex aortic aneurysms (CAAs) requiring suprarenal or supravisceral aortic cross-clamping during open repair, few data exist directly comparing the real-wo...
journal_title:Annals of vascular surgery
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abstract:BACKGROUND:Significantly reduced amputation rates for traumatic popliteal artery injuries have been achieved with improved revascularization and resuscitative techniques. Predictive scores have failed to accurately predict outcomes in patients who sustain popliteal artery damage. This study aimed to identify predictors...
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pub_type: 杂志文章
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abstract:BACKGROUND:In abdominal aortic aneurysm (AAA), pathophysiology deterioration of the medial aortic layer plays a critical role. Key players in vessel wall degeneration are reactive oxygen species (ROS), smooth muscle cell apoptosis, and extracellular matrix degeneration by matrix metalloproteinase-9 (MMP-9). Lipocalin-2...
journal_title:Annals of vascular surgery
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journal_title:Annals of vascular surgery
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doi:10.1016/j.avsg.2007.07.018
更新日期:2007-11-01 00:00:00
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pub_type: 杂志文章,多中心研究
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abstract::Cryosurgery is a relatively new treatment option for vein stripping in case of insufficiency of the great saphenous vein (GSV). A prospective randomized trial was performed to compare operation time, extracted vein length, and postoperative outcomes of cryosurgery with conventional short stripping. Forty patients with...
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pub_type: 杂志文章,随机对照试验
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journal_title:Annals of vascular surgery
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journal_title:Annals of vascular surgery
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journal_title:Annals of vascular surgery
pub_type: 杂志文章,meta分析
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journal_title:Annals of vascular surgery
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