Abstract:
BACKGROUND:Patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms can exhibit variations in sac behavior ranging from complete regression to expansion. We evaluated the impact of sac behavior at 1-year follow-up on late survival. METHODS:We used the Vascular Study Group of New England (VSGNE) registry from 2003 to 2011 to identify EVAR patients with 1-year computed tomography follow-up. Aneurysm sac enlargement ≥5 mm (sac expansion) and decrease ≥5 mm (sac regression) were defined per Society for Vascular Surgery guidelines. Predictors of change in sac diameter and impact of sac behavior on long-term mortality were assessed by multivariable methods. RESULTS:Of 2437 patients who underwent EVAR, 1802 (74%) had complete 1-year follow-up data and were included in the study. At 1 year, 162 (9%) experienced sac expansion, 709 (39%) had a stable sac, and 931 (52%) experienced sac regression. Sac expansion was associated with preoperative renal insufficiency (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.5-8.0; P < .01), urgent repair (OR, 2.7; 95% CI, 1.4-5.1; P < .01), hypogastric coverage (OR, 1.7; 95% CI, 1.1-2.7; P = .02), and type I/III (OR, 16.8; 95% CI, 7.3-39.0; P < .001) or type II (OR, 2.9; 95% CI, 2.0-4.3; P < .001) endoleak at follow-up, and sac expansion was inversely associated with smoking (OR, 0.6; 95% CI, 0.4-0.96; P = .03) and baseline aneurysm diameter (OR, 0.7; 95% CI, 0.6-0.9; P < .001). Sac regression (vs expansion or stable sac) was associated with female gender (OR, 1.8; 95% CI, 1.4-2.4; P < .001) and larger baseline aneurysm diameter (OR, 1.4; 95% CI, 1.2-1.5; P < .001) and inversely associated with type I/III (OR, 0.2; 95% CI, 0.1-0.5; P < .01) or type II endoleak at follow-up (OR, 0.2; 95% CI, 0.2-0.3; P < .001). After risk-adjusted Cox regression, sac expansion was independently associated with late mortality (hazard ratio, 1.5; 95% CI, 1.1-2.0; P = .01), even with adjustment for reinterventions and endoleak during follow-up. Sac regression was associated with lower late mortality (hazard ratio, 0.6; 95% CI, 0.5-0.7; P < .001). Long-term survival was lower (log-rank, P < .001) in patients with sac expansion (98% 1-year and 68% 5-year survival) compared with all others (99% 1-year and 83% 5-year survival). CONCLUSIONS:These data suggest that an abdominal aortic aneurysm sac diameter increase of at least 5 mm at 1 year, although infrequent, is independently associated with late mortality regardless of the presence or absence of endoleak and warrants close observation and perhaps early intervention.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Deery SE,Ergul EA,Schermerhorn ML,Siracuse JJ,Schanzer A,Goodney PP,Cambria RP,Patel VI,Vascular Study Group of New England.doi
10.1016/j.jvs.2017.06.075subject
Has Abstractpub_date
2018-01-01 00:00:00pages
157-164issue
1eissn
0741-5214issn
1097-6809pii
S0741-5214(17)31689-0journal_volume
67pub_type
杂志文章abstract:OBJECTIVE:In peripheral arterial disease (PAD) patients, a limiting factor in the success of percutaneous transluminal angioplasty (PTA) is the development of restenosis secondary to vascular smooth muscle cell (SMC) proliferation. Following endothelial damage and platelet activation, there is release of factors and ad...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jvs.2009.06.017
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:To determine the clinical and radiological outcomes of patients with symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) who were treated with conservative management. METHODS:This retrospective study included 27 consecutive patients who were diagnosed with symptomatic SIDS...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.07.112
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Acute aortic syndromes remain life-threatening. Time is of the essence, as mortality rises with increasing time after the acute episode. The aim of this report is to show changes in practice and outcomes after the establishment of an acute aortic treatment center (AATC) to expedite the care of acute aortic s...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.06.157
更新日期:2010-12-01 00:00:00
abstract::This article is a report on a case of a giant pseudoaneurysm of the inferior gluteal artery where important features of the diagnosis, with special mention of magnetic resonance imaging and arteriography, are discussed. Surgical therapy is the treatment of choice for these lesions. Historically, proximal arterial cont...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1988.avs0080716
更新日期:1988-12-01 00:00:00
abstract:PURPOSE:The purpose of this article was to report our long-term results of distal vertebral artery (DVA) reconstruction. METHOD:From 1978 to 2001 we performed 352 DVA reconstructions on 323 patients (177 men, 148 women; mean age, 60.0 +/- 12.1 years). Symptoms of vertebrobasilar insufficiency were present in 332 cases...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.126092
更新日期:2002-09-01 00:00:00
abstract::Patency of vein grafts may be influenced by the medium in which they are stored temporarily. We compared saline solution vs blood on prostanoid production and maintenance of endothelium in canine veins after 1 hour of storage at 23 degrees C with 0.2 mg/ml of papaverine. Spontaneous and arachidonate-stimulated prostag...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1988-04-01 00:00:00
abstract:PURPOSE:Recent studies have suggested that transrenal artery fixation of endovascular stent-grafts is safe and may be a desirable means of reducing the risk of type I endoleaks, particularly those with short infrarenal necks. The close proximity of the superior mesenteric and celiac arteries to the renal arteries may c...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.119387
更新日期:2002-01-01 00:00:00
abstract::Iatrogenic aortic injuries after spinal surgery have been described, but are rare. We describe a case of a 77-year-old woman who underwent surgical correction of a debilitating spinal deformity at an outside institution. Postoperative thoracic spine radiographs and computed tomography scans revealed a misplaced pedicl...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2003.10.056
更新日期:2004-04-01 00:00:00
abstract::Despite increasing popularity in the use of stent grafts to treat aortic diseases, stent grafts are used for pulmonary arterial lesions less frequently. In particular, to our knowledge no report has described stent graft implantation into the pulmonary arteries in patients with total cavopulmonary connection (Fontan o...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.12.043
更新日期:2010-05-01 00:00:00
abstract::High-resolution magnetic resonance imaging was combined with computational modeling to create focused three-dimensional reconstructions of the distal anastomotic region of autologous vein peripheral bypass grafts in a preliminary series of patients. Readily viewed on a personal computer or printed as hard copies, a de...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/s0741-5214(03)00604-9
更新日期:2003-09-01 00:00:00
abstract:OBJECTIVE:Diabetes and peripheral arterial disease (PAD) are independently associated with increased risk of amputation. However, the effect of poor glycemic control on adverse limb events has not been studied. We examined the effects of poor glycemic control (high hemoglobin A1c level) on the risk of amputation and mo...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2017.06.101
更新日期:2018-01-01 00:00:00
abstract::Fenestrated endovascular aneurysm repair (FEVAR) is an alternative to open repair of complex aortic aneurysms. Despite promising short-term results, the technical complexities of this procedure remain a considerable challenge. The risk of technical failure with loss of visceral or renal arteries is ubiquitous even in ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.12.139
更新日期:2017-07-01 00:00:00
abstract::Vascular surgeons are often called emergently to help treat bleeding patients. These cases may involve unexpected intraoperative bleeding, bleeding in the pregnant patient, or bleeding in patients in the emergency room. In many instances, the vascular surgeon is not "on call" and therefore has no legal duty to assist ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2010.02.028
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:Volume-outcome relationships for open abdominal aortic aneurysm (AAA) repair have received less attention in publicly funded health systems. Furthermore, the roles of surgeon seniority (years of experience) and composite volume (encompassing all major arterial cases) on outcomes after open AAA repair are less...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2017.10.050
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVES:Increased utilization of computed tomography angiography (CTA) has increased the radiologic diagnosis of penetrating atherosclerotic ulcers (PAUs), which are defined as the ulceration of atherosclerotic plaque through the internal elastic lamina into the aortic media. However, the presentation, treatment ind...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.08.005
更新日期:2012-01-01 00:00:00
abstract:PURPOSE:We evaluated the effects of wearing 20 to 30 mm Hg gradient thigh-length stockings during daily activity on the lower leg venous system. METHODS:Twenty-one healthy women volunteers, aged 39 +/- 12 years, were examined. One subject was clinical class 4, one was class 2, two were class 1, and the remainder were ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70007-8
更新日期:1999-11-01 00:00:00
abstract::A case is reported of a woman with an ischemic arm as a result of damage to the subclavian artery by the clavicular anomaly associated with cleidocranial dysostasis. Only one similar case has been reported previously. ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(97)70105-8
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:To evaluate patterns of use and outcomes of arteriovenous fistulas and prosthetic grafts within racial categories in a large population based cohort of hemodialysis (HD) patients in the United States. METHODS:A retrospective analysis of white, black, and Hispanic patients in the prospectively maintained Unit...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2019.07.092
更新日期:2020-05-01 00:00:00
abstract::The long-term patency of the internal mammary artery graft is better than that of the saphenous vein graft in coronary bypass surgery because of a low incidence of atherosclerosis in the internal mammary artery. In search of a possible biochemical explanation of the low degree of atherosclerosis in the internal mammar...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1990.17248
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:Aortic arch aneurysmal disease remains a therapeutic challenge. For patients unsuitable for standard open surgery, hybrid repair with debranching of the supra-aortic arteries followed by thoracic endovascular grafting has been shown to be an effective solution. The aim of this study was to report the clinical...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.11.033
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:Limb loss after lower extremity surgical revascularization occurs relatively frequently in patients receiving dialysis. The goal of the present study was to determine whether patients with milder degrees of renal insufficiency are also at risk for this complication. MATERIAL AND METHODS:This cohort study was...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2003.11.038
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVE:Dementia has been associated with increased complications and mortality in orthopedics and other surgical specialties, but has received limited attention in vascular surgery. Therefore, we evaluated the association of dementia with surgical outcomes for elderly patients with Medicare who underwent a variety o...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2019.07.087
更新日期:2020-05-01 00:00:00
abstract:PURPOSE:Thoracic endovascular aortic repair is increasingly becoming the standard treatment of many thoracic aortic pathologies. New reliable and accurate stent grafts are emerging to widen the endovascular treatment options. We report the results of RELAY (Bolton Medical, Barcelona, Spain) in the large RELAY Endovascu...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2010.09.050
更新日期:2011-03-01 00:00:00
abstract::To determine optimal fluid management after elective aortic surgery we compared postoperative administration of 5% dextrose Ringer's lactate solution (102 patients) with 5% dextrose half-normal saline solution (80 patients). For 72 hours after operation, intravenous fluids were titrated to maintain urine output betwee...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1986.avs0040164
更新日期:1986-08-01 00:00:00
abstract:BACKGROUND:The optimal strategy for revascularization in chronic limb-threatening ischemia (CLTI) is not yet completely known and is still under debate. Endovascular treatment methods predominate despite limited evidence for their advantage. In this concurrent, prospective observational cohort study, we investigated ou...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.03.029
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Percutaneous transluminal angioplasty ± stent (PTA/S) and surgical bypass are both accepted treatments for claudication due to superficial femoral artery (SFA) occlusive disease. However, long-term results comparing these modalities for primary intervention in patients who have had no prior intervention have...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.10.128
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:Reconstruction of infected aortic cases has shifted from extra-anatomic to in situ. This study reports the surgical strategy and early outcomes of abdominal aortic reconstruction in both native and graft-related aortic infection with in situ xenopericardial grafts. METHODS:Included in the analysis are 21 con...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.04.513
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to define a normal range of distal graft velocity (DGV) and peak systolic velocity (PSV) on the basis of outflow level and maximum graft diameter for infrainguinal reversed vein bypass grafting (RVG). METHODS:This study was designed as a prospective study of consecutive patien...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70172-2
更新日期:1999-07-01 00:00:00
abstract::We reviewed the results, systemic effects, and complications associated with the selective infusion of low-dose streptokinase in 151 patients. Successful thrombus lysis was achieved in 78% of atherosclerotic thrombotic occlusions less than 30 days old, in 81% of post-procedural occlusions less than 14 days old, and in...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1985.avs0020406
更新日期:1985-05-01 00:00:00
abstract::A technique is presented for revascularization of patients having a groin wound infection, which minimizes the risk of recurrent graft infection. A femorofemoral bypass with a subcutaneous perineal tunnel is constructed farther from the infected groin wound than the standard subcutaneous suprapubic tunnel. The route o...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1985.avs0020485
更新日期:1985-05-01 00:00:00