Abstract:
OBJECTIVE:The clinical decision-making utility of scoring algorithms for predicting mortality after ruptured abdominal aortic aneurysms (rAAAs) remains unknown. We sought to determine the clinical utility of the algorithms compared with our clinical decision making and outcomes for management of rAAA during a 10-year period. METHODS:Patients admitted with a diagnosis rAAA at a large university hospital were identified from 2005 to 2014. The Glasgow Aneurysm Score, Hardman Index, Vancouver Score, Edinburgh Ruptured Aneurysm Score, University of Washington Ruptured Aneurysm Score, Vascular Study Group of New England rAAA Risk Score, and the Artificial Neural Network Score were analyzed for accuracy in predicting mortality. Among patients quantified into the highest-risk group (predicted mortality >80%-85%), we compared the predicted with the actual outcome to determine how well these scores predicted futility. RESULTS:The cohort comprised 64 patients. Of those, 24 (38%) underwent open repair, 36 (56%) underwent endovascular repair, and 4 (6%) received only comfort care. Overall mortality was 30% (open repair, 26%; endovascular repair, 24%; no repair, 100%). As assessed by the scoring systems, 5% to 35% of patients were categorized as high-mortality risk. Intersystem agreement was poor, with κ values ranging from 0.06 to 0.79. Actual mortality was lower than the predicted mortality (50%-70% vs 78%-100%) for all scoring systems, with each scoring system overestimating mortality by 10% to 50%. Mortality rates for patients not designated into the high-risk cohort were dramatically lower, ranging from 7% to 29%. Futility, defined as 100% mortality, was predicted in five of 63 patients with the Hardman Index and in two of 63 of the University of Washington score. Of these, surgery was not offered to one of five and one of two patients, respectively. If one of these two models were used to withhold operative intervention, the mortality of these patients would have been 100%. The actual mortality for these patients was 60% and 50%, respectively. CONCLUSIONS:Clinical algorithms for predicting mortality after rAAA were not useful for predicting futility. Most patients with rAAA were not classified in the highest-risk group by the clinical decision models. Among patients identified as highest risk, predicted mortality was overestimated compared with actual mortality. The data from this study support the limited value to surgeons of the currently published algorithms.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Thompson PC,Dalman RL,Harris EJ,Chandra V,Lee JT,Mell MWdoi
10.1016/j.jvs.2016.07.121subject
Has Abstractpub_date
2016-12-01 00:00:00pages
1617-1622issue
6eissn
0741-5214issn
1097-6809pii
S0741-5214(16)31006-0journal_volume
64pub_type
杂志文章abstract:PURPOSE:Conventional pre-endovascular procedural evaluation uses both noninvasive testing and diagnostic arteriography. Diagnostic and therapeutic procedures often must be performed separately because of concerns about excessive contrast administration or inappropriate location of vascular access for the interventional...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70025-4
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to determine whether adenoviral inducible nitric oxide synthase (iNOS) gene transfer could inhibit intimal hyperplasia (IH) in porcine internal jugular veins interposed into the carotid artery circulation. METHODS:Porcine internal jugular veins were transduced passively with 1 x 10(1...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2001.113983
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:Aortic reconstruction for complex thoracoabdominal aortic aneurysms (TAAAs) can be challenging, especially in patients with connective tissue disorders (CTDs) in whom tissue fragility is a major concern. Branched graft reconstruction is a more complex operation compared with inclusion patch repair of the aort...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2017.03.451
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:It is well known that the clinical outcome of patients with critical limb ischemia (CLI) is poor. However, the relationship between stress-related hormone levels and CLI outcome remains unclear. The aim of this study was to reveal the association of stress hormones with the risk of a perioperative major adve...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2018.11.044
更新日期:2019-09-01 00:00:00
abstract:INTRODUCTION:Recent increases in the rate of carotid endarterectomies (CEAs) have been attributed to results of clinical trials demonstrating efficacy when CEA is performed in centers of excellence. Subsequent population-based data suggest that trial results may not be matched in the community. This study was undertake...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2000.105954
更新日期:2000-05-01 00:00:00
abstract::Treating flush iliac artery occlusion by endovascular means can be very challenging and is a cause of technical failure requiring open surgical intervention. We describe a simple endovascular technique that can be valuable in increasing technical success and avoiding the use of a re-entry device. The technique involve...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.10.029
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:The production of growth factors from several experimental arterial conduits was determined. METHODS:We implanted 105 experimental arterial grafts that were 1 cm long in the abdominal aorta of Lewis rats (average weight, 250 g). Five different types of grafts were analyzed: arterial isografts, vein grafts, ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2015.07.091
更新日期:2016-11-01 00:00:00
abstract::Aortic and renal vascular reconstruction often involve significant renal ischemia. Profound hypothermia during renal ischemia preserves renal tissue. However, in the clinical setting of vascular reconstruction specific attempts at cooling the kidney are often impractical, and renal ischemia frequently occurs at physio...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:Despite the current Centers for Medicare and Medicaid Services coverage criteria for carotid artery stenting (CAS), consensus regarding its appropriateness in patients with carotid artery stenosis has not been reached. This is one of the first population-based studies to use a dedicated administrative conven...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2010.05.010
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:The demand for vascular surgeons is expected to far exceed the current supply. In an attempt to decrease the training duration and to address the impending shortage, integrated vascular surgery residencies were approved and have expanded nationally. Meanwhile, vascular fellowships have continued to matriculat...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2017.12.031
更新日期:2018-05-01 00:00:00
abstract:PURPOSE:Open revascularization in patients with chronic mesenteric ischemia (CMI) is considered the gold standard. Percutaneous transluminal angioplasty and stenting (PTAS) is often reserved for patients not suitable for open revascularization. In our institute, endovascular revascularization is the first-choice treatm...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.08.055
更新日期:2010-02-01 00:00:00
abstract:PURPOSE:We evaluate here whether serial changes in the concentration of the aminoterminal propeptide of type III procollagen (PIIINP) in serum bear any relationship to the rate of abdominal aortic aneurysm (AAA) expansion and whether serum PIIINP has any predictive value with respect to the rupture event. METHODS:One ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(97)70222-2
更新日期:1997-05-01 00:00:00
abstract:INTRODUCTION:Acute aortic dissection (AAD) is one of the most common aortic emergencies that vascular specialists are asked to manage. Traditional surgical interventions for cases complicated by malperfusion have resulted in significant morbidity and mortality. With increasing availability of thoracic endografts, endov...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.04.025
更新日期:2011-11-01 00:00:00
abstract::Dissection of the internal carotid artery is an under-recognized cause of transient ischemic attack and cerebral vascular accident. Spontaneous dissections, in which no precipitating cause can be identified, occur infrequently. Endovascular intervention is an evolving treatment option in patients in whom anticoagulati...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2004.03.018
更新日期:2004-07-01 00:00:00
abstract::Ergotism is a rare condition of acute vasospasm found classically in young and middle-aged women taking ergot alkaloid agents to treat migraine headache. We report the case of a young man with human immunodeficiency virus (HIV) positivity and describe the drug interaction between protease inhibitors and ergot alkaloid...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2003.80
更新日期:2003-03-01 00:00:00
abstract::The current problems and conflicts associated with training of vascular and general surgery residents exemplify the larger dilemma of educating subspecialists while preserving the wellspring of general surgery. Previous vascular fellowship programs during the era of evolution of our subspecialty were characterized by ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1990.17470
更新日期:1990-07-01 00:00:00
abstract:OBJECTIVE:Previous publications have clearly established a correlation between timing of thoracic endovascular aortic repair (TEVAR) and complications after treatment of complicated acute type B aortic dissection (ATBAD). However, the temporal association of TEVAR with morbidity after uncomplicated presentations is poo...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.05.073
更新日期:2020-07-03 00:00:00
abstract:OBJECTIVE:Critical limb ischemia (CLI) is associated with high morbidity and mortality. Because most patients with CLI will eventually undergo some type of revascularization, the natural history of CLI is not well defined, although it is important to know when patients decide to pursue treatment. METHODS:We systematic...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2015.07.065
更新日期:2015-12-01 00:00:00
abstract:PURPOSE:A prospective controlled study was undertaken to determine how peripheral vascular disease (PVD) influences flow in the deep veins of the leg. METHODS:Eighty-nine patients with peripheral vascular disease and 35 age-matched control subjects were studied. The popliteal vein diameter and flow velocity were measu...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70247-8
更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:Reoperative carotid endarterectomy (CEA) is an accepted treatment for recurrent carotid stenosis. With reports of a higher operative morbidity than primary CEA and the advent of carotid stenting, catheter-based therapy has been advocated as the primary treatment for this reportedly "high-risk" subgroup. This...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.02.047
更新日期:2005-06-01 00:00:00
abstract::The lack of a rapid, noninvasive, and accurate method to confirm or rule out prosthetic graft infection continues to constitute a compelling and vexing clinical problem. A host of adjunctive diagnostic techniques has been used in the past, but early promising results subsequently have usually not yielded acceptable se...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1986.avs0030042
更新日期:1986-01-01 00:00:00
abstract:PURPOSE:Cyclooxygenase, either the cox1 or cox2 isoform, controls synthesis of prostaglandin E2 (PGE2), which regulates expression of matrix metalloprotease-9 (MMP-9). PGE2 and MMP-9 are elevated in aortic aneurysms. The mechanisms and time course of the inhibition of aneurysm expansion with a nonspecific cyclooxygenas...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(99)70216-8
更新日期:1999-05-01 00:00:00
abstract:BACKGROUND:Lower extremity arterial revascularization (LEAR) is the gold-standard for critical lower limb ischemia (CLI). The goal of this study was twofold. First, we evaluated the long-term functional status of patients undergoing primary LEAR for CLI. Second, prognostic factors of long-term functional status and sur...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.08.051
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Thrombolysis is a common method in the treatment of lower extremity bypass graft occlusion. The purpose of this study was to investigate the results of thrombolytic therapy in the management of acute bypass graft occlusion and to identify risk factors for technical failure and amputation. METHODS:All patien...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2011.05.008
更新日期:2011-11-01 00:00:00
abstract:PURPOSE:The purpose of this study was to utilize an objective endpoint analysis of aneurysm treatment, which is based on the primary objective of aneurysm repair, and to apply it to a consecutive series of patients undergoing open and endovascular repair. METHOD:Aneurysm-related death was defined as any death that occ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.126314
更新日期:2002-08-01 00:00:00
abstract::In a subset of patients requiring lower extremity revascularization, the popliteal artery may be used for inflow, thereby minimizing dissection and the length of vein required for bypass. This retrospective study was done to define the risks and benefits of arterial reconstruction in a population of patients having po...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1992.36607
更新日期:1992-05-01 00:00:00
abstract:OBJECTIVE:Fenestrated and branched endovascular devices are increasingly used for complex aortic diseases, and despite the challenging nature of these procedures, early experiences from pioneering centers have been encouraging. The objectives of this retrospective study were to report our experience of intraoperative a...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.02.065
更新日期:2014-09-01 00:00:00
abstract::Clostridium septicum aortitis is a rare infection that has a strong association with occult colonic malignancy. To our knowledge, we report the 25th and 26th cases of C septicum aortitis in the English literature and make recommendations for its management. The first patient was a 75-year-old man who presented with ab...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2008.11.058
更新日期:2009-05-01 00:00:00
abstract::Carotid endarterectomy has been advocated to prevent further neurologic deterioration in patients who have had a stroke. Previous reports have shown that endarterectomy within 2 weeks of a stroke is associated with high morbidity and mortality rates presumably from hemorrhagic complications in the brain. Some recommen...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:Studies have shown that a sizable percentage of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) is performed outside the instructions for use (IFU). We report our long-term outcomes after EVAR with respect to device-specific IFU. METHODS:Computed tomography angiography data from a c...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.01.034
更新日期:2016-07-01 00:00:00