Abstract:
BACKGROUND:Controversy exists about technique of repair for ruptured abdominal aortic aneurysms (rAAA). We studied rAAA treated at a single tertiary center from 2005 to 2015 to determine operative morbidity and mortality in open and endovascular aortic aneurysm repair (EVAR) of rAAA. METHODS:All rAAA (n = 144) treated from 2005 to 2015 were reviewed using an IRB-approved database. "EVAR first" strategy was used after 2010. rAAA treatment was open (rAAA began with open surgery); EVAR (rAAA began with EVAR and included EVARs converted to open); and EVAR only (successful EVAR). Preoperative, intraoperative and outcome variables were analyzed with t-test, chi-square and logistic and multivariate regression using SAS. RESULTS:One hundred forty-four rAAAs were treated from 2005 to 2015. Seventy-five percent (108/144) began with open surgery. Twenty-five percent (36/144) began with EVAR. After 2010, 54.5% began with EVAR. Eleven percent of EVARs (4/36) converted to open and 89% (32/36) had EVAR only. Fifty-nine percent (83/144) had preoperative systolic blood pressure (SBP) <90 mm Hg. Eighty-four percent of these (70/83) had open surgery and 16% (13/83) had EVAR. Hospital mortality for all rAAAs was 23.6% (34/144). Operative mortality was 25% (27/108) in open and 19.4% (7/36) in EVAR (P = 0.486). Mortality was 75% (3/4) in EVARs that converted to open and 12.5% (4/32) in EVAR only patients. In univariate analysis age, ASA 5, preoperative SBP <90 mm Hg, intraoperative complications, dialysis, MI/CHF, respiratory failure, stroke and reintervention were significant for mortality. In multivariate modeling preoperative SBP <90 mm Hg (P = 0.0018), ASA 5 (P = 0.0175), intraoperative complications (P = 0.0017), MI/CHF (P = 0.0045), respiratory failure (P = 0.0159) and new renal failure (P = 0.0073) were significant for mortality. There was no difference in mortality between open and EVAR (P = 0.9554) and no difference in cardiac or respiratory failure. Open had more renal failure and EVAR more endoleaks. Fifty-eight percent (21/36) of EVARs started with local anesthesia (LA) and 52.8% (19/36) finished with LA. Nineteen percent (4/21) of EVARs with LA versus 60% (9/15) with general anesthesia (GA) had preoperative SBP <90 mm Hg. In EVAR only there was no difference in mortality between LA (4/18, 22.2%) and GA (3/14, 21.4%) (P = 0.94). CONCLUSIONS:Operative mortality in ruptured AAA was associated with hypotension, ASA status 5, uncontrolled hemorrhage, cardiac events, and respiratory failure but not with type of repair. EVAR and open surgery also had comparable cardiac and respiratory morbidity. Selection was critical in EVAR for rAAA because mortality of unsuccessful EVAR was very high. There was no difference in mortality between LA and GA for EVAR.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Acher C,Acher CW,Castello Ramirez MC,Wynn Mdoi
10.1016/j.avsg.2019.10.073subject
Has Abstractpub_date
2020-07-01 00:00:00pages
70-76eissn
0890-5096issn
1615-5947pii
S0890-5096(19)30928-8journal_volume
66pub_type
杂志文章abstract::A 55-year-old woman with a history of hypertension, bilateral renal artery disease with a left renal artery stent, and a chronically occluded right renal bypass graft presented with anuria and acute renal failure. Diagnostic studies showed high-grade renal artery in-stent stenosis with thrombotic occlusion of the main...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.03.013
更新日期:2010-10-01 00:00:00
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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.2019.08.086
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-7713-8
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abstract::Accurate patient selection based on preoperative imaging is imperative to good risk reduction in patients undergoing carotid endarterectomy (CEA). The goal of this study was to assess the accuracy of gadolinium-enhanced magnetic resonance angiography (GE MRA) versus time-of-flight (TOF) MRA in the work-up of patients ...
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doi:10.1007/s10016-005-7974-2
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abstract::A 10 year retrospective study of 103 patients with amaurosis fugax was done. Sixty-two patients with symptoms of amaurosis fugax underwent arteriography, which demonstrated ulcerated carotid plaque in 36 and hemodynamically significant stenoses (greater than 75% diameter reduction) in 26. These 62 patients underwent c...
journal_title:Annals of vascular surgery
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.12.014
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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
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
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更新日期:1991-05-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.11.003
更新日期:2021-01-15 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
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更新日期:2005-11-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2020.08.115
更新日期:2021-01-01 00:00:00
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journal_title:Annals of vascular surgery
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abstract::A case-control study was undertaken to determine if asymptomatic carotid artery stenosis (ACS) is independently associated with ipsilateral hemispheric stroke following cardiac surgery (CS). All CS patients (3069) who were at two hospitals between 1989 and 1994 were reviewed. Cases (31) selected for this study were th...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169910036
更新日期:2000-05-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2017.10.034
更新日期:2018-05-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900278
更新日期:1999-07-01 00:00:00
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pub_type: 杂志文章,多中心研究
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.02.016
更新日期:2010-10-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.12.010
更新日期:2015-01-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.02.040
更新日期:2019-08-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.10.008
更新日期:2013-04-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
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更新日期:2017-01-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.06.043
更新日期:2021-01-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
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更新日期:2016-05-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.04.065
更新日期:2020-08-01 00:00:00
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journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02001376
更新日期:1990-03-01 00:00:00