Endovascular aneurysm repair (EVAR) surgery has become a more prevalent in recent years, as it is less invasive and requires a shorter hospital stay and recovery time, in addition to resulting in lower mortality. However, EVAR has the disadvantage of increased numbers of reintervention incidents, need of regular follow up, and uncertainty of long-term stability. Type II endoleak is the most common endoleak, but it mostly seals without intervention. Type I endoleak is a sealing failure around the graft and proximal neck or distal landing zone and usually occurs during the initial procedure, which can be corrected by ballooning, an additional stent (bare or graft), or surgery. Late type I endoleak can develop by migration of the graft or shrinkage or progression of aneurysm. Here we report a case of distal type I endoleak found 5 years after EVAR which was corrected by additional endovascular grafts.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Endoleak ; Follow-Up Studies ; Length of Stay ; Neck ; Postoperative Complications ; Stents ; Transplants ; Uncertainty

BACKGROUND: Endovascular aortic aneurysm repair (EVAR) has come into use and been widely extended because of the low complication rate and less-invasiveness. This article aimed to describe our experience in the treatment of abdominal aortic aneurysm with EVAR. MATERIALS AND METHODS: A retrospective review was conducted for the 22 patients who underwent EVAR in a single hospital December 2001 to June 2009. RESULTS: The mean age of the patients was 68.5+/-7.6 years. There were several risk factors and comorbidities in 20 patients (90.9%). The mean diameter of the aortic aneurysms was 61.2+/-12.9 mm. The mean length, diameter, and angle of the aneurysmal neck were 30.5+/-15.5 mm, 24.0+/-4.5 mm, and 43.9+/-16.0degrees, respectively. The mean follow-up period of the patients was 28.8+/-29.5 months. The 30-day postoperative mortality was none. Seven patients (31.8%) had endoleaks during the hospital stay and three patients (13.6%) had endoleaks during the follow-up period. One patient (4.5%) died due to a ruptured aortic aneurysm. The cumulative patient survival rates were 88.2%, 88.2%, and 70.6% at 1, 3, and 5 years of follow-up, respectively. CONCLUSION: EVAR is currently a safe, feasible procedure for high risk patients with abdominal aortic aneurysm because of low postoperative complication and mortality if patients are selected properly and followed up carefully.
Aneurysm ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortic Rupture ; Comorbidity ; Endoleak ; Follow-Up Studies ; Humans ; Length of Stay ; Neck ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Survival Rate

Aortic Aneurysm, Abdominal ; complications ; Arthritis, Rheumatoid ; complications ; Female ; Humans ; Lupus Erythematosus, Systemic ; complications ; Middle Aged

PURPOSE: Abdominal aortic aneurysm is a complex disease that has too many clinical manifestations for classifying these patients as the ruptured and nonruptured groups. To evaluate the effect of the patients preoperative status to the surgical outcomes, the authors classified the abdominal aortic aneurysm patient's into four groups according to their preoperative status and we studied their outcomes. METHOD: Between 1992 and 2004, 117 patients underwent abdominal aortic surgery. Among the patients, 47 asymptomatic abdominal aortic aneurysm patients were classified as group I. 34 abdominal aortic aneurysm patients with abdominal pain were classified as group II. 20 ruptured abdominal aortic aneurysm patients without hemodynamic instability were classified as group III. 16 ruptured abdominal aortic aneurysm patients with hemodynamic instability were classified as group IV. We then analysed their clinical outcomes retrospectively. RESULT: Group IV received the highest number of transfusions and they showed the highest incidence of postoperative ARDS and the highest mortality rate. Group III received more transfusions and they showed a higher incidence of ARDS than Group I and II, but they had the lowest mortality rate. There were no significant differences in the transfusion amount, complication and mortality between Group I and II. CONCLUSION: Massive transfusion causes postoperative ARDS and multiorgan failure and this causes death for patients with ruptured abdominal aortic aneurysm. Preoperative hemodynamic instablity is a definite factor for massive transfusion, whitch causes ARDS and death.
Abdominal Pain ; Aortic Aneurysm, Abdominal* ; Hemodynamics ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Retrospective Studies

BACKGROUND: Recently, endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), have been used for treatment of thoracic and abdominal aortic aneurysms. The purpose of this study was to analyze the outcome and predictors for 30-day mortality and complications, in patients that underwent EVAR and/or TEVAR under general anesthesia. METHODS: In this study, 151 cases of EVAR and/or TEVAR under general anesthesia in 140 patients during 2009–2017 were studied. The primary outcome was 30-day mortality after surgery. Multivariate logistic regression analysis was used, to clarify risk for postoperative 30-day mortality. RESULTS: Postoperative 30-day mortality rate was 9.9% in the study population (10.3% in EVAR, and 9.3% in TEVAR, respectively). Seventy-two cases (47.7%) experienced postoperative complications within 30 days. Elderly older than age 76.5 (odds ratio [ORs] = 48.89, 95% confidential interval [95% CI] 1.40–1,710.25, P = 0.032), technically expertness (OR = 0.01, 95% CI 0.00–0.40, P = 0.013), severity of systemic complications (OR = 23.24, 95% CI, 2.27–238.24, P = 0.008), and severity of local-vascular complications (OR = 31.87, 95% CI, 1.29–784.66, P = 0.034) were significantly associated with 30-day mortality. CONCLUSIONS: This study revealed that elderly, technically expertness, and severity of systemic and local-vascular complications were associated with 30-day mortality of EVAR and TEVAR in aortic aneurysm.
Aged ; Anesthesia, General ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Humans ; Length of Stay ; Logistic Models ; Mortality ; Postoperative Complications ; Risk Factors ; Treatment Outcome

When more abdominal aortic aneurysms are repaired by endovascular approaches, the post-operative endotension without endoleak increase along with the extended follow-up. An early detection of such endotension and a proper differentiation from endoleaks are particularly important for the treatment decision-making. This article reviews the mechanism, diagnosis, and management of endotension.
Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; Humans ; Postoperative Complications ; Stents

PURPOSE: Acute kidney injury (AKI) is an important postoperative complication that may impact mortality and morbidity. The incidence of AKI after elective endovascular aneurysm repair (EVAR) is not known well. The aim of this study is to assess the incidence of AKI after elective EVAR and examine the impact of AKI. MATERIALS AND METHODS: Data were collected and analyzed retrospectively from 78 elective EVARs for abdominal aortic aneurysm (AAA) among 102 total cases of conventional EVAR performed in Inha University Hospital from 2009 to 2015. The primary endpoint was incidence and risk factors of AKI. Secondary endpoints included drop in estimated glomerular filtration rate (eGFR) and the mortality of AKI. RESULTS: We included 78 patients (17 females, 21%; mean age, 73.9±12.5 years; mean AAA diameter, 59.3±8.9 cm), 11 (14.1%) of whom developed AKI. Within 48 hours, those with AKI experienced a decrease in eGFR from 65.5±21.2 to 51.2±19.6 mL/kg/1.73 m2, and those without AKI showed a change from 73.1±9.2 to 74.2±10.7 mL/kg/1.73 m2. There were no patients who required dialysis during follow-up (mean, 24.2±18.0 months). Development of AKI was related to operation time (odds ratio [OR], 2.024; 95% confidence interval [CI], 1.732–4.723; P < 0.010) and contrast dose (OR, 3.192; 95% CI, 2.182–4.329; P < 0.010). There were no differences in mortality between the 2 groups (P=0.784). CONCLUSION: The incidence of AKI after EVAR was related to operation time and contrast dose, but was not associated with medium-term mortality.
Acute Kidney Injury ; Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Dialysis ; Endovascular Procedures ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Retrospective Studies ; Risk Factors

BACKGROUNDAlthough it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).

METHODSA search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods.

RESULTSA search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR = 1.81, P = 0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR = 1.53, P = 0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P = 0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P < 0.001) and a shorter total postoperative stay (WMD 6.27 days, P < 0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR = 0.48, P < 0.001 and OR = 0.28, P = 0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70, P < 0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR = 1.13, P = 0.381) and re-intervention rate (OR = 2.19, P = 0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR = 0.33, P = 0.039) at late follow-up period.

CONCLUSIONSOn the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.

Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Female ; Humans ; Male ; Postoperative Complications ; Treatment Outcome ; Vascular Surgical Procedures ; adverse effects ; methods

Aged ; Aortic Aneurysm, Abdominal ; complications ; diagnosis ; Aortic Rupture ; diagnosis ; Diagnostic Errors ; Humans ; Intervertebral Disc Displacement ; diagnosis ; Lumbar Vertebrae ; Male

OBJECTIVETo evaluate and report surgical management and experience of atypical ruptured abdominal aortic aneurysm (RAAA).

METHODSClinical data of 52 RAAA patients from May 2002 to February 2015 were retrospectively collected and analyzed. Thirty-three cases were included into this study based on atypical clinical presentation and etiology, including 6 infected RAAA, 5 inflammatory RAAA, 1 traumatic aortic rupture, 6 tuberculotic RAAA, 2 aoritc-vena cava fistula, 3 intestinal fistula and 5 spine erosion cases. Two of them refused operation during preparation, 19 of them received emergency open repair and 13 of them received endovascular aortic repair (EVAR) with 1 case converted to open surgery.

RESULTSThe systolic blood pressure of atypical RAAA before operation was (88±16) mmHg (1 mmHg=0.133 kPa), duration time from admission to diagnosis making was (17±10) hours. Perioperative death occurred in 1 patient because of hemorrhagic shock induced acidosis. During follow-up for 3 to 72 months, no operation related complications occured, such as artificial graft infection.

CONCLUSIONSEmergent operation including open surgery and EVAR is crucial for RAAA treatment. Early diagnosis, excellent operative techniques and comprehensive perioperative management are measures conducive to reduce the mortality rate of RAAA.

Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Humans ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures