Humans ; Endovascular Aneurysm Repair ; Endovascular Procedures ; Blood Vessel Prosthesis Implantation ; Aortic Aneurysm, Abdominal/surgery* ; Treatment Outcome ; Postoperative Complications ; Risk Factors ; Aortic Rupture/surgery* ; Retrospective Studies

Objective: To evaluate the efficacy of surgical treatment of aortic coarctation combined with descending aortic aneurysm in adult patients. Methods: This is a retrospective cohort study. Adult patients with aortic coarctation who were hospitalized in Beijing Anzhen Hospital from January 2015 to April 2019 were enrolled. The aortic coarctation was diagnosed by aortic CT angiography, and the included patients were divided into the combined descending aortic aneurysm group and the uncomplicated descending aortic aneurysm group based on descending aortic diameter. General clinical data and surgery-related data were collected from the included patients, and death and complications were recorded at 30 days after surgery, and upper limb systolic blood pressure was measured in all patients at discharge. Patients were followed up after discharge by outpatient visit or telephone call for their survival and the occurrence of repeat interventions and adverse events, which included death, cerebrovascular events, transient ischemic attack, myocardial infarction, hypertension, postoperative restenosis, and other cardiovascular-related interventions. Results: A total of 107 patients with aortic coarctation aged (34.1±15.2) years were included, and 68 (63.6%) were males. There were 16 cases in the combined descending aortic aneurysm group and 91 cases in the uncomplicated descending aortic aneurysm group. In the combined descending aortic aneurysm group, 6 cases (6/16) underwent artificial vessel bypass, 4 cases (4/16) underwent thoracic aortic artificial vessel replacement, 4 cases (4/16) underwent aortic arch replacement+elephant trunk procedure, and 2 cases (2/16) underwent thoracic endovascular aneurysm repair. There was no statistically significant difference between the two groups in the choice of surgical approach (all P>0.05). In the combined descending aortic aneurysm group at 30 days after surgery, one case underwent re-thoracotomy surgery, one case developed incomplete paraplegia of the lower extremity, and one case died; and the differences in the incidence of endpoint events at 30 days after surgery were similar between the two groups (P>0.05). Systolic blood pressure in the upper extremity at discharge was significantly lower in both groups compared with the preoperative period (in the combined descending aortic aneurysm group: (127.3±16.3) mmHg vs. (140.9±16.3) mmHg, P=0.030, 1 mmHg=0.133 kPa; in the uncomplicated descending aortic aneurysm group: (120.7±13.2) mmHg vs. (151.8±26.3) mmHg, P=0.001). The follow-up time was 3.5 (3.1, 4.4) years. There were no new deaths in the combined descending aortic aneurysm group, no transient ischemic attack, myocardial infarction or re-thoracotomy surgery, and one patient (1/15) suffered cerebral infarction and 10 patients (10/15) were diagnosed with hypertension. The differences in the occurrence of endpoint events during postoperative follow-up were similar between the two groups (P>0.05). Conclusion: In experienced centers, long-term prognosis of patients with aortic coarctation combined with descending aortic aneurysm is satisfactory post surgical intervention.
Male ; Humans ; Adult ; Female ; Aortic Coarctation/surgery* ; Retrospective Studies ; Aortic Aneurysm, Abdominal/surgery* ; Treatment Outcome ; Blood Vessel Prosthesis Implantation/adverse effects* ; Endovascular Procedures/adverse effects* ; Hypertension/complications* ; Myocardial Infarction/complications* ; Aortic Aneurysm, Thoracic/surgery*

OBJECTIVE: Thoracoabdominal aortic aneurysm is one of the most challenging aortic diseases. Open surgical repair remains constrained with considerable perioperative morbidity and mortality. The emergence of a hybrid approach utilizing visceral debranching with endovascular aneurysm repair has brought an alternative for high-risk patients. This study aimed to compare the short- and long-term outcomes between hybrid and open repairs in the treatment of thoracoabdominal aortic aneurysms. METHODS: In this retrospectively observational study, patients with thoracoabdominal aortic aneurysm treated in a single center between January 2008 and December 2019 were reviewed, of whom 11 patients with hybrid repair, and 18 patients with open repair were identified. Demographic characteristic, operative data, perioperative morbidity and mortality, freedom from reintervention, and long-term survival were compared between the two groups. RESULTS: In the hybrid repair group, the patients with dissection aneurysm, preoperative combined renal insufficiency, and American Society of Anesthesiologists (ASA) score of 3 or more were significantly overwhelming than in the open repair group. The operation time of debranching hybrid repair was (445±85) min, and the intraoperative blood loss was (955±599) mL. There were 2 cases of complications in the early 30 days after surgery, without paraplegia, and 1 case died. The 30-day complication rate was 18.2%, and the 30-day mortality was 9.1%. The operation time of the patients with open repair was (560±245) min, and the intraoperative blood loss was (6 100±4 536) mL. Twelve patients had complications in the early 30 days after surgery, including 1 paraplegia and 4 deaths within 30 days. The 30-day complication rate was 66.7%, and the 30-day mortality was 22.2%. The bleeding volume in hybrid repair was significantly reduced compared with open repair (P < 0.001). Besides, the incidence of 30-day complications in hybrid surgery was significantly reduced (P=0.011). During the follow-up period, there were 4 reinterventions and 3 deaths in hybrid repair group. The 1-year, 5-year, and 10-year all-cause survival rates were 72%, 54%, and 29%, respectively. In open repair group, reintervention was performed in 1 case and 5 cases died, and the 1-year, 5-year, and 10-year all-cause survival rates were 81%, 71%, and 35%, respectively. There was no significant difference between hybrid repair and open repair in all-cause survival and aneurysm-specific survival. CONCLUSION Hybrid approach utilizing visceral debranching with endovascular aneurysm repair is a safe and effective surgical method for high-risk patients with thoracoabdominal aortic aneurysms. The incidence of early postoperative complications and mortality is significantly reduced compared with traditional surgery, but the efficacy in the medium and long term still needs to be improved.
Aortic Aneurysm, Abdominal/surgery* ; Aortic Aneurysm, Thoracic/surgery* ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Postoperative Complications/surgery* ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

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

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

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

BACKGROUNDLittle is known about the prognosis of coronary artery disease (CAD) in Chinese patients with abdominal aortic aneurysm (AAA). The aim of this study was to evaluate the predictors of in-hospital all-cause mortality of severe CAD in Chinese patients who were hospitalized for AAAs.

METHODSFrom January 2003 to August 2009, 368 patients were operated on for AAAs. The clinical characteristics were retrospectively collected. The primary outcome was the in-hospital all-cause mortality. The clinical risk factors were subjected to a multivariate analysis to determine the predictors of in-hospital all-cause mortality.

RESULTSDuring their hospitalization, 23% (85/368) of the patients underwent coronary angiography, which revealed significant lesions in 93% (79/85) of the patients. In 25 cases, coronary artery bypass grafting (CABG) was performed before the AAA repair and in 16 cases of percutaneous coronary intervention (PCI) was performed. Ten patients with AAA alone died before discharge, and eight patients diagnosed with AAA combined with CAD died. There was no statistical difference in the postoperative death between the two groups. The logistic analysis showed that age > 70 years and CAD (vessels ≥ 2) were the significant factors in predicting the adverse clinical outcome.

CONCLUSIONSThe prevalence of severe CAD in Chinese patients with AAAs seemed lower than those that were reported. Myocardial evaluation and subsequent revascularization before AAA surgery could improve the clinical outcome for these patients who have severe CAD.

Adult ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; complications ; mortality ; surgery ; China ; epidemiology ; Coronary Artery Disease ; epidemiology ; mortality ; surgery ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Retrospective Studies

OBJECTIVETo compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.

DATA SOURCESWe performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.

STUDY SELECTIONAccording to the inclusion criteria, 76 articles were finally analyzed to compare patient characteristics, clinical success, complications, and prognosis.

RESULTSWe analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group). There was no significant difference in the success rate of the procedures. Operative time, length of ICU stay, fasting time, duration of total postoperative stay, blood loss, and blood transfusion requirements during the procedure were significantly lower in the EVAR group. A 30-day follow up revealed more cardiac, renal, pulmonary, and visceral complications in the OS group (P < 0.01). Low-limb ischemia, however, was more common in the EVAR group (P < 0.05). The 30-day mortality rate, including aorta-related and non-aorta related mortality, was significantly lower in the EVAR group (P < 0.01). In the follow-up period, there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P < 0.01). The overall late mortality rate was higher in the OS group (P < 0.01), especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P < 0.01).

CONCLUSIONSEVAR was safer and less invasive for AAA patients. Patients suffered fewer complications and recovered sooner. However, complications such as artificial vessel occlusion, low-limb ischemia, and endoleak were common in EVAR. Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

Aged ; Aortic Aneurysm, Abdominal ; surgery ; China ; Endovascular Procedures ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Treatment Outcome

There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.
Adenocarcinoma/*complications/radiography/secondary/surgery ; Aged ; Aortic Aneurysm, Abdominal/*complications/radiography/surgery ; Biopsy ; Blood Vessel Prosthesis Implantation ; Cholecystectomy ; Cholecystitis/*complications/pathology/radiography/surgery ; Endovascular Procedures ; Female ; Gallbladder Neoplasms/*complications/pathology/radiography/surgery ; Granuloma/*complications/pathology/radiography/surgery ; Humans ; Tomography, X-Ray Computed ; Treatment Outcome ; Xanthomatosis/*complications/pathology/radiography/surgery

OBJECTIVETo evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), and to compare the prognosis between patients of different ages.

METHODSThe hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed. All the patients were divided into advanced age group (age ≥ 75 years, 24 cases) and relatively young group (age < 75 years, 57 cases). General conditions, comorbidity, procedure, in-hospital complications, and follow-up were compared between these two groups.

RESULTSAll covered stents were successfully deployed, a technical success rate of 91.4% (74/81) was achieved. There was no intraoperative death. In-hospital mortality was 1.2% (1/81). The follow-up rate was 91.4% (74/81), with a mean follow-up of 47.5 months. Twelve deaths were recorded during follow-up, 1, 2, 3, 4, and 5-year survival rates were 98.6%, 92.2%, 80.8%, 58.7%, and 44.1%, respectively. When compared with relatively young group, the advanced age group had a lower rate of abdominal pain as the major symptom, but a higher rates of renal diseases and coronary artery diseases. Furthermore, the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks, and also tended to have increased rates of pulmonary infection and access site hematoma, while the other parameters were similar between the two groups.

CONCLUSIONSEVAR of AAA is less invasive, safe, and effective during short to mid-tern follow-up. The patients of advanced age suffer from higher rates of some complications, thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.

Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Blood Vessel Prosthesis Implantation ; adverse effects ; methods ; Endoleak ; etiology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome