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Journal of Vascular Surgery Jun 2023To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic repair (FBEVAR).
METHODS
The PubMed, Embase, and Scopus databases were searched systematically for observational studies in patients undergoing elective fenestrated branched endovascular repair for aortic aneurysm. The included studies compared outcomes of interest based on the sex of the patients. The pooled effect sizes were reported as odds ratio (OR) and weighted mean difference (WMD). STATA software was used for statistical analysis.
RESULTS
The meta-analysis included nine studies. Compared with males, females had a higher risk of perioperative and in-hospital mortality (OR, 3.01; 95% confidence interval [CI], 2.01-4.53), mortality within 1 year postoperatively (OR, 1.79; 95% CI, 1.09-2.93) and mortality at more than 1 year postoperatively (OR, 1.31l 95% CI, 1.02-1.69). Female patients had significantly higher operative time (minutes) (WMD, 33.77; 95% CI, 12.01-55.52), length of hospital stay (days) (WMD, 2.29; 95% CI, 1.52-3.07), and the risk of major complications (OR, 2.93; 95% CI, 1.36-6.32) There was an increased risk of respiratory complications (OR, 1.70; 95% CI, 1.20-2.40), renal complications (OR, 2.68; 95% CI, 1.25-5.74), stroke (OR, 2.74; 95% CI, 1.44-5.22), sepsis (OR, 2.24; 95% CI, 1.23-4.09), and ischemic colitis (OR, 2.63; 95% CI, 1.48-4.68) in female patients, and they were less likely to be discharged home postoperatively (OR, 0.58; 95% CI, 0.43-0.77).
CONCLUSIONS
In patients undergoing FBEVAR, female sex is associated with higher risk of mortality and complications. These findings suggest the need for careful supervision and management by multidisciplinary team in females undergoing FBEVAR.
Topics: Humans; Male; Female; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Treatment Outcome; Postoperative Complications; Risk Factors; Aortic Aneurysm; Aortic Aneurysm, Abdominal
PubMed: 37232176
DOI: 10.1016/j.jvs.2022.10.029 -
European Journal of Vascular and... Nov 2023
Topics: Humans; Renal Veins; Aortic Aneurysm; Aorta; Aortic Aneurysm, Abdominal
PubMed: 37562762
DOI: 10.1016/j.ejvs.2023.08.004 -
Journal of Vascular Surgery Nov 2022The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another...
OBJECTIVE
The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another factor to consider. In the present study, we compared the degree of aortic tortuosity in ruptured AAAs with that of unruptured AAAs using computed tomography.
METHODS
We performed a retrospective review of a prospectively maintained database of patients who had undergone AAA repair from December 2014 to December 2019. Patients with a ruptured aneurysm (rAAA) were matched with patients with a nonruptured AAA (nrAAA) with the same maximal aneurysm diameter and age. The degree of aortic tortuosity, defined as the maximum lateral deviation from the aortic centerline, was measured on preoperative coronal computed tomography scans.
RESULTS
During a 5-year period, 572 AAA cases were identified. The aortic tortuosity of the 25 rAAA cases was compared with that of a matched control group of 31 nrAAAs, selected by the same mean maximum diameter of 8.4 cm and similar patient age. In the rAAA group, the mean age was 74.8 years (84% men). In the nrAAA group, the mean age was 76.3 years (88% men). The mean aortic tortuosity for the rAAA and nrAAA groups was 9.3 ± 7.9 mm and 18.0 ± 11.2 mm, respectively (P < .01).
CONCLUSIONS
Greater aortic tortuosity was seen in the nrAAA cases compared with the rAAA cases at the same matched aneurysm size. Thus, aortic tortuosity might confer a reduced rupture risk. Further studies with larger cohorts are needed to verify this observation.
Topics: Male; Humans; Aged; Female; Aortic Aneurysm, Abdominal; Risk Factors; Aortic Rupture; Tomography, X-Ray Computed; Aorta; Retrospective Studies
PubMed: 35489553
DOI: 10.1016/j.jvs.2022.03.879 -
Zhonghua Wai Ke Za Zhi [Chinese Journal... Aug 2020Aortic dissection is a life-threatening cardiovascular disease. Multi-center registration databases for aortic dissection have been established in many countries. The... (Review)
Review
Aortic dissection is a life-threatening cardiovascular disease. Multi-center registration databases for aortic dissection have been established in many countries. The International Registry of Acute Aortic Dissection has produced a number of research results, which had a significant impact on the diagnosis and treatment of aortic dissection worldwide. The Society for Thoracic Surgeons Adult Cardiac Surgery Database summarizes perioperative data on aortic dissection. German Registry for Acute Aortic Dissection Type A has made remarkable achievements in the neurological protection and organ perfusion of type A aortic dissection. The Nordic Consortium for Acute Type A Aortic Dissection provides guidelines for perioperative administration of aortic dissection. However, the first Registry of Aortic Dissection in China (Sino-RAD) has not reported any new aortic dissection data in the past five years, although it has proposed a number of pathogenic characteristics of Chinese people. Therefore, it is necessary to establish our own aortic dissection database.
Topics: Aortic Dissection; Aortic Aneurysm; Humans; Registries
PubMed: 32727191
DOI: 10.3760/cma.j.cn112139-20190906-00448 -
The Journal of Thoracic and... Feb 2021
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Humans; Stroke Volume; Surgeons; Ventricular Function, Left
PubMed: 31926694
DOI: 10.1016/j.jtcvs.2019.11.062 -
Rosmarinic Acid Suppresses Abdominal Aortic Aneurysm Progression in Apolipoprotein E-deficient Mice.Planta Medica Sep 2022An abdominal aortic aneurysm is a life-threatening cardiovascular disorder caused by dissection and rupture. No effective medicine is currently available for the > 90%...
An abdominal aortic aneurysm is a life-threatening cardiovascular disorder caused by dissection and rupture. No effective medicine is currently available for the > 90% of patients whose aneurysms are below the surgical threshold. The present study investigated the impact of rosmarinic acid, salvianolic acid C, or salvianolic acid B on experimental abdominal aortic aneurysms. Abdominal aortic aneurysms were induced in apolipoprotein E-deficient mice infusion of angiotensin II for 4 wks. Rosmarinic acid, salvianolic acid C, salvianolic acid B, or doxycycline as a positive control was provided daily through intraperitoneal injection. Administration of rosmarinic acid was found to decrease the thickness of the aortic wall, as determined by histopathological assay. Rosmarinic acid also exhibited protection against elastin fragmentation in aortic media and down-regulated cell apoptosis and proliferation in the aortic adventitia. Infiltration of macrophages, T lymphocytes, and neutrophils in aortic aneurysms was found, especially at the aortic adventitia. Rosmarinic acid, salvianolic acid C, or salvianolic acid B inhibited the infiltration on macrophages specifically, but these compounds did not influence T lymphocytes and neutrophils. Expression of matrix metalloproteinase 9 and macrophage migration inhibitory factor significantly increased in aortic aneurysms. Rosmarinic acid and salvianolic acid C decreased the expression of matrix metalloproteinase-9 in media, and rosmarinic acid also tended to reduce migration inhibitory factor expression. Further then, partial least squares-discriminate analysis was used to classify metabolic changes among different treatments. Rosmarinic acid affected most of the metabolites in the biosynthesis of the citrate cycle, fatty acid pathway significantly. Our present study on mice demonstrated that rosmarinic acid inhibited multiple pathological processes, which were the key features important in abdominal aortic aneurysm formation. Further study on rosmarinic acid, the novel candidate for aneurysmal therapy, should be undertaken to determine its potential for clinical use.
Topics: Angiotensin II; Animals; Aorta, Abdominal; Aortic Aneurysm; Aortic Aneurysm, Abdominal; Cinnamates; Depsides; Disease Models, Animal; Matrix Metalloproteinase 2; Mice; Mice, Inbred C57BL; Rosmarinic Acid
PubMed: 34741296
DOI: 10.1055/a-1659-3908 -
Journal of Endovascular Therapy : An... Oct 2020To investigate whether patients who develop aneurysm sac shrinkage following endovascular aneurysm repair (EVAR) have better outcomes than patients with a stable or... (Meta-Analysis)
Meta-Analysis Review
To investigate whether patients who develop aneurysm sac shrinkage following endovascular aneurysm repair (EVAR) have better outcomes than patients with a stable or increased aneurysm sac. The Healthcare Databases Advanced Search interface developed by the National Institute for Health and Care Excellence was used to interrogate MEDLINE and EMBASE. Thesaurus headings were adapted accordingly. Case-control studies were identified comparing outcomes in patients demonstrating aneurysm sac shrinkage after EVAR with those of patients with a stable or expanded aneurysm sac. Pooled estimates of dichotomous outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Meta-analysis of time-to-event data was conducted using the inverse-variance method; the results are reported as a summary hazard ratio (HR) and 95% CI. Summary outcome estimates were calculated using random-effects models. Eight studies were included in quantitative synthesis reporting a total of 17,096 patients (8518 patients with sac shrinkage and 8578 patients without sac shrinkage). The pooled incidence of sac shrinkage at 12 months was 48% (95% CI 40% to 56%). Patients with aneurysm sac shrinkage had a significantly lower hazard of death (HR 0.73, 95% CI 0.60 to 0.87), secondary interventions (HR 0.42, 95% CI 0.29 to 0.62), and late complications (HR 0.37, 95% CI 0.24 to 0.56) than patients with a stable or increased aneurysm sac. Furthermore, their odds of rupture were significantly lower than those in patients without shrinkage (OR 0.09, 95% CI 0.02 to 0.36). Sac regression is correlated to improved survival and a reduced rate of secondary interventions and EVAR-related complications. The prognostic significance of sac regression should be considered in surveillance strategies. Intensified surveillance should be applied in patients who fail to achieve sac regression following EVAR.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Postoperative Complications; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 32589118
DOI: 10.1177/1526602820937432 -
The Journal of Thoracic and... Dec 2021Although inguinal hernia and aortic aneurysm share similar pathogenic mechanisms of collagen and elastin destruction, their clinical association in geriatric patients is...
OBJECTIVE
Although inguinal hernia and aortic aneurysm share similar pathogenic mechanisms of collagen and elastin destruction, their clinical association in geriatric patients is inconclusive. We assessed the association between hernia and the subsequent occurrence of aortic aneurysm in geriatric patients.
METHODS
Adult patients with hernias between 2000 and 2012 were identified from a longitudinal claims database of 1 million beneficiaries from Taiwan's National Health Insurance program, and a control group of patients without hernia were matched by propensity score in a ratio of 1:3. Patients previously diagnosed with aortic aneurysms or connective tissue diseases were excluded. Follow-up ended on December 31, 2013. The incidence rate of aortic aneurysm was compared between patients with hernia and those without. Cox proportional hazards models were used to estimate relative hazards.
RESULTS
After propensity score matching, there were 16,933 patients with hernia (aged 20-64 years: 10,326; ≥65 years: 6607) and 50,799 patients without hernia (aged 20-64: 30,978; ≥65: 19,821). Patients with hernia had a greater incidence rate and hazard ratio of aortic aneurysm than did patients without hernia (6.4 vs 4.8/10,000 person-years; adjusted subdistribution hazard ratio [sdHR], 1.34; 95% confidence interval [CI], 1.02-1.76; P = .03), especially for those aged ≥65 years (15.6 vs 10.4/10,000 person-years; adjusted sdHR, 1.44; 95% CI, 1.07-1.94; P = .01) In addition, geriatric patients with hernia were associated with a marginally greater risk of thoracic (adjusted sdHR, 1.66; 95% CI, 0.96-2.86) and abdominal (adjusted sdHR, 1.36; 95% CI, 0.96-1.94) aortic aneurysm rupture.
CONCLUSIONS
Geriatric patients with hernia were associated with a greater incidence of aortic aneurysm than were those without.
Topics: Adult; Age Factors; Aged; Aortic Aneurysm; Female; Hernia, Inguinal; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 32222409
DOI: 10.1016/j.jtcvs.2020.01.100 -
The Journal of Thoracic and... Jul 2023
Commentary: Increased left ventricular outflow tract angulation correlates with increased size of ascending aortic aneurysms and aortic wall shear stress: But which comes first?
Topics: Humans; Aneurysm, Ascending Aorta; Heart; Aorta; Aortic Aneurysm
PubMed: 34253343
DOI: 10.1016/j.jtcvs.2021.06.034 -
Trends in Cardiovascular Medicine Nov 2020The proper management of small abdominal aortic aneurysms (AAAs), namely those under the threshold of 5.5 cm in diameter, has been under investigation for years. Risk... (Review)
Review
The proper management of small abdominal aortic aneurysms (AAAs), namely those under the threshold of 5.5 cm in diameter, has been under investigation for years. Risk of rupture for this group of AAAs is higher than the general population, although it remains low enough not to require a repair. However, specific factors have been associated with increased expansion or rupture rate, and these factors could identify potential candidates for earlier intervention. This review aims to collect and present all available data on the development and progress of small AAAs. Moreover, recommendations on proper management are discussed as well.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Clinical Decision-Making; Disease Progression; Humans; Practice Guidelines as Topic; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors
PubMed: 31796345
DOI: 10.1016/j.tcm.2019.11.006