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European Journal of Vascular and... Jul 2013The aim was to systematically review and meta-analyse the differences between the retroperitoneal (RP) and the transperitoneal (TP) approach to the infrarenal abdominal... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
The aim was to systematically review and meta-analyse the differences between the retroperitoneal (RP) and the transperitoneal (TP) approach to the infrarenal abdominal aorta.
DESIGN
Systematic review and meta-analysis.
METHODS
PubMed, the Cochrane library, Embase and ClinicalTrials.gov were searched for all studies on differences in clinical outcomes between the RP and TP approach. Outcomes were selected based on inclusion in two or more studies: Operative (length of procedure, intraoperative blood loss); Post operative complications (paralytic ileus, pneumonia, myocardial infarction (MI), renal failure and wound hernia); Mortality (30 day, 1 year); Post-operative changes in respiratory function (forced expiratory volume in 1 second, forced vital capacity); Length of hospital and Intensive care unit (ICU) stay and Cost. The data were pooled by outcome.
RESULTS
Eight randomised and 21 cohort studies involving 3035 patients were included. Meta-analysis showed significantly lower rates of postoperative ileus (Odds ratio (OR) 0.17[95% CI 0.10, 0.32] p < 0.00001), pneumonia (OR 0.42[95% CI 0.26, 0.68] p = 0.0004), ICU stay (standardised mean difference (SMD) 0.67[95% CI 1.28, 0.06] p = 0.03), total hospital stay (SMD 0.88[95% CI 1.32, 0.44] p < 0.0001) and cost (SMD 1.15[95% CI 2.11, 0.19] p = 0.02) for patients undergoing a RP approach. Study quality was generally low, with conflicting results and concerns over publication bias in some cohort studies.
CONCLUSIONS
The RP approach for open aortic surgery is associated with lower rates of postoperative ileus and pneumonia when compared to the TP approach.
Topics: Aortic Aneurysm, Abdominal; Humans; Postoperative Complications; Retroperitoneal Space; Vascular Surgical Procedures
PubMed: 23590870
DOI: 10.1016/j.ejvs.2013.03.018 -
Frontiers in Bioengineering and... 2023Brucellosis, the most common bacterial zoonosis, poses a serious threat to public health in endemic regions. Cardiovascular complications of brucellosis, mostly...
Brucellosis, the most common bacterial zoonosis, poses a serious threat to public health in endemic regions. Cardiovascular complications of brucellosis, mostly pericarditis or endocarditis, are the leading cause of brucellosis-related death. Complications involving the aorta and iliac arteries are extremely rare but can be life-threatening. Our objective was to identify and review all reported cases of aortic and iliac involvement in brucellosis to provide a deep, up-to-date understanding of the clinical characteristics and management of the disease. Online searches in PubMed, Web of Science, China National Knowledge Infrastructure, and the Chinese Wanfang database were conducted to collect articles reporting cases of brucellosis with aortic and iliac artery involvement. All data in terms of patient demographics, diagnostic methods, clinical manifestations, and treatment regimens and outcomes were extracted and analyzed in this systematic review. A total of 79 articles were identified, reporting a total of 130 cases of brucellosis with aortic and iliac artery involvement. Of the 130 cases, 110 (84.5%) were male individuals and 100 (76.9%) were over 50 years old. The patients had an overall mortality rate of 12.3%. The abdominal aorta was most commonly involved, followed by the ascending aorta, iliac artery, and descending thoracic aorta. Arteriosclerosis, hypertension, and smoking were the most common comorbidities. There were 71 patients (54.6%) who presented with systemic symptoms of infection at the time of admission. Endovascular therapy was performed in 56 patients (43.1%), with an overall mortality rate of 3.6%. Open surgery was performed in 52 patients (40.0%), with an overall mortality rate of 15.4%. Aortic and iliac involvement in brucellosis is extremely rare but can be life-threatening. Its occurrence appears to be associated with the male gender, an older age, arteriosclerosis, and smoking. Although the number of reported cases in developing countries has increased significantly in recent years, its incidence in these countries may still be underestimated. Early diagnosis and therapeutic intervention are critical in improving patient outcomes. Endovascular therapy has become a preferred surgical treatment in recent years, and yet, its long-term complications remain to be assessed.
PubMed: 38098968
DOI: 10.3389/fbioe.2023.1326246 -
European Journal of Trauma and... Oct 2022Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) represents a minimally invasive technique of aortic occlusion (AO). It has been demonstrated to be safe... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) represents a minimally invasive technique of aortic occlusion (AO). It has been demonstrated to be safe and effective with appropriate training in traumatic hemorrhage with hemodynamic instability; however, its indications are still debated. The aim of this systematic review and meta-analysis is to assess the impact of REBOA on mortality in torso trauma patient with severe non-compressible hemorrhage compared to other temporizing hemostatic techniques.
STUDY DESIGN
The primary outcome is represented by 24-h, and in-hospital mortality. Secondary outcomes are post-procedural hemodynamic improvement (systolic blood pressure-SBP), mean injury severity score (ISS) differences, treatment-related morbidity, transfusional requirements and identification of prognostic factors.
RESULTS
A significant survival benefit at 24 h (RR 0.46; 95% CI 0.27-0.79; I: 55%; p = 0.005) was highlighted in patients undergoing REBOA. Regarding in-hospital mortality (RR 0.99; 95% CI 0.75-1.32; I: 73%; p = 0.98) no differences in risk of death were noticed. A hemodynamic improvement-although not significant-was highlighted, with 55.8 mmHg post-AO SBP mean difference between REBOA and control groups. A significantly lower mean number of packed Red Blood Cells (pRBCs) was noticed for REBOA patients (mean difference: - 3.02; 95% CI - 5.79 to - 0.25; p = 0.033). Nevertheless, an increased risk of post-procedural complications (RR 1.66; 95% CI 0.39-7.14; p = 0.496) was noticed in the REBOA group.
CONCLUSIONS
REBOA may represent a valid tool in the initial treatment of multiple sites subdiaphragmatic hemorrhage with refractory hemodynamic instability. However, due to several important limitations of the present study, our findings should be interpreted with caution.
LEVEL OF EVIDENCE
Level III according to ELIS (SR/MA with up to two negative criteria).
Topics: Aorta; Balloon Occlusion; Endovascular Procedures; Exsanguination; Hemorrhage; Humans; Injury Severity Score; Resuscitation; Shock, Hemorrhagic
PubMed: 35307763
DOI: 10.1007/s00068-022-01955-6 -
European Journal of Vascular and... Nov 2009An overview of the knowledge of thoracic (TAA), and abdominal aortic aneurysm (AAA) dynamics, before and after endovascular repair, is given. (Review)
Review
OBJECTIVE
An overview of the knowledge of thoracic (TAA), and abdominal aortic aneurysm (AAA) dynamics, before and after endovascular repair, is given.
METHODS
Medline, EMBASE and the Cochrane database were searched for relevant articles. After inclusion and exclusion, 25 relevant articles reporting on aneurysm dynamics remained, allowing for comparison. Results provided in the included studies were assumed (statistically) significant if they were larger than the repeatability of the used method.
RESULTS
The sample size of dynamic studies is limited and translational studies are missing. Magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) were shown to have lower inter-observer variabilities than ultrasonography (US). The distension of several relevant stent-graft-landing zones during the cardiac cycle in both the abdominal and thoracic aorta are significant (mean diameter change of the AAA neck in the included studies ranged from 0.9 mm to 2.4 mm; mean area change of the thoracic aorta ranged from 4.8% to 12.7% at various levels). This distension remained preserved after stent-graft placement. Preoperatively, the renal arteries displace per heartbeat. Significant movement of the aorta in the anteroposterior (AP) and lateral direction, during the cardiac cycle, was observed.
CONCLUSION
The aorta exhibits a wide variety of morphologic changes throughout the cardiac cycle. CTA and MRA are reliable modalities to investigate aortic shape changes during the cardiac cycle. Significant changes per heartbeat are reported in the AAA neck and thoracic aorta. The renal artery displaces per heartbeat. The clinical relevance of dynamic imaging has not been proven yet, but dynamic changes of the aorta have to be taken into account in stent-graft selection and future stent-graft design.
Topics: Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Hemodynamics; Humans; Magnetic Resonance Angiography; Predictive Value of Tests; Prosthesis Design; Stents; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Interventional
PubMed: 19648032
DOI: 10.1016/j.ejvs.2009.06.018 -
Vascular and Endovascular Surgery Nov 2023Abdominal penetrating aortic ulcer (aPAU) is defined as an ulceration of the aortic intima and media lamina, even with rupture of the internal elastic lamina. Recently,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Abdominal penetrating aortic ulcer (aPAU) is defined as an ulceration of the aortic intima and media lamina, even with rupture of the internal elastic lamina. Recently, there have been an increasing number of publications on endovascular treatment for aPAU. This review aimed to assess the efficacy and safety of endovascular treatment and provide clinicians with the latest evidence-based medical data.
METHODS
3 academic databases (Embase, PubMed, and Scopus) were systematically searched for literature reporting on aPAU from 1986 (the earliest appearance of the concept of aPAU) to September 1, 2021, and related data were collected and evaluated. A fixed/random effects model was used to construct the forest plots. Funnel plots and linear regression tests were used to assess the publication bias.
RESULTS
6 articles including 121 patients were included in the analysis. The average age was 71.4 years, with 72.7% of males and 85.6% with hypertension. Saccular aneurysms (SA) were the most prevalent complication (35.5%). Endovascular treatment had a perioperative mortality rate of .24% (95% CI, .00-2.70). The technical success rate was 99.15% (95% CI, 96.49-100). The type-II endoleak rate was 5.69% (95% CI, .00-12.13). The 1-year survival rate was 95.69% (95% CI, 90.49-100). The revascularization rate was 7.20% (95% CI, .07-14.32). Endovascular treatments for aPAU would lead to a high rate of technical success, few complications, and satisfactory 1-year survival.
CONCLUSIONS
aPAU are a common disease that mainly affects elderly males with hypertension and hyperlipidemia. Endovascular treatment is required when an ulcer progresses rapidly or manifests symptoms. Endovascular treatment is associated with high technical success, low complication, and satisfactory 1-year survival. Further investigation into the long-term results of endovascular treatment is necessary.
Topics: Male; Humans; Aged; Penetrating Atherosclerotic Ulcer; Treatment Outcome; Endovascular Procedures; Aorta; Hypertension; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Ulcer; Risk Factors; Blood Vessel Prosthesis
PubMed: 37267067
DOI: 10.1177/15385744231180678 -
Current Osteoporosis Reports Feb 2018A systematic literature review was performed to evaluate diabetes mellitus (DM) as a risk factor of abdominal aortic calcification (AAC), and address factors that might...
PURPOSE OF REVIEW
A systematic literature review was performed to evaluate diabetes mellitus (DM) as a risk factor of abdominal aortic calcification (AAC), and address factors that might contribute to the development of AAC in DM patients.
RECENT FINDINGS
DM is an independent risk factor of AAC development. Bone metabolism along with lifestyle factors among DM patients makes them more prone to AAC. Hip and vertebral fractures, high phosphate, smoking, hypertension, and low osteocalcin could make DM patients prone to AAC. Low levels of high-density lipoprotein (HDL), high low-density lipoprotein (LDL), high total cholesterol/HDL ratio, low bone mineral density (BMD) may be risk factors, but the literature is more ambiguous. Body mass index (BMI) does not appear to increase risk of AAC. High phosphate levels and low osteocalcin levels seem to be biomarkers of AAC in patients with diabetes. However, the association between DM and AAC is complicated.
Topics: Aorta, Abdominal; Bone and Bones; Diabetes Complications; Diabetes Mellitus; Female; Humans; Male; Osteoporosis; Risk Factors; Vascular Calcification
PubMed: 29380116
DOI: 10.1007/s11914-018-0418-z -
Journal of Cardiothoracic and Vascular... Apr 2017Postoperative pulmonary complications (PPC) are among the most common complications after noncardiac surgery. Men, smokers, and elderly patients with chronic obstructive... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Postoperative pulmonary complications (PPC) are among the most common complications after noncardiac surgery. Men, smokers, and elderly patients with chronic obstructive pulmonary disease or heart failure are more likely to experience PPC. The majority of patients undergoing vascular surgery belong in these categories and are at higher risk of developing PPC. Moreover, the surgical site is one of the most important risk factors associated with PPC, and aortic surgery carries the highest risk. The aim of this systematic review was to obtain an additional understanding of the real incidence of PPC after open abdominal aortic surgery and the impact of PPC on survival.
DESIGN
Systematic review and meta-analysis.
SETTING
Hospitals PARTICIPANTS: Patients who underwent open abdominal aortic surgery.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A literature search was performed on BioMedCentral, PubMed, Embase, and the Cochrane Register of clinical trials. All prospective or retrospective studies reporting data on PPC after open abdominal aortic surgery were included. Co-primary endpoints were the PPC rate and the correlation between PPC and perioperative mortality. The secondary endpoint was the difference in the PPC rate and mortality between elective and urgent surgery. Data on 269,637 patients from 213 studies were analyzed. The overall median incidence of PPC was 10.3% (interquartile range 5.55%-19.1%). Pneumonia, respiratory insufficiency, prolonged mechanical ventilation, need for unplanned mechanical ventilation, atelectasis, acute respiratory distress syndrome, pulmonary edema, and pleural effusions were the most common PPC reported in the literature. Occurrence of PPC was associated with postoperative mortality (r = 0.65, p<0.01) and was significantly higher in urgent procedures (p<0.001).
CONCLUSIONS
Incidence of PPC after open abdominal aortic surgery is high and is associated with increased postoperative morbidity and mortality.
Topics: Aorta, Abdominal; Humans; Postoperative Complications; Prospective Studies; Respiration Disorders; Respiratory Insufficiency; Retrospective Studies
PubMed: 27988091
DOI: 10.1053/j.jvca.2016.09.034 -
European Journal of Trauma and... Aug 2018Circulatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Circulatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.
METHODS
Systematic review and meta-analysis (1900-2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords "aortic balloon occlusion", "aortic balloon tamponade", "REBOA", and "Resuscitative Endovascular Balloon Occlusion" in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.
RESULTS
A total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.
CONCLUSION
REBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.
Topics: Aorta; Balloon Occlusion; Exsanguination; Hemodynamics; Humans; Resuscitation; Shock, Hemorrhagic
PubMed: 29785654
DOI: 10.1007/s00068-018-0959-y -
APMIS : Acta Pathologica,... Jan 2023HIV-associated infective native aortic aneurysms (INAA) constitute a subcategory of the disease INAA. This is a very rare group of patients. The aim of this systematic... (Review)
Review
HIV-associated infective native aortic aneurysms (INAA) constitute a subcategory of the disease INAA. This is a very rare group of patients. The aim of this systematic literature review was to compile a description of patient characteristics with HIV-associated INAA. A systematic literature review was performed using the search terms HIV and aortic aneurysm in Ovid MEDLINE and Embase databases, on articles published between 1981 and 2022. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, articles were scrutinized according to a predefined protocol including age, sex, comorbidities, microbiological pathogens, CD4-count, HIV/AIDS state, aortic segment involved, treatment and outcome. Thirty-three studies, all case reports with a total of 39 patients, were included. The median age was 48 years (range 27-79), most were male n = 35 (90%), and the median follow-up was n = 6 months (range 0-63). Cardiovascular comorbidity was present in n = 1 (3%), median CD4-count was 216 (range 6-1236), and n = 12 (31%) had AIDS. The most common microbiological pathogens were Treponema pallidum, n = 12 (31%), Salmonella spp. n = 10 (26%), Mycobacterium species n = 5 (12%) and Staphylococcal spp. n = 5 (13%). The HIV-associated INAAs were localized in the abdominal aorta n = 32 (82%), in the thoracic aorta n = 5 (13%) and in the thoraco-abdominal aorta n = 2 (5%). Open surgery was performed in n = 23 (59%) patients, endovascular aortic repair n = 6 (15%), and n = 7 (18%) did not receive surgery. Infection-related complications were reported in n = 2 (7%) patients, both with postoperative development of fatal sepsis. Patients with HIV-associated INAAs were younger, had lower rate of cardiovascular comorbidity, demonstrated low CD4 counts as a measure of immunosuppression, and demonstrated diverse microbiological pathogens compared with other INAAs. Treponema pallidum and Mycobacterium spp. were common pathogens, which are very rare microbiological pathogens in other INAAs.
Topics: Humans; Male; Adult; Middle Aged; Aged; Female; Acquired Immunodeficiency Syndrome; Aneurysm, Infected; Aortic Aneurysm; Treatment Outcome; Postoperative Complications
PubMed: 36106509
DOI: 10.1111/apm.13273