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Minerva Anestesiologica Dec 2014A systematic review of the published literature clearly demonstrates the usefulness of thromboelastometry (ROTEM®) in detecting coagulation disorders in severe trauma,... (Meta-Analysis)
Meta-Analysis Review
A systematic review of the published literature clearly demonstrates the usefulness of thromboelastometry (ROTEM®) in detecting coagulation disorders in severe trauma, cardiac and aortic surgery, liver transplantation, and postpartum haemorrhage reliably and within a clinically acceptable turn-around time. In all of the above-mentioned scenarios, the transfusion of any allogeneic blood products could be reduced significantly using ROTEM®-guided bleeding management, thereby minimising or avoiding transfusion-related side effects. Based on the current body of evidence as assessed by the GRADE system, the use of ROTEM® may be recommended in particular for management of severe bleeding after trauma and during cardiac and aortic surgery. However, as laboratory testing contributes only one part of severe bleeding management, the implementation of safe and effective treatment algorithms must be ensured at the same time.
Topics: Blood Transfusion; Critical Care; Critical Illness; Hemorrhage; Hemostasis; Humans; Thrombelastography
PubMed: 24518216
DOI: No ID Found -
Vascular and Endovascular Surgery May 2013Recently, vascular endostapling systems were developed to achieve better sealing at the proximal neck of the aneurysm and to prevent endograft migration. The purpose of... (Review)
Review
PURPOSE
Recently, vascular endostapling systems were developed to achieve better sealing at the proximal neck of the aneurysm and to prevent endograft migration. The purpose of this study was to provide a systematic review about the current state and possible options of vascular endostapling systems.
RESULTS
No randomized controlled trials were published. The results showed that the use of an endostaple system considerably reduced the rates of endoleaks type 1a and endograft migration. Regarding the use of endostaples in different types of endografts, only a few results were available.
CONCLUSION
The results are not conclusive. With endostaple systems, patients with difficult anatomic features and high risk can potentially be treated. These systems might reduce the high reintervention rates after endovascular aneurysm repair. Controlled randomized trials with larger number of patients are warranted with endostapling use in primary endograft implantation and for use in reintervention for late endoleaks or endograft migrations.
Topics: Animals; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endoleak; Endovascular Procedures; Equipment Design; Foreign-Body Migration; Humans; Prosthesis Design; Prosthesis Failure; Surgical Staplers; Surgical Stapling; Treatment Outcome
PubMed: 23427286
DOI: 10.1177/1538574413478474 -
Critical Care (London, England) Jun 2024Women are at higher risk of mortality from many acute cardiovascular conditions, but studies have demonstrated differing findings regarding the mortality of cardiogenic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Women are at higher risk of mortality from many acute cardiovascular conditions, but studies have demonstrated differing findings regarding the mortality of cardiogenic shock in women and men. To examine differences in 30-day mortality and mechanical circulatory support use by sex in patients with cardiogenic shock.
MAIN BODY
Cochrane Central, PubMed, MEDLINE and EMBASE were searched in April 2024. Studies were included if they were randomised controlled trials or observational studies, included adult patients with cardiogenic shock, and reported at least one of the following outcomes by sex: raw mortality, adjusted mortality (odds ratio) or use of mechanical circulatory support. Out of 4448 studies identified, 81 met inclusion criteria, pooling a total of 656,754 women and 1,018,036 men. In the unadjusted analysis for female sex and combined in-hospital and 30-day mortality, women had higher odds of mortality (Odds Ratio (OR) 1.35, 95% confidence interval (CI) 1.26-1.44, p < 0.001). Pooled unadjusted mortality was 35.9% in men and 40.8% in women (p < 0.001). When only studies reporting adjusted ORs were included, combined in-hospital/30-day mortality remained higher in women (OR 1.10, 95% CI 1.06-1.15, p < 0.001). These effects remained consistent across subgroups of acute myocardial infarction- and heart failure- related cardiogenic shock. Overall, women were less likely to receive mechanical support than men (OR = 0.67, 95% CI 0.57-0.79, p < 0.001); specifically, they were less likely to be treated with intra-aortic balloon pump (OR = 0.79, 95% CI 0.71-0.89, p < 0.001) or extracorporeal membrane oxygenation (OR = 0.84, 95% 0.71-0.99, p = 0.045). No significant difference was seen with use of percutaneous ventricular assist devices (OR = 0.82, 95% CI 0.51-1.33, p = 0.42).
CONCLUSION
Even when adjusted for confounders, mortality for cardiogenic shock in women is approximately 10% higher than men. This effect is seen in both acute myocardial infarction and heart failure cardiogenic shock. Women with cardiogenic shock are less likely to be treated with mechanical circulatory support than men. Clinicians should make immediate efforts to ensure the prompt diagnosis and aggressive treatment of cardiogenic shock in women.
Topics: Humans; Shock, Cardiogenic; Female; Male; Sex Factors; Treatment Outcome
PubMed: 38845019
DOI: 10.1186/s13054-024-04973-5 -
International Angiology : a Journal of... Feb 2015Obesity is increasingly common among patients diagnosed with vascular disease. This article aims to perform systemic review and meta-analysis on 30-day postoperative... (Meta-Analysis)
Meta-Analysis Review
AIM
Obesity is increasingly common among patients diagnosed with vascular disease. This article aims to perform systemic review and meta-analysis on 30-day postoperative mortality and complication rate between open (OAR) and endovascular (EVAR) abdominal aortic aneurysm repair in obese patients.
METHODS
A systematic search was performed using the PubMed, Embase and Cochrane databases to identify original articles on obese (BMI ≥30) patients undergoing abdominal aortic aneurysm (AAA) repair. Outcomes considered were 30-day mortality and postoperative complication rate following OAR or EVAR. Random-effects Poisson regressions were fitted for each outcome to estimate the risk ratios comparing EVAR to OAR.
RESULTS
Four studies were included in the final analyses, all of which were observational in nature. There was no evidence of publication bias as suggested by funnel plots of the outcomes. Meta-analysis showed statistically significant fewer 30-day postoperative mortality in favour of EVAR (risk ratio 0.34 [95% confidence interval 0.25, 0.48], 4 studies, 2440 patients) and early postoperative complications: myocardial infarction (0.29 [0.13, 0.64]), chest infection (0.21 [0.12, 0.38]), renal failure (0.24 [0.11, 0.51]), wound infection (0.59 [0.48, 0.74]). Risk of postoperative bowel ischemia (0.26 [0.06, 1.13]) and stroke (0.32 [0.07, 1.55]) were equivocal between EVAR and OAR.
CONCLUSION
The current study strongly suggests EVAR is superior to OAR with regards to 30-day mortality and early postoperative outcome in obese patients.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Body Mass Index; Endovascular Procedures; Humans; Obesity; Odds Ratio; Postoperative Complications; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 24824839
DOI: No ID Found -
Annals of Vascular Surgery Nov 2018The detection of intraprosthetic thrombus (IPT) deposits is a common finding during follow-up for endovascular abdominal aneurysm repair (EVAR); however, its clinical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The detection of intraprosthetic thrombus (IPT) deposits is a common finding during follow-up for endovascular abdominal aneurysm repair (EVAR); however, its clinical significance is still debated. The aim of this study was to determine if IPT represents a risk factor for thromboembolic events (TEs; endograft or limb thrombosis, or distal embolization) after EVAR.
METHODS
A systematic review of English literature was undertaken until November 2017. Studies providing 2-group comparison (patients with IPT development on postoperative computed tomography angiography versus patients without IPT) with extractable outcome data (TE related to IPT and/or risk factors for IPT development) were included. Meta-analysis was performed when comparative data were given in 2 or more articles.
RESULTS
Five single-center studies (808 patients) were analyzed. IPT detection at any time during follow-up occurred in 20.8% (168/808) of patients. Extractable data for postoperative TE were available in 4 studies (613 patients): on comparative meta-analysis, IPT was not significantly associated with TE occurrence during follow-up (odds ratio 2.25, 95% confidence interval [CI] 0.50-10.1; P = 0.29). IPT is generally detected during the first year after EVAR (maximum reported median: 12 months, range: 1.2-23). Polyester graft material (odds ratio 2.34, 95% CI 1.53-3.58; P < 0.001) and aorto-uni-iliac configuration of the endograft (odds ratio 3.27, 95% CI 1.66-6.44; P = 0.001) were confirmed as risk factors for IPT formation on meta-analysis. The literature systematic review suggests that IPT formation may be also associated with long main bodies and large necks.
CONCLUSIONS
IPT detection on postoperative computed tomography angiography was not significantly associated with the occurrence of TE over time. The aorto-uni-iliac configuration and the use of polyester fabric for endografts were confirmed as risk factors for IPT development.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Computed Tomography Angiography; Endovascular Procedures; Female; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Polyesters; Prosthesis Design; Risk Factors; Stents; Thrombosis; Time Factors; Treatment Outcome
PubMed: 30012445
DOI: 10.1016/j.avsg.2018.04.027 -
The Journal of Cardiovascular Surgery Oct 2023The aim of the present study is to perform a systematic review of published papers regarding the suitability of the current off-the-shelf (OTS) devices for endovascular...
INTRODUCTION
The aim of the present study is to perform a systematic review of published papers regarding the suitability of the current off-the-shelf (OTS) devices for endovascular thoracoabdominal aortic aneurysm (TAAA) repair.
EVIDENCE ACQUISITION
A systematic review of the MEDLINE database via PubMed was performed in March 2023. All studies reporting the outcomes of the three currently available OTS stent-grafts: the Zenith t-Branch (Cook Medical, Bloomington, IN, USA), the Gore Excluder thoracoabdominal branch endoprosthesis (TAMBE; W.L. Gore & Associates, Flagstaff, AZ, USA) and the E-nside Multibranch Stent-Graft System (Artivion, Kennesaw, GA, USA), were retrieved and further analyzed. The main endpoints were technical success, reintervention rate, and primary branch patency. Theoretical feasibility studies of these OTS devices were also included and separately analyzed.
EVIDENCE SYNTHESIS
A total of 19 studies were published between 2014 and 2023. Thirteen clinical studies and six theoretical feasibility studies were included. Eleven studies reported the clinical outcomes of the t-Branch stent-graft, one detailed the observational results of the use of the E-nside endoprosthesis, and one described the TAMBE stent-graft results. The following data primarily involve the t-Branch device outcomes. A total of 1131 patients that underwent aneurysm repair using an OTS stent-graft were identified. Among those, 1002, 116 and 13 patients received a t-Branch, E-nside, and TAMBE stent-grafts, respectively. A total of 767 (67.8%) were men, with a mean age of 71.6±7.4 years old, and a mean Body Mass Index (BMI) of 26.3±3.8 kg/m. Technical success ranged from 64% to 100%. A total of 4172 target visceral vessels (TVV) were planned for bridging, with a success rate ranging from 92 to 100%. The total of early and late reinterventions reported were 64 and 48, respectively, mainly due to endoleaks and visceral branch occlusions. Among the theoretical feasibility studies, six described the feasibility of the t-Branch device in a total of 661 patients, two described the E-nside and the TAMBE devices feasibility comprising 351 patients for each stent-graft. The overall feasibility of the t-Branch device varied from 39% to 88%, the E-nside from 43% to 75%, and the TAMBE stent-graft ranged from 33% to 94%.
CONCLUSIONS
This systematic review demonstrated a good suitability for the use of OTS endografts for the treatment of TAAA.
PubMed: 37199677
DOI: 10.23736/S0021-9509.23.12704-2 -
Annals of Vascular Surgery Jan 2020Complications after thoracic endovascular aortic repair (TEVAR) are common. Even after a successful TEVAR, a late endoleak (>30 days) can occur. The objective of this...
BACKGROUND
Complications after thoracic endovascular aortic repair (TEVAR) are common. Even after a successful TEVAR, a late endoleak (>30 days) can occur. The objective of this study is to summarize the current evidence and, if lacking, the need of evidence regarding the incidence and predictive factors for type 1b endoleak in patients with aortic aneurysm treated with TEVAR.
METHODS
A systematic review of the literature was performed on endoleak type 1b, in patients with aortic aneurysm, after TEVAR. The PubMed and Embase databases were systematically searched for articles regarding endoleak type 1b up to January 2019. The main subjects discussed are the incidence, risk factors, treatment, and prognosis.
RESULTS
About 722 articles were screened, and 16 articles were included in this review. The reported incidence of endoleak is between 1.0% and 15.0%, with a mean follow-up duration of at least 1 year. Type 1b endoleak is associated with an increased aortic tortuosity index (>0.15 cm). No significant difference is found in relation to age and gender. Treatment is required in most cases (22/27) and is usually performed with distal extension of the stent graft (21/27). There are no data regarding stent graft oversizing, length of distal landing zone, and differences between devices or the prognosis for patients with type 1b endoleak.
CONCLUSIONS
Limited literature is available on the occurrence of type 1b endoleak after TEVAR. A tortuous aorta can be associated as a predictive factor for the occurrence of type 1b endoleak. Data clearly delineating the anatomic variables predicting type 1b endoleak should be examined and listed. Likewise, the impact of more recent conformable devices to prevent complications like type 1b endoleaks from occurring should be elucidated.
Topics: Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endoleak; Endovascular Procedures; Female; Foreign-Body Migration; Humans; Incidence; Male; Risk Assessment; Risk Factors; Stents; Time Factors; Treatment Outcome
PubMed: 31449934
DOI: 10.1016/j.avsg.2019.06.030 -
Seminars in Thoracic and Cardiovascular... 2019To assess the predictive value of preoperative cognitive impairment on postoperative in-hospital, short-term, and mid-term outcomes among patients undergoing surgical or...
To assess the predictive value of preoperative cognitive impairment on postoperative in-hospital, short-term, and mid-term outcomes among patients undergoing surgical or transcatheter aortic valve replacement. The review was conducted according to PRISMA guidelines. Articles were identified in EMBASE, Medline, and PubMed. Eligible articles compared the outcomes of patients with and without preoperative cognitive impairment who underwent aortic valve replacement and were published in English between January 1, 1997 and November 1, 2017. The quality of included observational studies was evaluated using the Newcastle-Ottawa scale. The strength of the body of evidence was also assessed. A total of 6163 abstracts were screened by 2 independent reviewers and 31 full-text articles were reviewed. Eight studies met inclusion criteria. The studies included 1 case-control, 5 prospective cohort, and 2 retrospective cohort studies. Given the paucity and heterogeneity of studies, meta-analysis was not possible. Five studies were of good quality. Preoperative cognitive impairment is a risk factor for postoperative delirium in 2 studies, increased mid-term mortality in 2 studies, and increased length of stay, risk of discharge to a health-care facility or progressive disability in 1 study. However, given the paucity and methodological flaws of the included studies, the body of evidence on the predictive value of preoperative cognitive impairment on postoperative outcomes remains weak. This systematic review highlights the need for more good quality studies to provide evidence regarding the incidence of cognitive impairment and associations with poor outcomes after aortic valve replacement.
Topics: Aged; Aortic Valve; Aortic Valve Stenosis; Cognition; Cognitive Dysfunction; Delirium; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Length of Stay; Middle Aged; Patient Discharge; Risk Assessment; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 30529383
DOI: 10.1053/j.semtcvs.2018.11.017 -
Surgery Feb 2015Operative injury to the body from all procedures causes a stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute phase responses. This response has been... (Review)
Review
BACKGROUND
Operative injury to the body from all procedures causes a stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute phase responses. This response has been examined commonly by the use of cortisol, interleukin-6 (IL-6), white cell count, and C-reactive protein (CRP). We aimed to determine which markers of the systemic inflammatory response were useful in determining the magnitude of injury after elective operations.
METHODS
A systematic review of the literature was performed using surgery, endocrine response, systemic inflammatory response, cortisol, IL-6, white cell count, and CRP. For each analyte the studies were grouped according to whether the operative injury was considered to be minor, moderate, or major and then by the operative procedure.
RESULTS
A total of 164 studies were included involving 14,362 patients. The IL-6 and CRP responses clearly were associated with the magnitude of operative injury and the invasiveness of the operative procedure. For example, the peak CRP response increased from 52 mg/L with cholecystectomy to 123 mg/L with colorectal cancer resection, 145 mg/L with hip replacement, 163 mg/L after abdominal aortic aneurysm repair, and 189 mg/L after open cardiac surgery. There also appeared to be a difference between minimally invasive/laparoscopic and open procedures such as cholecystectomy (27 vs 80 mg/L), colorectal cancer resection (97 vs 133 mg/L), and aortic aneurysm repair (132 vs 180 mg/L).
CONCLUSION
Peak IL-6 and CRP concentrations consistently were associated with the magnitude of operative injury and operative procedure. These markers may be useful in the objective assessment of which components of Enhanced Recovery after Surgery are likely to improve patient outcome and to assess the possible impact of operative injury on immune function.
Topics: Biomarkers; C-Reactive Protein; Elective Surgical Procedures; Female; Humans; Hydrocortisone; Interleukin-6; Laparoscopy; Leukocyte Count; Male; Minimally Invasive Surgical Procedures; Postoperative Complications; Systemic Inflammatory Response Syndrome
PubMed: 25616950
DOI: 10.1016/j.surg.2014.09.009 -
Hypertension (Dallas, Tex. : 1979) Dec 2009Carotid-femoral pulse wave velocity (cfPWV), a measure of large artery stiffness, is an important predictor of cardiovascular events. This has been attributed to it... (Review)
Review
Carotid-femoral pulse wave velocity (cfPWV), a measure of large artery stiffness, is an important predictor of cardiovascular events. This has been attributed to it being an integrative measure of the impact of cardiovascular risk factors on the arterial wall. Pulse wave velocity is strongly associated with age and blood pressure. However, findings with regard to its relation with other risk factors have been inconsistent. We performed a systematic review of cross-sectional published literature reporting independent associations of cfPWV in multivariable regression models. Articles were selected from a PubMed search using a prespecified search strategy. Studies were included if they did the following: (1) measured cfPWV; (2) reported on associations with cfPWV from regression models; and (3) considered age and blood pressure in the model. From 637 retrieved articles, 65 met our inclusion criteria, and 12 studies were included from reference searches. Age and blood pressure were consistently independently associated with cfPWV (91% and 90% of studies, respectively). Diabetes mellitus was associated with cfPWV in 52% studies, but the strength of the association was low. The majority of studies found no independent association between cfPWV and sex, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, smoking, or body mass index. The contribution of risk factors other than age and blood pressure to cfPWV is, thus, small or insignificant. The prognostic value of cfPWV may relate to a process of arterial ageing unrelated to classic risk factors other than hypertension.
Topics: Aorta; Aortic Diseases; Atherosclerosis; Blood Flow Velocity; Humans; Hypertension; Prognosis; Pulsatile Flow; Risk Factors
PubMed: 19884567
DOI: 10.1161/HYPERTENSIONAHA.109.137653