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European Journal of Vascular and... Sep 2019The aim of this systematic literature review was to compile an updated overview of mycotic aortic aneurysm (MAA) treatment and outcomes.
OBJECTIVES
The aim of this systematic literature review was to compile an updated overview of mycotic aortic aneurysm (MAA) treatment and outcomes.
METHODS
A systematic literature review was performed using the search terms mycotic and infected aortic aneurysms in the MEDLINE and ScienceDirect databases, published between January 2000 and September 2018. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, articles were scrutinised regarding surgical technique, aortic segment involved, pre- and post-operative antibiotic regimens, survival and infection related complications (IRCs), and factors associated with adverse or favourable outcomes.
RESULTS
Twenty-eight studies, with a total of 963 patients, were included. All publications were observational, retrospective studies. Patient and study heterogeneity, along with missing data, precluded meta-analyses. Overall treatment consisted of open surgical repair (OSR; n = 556 [58%]), endovascular aortic repair (EVAR; n = 373 [39%]), and medical treatment alone (n = 34 [3%]). OSR was the dominant surgical technique prior to 2010, shifting to EVAR thereafter. For MAAs located in the abdominal aorta, EVAR was associated with better short term survival than OSR. Antibiotic treatment for more than six months post-operatively was associated with better survival, but there was no consensus on the length of treatment. MAAs were complicated by IRCs in 21%, irrespective of surgical technique, of which 46%-70% were fatal. The most consistently reported factors associated with adverse outcomes were increasing age, rupture, suprarenal abdominal aneurysm location, and non-Salmonella positive culture.
CONCLUSIONS
With few exceptions, the literature mainly consists of small, retrospective single centre studies. Standardised reporting is needed to increase comparability of studies. EVAR appears to be associated with superior short term survival without late disadvantages, compared with OSR. This suggests that EVAR can be an acceptable alternative to OSR. However, MAA treatment should always be tailor made and planned individually, and general recommendations are in vain. IRCs pose a significant threat to patients after MAA repair and require further investigation.
Topics: Aneurysm, Infected; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Disease Management; Endovascular Procedures; Humans
PubMed: 31320247
DOI: 10.1016/j.ejvs.2019.05.004 -
European Journal of Vascular and... Sep 2016Methods are required to identify abdominal aortic aneurysms (AAAs) at increased risk of rupture. Inflammatory characteristics of AAA can be visualised using advanced... (Review)
Review
BACKGROUND
Methods are required to identify abdominal aortic aneurysms (AAAs) at increased risk of rupture. Inflammatory characteristics of AAA can be visualised using advanced imaging techniques and have been proposed as potential predictors of aneurysm progression. The objective of this review was to determine which inflammatory imaging biomarkers are associated with AAA growth and rupture.
METHODS
A systematic review was carried out in accordance with the PRISMA guidelines. The electronic databases of Medline (PubMed), Embase, and the Cochrane Library were searched up to January 1, 2016 for studies to determine the potential association between inflammatory imaging biomarkers and AAA growth or rupture.
RESULTS
Seven studies were included, comprising 202 AAA patients. (18)F-fluoro-deoxy-glucose positron emission tomography ((18)F-FDG PET-CT) was evaluated in six studies. Magnetic resonance imaging with ultrasmall superparamagnetic particles of iron oxide (USPIO-MRI) was evaluated in one study. Two of six (18)F-FDG PET-CT studies reported a significant negative correlation (r=.383, p = .015) or a significant negative association (p = .04). Four of six (18)F-FDG PET-CT studies reported no significant association between (18)F-FDG uptake and AAA growth. The single study investigating USPIO-MRI demonstrated that AAA growth was three times higher in patients with focal USPIO uptake in the AAA wall compared to patients with diffuse or no USPIO uptake in the wall (0.66 vs. 0.24 vs. 0.22 cm/y, p = .020). In the single study relating (18)F-FDG uptake results to AAA rupture, the association was not significant.
CONCLUSIONS
Current evidence shows contradictory associations between (18)F-FDG uptake and AAA growth. Data on the association with rupture are insufficient. Based on the currently available evidence, neither (18)F-FDG PET-CT nor USPIO-MRI can be implemented as growth or rupture prediction tools in daily practice. The heterogeneous results reflect the complex and partially unclear relationship between inflammatory processes and AAA progression.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Rupture; Aortitis; Aortography; Computed Tomography Angiography; Contrast Media; Dextrans; Disease Progression; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Angiography; Magnetite Nanoparticles; Molecular Imaging; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Risk Factors
PubMed: 27283346
DOI: 10.1016/j.ejvs.2016.05.002 -
Diagnostics (Basel, Switzerland) Apr 2024This study had two main objectives. Firstly, we conducted a thorough literature review on the prenatal diagnosis of abdominal congenital arteriovenous fistulas (CAVFs)...
This study had two main objectives. Firstly, we conducted a thorough literature review on the prenatal diagnosis of abdominal congenital arteriovenous fistulas (CAVFs) involving the abdominal aorta and hepatic arteries. Secondly, we aimed to provide detailed descriptions of eight additional cases diagnosed at our medical center and assess the outcome of this anomaly for informed counseling. We conducted a systematic search of online databases using specific keywords like "outcome", "ultrasound", "intrahepatic fistulae", and "fetal venous anomalies", focusing on studies published between 1998 and 2023. We selected 10 relevant articles and analyzed 13 cases. Additionally, we conducted a five-year prospective study in two referral centers, identifying eight CAVF cases with an incidence rate of 0.16%. Among the 21 cases evaluated, 11 resulted in live births, all of which received treatment. However, four cases (36.3%) had poor postnatal outcomes and neonatal demise due to heart failure. Prenatal signs of poor fetal hemodynamics, including cardiomegaly or hydrops, were observed in 52.3% of cases, regardless of outcome. Our findings highlight the rarity of this vascular malformation and emphasize the importance of effective treatment to avoid unfavorable outcomes. The long-term effectiveness of prenatal treatment or postnatal embolization remains uncertain, with liver transplantation being considered the most reliable treatment option.
PubMed: 38667471
DOI: 10.3390/diagnostics14080826 -
Journal of Multidisciplinary Healthcare 2022Point of care ultrasound (POCUS) has become more common for rapid evaluation. Applications are limited by lack of training of users, difficulty maintaining ultrasound... (Review)
Review
INTRODUCTION
Point of care ultrasound (POCUS) has become more common for rapid evaluation. Applications are limited by lack of training of users, difficulty maintaining ultrasound competencies, access to equipment for optimal imaging, and limitations in quality control. Such barriers exist in low-resource, underserved health care settings.
OBJECTIVE
The aim was to explore the use of POCUS in under-resourced health care settings, such as rural and remote locations in Australia and other countries. Key variables include health outcomes, quality of care, service availability, examinations types performed, equipment used, who performs the examinations, and the ultrasound training received.
METHODS
Literature was identified via CINAHL, Cochrane, Embase, Medline, PubMed, SCOPUS, and Web of Science, plus grey literature. Recommended guidelines were followed, and only research-based articles were included, with searches limited to English language and 2010-present.
RESULTS
After screening, 23 articles were reviewed. No studies had low risk of bias and, overall, the quality was poor and only two studies used random sampling. The majority were from developing countries, with only one performed in Australia. Echocardiographic screening in schools was common. Others included emergency department (ED) patients, abdominal aorta screening, obstetric scans, and intensive care unit (ICU) management. Operators included ED doctors, medical students, nurses, community healthcare workers and general practitioners, who received limited training in protocol-driven scanning, often monitored by experts. In comparison to clinical assessment, standard ultrasound or other imaging, accuracy was of the order of 70-95%, depending on the condition, with high efficacy in improving patient care.
CONCLUSION
Lack of studies of POCUS in Australia and other developed countries suggests a need for further research. Current evidence supports use of limited ultrasound using portable machines in locations with limited access to diagnostic ultrasound performed by sonographers, which has the potential to improve health outcomes in under-resourced communities in Australia and elsewhere.
PubMed: 35378744
DOI: 10.2147/JMDH.S359084 -
The Cochrane Database of Systematic... Jun 2021Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is...
BACKGROUND
Thoracic aortic arch aneurysms (TAAs) can be a life-threatening condition due to the potential risk of rupture. Treatment is recommended when the risk of rupture is greater than the risk of surgical complications. Depending on the cause, size and growth rate of the TAA, treatment may vary from close observation to emergency surgery. Aneurysms of the thoracic aorta can be managed by a number of surgical techniques. Open surgical repair (OSR) of aneurysms involves either partial or total replacement of the aorta, which is dependent on the extent of the diseased segment of the aorta. During OSR, the aneurysm is replaced with a synthetic graft. Hybrid repair (HR) involves a combination of open surgery with endovascular aortic stent graft placement. Hybrid repair requires varying degrees of invasiveness, depending on the number of supra-aortic branches that require debranching. The hybrid technique that combines supra-aortic vascular debranching with stent grafting of the aortic arch has been introduced as a therapeutic alternative. However, the short- and long-term outcomes of HR remain unclear, due to technical difficulties and complications as a result of the angulation of the aortic arch as well as handling of the arch during surgery.
OBJECTIVES
To assess the effectiveness and safety of HR versus conventional OSR for the treatment of TAAs.
SEARCH METHODS
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 22 March 2021. We also searched references of relevant articles retrieved from the electronic search for additional citations.
SELECTION CRITERIA
We considered for inclusion in the review all published and unpublished randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing HR to OSR for TAAs.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened all titles and abstracts obtained from the literature search to identify those that met the inclusion criteria. We retrieved the full text of studies deemed as potentially relevant by at least one review author. The same review authors screened the full-text articles independently for inclusion or exclusion.
MAIN RESULTS
No RCTs or CCTs met the inclusion criteria for this review.
AUTHORS' CONCLUSIONS
Due to the lack of RCTs or CCTs, we were unable to determine the safety and effectiveness of HR compared to OSR in people with TAAs, and we are unable to provide high-certainty evidence on the optimal surgical intervention for this cohort of patients. High-quality RCTs or CCTs are necessary, addressing the objective of this review.
Topics: Aortic Aneurysm, Thoracic; Humans; Negative Results
PubMed: 34085713
DOI: 10.1002/14651858.CD012923.pub2 -
The Cochrane Database of Systematic... Sep 2015The UK prevalence of abdominal aortic aneurysm (AAA) is estimated at 4.9% in over 65-year olds. Progressive and unpredictable enlargement can lead to rupture.... (Review)
Review
BACKGROUND
The UK prevalence of abdominal aortic aneurysm (AAA) is estimated at 4.9% in over 65-year olds. Progressive and unpredictable enlargement can lead to rupture. Endovascular repair of AAAs involves a stent graft system being introduced via the femoral artery and manipulated within the aorta under radiological guidance. Following endograft deployment, a seal is formed at the proximal and distal landing zones to exclude the aneurysm sac from the circulation. With the increasing popularity of endovascular repair there has been an increase in the number of commercially available stent graft designs on the market. This is an update of the review first published in 2013.
OBJECTIVES
This review aimed to assess the different stent graft types for endovascular repair of AAA.
SEARCH METHODS
The Cochrane Vascular Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched February 2015) and the Cochrane Register of Studies (2015, Issue 1). Trial databases were searched by the TSC for details of ongoing and unpublished studies.
SELECTION CRITERIA
All published and unpublished randomised controlled trials (RCTs) of stent graft types in the repair of AAAs were sought without language restriction and in consultation with the Cochrane Vascular Group TSC.
DATA COLLECTION AND ANALYSIS
We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.
MAIN RESULTS
No studies were identified that met the inclusion criteria. It was not possible to review the quality of the evidence in the absence of studies eligible for inclusion in the review.
AUTHORS' CONCLUSIONS
Unfortunately, no data exist regarding direct comparisons of the performance of different stent graft types. High quality randomised controlled trials evaluating stent graft types in abdominal endovascular aneurysm repair are required.
Topics: Aortic Aneurysm, Abdominal; Endovascular Procedures; Humans; Prosthesis Design; Stents
PubMed: 26402164
DOI: 10.1002/14651858.CD008447.pub3 -
PloS One 2018Abdominal aortic calcification (AAC) has a pretty high incidence in dialysis patients and may be associated with their prognosis. AAC can be assessed by abdominal CT or... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Abdominal aortic calcification (AAC) has a pretty high incidence in dialysis patients and may be associated with their prognosis. AAC can be assessed by abdominal CT or X-ray. We determined to investigate whether the occurrence of AAC is associated with all-cause mortality and cardiovascular (CV) events in dialysis patients through this meta-analysis and systematic review.
METHODS
A comprehensive literature search was conducted using the PubMed, Cochrane library, Embase, Medline databases to collect cohort studies investigating whether AAC is associated with all-cause mortality and CV events of patients, and we also searched gray articles and conferences abstracts. Meta-analysis was performed by STATA software. Pooled results were expressed as hazard ratio (HR) with corresponding 95% confidence intervals (CI). Fixed-effect models were used to pool the HR of each trial.
RESULTS
10 studies (2,724 dialysis patients) were identified. The presence of AAC was associated with increased risk for all-cause mortality among dialysis patients (HR, 2.84; 95% CI, 2.03-3.98; I2 = 9.8%; P = 0.354). Meanwhile, there was an association between AAC and increased risk for all CV events (fatal and non-fatal) in patients (HR, 2.04; 95% CI, 1.51-2.76, I2 = 44.6%; P = 0.125). 3 studies presented their endpoint as CV mortality, and the pooled HR was 2.46 (95%CI 1.38-4.40; I2 = 0.0%; P = 0.952). There were also 2 studies that reported their primary endpoint as all-cause mortality and CV events, and the pooled HR was 5.72 (95% CI 3.24-10.10; I2 = 0.0%; P = 0.453).
CONCLUSIONS
Among patients treated with dialysis, AAC is associated with adverse outcomes, including all-cause mortality and CV events (fatal and non-fatal). The abdominal X-ray or CT scan can be used as a useful added method to evaluate the patient's calcification. This may provide reasonable data for estimating the risk of adverse events in dialysis patients, which is helpful in guiding clinical treatment and improving the prognosis of dialysis patients.
Topics: Aorta, Abdominal; Cardiovascular Diseases; Humans; Prognosis; Renal Dialysis; Vascular Calcification
PubMed: 30240443
DOI: 10.1371/journal.pone.0204526 -
Journal of Vascular Surgery Jul 2004We undertook a quantitative systematic review of randomized controlled trials (RCTs) and observational studies to determine the effectiveness of cerebrospinal fluid... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
We undertook a quantitative systematic review of randomized controlled trials (RCTs) and observational studies to determine the effectiveness of cerebrospinal fluid (CSF) drainage to prevent paraplegia in thoracic aneurysm (TA) and thoracoabdominal aortic aneurysm (TAAA) surgery.
METHODS
We included RCTs and cohort studies that met the following criteria: elective or emergent aneurysm surgery involving the thoracic or thoracoabdominal aorta, documentation of postoperative neurologic deficits, and patient age older than 18 years. We excluded studies that reported results in 10 or fewer patients and duplicate publications. We identified eligible studies by searching computerized databases, our own files, and the reference lists of relevant articles and review articles. Database searching, eligibility decisions, relevance and method quality assessments, and data extraction were performed in duplicate with prespecified criteria.
RESULTS
Of 372 publications identified in our search, 14 met our eligibility criteria. Three RCTs reported 289 patients with type I or type II TAAA. Lower limb neurologic deficits occurred in 12% of patients who underwent CSF drainage and 33% of control subjects (number needed to treat, 9; 95% confidence interval [CI], 5-50). The pooled odds ratio (OR) for development of paraplegia in patients in the CSF drainage group was 0.35 (P =.05; 95% CI, 0.12-0.99). Similar results were found in five cohort studies with a control group (pooled OR, 0.26; P =.0002; 95% CI, 0.13-0.53). When all studies were considered together the pooled OR of TA and TAAA was 0.3 (95% CI, 0.17-0.54). There was no statistical heterogeneity among studies included in the meta-analysis. In six cohort studies without a control group, the incidence of paraplegia in high-risk TA and TAAA was 7.6%.
CONCLUSIONS
Evidence from randomized and nonrandomized trials and from cohort studies support the use of CSF drainage as an adjunct to prevent paraplegia when this adjunct is used in centers with large experience in the management of TAAA.
Topics: Aged; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Cerebrospinal Fluid; Drainage; Female; Humans; Male; Paraplegia; Treatment Outcome; Vascular Surgical Procedures
PubMed: 15218460
DOI: 10.1016/j.jvs.2004.03.017 -
BMC Pregnancy and Childbirth Jan 2019Severe obstetric hemorrhage caused by placenta accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Severe obstetric hemorrhage caused by placenta accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion (AABO) is becoming an important treatment for patients with placenta accreta. To evaluate the safety and efficacy of AABO, we conducted a systematic review and meta-analysis of previous studies.
METHODS
We used a three-check subset including placenta accreta (placenta previa, percreta, increta, etc.), balloon, and aortic (aortas, aorta, etc.) to form a retrieval formula and searched in MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov and Web of Science. All articles regarding placenta previa or placenta accreta and including the use of abdominal aortic balloon occlusion were included in our screening. Two researchers selected articles and extracted data independently. Finally, the Newcastle-Ottawa Quality Assessment Scale was used for quality assessments.
RESULTS
We retrieved 776 articles and eventually included 11 clinical studies. Meta-analysis showed that AABO significantly reduced the blood loss volume (MD - 1480 ml, 95% CI -1806 to - 1154 ml, P < 0.001) and blood transfusion volume (MD - 1125 ml, 95% CI -1264 to - 987 ml, P < 0.001). Similarly, obvious reductions in the hysterectomy rate (OR 0.30, 95% CI 0.19 to 0.48, P < 0.001), hospitalization duration (MD - 1.35 days, 95% CI -2.40 to - 0.31 days, P = 0.01), and operative time (MD - 29.23 min, 95% CI -46.04 to - 12.42 min, P < 0.001) were observed in the AABO group.
CONCLUSION
The prophylactic use of AABO in patients with placenta accreta is safe and effective.
Topics: Adult; Aorta, Abdominal; Balloon Occlusion; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Length of Stay; Operative Time; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Treatment Outcome
PubMed: 30646863
DOI: 10.1186/s12884-019-2175-0