468 results found
Machin M, Van Herzeele I, Ubbink D, et al., 2023, Shared Decision Making and the Management of Intact Abdominal Aortic Aneurysm: A Scoping Review of the Literature., Eur J Vasc Endovasc Surg, Vol: 65, Pages: 839-849
OBJECTIVE: The aim of this study was to summarise the current knowledge of shared decision making (SDM) in patients facing a treatment decision about an intact abdominal aortic aneurysm (AAA), and to identify where further evidence is needed. DATA SOURCES: MEDLINE, Embase, and the Cochrane Library were searched on 18 July 2021. An updated search was run on 31 May 2022 for relevant studies published from 1 January 2000 to 31 May 2022. REVIEW METHODS: This scoping review was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines following a pre-defined protocol, retrieving studies reporting on aspects of SDM in those with intact AAAs. Qualitative synthesis of the articles was performed, and the results grouped according to theme. RESULTS: Fifteen articles reporting on a total of 1 344 participants (age range 62-74 years) from hospital vascular surgery clinics with intact AAAs were included. Studies were observational (n = 9), non-randomised studies of an intervention (n = 3), and randomised clinical trials (n = 3). The first theme was the preferences and practice of SDM. The proportion of patients preferring SDM ranged from 58% to 95% (three studies), although objective rating of SDM practice was consistently < 50% (three studies). Clinician training improved SDM practice. The second theme was poor provision of information. Fewer than half of patients (0 - 46%) surveyed were informed about all available treatment options (three studies). Publicly available information sources were rated as poor. The third theme concerned the utility of decision making support tools (DSTs). Two randomised trials demonstrated that the provision of DSTs improves patient knowledge and agreement between patient preference and repair type received but not objective measures of SDM for patients with AAAs. CONCLUSION: SDM for patients with an intact AAA appears to be in its infancy. Most patients with an AAA w
Pouncey AL, Sweeting MJ, Bicknell C, et al., 2023, Sex-specific differences in the standard of care for infrarenal abdominal aortic aneurysm repair, and risk of major adverse cardiovascular events and death., Br J Surg, Vol: 110, Pages: 481-488
BACKGROUND: This study investigated whether sex-specific differences in preoperative/perioperative standard of care (SOC) account for disparity in outcomes after elective infrarenal abdominal aortic aneurysm repair. METHODS: This was a retrospective cohort study of elective infrarenal abdominal aortic aneurysm repairs (2013-2020) using depersonalized patient-level National Vascular Registry data. SOC was defined for waiting times, preoperative assessment (multidisciplinary/anaesthetic review), cardiovascular risk prevention, and perioperative medication. The primary outcome was major cardiovascular event and/or death (MACED). RESULTS: Some 21 810 patients with an infrarenal abdominal aortic aneurysm were included, 2380 women and 19 430 men. Women less often underwent aneurysm repair within SOC waiting times (51.5 versus 59.3 per cent; P < 0.001), but were equally likely to receive preoperative assessment (72.1 versus 72.5 per cent; P = 0.742). Women were less likely to receive secondary prevention for known cardiac disease (34.9 versus 39.6 per cent; P = 0.015), but more often met overall cardiovascular risk prevention standards (52.1 versus 47.3 per cent; P < 0.001). Women were at greater risk of MACED (open: 12.0 versus 8.9 per cent, P < 0.001; endovascular: 4.9 versus 2.9 per cent, P < 0.001; risk-adjusted OR 1.33, 95 per cent c.i. 1.12 to 1.59). A significant reduction in the odds of MACED was associated with preoperative assessment (OR 0.86, 0.75 to 0.98) and SOC waiting times (OR 0.78, 0.69 to 0.87). There was insufficient evidence to confirm a significant sex-specific difference in the effect of SOC preoperative assessment (women: OR 0.69, 0.50 to 0.97; men: OR 0.89, 0.77 to 1.03; interaction P = 0.170) or SOC waiting times (women: OR 0.84, 0.62 to 1.16; men: OR 0.76, 0.67 to 0.87; interaction P = 0.570) on the risk of MACED. CONCLUSION: SOC waiting times and preoperative assessment were not met for both sexes, which was associated with an increas
Boyle JR, Tsilimparis N, Van Herzeele I, et al., 2023, Editor's Choice - Focused Update on Patients Treated with the Nellix EndoVascular Aneurysm Sealing (EVAS) System from the European Society for Vascular Surgery (ESVS) Abdominal Aortic Aneurysm Clinical Practice Guidelines., Eur J Vasc Endovasc Surg, Vol: 65, Pages: 320-322
OBJECTIVE: After alerts on EndoVascular Aneurysm Seal (EVAS) failure were raised, the European Society for Vascular Surgery (ESVS) Abdominal Aortic Aneurysm (AAA) Clinical Practice Guidelines Writing Committee (WC) initiated a task force with the aim to provide guidance on surveillance and management of patients with implanted EVAS devices. METHODS: Based on a scoping review of risk for late serious aortic-related adverse events in patients treated with EVAS for AAA, the ESVS AAA Guidelines WC agreed on recommendations graded according to the European Society of Cardiology (ESC) grading system. RESULTS: EVAS has a very high incidence of late endograft migration resulting in proximal type 1 endoleak with risk of rupture, requiring open conversion with device explantation. The reported mortality rate for elective explantation varies between 0% and 14%, while acute conversion for rupture has a very dismal prognosis with a 67 - 75% mortality rate. CONCLUSION: It is recommended that all patients in whom a Nellix device has been implanted should be identified, properly informed, and enrolled in enhanced surveillance. If device failure is detected, early elective device explantation should be considered in surgically fit patients.
Machin M, Powell JT, 2022, Developing Core Outcome Sets for Vascular Conditions Across Europe, Not as Easy as It Sounds, EJVES VASCULAR FORUM, Vol: 58, Pages: 1-4, ISSN: 2666-688X
Pouncey AL, Khan A, Alharahsheh B, et al., 2022, Hypothesis for the increased rate of thromboembolic and microembolic complications following abdominal aortic aneurysm repair in women, European Journal of Vascular and Endovascular Surgery, Vol: 63, Pages: 348-349, ISSN: 1078-5884
Powell J, Wanhainen A, 2022, Response to "Re 'One Step Forward, Two Steps Backward'"., Eur J Vasc Endovasc Surg, Vol: 63
Powell JT, Koelemay MJW, 2022, Systematic Reviews of the Literature Are Not Always Either Useful Or the Best Way To Add To Science, EJVES Vascular Forum, Vol: 54, Pages: 2-6, ISSN: 2666-688X
Systematic reviews are becoming more popular as a way of doing research; however, not all systematic reviews are clinically useful and sometimes another type of review (scoping, topical, or critical) would be of greater value to the clinical and scientific community. The different types of review and their use are described, illustrated by examples relevant to vascular surgery.
Powell J, 2021, Low shear stress at baseline predicts expansion and aneurysm-related events in patients with abdominal aortic aneurysm, Circulation: Cardiovascular Imaging, Vol: 14, Pages: 1-12, ISSN: 1941-9651
BackgroundLow shear stress has been implicated in abdominal aortic aneurysm (AAA) expansion and clinical events. We tested the hypothesis that low shear stress in AAA at baseline is a marker of expansion rate and future aneurysm-related events. Methods Patients were imaged with computed tomography angiography (CTA) at baseline and followed up every six months >24 months with ultrasound measurements of maximum diameter. From baseline CTA, we reconstructed three dimensional models for automated computational fluid dynamics simulations and computed luminal shear stress. The primary composite endpoint was aneurysm repair and/or rupture, and the secondary endpoint was aneurysm expansion rate. Results We included 295 patients with median AAA diameter of 49mm (IQR 43-54mm) and median follow-up of 914 (IQR 670-1112) days. There were 114 (39%) aneurysm-related events, with 13 AAA ruptures and 98 repairs (one rupture was repaired). Patients with low shear stress (<0.4 Pa) experienced a higher number of aneurysm-related events (44%) compared to medium (0.4-0.6 Pa; 27%) and high (>0.6 Pa; 29%) shear stress groups (p=0.010). This association was independent of known risk factors (adjusted HR 1.72; 95% CI [1.08, 2.73]; p=0.023). Low shear stress was also independently associated with AAA expansion rate (β=+0.28mm/y; 95% CI [0.02, 0.53]; p=0.037). Conclusions We show for the first time that low shear stress (<0.4 Pa) at baseline is associated with both AAA expansion and future aneurysm-related events. Aneurysms within the lowest tertile of shear stress, versus those with higher shear stress, were more likely to rupture or reach thresholds for elective repair. Larger prospective validation trials are needed to confirm these findings and translate them into clinical management.
Bappoo N, Syed MBJ, Khinsoe G, et al., 2021, Low Shear Stress at Baseline Predicts Expansion and Aneurysm-Related Events in Patients With Abdominal Aortic Aneurysm., Circ Cardiovasc Imaging, Vol: 14, Pages: 1112-1121
BACKGROUND: Low shear stress has been implicated in abdominal aortic aneurysm (AAA) expansion and clinical events. We tested the hypothesis that low shear stress in AAA at baseline is a marker of expansion rate and future aneurysm-related events. METHODS: Patients were imaged with computed tomography angiography at baseline and followed up every 6 months >24 months with ultrasound measurements of maximum diameter. From baseline computed tomography angiography, we reconstructed 3-dimensional models for automated computational fluid dynamics simulations and computed luminal shear stress. The primary composite end point was aneurysm repair and/or rupture, and the secondary end point was aneurysm expansion rate. RESULTS: We included 295 patients with median AAA diameter of 49 mm (interquartile range, 43-54 mm) and median follow-up of 914 (interquartile range, 670-1112) days. There were 114 (39%) aneurysm-related events, with 13 AAA ruptures and 98 repairs (one rupture was repaired). Patients with low shear stress (<0.4 Pa) experienced a higher number of aneurysm-related events (44%) compared with medium (0.4-0.6 Pa; 27%) and high (>0.6 Pa; 29%) shear stress groups (P=0.010). This association was independent of known risk factors (adjusted hazard ratio, 1.72 [95% CI, 1.08-2.73]; P=0.023). Low shear stress was also independently associated with AAA expansion rate (β=+0.28 mm/y [95% CI, 0.02-0.53]; P=0.037). CONCLUSIONS: We show for the first time that low shear stress (<0.4 Pa) at baseline is associated with both AAA expansion and future aneurysm-related events. Aneurysms within the lowest tertile of shear stress, versus those with higher shear stress, were more likely to rupture or reach thresholds for elective repair. Larger prospective validation trials are needed to confirm these findings and translate them into clinical management.
Powell JT, 2021, Re: "Systemic Review and Meta-Analysis of the Effect of Weekend Admission on Outcomes for Ruptured Abdominal Aortic Aneurysms", EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 62, Pages: 660-660, ISSN: 1078-5884
Powell JT, Wanhainen A, 2021, One Step Forward, Two Steps Backward? COMMENT, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 62, Pages: 642-642, ISSN: 1078-5884
Powell JT, 2021, Great vascular surgeons needed for great aneurysms, Journal of Vascular Surgery, Vol: 74, Pages: 1161-1162, ISSN: 0741-5214
Pouncey AL, David M, Morris R, et al., 2021, Systematic review and meta-analysis of sex-specific differences in adverse events after open and endovascular intact abdominal aortic aneurysm repair: consistent worse outcomes for women, European Journal of Vascular and Endovascular Surgery, Vol: 62, Pages: 367-378, ISSN: 1078-5884
Objective: Previously, reports have shown women experience higher mortality than men after elective open (OAR) and endovascular (EVAR) repair of abdominal aortic aneurysm (AAA).With recent improvements in overall AAA repair outcomes, this study aimed to identify whether sex-specific disparity has been ameliorated by modern practice, and to define sex-specific differences in peri/post-operative complications and pre-operative status; factors which may contribute to poor outcome.Methods: Systematic review, meta-analysis and meta-regression of sex-specific differences in 30-day mortality and complications conducted according to PRISMA guidance (Prospero registrationCRD42020176398). Papers with ≥50 women, reporting sex-specific outcomes, following intact primary AAA repair, from 2000-2020 world-wide were included; separate analyses for EVAR and OAR. Data sources: Medline, Embase and CENTRAL databases 2005-2020 searched using ProQuest Dialog™. Results: 26 studies (371,215 men,65,465 women) included. Meta-analysis and meta-regression indicated sex-specific odds ratios(ORs) for 30-day mortality were unchanged from 2000-2020.Mortality risk was higher in women for OAR and more so for EVAR (OR [95%CI] 1.49 [1.37,1.61];1.86 [1.59,2.17] respectively) and remained following multivariable risk-adjustment. Transfusion, pulmonary complications and bowel ischemia were more common in women after OAR and EVAR (OAR: ORs 1.81 [1.60,2.04], 1.40 [1.28,1.53], 1.54 [1.36,1.75]; EVAR: ORs 2.18[2.08,2.29] 1.44 [1.17,1.77], 1.99 [1.51,2.62] respectively). Arterial injury, limb ischemia, renal and cardiac complications were more common in women after EVAR (ORs 3.02 [1.62-5.65], 2.13[1.48-3.06], 1.46 [1.22-1.72] and 1.19[1.03,1.37] respectively); the latter was associated with greater mortality risk on meta-regression. Conclusions: Increased mortality risk for women following AAA repair remains. Women had higher incidence of transfusion, pulmonary and bowel complications after EVAR and
Pouncey AL, Alharehsheh B, Khan A, et al., 2021, Quantification of Sex-specific Differences in Aorto-iliac Complexity for Patients Undergoing Abdominal Aortic Aneurysm Repair: A Retrospective Cohort Study., Vascular Society Annual Scientific Meeting 2021
Pouncey A-L, Powell JT, 2021, Womens lives at stake: Women Suffer Disproportionately After Abdominal Aortic Aneurysm Repair, So What Can We Do About It?, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 62, Pages: 1-3, ISSN: 1078-5884
Machin M, Ulug P, Pandirajan K, et al., 2021, Towards a core outcome set for abdominal aortic aneurysm: systematic review of outcomes reported following intact and ruptured abdominal aortic aneurysm repair, European Journal of Vascular and Endovascular Surgery, Vol: 61, Pages: 909-918, ISSN: 1078-5884
Objective:To encompass the needs of all stakeholders and allow effective data synthesis from trials, registries, and other studies; a core outcome set for infrarenal abdominal aortic aneurysm (AAA) repair is needed. In this first stage, the aim was to report the range, frequency, and time of pre-specified outcomes reported following AAA repair.Data Sources:Medline, Embase, and CENTRAL databases 2010 – 2019 were searched using ProQuest Dialog™.Review Methods:The systematic review was reported to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA), PROSPERO registration CRD42019130119. Outcomes were coded using Core Outcome Measures in Effectiveness Trials (COMET) taxonomy and presented separately for intact and rupture repairs, endovascular aneurysm repair (EVAR) and open repair, and time from repair (acute < 90 days vs. ≥ 1 year) (COMET Initiative 1582).Results:For intact AAA and rupture repair, a total of 231 and 70 reports with 589 255 and 177 465 patients respectively were included: only 98 and 19 respectively provided ≥ 1 year outcomes. Most studies were retrospective, with 13 randomised trials of intact AAA repair and five randomised trials of ruptured AAA repair. For intact AAA, the most common pre-specified COMET taxonomy outcomes were mortality (181), vascular complications (137), and re-intervention (52). EVAR studies dominated the vascular outcomes in acute and later time periods: excluding 47 reports from device registries, reduced vascular outcomes to 83. For ruptured AAA, the three most common outcomes were mortality (64), vascular (11), and hospital stay (10). The range of outcomes reported was wide with functioning outcomes reported from most randomised trials but few retrospective studies.Conclusion:This review identifies the paucity of long term data and the disproportionate attention paid to vascular complications vs. patient functioning outcomes, this skew being accentuated by reporting from
Ulug P, Powell JT, 2020, Clinical trial reporting, LANCET, Vol: 396, Pages: 1489-1489, ISSN: 0140-6736
Powell JT, 2020, Lost in Translation From Mice to Men: Grief and Pain and FAME, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 60, Pages: 461-461, ISSN: 1078-5884
Doyle BJ, Bappoo N, Syed MBJ, et al., 2020, Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm, European Journal of Vascular and Endovascular Surgery, Vol: 60, Pages: 365-373, ISSN: 1078-5884
ObjectiveTo test whether aneurysm biomechanical ratio (ABR; a dimensionless ratio of wall stress and wall strength) can predict aneurysm related events.MethodsIn a prospective multicentre clinical study of 295 patients with an abdominal aortic aneurysm (AAA; diameter ≥ 40 mm), three dimensional reconstruction and computational biomechanical analyses were used to compute ABR at baseline. Participants were followed for at least two years and the primary end point was the composite of aneurysm rupture or repair.ResultsThe majority were male (87%), current or former smokers (86%), most (72%) had hypertension (mean ± standard deviation [SD] systolic blood pressure 140 ± 22 mmHg), and mean ± SD baseline diameter was 49.0 ± 6.9 mm. Mean ± SD ABR was 0.49 ± 0.27. Participants were followed up for a mean ± SD of 848 ± 379 days and rupture (n = 13) or repair (n = 102) occurred in 115 (39%) cases. The number of repairs increased across tertiles of ABR: low (n = 24), medium (n = 34), and high ABR (n = 44) (p = .010). Rupture or repair occurred more frequently in those with higher ABR (log rank p = .009) and ABR was independently predictive of this outcome after adjusting for diameter and other clinical risk factors, including sex and smoking (hazard ratio 1.41; 95% confidence interval 1.09–1.83 [p = .010]).ConclusionIt has been shown that biomechanical ABR is a strong independent predictor of AAA rupture or repair in a model incorporating known risk factors, including diameter. Determining ABR at baseline could help guide the management of patients with AAA.
Ulug P, Powell JT, Martinez MA-M, et al., 2020, Surgery for small asymptomatic abdominal aortic aneurysms., Cochrane Database of Systematic Reviews, Vol: 7, Pages: CD001835-CD001835, ISSN: 1469-493X
BACKGROUND: An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the major abdominal artery. Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, but the size of the aneurysm is important, as risk of rupture increases with aneurysm size. Large asymptomatic AAAs (greater than 5.5 cm in diameter) are usually repaired surgically; very small AAAs (less than 4.0 cm diameter) are monitored with ultrasonography. Debate continues over the roles of early repair versus surveillance with repair on subsequent enlargement in people with asymptomatic AAAs of 4.0 cm to 5.5 cm diameter. This is the fourth update of the review first published in 1999. OBJECTIVES: To compare mortality and costs, as well as quality of life and aneurysm rupture as secondary outcomes, following early surgical repair versus routine ultrasound surveillance in people with asymptomatic AAAs between 4.0 cm and 5.5 cm in diameter. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, two other databases, and two trials registers to 10 July 2019. We handsearched conference proceedings and checked reference lists of relevant studies. SELECTION CRITERIA: We included randomised controlled trials where people with asymptomatic AAAs of 4.0 cm to 5.5 cm were randomly allocated to early repair or imaging-based surveillance at least every six months. Outcomes had to include mortality or survival. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data, which were cross-checked by other team members. Outcomes were mortality, costs, quality of life, and aneurysm rupture. For mortality, we estimated risk ratios (RR) (endovascular aneurysm repair only), hazard ratios (HR) (open repair only), and 95% confidence intervals (CI) based on Mantel-Haenszel Chi2 statistics at one and six years (open repair only) following randomisation
Powell JT, Wanhainen A, 2020, Analysis of the differences between the European Society for Vascular Surgery 2019 and National Institute for Health and Care Excellence 2020 guidelines for abdominal aortic aneurysm, European Journal of Vascular and Endovascular Surgery, Vol: 60, Pages: 7-15, ISSN: 1078-5884
ObjectiveThe aim was to understand why two recently published guidelines for the diagnosis and management of patients with abdominal aortic aneurysm, the National Institute for Health and Care Excellence (NICE) 2020 guidelines and the European Society for Vascular Surgery (ESVS) 2019 guidelines, have discordant recommendations in several important areas.MethodsA review of the approach, methodology, and evidence used by the two guideline committees was carried out to understand potential reasons for their differing recommendations in their two final published guidelines.ResultsNICE guidelines use a multidisciplinary committee to address a limited number of prospectively identified questions, using rigorous methods heavily reliant on evidence from randomised controlled trials (RCTs) supported by in house economic modelling, with the purpose of providing the best, cost-effective health care in the UK in 46 main recommendations. The ESVS guidelines use an expert committee to encourage clinical effectiveness across a range of European health economies. ESVS guideline topics, but not questions, are prospectively identified, assessment of evidence was less rigorous, and 125 recommendations were made. More up to date evidence searches by the ESVS committee partially underscore the differences in recommendations for screening women. The NICE committee did not consider sex specific analysis or evidence for thresholds for intervention but relied on sex specific modelling to support their advice to use endovascular repair (EVAR) for ruptures in women. Their recommendation to use open repair for ruptured abdominal aortic aneurysms (AAAs) in men aged < 71 years was based on in house economic modelling. NICE recommends an open first strategy for non-ruptured AAA mainly based on earlier RCTs and UK specific economic modelling, while the ESVS guidelines recommend an EVAR first strategy after consideration of modern, but lower quality, evidence from observational studies. Similar
Lyons O, Powell JT, 2020, The world is not enough: how can "big data" inform guidelines for elective AAA repair?, European Journal of Vascular and Endovascular Surgery, Vol: 59, Pages: 898-898, ISSN: 1078-5884
Powell JT, Hegele RA, 2020, From laundry list to rating scheme selection of the best scientific method, Arteriosclerosis, Thrombosis and Vascular Biology, Vol: 40, Pages: 1018-1019, ISSN: 1079-5642
Parker L, Powell J, Kelsey L, et al., 2020, Morphology and computational fluid dynamics support a novel classification of common iliac aneurysms, European Journal of Vascular and Endovascular Surgery, Vol: 59, Pages: 786-793, ISSN: 1078-5884
Objectives: Isolated common iliac artery aneurysms (CIAAs) are uncommon and evidence concerning their development, progression and management is weak. Our objective was to describe the morphology and haemodynamics of isolated CIAAs in a retrospective study.Methods: Initially a series of 25 isolated CIAAs (15 intact, 10 ruptured) in 23 patients were gathered from multiple centres, reconstructed from computed tomography (CT), then morphologically classified and analysed with computational fluid dynamics. The morphological classification was applied in a separate, consecutive cohort of 162 patients assessed for elective aorto-iliac intervention, in which 45 patients had intact CIAAs.Results: In the isolated CIAA cohort, three distinct morphologies were identified: complex, fusiform and kinked (distal to a sharp bend in the CIA), with mean diameters 90.3, 48.3 and 31.7 mm, and mean time-averaged wall shear stress of 0.16, 0.31 and 0.71 Pa, respectively (both ANOVA p<.001). Kinked cases, compared to fusiform cases, had less thrombus and favourable haemodynamics similar to the non-aneurysmal contralateral CIA. Ruptured isolated CIAA were large (mean diameter 87.5mm, range 55.5-138.0mm) and predominantly complex. Mean CIA length for aneurysmal arteries was greatest in kinked cases followed by complex and fusiform (100.8mm, 91.1mm and 80.6mm respectively). The morphological classification was readily applicable to a separate elective patient cohort.Conclusions: A new morphological categorization of CIAAs is proposed. This is potentially associated with both haemodynamics and clinical course. Further research is required to determine whether the kinked CIAA is haemodynamically protected from aneurysm progression and establish the wider applicability of the categorization presented.
Mitchell GF, Powell J, 2020, Arteriosclerosis: a primer for “In Focus” reviews on arterial stiffness, Arteriosclerosis, Thrombosis and Vascular Biology, Vol: 40, Pages: 1025-1027, ISSN: 1079-5642
Wanhainen A, Verzini F, Van Herzeele I, et al., 2020, Corrigendum to 'European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms' [European Journal of Vascular & Endovascular Surgery 57/1 (2019) 8-93]., Eur J Vasc Endovasc Surg, Vol: 59, Pages: 494-494
Soares Ferreira R, Powell JT, 2020, Elective repair of abdominal aortic aneurysm: the evidence is in but the jury may still be out, European Journal of Vascular and Endovascular Surgery, Vol: 59, Pages: 398-398, ISSN: 1078-5884
Kontopodis N, Galanakis N, Antoniou SA, et al., 2020, Meta-analysis and meta-regression analysis of outcomes of endovascular and open repair for ruptured abdominal aortic aneurysm, European Journal of Vascular and Endovascular Surgery, Vol: 59, Pages: 399-410, ISSN: 1078-5884
ObjectivesThe aim was to assess peri-operative mortality of endovascular aneurysm repair (EVAR) vs. open repair for ruptured abdominal aortic aneurysm (AAA) and to investigate whether outcomes have improved over the years and whether there is an association between institutional caseload and peri-operative mortality.MethodsElectronic information sources (MEDLINE, EMBASE, CINAHL and CENTRAL) were searched up to August 2019. A systematic review was carried out according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using a registered protocol (CRD42018106084). Studies were selected that reported peri-operative mortality of EVAR for ruptured AAA. A proportion meta-analysis was conducted, and summary estimates of odds ratios (ORs) and 95% confidence intervals (CIs) for EVAR vs. open surgical repair were obtained using random effects models. Mixed effects regression models were developed to investigate outcome changes over time and with institutional caseload.ResultsOne hundred and thirty-six studies were included in quantitative synthesis reporting a total of 267 259 patients (EVAR 58 273; open surgery 208 986). The pooled peri-operative mortality of EVAR and open surgical repair was 0.245 (95% CI 0.234–0.257) and 0.378 (95% CI 0.364–0.392), respectively. EVAR was associated with reduced peri-operative mortality (OR 0.54, 95% CI 0.51–0.57, p < .001). Meta-regression analysis found decreasing peri-operative mortality over the years following EVAR (p < .001) and open repair (p < .001), and a decreasing OR of peri-operative mortality in favour of EVAR (p = .053). Meta-regression found a significant positive association between peri-operative mortality and institutional case load for open repair (p = .004).ConclusionsIf EVAR can be done, it is a better treatment for ruptured AAA in view of the reduced peri-operative mortality compared with open surgery. The outcomes of both EVAR and open surgical repair
Powell JT, 2020, The Missing Biomarker or Biomarker Panel in the Recovery of Muscle Mitochondrial Function, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 59, Pages: 116-116, ISSN: 1078-5884
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