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Aortic dilatation after endovascular repair of blunt traumatic thoracic aortic injuries.

https://arctichealth.org/en/permalink/ahliterature143862
Source
J Vasc Surg. 2010 Jul;52(1):45-8
Publication Type
Article
Date
Jul-2010
Author
Thomas L Forbes
Jeremy R Harris
D Kirk Lawlor
Guy Derose
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre & The University of Western Ontario, London, Ontario, Canada. Tom.Forbes@lhsc.on.ca
Source
J Vasc Surg. 2010 Jul;52(1):45-8
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Aorta, Thoracic - injuries - radiography - surgery
Aortic Aneurysm, Thoracic - etiology - radiography
Aortography - methods
Blood Vessel Prosthesis Implantation - adverse effects
Dilatation, Pathologic
Humans
Middle Aged
Ontario
Thoracic Injuries - radiography - surgery
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Wounds, Nonpenetrating - radiography - surgery
Young Adult
Abstract
Endovascular repair of blunt traumatic thoracic aortic injuries (BTAI) has become routine at many trauma centers despite concerns regarding durability and aortic dilatation in these predominantly young patients. These concerns prompted this examination of thoracic aortic expansion after endovascular repair of a BTAI.
The immediate postoperative and most recent computed tomography (CT) scans of patients who had undergone urgent endovascular repair of a BTAI and had at least 1 year of follow-up were reviewed. Diameter measurements were made at four predetermined sites: immediately proximal to the left subclavian artery (D1), immediately distal to the left subclavian artery (D2), distal extent of the endograft (D3), and 15 mm beyond the distal end of the endograft (D4). Split screens permitted direct comparison of measurements between CTs at the corresponding levels.
During a 6-year period (2001-2007), 21 patients (mean age, 42.9 years; range, 19-81 years) underwent endovascular repair of a BTAI, 17 with at least 1 year of follow-up (mean, 2.6 years; range, 1-5.5 years). No patients required reintervention during this period. The mean rate of dilatation for each level of the thoracic aorta in mm/year was: D1, 0.74 (95% confidence interval [CI], 0.42-1.06); D2, 0.83 (95% CI, 0.55-1.11); D3, 0.63 (95% CI, 0.37-0.89); D4, 0.47 (95% CI, 0.27-0.67). The rate of expansion of D2 differed significantly vs D4 (P = .025).
During the first several years of follow-up, the proximal thoracic aorta dilates minimally after endovascular repair of BTAIs, with the segment just distal to the left subclavian artery expanding at a slightly greater rate. Longer-term follow-up is necessary to determine whether this expansion continues and becomes clinically significant.
PubMed ID
20434299 View in PubMed
Less detail

Midterm results of the Zenith endograft in relation to neck length.

https://arctichealth.org/en/permalink/ahliterature140893
Source
Ann Vasc Surg. 2010 Oct;24(7):859-62
Publication Type
Article
Date
Oct-2010
Author
Thomas L Forbes
Jeremy R Harris
D Kirk Lawlor
Guy Derose
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre and the University of Western Ontario, London, Ontario, Canada. Tom.Forbes@lhsc.on.ca
Source
Ann Vasc Surg. 2010 Oct;24(7):859-62
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - mortality - radiography - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Endoleak - etiology - surgery
Endovascular Procedures - adverse effects - instrumentation - mortality
Humans
Ontario
Prosthesis Design
Reoperation
Retrospective Studies
Stents
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
Successful endovascular repair of abdominal aortic aneurysms (AAAs) requires specific infrarenal neck anatomy to allow for a durable seal and fixation. This is a single-center study reviewing outcomes in relation to neck length after placement of a Zenith endograft.
Retrospective single-center review of all AAAs electively repaired with a Zenith endograft during a recent 5-year period. Patients were divided into those with infrarenal necks 4-15 mm in length and those >15 mm using center line measurements. Clinical outcomes and follow-up computed tomography scans were reviewed.
Between 2003 and 2008, 318 patients underwent elective repair of an infrarenal AAA with the Zenith endograft. Of 318 patients, 68 (21.4%) had necks measuring 4-15 mm in length and 250 (79.5%) had necks measuring >15 mm. Overall early mortality was 0.9% (p = 0.11) and the rate of type II endoleaks was 19% (p = 0.11); neither differed between the groups. Four patients in each group had immediate proximal type I endoleaks, which resolved spontaneously in two patients in each group. The remaining two in each group required further intervention (two endovascular and two conversion to open repair). Type I endoleaks and reinterventions did not differ statistically between groups (p = 0.06). On further analysis, those patients requiring reintervention or conversion for type I endoleaks had other unattractive neck features (large diameter, angulation). There have been no instances of new type I endoleaks during 5-yearfollow-up period.
These midterm results indicate that patients with shorter infrarenal necks can be treated as effectively as those with longer necks with the Zenith endograft unless these necks are tortuous or wide.
PubMed ID
20831986 View in PubMed
Less detail

Late conversion of endovascular to open repair of abdominal aortic aneurysms.

https://arctichealth.org/en/permalink/ahliterature124149
Source
Can J Surg. 2012 Aug;55(4):254-8
Publication Type
Article
Date
Aug-2012
Author
Thomas L Forbes
David M Harrington
Jeremy R Harris
Guy DeRose
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre and the University of Western Ontario, London, Ontario. Tom.Forbes@lhsc.on.ca
Source
Can J Surg. 2012 Aug;55(4):254-8
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - mortality - radiography - surgery
Aortography - methods
Blood Vessel Prosthesis Implantation - adverse effects - methods
Cohort Studies
Databases, Factual
Endovascular Procedures - adverse effects - methods - mortality
Female
Follow-Up Studies
Humans
Male
Middle Aged
Monitoring, Physiologic - methods
Ontario
Postoperative Complications - mortality - radiography - surgery
Reoperation - methods
Retrospective Studies
Risk assessment
Survival Rate
Time Factors
Treatment Outcome
Vascular Surgical Procedures - methods
Abstract
Failure of endovascular repair (EVAR) of an abdominal aortic aneurysm can result in significant risk of morbidity and mortality. We review our experience with late conversions to open repair.
We conducted a retrospective database review to identify all EVAR procedures performed between 1997 and 2010 and the number converted to open repair at our university-affiliated medical centre. Late conversion was defined as those occurring at least 30 days after initial EVAR.
In all, 892 EVARs took place during the study period. Six patients (0.7%) required late conversion to open repair. Their mean age was 71 (range 58-83) years, and half were women. Half of the initial EVARs were for ruptured aneurysms. The median time to conversion was 15.6 (range 1.7-61.3) months. Indications for secondary conversion (50% urgent, 50% elective) included persistent type I endoleak (n = 3), combined type II and III endoleak (n = 1), graft thrombosis (n = 1) and aneurysm rupture (n = 1). Supraceliac clamping was required in most patients (67%), and the mean transfusion requirement was 2.6 units. Total endograft explantation occurred in 2 patients (33%), whereas partial or total endograft preservation occurred in 4 (67%). Median length of stay in hospital after conversion was 7 (range 6-73) days. There were no instances of early or in-hospital mortality following conversion.
Our EVAR experience includes a low rate of late conversion to open repair, with most conversions being a result of persistent aneurysm perfusion. Although technically challenging, late conversion can be safe. Our experience supports ongoing surveillance after EVAR.
Notes
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PubMed ID
22617542 View in PubMed
Less detail

Early mortality following endovascular versus open repair of ruptured abdominal aortic aneurysms.

https://arctichealth.org/en/permalink/ahliterature141805
Source
Vasc Endovascular Surg. 2010 Nov;44(8):645-9
Publication Type
Article
Date
Nov-2010
Author
Ryaz B Chagpar
Jeremy R Harris
D Kirk Lawlor
Guy DeRose
Thomas L Forbes
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, ON, Canada.
Source
Vasc Endovascular Surg. 2010 Nov;44(8):645-9
Date
Nov-2010
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aortic Aneurysm, Abdominal - blood - mortality - physiopathology - surgery
Aortic Rupture - blood - mortality - physiopathology - surgery
Blood pressure
Blood Vessel Prosthesis Implantation - mortality
Consciousness
Endovascular Procedures - mortality
Female
Hemoglobins - metabolism
Humans
International Normalized Ratio
Male
Odds Ratio
Ontario
Patient Selection
Retrospective Studies
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Urea - blood
Abstract
To determine whether endovascular repair (EVAR) offers a survival advantage over open repair (OAR) with ruptured abdominal aortic aneurysms (RAAA).
Retrospective analysis of RAAA patients treated between 2003 and 2008. Univariate and multivariate analyses were performed.
167 patients presented with RAAA (OAR = 135, 80.8%, EVAR = 32, 19.2%). On univariate analysis, EVAR was associated with a decreased mortality relative to OAR, (15.6% vs 43.7%, P = .004). Patients who survived were younger (P
PubMed ID
20675315 View in PubMed
Less detail

The effect of patient transfer on outcomes after rupture of an abdominal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature164406
Source
Can J Surg. 2007 Feb;50(1):43-7
Publication Type
Article
Date
Feb-2007
Author
Heather Hames
Thomas L Forbes
Jeremy R Harris
D Kirk Lawlor
Guy DeRose
Kenneth A Harris
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre and the University of Western Ontario, London, Ontario, Canada.
Source
Can J Surg. 2007 Feb;50(1):43-7
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - mortality - surgery
Aortic Rupture - mortality - surgery
Female
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
Intensive Care - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Middle Aged
Ontario - epidemiology
Patient Transfer - statistics & numerical data
Referral and Consultation - statistics & numerical data
Retrospective Studies
Survival Rate
Time Factors
Treatment Outcome
Abstract
Centralization of vascular surgery services has resulted in patients being transferred longer distances for treatment of life-threatening conditions. The purpose of this study was to determine whether patient transfer adversely affects the survival of people with a ruptured abdominal aortic aneurysm (RAAA).
We performed a retrospective review of all patients undergoing attempted repair of an RAAA at our centre, over a recent 3.5-year period (August 2000-December 2003). Patients were divided into those presenting directly to our centre and those transferred from another hospital. The main outcome variable was in-hospital or 30-day mortality, with secondary variables including time to surgical treatment, mortality in the first 24 hours and length of hospitalization.
Eighty-one patients (73% men) underwent attempted open repair of an RAAA at our centre during this period. Twenty-four patients (29.6%) presented directly to our hospital, while 57 (70.4%) were transferred from another institution. The overall mortality rate was 53%. Although transferred patients took twice as long as direct patients to get to the operating room (6.3 v. 3.2 h, p=0.03), there was no difference in mortality between the 2 groups (50% v. 54%, p=ns). However, deaths of transferred patients were more likely to occur in the first 24 postoperative hours, compared with direct patients (40% v. 33%, p
Notes
Cites: J Vasc Surg. 1994 May;19(5):888-9008170044
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PubMed ID
17391616 View in PubMed
Less detail

Socioeconomic and geographic disparities in access to endovascular abdominal aortic aneurysm repair.

https://arctichealth.org/en/permalink/ahliterature107410
Source
Ann Vasc Surg. 2013 Nov;27(8):1061-7
Publication Type
Article
Date
Nov-2013
Author
Jason Faulds
Nathaniel J Bell
David M Harrington
Teresa V Novick
Jeremy R Harris
Guy DeRose
Thomas L Forbes
Author Affiliation
Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Source
Ann Vasc Surg. 2013 Nov;27(8):1061-7
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Blood Vessel Prosthesis Implantation - adverse effects - mortality
Centralized Hospital Services
Emergencies
Endovascular Procedures - adverse effects - mortality
Health Services Accessibility
Healthcare Disparities
Hospital Mortality
Humans
Odds Ratio
Ontario
Patient Acceptance of Health Care
Postoperative Complications - mortality - therapy
Referral and Consultation
Residence Characteristics
Retrospective Studies
Risk factors
Socioeconomic Factors
Surgical Procedures, Elective
Transportation
Treatment Outcome
Abstract
Within Southwestern Ontario, abdominal aortic aneurysm (AAA) surgery has been centralized to a single university-affiliated medical center. The referral area serves 1.9 million people and includes community hospitals with limited vascular surgery capabilities. We reviewed the role of patients' travel distance, geographic location, and socioeconomic status (SES) to determine if centralization of endovascular programs results in disparity in access to endovascular surgery. We hypothesized that patients would travel a longer distance to specifically seek elective endovascular surgery while having open and emergent surgery closer to home.
All patients who underwent AAA repair (July 2005-June 2010) at London Health Science Centre were identified from the vascular surgery database. Method of repair, clinical presentation, and in-hospital mortality were recorded. Travel distance from each patient's home to our hospital and rural versus urban status was determined for each patient. SES was determined by using a previously validated, locally developed deprivation index.
During this 5-year period, 1,243 patients were included in our analysis; 46.8% (n=581) underwent endovascular repair (EVAR) and 53.2% (n=662) underwent open repair. For elective cases, the in-hospital mortality rate was 2.0% (n=11) for EVAR and 3.6% (n=20) for open repair (P=0.1). There was no difference in clinical presentation between SES groups, but open repair was more frequently used in patients of lower SES compared to higher SES (odds ratio=1.32; 95% confidence interval: 1.02-1.72). Travel distance and rural/urban status were not associated with increased odds of EVAR. When ruptured aneurysms were excluded, elective patients of lower SES continued to have a higher rate of open surgery.
Despite the centralization of endovascular programs in Canada, patients do not appear to be traveling a longer distance for EVAR while having open repairs closer to home as we expected. We did note that higher SES was associated with increased odds of EVAR, which may suggest a health care access bias for EVAR for patients of higher SES. Larger, population-based studies at the provincial or national level could confirm these initial findings.
PubMed ID
24011807 View in PubMed
Less detail

Determination of patient preference for location of elective abdominal aortic aneurysm surgery.

https://arctichealth.org/en/permalink/ahliterature114793
Source
Vasc Endovascular Surg. 2013 May;47(4):288-93
Publication Type
Article
Date
May-2013
Author
John H Landau
Teresa V Novick
Luc Dubois
Adam H Power
Jeremy R Harris
Guy Derose
Thomas L Forbes
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre & Western University, London, Ontario, Canada.
Source
Vasc Endovascular Surg. 2013 May;47(4):288-93
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Catchment Area (Health)
Female
Health Care Surveys
Health Services Accessibility
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Male
Ontario
Outcome and Process Assessment (Health Care)
Patient Preference
Quality Indicators, Health Care
Questionnaires
Risk assessment
Risk factors
Surgical Procedures, Elective
Treatment Outcome
Vascular Surgical Procedures - adverse effects - mortality
Abstract
Aneurysm repair is centralized in higher volume centers resulting in reduced mortality, with longer travel distances. The purpose of this study is to explore patients' preference between local care versus longer distances and lower mortality rates.
Patients with abdominal aortic aneurysm (AAA) measuring 4 to 5 cm and living at least a 1-hour drive from our hospital were asked to assume it had grown to 5.5 cm, and repair was recommended with a mortality risk of 2%. The level of additional risk they would accept to undergo surgery locally was determined.
A total of 67 patients were surveyed. If mortality risk was equivalent at the local and regional hospitals, 44% preferred care at our tertiary center, while 56% preferred surgery locally. If perioperative mortality was increased at the local hospital, 9% preferred local surgery.
The vast majority of patients with AAA will accept longer travel distances for care as long as it results in a reduction in perioperative mortality.
PubMed ID
23579366 View in PubMed
Less detail

7 records – page 1 of 1.