Complications of stent grafts for popliteal aneurysms
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
At the completion of endovascular treatment for popliteal artery aneurysm, nearly all patients had reported success. This was defined as exclusion of aneurysm, absence of endoleak, and preservation of distal run-off. On follow-up imaging some patients were found to have re-perfusion of the aneurysm sac. As popliteal artery aneurysm is not as commonly found to exert mass effect and rupture as it is to thrombose or embolize, this has been deemed less of an issue with respect to guiding subsequent treatments. Endoleak types mirror those as described with endovascular repair of abdominal aortic aneurysm (EVAR).43 Most studies suggest absence of definable endoleak upon completion imaging.36,37,39 Despite this initial success, 5–10% of these patients were found to have evidence of endoleak on follow-up imaging modalities.5,9,29 One study suggested that upward of 15% (8/57) of interventions were complicated long term by stent graft migration leading to Type I or III endoleak.37 See Figures 11.3 and 11.4.
Explantation of aortic endografts
Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long in Endovascular and Open Vascular Reconstruction, 2017
Since its first description in the early 1990s, endovascular aneurysm repair (EVAR) has transformed aortic surgery. Today, EVAR is the preferred treatment for an abdominal aortic aneurysm (AAA) with approximately 70% of infrarenal AAAs treated this way. Although EVAR has lower perioperative morbidity and mortality compared to traditional open repair, long-term survival is similar. However, the rate of secondary intervention is higher among those patients undergoing EVAR—up to 20% within 6 years. Thus, continued surveillance imaging is important to detect complications and ensure long-term success. Given the mounting number of endovascular grafts being placed, the vascular surgeon must be familiar with the mechanisms of device failure, as well as the techniques available to assist in their removal and conversion to open repair when necessary.
Non-technical skills for surgeons: The NOTSS behaviour marker system
Rhona Flin, George G. Youngson, Steven Yule in Enhancing Surgical Performance, 2015
A ruptured abdominal aortic aneurysm is a life-threatening event. Surgical mortality, for patients who actually survive to reach the hospital, is quite high. Communication and teamwork in the operating room are important to operative success. Upon entering the operating room, the surgeon should exchange information with the anesthesiologist, even prior to making incision. Decisions should be made about target blood pressure, as well as when to make incision, as patients are at risk for dramatic drop in blood pressure after induction of anesthesia. The surgeon needs to be prepared to operate immediately, and most recommend that the patient be prepped and draped prior to intubation so as to allow quick entry into the abdomen. The surgeon should also establish a shared understanding with the entire surgical team. All members must know the gravity and urgency of the procedure and be prepared for the critical events. Part of the surgeon’s role is to coordinate team activities, which includes confirming that the team is ready to begin, making certain that all necessary retractors, sutures, and vascular grafts are available, and notifying the team when medications such as intravenous heparin (if needed) should be administered.
Characterising recovery following abdominal aortic aneurysm repair using cardiopulmonary exercise testing and patient reported outcome measures
Published in Disability and Rehabilitation, 2023
N. Dodds, J. Angell, S. L. Lewis, M. Pyke, P. White, A. Darweish-Medniuk, D. C. Mitchell, S. Tolchard
Forty-two patients undergoing abdominal aortic aneurysm (AAA) repair, by open (n = 21) or endovascular (EVAR; n = 21) approach, were recruited in the vascular outpatient’s clinic or during pre-operative assessment between 2010 and 2015. Informed consent was obtained by a consultant or clinical research fellow trained in Good Medical Practice. All patients received consultant-delivered surgical and anaesthetic care. The study received local ethical approval from our local Health Research Authority, Bristol NRES Southwest, with restrictions that limited the study design such that it was not possible to recruit consecutive patients. Patients over the age of 18 years were considered for the study, with the following exclusions; Patients that suffered post-operative complications or were considered inoperable, those patients unable or unwilling to perform an ergometer test or participate in the study, and patients from outside the Bristol area for whom participation would represent a significant burden. The approval also stipulated that patients not be re-tested within 4 weeks of surgery. The study incorporated patient safety pathways to identify patients with potentially reversible cardiac or pulmonary morbidity; in such cases, the surgeon was informed and the patient referred to the appropriate specialty. None of the patients in the study were involved in any prehabilitation or cardiac rehabilitation programs.
Age and diabetes control in an HIV-endemic country: is there an association?
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2022
RR Chetty, S Pillay
It is well established that there is an association between hypertension and cardiovascular disease (CVD), commonly resulting in increased mortality.26 PLWD have a 200–400% risk of dying from CVD,27 while some estimate that it can be as high as 10 times the risk of the general population.28 In patients with hypertension and DM, the CVD risk increases by a further 75%.29 In our study, systolic hypertension was positively associated with age. This is similar to what has been shown in other studies globally. An American study conducted by Ostchega et al. highlighted the increased prevalence of hypertension with age.30 In contrast to this, our study found that the mean age of patients with increased DBP ≥ 90 mmHg was younger than those with a DBP < 90 mmHg. According to Li et al., DBP is an important risk factor for coronary disease in younger patients.31 It has also been shown to be a risk factor for formation of an abdominal aortic aneurysm.32 Clinicians should be aware of this risk factor and pay special attention to diastolic blood pressures just as much in the younger PLWD as they do for older patients. In SA, Steyn et al. highlighted that the care of patients with DM and hypertension is suboptimal.33 Strained healthcare systems are a major challenge, especially in Africa, with only 2% of patients having good control of hypertension.34 It is therefore important to implement effective early interventions to manage non-communicable diseases such as DM and HPT, especially when they coexist.
Self-efficacy is an independent predictor for postoperative six-minute walk distance after elective open repair of abdominal aortic aneurysm
Published in Disability and Rehabilitation, 2018
Kazuhiro Hayashi, Kiyonori Kobayashi, Miho Shimizu, Yohei Tsuchikawa, Akio Kodama, Kimihiro Komori, Yoshihiro Nishida
Open surgery is performed to treat abdominal aortic aneurysm (AAA), although the patients experience surgical stress. Surgical recovery is a complex construct that comprises multiple dimensions of health [1,2]. Length of stay (LOS) in the hospital is a commonly used indicator of recovery [3], but this may not be an optimal indicator because LOS is influenced by many nonclinical factors such as patients’ expectations of the hospital stay, the availability of community and family postoperative support, and surgeons’ preferences [4]. On the other hand, functional exercise capacity is a key indicator of surgical recovery [5–7] that is required for patients to return to their normal employment and leisure activities. Six-minute walk distance (6MWD) has been validated in the context of recovery from several types of surgery [5–13]. There was a positive correlation between the changes in 6MWD and quality of life [10]. Postoperative 6MWD after thoracoabdominal surgery is predicted by preoperative physical status such as 6MWD [6–8], age [7,8], gender [8], surgical type [7,8], occurrence of postoperative complications [7], and comorbidities [8].
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