Open versus Endovascular AAA Repair in Patients Who are Morphological Candidates for Endovascular Treatment

2002 ◽  
Vol 9 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Bradley B. Hill ◽  
Yehuda G. Wolf ◽  
W. Anthony Lee ◽  
Frank R. Arko ◽  
Cornelius Olcott ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Outcome Measures ◽  
Endovascular Repair ◽  
Open Repair ◽  
Aneurysm Rupture ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Morphological Criteria ◽  
Secondary Procedures ◽  
Open Versus

Purpose: To compare the outcomes of open versus endovascular repair of abdominal aortic aneurysm (AAA) in a cohort of patients who fulfill morphological criteria for endovascular repair. Methods: A retrospective review of 229 consecutive AAA patients treated over a 3-year period identified 149 patients who were candidates for endovascular repair based on preoperative computed tomography and angiography. Of the 149 patients, 79 (68 men; mean age 74 ± 8 years) underwent endovascular repair with the AneuRx stent-graft; the remaining 70 (56 men; mean age 72 ± 8 years) had open repair. Short-term outcome measures were 30-day mortality and procedure-related morbidity, length of stay in the intensive care unit and hospital, intraoperative blood loss, interval to oral diet, and time to ambulation. Long-term outcome measures included death and secondary procedures. Results: There was no difference in the 30-day mortality between endovascular repair (2, 2.5%) and open repair (2, 2.9%), even though endovascular patients had more comorbidities (p<0.05). Overall length of stay was reduced for endovascular patients (3.9 ± 2.4 days versus 7.7 ± 3.1 days for surgical patients, p<0.0001). Fewer endograft patients had complications (24% versus 40% for open repair, p<0.05), and the severity of these complications was less, as evidenced by the shorter hospital stays for endovascular patients with complications compared to conventionally treated patients with complications (6.7 ± 2.4 days versus 22.5 ± 35.2 days, p<0.05). There were no aneurysm ruptures or late surgical conversions in either group. Conclusions: Patients with AAA who were endograft candidates but who were treated with open repair experienced more morbidity and had more complications than patients treated with stent-grafts. Despite increased comorbidities in the endograft patients, there was no increase in mortality compared to open repair. Both treatments required secondary procedures and appeared to be equally effective in preventing aneurysm rupture up to 3 years.

scholarly journals Functional Long-Term Outcome after Left- versus Right-Sided Intracerebral Hemorrhage

2017 ◽  
Vol 43 (3-4) ◽  
pp. 117-123 ◽  
Author(s):  
Vanessa D. Beuscher ◽  
Joji B. Kuramatsu ◽  
Stefan T. Gerner ◽  
Julia Köhn ◽  
Hannes Lücking ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Outcome Measures ◽  
A Priori ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Excellent Outcome ◽  
Confounding Variables ◽  
Baseline Characteristics

Background and Purpose: Hemispheric location might influence outcome after intracerebral hemorrhage (ICH). INTERACT suggested higher short-term mortality in right hemispheric ICH, yet statistical imbalances were not addressed. This study aimed at determining the differences in long-term functional outcome in patients with right- vs. left-sided ICH with a priori-defined sub-analysis of lobar vs. deep bleedings. Methods: Data from a prospective hospital registry were analyzed including patients with ICH admitted between January 2006 and August 2014. Data were retrieved from institutional databases. Outcome was assessed using the modified Rankin Scale (mRS) score. Outcome measures (long-term mortality and functional outcome at 12 months) were correlated with ICH location and hemisphere, and the imbalances of baseline characteristics were addressed by propensity score matching. Results: A total of 831 patients with supratentorial ICH (429 left and 402 right) were analyzed. Regarding clinical baseline characteristics in the unadjusted overall cohort, there were differences in disfavor of right-sided ICH (antiplatelets: 25.2% in left ICH vs. 34.3% in right ICH; p < 0.01; previous ischemic stroke: 14.7% in left ICH vs. 19.7% in right ICH; p = 0.057; and presence/extent of intraventricular hemorrhage: 45.0% in left ICH vs. 53.0% in right ICH; p = 0.021; Graeb-score: 0 [0-4] in left ICH vs. 1 [0-5] in right ICH; p = 0.017). While there were no differences in mortality and in the proportion of patients with favorable vs. unfavorable outcome (mRS 0-3: 142/375 [37.9%] in left ICH vs. 117/362 [32.3%] in right ICH; p = 0.115), patients with left-sided ICH showed excellent outcome more frequently (mRS 0-1: 64/375 [17.1%] in left ICH vs. 43/362 [11.9%] in right ICH; p = 0.046) in the unadjusted analysis. After adjusting for confounding variables, a well-balanced group of patients (n = 360/hemisphere) was compared showing no differences in long-term functional outcome (mRS 0-3: 36.4% in left ICH vs. 33.9% in right ICH; p = 0.51). Sub-analyses of patients with deep vs. lobar ICH revealed also no differences in outcome measures (mRS 0-3: 53/151 [35.1%] in left deep ICH vs. 53/165 [32.1%] in right deep ICH; p = 0.58). Conclusion: Previously described differences in clinical end points among patients with left- vs. right-hemispheric ICH may be driven by different baseline characteristics rather than by functional deficits emerging from different hemispheric functions affected. After statistical corrections for confounding variables, there was no impact of hemispheric location on functional outcome after ICH.

scholarly journals An Exploratory Study of Long-Term Outcome Measures in Critical Illness Survivors

2016 ◽  
Vol 44 (6) ◽  
pp. e362-e369 ◽  
Author(s):  
Angela S. McNelly ◽  
Jai Rawal ◽  
Dinesh Shrikrishna ◽  
Nicholas S. Hopkinson ◽  
John Moxham ◽  
...  
Keyword(s):  
Critical Illness ◽  
Outcome Measures ◽  
Exploratory Study ◽  
Term Outcome ◽  
Long Term Outcome

Do We Need to Review Outcome Measures in Schizophrenia to Capture ‘Real-life’ Situation?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Shrivastava
Keyword(s):  
Outcome Measures ◽  
Real Life ◽  
List Type ◽  
Life Situation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Study ◽  
Real Life Situation ◽  
New Perspective

Introduction:Outcome measures in schizophrenia are defining aspects for deciding the status of recovery based upon which people’ scientific body forms opinions. It is also important in dealing with stigma related to schizophrenia. Recently the concept of ‘recovery’ and ’ outcome’ has come under scientific scrutiny. Literature does not show a consistent pattern in outcome. both short term and long-term outcome show variability, which is often, explained by cultural factors. It has been generally considered that devolved countries have poor outcome than developing, non-industrialized countries. This view has also been challenged recently. the paper draws from the conceptual aspects if our outcome measure are capturing ‘real-life’ situation. We conducted two studies in Mumbai, India:1.Study of stigma & discrimination, which brought out the facts of families’ expectation and disappointments with level of recovery.2.A 10 years long term study, to determine recovery status of recovered patients.80% patients and families felt that recovery is inadequate and short of social integration despite continued treatment in stigma study. in outcome study, 60% patients showed good recovery as per CGIS. These patients were reassessed on 13 outcome criteria's of Meltzer. It is observed tat half of the patients who recovered continue to live with symptoms, a quarter with varying suicidality and side effects, most of the patients were not socially integrated, majority have not returned to productivity, employment and education It is concluded that outcome criteria's need a thoughtful revision and a new perspective to capture ground reality.

Hybrid Open-Endovascular Repair in a Patient With Giant Contained Aortic Aneurysm Rupture

2020 ◽  
Vol 54 (8) ◽  
pp. 725-728
Author(s):  
David Lee ◽  
January Moore ◽  
Tariq Almerey ◽  
Albert Hakaim ◽  
Houssam Farres
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
High Mortality ◽  
Endovascular Repair ◽  
Gold Standard ◽  
Thoracic Aortic Aneurysm ◽  
Open Repair ◽  
Aneurysm Rupture ◽  
Abdominal Aortic ◽  
Repair Techniques

Contained rupture of an aortic aneurysm is a high-mortality condition that requires immediate repair. Open repair has been the gold standard; however, endovascular and hybrid open-endovascular repair techniques have also emerged as less invasive solutions to this vascular emergency. Here. we present a patient with a giant 14.0 cm contained rupture of a Thoracic aortic aneurysm and 7.4 cm juxtarenal abdominal aortic aneurysm who was successfully treated with hybrid open-endovascular repair.

Long-term outcome and quality of life after ruptured abdominal aortic aneurysm repair

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 231-238 ◽  
Author(s):  
Hilin Yildirim ◽  
Guus W van Lammeren ◽  
Çagdas Ünlü ◽  
Eric P van Dongen ◽  
Rob HW van de Mortel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Open Repair ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Long Term Outcome ◽  
Abdominal Aortic

Objectives To evaluate long-term outcome and quality of life after open and endovascular repair of ruptured abdominal aortic aneurysms. Methods All consecutive ruptured abdominal aortic aneurysm patients at the St. Antonius Hospital treated for ruptured abdominal aortic aneurysm between January 2005 and January 2015 were included. Mortality, morbidity, and re-interventions within 30 days and during follow-up were registered. Quality of life was measured with Short Form-36 questionnaire among survivors. Additional subgroup analysis between open repair and endovascular repair was performed. Results A total of 192 patients with ruptured abdominal aortic aneurysm were included: 76.6% (147/192) underwent open repair and 23.4% (45/192) endovascular repair. All-cause 30-day mortality rate was 31.3% (60/192), and 30-day morbidity rate was 70.3% (135/192). Median stay at the intensive care unit was two days for endovascular repair and four days for open repair ( p = 0.002). No other statistically significant differences between endovascular repair and open repair were observed. After a mean follow-up period of 62 months (range 9–126), 72.4% (76/105) of the responders had equivalent Short Form-36 scores as compared to the age-matched general Dutch population, and 84.2% (64/76) of the responders would choose surgery again if they would have a ruptured abdominal aortic aneurysm. Conclusions Survivors of ruptured abdominal aortic aneurysm have similar long-term quality of life scores compared to the age-matched general population. The majority of all survivors would choose to undergo acute abdominal aortic aneurysm repair again.

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