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Complete replacemen...
Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair : a two-center 14-year experience
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- Mayer, D. (författare)
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
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- Aeschbacher, S. (författare)
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
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- Pfammatter, T. (författare)
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
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- Veith, F. J. (författare)
- The Cleveland Clinic, Cleveland OH, USA; New York University Medical Center, New York, USA
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- Norgren, Lars, 1942- (författare)
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
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- Magnuson, A. (författare)
- Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden
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- Rancic, Z. (författare)
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
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- Lachat, M. (författare)
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
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- Larzon, Thomas, 1950- (författare)
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
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(creator_code:org_t)
- Philadelphia, USA : Lippincott Williams & Wilkins, 2012
- 2012
- Engelska.
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Ingår i: Annals of Surgery. - Philadelphia, USA : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 256:5, s. 688-696
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Objective: To present the combined 14-year experience of 2 university centers performing endovascular aneurysm repair (EVAR) on 100% of noninfected ruptured abdominal aortic aneurysms (RAAA) over the last 32 months.Background: : Endovascular aneurysm repair for RAAA feasibility is reported to be 20% to 50%, and EVAR for RAAA has been reported to have better outcomes than open repair.Methods: We retrospectively analyzed prospectively gathered data on 473 consecutive RAAA patients (Zurich, 295; Örebro, 178) from January 1, 1998, to December 31, 2011, treated by an "EVAR-whenever-possible" approach until April 2009 (EVAR/OPEN period) and thereafter according to a "100% EVAR" approach (EVAR-ONLY period).Straightforward cases were treated by standard EVAR. More complex RAAA were managed during EVAR-ONLY with adjunctive procedures in 17 of 70 patients (24%): chimney, 3; open iliac debranching, 1; coiling, 8; onyx, 3; and chimney plus onyx, 2.Results: Since May 2009, all RAAA but one have been treated by EVAR (Zurich, 31; Örebro, 39); 30-day mortality for EVAR-ONLY was 24% (17 of 70). Total cohort mortality (including medically treated patients) for EVAR/OPEN was 32.8% (131 of 400) compared with 27.4% (20 of 73) for EVAR-ONLY (P = 0.376). During EVAR/OPEN, 10% (39 of 400) of patients were treated medically compared with 4% (3 of 73) of patients during EVAR-ONLY. In EVAR/OPEN, open repair showed a statistically significant association with 30-day mortality (adjusted odds ratio [OR] = 3.3; 95% confidence interval [CI], 1.4-7.5; P = 0.004). For patients with no abdominal decompression, there was a higher mortality with open repair than EVAR (adjusted OR = 5.6; 95% CI, 1.9-16.7). In patients with abdominal decompression by laparotomy, there was no difference in mortality (adjusted OR = 1.1; 95% CI, 0.3-3.7).Conclusions: The "EVAR-ONLY" approach has allowed EVAR treatment of nearly all incoming RAAA with low mortality and turndown rates. Although the observed association of a higher EVAR mortality with abdominal decompression needs further study, our results support superiority and more widespread adoption of EVAR for the treatment of RAAA.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- Abdominal compartment syndrome
- abdominal decompression
- chimney graft
- debranching
- endovascular repair
- open abdomen treatment
- open repair
- ruptured abdominal aortic aneurysm
- Kirurgi
- Surgery
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Mayer, D.
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Aeschbacher, S.
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Pfammatter, T.
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Veith, F. J.
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Norgren, Lars, 1 ...
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Magnuson, A.
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Rancic, Z.
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Lachat, M.
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Larzon, Thomas, ...
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