What Is A Surgical Aaa Repair
Am Fam Dr.. 2006 Apr one;73(vii):1198-1204.
Patient information: See related handout on abdominal aortic aneurysms, written past Jill Giordano, Medical Editing Clerk at Georgetown University Medical Eye.
Related Editorial
Article Sections
- Abstract
- Definition and Etiology
- Screening
- Clinical Evaluation
- Medical Optimization
- Open vs. Endovascular Repair
- References
Well-nigh abdominal aortic aneurysms (AAAs) are asymptomatic, non detectable on physical exam, and silent until discovered during radiologic testing for other reasons. Tobacco apply, hypertension, a family history of AAA, and male sex are clinical take a chance factors for the development of an aneurysm. Ultrasound, the preferred method of screening, is price-effective in high-run a risk patients. Repair is indicated when the aneurysm becomes greater than v.five cm in diameter or grows more than than 0.6 to 0.8 cm per twelvemonth. Asymptomatic patients with an AAA should be medically optimized earlier repair, including institution of beta blockade. Symptomatic aneurysms present with dorsum, abdominal, buttock, groin, testicular, or leg pain and require urgent surgical attention. Rupture of an AAA involves complete loss of aortic wall integrity and is a surgical emergency requiring immediate repair. The bloodshed charge per unit approaches xc pct if rupture occurs outside the hospital. Although open surgical repair has been performed safely, an endovascular arroyo is used in select patients if the aortic and iliac anatomy are amenable. Ii large randomized controlled trials did not detect any improvement in mortality rate or morbidity with this arroyo compared with conventional open surgical repair.
Abdominal aortic aneurysm (AAA) is a relatively common and ofttimes fatal condition that primarily affects older patients. AAAs and 15,000 deaths yearly and in 2000 were the 10th leading cause of decease in white men 65 to 74 years of age in the United States.one With an crumbling population, the incidence and prevalence of AAA is certain to rising. Virtually AAAs are asymptomatic, and physical examination lacks sensitivity for detecting an aneurysm.2 It is of import that family physicians empathise which patients are at risk for the evolution of AAA and the appropriate evaluation once a patient has been diagnosed with an aneurysm.
Definition and Etiology
- Abstract
- Definition and Etiology
- Screening
- Clinical Evaluation
- Medical Optimization
- Open up vs. Endovascular Repair
- References
An aneurysm is a permanent focal dilatation of an artery to 1.v times its normal bore. The normal infrarenal aortic diameters in patients older than 50 years are 1.five cm in women and 1.seven cm in men. By convention, an infrarenal aorta 3 cm in bore or larger is considered aneurysmal.iii
The primary event in the development of an AAA involves proteolytic deposition of the extracellular matrix proteins elastin and collagen. Diverse proteolytic enzymes, including matrix metalloproteinases, are critical during the degradation and remodeling of the aortic wall.four Oxidative stress as well plays an important role, and there is an autoimmune component to the development of AAA, with extensive lymphocytic and monocytic infiltration with deposition of immunoglobulin G in the aortic wall.4 Cigarette smoking elicits an increased inflammatory response inside the aortic wall.v An infectious etiology with Chlamydia pneumoniae has been proposed but non proven.4 Increased biomechanical wall stress also contributes to the formation and rupture of aneurysms with increased wall tension and disordered flow in the infrarenal aorta.four Finally, 12 to 19 per centum of start-caste relatives, predominantly men, of a patient with an AAA will develop an aneurysm.6
SORT: Cardinal RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Ultrasound should exist used to screen for the presence of AAA in men 65 to 75 years of age who have ever smoked, and it tin be considered for patients with a strong family history of AAA. | B | 7,8 |
| Beta blockade, with a goal resting centre rate of 60 beats per minute, should exist instituted earlier AAA repair in all patients unless contraindicated. | A | 17,26–29 |
| Repair of an AAA should be considered when the aneurysm reaches 5.five cm in maximal diameter in men. | A | 18,19,21 |
| Repair of an AAA likewise should be considered when the aneurysm expands by more than 0.6 to 0.viii cm per year. | C | 21,22 |
Screening
- Abstract
- Definition and Etiology
- Screening
- Clinical Evaluation
- Medical Optimization
- Open vs. Endovascular Repair
- References
Ultrasound is the standard imaging tool; if performed by trained personnel, it has a sensitivity and specificity approaching 100 and 96 percent, respectively, for the detection of infrarenal AAA7 ( Effigy 1 ). The U.S. Preventive Services Chore Strength has released a statement summarizing recommendations for screening for AAA.8 Information technology stated that screening benefits patients who have a relatively high risk for dying from an aneurysm; major take a chance factors are age 65 years or older, male sex, and smoking at least 100 cigarettes in a lifetime. The guideline recommends one-fourth dimension screening with ultrasound for AAA in men 65 to 75 years of age who have ever smoked. No recommendation was fabricated for or against screening in men 65 to 75 years of age who take never smoked, and information technology recommended against screening women. Men with a strong family history of AAA should be counseled most the risks and benefits of screening as they arroyo 65 years of age.
Figure ane.
Ultrasound of abdominal aortic aneurysm documenting aortic anterior-posterior (A-P) and transverse bore.
Clinical Evaluation
- Abstract
- Definition and Etiology
- Screening
- Clinical Evaluation
- Medical Optimization
- Open vs. Endovascular Repair
- References
ASYMPTOMATIC PATIENTS
Most patients with AAA are asymptomatic. Typically, aneurysms are noted on studies performed for other reasons, as opposed to during physical exam. In these patients, it is of import to confirm that there is no evidence of significant back, abdominal, or groin pain.
The medical, social, and family history are of import in determining if risk factors for evolution, expansion, and rupture of an aneurysm are present (Table anehalf dozen,9–14). Previous abdominal operations tin can make open up AAA repair technically hard and may necessitate a retroperitoneal approach instead of a transabdominal arroyo. A history of endovascular AAA repair also is important considering AAA rupture following endograft repair has been reported.15 Aneurysms proximal and distal to a previous graft (eastward.g., synchronous AAA) as well may occur and present as a pulsatile abdominal mass.
Table 1
Take a chance Factors for AAA-Related Events
| AAA consequence | Risk factors |
|---|---|
| Development | Family history (predominantly in men)half-dozen; hypercholesterolemia9; hypertension9; male sex9; tobacco use9 |
| Expansion | Advanced age (older than 70 years)10; cardiac or renal transplant11; previous stroke10; severe cardiac disease10; tobacco use10 |
| Rupture | Cardiac or renal transplant11; decreased forced expiratory volume in ane second12; female sex (two- to fourfold increase in hazard of rupture)12; college hateful blood pressure12; larger initial AAA diameter13; current tobacco utilize (length of time smoking is more significant than amount smoked)14 |
Abdominal examination in a patient with a suspected AAA should include deep manipulation to arm-twist pain on aortic palpation. The abdominal aorta may be palpated every bit part of a normal physical test without beingness frankly aneurysmal. However, AAAs in the three- to iii.9-cm range are palpable 29 percent of the time, whereas those greater than 5 cm are palpable 76 percent of the fourth dimension.two
The common iliac arteries besides may be aneurysmal and palpable in the lower intestinal quadrants. Patients should be examined for the presence of femoral and popliteal pulses and possible aneurysmal dilatation. The presence of a prominent popliteal or femoral artery pulse warrants an abdominal ultrasound to rule out an AAA and a lower extremity arterial ultrasound to rule out peripheral avenue aneurysm. There is a 62 percent take a chance that an AAA is present with a popliteal aneurysm and an 85 pct chance information technology is present with a femoral artery aneurysm; 14 per centum of patients with a known AAA will have a femoral or popliteal artery aneurysm.xvi
Patients who are diagnosed with an AAA, deny pain, and are clinically stable should exist triaged based on the size of the aneurysm ( Figure 2 17). Two large prospective studies18,19 determined independently that surveillance in compliant male person patients with an aneurysm four to 5.5 cm broad is safe; surgery on AAAs smaller than 5.v cm did non confer any survival advantage.
Assessment of a Patient Presenting with an Abdominal Mass
The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
Figure ii.
Patients with aneurysms greater than or equal to 5.5 cm should be considered for elective AAA repair. Because most clinically diagnosed AAAs are repaired, their long-term natural history is difficult to predict. The one-year incidence of rupture is nine percentage for aneurysms 5.5 to 6.0 cm in diameter, 10 pct for 6.0 to 6.9 cm, and 33 percent for AAAs of 7.0 cm or more than.eight Patients with an aneurysm less than 5.5 cm in diameter should have follow-up serial ultrasounds (Table 27 ). These recommendations serve only as guidelines; each patient should exist evaluated for the presence of risk factors for accelerated AAA growth and rupture (Tabular array 1vi,nine–14) and for surgical hazard and overall health. A validated clinical decision rule has been published that tin can help physicians determine a patient's perioperative mortality risk based on individual risk factors and the overall complication rate.20
Table 2
Recommended Ultrasound Surveillance for Patients with Intestinal Aortic Aneurysm
| Diameter of aneurysm | Interval for follow-upwardly |
|---|---|
| Less than iii cm | No further testing |
| 3 to 4 cm | Every 12 months |
| four to four.5 cm | Every half-dozen months |
| Greater than four.5 cm | Consider referral to vascular subspecialist. |
Traditionally, if the AAA expands past more than 0.6 to 0.8 cm per year, the patient should exist offered repair.21,22 A recent study23 examining expansion as a criterion for repair failed to observe a benefit in a small group of patients; further studies are needed. All patients with AAAs should exist educated on the signs of symptomatic and ruptured aneurysms. If they experience new or unusual pain in the back, groin, testicles, legs, or buttocks, emergent medical attention should exist sought.
SYMPTOMATIC PATIENTS
In patients presenting with back, abdominal, or groin pain in the presence of a pulsatile abdominal mass, the aorta needs to exist evaluated urgently. If the patient is clinically stable, an urgent computed tomography (CT) scan should be obtained ( Figure three ) to determine the presence and size of the aorta, as well every bit to rule out a ruptured AAA. Outcomes for repair of symptomatic AAAs are significantly worse than for asymptomatic aneurysms. I study24 noted a bloodshed charge per unit of 26 percent in patients with symptomatic AAAs compared with v per centum for asymptomatic AAAs and 35 percent for ruptured AAAs. Postoperative morbidity of patients undergoing symptomatic AAA repair is like to those undergoing ruptured AAA repair.24 This underscores the importance of intervention at a betoken where the risk of rupture is greater than the risk of surgery, merely before symptoms occur.
Effigy three.
Iii-dimensional computed tomography scan of an abdominal aortic aneurysm in a patient presenting with abdominal pain documenting an intact, but symptomatic aneurysm.
PATIENTS WITH RUPTURED AAA
The classic presentation of a ruptured AAA includes the triad of hypotension, abdominal or back hurting, and a pulsatile abdominal mass. In a study25 of 116 patients with ruptured AAAs, 45 percent were hypotensive, 72 percent had pain, and 83 percent had a pulsatile abdominal mass. Patients with ruptured AAAs need immediate intervention to foreclose death. Despite advances in perioperative care leading to significant decreases in mortality following AAA repair in asymptomatic patients, postoperative mortality following ruptured AAA repair is still more than 40 percent in patients who survive the operation.thirteen In full general, high-book hospitals (i.e., performing more than 30 AAA repairs per yr) accept lower mortality rates, every bit well as fewer postoperative complications, compared with depression-volume hospitals following elective AAA repair.13 If given the selection, it may be benign to refer patients with symptomatic or ruptured AAAs to high-volume centers when availability and time allow.
Medical Optimization
- Abstract
- Definition and Etiology
- Screening
- Clinical Evaluation
- Medical Optimization
- Open vs. Endovascular Repair
- References
When evaluating asymptomatic patients earlier AAA repair, it is of import to optimize their comorbidities, particularly cardiac, pulmonary, and renal functions. Patients with coronary avenue disease should undergo beta occludent.26 In a study27 of high-gamble patients undergoing vascular surgery, bisoprolol (Zebeta) was administered at a dosage of 5 mg in one case daily at least one week preoperatively. The dosage was increased to a maximum of 10 mg once daily if resting heart rate was yet greater than 60 beats per infinitesimal approximately one week afterward institution of therapy. Bisoprolol was withheld if the middle rate was less than 50 beats per infinitesimal or the systolic blood pressure fell to less than 100 mm Hg. Death from cardiac causes or nonfatal myocardial infarction occurred in 3.4 pct of the bisoprolol group and 34 percent of the standard-care group (P > .001). A recent meta-analysis28 has confirmed this do good in high-risk patients merely non in low-take chances patients.
The American College of Cardiology/American Heart Association Task Force on Practice Guidelines has provided an algorithm for evaluating what preoperative testing patients need. The guidelines were updated in 2002 and can exist accessed online athttp://circ.ahajournals.org/cgi/content/total/105/10/1257.29 More than recently, another study30 found that patients with stable cardiac disease practise not benefit from coronary revascularization before constituent vascular procedures. These information were not extrapolated to patients with unstable angina, aortic stenosis, or severe left ventricular dysfunction, and it was postulated that medical optimization earlier repair may have contributed to improved outcomes. Therefore, preoperative cardiac evaluation, including use of cardiac medications, is appropriate in certain patients who are to undergo constituent open up AAA repair. The cardiovascular evaluation is intended to reduce perioperative risk and better long-term survival. There are insufficient data to justify a reduced preoperative cardiology work-up earlier endovascular repair.31
Patients with chronic obstructive pulmonary disease have a higher risk of major clinical complications from AAA, specially in the presence of concurrent cardiac illness, suboptimal chronic obstructive pulmonary illness management, or chronic renal illness.32 Smoking cessation for at least two months preoperatively has been constitute to decrease the risk of pulmonary morbidity compared with patients who smoke up to the time of surgery.33
A study34 of 8,185 intact and 1,829 ruptured AAA repairs showed that impaired renal function has a strong effect on mortality. The bloodshed rate was 41.2 per centum in patients with renal failure and 6.ii percent in patients with normal renal function (P = .001) among patients undergoing elective repair of an intact AAA. Similar results were found in patients undergoing repair of a ruptured AAA.34 Diabetes does not increment mortality following AAA repair, but it is associated with an increment in length of infirmary stay.35 Recognition and optimization of a patient's comorbidities earlier open AAA repair may reduce postoperative morbidity.
Open up vs. Endovascular Repair
- Abstract
- Definition and Etiology
- Screening
- Clinical Evaluation
- Medical Optimization
- Open up vs. Endovascular Repair
- References
The two chief methods of AAA repair are open up and endovascular. Earlier repair, a CT browse of the aorta and iliac arteries is required (Tabular array three17). Traditional open AAA repair involves directly admission to the aorta through an incision in the abdomen. This repair method is well established as definitive, requiring essentially no follow-up radiologic studies. The majority of patients undergoing open AAA repair remain without significant graft-related complications during the rest of their lives (0.4 to 2.three per centum incidence of late graft-related complications in contempo studies).36
Table 3
Characteristics of AAA Imaging Modalities
The rightsholder did non grant rights to reproduce this item in electronic media. For the missing item, see the original impress version of this publication.
Endovascular repair of an AAA involves gaining admission to the lumen of the abdominal aorta, usually via pocket-sized incisions over the femoral vessels. An endograft, typically a cloth graft with a stent exoskeleton, is placed inside the lumen of the AAA extending distally into the iliac arteries. This serves every bit a bypass and decreases the pressure on the aortic wall, leading to a reduction in AAA size over time and a decrease in the take chances of aortic rupture. Close follow-upwards is required later endovascular repair with CT scans performed at one, six, and 12 months, and and then yearly to ensure that the graft is accomplishing its intended goal (e.one thousand., asymptomatic patient, decreasing AAA size, structurally intact endograft, no fixation site bug or significant graft migration).
Endograft AAA repair was canonical by the U.S. Food and Drug Administration in 1999 and it remains a relatively new technology; outcomes greater than v years in patients with endografts are now available.37 In-infirmary bloodshed of AAA open repair is 3.viii, versus ane.2 pct for endovascular repair.38 Thirty-solar day mortality has been reported as i.1 to 2.vii percent for open up repair and 0 to 1.seven pct for endovascular repair37,39; however, a 5-year comparison of open up versus endovascular repair did not show a significant difference in all-cause bloodshed during a recent nonrandomized prospective analysis. Postprocedural conversion to an open repair from endovascular was required in 2.8 percent of patients.37 The best evidence is from the Endovascular Aneurysm Repair (EVAR) 1 trial.40 It randomized 543 patients to endovascular repair and 539 to traditional open up repair; all of the patients were candidates for open up repair. Subsequently iii years, the all-cause mortality was identical in the two groups (28 percent).twoscore The EVAR 2 trial41 compared endovascular repair with watchful waiting in patients who were not candidates for open repair. Although 25 percent of patients in the watchful waiting group underwent AAA repair during the 4 years of follow-up, in that location was no difference in all-crusade bloodshed betwixt the groups.41
Emergent repair of ruptured AAAs is traditionally performed using the open method. However, more centers are performing endovascular repair on ruptured aneurysms that fit anatomic and physiologic criteria and experiencing promising results.42
To see the total article, log in or purchase access.
REFERENCES
show all references
ane. Anderson RN. Deaths: leading causes for 2000. Natl Vital Stat Rep. 2002;50:1–85. ...
2. Lederle FA, Simel DL. The rational clinical exam. Does this patient have intestinal aortic aneurysm?. JAMA. 1999;281:77–82.
3. Lederle FA, Johnson GR, Wilson SE, Gordon IL, Chute EP, Littooy FN, et al. Human relationship of age, gender, race, and trunk size to infrarenal aortic diameter. J Vasc Surg. 1997;26:595–601.
4. Wassef G, Baxter BT, Chisholm RL, Dalman RL, Fillinger MF, Heinecke J, et al. Pathogenesis of abdominal aortic aneurysms. J Vasc Surg. 2001;34:730–viii.
5. Rasmussen TE, Hallett JW Jr, Tazelaar HD, Miller VM, Schulte S, O'Fallon WM, et al. Human being leukocyte antigen class Ii allowed response genes, female gender, and cigarette smoking as chance and modulating factors in intestinal aortic aneurysms. J Vasc Surg. 2002;35:988–93.
6. van Vlijmenvan Keulen CJ, Pals One thousand, Rauwerda JA. Familial abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2002;24:105–16.
7. Kent KC, Zwolak RM, Jaff MR, Hollenbeck ST, Thompson RW, Schermerhorn ML, et al. Screening for abdominal aortic aneurysm. J Vasc Surg. 2004;39:267–9.
eight. U. S. Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation argument. Ann Intern Med. 2005;142:198–202.
9. Rodin MB, Daviglus ML, Wong GC, Liu Chiliad, Garside DB, Greenland P, et al. Center age cardiovascular run a risk factors and abdominal aortic aneurysm in older age. Hypertension. 2003;42:61–8.
x. Chang JB, Stein TA, Liu JP, Dunn ME. Take a chance factors associated with rapid growth of pocket-size abdominal aortic aneurysms. Surgery. 1997;121:117–22.
eleven. Englesbe MJ, Wu AH, Clowes AW, Zierler RE. The prevalence and natural history of aortic aneurysms in centre and abdominal organ transplant patients. J Vasc Surg. 2003;37:27–31.
12. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. Ann Surg. 1999;230:289–97.
13. Dimick JB, Stanley JC, Axelrod DA, Kazmers A, Henke PK, Jacobs LA, et al. Variation in decease charge per unit later on intestinal aortic aneurysmectomy in the Usa. Ann Surg. 2002;235:579–85.
14. Wilmink TB, Quick CR, Twenty-four hour period NE. The clan between cigarette smoking and intestinal aortic aneurysms. J Vasc Surg. 1999;30:1099–105.
fifteen. Corriere MA, Feurer ID, Becker SY, Dattilo JB, Passman MA, Guzman RJ, et al. Endoleak post-obit endovascular abdominal aortic aneurysm repair. Ann Surg. 2004;239:800–five.
16. Diwan A, Sarkar R, Stanley JC, Zelenock GB, Wakefield TW. Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg. 2000;31:863–9.
17. Schaub TA, Upchurch GR Jr. Pulsatile abdominal mass. ACS Surgery. New York: WebMD Inc., 2004. Accessed online November iv, 2005, at:http://world wide web.acssurgery.com/acs_toc.htm#link05.
eighteen. United kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of modest abdominal aortic aneurysms. N Engl J Med. 2002;346:1445–52.
19. Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346:1437–44.
20. Steyerberg EW, Kievit J, de Mol Van Otterloo JC, van Bockel JH, Eijkemans MJ, Habbema JD. Perioperative mortality of elective abdominal aortic aneurysm surgery. Arch Intern Med. 1995;155:1998–2004.
21. Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS. Guidelines for the treatment of intestinal aortic aneurysms. J Vasc Surg. 2003;37:1106–17.
22. Gadowski GR, Pilcher DB, Ricci MA. Abdominal aortic aneurysm expansion charge per unit: upshot of size and beta-adrenergic blockade. J Vasc Surg. 1994;19:727–31.
23. Sharp MA, Collin J. A myth exposed: fast growth in diameter does not justify precocious abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2003;25:408–eleven.
24. Sullivan CA, Rohrer MJ, Cutler BS. Clinical management of the symptomatic simply unruptured intestinal aortic aneurysm. J Vasc Surg. 1990;11:799–803.
25. Wakefield TW, Whitehouse WM Jr, Wu SC, Zelenock GB, Cronenwett JL, Erlandson EE, et al. Intestinal aortic aneurysm rupture. Surgery. 1982;91:586–96.
26. Mangano DT, Layug EL, Wallace A, Tateo I. Consequence of atenolol on mortality and cardiovascular morbidity after noncardiac surgery [published correction appears in North Engl J Med 1997;336:1039]. N Engl J Med. 1996;335:1713–20.
27. Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, et al. The outcome of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. N Engl J Med. 1999;341:1789–94.
28. Lindenauer PK, Pekow P, Wang K, Marmidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and bloodshed after major non-cardiac surgery. Northward Engl J Med. 2005;353:349–61.
29. Eagle KA, Berger Lead, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery. Circulation. 2002;105:1257–67.
thirty. McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, et al. Coronary-avenue revascularization before constituent major vascular surgery [published correction appears in N Engl J Med 2005;95:19]. North Engl J Med. 2004;351:2795–804.
31. Cuypers Pow, Buth J. Does endovascular aortic aneurysm repair justify a reduced cardiology piece of work-up?. J Cardiovasc Surg (Torino). 2003;44:437–42.
32. Upchurch GR Jr, Proctor MC, Henke PK, Zajkowski P, Riles EM, Ascher MS, et al. Predictors of severe morbidity and death after elective abdominal aortic aneurysmectomy in patients with chronic obstructive pulmonary disease. J Vasc Surg. 2003;37:594–9.
33. Warner MA, Offord KP, Warner ME, Lennon RL, Conover MA, Jansson-Schumacher U. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications. Mayo Clin Proc. 1989;64:609–xvi.
34. Katz DJ, Stanley JC, Zelenock GB. Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan. J Vasc Surg. 1994;19:804–15.
35. Axelrod DA, Upchurch GR Jr, DeMonner Southward, Stanley JC, Khuri South, Daley J, et al. Perioperative cardiovascular risk stratification of patients with diabetes who undergo elective major vascular surgery. J Vasc Surg. 2002;35:894–901.
36. Hertzer NR, Mascha EJ, Karafa MT, O'Hara PJ, Krajewski LP, Beven EG. Open infrarenal abdominal aortic aneurysm repair. J Vasc Surg. 2002;35:1145–54.
37. Moore WS, Matsumura JS, Makaroun MS, Katzen BT, Deaton DH, Decker Yard, et al. Five-year interim comparison of the Guidant bifurcated endograft with open repair of intestinal aortic aneurysm. J Vasc Surg. 2003;38:46–55.
38. Lee WA, Carter JW, Upchurch Grand, Seeger JM, Huber TS. Perioperative outcomes afterward open and endovascular repair of intact intestinal aortic aneurysms in the U.s.a. during 2001. J Vasc Surg. 2004;39:491–6.
39. Elkouri South, Gloviczki P, McKusick MA, Panneton JM, Andrews J, Bower TC, et al. Perioperative complications and early on result after endovascular and open surgical repair of abdominal aortic aneurysms. J Vasc Surg. 2004;39:497–505.
40. EVAR trial participants. Endovascular aneurysm repair versus open up repair in patients with abdominal aortic aneurysm (EVAR trial 1). Lancet. 2005;365:2179–86.
41. EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of intestinal aortic aneurysm (EVAR trial 2). Lancet. 2005;365:2187–92.
42. Peppelenbosch N, Yilmaz Northward, van Marrewijk C, Buth J, Cuypers P, Duijm L, et al. Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2003;26:303–x.
Copyright © 2006 by the American Academy of Family unit Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may utilize that printout simply for his or her personal, non-commercial reference. This cloth may non otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later on invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.
Virtually Contempo Outcome
Mar 2022
Access the latest consequence of American Family Doc
Read the Issue
Email Alerts
Don't miss a single issue. Sign up for the costless AFP e-mail tabular array of contents.
Sign Up Now
Source: https://www.aafp.org/afp/2006/0401/p1198.html
Posted by: shislergaidge.blogspot.com
0 Response to "What Is A Surgical Aaa Repair"
Post a Comment