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Variation in Surgical Treatment of Abdominal Aortic Aneurysms With Small Aortic Diameters in the Netherlands.

荷兰主动脉直径较小的腹主动脉瘤手术治疗的变异。

  • 影响因子:4.91
  • DOI:10.1097/SLA.0000000000003050
  • 作者列表:"Karthaus EG","Vahl A","van der Werf LR","Elsman BHP","Van Herwaarden JA","Wouters MWJM","Hamming JF
  • 发表时间:2020-04-01
Abstract

OBJECTIVE:To evaluate reasons to deviate from aneurysm diameter thresholds, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. BACKGROUND:Guidelines recommend surgical treatment for asymptomatic abdominal aortic aneurysms (AAAs) with a diameter of at least 55 mm for men and 50 mm for women. We evaluate reasons to deviate from these guidelines, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. METHODS:All patients undergoing elective AAA repair between 2013 and 2016 registered in the Dutch Surgical Aneurysm Audit (DSAA) were included. Surgery at diameters of <55 mm for men and <50 mm for women were considered guideline deviations. National deviation and hospital variation in deviation were evaluated over time. Questionnaires were distributed among all Dutch VSUs, inquiring for acceptable reasons for guideline deviation. VSUs were asked to estimate the guideline deviation percentage in their hospital which was then compared with their DSAA percentage. RESULTS:In all, 9039 patients were included. In 15%, we found guideline deviation, varying from 2% to 40% between VSUs. Over time, 21 VSUs were identified with a lower percentage of deviation than the national mean each year and 8 VSUs with a higher percentage. 44/60 VSUs completed the questionnaire. Most commonly reported reasons to deviate were concomitant large iliac diameter (91%) and saccular aneurysm (82%). The majority of the VSUs (77%) estimated their guideline deviation to be <5%. Eleven VSUs (25%) estimated their deviation concordant with their DSAA percentage, but 75% of VSUs underestimated their deviation. CONCLUSIONS:Dutch VSUs regularly deviate from the guidelines regarding aneurysm diameter, with variation between VSUs. Consensus exists amongst VSUs on acceptable reasons for guideline deviations; however, the majority underestimates their actual deviation percentage.

摘要

目的: 评估偏离动脉瘤直径阈值的原因,并重点讨论荷兰血管外科单位 (VSUs) 如何感知其偏差及其实际偏差的差异。 背景: 指南推荐手术治疗无症状的腹主动脉瘤 (AAAs),男性直径至少 55mm,女性 50mm。我们评估偏离这些指南的原因,并关注荷兰血管外科单位 (VSUs) 如何感知其偏差及其实际偏差的差异。 方法: 纳入 2013 年至 2016 年间在荷兰外科动脉瘤审核 (DSAA) 登记的所有接受择期AAA修复的患者。男性直径 <55mm和女性直径 <50mm的手术被认为是指南偏差。随着时间的推移,评价了全国偏差和医院偏差的变化。在所有荷兰VSUs中分发问卷,询问指南偏差的可接受原因。VSUs被要求估计他们医院的指南偏差百分比,然后与他们的DSAA百分比进行比较。 结果: 共纳入 9039 例患者。在 15% 中,我们发现指南偏差,VSUs之间的偏差从 2% 到 40% 不等。随着时间的推移,发现 21 个VSUs的偏差百分比低于国家每年的平均值,8 个VSUs的偏差百分比高于国家平均值。44/60 VSUs完成了调查问卷。最常报告的偏离原因是合并大髂骨直径 (91%) 和囊状动脉瘤 (82%)。大多数VSUs (77%) 估计其指南偏差 <5%。11 个VSUs (25%) 估计其偏差与DSAA百分比一致,但 75% 的VSUs低估了其偏差。 结论: 荷兰VSUs经常偏离关于动脉瘤直径的指南,VSUs之间存在变异。VSUs对指南偏差的可接受原因存在共识; 然而,大多数人低估了他们的实际偏差百分比。

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相关文献
影响因子:1.05
发表时间:2020-02-01
DOI:10.23736/S0021-9509.18.10206-0
作者列表:["Peters AS","Hatzl J","Bischoff MS","Böckler D"]

METHODS:BACKGROUND:Due to recent advances in endograft design and percutaneous access, technical success could be increased during endovascular aneurysm repair (EVAR). Beside EVAR, endovascular aneurysm sealing (EVAS) provides an alternative procedure to treat aneurysms. To compare the two methods, additional benchmark criteria should be evaluated: Screening time, dose area product (DAP), procedure time and contrast use. In this study these technical variables are analyzed for EVAS vs. EVAR in comparable patient cohorts. METHODS:It is a retrospective, single-center study. Only elective cases of infrarenal aortic aneurysms were included, all treated by the same surgeon (D.B.). Procedures were performed within the instructions for use without additional procedures. All operations were undertaken in a hybrid operating theatre. For EVAR, only the Medtronic Endurant® and the Gore C3 Excluder® were included. For EVAS the Nellix® from Endologix was used. RESULTS:Between 2012 and 2016, 67 patients were treated with EVAS and 40 with EVAR; of these 20 and 16 could be introduced into the study respectively. Median age was 73 and 72 years respectively (only men). The two groups were comparable in terms of BMI, GFR and ASA-status. Screening time was reduced for EVAS (10.6 vs. 14.5 min., P<0.01), while the DAP was not significantly different. Procedural time and contrast use were increased for EVAS (120 vs. 96 min., 120 vs. 79 mL, P<0.01). CONCLUSIONS:Especially the younger EVAS-procedure requires ongoing review in order to further reduce contrast agent. Reduced screening time for EVAS does not have a significant impact on radiation dose.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:4.91
发表时间:2020-04-01
来源期刊:Annals of surgery
DOI:10.1097/SLA.0000000000003050
作者列表:["Karthaus EG","Vahl A","van der Werf LR","Elsman BHP","Van Herwaarden JA","Wouters MWJM","Hamming JF"]

METHODS:OBJECTIVE:To evaluate reasons to deviate from aneurysm diameter thresholds, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. BACKGROUND:Guidelines recommend surgical treatment for asymptomatic abdominal aortic aneurysms (AAAs) with a diameter of at least 55 mm for men and 50 mm for women. We evaluate reasons to deviate from these guidelines, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. METHODS:All patients undergoing elective AAA repair between 2013 and 2016 registered in the Dutch Surgical Aneurysm Audit (DSAA) were included. Surgery at diameters of <55 mm for men and <50 mm for women were considered guideline deviations. National deviation and hospital variation in deviation were evaluated over time. Questionnaires were distributed among all Dutch VSUs, inquiring for acceptable reasons for guideline deviation. VSUs were asked to estimate the guideline deviation percentage in their hospital which was then compared with their DSAA percentage. RESULTS:In all, 9039 patients were included. In 15%, we found guideline deviation, varying from 2% to 40% between VSUs. Over time, 21 VSUs were identified with a lower percentage of deviation than the national mean each year and 8 VSUs with a higher percentage. 44/60 VSUs completed the questionnaire. Most commonly reported reasons to deviate were concomitant large iliac diameter (91%) and saccular aneurysm (82%). The majority of the VSUs (77%) estimated their guideline deviation to be <5%. Eleven VSUs (25%) estimated their deviation concordant with their DSAA percentage, but 75% of VSUs underestimated their deviation. CONCLUSIONS:Dutch VSUs regularly deviate from the guidelines regarding aneurysm diameter, with variation between VSUs. Consensus exists amongst VSUs on acceptable reasons for guideline deviations; however, the majority underestimates their actual deviation percentage.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:1.05
发表时间:2020-04-01
DOI:10.23736/S0021-9509.18.10639-2
作者列表:["Kodama H","Takahashi S","Okazaki T","Morita S","Go S","Watanabe M","Yamane Y","Katayama K","Kurosaki T","Sueda T"]

METHODS:BACKGROUND:Spinal cord ischemia (SCI) and paraplegia are complications of surgery for type A acute aortic dissection (TAAAD). Since the segmental arteries play a key role in SCI, this study evaluated the association between SCI and false lumen segmental arteries (FLSAs: segmental arteries originating from the false lumen). METHODS:The study included 101 consecutive TAAAD patients (mean age, 66±13; range, 34-89 years) who underwent surgery from January 2011 to April 2017. The diagnosis of TAAAD and the number of FSLAs were determined by preoperative computed tomography (CT). Patients were divided into two groups according to the number of FLSAs at the Th9-L2 level: Group A (N.=13), ≥8 FLSAs; and group B (N.=88), ≤7 FLSAs. Preoperative, perioperative, and postoperative findings were compared between the groups, and risk factors for SCI were evaluated. RESULTS:The frequency of preoperative paralysis was significantly higher in Group A than Group B (P=.0070). The overall incidence of postoperative SCI was 8% (8/101) and significantly higher in Group A than Group B (5/13 [45%] vs. 3/88 (4%), P<0.0001). Hospital mortality was 8% (8/101) and significantly higher in Group A than Group B (3/13 [23%] vs. 5/88 [6%], P=.0302). Multivariate analysis showed that the independent risk factors for SCI were ≥8 FLSAs at Th9-L2 (odds ratio [OR], 20.4; 95% confidence interval [95% CI], 3.34-124.9, P=0.0011) and diabetes mellitus (OR, 22.3; 95% CI, 1.69-294.5; P=0.0184). CONCLUSIONS:In patients who underwent surgery for TAAAD, ≥8 FLSAs at the Th9-L2 levels on preoperative CT was a risk factor for SCI.

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动脉瘤方向

动脉瘤是由于动脉壁的病变或损伤,形成动脉壁局限性或弥漫性扩张或膨出,以膨胀性、搏动性肿块为主要表现,可以发生在动脉系统的任何部位,而以肢体主干动脉、主动脉和颈动脉较为常见。

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