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1.
Background
Abdominal aortic aneurysm (AAA) rupture is associated with a high mortality. The only preventive therapy is early diagnosis and elective surgery of rupture prone AAAs. Using B-mode sonography AAAs can be detected early with great reliability. Thus, a population-based ultrasound screening might lower the risk of abdominal aortic aneurysm ruptures.Materials and methods
A literature analysis (until June 2014) was performed in the databases of MEDLINE, PubMed, and SCOPUS including all randomized controlled trials (RCT), systematic reviews, meta-analyses, health technology assessments (HTA reports) and medical guidelines on AAA screening. The following keywords were used: abdominal aortic aneurysm, ultrasound screening, evidence, guidelines. Clinically relevant endpoints were the following: AAA-associated mortality, overall mortality, number of elective AAA operations, number of ruptured AAAs and emergency surgery for different follow-up intervals.Results
In four RCTs men between 65 and 83 years either had a single or no ultrasound examination of the abdominal aorta. Older women were only analyzed in one RCT. The meta-analysis of the RCT results shows that ultrasound screening caused a significant decrease of AAA-associated mortality, number of ruptured abdominal aneurysms, and number of emergency operations, whereas the number of elective surgeries significantly increased. Overall mortality was only moderately decreased by AAA screening.Conclusion
Evidence was provided in population-based RCTs and meta-analyses for the efficiency of ultrasound based AAA screening for men older than 65 years. Presently the Federal Joint Committee (G-BA) and the Institute for Quality and Efficiency in Health Care (IQWIG) are evaluating a national ultrasound-based AAA screening program for Germany. However, additional clinical trials are necessary to assess risk groups especially men under 65 years, women with nicotine abuse and cardiovascular diseases which were underrepresented in previous studies. 相似文献2.
J.J. Earnshaw 《Gef?sschirurgie》2014,19(6):528-533
Background
Ruptured abdominal aortic aneurysm (AAA) is responsible for the premature death of more than 4,000 men in England and Wales every year. AAAs are usually asymptomatic before they rupture, yet they are easily detected by a simple abdominal ultrasound scan.Methods
This paper reviews the evidence for, and implementation of, a national AAA population screening programme in England.Results
Population screening of 65-year-old men can reassure most that they will not get an AAA, but it can also detect a small number of men with a large AAA at immediate risk of rupture, and a larger number of men with a small or medium AAA at minimal immediate risk, but who may be offered ongoing ultrasound surveillance. Population screening of men aged 65–74 has a sound evidence base, and reduces subsequent AAA-related mortality for at least 13 years by up to 50?%. Some Western countries, including the UK, have adopted population screening using public funding, whereas others remain to be convinced, and continue to collate research. The epidemiology of AAA is changing quickly, with the prevalence in 65-year-old men decreasing rapidly as smoking habits change and more medical treatments are used to manage cardiovascular risk factors.Conclusion
As evidence on the natural history of AAA continues to emerge, new and ongoing programmes will need to be responsive and adapt. The AAA screening programme of the future will evolve using emerging clinical and cost-effectiveness data. 相似文献3.
Rachel Claridge Sam Arnold Neil Morrison André M. van Rij 《Journal of vascular surgery》2017,65(6):1637-1642
Objective
This study aimed to determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the performance of radiologists to identify and report AAA.Methods
A retrospective audit of all abdominal CT scans performed on men and women ≥50 years at Dunedin Public Hospital between January 2013 and September 2014 was carried out. All CT scans for planning of AAA treatment or follow-up were excluded. The maximal anterior-posterior diameter of the infrarenal abdominal aorta was measured in both the sagittal and transverse planes on the picture archiving and communication system. The radiologist reports were analyzed. All detected AAAs were reviewed for clinical relevance.Results
A total of 3332 scans were performed, of which 86 scans were excluded, resulting in a total cohort of 3246. There were 187 incidental AAAs detected with a prevalence of 5.8%. The prevalence was 8.7% in men and 3.1% in women. Whereas the prevalence increased with age, a significant number were detected in those younger than 65 years, with a prevalence of 1.5%. Of the 187 AAAs, 122 (65%) were reported by radiologists: 100% reporting rate in AAAs ≥50 mm, 87% in AAAs ≥40 to 49 mm, and 52% in AAAs ≥30 to 39 mm. Of these, 15% were specifically recommended for referral to a vascular service. Of the incidentally detected AAAs, 72% were considered to be clinically relevant, which is an overall 4.1% prevalence of AAAs with an ability to benefit. In addition, all 3246 subjects avoided the need for further AAA screening.Conclusions
There is a high prevalence of AAAs (5.8%) and clinically relevant AAAs (4.1%) detected on routine abdominal CT. As an opportunistic approach, it is a simple and effective way to detect AAAs and to broaden traditional screening criteria to include women and those younger than 65 years in our region. Furthermore, large numbers of subjects with normal aortic diameters are identified who will not need to be screened. Consequently, we consider routine diagnostic abdominal CT to be an important adjunct to national and community AAA screening strategies. 相似文献4.
Prof. Dr. E.S. Debus G. Torsello T. Schmitz-Rixen I. Flessenkämper M. Storck H. Wenk R.T. Grundmann 《Gef?sschirurgie》2013,18(6):544-550
Background
The arterial vascular diseases grouped under the term arteriosclerosis are characterized by fibrous changes in the blood vessel walls.Aim of the study
This article reviews the epidemiology and manifestations of arteriosclerosis, as well as the risk factors associated with developing the disease.Materials and methods
The current article is a literature-based review that considers important studies relating to arteriosclerosis.Results
Atherosclerosis is the most common form of arteriosclerosis. The relevance of atherosclerosis for the health care system is highlighted by the following figures: in Germany, the prevalence of coronary heart disease (CHD) amongst the population aged 65 years and older is measured at 18?% for women and at 28?% for men. In 2004, CHD mortality rates were calculated to be 80.57 per 100,000 women and 149.21 per 100,000 men. According to the 1998 Federal Health Monitoring Report, about 3 million people in Germany were affected by peripheral artery occlusive disease (PAOD).Conclusion
The prevalence of atherosclerosis has increased dramatically during the last decade. In high-income countries like Germany, this increase is estimated at 13.1?%. As for the risk factors associated with PAOD, smoking has the greatest influence on disease development in high-income countries and in relative terms, hypercholesterolemia the least. In contrast to PAOD, data from the UK suggest that the incidence of abdominal aortic aneurysm (AAA) is on the decline. Correspondingly, the age-adjusted AAA mortality rate in England and Wales decreased from 40.4 per 100,000 inhabitants in 1997 to 25.7 per 100,000 in 2009. 相似文献5.
Masahiro Matsushita Teruo Ikezawa Masayuki Sugimoto Akihito Idetsu 《Surgery today》2014,44(4):620-625
Purpose
It is still difficult to determine the appropriate timing of surgery for a symptomatic abdominal aortic aneurysm (AAA). Since recent developments in computed tomography (CT) have made the procedure substantially less time-consuming, we used CT on patients with symptomatic AAA to determine the most appropriate management option.Methods
CT was performed on 79 patients with symptomatic AAA. If rupture of the AAA was confirmed by CT, patients underwent emergency surgery. If there was no rupture, patients were observed in an intensive care unit, and surgery was scheduled according to the results of repeated CT (2.1 times on average) and physical examinations, as well as on their clinical signs and symptoms.Results
By CT, we identified 42 ruptures, one contained rupture, one aortocaval fistula, five acute aortic dissections with AAAs, six inflammatory AAAs, six pseudoaneurysms and 18 non-ruptured AAAs. The mortality rate of the patients with ruptures was 33 %. For the 37 patients without rupture, as determined by CT, three emergency, nine urgent, and 20 elective operations were performed. Two patients who refused surgery experienced late rupture and died. Among the other 35 patients, the mortality rate was 6 %.Conclusion
CT was an effective modality to classify patients with symptomatic AAA into those who needed emergency surgery and those who did not. We could observe patients with symptomatic non-ruptured AAAs before urgent/elective operations by repeated CT and monitor the clinical findings. 相似文献6.
Background
Screening programs are currently of upmost importance in health politics. Large international studies of abdominal aortic aneurysm (AAA) screening programs showed a significant decrease in aneurysm-dependent mortality. In view of these findings, AAA screening programs have been implemented in various countries with variable healthcare infrastructures.Aim
In Germany a screening program also urgently needs to be introduced but realization depends on a variety of factors. This article presents the health service system in Germany and compares it with countries that have already established AAA screening programs. A comparative analysis of factors influencing possible conditions for introducing an AAA screening program in Germany was carried out.Material and methods
A nationwide written survey of 2000 representatively chosen German family practitioners was carried out in order to evaluate their knowledge of AAAs, the availability of ultrasound devices and the motivation for performing the screening.Results
A majority of German family practitioners possess the required knowledge of AAAs and the ultrasound skills to perform the screening. In addition, more than two thirds were in possession of an ultrasound device. Most practitioners were confident of performing a screening and would participate in a nationwide screening of AAAs.Conclusion
The conditions for a nationwide implementation of an AAA screening program performed with the help of general practitioners are fulfilled, considering knowledge, motivation und ultrasound availability. Owing to the lower logistic and financial expenditures in comparison to foreign AAA screening programs, the implementation by general practitioners seems to be advantageous. 相似文献7.
Background and objectives
The ideal method for screening investigations is one which is as free as possible from side effects, is easily learnt and can therefore be broadly employed to recognize abdominal aortic aneurysms (AAA) with a high degree of certainty. Although ultrasonography fulfils these criteria, the measurement method is not standardized. Different measurement methods are used in ultrasonography as well as in computed tomography (CT) studies and the measurement method is actually described sufficiently in only 57?% of cases.Methods
This article gives a critical review of the current literature on measurement methods and the validity of ultrasonography for determination of the diameter of the aorta, particularly for AAAs and presents the measurement principles for making measurements as precisely as possible.Results and conclusion
The most precise determination of the diameter is carried out by electrocardiogram (ECG) gating according to the leading edge method with orthogonal slicing. Within the framework of screening investigations, sufficient measurement precision can be achieved by adherence to orthogonal slicing. In these standardized measurement methods ultrasonography shows valid and reproducible results even in comparison to CT and is the method of choice in screening investigations for AAAs. 相似文献8.
Purpose
This retrospective study aimed to review our experiences with endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs), along with the incidence, risk factors and prognoses of associated embolic events. Our goal was to present the EVAR results and related risk factors from a single center, with a focus on embolic complications.Methods
We retrospectively reviewed the data of 539 patients with AAAs who underwent elective EVAR at Jikei University from July 2006 to April 2009. Of these, 438 patients were selected after excluding those requiring fenestrated and branched EVAR.Results
The technical success rate was 91.1 % (399/438) with no surgical mortality. Embolic complications occurred in nine patients (2 %), four of whom developed ischemic colitis and were successfully treated with bowel rest and hydration. Lower extremity atheroembolization and stroke occurred in three and one patients, respectively. Two patients died of cholesterol crystal embolization. Seven of the nine embolic complications (77.8 %) were associated with the use of Zenith stent-grafts. A Cox proportional-hazard regression analysis of the adjusted risk factors showed that smoking and severe arterial degeneration of the aorta, referred to as a shaggy aorta, to be independent predictors of embolic complications.Conclusions
The presence of a shaggy aorta and a history of smoking are independent predictors of embolic complications associated with EVAR. 相似文献9.
Background
An ultrasound screening examination is highly effective in the detection of abdominal aortic aneurysms (AAA) in males above the age of 65 years. Patients with small AAAs (diameter Objectives The effectiveness of medicinal treatment approaches on the overall cardiovascular risk and on the growth and rupture rate of small AAAs was analyzed.Material and methods
This article presents and discusses the currently available literature on the effectiveness of medicinal treatment of small AAAs.Results
Statins, beta blockers and angiotensin-converting enzyme (ACE) inhibitors reduce cardiovascular mortality in patients with AAAs and statins also reduce the growth rate of AAAs.Conclusion
Screening programs must implement strategies to improve total cardiovascular prognosis of patients with small AAAs. 相似文献10.
INTRODUCTION
The aim of this study was to determine the prevalence of abdominal aortic aneurysms (AAAs) in over 65-year-old men who have inguinal hernias and discuss if pre-operative selective screening of this population is appropriate.PATIENTS AND METHODS
A prospective study on 70 consecutive male patients with an age range of 65–88 years (mean, 74 years) who were referred to a single vascular consultant''s out-patient clinic with an inguinal hernia were screened for the presence of an AAA with an ultrasound scan before hernia repair over a period of 3 years.RESULTS
Two patients were found to have an AAA measuring 3.8 cm and 6.0 cm giving an AAA prevalence of 3% (exact 95% confidence interval = 0–10%).CONCLUSIONS
This study does not demonstrate an increased AAA prevalence in over 65-year-old male patients with inguinal hernias, scanned pre-operatively when compared to screening programmes. Selective screening of this cohort cannot be justified on this evidence. 相似文献11.
Sven-Erik Persson Kurt Boman Anders Wanhainen Bo Carlberg Conny Arnerlöv 《Journal of vascular surgery》2017,65(3):651-658
Objective
A significant reduction in the incidence of cardiovascular disease, including abdominal aortic aneurysm (AAA), has been observed in the past decades. In this study, a small but geographically well defined and carefully characterized population, previously screened for AAA and risk factors, was re-examined 11 years later. The aim was to study the reduction of AAA prevalence and associated factors.Methods
All men and women aged 65 to 75 years living in the Norsjö municipality in northern Sweden in January 2010 were invited to an ultrasound examination of the abdominal aorta, registration of body parameters and cardiovascular risk factors, and blood sampling. An AAA was defined as an infrarenal aortic diameter ≥30 mm. Results were compared with a corresponding investigation conducted in 1999 in the same region.Results
A total of 602 subjects were invited, of whom 540 (90%) accepted. In 2010, the AAA prevalence was 5.7% (95% confidence interval [CI], 2.8%-8.5%) among men compared with 16.9% (95% CI, 12.3%-21.6%) in 1999 (P < .001). The corresponding figure for women was 1.1% (95% CI, 0.0%-2.4%) vs 3.5% (95% CI, 1.2%-5.8%; P = .080). A low prevalence of smoking was observed in 2010 as well as in 1999, with only 13% and 10% current smokers, respectively (P = .16). Treatment for hypertension was significantly more common in 2010 (58% vs 44%; P < .001). Statins increased in the population (34% in 2010 vs 3% in 1999; P < .001), and the lipid profile in women had improved significantly between 1999 and 2010.Conclusions
A highly significant reduction in AAA prevalence was observed during 11 years in Norsjö. Treatment for hypertension and with statins was more frequent, whereas smoking habits remained low. This indicates that smoking is not the only driver behind AAA occurrence and that lifestyle changes and treatment of cardiovascular risk factors may play an equally important role in the observed recent decline in AAA prevalence. 相似文献12.
Ma CC Burchfiel CM Grove J Fekedulegn D Lu Y Andrew ME Willcox B Masaki KH Curb JD Rodriguez BL 《Archives of osteoporosis》2011,6(1-2):197-207
Summary
Baseline risk factors were associated with fractures that developed after 29?C31?years among Japanese-American men. Hip fracture risk increased with increasing BMI (28% increase for 1?U increase), physical activity (7% increase for 1?U increase), and was decreased with increasing arm girth (27% decrease for 1?U increase).Purpose
The objective of this study was to identify risk factors among Japanese-American men aged 45?C68?years at baseline that were associated with prevalence and incidence of fractures at advanced age.Methods
We used baseline information from Honolulu Heart Program (HHP) and Honolulu?CAsia Aging Study (HAAS). The HHP was a prospective study with primary focus on risk factors for cardiovascular disease. A cohort of 8,006 men of Japanese ancestry aged 45?C68?years residing on Oahu was recruited in 1965 and followed for 31?years. The HAAS started in 1991 in conjunction with the HHP with a focus on age-related health conditions. Self-reported hip, spine, and forearm fracture prevalence was ascertained in 1991?C1993 among 3,845 men aged 71?C93?years. Incidence was obtained during the period (1994?C1999) among 2,737 men aged 74?C98?years. Poisson regression models were used to determine multi-variable adjusted prevalence and incidence ratios for fracture.Results
Incident hip fracture was directly associated with baseline body mass index (BMI) and physical activity, and inversely associated with left upper arm girth. Incident spine fracture was directly associated with baseline age. Prevalent hip fracture was directly associated with baseline pack-years of smoking. Prevalent spine fracture was inversely associated with baseline education, and directly associated with standing height and use of medication for diabetes. Prevalent forearm fracture was inversely associated with baseline age, and directly associated with education.Conclusions
Results indicated that multiple baseline demographic lifestyle and anthropometric characteristics predict fracture risk at advanced age. In addition, associations varied by fracture location. 相似文献13.
E.S. Debus G. Torsello T. Schmitz-Rixen T. Hupp W. Lang T. Noppeney A. Oberhuber R.T. Grundmann 《Gef?sschirurgie》2013,18(7):644-651
Background
The relevance of atherosclerosis for the health care system is highlighted by the following figures: in Germany, the prevalence of coronary heart disease (CHD) amongst the population aged 65 years and older is measured at 18?% for women and at 28?% for men. In 2004, CHD mortality rates were calculated to be 80.57 per 100,000 women and 149.21 per 100,000 men.Aim of the study
This article reviews the literature on the manifestations of arteriosclerosis and documents the importance of preventative measures.Materials and methods
The current article is a literature-based review that considers international studies and guidelines.Results
According to German statistics, there were 61,550 cases (23,576 men/37,974 women) of death due to cerebrovascular disease in 2010. Stroke—not designated as hemorrhage or infarction—was responsible for the death of 8,422 men and 15,523 women. On the assumption that approximately 20?% of ischemic strokes are attributable to occlusion or stenosis of the extracranial carotid artery, an annual incidence of up to 30,000 carotid artery-associated strokes is estimated for Germany. According to the 1998 Federal Health Monitoring Report, around 3 million people in Germany were affected by peripheral arterial occlusive disease (PAOD). The prevalence of this disease has increased dramatically during the last decade. In high-income countries like Germany, this increase is estimated at 13.1?%. As for the risk factors associated with PAOD, smoking has the greatest influence on disease development in high-income countries and in relative terms, hypercholesterolemia the least. In contrast to PAOD, data from the UK suggest that the incidence of abdominal aortic aneurysm (AAA) is on the decline. Correspondingly, the age-adjusted AAA mortality rate in England and Wales decreased from 40.4 per 100,000 inhabitants in 1997 to 25.7 per 100,000 in 2009.Conclusion
The importance of arteriosclerosis prevention is undisputed; however, preventive measures such as those advocated by the WHO need to be applied as early as during childhood or adolescence. In Germany there exists a significant potential for improvement in terms of educating the public about the risks of smoking, obesity, poor nutrition and high blood pressure. Prevention education programs should be offered not only sporadically, but at the nationwide level. The English full-text version of this article is available at SpringerLink (under “Supplemental”). 相似文献14.
Wakasugi M Narita I Iseki K Moriyama T Yamagata K Tsuruya K Yoshida H Fujimoto S Asahi K Kurahashi I Ohashi Y Watanabe T 《Clinical and experimental nephrology》2012,16(2):259-268
Background
Weight gain after maturity is a risk factor for diabetes, coronary heart disease, and stroke, even in individuals with a normal body mass index; however, there is little information about the influence of weight gain after maturity on chronic kidney disease (CKD). Therefore, we examined the association between weight gain after 20?years of age and the prevalence of CKD.Methods
A cross-sectional study was performed on 28,151 women and 21,110 men aged between 40 and 59?years who participated in the specific health check and guidance system of Japan in 2008. We compared prevalence of CKD between participants with and without weight gain of at least 10?kg after 20?years of age. Multivariate logistic regression models and stratified analyses were used to adjust for possible confounding factors.Results
The prevalence of CKD among participants with weight gain was significantly higher than among those without weight gain both in women (11.8 vs 8.3%, p?p?Conclusions Weight gain after 20?years of age is associated with CKD among Japanese, even those without metabolic syndrome. 相似文献15.
Background
Therapy of abdominal aortic aneurysms (AAA) is currently based on a high level of evidence. This is not true in the same manner for iliac artery aneurysms (IAA) which are frequently associated with AAAs and occur only rarely as isolated lesions. The therapeutic principles apply in the same way to both aneurysm locations.Objectives
New findings, improved perioperative care and the rapid development of minimally invasive techniques require a constant update which is the aim of this article concerning the therapy of AAAs and IAAs.Material and methods
A systematic literature review was performed in PubMed and Medline and priority was given to recent publications with a high level of evidence.Results
Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) result in a similar long-term survival. The perioperative survival advantage with EVAR persists only during medium-term postoperative courses. The reintervention rate after EVAR is substantially higher compared to OAR. For older patients and those who are considered unfit for OAR the expected benefits from EVAR has not been proven to date. Aneurysmal ruptures after EVAR demonstrate that a life-long surveillance of these patients is necessary.Conclusion
Therapy of AAAs and IAAs is increasingly being performed by EVAR. Even the majority of complex aneurysms are amenable to minimally invasive treatment. Nevertheless, indications for OAR continue to exist. Screening for AAAs results in a decrease of aneurysmal ruptures for which EVAR is also gaining importance. 相似文献16.
Toshiro Ito Nobuyoshi Kawaharada Yoshihiko Kurimoto Tetsuya Koyanagi Takeshi Uzuka Mayuko Uehara Takayuki Hagiwara Yohsuke Yanase Toshiyuki Maeda Tetsuya Higami 《Surgery today》2013,43(9):1019-1024
Purpose
To evaluate the association of previous abdominal aortic aneurysm (AAA) graft replacement with infradiaphragmatic malperfusion in patients with acute aortic dissection.Methods
Between November 2006 and June 2011, 133 patients were referred to our hospital for management of acute aortic dissection. Eight (6.0 %) of these patients had undergone AAA graft replacement prior to the acute aortic dissection. We compared the computed tomography (CT) images of these 8 patients with those of the remaining 125 patients without previous AAA graft replacement, in terms of organ ischemia as a complication induced by acute aortic dissection.Results
Infradiaphragmatic malperfusion from acute aortic dissection was confirmed in four of the eight patients who had undergone AAA graft replacement. Contrasted CT scan images indicated that the main cause of infradiaphragmatic malperfusion was collapse of the true lumen from compression by the false lumen into the suprarenal aorta. Although there was no significant difference between the groups in terms of cerebral ischemia and myocardial ischemia, bilateral leg ischemia and visceral ischemia occurred more frequently in the patients who had undergone AAA graft replacement.Conclusion
Previous AAA graft replacement is a risk factor for infradiaphragmatic malperfusion in patients with acute aortic dissection. 相似文献17.
J. Tamaki M. Iki Y. Fujita K. Kouda A. Yura E. Kadowaki Y. Sato J. S. Moon K. Tomioka N. Okamoto N. Kurumatani 《Osteoporosis international》2011,22(1):133-141
Summary
Our cross-sectional analysis of 1,576 men aged ??65?years examined smoking effects on bone status. Number of smoking years was associated with decreased bone mineral density (BMD), after adjusting for age, height, weight, and number of cigarettes smoked daily. Smoking did not affect biochemical marker serum values for bone turnover.Introduction
The impact of smoking on bone status in men has not been conclusively established. We examined how smoking and its cessation influence bone status and metabolism in men.Methods
We analyzed 1,576 men among a baseline survey of Japanese men aged ??65?years, the Fujiwara-kyo Osteoporosis Risk in Men study, conducted during 2007?C2008.Results
Lumbar spine (LS) BMD values among never, former, and current smokers were 1.045?±?0.194, 1.030?±?0.189, and 1.001?±?0.182?g/cm2 (P?=?0.005), respectively, while total hip (TH) BMD values were 0.888?±?0.120, 0.885?±?0.127, and 0.870?±?0.124 (P?=?0.078), respectively. The significant trend for LS BMD remained after adjusting for the covariates; age, height, weight, physical activity, milk consumption, and drinking habit (P?=?0.036). Among never and ever (current and former) smokers, LS and TH BMD decreased with the number of pack years or the number of smoking years, respectively, adjusted for those covariates. Among ever smokers, LS and TH BMD decreased with the number of smoking years after adjusting for age, height, weight, and number of cigarettes smoked daily. Smoking did not reveal significant effect for serum osteocalcin or tartrate resistant acid phosphatase isoenzyme 5b.Conclusion
The impact of smoking on bone status is mainly associated with the number of smoking years in elderly men. 相似文献18.
Prof. Dr. E.L.G. Verhoeven A. Katsargyris B. Ritter K. Oikonomou W. Ritter 《Gef?sschirurgie》2012,17(7):640-643
Purpose
The aim of this article is to review the literature reporting the use of the chimney graft (CG) technique for the treatment of complex abdominal aortic aneurysms (AAA).Methods
Studies were included in the present review if revascularization of visceral branches during endovascular treatment of complex AAAs was accomplished with the CG technique. Case reports and non-consecutive series with less than ten patients were excluded.Results
A total of 5 publications with a total number of 94 patients fulfilled the inclusion criteria. The CG procedure was applied for the treatment of primary pararenal or juxtarenal AAAs in 78.7?% and for the repair of para-anastomotic pseudoaneurysms or endoleaks after prior open or endovascular repair in 19.2%. Of the patients 2 (2.1?%) were operated on for atheromatous aortic occlusive disease and 16 (17%) in an urgent setting. A total of 148 (average 1.57 per patient) visceral vessels were treated with CGs: 124 (83.8?%) renal arteries, 21 (14.2?%) superior mesenteric arteries (AMS) and 3 (2?%) celiac arteries (CT). Primary technical success was 96.8?% with an early type I endoleak rate of 11?%. The 30-day in-hospital mortality was 5.3?% (5.1?% and 6.3?% for elective and urgent cases, respectively) and CG patency during follow-up (mean 9.9 months) was 97.3?%. Postoperative renal function impairment occurred in 16?%, cardiac complications in 7.4?% and ischemic stroke in 3.2?% of patients.Conclusions
Early results of the CG method demonstrate feasibility but due to the lack of long-term outcome data this technique should be currently limited to bail-out procedures or acute situations. For elective cases, fenestrated stent grafting or open repair remain the treatments of choice. 相似文献19.
Fillo J Breza J Levčíkova M Luha J Vachulova A Durdík Š Labaš P 《International urology and nephrology》2012,44(4):1113-1120
Aim
The aim of this study was to determine the prevalence of erectile dysfunction (ED), testosterone deficiency syndrome (TDS), and metabolic syndrome in patients with abdominal obesity (AO) and the prevalence of morbidity at different levels of testosterone (TST).Background
Male sex hormones play an important role in ED and variety of TDS and may have influence on the development of metabolic syndrome. The number of men with AO which constitutes a serious health risk is continuously growing. Currently, there are different views that TST levels are already insufficient, and the patient should benefit from treatment.Objectives
This study examined the association between ED, testosterone level and metabolic syndrome in men with AO.Design, setting, and participants
The study was carried out in an outpatient urology center of Urology Clinic and Obesity Center of the Clinic of Internal Medicine. There were 167 participants??men with AO which were examined as part of preventive examination.Methods
Hormonal, a complete urological and internal evaluation was carried out in every patient.Results and limitations
We found some degree of ED in 73% (122/167) in men with AO. The TST levels below 14?nmol/l had of these 122 patients 84 patients (68.9%) and 49 patients (40.2%) below 10?nmol/l. In this group of patients, we found 103/167 patients (61.7%) with metabolic syndrome. When we compared TST level and morbidity, we found significantly more patients with diabetes mellitus (DM), hypertension and dyslipidemia in group with TST below 10?nmol/l. We also found difference in the levels of HDL cholesterol and triglycerides in the group of patients with TST 10?C14 and over 14?nmol/l.Conclusion
Patients over 40?years of age with AO and ED should also be examined for TDS and metabolic syndrome. In this group of patients we found that 113/167 patients (67.6%) had total TST below 14?nmol/l, and sufficient level of TST seems to be above this level. 相似文献20.