ABSTRACT
OBJECTIVE: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR). METHODS: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests. RESULTS: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively). CONCLUSION: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.
Subject(s)
Iliac Aneurysm/surgery , Aged , Aged, 80 and over , Endovascular Procedures/methods , Endovascular Procedures/mortality , Endovascular Procedures/statistics & numerical data , Female , Guideline Adherence/statistics & numerical data , Humans , Iliac Aneurysm/epidemiology , Iliac Aneurysm/mortality , Iliac Aneurysm/pathology , Iliac Artery/pathology , Iliac Artery/surgery , Male , Netherlands/epidemiology , Registries , Retrospective Studies , Sex Factors , Treatment OutcomeABSTRACT
Hemodialysis access failure is a major cause of morbidity for patients with end stage renal disease with costs in excess of $743 million annually. Color-flow doppler ultrasound is the only mobile noninvasive technique that provides direct visual imaging of the access and measurement of access flow. Doppler ultrasound can identify patients at increased risk of future thrombosis and allow preventive intervention. Prospective trials show that ultrasound-based access management programs can decrease thrombosis rates, prolong access longevity, and decrease the cost of hemodialysis access management. It should be included as part of a coordinated program of hemodialysis management.
