Aortic Neck Anatomic Features and Predictors of Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms Following vs Not Following Instructions for Use.

BACKGROUND: A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR) outside the instructions for use (IFU). This study will examine various aortic neck features and their predictors of clinical outcomes. STUDY DESIGN: We performed a retrospective analysis of prospectively collected data on EVAR patients. Neck features outside IFU were analyzed. Kaplan-Meier and multivariate analyses were used to predict their effect as single features, or in combination, on outcomes. RESULTS: Fifty-two percent of 526 patients had 1 or more features outside the IFU. The overall technical success rate was 99%, and perioperative complication rates were 7% and 12% for IFU vs outside IFU use, respectively (p = 0.04). Type I early endoleak and early intervention rates were 7% and 10% for IFU vs 18% and 24% for outside IFU (p = 0.0002 and p < 0.0001). At a mean follow-up of 30 months, freedom from late type I endoleak and late reintervention at 1, 2, and 3 years for IFU were 99.5%, 99.5%, and 98.4%, and 99.4%, 98%, and 96.8%; vs 98.9%, 98.1%, and 98.1%, and 97.5%, 96.2%, and 95.2% for outside IFU (p = 0.049 and 0.799), respectively. Survival rates at 1, 2, and 3 years for IFU were 97%, 93.5%, and 89.8%; vs 93.7%, 88.8%, and 86.3% for outside IFU (p = 0.035). Multivariate analysis showed that a neck angle > 60 degrees had odds ratios for death, sac expansion, and early intervention of 6, 2.6, and 3.3, respectively; neck length < 10 mm had odds ratios of 2.8 for deaths, 3.4 for early intervention, 4.6 for late reintervention, and 4.3 for late type I endoleak. CONCLUSIONS: Patients with neck features outside IFU can be treated with EVAR; however, they have higher rates of early and late type I endoleak, early intervention, and late death.

The relationships between serum C-reactive protein level and risk and progression of coronary and carotid atherosclerosis.

The acute-phase protein, C-reactive protein (CRP), was discovered >80 years ago and has been used clinically as a biomarker of inflammation. The measurement of serum CRP levels has proven useful to determine disease progression and the effectiveness of treatments for a number of medical conditions (eg, cancer, infection, and inflammation). During the last 20 years, multiple studies have shown an increased CRP level to be an indicator of risk for coronary artery disease and to be associated with progression of atherosclerotic carotid occlusive disease. In this review, the most recent associations of CRP with cardiovascular disease in both coronary and carotid artery circulations are analyzed. It is imperative that the vascular surgeon and other vascular specialists recognize the relationship between serum CRP levels and atherosclerotic disease to identify at-risk patient populations, screen for occlusive disease severity, and employ this biomarker in patient counseling.