Clinical evaluation of endovascular repair of abdominal aortic aneurysm based on long-term experiences.

INTRODUCTION: The endovascular method as a less invasive treatment for patients with abdominal aortic aneurysm (AAA) has become an alternative to conventional open surgery. AIM: The objective of the present study was to analyse the outcomes of endovascular treatment of AAA patients in long-term observation. MATERIAL AND METHODS: A group of 236 AAA patients subjected to planned endovascular aneurysm repair (EVAR) between 2010 and 2015 was reviewed. Rates of mortality, surgical complications and re-interventions were collected in the separate time periods, i.e. up to 30 days after surgery, 30 days to 3 years, and from 3 to 5 years after surgery. Cumulative rates of these parameters were evaluated in the short-term (up to 30 days after surgery), medium-term (up to 3 years), and long-term (up to 5 years after surgery) perspective. RESULTS: The median age of patients was 75 years, and the most common comorbidities were arterial hypertension (54%) and ischaemic heart disease (52%). Cumulative short-, medium- and long-term mortality rates were 2.5%, 14.2% and 28.9%, respectively. Total rates of surgical complications in short-, medium- and long-term observation were 7.6%, 12.6% and 17.5%, respectively. The cumulative rate of re-interventions ranged from 4.2% to 11.4%. CONCLUSIONS: In the consecutive time periods, the increase in the percentage of surgical complications and re-interventions increased gradually, in contrast to mortality, where the curve grew significantly, which is expected due to the aging and numerous comorbidities in the observed group of patients.

Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study.

PURPOSE: We performed a retrospective cohort study in patients who underwent endovascular aneurysm repair (EVAR) to determine the incidence and predictors of myocardial injury and acute kidney injury (AKI). METHODS: We included 267 consecutive patients who underwent EVAR at two tertiary centres in Canada and Poland. The primary outcome was myocardial injury during hospital stay after EVAR defined as a troponin elevation (ultra-sensitivity troponin I Vidas ≥ 19 ng·L-1, non-high-sensitivity troponin I Vidas ≥ 0.01 µg·L-1, high-sensitivity troponin T ≥ 20 ng·L-1, non-high-sensitivity troponin T ≥ 0.03 ng·mL-1). The secondary outcome was AKI defined using the stage 1 of the Acute Kidney Injury Network criteria. RESULTS: Myocardial injury occurred in 78/267 patients (29%; 95% confidence interval [CI], 24.1 to 34.9) and with AKI occurring in 25/267 (9.4%; 95% CI, 6.4 to 13.5). In a multivariable analysis, the following variables were associated with an increased risk of myocardial injury: age (adjusted odds ratio [aOR], 1.65 per ten-year increase; 95% CI, 1.09 to 2.49), Revised Cardiac Risk Index score ≥3 (aOR, 2.85; 95% CI, 1.26 to 6.41), The American Society of Anesthesiology physical status score 4 (aOR, 2.24; 95% CI, 1.12 to 4.47), duration of surgery (aOR, 1.27 per each hour; 95% CI, 1.00 to 1.61), and perioperative drop in hemoglobin (aOR, 3.35 per 10 g·dL-1 decrease; 95% CI, 1.00 to 11.3). Predictors of AKI were duration of surgery (aOR, 1.72 per hour; 95% CI, 1.36 to 2.17), a preoperative estimated glomerular filtration rate (eGFR) of 30-59 mL·min-1 (aOR, 3.82; 95% CI, 1.42 to 10.3), and an eGFR < 30 mL·min-1 (aOR, 37.0; 95% CI, 7.1 to 193.8). CONCLUSION: Myocardial injury and AKI are frequent during hospital stay after EVAR and warrant further investigation in prospective studies.

Infrarenal versus Suprarenal Abdominal Aortic Aneurysms: Comparison of Associated Aneurysms and Renal Artery Stenosis.

BACKGROUND: The aim of our study is to assess the prevalence of concomitant arterial abnormalities (true aneurysms of iliac, common femoral, renal, visceral arteries and stenoses of iliac and renal arteries) in patients with abdominal aortic aneurysm, and to evaluate whether the type of the aneurysm (suprarenal versus solely infrarenal) is associated with this prevalence. METHODS: In this retrospective cross-sectional study, we assessed computed tomography angiography scans of 933 patients with abdominal aortic aneurysm, including thoracoabdominal aortic aneurysms type II-IV, with no history of abdominal aortic surgery. We compared 2 groups of patients: group 1 (n = 859) with solely infrarenal abdominal aortic aneurysm and group 2 (n = 74) with the suprarenal aneurysm component. Patients with history of aortic dissection or thoracoabdominal aortic aneurysms type I and V were excluded from the study. All computed tomography angiography scans were visually assessed by 2 independent experienced physicians. RESULTS: Study group comprised 933 patients with the median age of 73.0 years, 83.8% of whom were male. We observed higher prevalence of common iliac artery aneurysms (44.6% vs. 30.6%, P = 0.013), internal iliac artery aneurysms (28.4% vs. 18.0%, P = 0.03), common femoral artery aneurysms (13.5% vs. 4.4%, P < 0.001), visceral artery aneurysms (5.4% vs. 1.2%, P = 0.019), renal artery stenosis (20.3% vs. 5.2%, P < 0.001), renal atrophy (6.7% vs. 1.1%, P = 0.004), and severe chronic kidney disease (14.1% vs. 1.8%, P < 0.001) in group 2 compared to group 1. There were no significant differences in the prevalence of iliac arterial stenoses between the groups. CONCLUSIONS: Among patients with abdominal aortic aneurysm, concomitant aneurysms and renal artery stenosis are more common in patients with suprarenal component when compared to those with solely infrarenal presentation.

[Cardio-vascular risk factors control in elderly patients with peripheral artery disease]. / Kontrola czynników ryzyka sercowo-naczyniowego u starszych pacjentów z choroba tetnic obwodowych.

OBJECTIVE: The assessment of control of modifiable risk factors among elderly patients with peripheral artery disease (PAD) admitted to the hospital angiology ward. METHODS: The results of treatment of dyslipidemia (DL), hypertension (HT), diabetes mellitus (DM) and prevalence of cigarette smoking were assessed among older (>65 years old, group I) and younger patients (group II) with PAD in a admission day to hospital. RESULTS: The study population included 154 patients (I--92 and II--65 subjects) aged 67.4 ± 9.4 years, 69.5% men. The study groups presented similar grades of PAD classification by Rutherford. Group I was older (73.5 ± 6.4 vs 58.3 ± 4.7 yrs, p < 0.001), had lower frequency of current smokers (21.7 vs 48.4%, P < 0.001) than group II. Diagnosis of DL, HT and DM were equally frequent in both groups. However, coronary heart disease was diagnosed more frequently in group I than II (52.2 vs 29.0%, p = 0.004). Both groups were similar according to systolic blood pressure (BP) values and levels of glucose and HDL cholesterol. Group I had lower diastolic BP than group II (69.5 ± 11.1 vs 74.0 ± 9.9 mmHg, p = 0.02), but control of HT was similar in both groups (71.7 vs 67.7%). LDL cholesterol levels were lower in a group I than II (2.2 ± 1.0 vs 2.5 ± 1.1 mmol/l, p = 0.04), but LDL cholesterol values < 1.8 mmol/l were observed with similar frequency in both groups (40.2 vs 27.4%). CONCLUSIONS: Patient's age seems to have no important impact on the control of atherosclerosis risk factors in patients with PAD.