Unit:
Speciality Endovascular TechniquesLibrary of the School of Health Sciences
Supervisors info:
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Κακίσης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αχιλλέας Χατζηϊωάννου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Συστηματική μελέτη και μετα-ανάλυση των αποτελεσμάτων της ανοικτής και ενδαγγειακής αντιμετώπισης των ραγέντων ανευρυσμάτων σε ασθενείς με εχθρική συγκριτικά με φιλική ανατομία αορτής
Translated title:
Systematic review and meta-analysis of outcomes of open and endovascular repair of ruptured aortic aneurysms in patients with hostile versus friendly aortic anatomy
Summary:
Vascular surgery has made huge leaps the last decades in the management of the aneurysmal disease of the abdominal aorta , not only in elective cases but also in the case of ruptured aneurysms. This is due to the development of new synthetic grafts and endografts and the development of new imaging methods and technics. The last few years , many studies have been conducted in order to answer , which is the preferred method for treatment of an aneurysm. In the case of the elective AAA repair , these studies have shown a significant benefit in morbidity and mortality for those patients undergoing EVAR , compared with those undergoing open aneurysm repair. This benefit is substantial in the early postoperative period and is lost 6-12 months after the operation. In the case of the ruptured aneurysms , recent studies have shown a lower morbidity and mortality in the EVAR group , in such extend , that the latest SVS guidelines , suggest the endovascular procedure as the preferred in case of an AAA rupture. This of course rises the question , whether these results that led to these latest guidelines are affected by the aortic anatomy. It is widely accepted that patients undergoing an endovascular procedure for a ruptured AAA , are generally more anatomically suited and more haemodynamically stable than those undergoing an open procedure. Our meta-analysis of
the studies published , has produced some interesting results. Specifically our meta-analysis has shown that patients with hostile aortic anatomy undergoing EVAR for ruptured AAA , have higher perioperative mortality and lower overall survival in follow up than patients with favourable anatomy and who are treated with EVAR. On the contrary , hostile anatomy has no prognostic significance in open surgery for ruptured AAA. Based on these results , we could suggest that in patients with favourable aortic anatomy , EVAR may be the preferred treatment modality for ruptured AAA , in centers where expertise and resources are available. Future research may provide further insight into the optimal therapeutic approach in patients with a ruptured aneurysm and hostile aortic anatomy.
Main subject category:
Health Sciences
Keywords:
Aneurysm, Rupture, Anatomy, Meta-analysis
