Ayesha Noorani

Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery.

Surgical‐site infection increases morbidity, mortality and financial burden. The preferred topical antiseptic agent (chlorhexidine or povidone–iodine) for preoperative skin cleansing is unclear.

Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: a systematic review and meta-analysis.

INTRODUCTION Recent studies suggest an increased risk of neurologic complications after coverage of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR). The preventative role of preoperative revascularization of the LSA using carotid-subclavian bypass or transposition remains controversial. We assessed this increased risk and the role of revascularization by undertaking a systematic review and meta-analysis of the literature. METHODS In the absence of any randomized controlled trials, the Pubmed and Embase databases were searched to identify all series reporting TEVAR without LSA coverage compared with LSA coverage with and without revascularization. The incidence of neurologic complications, namely cerebrovascular accident (CVA) and spinal cord ischemia (SCI), were recorded for each group. Pooled odds ratios (POR) were then calculated for postoperative CVA and SCI. RESULTS Compared with patients without LSA coverage, the risk of CVA was increased both in patients with LSA coverage alone (4.7% vs 2.7%; POR, 2.28; 95% confidence interval [CI], 1.28-4.09; P = .005) and in those with LSA coverage after revascularization (4.1% vs 2.6%; POR, 3.18; 95% CI, 1.17-8.65; P = .02). The risk of SCI was also increased in patients requiring LSA coverage (2.8% vs 2.3%; POR, 2.39; 95% CI, 1.30-4.39; P = .005) but not for LSA coverage after revascularization (0.8% vs 2.7%; POR, 1.69; 95% CI, 0.56-5.15; P = .35). CONCLUSION The risk of neurologic complications is increased after coverage of the LSA during TEVAR. Preemptive revascularization offers no protection against CVA, perhaps indicating a heterogeneous etiology. Revascularization may reduce the risk of SCI, although limited data tempers this conclusion. Improved or perhaps compulsory reporting to registries of a minimum data set may help further assess the exact etiology of these complications and identify a higher-risk subset of patients in whom revascularization might prove protective.

Cost-Effectiveness Analysis of Endovascular versus Open Surgical Repair of Acute Abdominal Aortic Aneurysms Based on Worldwide Experience:

Purpose: To present an economic evaluation of endovascular versus open surgical repair of ruptured abdominal aortic aneurysms (AAA). Methods: Endovascular aneurysm repair (EVAR) is currently being appraised by the National Institute for Clinical Excellence. To aid in this appraisal, a health economic model developed to demonstrate the cost-effectiveness of EVAR for elective treatment of nonruptured AAAs versus OSR was used for an analysis in the emergency setting. The base case data on 730 patients undergoing EVAR was extracted from our recently published 22- study meta-analysis of 7040 patients presenting with acute AAA (ruptured or symptomatic) treated with either emergency EVAR or OSR. These data reflected a patient population with an average age of 70 years. The base case model, which assumed a time horizon of 30 years and applied all-cause mortality rates, was subjected to a number of 1-way sensitivity analyses. A multivariate analysis was undertaken using 10,000 Monte-Carlo simulations. Results: EVAR dominated OSR in the base case analysis, with a mean cumulative cost/patient of £17,422 (

Gene therapy as a novel therapeutic option in the treatment of peripheral vascular disease: systematic review and meta-analysis

26,133) for EVAR and £18,930 (

Amplification of TRIM44: Pairing a Prognostic Target With Potential Therapeutic Strategy

28,395) for OSR [-£1508 (

Atrial fibrillation following elective open abdominal aortic aneurysm repair

2262) difference]. The mean quality-adjusted life years (QALYs)/patient was 3.09 for EVAR versus 2.49 for OSR (0.64 difference). EVAR was cost-effective compared with OSR at a threshold value of £20,000 to £30,000 (

Cerebral hemodynamic changes following carotid endarterectomy: 'cerebral hyperperfusion syndrome'.

30,000-

Comparison of Aortomonoiliac Endovascular Aneurysm Repair versus a Bifurcated Stent-Graft: Analysis of Perioperative Morbidity and Mortality

45,000)/QALY. In no single combination tested did open surgical repair provide the patient with more QALYs than EVAR. Sensitivity analyses demonstrated that the results were most sensitive to length of hospital and intensive care stays, use of blood products, and the cost of the EVAR device, which were the main cost drivers. Conclusion: While the UKs National Institute for Clinical Excellence does not set an absolute limit at which treatments would not be funded, £30,000 (

Emergency endovascular management of peripheral artery aneurysms and pseudoaneurysms – a review

45,000) is generally regarded as the upper limit of acceptability. At this level, there is almost a 100% probability that EVAR is a cost-effective treatment for ruptured AAA.

Assessment of Renal Injury in Patients Undergoing Elective EVAR Using Urinary Neutrophil Gelatin-Associated Lipocalin, Interleukin 18, and Retinol-Binding Protein

Background:  Stimulation of therapeutic angiogenesis using gene therapy is a novel intervention for peripheral vascular disease (PVD). Despite encouraging outcomes from animal studies and phase 1 trials, results from larger trials in this area have been conflicting. We undertook a systematic review and meta‐analysis of randomised controlled trials in this field, to clarify the current situation.