P. de Smit

Ruptured Abdominal Aortic Aneurysm: Endovascular Repair is Feasible in 40% of Patients

INTRODUCTION Open repair of ruptured abdominal aortic aneurysm (rAAA) still has a high mortality. Endovascular aortic repair (EVAR) may be the way to improve survival rates. However, it is not clear how many patients with rAAA will be suitable for acute EVAR. METHODS Between October 2000 and April 2002 all patients with acute symptomatic or ruptured AAA were assessed for EVAR on an intention-to-treat basis with emergency computed tomographic angiography (CTA). Patient and logistic characteristics were analysed. We used two commercially available aorto uni-iliac devices with a maximum proximal diameter of 28 and 34 mm. RESULTS Five out of 26 patients were excluded for CTA and EVAR because of severe and persistent hypotension (3 pts) or logistic reasons (2 pts, both eligible). Twelve patients were found not eligible for EVAR due to unsuitable infrarenal aortic neck length (3 pts), neck diameter (1 pt) or a combination of both (8 pts). The remaining six patients were treated with EVAR. After 6 months no graft failure or aneurysm related deaths were recorded in the EVAR group. CONCLUSION A total of 28% of patients with symptomatic or ruptured AAA was treated with EVAR. A potential 42% of patients could have been suitable for EVAR, if the correct devices had been in stock and all patients had been properly assessed.

Outcome of abdominal aortic aneurysm repair in the era of endovascular treatment

The effect on outcome of the introduction of endovascular techniques for the exclusion of abdominal aortic aneurysm (AAA) is largely unknown. The aim of the study was to contrast the early and mid‐term outcome after open and endovascular AAA repair.

Dutch oral anticoagulation trial

A prospective randomized placebo-controlled study with 300 patients was performed in order to evaluate the potentially beneficial effects of long-term treatment with oral anticoagulants (Fenprocoumon, Marcoumar) in patients with chronic peripheral arterial obstructive disease. Both conservatively and surgically treated patients were included. The difference in progression of peripheral vascular disease, cardiovascular disease and cerebrovascular disease is statistically highly significant (p<0.0001, log-rank test) in favour of oral anticoagulants. Bleeding complications were relatively infrequent in both groups.Conclusion: the long-term use of oral anticoagulants is recommended for the treatment of patients with chronic peripheral atherosclerotic obstructive disease, both after surgical vascular reconstructions and as an adjunct to conservative treatment regimens.ZusammenfassungUm den Wert einer oralen Langzeitantikoagulation (Phenprocoumon, Marcoumar) bei Patienten mit arterieller Verschlußkrankheit zu untersuchen, werden 300 Patienten für eine prospektive randomisierte placebokontrollierte klinische Prüfung rekrutiert. Sowohl konservativ als auch operativ behandelte Patienten konnten in die Studie aufgenommen werden. Der Unterschied im Fortscreiten der peripheren arteriellen sowie der kardiobzw, zerebrovaskulären Verschlußkrankheit sprach in statistisch hochsignifikanter Weise (p<0.0001, log-rank-Test) für die Anwendung oraler Antikoagulanzien. Blutungskomplikationen waren in beiden Gruppen selten.Schlußfolgerung: Die Langzeittherapie mit oralen Antikoagulanzien kann bei Patienten mit chronisch-arterieller Verschlußkrankheit empfohlen werden, unabhängig davon, ob operative oder konservative Therapiemethoden verwendet werden.