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The use of anticoagulants to prevent deep venous thrombosis and pulmonary embolism following surgery for abdominal aortic aneurysm

Deep vein thrombosis (DVT) is a preventable complication of surgery. The blood clot can break away and travel to the lungs to cause respiratory distress and death (pulmonary embolism). Deep vein thrombosis is believed to occur less often following aortic surgery than in general surgical operations because heparin used during most vascular operations may protect against intra‐operative DVT. Vascular patients are usually older, with more co‐morbidity (presence of other diseases or conditions), and are subject to prolonged immobility, which increase the likelihood of developing DVT. Bleeding (haemorrhagic) complications could however occur if further anticoagulants are used for DVT prophylaxis during recovery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Screening for abdominal aortic aneurysm

An aneurysm is a localised widening (dilation) of an artery. The blood vessel can burst (rupture) because the vessel wall is weakened. Some 5% to 10% of men aged between 65 and 79 years have an abdominal aneurysm in the area of the aorta, the main artery from the heart as it passes through the abdomen. Abdominal aortic aneurysms are often asymptomatic but a rupture is a surgical emergency and often leads to death. An aneurysm larger than 5 cm carries a high risk of rupture. Smaller aneurysms are monitored regularly using ultrasound to see if they are becoming larger. Elective surgical repair of aortic aneurysms aims to prevent death from rupture. The incidence of aortic aneurysm in women as they age is lower than for men.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Cerebrospinal fluid drainage for thoracic and thoracic abdominal aortic aneurysm surgery

An aneurysm is a local bulging of a blood vessel that carries a risk of rupture. Surgery for an aortic aneurysm requires clamping the aorta, the biggest artery in the body. This reduces the supply of blood and oxygen to the spinal cord (ischaemia) and tissue damage can lead to the partial or incomplete paralysis of the lower limbs (paresis) and paraplegia (paralysis of the legs and lower part of the body). These deficits are frequently irreversible. The cerebrospinal fluid (CSF) pressure increases during clamping further decreasing the perfusion pressure of the spinal cord. As more of the blood supply to the spinal cord is interrupted, the likelihood of paraplegia is increased. Various treatments are used to reduce the ischaemic insult to the spinal cord including temporary blood shunts (such as distal atriofemoral bypass and re‐connection of intercostal and lumbar vessels), pharmaceutical interventions (to protect the heart and cerebral blood vessels), epidural cooling and CSF drainage. Draining CSF from the lumbar region may lessen the CSF pressure, improve blood flow to the spinal cord and reduce the risk of ischaemic spinal cord injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Endovascular treatment for ruptured abdominal aortic aneurysm

The abdominal aorta is the main artery supplying blood to the lower part of the body. An abnormal ballooning and weakening of the wall of the aorta (aortic aneurysm) particularly affects men as they grow older. An aneurysm may progressively enlarge without obvious symptoms yet it is potentially lethal as the aneurysm can burst (rupture) causing massive internal bleeding. Death is inevitable unless the bleeding can be stopped and blood flow to the lower body restored promptly. Until recently this required an open operation (laparotomy) to clamp the abdominal aorta and replace the segment of the aorta with a synthetic artery tube‐graft. Many patients do not survive this major operation due to the effects of massive bleeding or failure of vital organs, such as the heart, lungs, and kidneys, despite improvements in the surgical technique and care of the critically ill patient.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Primary Care Screening for Abdominal Aortic Aneurysm: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

To assess the benefits and harms of AAA screening programs and approaches to treating small aneurysms, and to determine screening yield for subgroup populations.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: January 2014
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Medical treatment of vascular risk factors for reducing mortality and cardiovascular events in people with abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a potentially life‐threatening condition where the aorta enlarges and can ultimately burst leading to massive internal bleeding. Current guidelines recommend that AAAs ≥ 55 mm should be surgically repaired as at this size the risk of rupture outweighs the risk of surgical repair. AAAs between 30 and 54 mm in size are not as high risk and are generally monitored by regular scans to check for further enlargement. Recent research has shown that even after the aneurysm is repaired, the survival rate in people with AAA is poorer than in people without AAA. In the majority of cases, the cause of death is a cardiovascular event such as a heart attack or a stroke. Conditions such as high blood pressure or high cholesterol increase the risk of cardiovascular death. However, both conditions can be reversed through medical treatment. Given the increased risk of mortality with AAA, it is important to determine which medical treatment is most effective in preventing cardiovascular death in people with AAA.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Endovascular repair of abdominal aortic aneurysm

The abdominal aorta is a major blood vessel in the body that carries blood from the heart to the major organs in the chest and abdomen. An abdominal aortic aneurysm (AAA) is a balloon‐like bulge (dilation) of the aorta that is greater than 3 cm in diameter. If an AAA ruptures (bursts), this is often fatal. Hence, AAAs that are larger than 5.5 cm are usually treated surgically in order to try to prevent such a rupture. Traditionally, AAAs are treated using an open surgical repair (OSR) technique, in which the abdomen is cut open (referred to as open surgery) and the dilated aorta is repaired using fabric graft material. However, over the past 20 years, a newer, 'key hole' technique has been used, in which the AAA is repaired without the need for open surgery ‐ a thin tube is passed via the blood vessels in the groin to the site of the AAA. Once in the correct position, a sheath is introduced that acts to reline the dilated aorta, acting as an artifical blood vessel through which blood can continue to flow, bypassing the aneurysm. Hence, the risk of further expansion or rupture of the AAA is reduced, This technique is referred to as endovascular aneurysm repair (EVAR). As EVAR is a less invasive technique than OSR, in that there is no need for open surgery, it may have advantages over OSR. In addition, some individuals with other medical illnesses, for whom open surgery may be considered a high‐risk procedure and who are not fit for OSR, can be offered EVAR instead.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Distal aortic perfusion during thoracoabdominal aneurysm repair for prevention of paraplegia

Aneurysm of an artery is a localised abnormal dilation with a diameter of the artery at least one and a half times its normal size. Aneurysms in both the thoracic and abdominal aorta are termed thoracoabdominal aortic aneurysms (TAAA). Open surgical repair is effective in ensuring the survival of people with such aneurysms. Complications of paralysis of the legs and lower parts of the body (paraplegia) and partial paralysis affecting the lower limbs (paraparesis) can however develop during surgery and in the postoperative period, following apparently successful surgery. This is the result of inadequate blood flow to the spinal cord and the vulnerability of the spinal cord to ischaemic injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Different stent grafts for repair of abdominal aortic aneurysms

An aneurysm is a localised widening of an artery. The abdominal aorta is the largest artery in the body, delivering blood from the heart to the organs in the abdomen and the legs. If an aneurysm occurs in the abdominal aorta it can expand and may rupture, resulting in death. Open surgery can treat these aneurysms; this involves opening the abdomen and placing an artificial graft over the widening. A new alternative treatment involves an artifical stent graft, delivered through an arterial blood vessel in the groin, fixed over the widening. This technique is called endovascular repair. There are many different types of stent graft available. They differ in how they are inserted in/access the blood vessel, how they attach to the walls of the artery and the design and materials they are made from. We searched for evidence directly comparing the different types of stent grafts in aneurysm repair. This review found no randomised controlled trial evidence investigating if any specific stent graft performs better than another type of stent graft. More research is required to help surgeons decide which specific type of stent graft to use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Drug treatment for small abdominal aortic aneurysms

An aneurysm is an abnormal localised widening (dilatation) of an artery. The most common place for such a dilatation is the abdominal aorta. This is the main artery linking the heart to the lower limbs and the organs of the abdomen, and a dilatation here is termed an abdominal aortic aneurysm (AAA). About 4% of men over 55 years of age have an AAA, but it is less common in women. Aneurysms over 55 mm in diameter carry a high risk of rupture, and rupture carries a high risk of death. To reduce the risks, screening programmes using ultrasound scanning have been introduced for selected groups in a number of countries. Patients with aneurysms over 55 mm are then evaluated for elective aneurysm repair. For aneurysms at or below the 55 mm cut‐off, the current treatment is 'watchful waiting', where the aneurysm is repeatedly scanned over time to see if it is enlarging. This review aimed to identify medical treatments which could slow or even reverse aneurysm growth, and thus delay or avoid the need for elective surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Surgery for small abdominal aortic aneurysms that do not cause symptoms

An aneurysm is a ballooning of an artery (blood vessel), which, in the case of an abdominal aortic aneurysm (AAA), occurs in the major artery in the abdomen (aorta). Ruptured AAAs cause death unless surgical repair is rapid, which is difficult to achieve. Surgery is considered necessary for people with aneurysms of more than 5.5 cm in diameter or who have associated pain, to relieve symptoms and to reduce the risk of rupture and death. However, risks are associated with surgery. Surgical repair consists of insertion of a prosthetic inlay graft, either by open surgery or endovascular repair.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Intravenous fluids for body fluid management during abdominal aortic surgery

There is not enough evidence to show the best fluid replacement to use during and following surgery on the abdominal aorta. Surgery on the abdominal aorta is a major surgical procedure with a mortality of 1.5% in elective patients and up to 5% in emergency surgery. Fluid replacement is needed to replace tissue fluids lost during surgery. Blood products, non‐blood products, or combinations including crystalloid solutions and colloids are used. Combination therapy is most common. The review of trials found that although 38 randomised trials involving 1589 patients were identified, there was not enough evidence on the benefits of any particular individual or combination fluid therapy. No single fluid affected any outcome measure significantly more than another fluid across a range of outcomes. The trials used many different fluid replacement comparisons so that few results could be pooled. Important outcomes are the need for allogenic blood transfusion, complications of organ failure, and length of stay in both the intensive care unit and hospital.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Surgical repair of inflammatory abdominal aortic aneurysms

An aneurysm is a localised widening or enlargement of an artery that may ultimately lead to rupture (bursting) and may be fatal. The abdominal aorta is the artery most frequently involved in the enlargement process. In inflammatory abdominal aortic aneurysms, the aortic enlargement is accompanied by inflammation around the aorta with thickening of the adjacent tissues and potential entrapping of the adjacent organs, mostly the ureters (the tubes draining the kidneys) or intestines, thus potentially causing kidney or bowel problems. The aim of aneurysm treatment is to prevent rupture. It can be accomplished by an open repair, which involves surgery to open the abdomen and replace the aneurysm with an artificial graft (tube), or by an endovascular repair, which places an artificial stent graft inside the aneurysm, delivered through the blood vessel in the groin. In inflammatory aneurysm, inflammation and involvement of the ureters or intestines make open repair more difficult. However, endovascular repair may not last as well and may not relieve the inflammation as much or may worsen it. It is currently unclear whether open repair or endovascular repair is the best treatment for inflammatory aortic aneurysm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Skin puncture versus exposing the femoral artery for minimally invasive repairs of abdominal aortic aneurysms

Abdominal aortic aneurysms are a ballooning of the largest blood vessel in the abdomen, the abdominal aorta, due to weakness of the vessel wall. This ballooning may lead to life threatening rupture. Repair of the aneurysm is recommended if it is felt to pose a significant risk. All repairs involve putting in an artifical graft, a tube composed of fabric, to help reinforce the artery wall. There are two main methods for repair. One is an open technique in which the whole abdomen is opened and the graft is put inside the blood vessel. The other technique is an endovascular aneurysm repair. With this technique the graft is fed into the abdominal aorta through an artery in the groin (the femoral artery) and it avoids the large abdominal incision. This review looked at an alternative method for introducing the graft into the femoral artery, percutaneous access. Instead of making an incision in the groin to expose the femoral artery (a cut‐down), a small hole is made in the skin and then a needle with a plastic tube sitting over it is introduced into the femoral artery. Once introduced, the needle can be pulled back up the tube leaving the tube in place in the artery. The graft and all other materials can then be fed into the artery via the plastic tube. Once the procedure is complete the tube can be withdrawn. The surface incision can usually be closed with one stitch.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Current modalities for abdominal aortic aneurysm repair: implications for nurses

BACKGROUND: Abdominal aortic aneurysms (AAAs) represent a significant health problem in the United States as more than 1 million people are afflicted and the prevalence is only expected to increase. Given that AAA rupture carries a high mortality rate, there is interest in repairing the aneurysm electively before aneurysm rupture. Two approaches to aneurysm repair are open repair and endovascular repair. However, limited data comparing the outcomes of these different methods exist.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model

Abdominal aortic aneurysms (AAAs) carry a high risk of rupture, which is associated with a mortality rate of about 80%. AAAs can be treated by surgical repair to prevent rupture. However, open repair involves significant risks and approximately 25% of patients with an AAA requiring surgery are considered unfit for open surgery. Endovascular aneurysm repair (EVAR) is a minimally invasive technique that has been used to treat patients with appropriate aneurysm morphology who are classified as either fit for open repair or unfit. EVAR is used both as an elective procedure and to treat symptomatic and ruptured aneurysms.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2009

Quality of life after repair of ruptured abdominal aortic aneurysm

BACKGROUND: Ruptured abdominal aortic aneurysm (AAA) continues to be associated with high operative mortality. Though survivors can expect to return to a normal life expectancy, their postoperative health related quality of life (HRQoL) remains uncertain. This review examines HRQoL following operative repair of ruptured AAA.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

The Hardman index in patients operated on for ruptured abdominal aortic aneurysm: a systematic review

BACKGROUND: The aims of the present study were to (1) analyze preoperative predictors for outcome suggested by Hardman and surgical mortality after open repair and endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), and (2) further evaluate the Hardman index in a systematic review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Systematic review and meta-analysis of sex differences in outcome after intervention for abdominal aortic aneurysm

BACKGROUND: The aim of this study was to assess possible differences in mortality between men and women with an abdominal aortic aneurysm (AAA) treated either by elective repair or following aneurysm rupture.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Outcome after open repair of ruptured abdominal aortic aneurysm in patients >80 years old: a systematic review and meta-analysis

BACKGROUND: The role of open repair in the management of ruptured abdominal aortic aneurysm (RAAA) in patients>80 years old is questioned by the perceived high operative risk of these patients. This issue has been investigated in the present meta-analysis of observational studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

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