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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

Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm

An abdominal aortic aneurysm (AAA) is a swelling (aneurysm) of the aorta, the main blood vessel that leads away from the heart and through the abdomen to the rest of the body. It can develop in both men and women. A growing aneurysm can burst (rupture), which leads to massive blood loss and shock. It is frequently fatal and accounts for the death of at least 45 people per 100,000 population.

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

Version: 2016

Medical treatment of vascular risk factors for reducing death 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 of 55 mm or more should be surgically repaired because, at this size, the risk of rupture outweighs the risk of surgical repair. AAAs between 30 mm 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 most 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: 2017

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

Abdominal aortic aneurysm: Overview

An abdominal aortic aneurysm may arise if the wall of the aorta becomes less elastic, for example due to the normal aging process, smoking or high blood pressure. Abdominal aortic aneurysms are more common in men than in women. Most remain harmless.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 14, 2017

When is surgery recommended for the treatment of abdominal aortic aneurysm?

Large abdominal aortic aneurysms may rupture (break open) unexpectedly. Surgery can prevent that from happening, but carries risks of its own. So it’s important to carefully consider the pros and cons of surgery before making a decision.The larger an aneurysm is, the greater the chances are that it will rupture. It is estimated that an abdominal aortic aneurysm that is over 5.5 cm in diameter will rupture within one year in about 3 to 6 out of 100 men. That's why surgery is often recommended. But there may also be good reasons to not have surgery.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 14, 2017

Different surgical approaches to access the infrarenal abdominal aorta during an operation to repair an abdominal aortic aneurysm

There has been a lot of debate in the surgical literature about the best way to surgically access the infrarenal abdominal aorta during an operation to repair an abdominal aortic aneurysm (AAA; a ballooning of an artery (blood vessel) which occurs in the major artery in the abdomen (aorta)). Two approaches are commonly used: the retroperitoneal (RP) approach and the transperitoneal (TP) approach. Both approaches appear to have advantages and disadvantages. Many trials comparing RP and TP aortic surgery have been published with conflicting results. The aim of this Cochrane review is to assess the effectiveness and safety of the TP versus RP approach for planned surgical open AAA repair on mortality, complications, hospital stay and blood loss.

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

Version: 2016

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) can occur with age, particularly in older men. An aneurysm may progressively enlarge without obvious symptoms, yet it is potentially lethal as it can burst (rupture), causing massive internal bleeding. Death is inevitable unless the bleeding can be stopped and blood flow to the lower body promptly restored. 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: 2017

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

The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: a systematic review and cost-effectiveness analysis

The study found that it was not possible to conduct a cost-effectiveness analysis for treating abdominal aortic aneurysms using fenestrated/branched endovascular repair versus conventional treatment (open repair surgery/no surgery) because of a lack of clinical effectiveness data. Future clinical trials are required to obtain the necessary data.

Health Technology Assessment - NIHR Journals Library.

Version: December 2014
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Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

This study found the use of the Aneurysm Repair Decision Aid (ARDA) provides detailed information on the potential consequences of abdominal aortic aneurysm repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty.

Health Technology Assessment - NIHR Journals Library.

Version: April 2015
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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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Combined coronary artery bypass grafting and open abdominal aortic aneurysm repair is a reasonable treatment approach: a systematic review

We reviewed the literature for studies investigating the outcomes of combined 1-stage coronary artery bypass grafting (CABG) and abdominal aortic aneurysm (AAA) open repair (OR) procedures. An electronic search of the English literature was conducted using the PubMed, EMBASE, and Cochrane databases. Age, coronary heart disease severity, AAA size, mean duration from CABG to AAA OR procedures, details of each procedure, mortality, and morbidity rates were analyzed. Between 1994 and 2012, 12 studies (256 patients) with 1-stage treatment fulfilled the inclusion criteria and were analyzed. There were 20 early (30 days) deaths, accounting for a 30-day mortality rate of 7.8%. The early morbidity was 53% (136 of 256). One-stage treatment when necessary can be undertaken with acceptable mortality and reasonable morbidity rates considering the complexity of both the operations. Nowadays, endovascular AAA repair is preferred over OR. The outcomes of combined cardiac surgery and endovascular AAA repair have not been extensively evaluated.

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

Version: 2013

Why are men offered screening for abdominal aortic aneurysms?

Men over the age of 65 are more likely to develop an abdominal aortic aneurysm than other groups of people are. That's why they are offered screening for abdominal aortic aneurysms. Screening lowers the risk of the aneurysm rupturing and leading to death. But treatment is associated with serious complications.Abdominal aortic aneurysms rarely rupture, but if they do it is a life-threatening medical emergency. Screening for abdominal aortic aneurysms may be a good idea in men over the age of 65. It is done to discover larger aneurysms so that they can be operated on in order to prevent a rupture. Smaller bulges in the vessel are monitored on a regular basis to see whether they get larger.But screening can have drawbacks too. Some of the aneurysms that are detected never would have caused any health problems. Knowing that you have an aneurysm can also be very distressing.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 31, 2017

Different stent graft types to repair thoracic aortic aneurysms

An aneurysm is a localised widening of an artery. The thoracic aorta is the largest artery in the body, delivering blood from the heart to the arms and head. If an aneurysm occurs in the thoracic aorta it can expand and may rupture, resulting in death. Open surgery can treat these aneurysms, which involves opening the chest and placing an artificial graft over the widening. A new alternative treatment involves an artificial 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 grafts available. They differ in how they are inserted into/access the blood vessel, how they attach to the walls of the artery and the design and materials they are made from.

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

Version: 2015

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.

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

Version: 2015

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

Intravenous heparin during ruptured abdominal aortic aneurysmal repair

An abdominal aortic aneurysm (AAA) is a swelling (aneurysm) of the aorta, the main blood vessel that leads away from the heart down through the abdomen to the rest of the body, and can develop in both men and women. A growing aneurysm can lead to rupture. The rupture of an AAA leads to massive blood loss and is frequently fatal.

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

Version: 2016

First‐line beta‐blockers versus other antihypertensive medications for chronic type B aortic dissection

The aorta is the largest blood vessel in the body. It begins in the heart and provides oxygen to all parts of the body. Aortic dissection occurs when there is a tear in the inner wall of the aorta and bleeding occurs between the inner and outer walls of the blood vessel. It is a severe and often lethal complication. High blood pressure (hypertension) may be a key cause. Other risk factors may include connective tissue disorders, congenital vascular disease (abnormalities present at birth), aortitis (inflammation of the aortic wall), trauma or iatrogenic causes (problems resulting from medical treatment). Chronic type B aortic dissections are typically managed with medical therapy to reduce the stress on the aorta. Current practice guidelines suggest the use of beta‐blockers as a first‐line treatment.

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

Version: 2014

Treatments for swelling of an artery in the groin following vascular procedures

People with heart disease and diseased leg arteries often undergo investigations and treatments that involve placing a needle into the main artery in the groin (endovascular procedures, for example diagnostic arteriogram, angioplasty, cardiac catheterization). One possible complication is the formation of a large swelling in the artery (a pseudoaneurysm) in the groin. This happens when the hole that the needle makes in the wall of the artery does not seal properly afterwards and blood collects, causing pain, swelling and bruising. Small pseudoaneurysms may clot spontaneously or surgery may be required. Less invasive treatment is now possible to stop the blood flow into the swelling. This involves sedation or analgesia to allow pressure to be placed over the puncture in the artery using a special mechanical device or a probe guided by ultrasound. Another option is injection of a clotting agent (thrombin) through the skin into the swelling.

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

Version: 2013

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