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Enlargement and ballooning of the vessel that supplies arterial blood to the abdomen, pelvis and legs.

Results: 18

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

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

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

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.

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

Version: 2015

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

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 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

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

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

Treatments for coarctation of the thoracic aorta

Coarctation of the aorta (CoA) is a congenital narrowing of the lumen in a section of the aorta. The narrowing is most commonly in the upper thoracic aorta but can occur in the abdominal aorta. It is present at birth and males are more often affected than females. Clinical symptoms are variable and depend on the position, degree and extent of the narrowed segment of the aorta. Other congenital heart abnormalities may also be present. In general, the diagnosis is made by finding a difference in pulsations and blood pressure between the upper body and arms and the lower body and legs. If left unrepaired, average survival is 31 years. The treatment of CoA is intended to improve life expectancy and quality of life by reducing the incidence of aortic and cardiac disabling conditions such as aneurysm (dilation) of the ascending aorta, coronary artery disease, high blood pressure, and aortic and mitral valvular disease. The treatment of CoA consists of enlarging of the narrowed segment. Traditionally this required open heart surgery. Balloon angioplasty became available as an alternative treatment in the 1980s but recurrence, aneurysm and aortic dissection (a tear in the inner wall of the aorta causing blood to flow between the layers of the blood vessel wall) remained disadvantages of both treatments. In the early 1990s, endovascular stents were introduced and have become an alternative approach to surgical repair. The present review looked at the available evidence for the effectiveness of open surgery compared with placing a stent in the coarctation of the thoracic aorta. The review authors searched the medical literature but they did not found any studies that compared open surgery and stent placement for the treatment of coarctation of the thoracic aorta. The treatment of CoA is a challenging procedure and the centers that perform this treatment have a well‐established strategy for patients with CoA; the strategy is in accordance with the experience of involved professionals and local resources. In both situations experience and resources have improved the results of the treatment. However a more concrete and long‐term analysis of these strategies is needed.

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

Version: 2012

Testing Treatments: Better Research for Better Healthcare. 2nd edition

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Pinter & Martin.

Version: 2011
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