21 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter"[Jour]

These pubmed results were generated on 2010/03/09

PubMed, a service of the National Library of Medicine, includes over 15 million citations for biomedical articles back to the 1950's. These citations are from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.

21 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter"[Jour]

These pubmed results were generated on 2010/02/10

PubMed, a service of the National Library of Medicine, includes over 15 million citations for biomedical articles back to the 1950's. These citations are from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.

A retrospective multicentric study of endovascular treatment of popliteal artery aneurysms.

J Vasc Surg. 2010 Feb 6;

Authors: Midy D, Berard X, Ferdani M, Alric P, Brizzi V, Ducasse E, Sassoust G,

PURPOSE: To evaluate the feasibility of endovascular exclusion of popliteal artery aneurysm (PAA) using stent grafts. METHODS: The clinical data of all patients who underwent endovascular exclusion of PAA at three French vascular departments between December 1999 and December 2007 were retrospectively analyzed. Outcome measures included graft patency and endoleak. The Kaplan-Meier method was used to calculate the primary and secondary patency curves. RESULTS: A total of 57 PAA in 50 patients (48 men; mean age, 72 +/- 11 years; range, 57-96 years) were treated. The type of stent graft used was Hemobahn/Viabahn in 42 (73.7%) cases, Wallgraft in 14 (24.5%) and Passager in one. The mean duration of hospitalization was 5 +/- 1.8 days (range, 3-11 days). No patients were lost from follow up (mean, 36 +/- 19.4 months; range, 6-96 months). Nine (16%) occlusions and six (10.5%) endoleaks occurred. The global limb salvage rate was 96.5% (55 of 57 PAA). Kaplan-Meier estimates for primary and secondary patency were 85.8% and 87.5% at one year and 82.3% and 87.5% at three years. CONCLUSIONS: Endovascular treatment of PAA is feasible in selected patients. The main determinants of success are suitable aneurysm anatomy and dual antiplatelet postoperative therapy. Further studies are warranted to determine long-term outcomes of endovascular repair for PAA.

PMID: 20138731 [PubMed - as supplied by publisher]

Entrapment of the popliteal artery.

J Vasc Surg. 2010 Feb 6;

Authors: Tanaka H, Higashi M, Fukumoto Y, Ogino H

PMID: 20138730 [PubMed - as supplied by publisher]

Discussion.

J Vasc Surg. 2010 Feb 6;

Authors:

PMID: 20138729 [PubMed - as supplied by publisher]

Renal parenchymal preservation after percutaneous renal angioplasty and stenting.

J Vasc Surg. 2010 Feb 6;

Authors: Davies MG, Saad WE, Bismuth J, Naoum JJ, Peden EK, Lumsden AB

BACKGROUND: The intent of endovascular therapy for symptomatic atherosclerotic renal artery stenosis (ARAS) is to preserve parenchyma and avoid renal-related morbidity. The aim of this study is to examine the impact of renal artery intervention on parenchymal preservation. METHODS: We performed a retrospective analysis of records from patients who underwent endovascular intervention for ARAS and were followed by duplex ultrasound between 1990 and 2008. Renal volume (in cm(3)) was estimated in all patients as renal length (cm) x renal width (cm) x renal depth (cm) x 0.5. The normal renal volume was calculated as 2 x body weight (kg) in cm(3). Failure of preservation was considered to be a persistent 10% decrease in volume. Clinical benefit defined as freedom from renal-related morbidity (increase in persistent creatinine >20% of baseline, progression to hemodialysis, death from renal-related causes) was calculated. RESULTS: Five hundred ninety-two renal artery interventions were performed. One hundred eighty-six kidneys suffered parenchymal loss (>5%) with an actuarial parenchymal loss rate of 29% +/- 1% at five years respectively. There were no significant differences in age, gender, starting renal volume, or kidney size. However, patients with parenchymal loss had lower eGFR (45 +/- 24 vs 53 +/- 24 mL/min/1.73 m(2); Loss vs noLoss,P = .0002, Mean +/- SD) higher resistive index (0.75 +/- 0.9 vs 0.73 +/- 0.10; P = .0001) and worse nephrosclerosis grade (1.43 +/- 0.55 vs 1.30 +/- 0.49; P = .006) then those not suffering parenchymal loss. Parenchymal loss was associated with significantly worse five-year survival (26% +/- 4% vs 48% +/- 2%; Loss vs noLoss; P < .001) and freedom from renal-related morbidity (70% +/- 5% vs 82% +/- 2%; P < .05) with increased numbers progressing to dialysis (17% vs 7%; P < .006). CONCLUSION: While parenchymal preservation occurs in most patients, parenchymal loss occurs in 31% of patients and is associated with markers of impaired parenchymal perfusion (resistive index and nephrosclerosis grade) at the time of intervention. Pre-existing renal size or volumes were not predictive of parenchymal loss. Parenchymal loss is associated with a significant decrease in survival and a marked increased renal related morbidity and progression to hemodialysis.

PMID: 20138728 [PubMed - as supplied by publisher]

44 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter"[Jour]

These pubmed results were generated on 2010/02/02

PubMed, a service of the National Library of Medicine, includes over 15 million citations for biomedical articles back to the 1950's. These citations are from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.

Blood transfusion is associated with increased morbidity and mortality after lower extremity revascularization.

J Vasc Surg. 2010 Jan 26;

Authors: O'Keeffe SD, Davenport DL, Minion DJ, Sorial EE, Endean ED, Xenos ES

BACKGROUND: Little is known about the significance of blood transfusion in patients with peripheral arterial disease. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to examine the effect of intraoperative blood transfusion on the morbidity and mortality in patients who underwent lower extremity revascularization. METHODS: We analyzed data from the participant use data file containing vascular surgical cases submitted to the ACS NSQIP in 2005, 2006, and 2007 by 173 hospitals. Current procedural terminology codes were used to select lower extremity procedures that were grouped into venous graft, prosthetic graft, or thromboendarterectomy. Thirty-day outcomes analyzed were (1) mortality, (2) composite morbidity, (3) graft/prosthesis failure, (4) return to the operating room within 30 days, (5) wound occurrences, (6) sepsis or septic shock, (7) pulmonary occurrences, and (8) renal insufficiency or failure. Intraoperative transfusion of packed red blood cells was categorized as none, 1 to 2 units, and 3 or more units. Outcome rates were compared between the transfused and nontransfused groups using the chi(2) test and multivariable regression adjusting for transfusion propensity, comorbid and procedural risk. RESULTS: A total of 8799 patients underwent lower extremity revascularization between 2005 and 2007. Mean age was 66.8 +/- 12.0 years and 5569 (63.3%) were male. Transfusion rates ranged from 14.5% in thromboendarterectomy patients to 27.1% in prosthetic bypass patients (P < .05). After adjustment for transfusion propensity and patient and procedural risks, transfusion of 1 or 2 units remained significantly predictive of mortality, composite morbidity, sepsis/shock, pulmonary occurrences, and return to the operating room. The adjusted odds ratios for 30-day mortality ranged from 1.92 (95% confidence interval [CI] 1.36-2.70) for 1 to 2 units to 2.48 (95% CI 1.55-3.98) for 3 or more units. CONCLUSION: In a large number of patients undergoing lower extremity revascularization, we have found that there is a higher risk of postoperative mortality, pulmonary, and infectious complications after receiving intraoperative blood transfusion. Additional studies are necessary to better define transfusion triggers that balance the risk/benefit ratio for blood transfusion.

PMID: 20110154 [PubMed - as supplied by publisher]

Efficacy and safety of alfimeprase in patients with acute peripheral arterial occlusion (PAO).

J Vasc Surg. 2010 Jan 26;

Authors: Han SM, Weaver FA, Comerota AJ, Perler BA, Joing M

PURPOSE: To investigate the safety and effectiveness of a novel thrombolytic, alfimeprase, in catheter-directed thrombolysis (CDT) of acute peripheral arterial occlusions (PAO). METHODS: Between April 2005 and March 2007, patients with acute PAO (Rutherford class I or IIa) of a lower extremity and onset of symptoms within 14 days prior to randomization were included. Studies HA004 and HA007 enrolled respectively 300 and 102 patients. Both studies HA004 and HA007 were placebo-controlled. HA004 had two placebo arms, intrathrombus and perithrombus, while HA007 had intrathrombus placebo arm. HA004 was partially double-blind (perithrombus group was not blinded) and HA007 was double-blind. Patients were randomized to intrathrombus alfimeprase (0.3 mg/kg), intrathrombus (IT) placebo, or perithrombus (PT) placebo (HA004 only) in two divided weight-based infusions 2 hours apart. Depending on arteriographic results after treatment, patients received no further intervention or underwent endovascular therapy or open vascular surgery. The primary endpoint of both studies was efficacy of alfimeprase compared with placebo as measured by avoidance of an open vascular surgery procedure at 30 days. RESULTS: The avoidance of open vascular surgery at 30 days was seen in 52 (34.9%), 42 (37.2%), and 7 patients (18.4%) with alfimeprase, IT placebo, and PT placebo in HA004 and 15 (29.4%) and 9 patients (17.6%) with alfimeprase and IT placebo in HA007; differences between alfimeprase and IT placebo were not statistically significant. Results were similar for secondary endpoints, including arterial flow restoration in 4 hours, 30-day ankle-brachial index, index limb pain severity, and hospital stay duration. The overall rate of adverse events was higher with alfimeprase than placebo. Hemorrhagic and peripheral embolic event rates with alfimeprase were 23% (34 patients) and 10.1% (15 patients) in HA004 and 9.4% (5 patients) and 9.8% (5 patients) in HA007; rates with IT placebo were 11% (12 patients, P = .107) and 5% (5 patients, P = .148) in HA004 and 10% (5 patients, P = .982) and 0% in HA007 (P = .07). No deaths were related to study drug administration. CONCLUSIONS: CDT for acute PAO with alfimeprase was as safe as placebo. However, alfimeprase was no more effective than placebo in increasing 30-day surgery-free survival. The surprising effectiveness of placebo alone demonstrates that the inclusion of a placebo arm is essential to the design of future lytic trials.

PMID: 20110153 [PubMed - as supplied by publisher]

Open surgical repair of ruptured juxtarenal aortic aneurysms with and without renal cooling: Observations regarding morbidity and mortality.

J Vasc Surg. 2010 Jan 23;

Authors: Yeung KK, Tangelder GJ, Fung WY, Coveliers HM, Hoksbergen AW, Van Leeuwen PA, Klerk ES, Wisselink W

OBJECTIVES: Little is known about the outcome of ruptured juxtarenal aortic aneurysm (RJAA) repair. Surgical treatment of RJAAs requires suprarenal aortic cross-clamping, which causes additional renal ischemia-reperfusion injury on top of the pre-existing hypovolemic shock syndrome. As endovascular alternatives rarely exist in this situation, open repair continues to be the gold standard. We analyzed our results of open RJAA repair during an 11-year period. DESIGN: Retrospective observational study. MATERIALS AND METHODS: Between July 1997 and December 2008, all consecutive patients with RJAAs were included in the study. Part of these patients received cold perfusion of the kidneys during suprarenal aortic cross-clamping. Perioperative variables, morbidity, and 30-day or in-hospital mortality were assessed. Renal insufficiency was defined as an acute rise of >/=0.5 mg/dL in serum creatinine level. Multiple organ failure (MOF) was scored using the sequential organ failure assessment score (SOFA score). RESULTS: A total of 29 consecutive patients with an RJAA, confirmed by computed tomography-scanning, presented to our hospital. In eight patients, the operation was aborted before the start of aortic repair, because no blood pressure could be regained in spite of maximal resuscitation measures. They were excluded from further analysis. Of the remaining 21 patients, 10 died during hospital stay. Renal insufficiency occurred in 11 out of 21 of the patients. Eleven out of 21 patients developed MOF postoperatively. In a subgroup of patients who received renal cooling during suprarenal aortic clamping, the 30-day or in-hospital mortality was two of 10 vs eight of 11 in patients who did not receive renal cooling (P = .03); renal insufficiency occurred in one out of 10 patients in the subgroup with renal cooling vs 10 out of 11 without renal cooling (P < .001) and MOF in two of 10 vs nine of 11, respectively (P = .009). CONCLUSIONS: Open surgical repair of RJAAs is still associated with high mortality and morbidity. To our knowledge, this is the first report of cold perfusion of the kidneys during RJAA repair. Although numbers are small, a beneficial effect of renal cooling on the outcome of RJAA repair is suggested, warranting further research with this technique.

PMID: 20100646 [PubMed - as supplied by publisher]

A case of external iliac arteriovenous fistula and high-output cardiac failure after endovenous laser treatment of great saphenous vein.

J Vasc Surg. 2010 Jan 23;

Authors: Ziporin SJ, Ifune CK, Macconmara MP, Geraghty PJ, Choi ET

Valvular incompetence in the great saphenous vein (GSV) is the most common cause of superficial venous insufficiency and symptomatic varicose vein development. Recently, less invasive modalities such as foam sclerotherapy, radiofrequency ablation (RFA), and endovenous laser treatment (EVLT) have gained popularity in the treatment of saphenofemoral junction and saphenous truncal incompetence over the traditional approach of surgical ligation and stripping. Here, we present the case of a 32-year-old woman who underwent EVLT and was diagnosed subsequently with ipsilateral external iliac arteriovenous (AV) fistula and high-output cardiac failure. She was stabilized medically and treated surgically with a covered stent placed in the external iliac artery with complete resolution of the fistula and cardiac failure. We reviewed the literature and discuss the complications of AV fistulae after EVLT.

PMID: 20100645 [PubMed - as supplied by publisher]

Circulation levels of acute phase proteins in patients with Takayasu arteritis.

J Vasc Surg. 2010 Jan 23;

Authors: Ma J, Luo X, Wu Q, Chen Z, Kou L, Wang H

OBJECTIVE: Takayasu arteritis (TA) is an immune-mediated disease with an unknown etiology. Assessment of disease activity in patients with TA is challenging owing to the absence of reliable serologic markers. Because circulation levels of acute-phase proteins fluctuate with the severity and extent of the inflammatory reaction, they may be potential biomarkers for the identification of TA activity. To test this hypothesis, certain acute-phase proteins were examined in TA patients and controls. METHODS: The study included 43 prospectively selected TA patients, with 18 in active phase and 25 in inactive phase. The Sharma modified criteria were used for disease diagnosis, and the National Institutes of Health criteria were used for TA activity assessment. Circulation levels of acute-phase proteins, including serum amyloid A (SAA), fibrinogen, complement C4-binding protein (C4BP), C-reactive protein, serum amyloid P, haptoglobin, alpha-acid glycoprotein, transthyretin, alpha1-microglobin, and complement fraction C3c and C4a were investigated by enzyme-linked immunosorbent assay in each participant. RESULTS: Circulating levels of SAA and C4BP were significantly increased in active TA patients compared with inactive TA patients and in controls, with (SAA: 95.9 [interquartile range, 51.9] vs 49.2 [82.0], P = .009; and 23.9 [50.1] mg/L, P = .001, respectively; C4BP: 88.5 [72.6] vs 61.7 [57.7], P = .023; and 32.6 [32.1] mg/L, P < .001, respectively). The levels of both proteins in inactive TA patients were still higher than those in controls (SAA: 49.2 [82.0] vs 23.9 [50.1] mg/L, P = .021; C4BP: 61.7 [57.7] vs 32.6 [32.1] mg/L, P = .025). No difference was found in the levels of the other acute-phase proteins studied. CONCLUSIONS: SAA and C4BP may be useful biomarkers in determining the disease activity of TA. More work should be done to test these results in a large cohort of patients in a longitudinal manner.

PMID: 20100644 [PubMed - as supplied by publisher]

Techniques and results of portal vein/superior mesenteric vein reconstruction using femoral and saphenous vein during pancreaticoduodenectomy.

J Vasc Surg. 2010 Jan 15;

Authors: Lee DY, Mitchell EL, Jones MA, Landry GJ, Liem TK, Sheppard BC, Billingsley KG, Moneta GL

BACKGROUND: Patients with pancreatic tumors may have portal vein (PV) and/or superior mesenteric vein (SMV) invasion. In such cases, lower extremity veins can provide an autogenous conduit for PV/SMV reconstruction. Little data exist, however, describing the technique of PV/SMV reconstruction, patency of such reconstructions, and the morbidity of using lower extremity veins for PV/SMV reconstruction during pancreaticoduodenectomy. METHODS: Thirty-four patients underwent PV/SMV reconstruction during pancreaticoduodenectomy using lower extremity vein. The saphenous vein was preferred for patching and femoral vein for replacement. We analyzed preoperative imaging, reconstruction patency, vein harvest morbidity, and late mortality. RESULTS: The mean age was 62.6 years. All 34 patients had preoperative computed tomography (CT) imaging and/or endoscopic ultrasound (EUS) scan. Fourteen of the 34 patients had evidence of PV/SMV invasion on CT or EUS scans, 14 did not, and six studies were indeterminate. Twenty-five patients had follow-up imaging, and 22 (88%) had patent reconstructions. Fifteen patients had PV/SMV replacement using femoral vein. Seven of these 15 had minor postoperative lower extremity edema that resolved over time, five had wound complications from the femoral vein harvest site, three of which required minor operative procedures for treatment. Fifteen patients had PV/SMV patching with the great saphenous vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Four patients had PV/SMV patching using femoral vein, none had postoperative wound problems, and one had minimal postoperative lower extremity edema. Compared with patients undergoing pancreaticoduodenectomy without PV/SMV reconstruction, by Kaplan-Meier analysis, there was no difference in late mortality. CONCLUSION: Preoperative imaging may fail to detect PV/SMV involvement in patients undergoing pancreaticoduodenectomy. The PV/SMV reconstruction with leg vein provides good patency with minimal postoperative lower extremity complications and no increase in late mortality. The lower extremities should be routinely included in the operative field of patients undergoing pancreaticoduodenectomy.

PMID: 20080375 [PubMed - as supplied by publisher]

Hybrid treatment of an ascending aortic pseudoaneurysm following multiple sternotomies.

J Vasc Surg. 2010 Jan 14;

Authors: Ruggieri VG, Malezieux R, Bina N, Favre JP

Ascending aortic pseudoaneurysm following prior cardiac or aortic surgery is a rare entity that requires reoperation. Surgical repair is a complex procedure associated with high operative mortality. We report the case of a 76-year-old male patient with an ascending aortic pseudoaneurysm developing from distal anastomosis of a Dacron aorto-aortic prosthesis. This high-risk patient had previously undergone multiple cardiovascular operations and was treated by performing an extra-anatomic bypass between the descending thoracic aorta and supra-aortic vessels, followed by endovascular stent graft placement, avoiding median re-sternotomy.

PMID: 20080010 [PubMed - as supplied by publisher]

Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula.

J Vasc Surg. 2010 Jan 14;

Authors: Son HJ, Min SK, Min SI, Park YJ, Ha J, Kim SJ

PURPOSE: Since the publication of Dialysis Outcomes Quality Initiative (DOQI) guidelines, the use of native veins for the construction of arteriovenous fistulas (AVF) for hemodialysis has been highly recommended rather than prosthetic arteriovenous grafts (AVG). Upper arm basilic vein transposition (BVT) has been accepted widely, with superior patency compared with AVG, but only a few studies have reported outcomes of forearm BVT (FBVT). This study evaluated the efficacy of FBVT compared with direct AVF (DAVF) and AVG in a tertiary referral center. METHODS: From January 2005 to December 2007, 461 patients underwent AV access for hemodialysis in Seoul National University Hospital. We retrospectively reviewed the medical records and dialysis sheets and evaluated the current AVF function in the outpatient clinic or by telephone interviews. Patients were grouped by the operation type: DAVF, FBVT, and AVG. The outcomes compared were primary, assisted-primary and secondary patency rates, maturation failure, and complications. RESULT: The mean age was 59 years (range, 14-92 years), and 280 patients (60.7%) were male. By operation type, the 461 accesses were 389 DAVF (84.4%), 34 FBVT (7.4%), and 38 AVG (8.2%). Mean follow-up duration was 21 months (range, 1-51 months). The primary patency rates for DAVF, FBVT, and AVG were 67.6%, 41.5%, 35% at 12 months and 53.9%, 30.2%, 10.3% at 24 months, respectively. The secondary patency rates were 89.2%, 79.1%, 78.3% at 12 months and 83.8%, 74.4%, 64.9% at 24 months, respectively. Maturation failure occurred in five DAVF patients and in one FBVT patient. The infection rate was 0.3% in DAVF and 12.5% in AVG, but no infection occurred in patients with FBVT. Multivariate analysis revealed that age and history of previous access were associated with lower primary patency. CONCLUSION: Forearm BVT showed an acceptable, high 2-year patency rate and fewer thromboses and infectious complications than AVG. Forearm BVT could be considered before forming an upper arm AVF or forearm AVG, if the basilic vein is available.

PMID: 20080009 [PubMed - as supplied by publisher]

Multiple hereditary exostoses as a rare nonatherosclerotic etiology of chronic lower extremity ischemia.

J Vasc Surg. 2010 Jan 14;

Authors: Khan I, West Jr CA, Sangerster GP, Heldman M, Doucet L, Olmedo M

Nonatherosclerotic etiologies of arterial insufficiency are uncommon but important causes of chronic lower extremity ischemia. We report a patient with multiple hereditary exostoses (MHE) presenting with lifestyle-limiting lower extremity claudication and popliteal artery occlusion secondary to a large osteochondroma. The presence of MHE with associated osteochondroma resulting in arterial occlusion is a rare condition. Management strategies for treating large osteochondromas adjacent to or with vessel involvement in asymptomatic patients remain undefined.

PMID: 20080008 [PubMed - as supplied by publisher]

Total aortic repair in Marfan syndrome using stent grafting with hybrid techniques.

J Vasc Surg. 2010 Jan 14;

Authors: Takahashi Y, Tsutsumi Y, Shirakawa Y, Ohashi H

PMID: 20080007 [PubMed - as supplied by publisher]

Racial and ethnic differences in patterns of treatment for acute peripheral arterial disease in the United States, 1998-2006.

J Vasc Surg. 2010 Jan 14;

Authors: Rowe VL, Weaver FA, Lane JS, Etzioni DA

OBJECTIVE: Prior studies have documented racial and ethnic disparities in rates of amputations for peripheral arterial disease (PAD) in the United States. We analyze whether there are underlying differences in the types of treatment provided to patients who are acutely hospitalized for PAD. METHODS: The 1998-2006 Nationwide Inpatient Sample was used to examine patterns of treatment. We considered a hospitalization an acute admission for PAD if (1) the primary diagnosis was PAD, and (2) the patient was admitted urgently or emergently or through an emergency department. Vascular interventions were designated as open bypass, endovascular intervention, or major amputation, defined as disarticulation at the ankle or higher amputation. RESULTS: From 1998 through 2006, the likelihood of an endovascular procedure being performed during an acute hospitalization for PAD increased from 11.5% to 35.3%, and open vascular procedures decreased from 34.9% to 25.4%. The likelihood of a major amputation during an acute hospitalization for PAD decreased from 29.7% to 20.3%. Black and Hispanic patients were more likely than white patients to undergo amputation and were less likely to have an endovascular or open revascularization. CONCLUSION: Use of endovascular procedures has increased and use of open vascular bypass has decreased in the inpatient treatment of acute PAD. Although the overall likelihood of amputation has decreased, racial and ethnic differences persist, with black and Hispanic patients experiencing a higher likelihood of amputation.

PMID: 20080006 [PubMed - as supplied by publisher]

Gender trends in the repair of ruptured abdominal aortic aneurysms and outcomes.

J Vasc Surg. 2010 Jan 14;

Authors: Mureebe L, Egorova N, McKinsey JF, Kent KC

BACKGROUND: This study evaluated gender-specific trends in the diagnosis and treatment of ruptured abdominal aortic aneurysms (rAAAs) in the United States Medicare population. METHODS: The Medicare beneficiary database (1995 through 2006) was examined for patients with rAAAs using International Classification of Diseaes, 9th Edition, Clinical Modification (ICD-9-CM) codes. Codes for endovascular aneurysm repair (EVAR) were only available for the year 2000 forward, and thus, analysis of EVAR was limited to 2000 through 2006. Proportions were analyzed by chi(2) and continuous variables by t-test. Factors associated with 30-day mortality and discharge home after surgery were analyzed by multivariate logistic regression. The effect of gender and repair type (open or EVAR) on death and the probability of discharge to home after repair were also evaluated. RESULTS: The rate of hospitalizations per 100,000 Medicare fee-for-service beneficiaries for men decreased by 52% (from 40 to 19) and by 36% for women (from 11 to 7). The observed 30-day mortality rate was overall 7.7% higher for women vs men. The mortality rate for women was higher by 8.9% for open repair and higher by 7.1% for EVAR vs men. Female gender was associated with increased risk of death in multivariate analysis after controlling for age, year, and type of procedure. Women were 9.8% less likely to be discharged to home after rAAA repair, regardless of the type of repair. CONCLUSION: In addition to the fact that we have failed to realize a change in the number of women diagnosed with or treated for rAAA, a significant gender difference remains in the outcomes after treatment for rAAA. This differential is present in both the 30-day mortality rate and in the potential to be discharged to home after repair.

PMID: 20080005 [PubMed - as supplied by publisher]

Discussion.

J Vasc Surg. 2010 Jan 14;

Authors:

PMID: 20080004 [PubMed - as supplied by publisher]