The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge.
endovascular repair
high-volume center
open surgical repair
preoperative scores
ruptured abdominal aortic aneurysm
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
25 Aug 2023
25 Aug 2023
Historique:
received:
13
06
2023
revised:
18
08
2023
accepted:
23
08
2023
medline:
9
9
2023
pubmed:
9
9
2023
entrez:
9
9
2023
Statut:
epublish
Résumé
despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment. we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms' incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies. the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention. RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk-benefit assessment may improve outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment.
METHODS
METHODS
we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms' incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies.
RESULTS
RESULTS
the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention.
CONCLUSIONS
CONCLUSIONS
RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk-benefit assessment may improve outcomes.
Identifiants
pubmed: 37685601
pii: jcm12175530
doi: 10.3390/jcm12175530
pmc: PMC10488063
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Références
Cardiovasc Intervent Radiol. 2014 Apr;37(2):337-42
pubmed: 23756880
Br J Surg. 2016 Aug;103(9):1125-31
pubmed: 27270466
J Vasc Surg. 1996 Oct;24(4):614-20; discussion 621-3
pubmed: 8911410
J Cardiovasc Surg (Torino). 2018 Apr;59(2):190-194
pubmed: 29327568
JAMA Netw Open. 2022 May 2;5(5):e2211336
pubmed: 35536576
J Vasc Surg. 2020 Aug;72(2):508-517.e11
pubmed: 32144013
Vascular. 2009 Nov-Dec;17(6):309-15
pubmed: 19909677
Eur J Vasc Endovasc Surg. 2008 Nov;36(5):536-44
pubmed: 18801667
Eur J Vasc Endovasc Surg. 2017 Jun;53(6):811-819
pubmed: 28392057
J Vasc Surg. 2006 Aug;44(2):237-43
pubmed: 16890847
J Vasc Surg. 2018 Oct;68(4):991-997
pubmed: 29753581
Lancet. 2014 Mar 15;383(9921):963-9
pubmed: 24629298
Herz. 2004 Feb;29(1):123-9
pubmed: 14968348
J Vasc Surg. 2021 Nov;74(5):1508-1518
pubmed: 33957228
Am J Surg. 1997 Dec;174(6):667-72; discussion 672-3
pubmed: 9409594
J Vasc Surg. 2000 Dec;32(6):1091-100
pubmed: 11107080
J Vasc Surg. 2002 Feb;35(2):246-53
pubmed: 11854721
J Vasc Surg. 2022 Dec;76(6):1548-1554.e1
pubmed: 35752382
Eur J Vasc Endovasc Surg. 2005 Oct;30(4):359-64
pubmed: 15963743
Br J Surg. 2003 Apr;90(4):421-5
pubmed: 12673742
J Vasc Surg. 2022 Jan;75(1):348-355.e10
pubmed: 34500028
J Vasc Surg. 1996 Jan;23(1):123-9
pubmed: 8558727
Eur J Vasc Endovasc Surg. 2020 May;59(5):717-728
pubmed: 31948911
Ann Vasc Dis. 2013;6(3):631-6
pubmed: 24130620
BMJ. 2014 Jan 13;348:f7661
pubmed: 24418950
Angiology. 2020 Aug;71(7):626-632
pubmed: 32166957
Br J Surg. 2013 Oct;100(11):1405-13
pubmed: 24037558
Br J Surg. 2004 Nov;91(11):1449-52
pubmed: 15499653
Int Angiol. 2023 Aug;42(4):310-317
pubmed: 37377396
J Vasc Surg. 2016 Dec;64(6):1609-1616
pubmed: 27575812
Semin Vasc Surg. 2021 Mar;34(1):29-37
pubmed: 33757632
Lancet. 2005 Jun 25-Jul 1;365(9478):2179-86
pubmed: 15978925
Am J Epidemiol. 2001 Aug 1;154(3):236-44
pubmed: 11479188
J Vasc Surg. 2008 Nov;48(5):1101-7
pubmed: 18771883
Eur J Vasc Endovasc Surg. 2017 Feb;53(2):168-174
pubmed: 27916478
J Vasc Surg. 2015 Mar;61(3):648-54
pubmed: 25499708
Eur J Vasc Endovasc Surg. 2018 Jul;56(1):31-39
pubmed: 29636250
Surg Clin North Am. 2021 Oct;101(5):785-798
pubmed: 34537143
Ann Vasc Surg. 2007 Sep;21(5):580-5
pubmed: 17521873
J Vasc Surg. 2008 Nov;48(5):1092-100, 1100.e1-2
pubmed: 18971032
Ann Vasc Surg. 2021 Aug;75:12-21
pubmed: 33951521
Lancet. 2002 Nov 16;360(9345):1531-9
pubmed: 12443589
BMJ Open. 2016 Feb 12;6(2):e008391
pubmed: 26873043
J Vasc Surg. 2009 Apr;49(4):1077-80
pubmed: 19341900
Br J Surg. 2001 Jul;88(7):958-63
pubmed: 11442527
Eur J Vasc Endovasc Surg. 2020 May;59(5):757-765
pubmed: 32033872
Eur J Vasc Endovasc Surg. 2018 Aug;56(2):181-188
pubmed: 29482972
J Vasc Surg. 2019 Sep;70(3):869-881
pubmed: 30850284
Eur J Trauma Emerg Surg. 2018 Aug;44(4):535-550
pubmed: 29785654
J Vasc Surg. 2017 Mar;65(3):626-634
pubmed: 27988158
J Vasc Surg. 2009 Apr;49(4):817-26
pubmed: 19147323
Br J Surg. 2014 Feb;101(3):208-15
pubmed: 24469619
J Cardiovasc Surg (Torino). 2016 Apr;57(2):233-41
pubmed: 26784556
Chang Gung Med J. 2011 Sep-Oct;34(5):520-7
pubmed: 22035897
Eur J Vasc Endovasc Surg. 2016 Mar;51(3):371-8
pubmed: 26652956
Circulation. 2016 Dec 13;134(24):1948-1958
pubmed: 27784712
J Endovasc Ther. 2005 Oct;12(5):556-9
pubmed: 16212455
J Vasc Surg. 1991 Dec;14(6):812-8; discussion 819-20
pubmed: 1960812
Arch Surg. 2004 Sep;139(9):941-4; discussion 945-6
pubmed: 15381610
World J Surg. 2020 Jun;44(6):2020-2027
pubmed: 32152740
J Vasc Surg. 2013 Feb;57(2):354-61
pubmed: 23182157
J Vasc Surg. 2012 Jul;56(1):15-20
pubmed: 22626871
J Vasc Surg. 2016 Dec;64(6):1617-1622
pubmed: 27871490
Eur J Vasc Endovasc Surg. 2020 Jan;59(1):16-22
pubmed: 31810836
Lancet. 1994 Dec 10;344(8937):1645
pubmed: 7984027
J Vasc Surg. 2022 Sep;76(3):663-670.e2
pubmed: 35276257
Eur J Vasc Endovasc Surg. 2021 Sep;62(3):388-398
pubmed: 34384687
Ann Surg. 2009 Nov;250(5):818-24
pubmed: 19809296
Jpn J Surg. 1986 Jul;16(4):272-6
pubmed: 3773359
Ann Vasc Surg. 2019 Apr;56:163-174
pubmed: 30476604
J Vasc Surg. 2014 Dec;60(6):1439-45
pubmed: 25103257
Surgery. 1982 May;91(5):586-96
pubmed: 7071747
J Vasc Surg. 2008 Jan;47(1):222-30
pubmed: 17928187
Eur J Vasc Endovasc Surg. 2004 Oct;28(4):365-72
pubmed: 15350557