Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study.
AJTES Volume 8, Number 1, January 2024
Nuellari E. et al. - Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study

Keywords

aortic repair
operative surgical procedures
screening program
quality of care
treatment outcome

How to Cite

Nuellari, E., Kuci, S., Kenga, A., Kosovrasti, D., Ibrahimi, A., & Bejko, E. (2024). Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study. Albanian Journal of Trauma and Emergency Surgery, 8(1), 1323-1330. https://doi.org/10.32391/ajtes.v8i1.356

Abstract

Introduction: Surgical treatment of abdominal aortic aneurysms poses a significant challenge in the field of vascular surgery, with numerous factors influencing operative technique and surgical outcome.

This study aimed to assess the outcomes of open surgical treatment for patients with abdominal aortic aneurysms at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana and provide recommendations for improving outcomes.

Material and Methods: A single-center, non-randomized, retrospective study of the results of open surgical treatment of abdominal aortic aneurysms in 206 patients from January 2008 to December 2015 was performed at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana. The study only included patients with a histologically confirmed diagnosis of abdominal aortic aneurysm, while patients with ruptured abdominal aortic aneurysm were excluded.

The study evaluated the incidence of abdominal aortic aneurysms, clinical and imaging findings of the disease (ultrasound, tomographic, and arteriographic), frequency of involvement of the iliac artery in the pathological process, and postoperative complications. Transabdominal access was the most commonly utilized, while retroperitoneal access was deemed the safest. No significant differences in recurrence rates were noted between the two approaches.

Results: During the study period, 206 patients underwent surgery for AAA and met the inclusion criteria. Of these, 188 (91.3%) were male and 18 (8.7%) were female. The mean age of the patients was 67.8±5.7 years, with 67.7±5.9 years for men and 69±3.1 years for women. There were no statistically significant differences in age between genders (p>0.05).

Conclusion: In all other cases of abdominal aortic aneurysms, surgical treatment should be strongly recommended. Finally, given the clinical benefits of using surgical treatment of asymptomatic aneurysms to reduce mortality, it is necessary to conduct an economic assessment of the feasibility of abdominal aortic aneurysms screening in the population over 55 of the age of both sexes.

 

https://doi.org/10.32391/ajtes.v8i1.356
Nuellari E. et al. - Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study

References

Sakalihasan N, Michel JB, Katsargyris A, Kuivaniemi H, Defraigne JO, Nchimi A, Powell JT, Yoshimura K, Hultgren R. Abdominal aortic aneurysms. Nat Rev Dis Primers. 2018 Oct 18;4(1):34. doi: 10.1038/s41572-018-0030-7. PMID: 30337540.

Blackstock CD, Jackson BM. Open Surgical Repair of Abdominal Aortic Aneurysms Maintains a Pivotal Role in the Endovascular Era. Semin Intervent Radiol. 2020 Oct;37(4):346-355. doi: 10.1055/s-0040-1715881. Epub 2020 Oct 1. PMID: 33041480; PMCID: PMC7540643.

Witheford M, Chong DST, Martin-Gonzalez T, et al. Women undergoing endovascular thoracoabdominal aortic aneurysm repair differ significantly from their male counterparts preoperatively and postoperatively. J Vasc Surg 2020;71:748-57. [Crossref]

[PubMed]

Kessler, V., Klopf, J., Eilenberg, W., Neumayer, C., Brostjan, C. 2022. AAA revisited: A comprehensive review of risk factors, management, and hallmarks of pathogenesis. Biomedicines, 10(1), 94. https://doi.org/10.3390/biomedicines10010094.

Castro-Ferreira, R., Lachat, M., Schneider, P.A., Freitas, A., Leite-Moreira, A., Sampaio, S.M. 2019. Disparities in contemporary treatment rates of abdominal aortic aneurysms across western countries. European Journal of Vascular and Endovascular Surgery, 58(2), 200-205.

Alberga, A.J., Karthaus, E.G., Wilschut, J.A., de Bruin, J.L., Akkersdijk, G.P., Geelkerken, R.H., Hamming, J.F., Wever, J.J., Verhagen, H.J.M., Dutch Society of Vascular Surgery, Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing. 2022. Treatment outcome trends for non-ruptured abdominal aortic aneurysms: A nationwide prospective cohort study. European Journal of Vascular and Endovascular Surgery, 63(2), 275–283. https://doi.org/10.1016/j.ejvs.2021.08.019.

Brown, C.S., Montgomery, J.R., Kim, G.Y., Kemp, M.T., Osborne, N.H. (2022). Reliability of hospital-level mortality in abdominal aortic aneurysm repair. Journal of Vascular Surgery, 75(2), 535–542. https://doi.org/10.1016/j.jvs.2021.07.241.

Sharma, G., Madenci, A.L., Wanis, K., Comment, LA, Lotto, C.E., Shah, S.K., Ozaki, C.K., Subramanian, S.V., Eldrup-Jorgensen, J., Belkin, M. (2021). Association and interplay of surgeon and hospital volume with mortality after open abdominal aortic aneurysm repair in the modern era. Journal of Vascular Surgery, 73(5), 1593–1602. https://doi.org/10.1016/j.jvs.2020.07.108.

Tshomba, Y., Sica, S., Minelli, F., Ferraresi, M., de Waure, C., Donati, T., De Nigris, F., Vincenzoni, C., Snider, F., Tinelli, G. 2022. Long-term results of complex abdominal aortic aneurysm open repair. Journal of Personalized Medicine, 12(10), 1630. https://doi.org/10.3390/jpm12101630.

Pratesi, C., Esposito, D., Apostolou, D., Attisani, L., Bellosta, R., Benedetto, F., Blangetti, I., Bonardelli, S., Casini, A., Fargion, A. T., Favaretto, E., Freyrie, A., Frola, E., Miele, V., Niola, R., Novali, C., Panzera, C., Pegorer, M., Perini, P., Piffaretti, G., Pini, R., Robaldo, A., Sartori, M., Stigliano, A., Taurino, M., Veroux, P., Verzini, F., Zaninelli, E., Orso, M., Italian Guidelines for Vascular Surgery Collaborators – AAA Group. 2022. Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE). The Journal of Cardiovascular Surgery, 63(3), 328-352. https://doi.org/10.23736/S0021-9509.22.12330-X.

Powell, J.T., Wanhainen, A. (2020). Analysis of the differences between the ESVS 2019 and NICE 2020 guidelines for abdominal aortic aneurysm. European Journal of Vascular and Endovascular Surgery, 60(1), 7–15. https://doi.org/10.1016/j.ejvs.2020.04.038

Carnevale, M.L., Koleilat, I., Lipsitz, E.C., Friedmann, P., Indes, J.E. 2020. Extended screening guidelines for the diagnosis of abdominal aortic aneurysm. Journal of Vascular Surgery, 72(6), 1917-1926. https://doi.org/10.1016/j.jvs.2020.03.047.

O'Donnell, T.F.X., Schermerhorn, M.L. (2020). Abdominal aortic aneurysm screening guidelines: United States Preventative Services Task Force and Society for Vascular Surgery. Journal of Vascular Surgery, 71(5), 1457–1458. https://doi.org/10.1016/j.jvs.2020.01.054.

Dansey, K.D., Varkevisser, R.R.B., Swerdlow, N.J., Li, C., de Guerre, L.E.V.M., Liang, P., Marcaccio, C., O’Donnell, T.F.X., Carroll, B.J., Schermerhorn, M.L. 2021. Epidemiology of endovascular and open repair for abdominal aortic aneurysms in the United States from 2004 to 2015 and implications for screening. Journal of Vascular Surgery, 74(2), 414-424. https://doi.org/10.1016/j.jvs.2021.01.044.

Kapila, V., Jetty, P., Wooster, D., Vucemilo, V., Dubois, L., Canadian Society for Vascular Surgery. 2021. Screening for abdominal aortic aneurysms in Canada: 2020 review and position statement of the Canadian Society for Vascular Surgery. Canadian Journal of Surgery, 64(5), 461–466. https://doi.org/10.1503/cjs.009120.

Chaikof, E.L., Dalman, R.L., Eskandari, M.K., Jackson, B.M., Lee, W.A., Mansour, M.A., Mastracci, T.M., Mell, M., Murad, M.H., Nguyen, L.L., Oderich, G.S., Patel, M.S., Schermerhorn, M.L., Starnes, B.W. 2018. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery, 67(1), 2-77. https://doi.org/10.1016/j.jvs.2017.10.044.

Kinio, A., Ramsay, T., Jetty, P., Nagpal, S. 2021. Declining institutional memory of open abdominal aortic aneurysm repair. Journal of Vascular Surgery, 73(3), 889-895. https://doi.org/10.1016/j.jvs.2020.06.125.

Park, J.K., Kang, J., Kim, Y.W., Kim, D.I., Heo, S.H., Gil, E., Woo, S.Y., Park, Y.J. 2021. Outcomes after elective open abdominal aortic aneurysm repair in octogenarians compared to younger patients in Korea. Journal of Korean Medical Science, 36(47), e314. https://doi.org/10.3346/jkms.2021.36.e314.

Dang, Q., Statius van Eps, R.G., Wever, J.J., Veger, H.T.C., Dutch Society of Vascular Surgery, the Steering Committee of the Dutch Surgical Aneurysm Audit, and the Dutch Institute for Clinical Auditing. 2020. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. Journal of Vascular Surgery, 72(2), 531–540. https://doi.org/10.1016/j.jvs.2019.09.060.

Premnath, S., Zaver, V., Hostalery, A., Rowlands, T., Quarmby, J., Singh, S. (2021). Mycotic abdominal aortic aneurysms – A tertiary centre experience and formulation of a management protocol. Annals of Vascular Surgery, pp. 74, 246–257. https://doi.org/10.1016/j.avsg.2020.12.025.

Touma, J., Couture, T., Davaine, J.M., de Boissieu, P., Oubaya, N., Michel, C., Cochennec, F., Chiche, L., Desgranges, P. 2022. Mycotic/infective native aortic aneurysms: Results after preferential use of open surgery and arterial allografts. European Journal of Vascular and Endovascular Surgery, 63(3), 475-483. https://doi.org/10.1016/j.ejvs.2021.10.041.

Ibrahim, A., Yordanov, M.D., Hasso, M., Heine, B., Oberhuber, A. 2022. Open treatment of abdominal aortic aneurysm in the endovascular era. Journal of Clinical Medicine, 11(11), 3050. https://doi.org/10.3390/jcm11113050.

Tripodi, P., Mestres, G., Riambau, V., Vascular Advisory Committee – Catalan Health Service. 2020. Impact of centralisation on abdominal aortic aneurysm repair outcomes: Early experience in Catalonia. European Journal of Vascular and Endovascular Surgery, 60(4), 531–538. https://doi.org/10.1016/j.ejvs.2020.03.009.

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