Aortic Center LUMC

🎖️ What happens when patient approach the surgical treshold for #AAA focusing on QoL, anxiety and deppression? 🧧 A multicenter cohort study of 124 patients with AAA (≥40 mm diameter) was conducted using the EuroQol 5-Dimension 5-Level, Hospital Anxiety and Depression Scale and the Patient Health Questionnaire to measure outcomes at baseline and annually over two years or until surgery/death. Key Findings 🥉 Health related (hr)QoL, anxiety, and depression scores remained stable in most patients under surveillance. 🥈 Anxiety and depression decreased in patients who underwent surgery 🏅 Patients with a family history of AAA or only primary education experienced higher anxiety and depression, suggesting a need for tailored psychological support. While surveillance does not negatively impact overall HRQoL, psychological distress in certain groups highlights the importance of individualized interventions. Link to article published in the BJS Open: https://lnkd.in/em6DNe9d Congratulations to authors: Alexander Vanmaele, Petros Branidis, Maria Karamanidou, Elke Bouwens, Sanne Hoeks, Jorg Lucas de Bruin, Sander ten Raa, Martijn Akkerhuis, Felix van Lier, Ricardo Budde, MD, PhD, Bram Fioole, Hence Verhagen, Eric Boersma and Isabella kardys #aneurysm #QoL #followup

🏜️ Long-term Cardiovascular and All-Cause Mortality following Elective Infrarenal Repair of the Abdominal Aortic Aneurysm: A Systematic Review and Meta-analysis! 🏖️ This study evaluated the long-term outcomes of cardiovascular and all-cause mortality rates following elective repair of the infrarenal abdominal aortic aneurysm. The results of this systematic review and meta-analysis emphasizes the -suboptimal cardiovascular risk profile observed in this patient population -importance of optimization and emphasis of cardiovascular risk management, including in the long-term after surgical intervention. Congratulations to the authors: Samira van Knippenberg, Cecilia Fenelli, Susan van Dieren, Ronak Delewi, Ron Balm and Kak Khee Yeung Link to article published in the Journal Of Endovascular Thrpy: https://lnkd.in/e-9tFNcW

Do you ever use the PMEG concept ⚒️ ? This study analyzed data from a tertiary care center on physician-modified endovascular grafts (PMEGs) compared to custom made fenestrated grafts (ZFEN Cook Medical) over 11 years. The PMEG cohort included more complex cases, such as larger aneurysms, more comorbidities, and prior aortic surgeries. Despite these challenges, perioperative outcomes, long-term survival, and reintervention rates were comparable between PMEGs and ZFENs. Key findings: 🐴 PMEGs had higher rates of transient spinal ischemia (9% vs. 0%) 🐭 PMEGs had higher rates of type II endoleaks at 2 years (43% vs. 15%), no difference in type I and III endoleaks 🦌 Five-year survival was lower for PMEGs (54% vs 65%) 🐷 Long-term aorta-specific survival (93% PMEG vs. 92% ZFEN) was similar 🐺 Freedom from reintervention (74% PMEG vs. 74% ZFEN after excluding prior EVAR cases) were similar. Technological advances and surgeon experience improved outcomes over time, even as case complexity increased. The study highlights PMEGs as a viable option for complex aneurysm repairs, particularly in urgent scenarios. Link to article published in the Journal of Vascular Surgery: https://lnkd.in/exEc-HNw Congratulations to authors: Andrew Sanders, Jorge L. Gomez-Mayorga, Mohit Manchella, Nicholas Swerdlow, Marc Schermerhorn #aortaed #aorta #PMEG #aneurysm

Thanks for the organization to Robin Heijmen, Jan Albert Vos and of course Judith Otten from Hippocrates Academy. We had a great day at this symposium!

Maximal systolic acceleration (ACCmax) after complex endo aneurysm repair: This paper describes two cases in which it was utilized. After complex endovascular aortic repair long-term surveillance is needed to detect complications. Computed tomography angiography (CTA) is commonly used, but it can be limited by metal artifacts. The ACCmax measured by duplex ultrasound (DUS) is a promising alternative, as it avoids these issues and provides information on arterial perfusion distal to a stenosis. Higher ACCmax values indicate better perfusion. Conclusion: ACCmax could be a valuable addition to DUS follow-up after complex EVAR or stenting, potentially reducing radiation exposure, nephrotoxicity, and healthcare costs. It provides reliable assessment of arterial perfusion without the limitations of CTA. Congratulations to the authors from the Aortic Center LUMC: Siem Willems, Jeroen Brouwers, Jaap Hamming, Janwillem Hinnen, Joost van der Vorst and Jan van Schaik. Link to article published in journal of endovascular therapy #JEVT: https://lnkd.in/eRCnXDjN

🧙♂️ Open vs endo for juxtarenal aneurysms? 🧙♀️ This study compared the short- and mid-term outcomes of two treatments for juxtarenal AAAs in Sweden from 2018 to 2021 using the Swedish Vascular Registry. Open surgical repair (OSR) was compared to fenestrated endovascular aneurysm repair (FEVAR) in an elective setting. Key findings: 🎅 Of 418 JAAA cases, 54.5% underwent OSR, 42.1% received FEVAR, and the remaining used other endovascular methods. 🤶 The 30-day mortality rate was low and similar between treatments: 2.6% for OSR and 1.7% for FEVAR. 👼 Major perioperative complications were higher in OSR (19.3%) compared to FEVAR (7.4%), though vascular complications were comparable. 🦸 At one and three years, survival rates were similar between OSR (93.1% and 85.9%) and FEVAR (95.2% and 80.9%). In conclusion, despite differences in patient demographics and treatment practices across Swedish centers, survival rates were similar for both OSR and FEVAR, though perioperative complications were more frequent in OSR. Link to article published in the British Journal of Surgery: https://lnkd.in/eyS9BqDy Congratulations to the authors: Harry Yu, Giuseppe Asciutto, Nuno Dias, Anders Wanhainen, Angelos Karelis, Björn Sonesson and Kevin Mani #AAA #FEVAR #aneurysm #

Category of debate --> what do you do with a type A intramural hematoma based on what parameters? 🦭 This retrospective study of 98 patients evaluates the relation between ascending aortic length and outcomes in patients with acute type A intramural hematoma managed medically. It reported that patients with an ascending aortic length of 11 cm or more had a significantly higher risk of aortic progression, surgical intervention, and ulcer-like projections compared to those with shorter lengths. Ascending aortic length could help identify high-risk patients who might benefit from early surgical intervention, suggesting its role in risk assessment and treatment planning. Congratulations to authors: Zerui Chen, Jinlin Wu, Jie Liu, Jiayu Song, Hailong Qiu, Jian Zhuang from the School of Medicine, South China Guangzhou College of South China University of Technology Link to article published in the European Journal of Cardio-Thoracic Surgery: https://lnkd.in/etyZMmGp #IMH #dissection #typeA

We recently operated on this fit octogenarian, who was referred from another hospital with signs of a contained rupture following a previous EVAR more than 10 years ago. We opted for endovascular repair using a custom-made T-branch graft (Cook Medical) with short proximal sealing to minimize the risk of spinal cord ischemia (with great thanks to the Erasmus MC, Hence Verhagen for providing this graft for this patient in an acute setting). The procedure and postoperative course were uneventful, and the patient was discharged six days postoperatively. #aorta #endovascular #aneurysm #rupture

Open aneurysmorraphy following B/FEVAR for thoracic aneurysms, would you do this? The study discusses the use of open aneurysmorraphy following TEVAR and F/BEVAR for thoracic aortic aneurysms. Endovascular repair has become the preferred initial treatment due to lower morbidity and mortality compared to open surgery. However, persistent complications like endoleaks and sac enlargement can necessitate further intervention. The authors present a hybrid approach combining the advantages of endovascular repair with the durability of open surgical repair to manage complex cases, particularly large aneurysms or those with persistent sac enlargement. The technique involves meticulous pre-operative planning, thoracotomy, aneurysm wall resection, and thrombus removal while preserving the endograft integrity. Early outcomes are promising with no 30-day mortality and significant reduction in aneurysm size post-procedure, suggesting potential benefits for long-term outcomes in selected patients, especially young individuals at higher risk from open surgical repair. Congratulations to the authors: Florent POREZ, dominique fabre, Blandine Maurel, Antoine Gaudin, Alessandro Costanzo, Mark Tyrrell, Thomas LE HOUÉROU, Stéphan Haulon Link to article published in Journal in Vascular Surgery: https://lnkd.in/gXf5-q5z

🌶 What's the optimal degree of core temperature for hypothermic circulatory arrest in complex aortic arch surgery?? 🌶 This study aimed to determine the optimal degree of core temperature for hypothermic circulatory arrest (HCA) during complex aortic arch surgery. The researchers conducted a retrospective analysis of 1310 patients who underwent complex aortic arch surgery involving hypothermic circulatory arrest. They compared outcomes based on varying degrees of core temperatures used during HCA, ranging from mild to deep hypothermia. Key Findings: ♨ The study found that higher core temperatures during HCA (referred to as moderate hypothermia) were associated with lower operative mortality compared to deeper hypothermia. 🛎 Moderate hypothermia emerged as the most protective approach for operative mortality, suggesting that it might offer better outcomes than deeper hypothermia. 🛋 Long-term Outcomes: Different HCA temperatures did not significantly affect long-term survival or quality of life, indicating that while operative mortality may be influenced by the degree of hypothermia, long-term outcomes remain similar across different temperature ranges. Conclusions: The findings suggest that higher core temperatures during hypothermic circulatory arrest are beneficial for reducing operative mortality in complex aortic arch surgeries. Contrary to previous beliefs, deep hypothermia does not necessarily provide superior surgical protection. Moderate hypothermia (HMH) is recommended as the optimal choice for improving operative outcomes. Long-term survival and quality of life are not significantly impacted by the degree of hypothermia used during the procedure. Link to article: https://lnkd.in/e2JCihCu Congratulations to: Kai Zhang, Chenyu Zhou, Shiqi Gao, Yumeng Ji, Jiawei Qiu, Fangfang Cao, Juntao Qiu, Cuntao Yu from the Fuwai Hospital, Chinese Academy of Medical Sciences (CAMS)