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      Natural History Of an Untreated Type 1 Endoleak: A Case Report

      case-report
      1 , 1 , , 1 , 2
      ,
      Cureus
      Cureus
      endovascular aneurysm repair (evar), endoleak, abdominal aortic aneurysm (aaa)

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          Abstract

          We present a case of giant abdominal aortic aneurysm greater than 17 cm complicated by an endoleak, demonstrating the natural history of an untreated Type 1 endoleak.

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          Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial.

          Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair. To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial. A randomized, multicenter clinical trial of 881 veterans (aged > or = 49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008. Elective endovascular (n = 444) or open (n = 437) repair of AAA. Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality. Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function. In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures. clinicaltrials.gov Identifier: NCT00094575.
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            Epidemiology and potential for prevention of abdominal aortic aneurysm.

            Ruptured abdominal aortic aneurysm (AAA) is a common cause of death which is preventable by elective repair of an asymptomatic AAA. The literature was reviewed with emphasis on epidemiological studies and population-based screening surveys. The prevalence of small AAA ranges between 3 and 8 per cent. The incidence of asymptomatic AAA seems to be increasing, although exact incidence estimates vary. The most important risk factors for AAA are male sex, age, family history and smoking. Hypertension is associated with a mildly increased risk, but diabetes is not associated with any increase. Primary prevention of AAA is not a realistic option. There is no evidence of an effective medical treatment to prevent growth of small AAAs, although trials with propranolol are under way. The only intervention to prevent death from aneurysm is elective repair of the asymptomatic lesion. Screening for asymptomatic AAA can reduce the incidence of rupture. However, further studies are needed to determine the cost effectiveness of screening compared with that of other health programmes.
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              The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm.

              Endovascular repair of infrarenal abdominal aneurysms (EVAR) is currently used in patients with large aneurysm. Two randomized studies, Dutch Randomised Endovascular Aneurysm Management (DREAM) and Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR-1), showed favorable early results with EVAR; but at 2 and 4 years, the rates of all-cause mortalities were no longer different. Patients in EVAR groups required more reinterventions. These data were confirmed by national audits and large registries. However, there is still uncertainty concerning the durability of the devices, and long-term results are unknown. The ACE (Anevrysme de l'aorte abdominale, Chirurgie versus Endoprothese) trial is a multicenter, prospective randomized trial aimed at assessing the results of EVAR and of open surgery in relatively good-risk patients presenting with an asymptomatic abdominal aortic or aortoiliac aneurysm. The primary end point is death and major complications up to 5 years after randomization. Analysis of results is underway, and publication due by the end of the year.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                24 July 2017
                July 2017
                : 9
                : 7
                : e1507
                Affiliations
                [1 ] General Surgery, Guthrie Clinic/Robert Packer Hospital
                [2 ] Vascular Surgery, Guthrie Clinic/Robert Packer Hospital
                Author notes
                Article
                10.7759/cureus.1507
                5608480
                0a6e74e4-fce6-42db-8c24-3ac4a66a47e6
                Copyright © 2017, Shen et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 June 2017
                : 24 July 2017
                Categories
                Medical Education
                Cardiac/Thoracic/Vascular Surgery
                Family/General Practice
                Medical Education

                endovascular aneurysm repair (evar),endoleak,abdominal aortic aneurysm (aaa)

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