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Abdominal Aortic Aneurysm Repair (abdominal aortic + aneurysm_repair)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Surgery & Surgical Specialties	76%
Cardiovascular Disease	8%
3 Other Subdomains	16%

Kinds of Abdominal Aortic Aneurysm Repair

endovascular abdominal aortic aneurysm repair

Selected Abstracts

ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR: A 7 YEAR EXPERIENCE AT THE LAUNCESTON GENERAL HOSPITAL

ANZ JOURNAL OF SURGERY, Issue 5 2005
Kate L. A. Borchard
Background: To review our 7 year experience of endovascular abdominal aortic aneurysm repair (EVR) and to compare this to open repair (OR) during the same time period. Methods: One hundred and one EVR and 65 OR patients were studied. Parameters analysed included patient and procedure details, intensive care unit (ICU) and hospital admission time, and morbidity and mortality with particular emphasis on procedure-related problems. Results: Endovascular grafts were deployed with successful abdominal aortic aneurysm (AAA) exclusion in 100 patients. Primary technical success was achieved in 84%, clinical success in 86% and secondary success in 90% of cases. Complications occurred in 63% and 88% of EVR and OR patients, respectively. Early device-related complications occurred in 40 EVR patients (40%); 24 (60%) were corrected immediately by further stenting. Late device-related complications occurred in 15 EVR patients (15%); four (27%) required additional stenting. Most of the complications in the OR group were systemic (89%) resulting in longer ICU and hospital stays (median 48 vs 17 h and 13 vs 4 days for OR and EVR, respectively). Death within 30 days of the procedure occurred in three EVR patients. There was no perioperative mortality in the OR group. Conclusion: Endovascular AAA repair can be undertaken successfully in a district general hospital. The majority of local and device-related complications can be corrected immediately, while those persisting beyond the initial procedure usually resolve spontaneously. EVR offers a minimally invasive approach to a problem that in the past has involved major surgery. [source]

Endovascular Abdominal Aortic Aneurysm Repair by Interventional Cardiologists,A Community-Based Experience

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2010
ABHIJEET BASOOR M.D.
Introduction:,Endovascular repair of abdominal aortic aneurysm (AAA) is a relatively recent technology. In comparison to the conventional open surgical treatment for AAA, endovascular AAA repair (EVAR) combines a less-invasive approach with lower morbidity and mortality. There have been few studies regarding the performance of this procedure in a community-based setting. We report our experience of EVAR performed primarily by interventional cardiologists in a community hospital. Methods:,In our community hospital setting, between September 2005 and November 2007, we included all patients who underwent EVAR by interventional cardiologists, with available on-site vascular surgical support. Clinical and serial computed angiographic imaging outcomes were followed by a retrospective chart review. Data collection tools included demographic and clinical characteristics, anatomical aneurysm features, length of stay, peri- and postprocedural complications, and mortality. Results:,A total of 71 consecutive patients had EVAR attempted. The endovascular stent placement was successful in 67 (93%) patients. Thirty-day mortality in this study was 1 of 71 (1.4%). All four procedural failures and the single periprocedural mortality occurred in women. Mean follow-up was 12 months. There were a total of six mortalities and among these four were women (P , 0.001); however, multivariate analysis revealed loss of significant difference in mortality (P = 0.16). Major complications following EVAR were noted in 10 of 71 (14%) patients. Conclusion:,EVAR can be successfully performed by experienced interventional cardiologists with vascular surgical support in a community-based setting. In our experience, there is acceptable rate of complications and mortality in a carefully selected patient population. (J Interven Cardiol 2010;23:485,490) [source]

Abdominal aortic aneurysm repair: balance of risk

ANZ JOURNAL OF SURGERY, Issue 11 2004
FRACS, Justin A. Roake DPhil (Oxon)
No abstract is available for this article. [source]

Glasgow Aneurysm Score predicts survival after endovascular stenting of abdominal aortic aneurysm in patients from the EUROSTAR registry

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2006
F. Biancari
Background: The aim of the present study was to evaluate the efficacy of the Glasgow Aneurysm Score (GAS) in predicting the survival of 5498 patients who underwent endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA) and were enrolled in the EUROpean collaborators on Stent-graft Techniques for abdominal aortic Aneurysm Repair (EUROSTAR) Registry between October 1996 and March 2005. Methods: The GAS was calculated in patients who underwent EVAR and was correlated to outcome measurements. Results: The median GAS was 78·8 (interquartile range 71·9,86·4, mean 79·2). Tertile 30-day mortality rates were 1·1 per cent for patients with a GAS less than 74·4, 2·1 per cent for those with a score between 74·4 and 83·6, and 5·3 per cent for patients with a score over 83·6 (P < 0·001). Multivariate analysis showed that GAS was an independent predictor of postoperative death (P < 0·001). The receiver,operator characteristic curve showed that the GAS had an area under the curve of 0·70 (95 per cent confidence interval 0·66 to 0·74; s.e. 0·02; P < 0·001) for predicting immediate postoperative death. At its best cut-off value of 86·6, it had a sensitivity of 56·1 per cent, specificity 76·2 per cent and accuracy 75·6 per cent. Multivariable analysis showed that overall survival was significantly different among the tertiles of the GAS (P < 0·001). Conclusion: The GAS was effective in predicting outcome after EVAR. Because its efficacy has also been shown in patients undergoing open repair of AAA, it can be used to aid decisions about treatment in all patients with an AAA. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Platelet activation, myocardial ischemic events and postoperative non-response to aspirin in patients undergoing major vascular surgery

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 10 2007
S. RAJAGOPALAN
Summary.,Objectives:,Myocardial ischemia is the leading cause of postoperative mortality and morbidity in patients undergoing major vascular surgery. Platelets have been implicated in the pathogenesis of acute thrombotic events. We hypothesized that platelet activity is increased following major vascular surgery and that this may predispose patients to myocardial ischemia.Methods:,Platelet function in 136 patients undergoing elective surgery for subcritical limb ischemia or infrarenal abdominal aortic aneurysm repair was assessed by P-selectin expression and fibrinogen binding with and without adenosine diphosphate (ADP) stimulation, and aggregation mediated by thrombin receptor-activating peptide and arachidonic acid (AA). Cardiac troponin-I (cTnI) was performed.Results:,P-selectin expression increased from days 1 to 3 after surgery [median increase from baseline on day 3: 53% (range: ,28% to 212%, P < 0.01) for unstimulated and 12% (range: ,9% to 45%, P < 0.01) for stimulated]. Fibrinogen binding increased in the immediate postoperative period [median increase from baseline: 34% (range: ,46% to 155%, P < 0.05)] and decreased on postoperative day 3 (P < 0.05). ADP-stimulated fibrinogen binding increased on day1 (P < 0.05) and thereafter decreased. Platelet aggregation increased on days 1,5 (P < 0.05). Twenty-eight (21%) patients had a postoperative elevation (> 0.1 ng mL,1) of cTnI. They had significantly increased AA-stimulated platelet aggregation in the immediate postoperative period and on day 2 (P < 0.05), and non-response to aspirin (48% vs. 26%, P = 0.036).Conclusions:,This study has shown increased platelet activity and the existence of non-response to aspirin following major vascular surgery. Patients with elevated postoperative cTnI had significantly increased AA-mediated platelet aggregation and a higher incidence of non-response to aspirin compared with patients who did not. [source]

Early discharge following abdominal aortic aneurysm repair: Impact on patients and caregivers

RESEARCH IN NURSING & HEALTH, Issue 5 2002
Mildred A. Jones
Abstract Although early discharge is common place, little is known about its impact after abdominal aortic aneurysm (AAA) surgery. We sought to prospectively describe patient outcomes and caregiving experience after early discharge following elective AAA repair using a standard or endovascular grafting system (EGS) procedure. Fifty-one patients (Standard, n=25; EGS, n=26) completed questionnaires on symptoms and health-related quality of life (HRQoL) while hospitalized and 1, 4, and 8 weeks after discharge. Data were also obtained from caregivers. HRQoL decreased at Week 1 in both groups but returned to near baseline by Week 8. Standard AAA patients experienced more symptoms and activity limitations, but these were concentrated in Week 1. Most caregivers were positive about caregiving and required no additional resources. Findings suggest that most patients who undergo early discharge following elective AAA surgery experience few problems. Those problems that occur concentrate in the week following discharge, suggesting the need for closer monitoring at this time. © 2002 Wiley Periodicals, Inc. Res Nurs Health 25:345,356, 2002 [source]

Open abdominal aortic aneurysm repair in the 21st century , is decreasing exposure a problem for the future?

ANAESTHESIA, Issue 4 2009
H. I. Alexander
No abstract is available for this article. [source]

Presumed interaction of fusidic acid with simvastatin

ANAESTHESIA, Issue 6 2008
A. J. Burtenshaw
Summary A 63-year-old man was admitted 6 weeks after an elective abdominal aortic aneurysm repair following which methicillin resistant Staphylococcus aureus (MRSA) had been cultured from the aneurysmal sac. He had been commenced on a course of fusidic acid at discharge in addition to his ongoing statin prescription and presented 4 weeks later with symptoms consistent with rhabdomyolysis. Severe rhabdomyolysis was confirmed and despite prolonged and complicated critical care management, his treatment was unsuccessful. Extensive investigations ruled out other known causes of this clinical presentation and failed to identify any other precipitating cause of rhabdomyolysis. We believe the most likely cause was hepatic inhibition of the CYP3A4 hepatic isoenzyme by fusidic acid resulting in an acute severe rise in plasma simvastatin level and extensive myocellular damage. Increasing MRSA colonisation and infection rates together with increased statin usage have the potential to increase the incidence of this presumed drug interaction. [source]

Minilaparotomy abdominal aortic aneurysm repair in the era of minimally invasive vascular surgery: preliminary results

ANZ JOURNAL OF SURGERY, Issue 11 2009
Chris N. Bakoyiannis
Abstract Background:, This study aimed to evaluate the early post-operative clinical impact of minimal incision aortic surgery (MIAS) for infrarenal abdominal aortic aneurysm (AAA) repair in comparison with the standard open repair. Methods:, A case-control study was conducted. Patients of groups A (19 patients) and B (18 patients) were treated with the MIAS technique and the standard open method, respectively. Results:, There were significant differences between the two groups in fluid resuscitation during the operation. Post-operatively, there were significant differences between groups A and B in the time until starting liquid diet (2 ± 0.74 versus 3.55 ± 0.85 post-operative days (PD), respectively; P < 0.05), the time until starting the solid diet (3.05 ± 0.77 versus 5.11 ± 0.75 PD, respectively; P < 0.05), the time of ambulation (2 ± 0.74 versus 3.4 ± 0.98 PD, respectively; P < 0.05) and in the hospital length of stay (4 ± 0.81 versus 9.7 ± 2.66 days, respectively; P < 0.05). Conclusions:, The MIAS technique, for repair of infrarenal aortic aneurysms, is a safe and feasible procedure that combines the early advantages of endovascular repair with the long-term advantages of the traditional open repair. [source]

Cyanoacrylate embolization of endoleaks after abdominal aortic aneurysm repair

ANZ JOURNAL OF SURGERY, Issue 11 2009
Timothy Buckenham
Abstract Introduction:, Type II endoleaks occur in up to a fifth of endoluminal repairs for abdominal aortic aneurysms and are commonly treated when aortic sac expansion can be demonstrated. Technical failure is common when catheter-guided particulates or coil embolic agents are used. Presented here is a feasibility study using catheter-directed N-butyl-2-cyanoacrylate (Histoacryl, Braun, Tuttlingen, Germany) embolotherapy. Method:, A retrospective review of the case notes of patients undergoing embolization procedures for type II endoleaks with expanding sacs was performed from this centre's cohort of endoluminal aortic repair patients under surveillance. Data on patients with type II endoleaks who were treated with either or both cyanoacrylate and coil embolization were extracted. The outcomes were then compared. Results:, In total, five cases were identified, and four of these cases had both coil and glue embolization. Technical success was defined as endoleak closure proven on follow-up computed tomographic imaging. Technical success was achieved in all four patients treated with intra-sac cyanoacrylate. One case treated initially with coil embolization was successful. All patients had a computed tomographic scan at 3 months. One minor complication occurred that resolved without treatment. Discussion:, Type II endoleaks after EVAR with expanding sacs require treatment. Percutaneous catheter-directed cyanoacrylate embolization offers an alternative to coil or particulate embolization and, in this series, was found to be more likely to result in endoleak closure. [source]

ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR: A 7 YEAR EXPERIENCE AT THE LAUNCESTON GENERAL HOSPITAL

Spectral doppler characterization of endoleaks following endoluminal abdominal aortic aneurysm repair

ANZ JOURNAL OF SURGERY, Issue 3 2005
Isabel A. Wright
Background: Colour Doppler ultrasound of endoluminal abdominal aortic aneurysm repair is becoming an established imaging technique in identifying endoleak. Management and treatment of endoleak is determined in part by the exact nature of the endoleak, namely its type and whether it has single or multiple vessel inflow and outflow. To date, spectral Doppler waveform analysis has provided some information about the propensity for spontaneous seal of isolated type II endoleaks, rather than assisting in their classification. Methods: We present a collection of three case reports outlining the directionality/phasicity of the Doppler waveform profile associated with endoleaks whose type and subtype (uni- /or multi-conduital) were angiographically determined. Results: In all three cases uniconduital type II endoleak demonstrated a to-and-fro waveform on Doppler ultrasound imaging. Conclusions: To-and-fro Doppler waveforms may be associated with uniconduital type II endoleaks. If upon investigation of further cases this is found to be the case, this waveform classification may facilitate determination of the subtype (uni- or multi-conduital) of endoleak, thus identifying those cases which may be more amenable to percutaneous repair. [source]

EARLY EXPERIENCE WITH CLINICAL INDICATORS IN SURGERY

ANZ JOURNAL OF SURGERY, Issue 6 2000
B. T. Collopy
Background: In 1997 a set of 53 clinical indicators developed by the Royal Australasian College of Surgeons (RACS) and the Australian Council on Healthcare Standards (ACHS) Care Evaluation Programme (CEP), was introduced into the ACHS Evaluation and Quality Improvement Programme (EQuIP). The clinical indicators covered 20 different conditions or procedures for eight specialty groups and were designed to act as flags to possible problems in surgical care. Methods: The development process took several years and included a literature review, field testing, and revision of the indicators prior to approval by the College council. In their first year 155 health-care organizations (HCO) addressed the indicators and this rose to 210 in 1998. Data were received from all states and both public and private facilities. Results: The collected data for 1997 and 1998 for some of the indicators revealed rates which were comparable with those reported in the international literature. For example, the rates of bile duct injury in laparoscopic cholecystectomy were 0.7 and 0.53%, respectively; the mortality rates for coronary artery graft surgery were 2.5 and 2.1%, respectively; the mortality rates after elective abdominal aortic aneurysm repair were 2.5 and 3.7%, respectively; and the post-tonsillectomy reactionary haemorrhage rates were 0.9 and 1.3%, respectively. Results for some indicators differed appreciably from other reports, flagging the need for further investigation; for example, the negative histology rates for appendectomy in children were 18.6 and 21.2%, respectively, and the rates for completeness of excision of malignant skin tumours were 90.7 and 90%, respectively. The significance of these figures, however, depends upon validation of the data and their reliability and reproducibility. Because reliability can be finally determined only at the hospital level they are of limited value for broader comparison. Conclusion: The process of review established for the indicator set has led to refinement of some indicators through improvement of definitions, and to a considerable reduction in the number of indicators to 29 (covering 18 procedures), for the second version of the indicators (which was introduced for use from January 1999). The clinical indicator programme, as it has with other disciplines, hopefully will provide a stimulus to the modification and improvement of surgical practice. Clinician ownership should enhance the collection of reliable data and hence their usefulness. [source]

Screened individuals' preferences in the delivery of abdominal aortic aneurysm repair

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2010
P. J. E. Holt
Background: This study aimed to determine preferences for service attributes in a population screened for abdominal aortic aneurysm. Methods: A questionnaire was designed to encompass various aspects of service provision. Questions were calibrated against the time an individual was willing to travel to access specific attributes. Subjects attending an aneurysm screening programme were asked to complete a questionnaire before their screening ultrasound scan. Statistical analysis was through pairwise analysis of the median travel times with the signed rank test. The Wilcoxon rank sum, analysed by the Kruskal,Wallis test, was used to compare preference ratings. Results: A total of 262 individuals were asked to complete the questionnaire; the response rate was 98·5 per cent. Approximately 92 per cent of individuals stated a willingness to travel for at least 1 h beyond their nearest hospital in order to access services with a 5 per cent lower perioperative mortality rate, a 2 per cent lower amputation or stroke rate, a high annual caseload of aneurysm repairs, and routine availability of endovascular repair. Conclusion: Patients attending aneurysm screening were willing to travel beyond their nearest hospital to access a service with better outcomes, higher surgical volumes and endovascular surgery. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Long-term outcome of endovascular abdominal aortic aneurysm repair

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2009
J. R. Boyle
Renal function is a concern [source]

Modelling the long-term cost-effectiveness of endovascular or open repair for abdominal aortic aneurysm,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2008
D. M. Epstein
Background: Recent randomized trials have shown that endovascular abdominal aortic aneurysm repair (EVAR) has a 3 per cent aneurysm-related survival benefit in patients fit for open surgery, but it also has uncertain long-term outcomes and higher costs. This study assessed the cost-effectiveness of EVAR. Methods: A decision model was constructed to estimate the lifetime costs and quality-adjusted life years (QALYs) with EVAR and open repair in men aged 74 years. The model includes the risks of death from aneurysm, other cardiovascular and non-cardiovascular causes, secondary reinterventions and non-fatal cardiovascular events. Data were taken largely from the EVAR trial 1 and supplemented from other sources. Results: Under the base-case (primary) assumptions, EVAR cost £3800 (95 per cent confidence interval (c.i.) £2400 to £5200) more per patient than open repair but produced fewer lifetime QALYs (mean , 0·020 (95 per cent c.i. , 0·189 to 0·165)). These results were sensitive to alternative model assumptions. Conclusion: EVAR is unlikely to be cost-effective on the basis of existing devices, costs and evidence, but there remains considerable uncertainty. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Impact of renal dysfunction on operative mortality following endovascular abdominal aortic aneurysm surgery,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2007
R. G. Statius van Eps
Background: Preoperative renal dysfunction is a significant risk factor for death after open abdominal aortic aneurysm repair. The aim of this study was to determine whether renal dysfunction also affected mortality after endovascular aneurysm repair. Methods: Patients from the EUROSTAR registry were stratified into two groups: 4198 with normal renal function (creatinine less than 133 µmol/ml) and 969 with renal dysfunction (serum creatinine more than 133 µmol/ml). Patient characteristics and postoperative complications in the two groups were compared and the effect of renal dysfunction on operative mortality was analysed by multivariable regression models. Results: Patients with renal dysfunction had significantly more co-morbidities, including cardiac and pulmonary impairment. Thirty-day mortality was significantly higher in the group with renal dysfunction (6·2 versus 2·0 per cent; P < 0·001). A significant increase in mortality (5·5 per cent) was also seen in patients with moderate renal dysfunction (serum creatinine 133,265 µmol/ml). After adjustment for age and other risk factors, renal dysfunction was still an independent risk factor for 30-day mortality (odds ratio 2·3, 95 per cent confidence interval 1·6 to 3·3; P < 0·001). Conclusion: Renal dysfunction was a significant and independent risk factor for death after endovascular aneurysm repair. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Letter: Mid-term results of endovascular repair of abdominal aortic aneurysm (Br J Surg 2005; 92: 925-927); Cost-effectiveness of endovascular abdominal aortic aneurysm repair (Br J Surg 2005; 92: 960-967)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2006
H. D. I. De'Ath
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (http://www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4-sized paper in double spacing and should be accompanied by a disk. [source]

Authors' reply: cost-effectiveness of endovascular abdominal aortic aneurysm repair (Br J Surg 2005; 92: 960-967)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2006
J. A. Michaels
No abstract is available for this article. [source]

Authors' reply: Randomized clinical trial of vertical or transverse laparotomy for abdominal aortic aneurysm repair (Br J Surg 2005; 92: 1208,1211)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2006
N. Fassiadis
No abstract is available for this article. [source]

Validity of the Glasgow Aneurysm Score and the Hardman Index in predicting outcome after ruptured abdominal aortic aneurysm repair (Br J Surg 2005; 92: 570-573)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2005
Authors' reply to letters in correspondence (Br J Surg 2005; 92: 1178-1179)
No abstract is available for this article. [source]

Cardiac troponin I predicts outcome after ruptured abdominal aortic aneurysm repair

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2005
A. L. Tambyraja
Background: Cardiac troponin I (cTnI) is a highly sensitive and specific marker for myocardial injury that predicts mortality in patients with acute coronary syndromes. This study examined the relationship between perioperative cTnI levels and clinical outcome in patients with ruptured abdominal aortic aneurysm (AAA). Methods: Consecutive patients who underwent operative repair of a ruptured AAA over a 22-month interval and survived for more than 24 h were entered into a prospective observational cohort study. Levels of cTnI were measured immediately before, and at 24 and 48 h after surgery, and related to clinical outcome. Results: Of 62 patients who underwent attempted operative repair of ruptured AAA, 50 (81 per cent) survived for more than 24 h and were included in this study. Twenty-three (46 per cent) of the 50 had a detectable cTnI level at one or more time points during the first 48 h. Of these, 11 patients had clinical or electrocardiographic evidence of an acute cardiac event and 12 did not; five patients in each of these two groups died. Of 27 patients with no increase in cTnI in the first 48 h, only three died (P = 0·031 and P = 0·043 respectively, relative to the groups with detectable cTnI). Conclusion: Approximately half of patients who survived repair of ruptured AAA for more than 24 h sustained a detectable myocardial injury within the first 48 h. A perioperative increase in the level of cTnI, with or without clinically apparent cardiac dysfunction, was associated with postoperative death. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Cytokine gene polymorphisms and the inflammatory response to abdominal aortic aneurysm repair,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2003
M. J. Bown
Background: Cytokines are key mediators of the inflammatory response to surgery and polymorphic sites in their genes have been shown to affect cytokine production in vitro. The aim of this study was to determine whether cytokine gene polymorphisms affect cytokine production in vivo in patients undergoing abdominal aortic aneurysm (AAA) repair. Methods: One hundred patients admitted for elective AAA repair had plasma levels of interleukin (IL) 1,, IL-6, IL-10 and tumour necrosis factor (TNF) , measured at induction of anaesthesia and 24 h after operation. Genotypes for each patient were determined using induced heteroduplex genotyping for the following loci: IL-1, + 3953, IL-6 , 174, IL-10 , 1082/,592 and TNF-, , 308. Results: Patients with an IL-10 , 1082 A allele had a significantly higher IL-10 response to surgery than those without an A allele (P = 0·030) and there was also a significant difference in IL-10 response between patients with IL-10 , 1082 AA genotypes and those with GG genotypes (P = 0·030). Conclusion: Elective AAA repair results in a measurable cytokine response. In this study the magnitude of this response was not affected by the individual patient's cytokine gene polymorphisms. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Medical management of significant coronary angiographic stenoses: Outcome of 60 patients observed for 433 patient years

CLINICAL CARDIOLOGY, Issue 8 2000
Charles L. Baird Jr. M.D.
Abstract Background: Percutaneous transluminal coronary angioplasty (PTCA) has become routine in the management of patients with stable angina pectoris and significant coronary stenoses, while medical management of such patients has declined. Hypothesis: The purpose of the present study was to evaluate the outcome of 60 patients at the Virginia Heart Institute with stable angina pectoris, observed between 1976 and 1997, who had documented evidence of severe angiographic disease but were elected to be monitored and managed in an outpatient pharmacologic rehabilitation program. Methods: Sixty patients with significant stenoses by coronary angiography (21 with single-vessel, 26 with double-vessel, and 13 with triple-vessel) without impaired ventricular function, exercise-induced ischemia or hypotension, limited exercise performance, malignant arrhythmias, or drug intolerance were enrolled in a program of pharmacologic rehabilitation and observed for an average of 7.2 years. Results: Among the 60 patients, there were 6 deaths at a mean interval of 8.3 years. Two deaths were in patients ineligible for revascularization. Another patient who died had refused revascularization after new-onset left ventricular dysfunction, and another died intraoperatively during abdominal aortic aneurysm repair. Two patients died while exercising. Thirteen patients underwent follow-up catheterization for worsening angina; 11 of 13 showed progression, predominantly from new lesions. Four of 11 were referred for revascularization; 7 of 11 continued medical treatment; 49 patients were stable on medical therapy throughout the period of observation. Conclusion: Medical management of selected patients with significant coronary stenoses is safe and effective. [source]