Vascular
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Comparative Study
Secondary endovascular and conversion procedures for failed endovascular abdominal aortic aneurysm repair: can we still be optimistic?
The purpose of this study was to evaluate the incidence, etiology, and outcome of secondary endovascular and "open" conversion procedures after failed endovascular abdominal aortic aneurysm repair (EVAR). From January 1997 until December 2005, 625 patients with an infrarenal abdominal aortic aneurysm were treated by elective EVAR, with 98.7% (n = 617) primary EVAR success. The mean follow-up of the 617 patients was 46.7 +/- 11.2 months. ⋯ The aneurysm-related mortality rate in our series was below 1%. Abdominal conversion surgery still carries a high mortality rate, but the overall EVAR-related mortality rate remains low. Early pitfall detection and proper reintervention are crucial to long-term EVAR success.
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Pneumonia is a common postoperative complication, with a mortality of up to 40%. The Post-operative Pneumonia Risk Index (PPRI) was derived from a large cohort of general surgical patients but has not been validated in patients undergoing open abdominal aortic aneurysm (AAA) repair. The PPRI was applied to patients undergoing elective open AAA repair in a tertiary referral vascular unit. ⋯ At this cutoff, the likelihood ratio for pneumonia was 1.35 (95% confidence interval 1.08-1.62). However, in a multivariate analysis, only weight loss in excess of 10% over the preceding 6 months was an independent predictor of postoperative pneumonia. Although the PPRI is of some value in identifying high-risk patients undergoing AAA repair, weight loss alone may be predictive, allowing targeted preventive measures in aneurysm patients at increased risk.