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A simple, noninvasive and cost-effective diagnostic test for the detection of endoleaks after endovascular aneurysm repair (EVAR) would complement (or even replace) current surveillance modalities. We reviewed the literature for studies correlating circulating levels of matrix metalloproteinases (MMPs)/tissue inhibitors of MMPs with the presence of endoleaks after EVAR. An electronic search of databases was performed to identify studies reporting circulating concentrations of MMPs in patients with and without an endoleak after EVAR. Four studies were identified. Patients with an endoleak had higher plasma MMP-9 levels compared with those without an endoleak. Two studies that also evaluated plasma MMP-3 levels after EVAR suggest that these levels may also be higher in patients with an endoleak. Preliminary evidence suggests that MMP-9 levels are increased in patients developing an endoleak after EVAR. Larger studies are required to confirm or refute our findings. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate 2 different aortic endograft systems with suprarenal fixation in patients with unfavorable neck morphology. Methods: A prospective observational study assigning patients with abdominal aortic aneurysm with unfriendly neck anatomy treated with 2 different endograft systems (Endurant and Zenith) was conducted. The log-rank test was applied to investigate the differences in cumulative outcome parameters. Results: Successful endograft implantation was achieved in all patients. Requirement for troubleshooting techniques was similar in the 2 groups (P ¼ .156 and P ¼ .081, respectively). In-hospital procedure-related morbidity occurred in 7 patients (Zenith vs Endurant, P ¼ .690). Freedom from any type of endoleak and overall mortality did not differ significantly between the groups (log-rank test, P ¼ .068 and P ¼ .087). Reinterventions were more commonly required in the Zenith group (log-rank rest, P ¼ .041), and were all nongraft/aneurysm-related. Conclusions: Similar performances of the Zenith and the Endurant endograft systems were demonstrated. [ABSTRACT FROM AUTHOR]

The objective of this study was to systematically review the literature reporting on the chimney technique and perform an analysis of the outcomes. A search of electronic databases was undertaken to identify all studies reporting on the outcome of the chimney technique. The selected articles were divided into those reporting on the treatment of aortic pathology involving the visceral and those involving the supra-aortic branches. Twenty-one articles reporting on the treatment of juxta/supra-renal aorta and aortic arch disease in 102 and 37 patients, respectively, were identified. In the visceral group, an overall technical success rate of 91% was achieved, the perioperative major morbidity and mortality rates were 17 and 5%, respectively, and an early type I endoleak developed in 13 patients (13%). During follow-up, one patient died of intestinal ischemia. In the supra-aortic group, the technical success rate was recorded in 95%, and three patients (8%) developed an early type I endoleak. Three patients (13%) required conversion to open surgery during follow-up. In conclusion, this technique may be viewed as a complementary technique in high-surgical-risk patients. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study is to determine whether presentation and outcomes of inflammatory abdominal aortic aneurysms (IAAA) have changed over the last five decades. Methods: Comparison of current outcomes (January 2001 to December 2007) with results of the earliest report from our unit in 1972. Results: In contemporary series, 421 patients underwent AAA repair; 38 (9%) were IAAA. In 58% patients, IAAA was an incidental finding, whereas 42% patients were symptomatic with abdominal or back pain. Of those, 32% were ruptured IAAA. Male-to-female ratio was 12:1. Thirty-day mortality was 13%; elective 11.5%; emergency 17%. Comparison with 1972 study showed no change in the incidence and gender predilection. Presentation as an incidental finding and rupture increased 4- and 2-folds, respectively. Conclusion: The incidence and gender predilection of IAAA have remained unchanged. The 4-fold increase in the presentation as an incidental finding reflects current trends in patient evaluation. [ABSTRACT FROM AUTHOR]

Ten patients undergoing elective infrarenal aortic surgery were studied. Samples were taken perioperatively from a sigmoid tonometer to determine intramucosal pH (pHi) of the sigmoid colon, and simultaneously venous blood was taken for endotoxin measurement. Colonoscopy and biopsy were performed preoperatively and one week postoperatively. Significant endotoxemia was detected in 5 patients (50%), all of whom had transient colonic ischemia on the basis of tonometry, and of whom 2 had histologic evidence of ischemia at one week. Endotoxemia does occur during aortic surgery and appears to be associated with colonic ischemia, though this requires further evaluation. [ABSTRACT FROM AUTHOR]