Back to Search
Start Over
Postoperative initial 2-day blood pressure management facilitates the shrinkage of abdominal aortic aneurysm after endovascular aneurysm repair by reducing the incidence of type II endoleak.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2018 Jan; Vol. 67 (1), pp. 166-173. Date of Electronic Publication: 2017 Aug 12. - Publication Year :
- 2018
-
Abstract
- Objective: The aim of this study was to evaluate the effect of initial 2-day blood pressure management (BPM) after endovascular aneurysm repair (EVAR) for the incidence of subsequent type II endoleak (T2E) and shrinkage of abdominal aortic aneurysm (AAA) sac diameter.<br />Methods: We reviewed 136 patients who underwent EVAR for atherosclerotic AAA between July 2008 and July 2014 with one of three stent grafts (Excluder [W. L. Gore & Associates, Flagstaff, Ariz], Powerlink [Endologix Inc, Irvine, Calif], and Endurant [Medtronic Vascular, Santa Rosa, Calif]). Starting from 2013, the mean blood pressure of 76 participating patients (treatment group) was maintained at 75 to 90 mm Hg for the initial 48 hours after EVAR. The incidence of T2E at 7 days and AAA sac diameter 12 months after EVAR were evaluated using computed tomography scanning. The results so obtained were then compared with those of the control group composed of 60 consecutive patients who underwent EVAR before 2013.<br />Results: The incidence of T2E at 7 days was significantly lower in patients who received treatment (treatment group, 19.7%; control group, 40.0%; P = .013), and AAA sac diameter at 12 months in the treatment group had a mean decrease of 5.1 mm compared with the mean 2.2 mm in the control group (P = .004). In multivariate regression analysis, BPM was significantly related to the reduction of incidence of T2E at 7 days (odds ratio, 0.31; P = .007) and a decrease in AAA sac diameter at 12 months (P = .005). In addition, although the use of Endurant had less effect, the use of Excluder under controlled blood pressure conditions improved the incidence of T2E from 80% to 23% compared with those under normal postoperative management (P = .001).<br />Conclusions: The initial 2-day postoperative BPM might have positive effects, such as lower incidence of T2E and facilitation of AAA sac shrinkage.<br /> (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Antihypertensive Agents therapeutic use
Aorta, Abdominal diagnostic imaging
Aorta, Abdominal drug effects
Aorta, Abdominal physiology
Aorta, Abdominal surgery
Aortography methods
Blood Pressure Determination
Blood Vessel Prosthesis adverse effects
Blood Vessel Prosthesis Implantation instrumentation
Blood Vessel Prosthesis Implantation methods
Computed Tomography Angiography methods
Endoleak etiology
Endoleak prevention & control
Endovascular Procedures instrumentation
Endovascular Procedures methods
Female
Humans
Incidence
Male
Middle Aged
Platelet Aggregation Inhibitors therapeutic use
Postoperative Period
Reoperation
Retrospective Studies
Stents adverse effects
Treatment Outcome
Aortic Aneurysm, Abdominal surgery
Blood Pressure drug effects
Blood Vessel Prosthesis Implantation adverse effects
Endoleak epidemiology
Endovascular Procedures adverse effects
Postoperative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 67
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 28807381
- Full Text :
- https://doi.org/10.1016/j.jvs.2017.05.118