RR27. Validation of a Modified Frailty Index to Predict Mortality in Vascular Surgery Patients (original) (raw)
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Pediatric nonaortic arterial aneurysms
Journal of vascular surgery, 2016
Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention. The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0...
Annals of Pediatric Surgery, 2015
Introduction Pediatric arterial aneurysms are extremely rare. Their etiology can be congenital, mycotic, following infective endocarditis, post-traumatic pseudoaneurysms, or vasculitis. The treatment strategy in children is not very clear because of the small number of cases. Methods This study included eight children with arterial aneurysms, which included one thoracic, two abdominal aortic, one iliac, three upper-extremity, and two carotid aneurysms. Revascularization was performed using an autogenous vein whenever feasible. Anastomoses were performed with interrupted sutures with nonabsorbable material to allow for future growth of the vessels. Ligation was allowed only after ensuring that the distal collateral circulation was adequate. Results Eight aneurysms were reconstructed and one carotid aneurysm was ligated. No neurologic events occurred after the carotid ligation. Follow-up ranged between 4 months and 4 years and showed no recurrences or occlusion of reconstructed aneurysms, as detected clinically and radiologically. The grafts used for reconstruction-including the synthetic ones-were found to be growing with the age of the children. In one aortic case, there was mild stenosis in one of the iliac limbs, but that was asymptomatic. The extremity aneurysms repair were uneventful, with good flow in the affected extremity. Conclusion Repair of aneurysms in children is feasible and yields good midterm results. Management is usually individual and tailored to each case. Finding the suitable conduit is a challenge, and autogenous veins are preferred whenever available.
The contemporary management of renal artery aneurysms
Journal of Vascular Surgery, 2015
Background: Renal artery aneurysms (RAAs) are rare, with little known about their natural history and growth rate or their optimal management. The specific objectives of this study were to (1) define the clinical features of RAAs, including the precise growth rate and risk of rupture, (2) examine the current management and outcomes of RAA treatment using existing guidelines, and (3) examine the appropriateness of current criteria for repair of asymptomatic RAAs. Methods: A standardized, multi-institutional approach was used to evaluate patients with RAAs at institutions from all regions of the United States. Patient demographics, aneurysm characteristics, aneurysm imaging, conservative and operative management, postoperative complications, and follow-up data were collected. Results: A total of 865 RAAs in 760 patients were identified at 16 institutions. Of these, 75% were asymptomatic; symptomatic patients had difficult-to-control hypertension (10%), flank pain (6%), hematuria (4%), and abdominal pain (2%). The RAAs had a mean maximum diameter of 1.5 6 0.1 cm. Most were unilateral (96%), on the right side (61%), saccular (87%), and calcified (56%). Elective repair was performed in 213 patients with 241 RAAs, usually for symptoms or size >2 cm; the remaining 547 patients with 624 RAAs were observed. Major operative complications occurred in 10%, including multisystem organ failure, myocardial infarction, and renal failure requiring dialysis. RAA repair for difficultto-control hypertension cured 32% of patients and improved it in 26%. Three patients had ruptured RAA; all were transferred from other hospitals and underwent emergency repair, with no deaths. Conservatively treated patients were monitored for a mean of 49 months, with no acute complications. Aneurysm growth rate was 0.086 cm/y, with no difference between calcified and noncalcified aneurysms. Conclusions: This large, contemporary, multi-institutional study demonstrated that asymptomatic RAAs rarely rupture (even when >2 cm), growth rate is 0.086 6 0.08 cm/y, and calcification does not protect against enlargement. RAA open repair is associated with significant minor morbidity, but rarely a major morbidity or mortality. Aneurysm repair cured or improved hypertension in >50% of patients whose RAA was identified during the workup for difficult-to-control hypertension.
A large unilateral renal artery aneurysm in a young child
Pediatric Radiology, 2004
Although rare in adults, secondary hypertension is the most common form of hypertension in childhood, particularly in the younger age group: parenchymal renal disease and lesions of the renal artery account for the majority of such cases. Before the age of 5 years, hypertension is correctable in almost 80% of cases [1]. In children, fibromuscular dysplasia (FMD) represents one of the most common causes of hypertension of vascular origin . Such hypertension can be corrected by revascularization, angioplasty, or occasionally nephrectomy under exceptional circumstances . Aneurysm formation is a well-recognized complication of FMD, but has rarely been reported in children . We describe the case of a 13-month-old boy who presented with severe hypertension secondary to multiple renal arterial stenoses and aneurysms, one being remarkably large (1.7 cm in diameter).
Aneurysms in children: Review of 15 years experience
Journal of Clinical Neuroscience, 2006
Introduction: Intracranial aneurysms in children are rare. The location, size, age, and presentation in the young are markedly different from that of adults. The 15-year experience of the senior author in southern California is presented. Methods: All paediatric patients treated for cerebral aneurysm over a 15-year period were identified. Intraoperative and postoperative data were collected retrospectively from the medical records. The need for additional surgery as well as the incidence of complications including death, hemiparesis, seizures, memory disturbances, and the need for subsequent cerebrospinal fluid (CSF) diversion were identified. Results: Fifty children were identified (54 lesions). Subarachnoid haemorrhage was the most common mode of presentation with the average Hunt-Hess grade being I-II. The locations of the lesions were middle cerebral (10), internal carotid (8), anterior communicating (7), posterior cerebral (6), posterior communicating (5), pericallosal (4), anterior cerebral (3), choroidal (3), posterior inferior cerebellar (3), basilar (2), vertebral (2) and frontopolar (1) arteries. Clinical vasospasm was encountered in eight of our patients, but no cases were observed in those younger than nine years. Long-term outcome was excellent in 22 cases, good in 20 and poor in nine, with one death and two patients lost to follow-up. Conclusion: Analysis of our data suggested a predilection for the posterior circulation compared to adults, larger size, more complex architecture, and a decreased incidence of clinical vasospasm in the younger age group. This series and a review of the literature suggest that aneurysmal disease in children may be distinct from that of adults.
Surgical management of renal artery aneurysms
Journal of Vascular Surgery, 2004
This retrospective review describes the surgical management and clinical outcome for renal artery aneurysms (RAAs) in 62 consecutive patients. Methods: From January 1987 through July 2003, 804 patients had operative renal artery (RA) repair involving 1206 kidneys at our center. A subgroup of 62 patients (42 women, 20 men; mean age 46 ؎ 18 years) received repair of 72 RAAs. Demographic data, comorbidity, and surgical technique were examined. Blood pressure and renal function response were determined. Patency of repair was evaluated by renal duplex sonography. Primary patency and patient survival were estimated by life-table methods. Tests of association were performed using 2 and the Student t tests. Results: Seventy-two RAs were repaired for RAA with a mean diameter of 2.6 cm (range, 1.3 to 5.5 cm). Bilateral RAAs were present in 21 patients. Associated conditions included fibromuscular dysplasia, atherosclerosis, and arteritis in 54%, 35%, and 7%, respectively. Hypertension was present in 89% (mean blood pressure, 171 ؎ 35/95 ؎ 19 mm Hg; mean medications, 2.2 ؎ 1.2 drugs) and renal insufficiency was present in 8% (mean serum creatinine, 1.9 ؎ 0.6 mg/dL). RAA repair included bypass (67%), aneurysmorrhaphy (15%), or a combination (17%). One planned nephrectomy (1%) was performed for un-reconstructable disease. Branch RA reconstruction in 78% used ex vivo cold perfusion in 50%, in situ cold perfusion in 29%, and warm in situ repair in 21%. Of 9 bilateral RAA repairs, 7 (78%) were staged and 2 (22%) were simultaneous. Combined aortic reconstruction was required in 6 (10%) patients. Perioperative death occurred in 1 patient (1.6%), and significant morbidity was observed in 8 patients (12%). Hypertension was considered improved in 54%, cured in 21%, and unchanged in 25% at mean follow-up of 48 months (range, 1-156 months). Among patients with renal insufficiency, renal function was improved in 3 (60%), unchanged in 1 (20%), and declined in 1 (20%). Follow-up patency (mean, 33 months; range, 1-118 months) was determined for 64 (91%) RA reconstructions. Product-limit estimate of primary patency at 48 months was 96%. Product-limit estimate of survival was 91% at 120 months. Conclusion: RAAs were repaired with low morbidity and mortality. Complex branch RAA repair using cold perfusion preservation and ex vivo techniques resulted in no unplanned nephrectomy, with an estimated primary patency of 96% at 48 months. Beneficial blood pressure response was observed in the majority of hypertensive patients. These results support selective surgical management of RAA.
Surgery of Renal Artery Aneurysms: A Monocentric Retrospective Study
Annals of Vascular Surgery, 2020
Objective: To report the results of conventional surgery for renal artery aneurysms (RAA) in our center. Material and methods: We retrospectively reviewed the files of all the patients operated for RAA between 2009 and 2018 in our center. We collected demographic, biological (renal function), morphological (CT-scan), and functional (ultrasound examination, resistance index) pre and postoperative data. Clinical and paraclinical operative data were examined. Results were expressed as average ± standard deviation or median and extremes. Results: 26 aneurysms were operated in 20 kidneys (10 right kidneys) among 19 patients, including 13 (68%) women with an average age of 55 (±12) years. Three (16%) patients presented an aneurysm in a single kidney. The discovery of the aneurysm was fortuitous in 14 (74%) patients. One Marfan patient was operated after a postpartum rupture. The median
Annals of Vascular Surgery, 2009
The purpose of this study was to evaluate changing trends in therapy and determinants of outcomes among patients with a renal artery aneurysm (RAA) undergoing surgical or endovascular repair in New York State (NYS). A retrospective cohort study of patients who underwent therapy for RAA in NYS from October 1, 2000, to December 31, 2006, was identified from the Statewide Planning and Research Cooperative System database. Regression models which included hospital and patient characteristics were created to identify predictors of untoward events following surgical or endovascular intervention. Over this time period 215 patients with RAA repairs were analyzed. In multivariate analysis, preoperative predictors of death included diabetes (adjusted odds ratio [OR] ¼ 57.8, 95% confidence interval [CI] 2.3-1,430.1, p ¼ 0.013), the presence of other aneurysms (adjusted OR ¼ 18.5, CI 1.5-234.4, p ¼ 0.024), and coagulopathy (adjusted OR ¼ 16.9, CI 3.4-393.1, p ¼ 0.03) but not repair type. Perioperative cardiac (adjusted OR ¼ 16.7, CI 1.4-197.1, p ¼ 0.026) and vascular device-related (adjusted OR ¼ 11.1, CI 1.003-123.0, p ¼ 0.049) complications were predictive of mortality. When patients with other aneurysms were excluded from analysis (n ¼ 153), there were no significant predictors of death. Ninety-one endovascular and 124 open surgical repairs were performed with a significant increase in the proportion of endovascular repairs performed over time ( p < 0.001), although since 2003 the proportion of both has been roughly equal. Diabetes (15.4% vs. 5.6%, p ¼ 0.018), chronic anemia (5.5% vs. 0.8%, p ¼ 0.04), and emergent admission (48.4% vs. 24.2%, p < 0.001) were more prevalent among those with endovascular repair. Endovascular therapy was associated with a lower incidence of complications, lower median length of stay (4 vs. 7 days, p < 0.001), and lower rates of discharge to skilled nursing facilities (18.9% vs. 39.2%, p ¼ 0.001). There has been an increasing number of treated RAAs in NYS since 2000, with the increase being primarily in those treated by endovascular techniques. Whether this represents a true increase in RAA incidence requiring management or an extension of indications is unknown. Outcomes after endovascular repair were better than those after conventional surgery, although whether this was due to the technique of repair itself or preprocedural selection bias cannot be determined.