Effect on post 30d outcomes of CKD and statin Rx on juxtarenal open AAA repairs, by Sivaram Premnath
CKD and statin talk
Premnath
Staff grade at Derby
Long term survival outcomes after open repair of JAAA
2011-22
juxta AAA defined as neck less than 10 mm
CKD as less than eGFR 60
looked at AKI post op too
Analysis Outcomes:
MACE looked at
77 patients
81% male
18% had underlyng CKD
39% were emergency repair
No difference in LTS between planned and emergency repair (THE ANALYSIS EXCLUDED ALL MORTALITY WITHIN 30 DAYS)
In terms of MACE as well, no difference between elective and emergency groups
Long Term Survival
big difference between yes and no CKD in terms survival
Those who had post op AKI as well, big diff between these on survival
big difference in LTS favouring those who were on pre op statin therapy
Qn:
what about cross clamp
Only 30% had supra renal clamp
The remainder had inter renal or angulated clamp
Those who had supra renal clamp had higher 30d M
however all those with 30D mortality were removed from this analysis!
Correlation of hostile neck with infrarenal EVAR type 1a, by Emily Kirkham.
EMILY KIRKHAM
vascular reg presently at Gloucester.
Wilson Kulkarni and Cooper listed.
looked through their database since 2009
relationship between AAA anatomy, neck ultilisation and 1a endoleak
10 year patient recruited from DB
a=neck length
b=neck diameter
neck alpha angle
length of neck coverage
1a in 5%: 15 patients
Every pt who had a 1a had at least one non-desirable characteristic (NDC)
1 NDC : 5% risk
More than 1 NDC: 25% risk
NDC defined as anatomical features that rendered the specific graft being off IFU.
% endoleak increases with increase in % NDC factors
- paper supports mantra of strict adherence to IFU.
Qn: type of stent
Majority used were Gore and Medtronic.
Qn: Has practice in the unit changed over time?
Earlier used to push the limits of EVAR
Now doing more of non op care rather than pushing the limtis of IFU in light of these findings and of NICE guidance.
I had a nice d/w Gabriel Sayer from Romford at the back of the room as the session ended with this talk. What would be good to explore would also be: What were the actual consequences of these 1a ELs? And also, another way to look at the data would be to say that 95% cases with 1 NDC did NOT have an EL.
Determination of AAA wall stiffness by nano-indentation, by Martin Hossack.
Martin Hossack
Liverpool
Vascular trainee
Repair only based on diameter is not dependable in terms ot doing / not doing; some rupture at smaller than threshold and in others the diameter does not correlate well with rupture risk.
Tensile testing only measures global property of material; rupture is a focal event.
They harvested reddndant aortic wall from 21 pts who had open repair
Oscillatory nano-indentation used to test the layers of the wall.
The histo analysis appears to have looked at Elastic Collagen and GAG
Median max diameter was 62 mm
The ‘elastic modulus’ varied widely
Found no correlation between maximum aortic diameter and median elastic modulus.
Summary:
There is a high variation in stiffness
Stifnes not related to diameter
Increased calcification and tissue disruption increase the stiffness.
Suggestion that calcium scoring should be incorporated into future rupture risk estimate methods.
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Obesity paradox in relation to AAA CPET
Obesity talk in relation to CPET before repair of AAA open or endo.
Looks like from either Preston or Blackpool
Proportion of obese patients undergoing elective AAA repair is increasing
Retrospective review of vascular dabatabase over 5y period
224 EVAR
74 Open
Similar BMI % in both categories.
Overall ventilatory equivalents were significantly higher in the normal weight group than the overweight and obese groups
The difference in AT was only significant between the normal weight and obese groups
- evidence of conscious selection bias towards EVAR in pts with respiratory comprosimse
- Higher VEs are more ‘accepted’ in the normal weight group
Chair comments: the paradox is even stronger rather than the study explaining the paradox.