Hakkı Zafer Iscan

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Background.Endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used and become the standard treatment option for AAA. The aim of the current study was to evaluate the outcomes and predictors of survival of endovascular treatment of AAA at the short and medium-term. Methods.A total of 222 patients having endovascular AAA repair between January 2013 and December 2019 by the same surgical team were included in the study. Patient demographics, perioperative and follow-up data including mortality,complications and need for secondary intervention were collected.Primary endpoint was all-cause mortality.Kaplan-Meier analysis was conducted for survival and Cox regression models were assessed for predictors of survival. Results. Median age was 70 years with male predominance(202 patients,91%). Thirty-day mortality was 1.8%. Median follow-up to the primary endpoint was 20 months(range,1 to 80 months). Survival rates at one, three and five years were 93.5%,81.4% and 62.2% respectively. Freedom from secondary intervention rates were 95.5% at one year,88.7% at three years and 82.1% at five years. Cox proportional hazard models showed that preoperative creatinine levels ≥1.8 mg/dl(hazard ratio (HR) 2.68, 95%CI1.21-6.42, p=0.027), hemoglobin levels <10 gr/dl (HR 3.38 95%CI 1.16-9.90,p=0.026), ejection fraction < 30% (HR 5.67,95%CI1.29-24.86,p=0.021)and AAA diamete≥6.0 cm(HR 2.20,95%CI1.01-4.81,p=0.049)were independently associated with mid-term survival. Conclusion.EVAR is a safe procedure with low postoperative morbidity and mortality. This study confirms that the mid-term survival and results are favorable.However, the analyzed factors in this study that predict reduced survival(high preoperative creatinine,ow hemoglobin,low ejection fraction and larger aneurysms) should be judged when planning EVAR.

HAKKI ISCAN

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Objective.As aneurysm related events and rupture is not eliminated, postoperative lifelong surveillance is mandatory after endovascular aneurysm repair(EVAR).For surveillance colored Doppler ultrasound(CDUS) is a standard method of noninvasive evaluation having the advantages of availability, cost-effectiveness and lack of nephrotoxicity and radiation.We evaluated CDUS for primary surveillance tool after elective EVAR by comparing with computerized tomography. Methods.Between 2018-2020, 84 consecutive post-EVAR patients were evaluated.Firstly, CDUS was performed by two Doppler operators from the Radiology and computed tomographic angiography (CTA) was performed.A reporting protocol was organized for endoleak detection and largest aneurysm diameter. Results.Among 84 patients, there were 11 detected endoleaks(13,1%) with CTA and 7 of them was detected with CDUS (r=0,884,p<0.001).There is an insufficiency in detecting low flow by CDUS.Eliminating this frailty, there was a strong correlation of aneurysm sac diameter measurement between CTA and CDUS (r=0,777,p<0,001).The sensitivity and specificity of CDUS was 63,6% and 100% respectively.The accuracy was 95,2%.Positive and negative predictive values were 100% and 94,8%.Bland-Altman analysis and linear regression analysis showed no proportional bias (mean difference of 1.5±2.2mm,p=0.233). Conclusions.CDUS promises accurate results without missing any potential complication requiring intervention as Type I or III endoleak.Lack of detecting type II endoleaks may be negligible as sac enlargement was the key for reintervention in this situation and CDUS has a remarkably high correlation with CTA in sac diameter measurement. CDUS may be a primary surveillance tool for EVAR and CTA will be reserved in case of aneurysm sac enlargement,detection of an endoleak,inadequate CDUS or in case of unexplained abdominal symptomatology