FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2119963085> ?p ?o ?g. }

• W2119963085 endingPage "623" @default.
• W2119963085 startingPage "622" @default.
• W2119963085 abstract "Our authors have provided us with a healthy debate regarding the appropriateness of endovascular repair (EVAR) of abdominal aortic aneurysms in healthy, young patients. Common themes were discussed, with differing viewpoints regarding procedure durability, life expectancy, and reintervention rates, challenging us to put this into perspective and apply this information to our own practices. No one's life expectancy is indefinite, and this includes the supposedly “young, good risk” aneurysm patient. Although these patients should expect to live longer than their older counterparts, the presence of an aneurysm reflects generalized cardiovascular risk and they may not have the same life expectancy as non-aneurysm patients. Regardless, these young, good risk aneurysm patients should expect at least a decade or two of longevity, which provides us with a horizon regarding long-term outcomes following aneurysm repair. There are well-known early advantages with EVAR in aneurysm patients, regardless of patient age. Several randomized controlled trials have consistently shown an early survival advantage with EVAR in the first 30 days. Admittedly, early post-operative mortality should be low in young, good risk patients, regardless of method of repair, and this survival advantage could be lost as mortality falls with open repair. The potential absence of early survival advantage can be spun in different ways depending on which side of the debate one sits on. It can be seen as a “failure to improve perioperative survival” by those who advocate open repair or as “equivalent to the gold standard” by endovascular advocates. Of course, shorter hospital stay and quicker return to work and normal activities provides further ammunition, in the short term, for endovascular enthusiasts. The loss of this early survival advantage with EVAR and the equivalence of longer-term survival have been well described and discussed with respect to these same randomized trials. It's interesting that a negative connotation is often applied to these findings, namely that EVAR “fails to improve longer-term survival” or there is “no survival benefit with EVAR”, rather than EVAR provides “similar or equivalent long-term survival” compared to open repair. The main crux of the argument is the durability of EVAR compared with open repair in those with a longer life expectancy. As highlighted by our authors, issues regarding durability include anatomy, life expectancy, re-interventions, surveillance, and surgeon/hospital experience. Anatomy is by far the most important factor in determining procedure durability when it comes to aneurysm repair, regardless if its EVAR or open. Many attachment site EVAR re-interventions can be prevented by ensuring adequate seal zones at the initial operation, as reflected by long, narrow, straight and non-calcified, non-thrombus-lined infrarenal necks and long, non-aneurysmal common iliac arteries. Similarly, appropriate selection of anastomotic sites during open repair is essential to prevent aneurysmal progression in the adjacent infrarenal aorta or common iliac arteries. Regardless, aorta-specific re-interventions will continue to be more common following EVAR than open repair, with most being amenable to further endovascular or percutaneous interventions. Often underappreciated, though, is that “access site”, or laparotomy-related, re-interventions (incisional hernias, small bowel obstructions) are more common after open repair and should be included in any discussion regarding durability of aneurysm repair. Surveillance regimens following both methods of repair are important and worthy of discussion. Although most commonly discussed with respect to EVAR, concerns regarding radiation and cancer-causing effects of computed tomography (CT) scans also apply to open repair. Surveillance following open repair is also important and many advocate a CT scan or ultrasound every 5 years after open repair. Surveillance regimens are becoming less contingent on CTs, and as this continues surveillance itself shouldn't be a factor in choosing method of repair, unless the surveillance regimen is important from the patient's perspective. Healthcare costs and surgeon expertise and experience are other issues raised by our authors, and are factors that differ between countries. Costs of EVAR and open repair have been widely analyzed, but any analysis depends on its perspective, the jurisdiction in which it takes place, its scope, and its time frame. Regarding expertise, Drs Vallabhaneni and Farber raise an interesting point regarding low-volume surgeons and hospitals in the USA being more adept at EVAR than open repair. This is an important jurisdiction-specific observation that reflects practice driving training driving practice and could be the subject of a whole other debate. Finally, should we consider EVAR in a young, good risk patient? Well, the durability of the procedure is relative to the life expectancy of the patient and is predicted by anatomy. The longer the life expectancy of the patient the more perfect the anatomy is required to maximize EVAR durability. So the answer is yes if the patient has excellent anatomy for EVAR. However, if there is any anatomical feature that might hint at limited durability, namely infrarenal neck and common iliac artery features, then an open repair should be chosen." @default.
• W2119963085 created "2016-06-24" @default.
• W2119963085 creator A5006631119 @default.
• W2119963085 creator A5071311565 @default.
• W2119963085 date "2013-12-01" @default.
• W2119963085 modified "2023-09-27" @default.
• W2119963085 title "Trans-Atlantic Debate: Should Young Patients with Good Risk Factors be Treated with EVAR?" @default.
• W2119963085 doi "https://doi.org/10.1016/j.ejvs.2013.10.002" @default.
• W2119963085 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/24400352" @default.
• W2119963085 hasPublicationYear "2013" @default.
• W2119963085 type Work @default.
• W2119963085 sameAs 2119963085 @default.
• W2119963085 citedByCount "5" @default.
• W2119963085 countsByYear W21199630852015 @default.
• W2119963085 countsByYear W21199630852016 @default.
• W2119963085 countsByYear W21199630852020 @default.
• W2119963085 countsByYear W21199630852022 @default.
• W2119963085 crossrefType "journal-article" @default.
• W2119963085 hasAuthorship W2119963085A5006631119 @default.
• W2119963085 hasAuthorship W2119963085A5071311565 @default.
• W2119963085 hasBestOaLocation W21199630851 @default.
• W2119963085 hasConcept C133925201 @default.
• W2119963085 hasConcept C141071460 @default.
• W2119963085 hasConcept C142362112 @default.
• W2119963085 hasConcept C153349607 @default.
• W2119963085 hasConcept C162324750 @default.
• W2119963085 hasConcept C168563851 @default.
• W2119963085 hasConcept C177713679 @default.
• W2119963085 hasConcept C187736073 @default.
• W2119963085 hasConcept C188353592 @default.
• W2119963085 hasConcept C2776035091 @default.
• W2119963085 hasConcept C2776098176 @default.
• W2119963085 hasConcept C2776543907 @default.
• W2119963085 hasConcept C2779993416 @default.
• W2119963085 hasConcept C2908647359 @default.
• W2119963085 hasConcept C31174226 @default.
• W2119963085 hasConcept C61434518 @default.
• W2119963085 hasConcept C71924100 @default.
• W2119963085 hasConcept C99454951 @default.
• W2119963085 hasConceptScore W2119963085C133925201 @default.
• W2119963085 hasConceptScore W2119963085C141071460 @default.
• W2119963085 hasConceptScore W2119963085C142362112 @default.
• W2119963085 hasConceptScore W2119963085C153349607 @default.
• W2119963085 hasConceptScore W2119963085C162324750 @default.
• W2119963085 hasConceptScore W2119963085C168563851 @default.
• W2119963085 hasConceptScore W2119963085C177713679 @default.
• W2119963085 hasConceptScore W2119963085C187736073 @default.
• W2119963085 hasConceptScore W2119963085C188353592 @default.
• W2119963085 hasConceptScore W2119963085C2776035091 @default.
• W2119963085 hasConceptScore W2119963085C2776098176 @default.
• W2119963085 hasConceptScore W2119963085C2776543907 @default.
• W2119963085 hasConceptScore W2119963085C2779993416 @default.
• W2119963085 hasConceptScore W2119963085C2908647359 @default.
• W2119963085 hasConceptScore W2119963085C31174226 @default.
• W2119963085 hasConceptScore W2119963085C61434518 @default.
• W2119963085 hasConceptScore W2119963085C71924100 @default.
• W2119963085 hasConceptScore W2119963085C99454951 @default.
• W2119963085 hasIssue "6" @default.
• W2119963085 hasLocation W21199630851 @default.
• W2119963085 hasLocation W21199630852 @default.
• W2119963085 hasOpenAccess W2119963085 @default.
• W2119963085 hasPrimaryLocation W21199630851 @default.
• W2119963085 hasRelatedWork W1982778236 @default.
• W2119963085 hasRelatedWork W2017103660 @default.
• W2119963085 hasRelatedWork W2090543750 @default.
• W2119963085 hasRelatedWork W2137190715 @default.
• W2119963085 hasRelatedWork W2186960680 @default.
• W2119963085 hasRelatedWork W2330404122 @default.
• W2119963085 hasRelatedWork W2336904041 @default.
• W2119963085 hasRelatedWork W2757358183 @default.
• W2119963085 hasRelatedWork W3037686638 @default.
• W2119963085 hasRelatedWork W3014013020 @default.
• W2119963085 hasVolume "46" @default.
• W2119963085 isParatext "false" @default.
• W2119963085 isRetracted "false" @default.
• W2119963085 magId "2119963085" @default.
• W2119963085 workType "article" @default.