| Six years' experience with prostaglandin I2 infusion in elective open repair of abdominal aortic aneurysm: a parallel group observational study in a tertiary referral vascular center. | |
| | |
MedLine Citation:
|
PMID: 18992665 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
The prostaglandin I(2) (PGI(2)) analogue iloprost, a potent vasodilator and inhibitor of platelet activation, has traditionally been utilized in pulmonary hypertension and off-label use for revascularization of chronic critical lower limb ischemia. This study was designed to assess the effect of 72 hr iloprost infusion on systemic ischemia post-open elective abdominal aortic aneurysm (EAAA) surgery. Between January 2000 and 2007, 104 patients undergoing open EAAA were identified: 36 had juxtarenal, 15 had suprarenal, and 53 had infrarenal aneurysms, with a mean maximal diameter of 6.9 cm. The male-to-female ratio was 2.5:1, with a mean age of 71.9 years. No statistically significant difference was seen between the study groups with regard to age, sex, risk factors, American Society of Anesthesiologists (ASA) grade, or diameter of aneurysm repaired. All emergency, urgent, and endovascular procedures for aneurysms were excluded. Fifty-seven patients received iloprost infusion for 72 hr in the immediate postoperative period compared with 47 patients who did not. Patients were monitored for signs of pulmonary, renal, cardiac, systemic ischemia, and postoperative intensive care unit (ICU) morbidity. Statistically significantly increased ventilation rates (p=0.0048), pulmonary complication rates (p=0.0019), and myocardial ischemia (p=0.0446) were noted in those patients not receiving iloprost. These patients also had significantly higher renal indices including estimate glomerular filtration rate changes (p=0.041) and postoperative urea level rises (p=0.0286). Peripheral limb trashing was noted in five patients (11.6%) in the non-iloprost group compared with no patients who received iloprost. Increased rates of transfusion requirements and bowel complications were noted in those who did not receive iloprost, with their ICU stay greater than twice that of iloprost patients. All-cause morbidity affected 67% of patients not receiving iloprost compared to 40% who did. Survival rates were significantly better with iloprost than without in both 30-day (p=0.009) and 5-year cumulative (p=0.0187) survival. Iloprost infusion for 72 hr after open AAA repair was associated with improved systemic perfusion and decreased systemic ischemia. Patients had a significant survival benefit at 30 days and 5 years and significantly improved renal, cardiac, and respiratory function. |
| | |
Authors:
|
Chris Beirne; Niamh Hynes; Sherif Sultan |
Related Documents
:
|
19922395 - Patients with supratentorial aneurysmal subarachnoid hemorrhage during the intermediate... 18184845 - Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endov... 12107405 - Inflammatory aneurysms of infra-renal abdominal aorta. a case-control study. 7901685 - Is surgery necessary for abdominal aortic aneurysm less than 6 cm in diameter? 10660025 - Postoperative mri appearance after transsphenoidal pituitary tumor resection. 7901585 - Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Annals of vascular surgery Volume: 22 ISSN: 1615-5947 ISO Abbreviation: Ann Vasc Surg Publication Date: 2008 Nov |
Date Detail:
|
Created Date: 2008-11-10 Completed Date: 2009-01-15 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 750-5 Citation Subset: IM |
Affiliation:
|
Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospitals, Galway, Ireland. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Aortic Aneurysm, Abdominal / mortality, physiopathology, surgery* Databases as Topic Epoprostenol / administration & dosage*, adverse effects Female Gastrointestinal Diseases / etiology Glomerular Filtration Rate / drug effects Humans Infusions, Parenteral Intensive Care Ischemia / etiology, prevention & control* Kidney / blood supply*, physiopathology Lung / blood supply*, physiopathology Male Myocardial Ischemia / etiology, physiopathology, prevention & control Platelet Aggregation Inhibitors / administration & dosage*, adverse effects Regional Blood Flow / drug effects Respiration, Artificial Surgical Procedures, Elective Time Factors Treatment Outcome Vascular Surgical Procedures / adverse effects*, mortality Vasodilator Agents / administration & dosage*, adverse effects |
| Chemical | |
Reg. No./Substance:
|
0/Platelet Aggregation Inhibitors; 0/Vasodilator Agents; 35121-78-9/Epoprostenol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Direct and indirect measurement of patient radiation exposure during endovascular aortic aneurysm re...
Next Document: Infrainguinal atherectomy: a retrospective review of a single-center experience.