Evidence map›Paper›PMID 35605910›Full record

ArticleEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery2022

Retroperitoneal versus Transperitoneal Approach for Open Repair of Complex Abdominal Aortic Aneurysms.

Vinamr Rastogi, Nicole H Kim, Christina L Marcaccio, Priya B Patel, Rens R B Varkevisser, Jorg L de Bruin, Hence J M Verhagen, Marc L Schermerhorn

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Article in European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Vinamr RastogiDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Nicole H KimDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Christina L MarcaccioDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Priya B PatelDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Rens R B VarkevisserDepartment of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Jorg L de BruinDepartment of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Hence J M VerhagenDepartment of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Marc L SchermerhornDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA. Electronic address: mscherm@bidmc.harvard.edu.

Funding

HARVARD-LONGWOOD RESEARCH TRAINING IN VASCULAR SURGERYT32HL007734 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI FERRAN, CHRISTIANE, LOGERFO, FRANK W · 1993 to 2023
$10.5M
Harvard-Longwood Short-Term Research Training in Vascular SurgeryT35HL110843 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI CHRISTIANE FERRAN, FRANK W LOGERFO · 2013 to 2026
$609k
Disparities in Detection and Treatment of Abdominal Aortic Aneurysm DiseaseF32HS027285 · AHRQ · BETH ISRAEL DEACONESS MEDICAL CENTER · PI MARCACCIO, CHRISTINA · 2020 to 2021
$154k
AHRQ HHS F32 HS027285NHLBI NIH HHS T32 HL007734NHLBI NIH HHS T35 HL110843
6 · The paper itself

Abstract

objectiveSeveral studies have demonstrated advantages of the retroperitoneal approach (RP) over the transperitoneal approach (TP) for infrarenal abdominal aortic aneurysm (AAA) repair. A retrospective analysis was performed comparing the outcomes of a TP vs. RP surgical approach for open complex AAA (cAAA) repair and evaluated their relative use over time.

methodsPatients undergoing open repair for intact cAAA (juxtarenal, suprarenal, or type IV thoraco-abdominal aortic aneurysms) between 2011 and 2019 were identified in the National Surgical Quality Improvement Program. The primary outcome was peri-operative death. Secondary outcomes included peri-operative complications and approach use over time. Multivariable adjustment was performed by creating propensity scores and using inverse probability weighted logistic regression.

resultsAmong 1 195 patients identified, 729 (61%) underwent cAAA repair via a TP approach and 466 (39%) via an RP approach. Compared with a TP approach, RP patients more frequently had a supracoeliac clamp position (32% vs. 20%, p < .001) and concomitant renal revascularisation (30% vs. 18%, p < .001). After adjustment, an RP approach was associated with lower odds of peri-operative death (4.0% vs. 7.2%; odds ratio [OR] 0.54; 95% confidence interval [CI] 0.32 - 0.91; p = .022). Furthermore, an RP approach was associated with lower odds of any major complication (24% vs. 30%; OR 0.73; 95% CI 0.56 - 0.94), cardiac complications (4.9% vs. 8.2%; OR 0.60; 95% CI 0.37 - 0.96), wound complications (2.1% vs. 6.0%; OR 0.34; 95% CI 0.17 - 0.64), and post-operative sepsis (0.8% vs. 2.4%; OR 0.37; 95% CI 0.12 - 0.99). The proportion of repairs using an RP approach decreased between 2011 - 2015 and 2016 - 2019 (42% vs. 35%, p = .020), particularly for suprarenal and type IV thoraco-abdominal aneurysms (49% vs. 37%, p = .023).

conclusionIn open cAAA repair, the RP approach may be associated with lower peri-operative mortality and morbidity rates compared with the TP approach. However, it was found that the relative use of the RP approach is decreasing over time, even in suprarenal/type IV thoraco-abdominal aneurysms, and repairs using a supracoeliac clamp. Increased use of the RP approach, when appropriate, may lead to improved outcomes following open cAAA repair.

Indexed as

Aortic Aneurysm, AbdominalBlood Vessel Prosthesis ImplantationHumansPostoperative ComplicationsRetroperitoneal SpaceRetrospective StudiesRisk FactorsTreatment OutcomeComplex abdominal aortic aneurysmsOpen aneurysm repairRetroperitonealSurgical approachTransperitoneal

Identifiers

PMID35605910
PMCPMC9420765

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.