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    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.

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    Authors
    Beirne, Chris
    Hynes, Niamh
    Sultan, Sherif
    Affiliation
    Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospitals, Galway, Ireland.
    Issue Date
    2008-11
    MeSH
    Aged
    Aortic Aneurysm, Abdominal
    Databases as Topic
    Epoprostenol
    Female
    Gastrointestinal Diseases
    Glomerular Filtration Rate
    Humans
    Infusions, Parenteral
    Intensive Care
    Ischemia
    Kidney
    Lung
    Male
    Myocardial Ischemia
    Platelet Aggregation Inhibitors
    Regional Blood Flow
    Respiration, Artificial
    Surgical Procedures, Elective
    Time Factors
    Treatment Outcome
    Vascular Surgical Procedures
    Vasodilator Agents
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    Citation
    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. 2008, 22 (6):750-5 Ann Vasc Surg
    Publisher
    Annals of vascular surgery
    Journal
    Annals of vascular surgery
    URI
    http://hdl.handle.net/10147/304780
    DOI
    10.1016/j.avsg.2008.08.036
    PubMed ID
    18992665
    Abstract
    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.
    Item Type
    Article
    Language
    en
    ISSN
    1615-5947
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.avsg.2008.08.036
    Scopus Count
    Collections
    Galway University Hospitals

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