A randomized, placebo-controlled trial of doxycycline after endoluminal aneurysm repair Amy E. Hackmann, MD, Brian G. Rubin, MD, Luis A. Sanchez, MD,

Slides:

Advertisements

Similar presentations

Jon S. Matsumura, MD, Wesley S. Moore, MD Journal of Vascular Surgery

Advertisements

Duplex ultrasound imaging alone is sufficient for midterm endovascular aneurysm repair surveillance: A cost analysis study and prospective comparison.

Dynamic magnetic resonance angiography of the aneurysm neck: Conformational changes during the cardiac cycle with possible consequences for endograft.

Jordan Knepper, MD, Enrique Criado, MD Journal of Vascular Surgery

Lee J. Goldstein, MD, Combiz Rezayat, MD, Gautam V

Victor J. Davila, MD, William Stone, MD, Audra A

Graft infection after endovascular abdominal aortic aneurysm repair

Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective

Endovascular abdominal aortic aneurysm repair to prevent rupture in a patient requiring lithotripsy Rick de Graaf, MSc, Frank J Veith, MD, Nicholas J.

Retrograde migration of an abdominal aortic aneurysm endograft leading to postoperative renal failure Barry T. Katzen, MD, Alexandra A. MacLean, MD,

Surgeon-modified fenestrated-branched stent grafts to treat emergently ruptured and symptomatic complex aortic aneurysms in high-risk patients Joseph.

Aortic neck enlargement after endovascular aneurysm repair using balloon-expandable versus self-expanding endografts Janis Savlovskis, MD, Dainis Krievins,

Combined surgical and endovascular treatment of aortic arch aneurysms

Thoracic endografting in a patient with hereditary hemorrhagic telangiectasia presenting with a descending thoracic aneurysm Nicholas D. Andersen, MD,

Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective

Role of type II endoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms Jared Kray, DO, Spencer Kirk, DO, Jan Franko,

John W. Fehrenbacher, MD, Robert A. McCready, MD

Nitin Garg, MBBS, MPH, Mark A. Lewis, MD, Joseph J

Aortic angiosarcoma masquerading as a thoracic aortic aneurysm

Twenty consecutive cases of endograft repair of traumatic aortic disruption: Lessons learned David G. Neschis, MD, Sina Moaine, MD, Rao Gutta, MD, Kirk.

Late Gore Excluder endoprosthesis fabric tear leading to abdominal aortic aneurysm rupture 5 years after initial implant Anand Dayama, MD, Nikolaos Tsilimparis,

Bruce A. Perler, MD, MBA Journal of Vascular Surgery

ITalian Excluder Registry and results of Gore Excluder endograft for the treatment of elective infrarenal abdominal aortic aneurysms Carlo Pratesi, MD,

What is the clinical utility of a 6-month computed tomography in the follow-up of endovascular aneurysm repair patients? Michael R. Go, MD, Joel E. Barbato,

High prevalence of abdominal aortic aneurysms in brothers and sisters of patients despite a low prevalence in the population Anneli Linné, MD, David.

Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula Heleen D. de Koning, MSc, Steven M.M. van Sterkenburg,

The natural history of type II endoleaks after endovascular aneurysm repair for ruptured abdominal aortic aneurysm Anna E. Boniakowski, MD, Randall R.

Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair? L.Richard Sprouse, MD, George H. Meier,

Is abdominal aortic aneurysm repair appropriate in oxygen-dependent chronic obstructive pulmonary disease patients? Christopher N. Compton, MD, Ellen.

Raghuveer Vallabhaneni, MD, Luis A. Sanchez, MD

Niyant V. Patel, MD, Graham W. Long, MD, Zulfiqar F

Reduced protease inhibitory capacity in patients with abdominal aortic aneurysms is reversed with surgical repair Vivienne J. Halpern, MD, Mahesh Mathrumbutham,

Nonoperative approach to endotension

Endovascular abdominal aortic aneurysm repair in a patient with Ehlers-Danlos syndrome Maseer A. Bade, MD, Luis A. Queral, MD, Dipankar Mukherjee, MD,

Carlos E. Donayre, MD, Christopher K. Zarins, MD, Dainis K

Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery.

Outcome of common iliac arteries after straight aortic tube-graft placement during elective repair of infrarenal abdominal aortic aneurysms Réda Hassen-Khodja,

Stent graft migration after endovascular aneurysm repair: importance of proximal fixation Christopher K Zarins, MD, Daniel A Bloch, PhD, Tami Crabtree,

Christopher M. Faries, BA, Rami O. Tadros, MD, Paul S

Abdulhameed Aziz, MD, Christine O. Menias, MD, Luis A

Jon S. Matsumura, MD, Wesley S. Moore, MD Journal of Vascular Surgery

Outcomes of endovascular aneurysm repair with selective internal iliac artery coverage without coil embolization Konstantinos O. Papazoglou, MD, PhD,

Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair: A comparison of AneuRx and Zenith endografts Britt H. Tonnessen,

Adam Keefer, MD, Sean Hislop, MD, Michael J

The role of aortic stent grafting in the treatment of atheromatous embolization syndrome: Results after a mean of 15 months follow-up Alfio Carroccio,

Use of a surgeon-modified branched thoracic endograft to preserve an aortorenal bypass during treatment of an intercostal patch aneurysm Jeffrey Jim,

Outcomes of original and low-permeability Gore Excluder endoprosthesis for endovascular abdominal aortic aneurysm repair William Tanski, MD, Mark Fillinger,

Psoas abscess in patients with an infected aortic aneurysm

Extra-anatomic arterial reconstruction with ligation of common iliac arteries and embolization of the aneurysm for the treatment of abdominal aortic aneurysms.

Axillobifemoral bypass and aortic embolization for the treatment of two patients with ruptured infrarenal aortic aneurysms David Coleman, MD, Theodore.

Probable zoonotic aortitis due to group C streptococcal infection

Ramesh Lokanathan, MD, FRCS(C), David C. Taylor, MD, FRCS(C)

P Jetty, MD, G.G Barber, MD Journal of Vascular Surgery

Journal of Vascular Surgery

Aortic neck enlargement after endovascular aneurysm repair using balloon-expandable versus self-expanding endografts Janis Savlovskis, MD, Dainis Krievins,

Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery.

Maureen K. Sheehan, MD, Joel Barbato, MD, Christopher N

Contrast-enhanced Duplex surveillance after endovascular abdominal aortic aneurysm repair: Improved efficacy using a continuous infusion technique Esteban.

What imaging studies are necessary for abdominal aortic endograft sizing? A prospective blinded study using conventional computed tomography, aortography,

Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm Thorarinn Kristmundsson, MD, PhD, Björn Sonesson, MD, PhD, Nuno Dias, MD, PhD,

Robert J. Hinchliffe, MD, MRCS, Janet T

Midterm outcomes of the Zenith Renu AAA Ancillary Graft

Retrograde visceral vessel revascularization followed by endovascular aneurysm exclusion as an alternative to open surgical repair of thoracoabdominal.

Complete regression of a symptomatic, mycotic juxtarenal abdominal aortic aneurysm after treatment with fenestrated endovascular aneurysm repair Jonathan.

AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: Multicenter prospective clinical trial Christopher K. Zarins, MD, Rodney.

Kenji Sakai, MD, Taiju Watanabe, MD, PhD, Tetsuya Yoshida, MD, PhD

Michael P. Jenkins, MD, Stéphan Haulon, MD, PhD, Roy K

Rupture of abdominal aortic aneurysm: Concurrent comparison of outcome of those occurring after endovascular repair versus those occurring without previous.

Retrograde ascending Stanford B aortic dissection complicating a routine infrarenal endovascular aortic reconstruction Apostolos T. Mamopoulos, MD, Thomas.

Open repair of abdominal aortic aneurysm in a centenarian

Presentation transcript:

A randomized, placebo-controlled trial of doxycycline after endoluminal aneurysm repair Amy E. Hackmann, MD, Brian G. Rubin, MD, Luis A. Sanchez, MD, Patrick A. Geraghty, MD, Robert W. Thompson, MD, John A. Curci, MD Journal of Vascular Surgery Volume 48, Issue 3, Pages 519-526 (September 2008) DOI: 10.1016/j.jvs.2008.03.064 Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 1 Study enrollment data. Inclusion and exclusion criteria for enrollment are as listed at the conclusion of the study. During the first year of enrollment, the maximal aortic diameter necessary for enrollment was 5.0 cm; this resulted in most of the anatomic exclusions. After randomization, but before dispensing the study medications we had four withdrawals: one developed a postoperative ileus and was unable to take the medication. One patient had an open abdominal aortic aneurysms (AAA) repair, and one patient from each group decided not to accept the study medications after surgery and withdrew. After the medications were dispensed, we had an additional 11 patients without 6 month follow-up. Two (1 doxycycline and 1 placebo) patients withdrew claiming medication gastrointestinal (GI) side effects, 4 developed other illnesses and declined further participation, and 2 withdrew without stating a reason, 1 person withdrew due to a change in insurance coverage and did not return to our facility, 1 patient in the placebo group died from complications of chronic obstructive pulmonary disorder, and there was 1 patient whom we could not contact and was lost to subsequent follow-up. Journal of Vascular Surgery 2008 48, 519-526DOI: (10.1016/j.jvs.2008.03.064) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 2 Correlation between pre-operative matrix metalloproteases (MMP)-9 and MMP-2 and maximum aortic diameter. Although the adjusted correlation coefficient (adj. R2) for MMP-9 is considerably greater than that for MMP-2, circulating levels of both enzymes significantly correlate with the magnitude of aneurysmal dilatation. Journal of Vascular Surgery 2008 48, 519-526DOI: (10.1016/j.jvs.2008.03.064) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 3 Effect of doxycycline treatment on maximal aneurysm diameter change after endoluminal exclusion of an abdominal aortic aneurysm. Change in maximal diameter was calculated as a percentage change in the maximum infrarenal aortic diameter between the 1 and 6 month computed tomography (CT) scans. Patients with evidence of a type II endoleak on the 6-month CT follow-up were excluded from this analysis. Doxycycline treatment resulted in a significantly greater decrease in maximal aneurysm size among the combined group of AneuRx and Excluder treated patients (P < .05). Journal of Vascular Surgery 2008 48, 519-526DOI: (10.1016/j.jvs.2008.03.064) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 4 Effect of doxycycline treatment on aortic neck diameter among patients with Excluder endograft. In the placebo treated group all aortic necks significantly increased in diameter between the preoperative and 6-month computed tomography (CT) scan measures. Among the patients treated with an Excluder endograft, doxycycline prevented this increase in aortic neck diameter. The treated patients demonstrated a significantly smaller increase in aortic diameter than the untreated patients for this sub-group (P < .05). Data is expressed as a percentage of the aortic neck diameter as measured on cross-sectional imaging relative to the nominal endograft diameter (percentage oversized). Journal of Vascular Surgery 2008 48, 519-526DOI: (10.1016/j.jvs.2008.03.064) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions

Fig 5 Effect of doxycycline therapy on the circulating levels of matrix metalloproteases (MMP)-9. The mean levels of plasma MMP-9 are plotted before and at all follow-up intervals after placement of an aortic endograft. While the surgical procedure caused an initial increase in plasma MMP-9, these levels decreased over the first postoperative month in both groups. While plasma MMP-9 subsequently increased by 6 months in the placebo treated patients, doxycycline treatment resulted in a continued decrease of circulating MMP-9 in this interval. At 6 months, plasma MMP-9 decreased significantly below preoperative levels in the doxycycline treated group (P < .03), but not in the placebo treated patients. The overall change in MMP-9 during the study was significantly different between treatment groups (P < .009). Journal of Vascular Surgery 2008 48, 519-526DOI: (10.1016/j.jvs.2008.03.064) Copyright © 2008 The Society for Vascular Surgery Terms and Conditions