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"Introduction: This study aims to know the performance of the Vascular – Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (V-POSSUM) score as a predictor of 30-day mortality after the Endovascular Aortic Aneurysm Repair (EVAR) – Thoracic Endovascular Aortic Repair (TEVAR) procedure in Abdominal Aortic Aneurysms (AAA) and Thoracic Aortic Aneurysms (TAA) patients in Cipto Mangunkusumo Hospital. Method: This was a retrospective cohort study using data from medical records. Data were taken according to the variables contained in the V-POSSUM scoring system in the patient who undergone EVAR – TEVAR procedure, on the period of 2013 to July 2018. Results: The study involved 85 patients who met the study requirements. It was known that physiological scores, morbidity risk, and mortality risk could be used as a model to predict mortality outcomes because they had good accuracy and discrimination performance, while the severity of the operation score cannot. The result of the goodness of fit model’s physiological score, morbidity risk, and mortality risk was significant (p <0.001), while the severity score of the operation was 0.18 (p >0.05). The Area Under the Curve (AUC) was 94%, 93%, 93%, with the cut points at 31, 68.8, and 10.6 for the physiological score, morbidity risk, and mortality risk, respectively. Conclusion: The V-POSSUM score had good accuracy and discrimination for the physiological score, morbidity risk, and mortality risk."

"Latar Belakang: Endovascular repair of abdominal aortic aneurysms (EVAR) menggunakan stent graft merupakan terapi utama pada pasien dengan aneurisma aorta abdominal. Aplikasi klinis EVAR dihadapkan dengan tingginya variasi anatomik aneurisma yang menyebabkan ketidaksesuaian ukuran stent yang dapat menyebabkan komplikasi berupa endoleak. Pembuatan instructions for use (IFU) merupakan upaya standardisasi dari produsen stent sehingga dapat sesuai dengan kondisi anatomik pasien dan menghindari komplikasi. Belum adanya penelitian mengenai kesesuaian IFU pada EVAR dan keluaran operasinya khususnya endoleak pasca-EVAR. Penelitian ini ditujukan untuk melihat hubungan kesesuaian IFU pada EVAR dengan kejadian endoleak pasca-EVAR.Metode: Studi dilakukan secara kohort retrospektif yang menilai hubungan kesesuaian IFU pada EVAR dengan kejadian endoleak pasca-EVAR. Penelitian akan dilakukan dari bulan Desember 2018-Februari 2019 di Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Pengambilan subjek dilakukan dengan pengambilan subjek total.Hasil: Pada pengambilan subjek didapatkan 39 subjek yang menjalani prosedur EVAR. Pada penelitian ini didapatkan 27 subjek (69.2%) menjalani EVAR sesuai dengan IFU dan 12 subjek (30.8%) tidak sesuai dengan IFU. Pada penelitian ini didapatkan 3 subjek penelitian (7.7%) mengalami endoleak pasca-EVAR. Pada analisis data, ditujukan bahwa kesesuaian IFU dalam menjalani EVAR tidak menunjukan hubungan yang bermakna dengan kejadian endoleak pasca-EVAR (p=0.539). Pada penelitian ini didapatkan bahwa seluruh pasien yang mengalami endoleak pasca-EVAR berasal dari kelompok yang menjalankan IFU yang sesuai. Analisis data panjang, sudut, dan diameter leher juga tidak menunjukan hubungan yang bermakna dengan kejadian endoleak pasca-EVAR.Kesimpulan: Tidak terdapat adanya hubungan antara kesesuaian IFU dalam menjalani EVAR dengan kejadian endoleak pasca-EVAR.

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Background: Endovascular repair of abdominal aortic aneurysms (EVAR) with stent-graft is the main treatment for patients with abdominal aortic aneurysm. Clinical application of EVAR is faced with the wide anatomic variety of aneurysm that could lead to incompatibility of stent size that could cause complications like endoleak. Instruction of use (IFU) is a standardization effort from the producer of the stent so that it would be more suitable for the patients anatomical condition thus avoiding the complications. Up until now, there has not been a research that studied the use of IFU on EVAR and its post-surgical outcome, especially post-EVAR endoleak. The objective of this study is to see the association between IFU accordance in EVAR with post-EVAR endoleak.Method: The study was conducted by cohort-retrospective which assesses the association between IFU accordance in EVAR with post-EVAR endoleak. This study was done from December 2018 to February 2019 at vascular surgery out-patient clinic in Cipto Mangunkusumo Hospital. Total sampling was conducted to obtain subjects by collecting all patients treated by EVAR.Results: There were 39 subjects selected in this study. We found 27 subjects (69.2%) underwent EVAR appropriately according to IFU and 12 subjects (30.8%) that did not. Three of the subjects (7.7%) had post-EVAR endoleak. In the data analysis, IFU accordance in EVAR did not have a significant association with post-EVAR endoleak incidence (p=0.539). This study also found that every single subject with post-EVAR endoleak was from the IFU appropriate EVAR group. Data analysis on neck length, angle, and diameter also did not show any significant association with post-EVAR endoleak incidence (p>0.05).Conclusion: There is no association between IFU accordance in EVAR with post-EVAR endoleak. Another study with larger sample size is needed to show association between IFU accordance with post-EVAR endoleak more accurately."

"Latar Belakang: Penyakit AAA sebagian besar berlokasi pada infrarenal. Mortalitas meningkat dengan ruptur. Faktor risiko utama ruptur adalah diameter aneurisma dan hipertensi. Analisis computational fluid dynamic (CFD) pada aliran darah memungkinkan untuk mengetahui predileksi area tempat terjadinya ruptur. Wall shear stress (WSS) dan tekanan dinding merupakan parameter yang bisa dianalisis melalui CFD untuk melihat potensi ruptur pada AAA. Tujuan: Mengetahui morfologi aneurisma AAA infrarenal beserta sebaran nilai WSS dan tekanan dinding aneurisma berdasarkan CFD untuk memprediksi ruptur aneurisma. Metode: Studi cross-sectional dengan analisis CT angiogram pasien AAA infrarenal di Divisi Vaskular dan Endovaskular-Departemen Bedah dan Departemen Radiologi RSUPN Dr. Cipto Mangunkusumo pada bulan Juli–Desember 2022. Data CT angiografi diolah dengan Radiant Viewer untuk dijadikan model 3D. Dari keseluruhan sampel, dikelompokkan menjadi 5 tipe aneurisma. Kemudian masing-masing model dilakukan proses pembuatan solid vessel dengan Meshmixer. Proses selanjutnya adalah geometri, meshing, setup parameter CFD, dan solution untuk menghasilkan kontur WSS dan tekanan dinding pada berbagai kecepatan dan tekanan darah dengan program ANSYS 2022 R2 Academic Student. Hasil visual pada tiap tipe dianalisis dan dibandingkan. Uji statistik non-parametrik WSS dan tekanan dinding pada tiap tipe dan antar grup menggunakan SPSS 25.0 dengan nilai p dianggap bermakna jika p<0,05. Hasil: Dari 93 CT angiogram, setelah eksklusi didapatkan 40 sampel. Median usia 67 (47-76 th), dengan 90% adalah laki-laki. Sebanyak 25% sampel memiliki komponen sakular. Hasil analisis visual, terdapat korelasi area antara WSS terendah dengan tekanan dinding tertinggi. Perubahan kecepatan dan tekanan darah inisial juga mengubah nilai dan luas area pada kontur WSS dan tekanan dinding aorta, meskipun pusat perubahan kontur masih berada pada area yang relatif sama. Terdapat perbedaan bermakna pada WSS dan tekanan dinding (p=0,038 dan p<0,001). Kesimpulan: Area WSS terendah berkaitan dengan lokasi tekanan dinding tertinggi. Berubahnya kecepatan dan tekanan darah, mempengaruhi luas dan nilai dari WSS dan tekanan dinding.

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Background: AAA disease is mostly located in infrarenal. Mortality increases with rupture. The main risk factors for rupture are diameter sac and hypertension. Computational fluid dynamic (CFD) analysis of blood flow allows for a detection where rupture area will occur. Wall shear stress (WSS) and wall pressure are parameters that can be analyzed through CFD to see the potential location for rupture in AAA. Objective: Knowing the morphology of infrarenal AAA along with the distribution of WSS values ​​and aneurysmal wall pressure based on CFD to predict aneurysm rupture. Method: Cross-sectional study with CT angiogram analysis of infrarenal AAA patients in the Vascular and Endovascular Division-Department of Surgery and the Department of Radiology RSUPN Dr. Cipto Mangunkusumo in July–December 2022. CT angiography data was processed with Radiant Viewer to be used as a 3D model. From the whole sample, grouped into 5 types of aneurysms. Then for each model the process of making a solid vessel is carried out with the Meshmixer. The next process is geometry, meshing, CFD parameter setup, and solutions to produce WSS and wall pressure contours at various speeds and blood pressures with the ANSYS 2022 R2 Academic Student program. Visual results for each type were analyzed and compared. WSS and wall pressure non-parametric statistical test were performed for each type and between groups using SPSS 25.0 with a p-value considered significant if p <0.05. Results: Of the 93 CT angiograms, after exclusion, 40 samples were obtained. Median age 67 (47-76 years), with 90% were men. As much as 25% of the sample had a saccular component. The results of the visual analysis showed that there was an area correlation between the lowest WSS and the highest wall pressure. Changes in velocity and initial blood pressure also changed the value and area of ​​the WSS and the aortic wall pressure contours, although the center of the contour change was still in the relatively same area. There was a significant difference in WSS and wall pressure (p=0.038 and p<0.001). Conclusion: The area of ​​lowest WSS corresponds to the location of the highest wall pressure. Changes in blood velocity and pressure affect the area and value of WSS and wall pressure."

"Latar Belakang: Saat ini, endovascular aneurysm repair (EVAR) lebih diutamakan pada sebagian besar kasus aneurisma aorta abdominalis (AAA) dibandingkan open surgical repair (OSR). Namun, terdapat kontroversi keluaran jangka panjang yang diperlihatkan kedua pilihan tatalaksana tersebut, terutama pada kelompok usia tua. Metode: Tinjauan sistematis dilakukan dengan mengikutsertakan studi yang membandingkan mortalitas jangka panjang, kesintasan jangka panjang, tingkat reintervensi, dan ruptur sekunder antara EVAR dan OSR pada pasien AAA berusia ≥65 tahun dengan minimal follow-up selama dua tahun. Pencarian artikel dilakukan pada empat pangkalan data elektronik yaitu Cochrane, Pubmed, EBSCOHost, dan Scopus. Studi yang diikutsertakan merupakan publikasi dari titik waktu awal yang tidak ditentukan sampai dengan bulan Maret 2024. Telaah kritis melalui instrumen yang sesuai dengan desain studi juga dilakukan untuk memastikan kualitas studi. Keluaran pada setiap studi disintesis ulang, disajikan dalam bentuk tabel, serta dilakukan pembahasan. Hasil: Studi sistematis ini berhasil mengikutsertakan 6 studi, yakni 1 studi meta-analisis dan 5 studi kohort. Mayoritas studi menunjukkan tidak adanya perbedaan mortalitas jangka panjang, kesintasan jangka panjang, tingkat reintervensi, dan tingkat ruptur sekunder antara EVAR dan OSR. Terdapat peningkatan mortalitas dan penurunan kesintasan EVAR dibandingkan OSR pada follow-up sampai dengan tahun keempat, namun tidak ada perbedaan pada tahun kelima dan rerata keseluruhan. Terdapat peningkatan mortalitas dan penurunan kesintasan EVAR pada kelompok usia ≥80 tahun dibandingkan kelompok usia 65-79 tahun. Kesimpulan: Tidak ada perbedaan keluaran jangka panjang antara EVAR dan OSR pada pasien AAA berusia ≥65 tahun.

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Introduction: Nowadays, endovascular aneurysm repair (EVAR) is preferred in most cases of abdominal aortic aneurysm (AAA) than open surgical repair (OSR). However, there are controversies regarding the long-term outcomes of both modalities, especially in the geriatric population. Method: We conducted a systematic review of studies comparing the long-term mortality, long-term survival, reintervention rate, and secondary rupture rate between EVAR and OSR in ≥65-year patients with AAA with a minimum of two years of follow-up. The literature search was conducted in four electronic databases, Cochrane, Pubmed, EBSCOHost, and Scopus, from an undefined start point until March 2024. Studies included also critically appraised with relevant instruments based on the study design. The long-term outcomes of every study were synthesized, presented in tables, and discussed thoroughly. Result: A total of six studies were included, consisting of one systematic review/meta-analysis and five cohort studies. Most studies did not show differences in long-term mortality, long-term survival, reintervention rate, or secondary rupture rate between EVAR and OSR. There was higher mortality and lower survival in EVAR compared to OSR after four years of follow-up, but no differences were found in five years and overall follow-up. There was higher mortality and lower survival after EVAR in patients≥80 years old compared to those 65-79 years old. Conclusion: There are no differences in long-term outcomes between EVAR and OSR in ≥65-year patients with AAA."

"Tesis ini membahas mengenai performa skor V-POSSUM sebagai prediktor mortalitas 30 hari pasca tindakan EVAR TEVAR pada pasien AAA dan TAA di RSUPN Cipto Mangunkusumo.Penelitian ini merupakan studi kohort retrospektif menggunakan data dari rekam medis. Data yang diambil sesuai variabel yang terdapat dalam sistem skoring dalam bentuk kategorik lalu diolah secara statistik untuk menguji validitas skor V-POSSUM. Hasil penelitian melibatkan 85 pasien yang memenuhi syarat penerimaan penelitian. Dari pengolahan data statistik diketahui bahwa skor fisiologis, risiko morbiditas, dan risiko mortalitas dapat digunakan sebagai model untuk memprediksi luaran kematian karena memiliki performa akurasi dan diskriminasi yang baik, sedangkan skor kepelikan operasi tidak dapat digunakan karena secara statistik tidak menunjukkan hal yang sama. Nilai P hasil perhitungan 'Goodnes of Fit Model' skor fisiologis, risiko morbiditas, risiko mortalitas masing-masing adalah 0.00, sedangkan skor kepelikan operasi 0.18 (>0.05). 'Area Under the Curve' (AUC) masing-masing adalah 94%, 93%, 93%, dengan titik potong masing-masing berada di angka 31, 68.8, dan 10.6. Sebagai kesimpulan adalah bahwa skor V-POSSUM memiliki akurasi dan diskriminasi yang baik bukan hanya pada skor risiko mortalitasnya saja, namun pada skor fisiologis dan skor risiko morbiditasnya.

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This thesis discusses the performance of V-POSSUM score as a predictor of 30 days mortality after EVAR TEVAR in AAA and TAA patients at Cipto Mangunkusumo Hospital. This study is a retrospective cohort method using data from medical records. Data taken according to the variables contained in the scoring system in categorical form then processed statistically to test the validity of the V-POSSUM score. The results of the study involved 85 patients who met the research acceptance requirements. From the processing of statistical data it is known that physiological scores, morbidity risk, and mortality risk can be used as a model to predict the outcome of death because it has good performance in accuracy and discrimination, while the severity score of surgery cannot be used because it does not show the same result statistically. The P value calculated by the Goodnes of Fit Model physiological score, the morbidity risk, the mortality risk of each was 0.00, while the severity score of the operation was 0.18 (> 0.05). Area Under the Curve (AUC) are 94%, 93%, 93%, respectively, with points 31, 68.8 and 10.6. The conclusion is that the V-POSSUM score has good accuracy and discrimination not only on the mortality risk score, but also on the physiological score and the morbidity risk score."

"Latar belakang :Tesis ini membahas tentang analisis kasus kematian pada pasien Aneurisma aorta abdominal di RSUP Fatmawwati yang menjalani operasi elektif. Sampel dan Metode : Data pasien diambil periode 2013 sampai April 2018. Semua pasien yang meninggal dari operasi elektif aneurisma aorta abdominal akan di data. Penelitian ini ditampilkan dalam bentuk deskriptif, dengan data kualitatif dan kuantitatif. Data kualitatif didapatkan dengan melakukan wawancara dengan tim operasi, operator, tim anestesi dan paramedis instrumen. Data kuantitatif didapatkan dengan telusur rekam medis. Hasil : Terdapat 27 kasus, selama periode 2013 sampai April 2018. Hanya 15 kasus yang rekam medis lengkap, 5 kasus hidup, 2 kasus meninggal pada operasi emergency dan 8 kasu meninggal pada operasi elektif. Dari 8 kasus ini, 5 kasus disertai anemia dan trombositopenia yang menetap sampai pada tahap postoperasi, 2 kasus dengan gangguan ginjal dan 1 kasus dengan penyebab yang belum jelas. Pada 8 kasus kematian, lama operasi berkisar dari 4 jam 20 menit sampai 8 jam 10 menit. Jumlah perdarahan berkisar dari 750 cc sampai 7.000 cc. Kadar creatinin preoperasi, berkisar dari 1,0 sampai 4,3 mg/dL. Kadar creatinin postoperasi berubah dari 1,0 sampai 4,5 mg/dL. Kadar hemoglobin postoperasi berkisar 5,9 sampai 9,4 g/dL. Kadar trombosit, berkisar 45.000 sampai 108.000/uL. Rata rata jumlah perdarahan adalah 3.156 cc. Kesimpulan : Penelitian ini menyimpulkan bahwa kasus dengan hasil akhir kematian, sebagian besar disertai oleh jumlah perdarahan yang masif. Perbaikan yang dilakukan untuk resusitasi komponen darah tidak mencapai hasil yang optimal.

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Background : The aim of this study is to confirm the factors that affect the mortality following open elective abdominal aortic aneurysm repair. Subject and Methode : This study was a retrospective study. Qualitative and quantitave data were collected from interviewing the team in charge and from the hospital database medical record. The data were collected for five years, from 2013 until April 2018. Data will be displayed in descriptive. Result : Twentyseven cases were hospitalized during the periode of 2016 until April 2018. Ten cases were not availlable to analyze, medical record were missing. Out of two case from these fivteen cases, was an emergency case. Five cases were alive when they discharge from the hospital. The other eight were elective cases and were able to analyze. Five cases, out of this eight, were accompanied by anemia and thrombositopenia, which last until they all move from the surgery room to the ICU. Two cases with renal disfunction, and one case with unclear cause of death. Duration of surgery in all this elective cases, ranged from 4 hours 20 minutes until 8 hours 10 minutes. Bood loss during surgery, estimated from 750 cc to 7.000 cc. Preoperative creatinin level, ranged from 1,0 to 4,3 mg/dL. Postoperative cretainin level, ranged from 1,0 to 4,5 mg/dL. Postoperative hemoglobin level, ranged from 5,9 to 9,4 g/dL. Postoperative platelet count , ranged from 45.000 to 108.000/uL. Mean blood loss during surgery was 3.156 cc. Conclusion : This study concluded that most of the death case was accompanied by massive bleeding. And all those attempt to improve by blood rescusitation, was not promptly worked."