Background: Abdominal aortic aneurysm (AAA) has a prevalence of 4.8%. AAA rupture is associated with significant mortality, thus surgical intervention is generally required once the aneurysm diameter exceeds 5.5 cm. Endovascular aneurysm repair (EVAR) is the predominant repair modality for AAA. However, in patients with complex aortic anatomy, fenestrated or branched EVAR is a superior repair option vs standard EVAR. Fenestrated and branched endoprostheses can be off-the-shelf or custom-made, which offers a more individualised approach. Aim: To summarise and evaluate the clinical outcomes achieved by fenestrated EVAR (FEVAR) and branched EVAR (BEVAR), and to explore the role of custom-made endoprostheses in contemporary AAA management. Methods: A literature search using Ovid Medline and Google Scholar was conducted to identify literature pertaining to the use and outcomes of fenestrated, branched, fenestrated-branched and custom-made endoprostheses for AAA repair. Results: FEVAR is an effective repair modality for patients with AAA that offers similar early survival, improved early morbidity but higher rates of reintervention in comparison to open surgical repair (OSR). Compared with standard EVAR, FEVAR is associated with similar in-hospital mortality yet higher rates of morbidity, especially regarding renal outcomes. BEVAR outcomes are rarely reported exclusively in the context of AAA repair. When reported, BEVAR is an acceptable alternative to EVAR in the treatment of complex aortic aneurysms and has similar reported complication issues to FEVAR. Custom-made grafts are a good alternative treatment option for complex aneurysms where hostile aneurysm anatomy precludes the use of conventional EVAR and sufficient time is available for the manufacturing of such devices. Conclusion: FEVAR offers a very effective treatment for patients with complex aortic anatomy and has been well-characterised over the past decade. RCTs and longer-term studies are desirable for unbiased comparison of non-standard EVAR modalities.

Background: Men are known to have a higher incidence of acute cardiovascular events, while women are recognized for their increased mortality following diagnosis or intervention for these conditions. The aim of this study is to explore the sex differences in clinical profiles and outcomes of patients undergoing ascending aortic aneurysm (AscAA) surgery. Methods: A PRISMA compliant literature search and data extraction were conducted using PubMed, EMBASE, and SCOPUS. Observational cohort or retrospective registries that compared a defined number of male and female adults undergoing ascending aortic surgery for AscAA were included. Data analysis was conducted in compliance with Cochrane methods. Results: A total of 11 unique studies met the inclusion criteria, from which 13636 patients were included, with a distribution of 9124 males (67%) and 4512 females (33%). Overall, 91% underwent elective surgery. Male patients had significantly lower 30-day mortality, (RR: 0.68, 95% Cl [0.57, 0.81], p < 0.0001) and shorter stays in the intensive care unit, with a mean difference (MD) of −0.48 days ([−0.84, −0.13], p = 0.008). Males were significantly younger at the time of surgery (MD: −3.94 years, 95% CI [−5.58, −2.31], p < 0.00001). Male patients had significantly more frequent concomitant CABG (21% vs. 14.5%; p < 0.0001), while females had more frequent isolated supra-coronary ascending aortic replacement (22% vs. 36%; p = 0.004). Female patients who underwent AscAA surgery had significantly lower long-term survival (HR: 1.25, [1.05, 1.50], p = 0.013). Conclusions: Women undergo surgery for AscAA at older ages and face greater mortality. The disparities in preoperative age and timing of surgery between males and females can be explained by differences in comorbidity profiles and the need for concomitant surgery.

Background: The use of glaucoma drainage devices (GDDs) in the management of glaucoma is increasing; however, there is a paucity of data comparing the surgical outcomes of different devices in an African context. Aim: The aim of the study was to compare the surgical outcomes of the Ahmed glaucoma valve and the aurolab aqueous drainage implant (AADI) device in glaucoma cases within an African context. Setting: Patient data were obtained from Groote Schuur Hospital and Eerste River Hospital in Cape Town, South Africa. Methods: The study was a comparative retrospective review of the medical records of consecutive adult patients who received GDD surgery over a 2-year period using standardised surgical techniques. Results: A total of 76 patients/eyes were included in the study, 48 in the Ahmed group and 28 in the AADI group. The overall 1-year and 2-year qualified success rates were 75% and 77.1% respectively, for the Ahmed, and 78.6% and 85.7% respectively, for the AADI (P = 0.757; P = 0.873). The mean intraocular pressure (IOP) in the Ahmed group decreased from 32 ± 12 mmHg to 16 ± 6 mmHg at 2 years, compared to 33 ± 13 mmHg to 14 ± 6 mmHg at 2 years in the AADI group. Most (63, 82.9%) patients required postoperative glaucoma medications. Conclusion: The Ahmed and AADI groups achieved comparable success rates over a 2-year period. A similar IOP reduction was achieved with no difference in the need for medication between the two groups. Contribution: This study adds to the knowledge of GDD surgical outcomes in an African context.