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Georgakarakos E, Xenakis A, Georgiadis GS. Computational Comparison Between a Classic Bifurcated Endograft and a Customized Model With "Dog Bone"-Shaped Limbs. J Endovasc Ther 2019; 26:250-257. [PMID: 30898071 DOI: 10.1177/1526602819834713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To use computational simulations to compare the hemodynamic characteristics of a classic bifurcated stent-graft to an equally long endograft design with "dog bone"-shaped limbs (DB), which have large diameter proximal and distal ends and significant narrowing at the midsection to accommodate aneurysms with an extremely narrow bifurcation. MATERIALS AND METHODS A 3-dimensional model was constructed using commercially available validated software. Inlet and outlet diameters were 28 and 14 mm, respectively. The total length of both models was kept constant to 180 mm, but the main body of the DB model was 20 mm shorter than the bifurcated endograft. The iliac limbs of the DB model had a 9-mm stenosis over a 30-mm segmental length in the midsection. Flow was quantified by time-averaged wall shear stress, oscillatory shear index (OSI), and relative residence time (RRT). The displacement forces in newtons (N) and maximum wall shear stress (WSS) in pascals (Pa) were compared during a cardiac cycle at 3 segments (main body, bifurcation, and iliac limbs) of both models with computational fluid dynamics analysis. RESULTS The DB accommodation was associated with higher forces at the main body (range 3.15-4.9 Ν) compared with the classic configuration (1.56-2.34 N). On the contrary, the forces at the bifurcation (3.81-5.98 vs 3.76-5.54 N) and at the iliac limbs (0.34-0.85 vs 0.49-0.74 N) were comparable for both models. Accordingly, maximum WSS was detected at the iliac sites for both models throughout the cardiac cycle. The highest values were detected at peak systole and equaled 26.6 and 12 Pa for the DB and bifurcated configurations, respectively. The narrow segments in the DB model displayed high stress values but low OSI and very low RRT. CONCLUSION The DB accommodation seems to correlate with higher displacement forces at the main body and higher stresses at the iliac limbs. Consequently, regular imaging follow-up of the DB design deems necessary to delineate its mid- and long-term clinical performance.
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Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Xenakis
- 2 Fluids Section, School of Mechanical Engineering, National Technical University of Athens, Greece
| | - George S Georgiadis
- 1 Department of Vascular Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Current Status of Endovascular Preservation of the Internal Iliac Artery with Iliac Branch Devices (IBD). Cardiovasc Intervent Radiol 2019; 42:935-948. [DOI: 10.1007/s00270-019-02199-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/06/2019] [Indexed: 02/06/2023]
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Patient-specific in silico endovascular repair of abdominal aortic aneurysms: application and validation. Biomech Model Mechanobiol 2019; 18:983-1004. [PMID: 30834463 DOI: 10.1007/s10237-019-01125-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
Non-negligible postinterventional complication rates after endovascular aneurysm repair (EVAR) leave room for further improvements. Since the potential success of EVAR depends on various patient-specific factors, such as the complexity of the vessel geometry and the physiological state of the vessel, in silico models can be a valuable tool in the preinterventional planning phase. A suitable in silico EVAR methodology applied to patient-specific cases can be used to predict stent-graft (SG)-related complications, such as SG migration, endoleaks or tissue remodeling-induced aortic neck dilatation and to improve the selection and sizing process of SGs. In this contribution, we apply an in silico EVAR methodology that predicts the final state of the deployed SG after intervention to three clinical cases. A novel qualitative and quantitative validation methodology, that is based on a comparison between in silico results and postinterventional CT data, is presented. The validation methodology compares average stent diameters pseudo-continuously along the total length of the deployed SG. The validation of the in silico results shows very good agreement proving the potential of using in silico approaches in the preinterventional planning of EVAR. We consider models of bifurcated, marketed SGs as well as sophisticated models of patient-specific vessels that include intraluminal thrombus, calcifications and an anisotropic model for the vessel wall. We exemplarily show the additional benefit and applicability of in silico EVAR approaches to clinical cases by evaluating mechanical quantities with the potential to assess the quality of SG fixation and sealing such as contact tractions between SG and vessel as well as SG-induced tissue overstresses.
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Veraldi GF, Mezzetto L, Scorsone L, Macrì M, Bovo C, Simoncini F, Criscenti P, Lippi G. Red blood cell distribution width (RDW) is an independent predictor of post-implantation syndrome in patients undergoing endovascular aortic repair for abdominal aortic aneurysm. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:453. [PMID: 30603641 DOI: 10.21037/atm.2018.11.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background This observational, retrospective study aims establishing the role of red blood cell distribution width (RDW) for identifying abdominal aortic aneurism (AAA) patients at risk of developing post-implantation syndrome (PiS) after endovascular aneurysm repair (EVAR). Methods The study population consisted of all patients undergoing EVAR for AAA at the University Hospital of Verona (Italy), between June 1, 2016 and May 31, 2018. Blood samples for measuring hemoglobin, mean corpuscular volume (MCV) and RDW were collected at hospital admission and the day after EVAR. The primary endpoint was PiS development. Delta variations were calculated as the ratio between values measured after and before EVAR. Results The final study population consisted of 124 patients (10 women and 114 men; median age, 75 years), 55 of whom developed PiS. In patients with or without PiS hemoglobin significantly decreased after EVAR, whilst RDW significantly increased in patients with PiS and decreased in those without. Age, sex, hypertension, diabetes and renal failure were similar in patients who developed PiS or not, whilst a positive history of coronary artery disease was more frequent in PiS patients. Although hemoglobin and MCV changes after EVAR did not differ in patients with or without PiS, delta RDW was higher in those with PiS. The rate of patients with delta RDW >1 was significantly higher in patients with PiS that in those without (61.8% vs. 34.8%; P=0.002). In multivariate analysis, delta RDW remained independently associated with PiS (β coefficient, 2.023; P=0.001). A delta RDW >1 after EVAR was associated with ~3-fold enhanced risk of PiS (odds ratio, 3.04; P=0.003) and exhibited a good prognostic performance (area under the curve, 0.69; P<0.001). Conclusions Calculation of delta RDW after EVAR seems an efficient prognostic tool for stratifying the risk of developing PiS, especially in the early postoperative period.
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Affiliation(s)
- Gian Franco Veraldi
- Department of Vascular Surgery, University of Verona-School of Medicine, University Hospital of Verona, Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University of Verona-School of Medicine, University Hospital of Verona, Verona, Italy
| | - Lorenzo Scorsone
- Department of Vascular Surgery, University of Verona-School of Medicine, University Hospital of Verona, Verona, Italy
| | - Marco Macrì
- Department of Vascular Surgery, University of Verona-School of Medicine, University Hospital of Verona, Verona, Italy
| | - Chiara Bovo
- Medical Direction, University Hospital of Verona, Verona, Italy
| | - Fabio Simoncini
- Department of Vascular Surgery, University of Verona-School of Medicine, University Hospital of Verona, Verona, Italy
| | - Paolo Criscenti
- Department of Vascular Surgery, University of Verona-School of Medicine, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Spiliopoulos S, Moulakakis K, Palialexis K, Konstantos C, Reppas L, Kakisis I, Lazaris A, Geroulakos G, Brountzos E. Long-Term Outcomes of Percutaneous Stenting of Aortic Endograft Limb Occlusion. Ann Vasc Surg 2019; 54:226-232. [PMID: 30092436 DOI: 10.1016/j.avsg.2018.05.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION To investigate the safety and efficacy of percutaneous stenting for the management of chronic ischemia caused by endograft limb occlusion following endovascular aortic aneurysm repair (EVAR). METHODS This is a retrospective, single-center study investigating all patients who underwent percutaneous endovascular covered or bare metal stent placement for the management of intermittent claudication (IC) or critical limb ischemia following EVAR limb occlusion, between January 2010 and October 2017. Cases suffering from acute limb ischemia were treated surgically and were excluded from the analysis. Primary outcome measures were technical success and symptoms-free interval. Secondary outcome measures included clinically driven target-lesion reintervention (TLR)-free survival, primary patency, and complication rates. RESULTS Of 29 limb occlusions, 11 limbs (11 patients; 100% male; mean age: 71.6 ± 6.9 years) were treated percutaneously and were included in the study. The majority suffered from IC (10/11; 90.9%) with a single case of rest pain. Technical success was obtained in 10 patients (90%). No major complications occurred. Mean follow-up time was 37.6 ± 25.7 months. Stent grafts were mainly used, while and in 2 cases (18.18%), only nitinol bare stents were deployed. According to Kaplan-Meier analysis, both symptoms-free interval and primary patency were 83.33% in up to 5 years follow-up. TLR-free survival was 100% at 5 years, as 2 cases of claudication relapse were managed conservatively. CONCLUSIONS Percutaneous stenting for the management chronic ischemia due to EVAR limb occlusion is feasible and safe, with satisfactory long-term outcomes. Careful patient selection warrants clinical success.
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Affiliation(s)
- Stavros Spiliopoulos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
| | - Konstantinos Moulakakis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Chrysostomos Konstantos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Lazaros Reppas
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioannis Kakisis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, ESVS Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019; 57:8-93. [DOI: 10.1016/j.ejvs.2018.09.020] [Citation(s) in RCA: 873] [Impact Index Per Article: 174.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rödel SGJ, Zeebregts CJ, Meerwaldt R, van der Palen J, Geelkerken RH. Incidence and Treatment of Limb Occlusion of the Anaconda Endograft After Endovascular Aneurysm Repair. J Endovasc Ther 2018; 26:113-120. [DOI: 10.1177/1526602818821193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the incidence and treatment of limb occlusions of the second- and third-generation Anaconda endografts. Methods: A single-center retrospective study was conducted involving 317 consecutive patients (mean age 76 years; 289 men) who underwent endovascular aneurysm repair for elective asymptomatic, symptomatic intact, and ruptured infrarenal abdominal aortic aneurysm with 2 versions of the Anaconda device. From September 2003 to July 2011, the second-generation device was used in 189 patients (mean age 77 years; 169 men) and from July 2011 to September 2015, the third-generation device was implanted in 128 patients (mean age 75 years; 120 men). The rates of limb occlusion were compared between groups and according to compliance with the instructions for use (IFU); predictors were sought in multivariate analysis. The results of the latter are given as the hazard ratio (HR) and 95% confidence interval (CI). Results: Kaplan-Meier freedom of occlusion estimates for second- and third-generation devices, respectively, was 96.6% and 95.0% at 1 year, 89.9% and 95.0% at 2 years, and 86.5% and 88.6% at 5 years. There was no significant difference in overall occlusion rate between the second-generation devices (p=0.332) or with regard to use within the IFU (p=0.827); however, there was a clinically relevant decrease in the occlusion rate for elective patients treated with the third-generation device (6.4% vs 13.1%, p=0.077). There was an increase in the occlusion rate when the iliac limb diameter was ≤13 mm. In multivariate analysis, the only independent predictor of limb occlusion was a small distal prosthesis diameter (HR 0.732, 95% CI 0.63 to 0.86, p<0.001). Symptomatic nonruptured and ruptured abdominal aortic aneurysm (AAA) interventions had an almost 2-fold increased risk of occlusion (HR 1.95, 95% CI 0.93 to 4.11, p=0.078), though this did not reach statistical significance. Conclusion: The Anaconda design has proven effectiveness in AAA exclusion in daily practice inside the IFU. However, efforts could be made to further reduce the limb occlusion rate.
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Affiliation(s)
| | - Clark J. Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Robert Meerwaldt
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
| | - Job van der Palen
- Department of Epidemiology and Statistics, Medisch Spectrum Twente, Enschede, the Netherlands
- Department of Epidemiology and Statistics, University of Twente, Enschede, the Netherlands
| | - Robert H. Geelkerken
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
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Takeuchi Y, Morikage N, Mizoguchi T, Nagase T, Samura M, Ueda K, Suehiro K, Hamano K. Using bifurcated endoprosthesis after iliac artery recanalization for concomitant abdominal aortic aneurysm and chronic total occlusions of access routes. J Vasc Surg 2018; 70:117-122. [PMID: 30553731 DOI: 10.1016/j.jvs.2018.08.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Concurrent abdominal aortic aneurysm (AAA) and unilateral iliac occlusion is a challenge in the implantation of bifurcated stent grafts (BFGs). The endovascular approach is less invasive than open surgery; the aortouni-iliac (AUI) graft with crossover femorofemoral bypass (CFFB) has many problems associated with extra-anatomic reconstruction. We attempted endovascular aneurysm repair (EVAR) using BFGs in such cases and evaluated the outcomes. METHODS This was a retrospective study. Between October 2012 and December 2017, there were 649 patients who underwent surgery for AAA, of whom 32 patients underwent open reconstruction and 617 patients underwent endovascular aneurysm repair; 15 patients with unilateral occluded iliac arteries and AAA were included. The analysis included patients with unilateral iliac chronic total occlusion (CTO). The intraoperative, postoperative, and follow-up variables were reviewed. RESULTS The occluded lesions were the common iliac artery in 5 patients, the common iliac artery-external iliac artery (EIA) in 2 patients, the EIA in 7 patients, and the EIA-common femoral artery in 1 patient. The mean occlusive length was 89.7 ± 43.6 mm, and the mean AAA size was 54.6 ± 5.6 mm. Technical success was achieved in 13 patients (87%). All patients underwent recanalization through the true lumen and stent placement. The only procedure-related complication was distal embolism, which was treated with intraoperative thrombectomy. Recanalization of CTO lesions was not possible in two patients (13%), who underwent AUI graft placement with CFFB. The 30-day mortality and morbidity rates were 0%. The mean follow-up periods were 12 and 32 months for patients who underwent BFG placement and AUI graft placement with CFFB, respectively. During follow-up, the primary patency rate of successfully recanalized arteries was 100%. Aneurysm size decreased in four patients who underwent BFG placement; no change was seen in the other 11 patients. Freedom from aneurysm-related events was 100%; no patient needed secondary interventions. All patients with claudication pain preoperatively reported improvement in their symptoms during follow-up. In addition, the ankle-brachial index improved significantly from 0.51 ± 0.25 preoperatively to 0.88 ± 0.20 postoperatively (P < .001) in patients who underwent BFG placement. CONCLUSIONS Recanalization of unilateral iliac CTO lesions and placement of BFG in cases with concomitant aneurysmal disease and unilateral iliac occlusive disease demonstrated a significant primary patency rate with improvements in claudication and ankle-brachial index.
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Affiliation(s)
- Yuriko Takeuchi
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Noriyasu Morikage
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Takahiro Mizoguchi
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Nagase
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Makoto Samura
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Koshiro Ueda
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kotaro Suehiro
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kimikazu Hamano
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Meta-analysis and meta-regression analysis of iliac limb occlusion after endovascular aneurysm repair. J Vasc Surg 2018; 68:1916-1924.e7. [DOI: 10.1016/j.jvs.2018.08.153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/07/2018] [Indexed: 11/20/2022]
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Hemmler A, Lutz B, Reeps C, Kalender G, Gee MW. A methodology for in silico endovascular repair of abdominal aortic aneurysms. Biomech Model Mechanobiol 2018; 17:1139-1164. [PMID: 29752606 DOI: 10.1007/s10237-018-1020-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
Endovascular aneurysm repair (EVAR) can involve some unfavorable complications such as endoleaks or stent-graft (SG) migration. Such complications, resulting from the complex mechanical interaction of vascular tissue, SG and blood flow or incompatibility of SG design and vessel geometry, are difficult to predict. Computational vascular mechanics models can be a predictive tool for the selection, sizing and placement process of SGs depending on the patient-specific vessel geometry and hence reduce the risk of potential complications after EVAR. In this contribution, we present a new in silico EVAR methodology to predict the final state of the deployed SG after intervention and evaluate the mechanical state of vessel and SG, such as contact forces and wall stresses. A novel method to account for residual strains and stresses in SGs, resulting from the precompression of stents during the assembly process of SGs, is presented. We suggest a parameter continuation approach to model various different sizes of SGs within one in silico EVAR simulation which can be a valuable tool when investigating the issue of SG oversizing. The applicability and robustness of the proposed methods are demonstrated on the example of a synthetic abdominal aortic aneurysm geometry.
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Affiliation(s)
- André Hemmler
- Mechanics and High Performance Computing Group, Technische Universität München, Parkring 35, 85748, Garching b. München, Germany
| | - Brigitta Lutz
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Reeps
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Günay Kalender
- Klinik für vaskuläre und endovaskuläre Chirurgie, DRK Kliniken Berlin, Salvador-Allende-Straße 2-8, 12559, Berlin, Germany
| | - Michael W Gee
- Mechanics and High Performance Computing Group, Technische Universität München, Parkring 35, 85748, Garching b. München, Germany.
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Truong C, Kugler NW, Rossi PJ, Patel PJ, Hieb RA, Brown KR, Lewis BD, Seabrook G, Lee CJ. Sex-dependent outcomes following elective endovascular aortic repair. J Surg Res 2018; 229:177-185. [PMID: 29936987 DOI: 10.1016/j.jss.2018.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/01/2018] [Accepted: 03/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence has shown that women derive less benefit from endovascular aortic repair (EVAR) in large part due to more challenging aortoiliac anatomy. This study sought to examine whether sex-dependent outcomes exist following elective EVAR cases. METHODS An institutional retrospective review was performed on patients who underwent elective EVAR procedures between 2008 and 2014. Outcome data collected included procedural and hospital morbidity, mortality, and overall EVAR durability based on the incidence of unplanned graft-related secondary interventions (SIs) (e.g., open conversion, proximal or distal extensions, and coil embolizations). RESULTS One hundred eighty-one patients (150 men, 31 women) met the study inclusion criteria. Median follow-up was 40.3 mo. Women had more challenging anatomy compared to men including smaller overall iliac diameters (6.8 mm versus 8.0 mm, P < 0.001) and more severe iliac angulation (77% moderate to severe versus 44%, P < 0.001). Women had increased risk of postoperative complications compared to men (41.9% versus 11.3%, P = 0.003). There was no perioperative mortality in our series of elective EVAR cases. Median 5-y survival following EVAR was 64.4% for men and 76.3% for women (P = 0.599). Late SI rates following EVAR was 10.5% with 16 (10.7%) men and 3 (9.7%) women needing interventions (P = 0.870). Overall durability of EVAR extrapolated as time to SIs was 91% at 2 y and 85% at 5 y. Factors predisposing SIs were iliac tortuosity (P = 0.046), aortic neck angle (P = 0.022), and endoleak at the follow-up (P = 0.030). CONCLUSIONS In this study, immediate outcomes following EVAR were different between men and women, with women having increased rates of postoperative complications. Mortality and overall long-term durability of EVAR, however, were the same between sexes despite anatomical differences. EVAR durability was significantly dependent on the severity of iliac tortuosity, aortic neck angulation, and presence of endoleak at the follow-up.
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Affiliation(s)
- Connie Truong
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathan W Kugler
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter J Rossi
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parag J Patel
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert A Hieb
- Division of Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kellie R Brown
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D Lewis
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gary Seabrook
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cheong J Lee
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Characterization and outcomes of reinterventions in Food and Drug Administration-approved versus trial endovascular aneurysm repair devices. J Vasc Surg 2018; 67:1082-1090. [DOI: 10.1016/j.jvs.2017.08.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022]
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63
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Hofmann M, Pecoraro F, Planer D, Pfammatter T, Puippe G, Bettex D, Veith FJ, Lachat M, Chaykovska L. Early outcomes with a single-sided access endovascular stent. J Vasc Surg 2018; 68:83-90.e2. [PMID: 29602473 DOI: 10.1016/j.jvs.2017.11.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to report the 1-year follow-up study results of the new Horizon stent graft (Endospan, Herzliya, Israel) from two different prospective consecutive trials. The Horizon abdominal aortic aneurysm stent graft system is a 14F profile system requiring only a single access site. It consists of three modules, introduced separately: base limb (iliac to iliac limb); distal aortic limb; and proximal aortic limb with a bare suprarenal crown and active fixation. METHODS Data from the first in man (FIM) clinical study with 10 patients enrolled and the pivotal study with 30 patients were analyzed. Outcomes measured were freedom from major adverse events (MAEs) including all-cause mortality, myocardial infarction, renal failure, respiratory failure, paraplegia, stroke, bowel ischemia, and procedural blood loss ≥1000 mL. Performance end points included successful delivery and deployment of the device, freedom from aneurysm growth ≥5 mm, type I or type III endoleak, stent graft occlusion, conversion to open surgery, rupture, and stent graft migration. RESULTS In the FIM study, one conversion to open surgery with >1000 mL of blood loss was registered perioperatively. In the pivotal study, no perioperative MAE was registered. Overall, at 1-year follow-up, two deaths and one aneurysm growth unrelated to endoleak were registered. CONCLUSIONS The results of both the FIM and pivotal studies demonstrated that 39 of 40 procedures were successful for delivery and deployment of the Horizon stent graft. No MAE was registered during the follow-up. The primary safety and performance end points were met in both studies.
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Affiliation(s)
- Michael Hofmann
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland
| | - Felice Pecoraro
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland; Vascular Surgery Unit, AOUP "P. Giaccone", University of Palermo, Palermo, Italy.
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
| | - Thomas Pfammatter
- Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Gilbert Puippe
- Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank J Veith
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland; New York University Medical Center, New York, NY
| | - Mario Lachat
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland
| | - Lyubov Chaykovska
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland
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Schoretsanitis N, Argyriou C, Nikova AS, Valsamidou CD, Georgakarakos EI, Lazarides MK, Georgiadis GS. Positional Changes of an Endurant Endograft Leading to Simultaneous Ipsilateral Iliac Limb Obstruction and Contralateral Type IIIa Endoleak. Ann Vasc Surg 2018; 48:252.e9-252.e14. [PMID: 29421417 DOI: 10.1016/j.avsg.2017.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022]
Abstract
We report the case of a 79-year-old man who was admitted to our department with acute limb ischemia due to the occlusion of the left iliac limb of an Endurant endograft. The admission computed tomography angiography revealed also a type IIIa endoleak due to modular disconnection of the iliac extensions from the right iliac limb of the endograft main body. Interestingly, during the 4-year post-endovascular aneurysm repair period, an increased kinking of the right limb has been observed leading to an almost cross-limb configuration of the limbs at the time of complications. To our knowledge, this is the first case in the literature of the simultaneous presence of limb thrombosis and late type IIIa endoleak with this particular device. The ischemia was treated with a femoro-femoral cross-over bypass, and the endoleak was corrected with the position of 2 Endurant iliac limb extensions bridging the dislocated endograft pieces.
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Affiliation(s)
- Nikolaos Schoretsanitis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Alexandrina S Nikova
- Faculty of Medicine, School of Health Sciences, "Democritus" University of Thrace, Alexandroupolis, Greece
| | - Christina D Valsamidou
- Faculty of Medicine, School of Health Sciences, "Democritus" University of Thrace, Alexandroupolis, Greece
| | - Efstratios I Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece.
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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66
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Moulakakis KG, Antonopoulos CN, Klonaris C, Kakisis J, Lazaris AM, Sfyroeras GS, Mantas G, Mylonas SN, Vasdekis SN, Brountzos EN, Geroulakos G. Bilateral Endograft Limb Occlusion after Endovascular Aortic Repair: Predictive Factors of Occurrence. Ann Vasc Surg 2018; 46:299-306. [DOI: 10.1016/j.avsg.2017.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/12/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
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67
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Endovascular treatment of abdominal aortic aneurysms with narrow aortic bifurcation using Excluder bifurcated stent grafts. J Vasc Surg 2018; 67:113-118. [DOI: 10.1016/j.jvs.2017.04.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/30/2017] [Indexed: 11/22/2022]
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68
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Behrendt CA, Dayama A, Debus ES, Heidemann F, Matolo NM, Kölbel T, Tsilimparis N. Lower Extremity Ischemia after Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2017; 45:206-212. [DOI: 10.1016/j.avsg.2017.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/06/2017] [Accepted: 05/29/2017] [Indexed: 11/28/2022]
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69
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Sirignano P, Capoccia L, Pranteda C, Montelione N, Mansour W, d’Adamo A, Formiconi M, Speziale F. Aortic Bifurcation Morphology Alone is Not Able to Predict Outcome in Patients Submitted to Elective Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2017; 41:218-224. [DOI: 10.1007/s00270-017-1831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/25/2017] [Indexed: 12/01/2022]
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Bargay Juan P, Plaza Martínez Á, Ramírez Montoya M, Sala Almonacil V, Molina Nácher V, Gómez Palonés F. Factores de riesgo de la trombosis de rama en el tratamiento endovascular aórtico infrarrenal: nuestra experiencia. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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A new approach for the pre-clinical optimization of a spatial configuration of bifurcated endovascular prosthesis placed in abdominal aortic aneurysms. PLoS One 2017; 12:e0182717. [PMID: 28793343 PMCID: PMC5549977 DOI: 10.1371/journal.pone.0182717] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 07/24/2017] [Indexed: 11/19/2022] Open
Abstract
Complexity of the spatial configuration of an aortic implant with bifurcation in the distal part is related to changes in blood hemodynamic in the area of bifurcation which may disturb blood flow and lead to thrombus formation. This study was designed to characterize parameters which define spatial configuration of an aortic implant for which the risk of thrombus formation is the smallest. We used AngioCT data from 74 patients, aged 55 ±10 years, after endovascular procedure to prepare 3D geometries of stent-grafts. Computational Fluid Dynamics (CFD) simulations were used to reconstruct blood hemodynamic and simulate thrombus formation. Next, geometric parameters of stent-grafts included the ratio of volume of upper part to the bifurcations, the relation of inlet and outlet diameters of a stent-graft and deformations in the iliac part of the stent-graft were analyzed. We also analyzed tortuosities (spiral twisting of the flow around the flow direction) and bends (the largest angulation in distal part of a stent-graft). The CFD results were confronted with AngioCT data to verify if computer generated thrombus appeared in particular patient. Additionally, geometric parameters of analyzed stent-grafts were used to propose a mathematical tool for prediction of thrombus appearance. The results showed that tortuosities and bends of a stent-graft had the highest impact on thrombus formation. Formation of thrombi was observed in 22% to 31% of cases (at blood hematocrit Hct = 40%) even for small values of tortuosities and bends indicating that these parameters are dominant in determining blood clotting. Our calculated results overlapped with clinical data in 80% to 91%. Therefore, we conclude that tortuosities and bends have high impact on thrombus formation and should be under special attention during stent-graft recommendation and patients’ follow-ups.
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Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort. Exp Ther Med 2017; 14:1763-1768. [PMID: 28810647 DOI: 10.3892/etm.2017.4658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR. A total of 61 bifurcated grafts and 5 aortauniilac grafts (127 limbs in total) were used. Physical examination, ankle-brachial-index and computer tomographic angiography were performed at 10 days, at 3, 6 and 12 months and annually thereafter. It was found that 7 limbs in 7 patients (10.6% of patients, 5.5% of limbs) were occluded between 20 days and 12 months (average, 7.8±5.3 months) after EVAR. Acute and severe ischemia was found in 2 cases, claudication was in found 3 cases, asthenia in both legs was found in 1 case and 1 case was asymptomatic. Femoral-femoral bypass, femoral-femoral bypass and stenting, aorto-iliac/femoral bypass, thrombectomy and conservative treatment were performed in 1 patient each and thrombectomy together with stenting was performed in 2 cases. Limb graft occlusion was not rare after EVAR. Treatment of this complication included surgery and endovascular therapy such as bypass, thrombectomy and thrombolysis. In conclusion, aggressive pre-emptive treatment including angioplasty and stenting prevented occlusion in certain cases.
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73
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Boersen JT, Groot Jebbink E, Versluis M, Slump CH, Ku DN, de Vries JPPM, Reijnen MMPJ. Flow and wall shear stress characterization after endovascular aneurysm repair and endovascular aneurysm sealing in an infrarenal aneurysm model. J Vasc Surg 2017; 66:1844-1853. [PMID: 28285931 DOI: 10.1016/j.jvs.2016.10.077] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/10/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) with a modular endograft has become the preferred treatment for abdominal aortic aneurysms. A novel concept is endovascular aneurysm sealing (EVAS), consisting of dual endoframes surrounded by polymer-filled endobags. This dual-lumen configuration is different from a bifurcation with a tapered trajectory of the flow lumen into the two limbs and may induce unfavorable flow conditions. These include low and oscillatory wall shear stress (WSS), linked to atherosclerosis, and high shear rates that may result in thrombosis. An in vitro study was performed to assess the impact of EVAR and EVAS on flow patterns and WSS. METHODS Four abdominal aortic aneurysm phantoms were constructed, including three stented models, to study the influence of the flow divider on flow (Endurant [Medtronic, Minneapolis, Minn], AFX [Endologix, Irvine, Calif], and Nellix [Endologix]). Experimental models were tested under physiologic resting conditions, and flow was visualized with laser particle imaging velocimetry, quantified by shear rate, WSS, and oscillatory shear index (OSI) in the suprarenal aorta, renal artery (RA), and common iliac artery. RESULTS WSS and OSI were comparable for all models in the suprarenal aorta. The RA flow profile in the EVAR models was comparable to the control, but a region of lower WSS was observed on the caudal wall compared with the control. The EVAS model showed a stronger jet flow with a higher shear rate in some regions compared with the other models. Small regions of low WSS and high OSI were found near the distal end of all stents in the common iliac artery compared with the control. Maximum shear rates in each region of interest were well below the pathologic threshold for acute thrombosis. CONCLUSIONS The different stent designs do not influence suprarenal flow. Lower WSS is observed in the caudal wall of the RA after EVAR and a higher shear rate after EVAS. All stented models have a small region of low WSS and high OSI near the distal outflow of the stents.
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Affiliation(s)
- Johannes T Boersen
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Physics of Fluids, Faculty of Science and Technology, Technical University of Twente, Enschede, The Netherlands.
| | - Erik Groot Jebbink
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Department of Physics of Fluids, Faculty of Science and Technology, Technical University of Twente, Enschede, The Netherlands
| | - Michel Versluis
- Department of Physics of Fluids, Faculty of Science and Technology, Technical University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - David N Ku
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Ga
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Majka M, Gadda G, Taibi A, Gałązka M, Zieliński P. Earliest effects of sudden occlusions on pressure profiles in selected locations of the human systemic arterial system. Phys Rev E 2017; 95:032414. [PMID: 28415274 DOI: 10.1103/physreve.95.032414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Indexed: 06/07/2023]
Abstract
We have developed a numerical simulation method for predicting the time dependence (wave form) of pressure at any location in the systemic arterial system in humans. The method uses the matlab-Simulink environment. The input data include explicitly the geometry of the arterial tree, treated up to an arbitrary bifurcation level, and the elastic properties of arteries as well as rheological parameters of blood. Thus, the impact of anatomic details of an individual subject can be studied. The method is applied here to reveal the earliest stages of mechanical reaction of the pressure profiles to sudden local blockages (thromboses or embolisms) of selected arteries. The results obtained with a purely passive model provide reference data indispensable for studies of longer-term effects due to neural and humoral mechanisms. The reliability of the results has been checked by comparison of two available sets of anatomic, elastic, and rheological data involving (i) 55 and (ii) 138 arterial segments. The remaining arteries have been replaced with the appropriate resistive elements. Both models are efficient in predicting an overall shift of pressure, whereas the accuracy of the 55-segment model in reproducing the detailed wave forms and stabilization times turns out dependent on the location of the blockage and the observation point.
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Affiliation(s)
- Marcin Majka
- Institute of Nuclear Physics Polish Academy of Sciences, ulica Radzikowskiego 152, PL-31342 Cracow, Poland
- University of Ferrara, Department of Physics and Earth Sciences, Via Saragat 1, 44122 Ferrara, Italy
| | - Giacomo Gadda
- University of Ferrara, Department of Physics and Earth Sciences, Via Saragat 1, 44122 Ferrara, Italy
| | - Angelo Taibi
- University of Ferrara, Department of Physics and Earth Sciences, Via Saragat 1, 44122 Ferrara, Italy
| | - Mirosław Gałązka
- Institute of Nuclear Physics Polish Academy of Sciences, ulica Radzikowskiego 152, PL-31342 Cracow, Poland
| | - Piotr Zieliński
- Institute of Nuclear Physics Polish Academy of Sciences, ulica Radzikowskiego 152, PL-31342 Cracow, Poland
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Kadoya Y, Kenzaka T, Naito D. Extensive ischemic ulcers due to limb occlusion after endovascular aneurysm repair: a case report. SPRINGERPLUS 2016; 5:782. [PMID: 27386268 PMCID: PMC4912498 DOI: 10.1186/s40064-016-2345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/13/2016] [Indexed: 11/10/2022]
Abstract
Introduction Limb occlusion after endovascular aneurysm repair (EVAR) is a well-known complication. However, extensive ischemic ulcers due to limb occlusion are extremely rare. Case description We report a rare case of extensive ischemic ulcers that developed seven months after EVAR in an 85-year-old Japanese man. He had been taking appropriate anticoagulant therapy because of paroxysmal atrial fibrillation. Angiography showed a left limb occlusion and superficial femoral artery (SFA) chronic total occlusion (CTO), and intravascular ultrasound showed limb kinking. Endovascular therapy (EVT) was performed, and stent placement was used to cover a large amount of thrombi and correct the limb kinking, leading to complete recovery of left limb blood flow. After additional EVT was performed for the SFA CTO, outflow improved and the ulcers healed completely. Discussion and evaluation It seemed that the combination of poor inflow and poor outflow led to limb thrombosis. Conclusions Here, we describe an extremely rare case of extensive ischemic ulcers due to limb occlusion after EVAR. Patients should undergo careful follow-up after EVAR to monitor blood flow to the lower extremities. Additionally, the early detection and correction of limb kinking and poor outflow are essential to prevent the development of ischemic ulcers.
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Georgakarakos E, Georgiadis GS, Argyriou C, Schoretsanitis N, Antoniou GA, Lazarides MK. Preliminary Single-Center Experience with the Bolton Treovance Endograft in the Treatment of Abdominal Aortic Aneurysms. Ann Vasc Surg 2016; 34:68-74. [DOI: 10.1016/j.avsg.2015.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 09/29/2015] [Accepted: 12/06/2015] [Indexed: 11/28/2022]
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Endovascular repair of abdominal aortic aneurysms. Best Pract Res Clin Anaesthesiol 2016; 30:331-40. [PMID: 27650343 DOI: 10.1016/j.bpa.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/10/2016] [Indexed: 12/17/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms is an important technique in the vascular surgeon's armamentarium, which has created a seismic shift in the management of aortic pathology over the past two decades. In comparison to traditional open repair, the endovascular approach is associated with significantly improved perioperative morbidity and mortality. The early survival benefit of endovascular abdominal aortic aneurysm repair is sustained up to 3 years postoperatively, but longer-term life expectancy remains poor regardless of operative modality. Nonetheless, most abdominal aortic aneurysms are now repaired using endovascular stent grafts. The technology is not perfect as several postoperative complications, namely endoleak, stent-graft migration, and graft limb thrombosis, can develop and therefore lifelong imaging surveillance is required. In addition, a postoperative inflammatory response has been documented after endovascular repair of aortic aneurysms; the clinical significance of this finding has yet to be determined. Subsequently, the safety and applicability of endovascular stent grafts are likely to improve and expand with the introduction of newer-generation devices and with the simplification of fenestrated systems.
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Perrin D, Badel P, Orgeas L, Geindreau C, du Roscoat SR, Albertini JN, Avril S. Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts. J Mech Behav Biomed Mater 2016; 63:86-99. [PMID: 27344232 DOI: 10.1016/j.jmbbm.2016.06.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/10/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
Abstract
The rate of post-operative complications is the main drawback of endovascular repair, a technique used to treat abdominal aortic aneurysms. Complex anatomies, featuring short aortic necks and high vessel tortuosity for instance, have been proved likely prone to these complications. In this context, practitioners could benefit, at the preoperative planning stage, from a tool able to predict the post-operative position of the stent-graft, to validate their stent-graft sizing and anticipate potential complications. In consequence, the aim of this work is to prove the ability of a numerical simulation methodology to reproduce accurately the shapes of stent-grafts, with a challenging design, deployed inside tortuous aortic aneurysms. Stent-graft module samples were scanned by X-ray microtomography and subjected to mechanical tests to generate finite-element models. Two EVAR clinical cases were numerically reproduced by simulating stent-graft models deployment inside the tortuous arterial model generated from patient pre-operative scan. In the same manner, an in vitro stent-graft deployment in a rigid polymer phantom, generated by extracting the arterial geometry from the preoperative scan of a patient, was simulated to assess the influence of biomechanical environment unknowns in the in vivo case. Results were validated by comparing stent positions on simulations and post-operative scans. In all cases, simulation predicted stents deployed locations and shapes with an accuracy of a few millimetres. The good results obtained in the in vitro case validated the ability of the methodology to simulate stent-graft deployment in very tortuous arteries and led to think proper modelling of biomechanical environment could reduce the few local discrepancies found in the in vivo case. In conclusion, this study proved that our methodology can achieve accurate simulation of stent-graft deployed shape even in tortuous patient specific aortic aneurysms and may be potentially helpful to help practitioners plan their intervention.
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Affiliation(s)
- David Perrin
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France
| | - Pierre Badel
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France
| | - Laurent Orgeas
- CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France
| | - Christian Geindreau
- CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France
| | | | - Jean-Noël Albertini
- INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France; CHU Hôpital Nord Saint-Etienne, Department of CardioVascular Surgery, Saint-Etienne F-42055, France
| | - Stéphane Avril
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France.
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Mousa AY, Bozzay J, Broce M, Yacoub M, Stone PA, Najundappa A, Bates MC, AbuRahma AF. Novel Risk Score Model for Prediction of Survival Following Elective Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2016; 50:261-9. [PMID: 27114446 DOI: 10.1177/1538574416638760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to identify significant predictors of long-term mortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS We included all cases with elective EVAR based on a national data set from the Society for Vascular Surgery Patient Safety Organization. Clinical and anatomic variables were analyzed with a Kaplan-Meier and Cox-regression model to determine predictors of mortality and develop a score equation to categorize patients into low, medium, and high long-term mortality risk. RESULTS A total of 5678 patients with EVAR were included with an average age of 73.6 ± 8.2 years. The majority were male (81.6%) with a history of smoking (86.1%). There were 3 deaths within 30 days (0.1%). Several factors were associated with poor survival: unstable angina (hazard ratio [HR], 2.8; P = .008), dialysis (HR, 3.7; P < .001), estimated glomerular filtration rate (eGFR) <30 (HR, 1.7; P = .044), eGFR 30 to 59 (HR, 1.4; P = .002), age >80 (HR, 3.2; P < .001), age 75 to 79 (HR, 2.2; P < .001), chronic obstructive pulmonary disease on oxygen (HR, 3.3; P < .001), aortic diameter >5.8 cm (HR, 1.2; P = .043), and high risk for surgery (HR, 1.4; P = .043). Preoperative aspirin use and body mass index 25 to 35 were both found to be protective (HR, 0.78; P = .017 and HR, 0.8; P = .024, respectively). With our scoring model, 5- and 10-year survival rates for patients with low, medium, and high risk were 89.2%, 80.7%, and 64.1% and 77.2%, 60.1%, and 40.1%, respectively (P < .001). CONCLUSION Ten-year survival following EVAR in patients with a high-risk score utilizing the model provided was 40.1%. Patients with multiple comorbidities at risk for decreased long-term survival can be identified with our model, which is more applicable for high-volume contemporary institutions.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Joseph Bozzay
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Mike Broce
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Michael Yacoub
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Patrick A Stone
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Aravinda Najundappa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Mark C Bates
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
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Jawad N, Parker P, Lakshminarayan R. The role of contrast-enhanced ultrasound imaging in the follow-up of patients post-endovascular aneurysm repair. ULTRASOUND (LEEDS, ENGLAND) 2016; 24:50-9. [PMID: 27433275 PMCID: PMC4760610 DOI: 10.1177/1742271x15627303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/22/2015] [Indexed: 11/16/2022]
Abstract
Endovascular aneurysm repair is a minimally invasive technique for the treatment of abdominal aortic aneurysms. Patients who undergo endovascular aneurysm repair are potentially at risk of developing problems related to the graft such as the development of endoleaks. Endoleaks can cause expansion of the aneurysmal sac, which can potentially lead to rupture. It is for this reason that lifelong surveillance of patients is required to assess the graft and the aneurysmal sac. This article discusses the role of contrast-enhanced ultrasound in the follow-up of patients post-endovascular aneurysm repair. Contrast-enhanced ultrasound is rapidly becoming a powerful, accurate and cost-effective tool to complement computed tomography in the follow-up of endovascular aneurysm repair patients. Real-time imaging of contrast filling into the arterial system means that contrast-enhanced ultrasound is an excellent problem-solving tool, particularly when assessing for the type and anatomy of endoleaks. In some instances, contrast-enhanced ultrasound can detect endoleaks when other modalities are equivocal.
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81
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Chung C, Fremed D, Han D, Faries P, Marin M. Update on the use of abdominal and thoracic endografts for treating aortic aneurysms. Expert Rev Med Devices 2016; 13:287-95. [PMID: 26814185 DOI: 10.1586/17434440.2016.1143357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular abdominal and thoracic aneurysm repair has heralded a paradigm shift in the management of abdominal and thoracic aortic aneurysms. Randomized controlled trials have suggested superior short-term and equivalent long-term outcomes of endovascular repair compared with open surgery. Existing endografts have undergone several modifications to meet anatomic challenges and improve patient results. In the past, endovascular repair has been limited to infrarenal abdominal aortic aneurysms and isolated thoracic aortic aneurysms. The advent of fenestrated and branched endografts have made endovascular repair of thoracoabdominal and juxtarenal aneurysms possible. Continued evolution of endograft technology will maximize the benefit and minimize complications in patients with a range of aneurysmal disease.
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Affiliation(s)
- Christine Chung
- a Department of Surgery, Division of Vascular Surgery , Mount Sinai Hospital , New York , NY , USA
| | - Daniel Fremed
- a Department of Surgery, Division of Vascular Surgery , Mount Sinai Hospital , New York , NY , USA
| | - Daniel Han
- a Department of Surgery, Division of Vascular Surgery , Mount Sinai Hospital , New York , NY , USA
| | - Peter Faries
- a Department of Surgery, Division of Vascular Surgery , Mount Sinai Hospital , New York , NY , USA
| | - Michael Marin
- a Department of Surgery, Division of Vascular Surgery , Mount Sinai Hospital , New York , NY , USA
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82
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Tatli E, Tokatli A, Vatan MB, Aksoy M, Can Y, Pabuccu MT, Agac MT. Percutaneous approach to the treatment of a totally occluded abdominal aortic stent graft. Perfusion 2016; 31:521-4. [PMID: 26747686 DOI: 10.1177/0267659115625437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aorto femoral bypass is usually the recommended therapy for diffuse disease involving the aorta and iliac arteries. In this case report, a case involving a chronic endovascular abdominal aortic stent graft occlusion in which percutaneous angioplasty was performed via a transbrachial and transfemoral approach is presented. This case emphasized that occlusion of an endovascular abdominal aortic stent graft can also be treated, primarily, with an endovascular technique.
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Affiliation(s)
- Ersan Tatli
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Alptug Tokatli
- Department of Cardiology, Golcuk Military Hospital, Kocaeli, Turkey
| | - M Bulent Vatan
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Murat Aksoy
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Yusuf Can
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - M Turker Pabuccu
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - M Tarik Agac
- Department of Cardiology, Sakarya University School of Medicine, Sakarya, Turkey
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83
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Shirasugi T, Kimura N, Yuri K, Nomura Y, Yamaguchi A, Adachi H, Morita H. Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass. Ann Vasc Dis 2016; 8:314-7. [PMID: 26730257 DOI: 10.3400/avd.cr.15-00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/28/2015] [Indexed: 11/13/2022] Open
Abstract
We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.
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Affiliation(s)
- Takehiro Shirasugi
- Department of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Yohei Nomura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideki Morita
- Department of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan
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84
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Strajina V, Oderich GS, Fatima J, Gloviczki P, Duncan AA, Kalra M, Fleming M, Macedo TA. Endovascular aortic aneurysm repair in patients with narrow aortas using bifurcated stent grafts is safe and effective. J Vasc Surg 2015; 62:1140-7.e1. [DOI: 10.1016/j.jvs.2015.07.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
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85
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Vinha AJ, Sampaio S. Correção de aneurisma por via endovascular: fatores de risco para oclusão de ramo. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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86
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Oliveira N, Hoeks S, Ten Raa S, Ultee K, Rouwet E, Hendriks J, Verhagen H, Bastos Gonçalves F. Trombo intraprotésico após tratamento endovascular de aneurismas da aorta. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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87
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Oliveira NF, Bastos Gonçalves FM, Hoeks SE, Ten Raa S, Ultee KH, Rouwet E, Hendriks JM, Verhagen HJ. Clinical outcome and morphologic determinants of mural thrombus in abdominal aortic endografts. J Vasc Surg 2015; 61:1391-8. [DOI: 10.1016/j.jvs.2015.01.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/18/2015] [Indexed: 11/29/2022]
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88
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Georgakarakos E, Raptis A, Schoretsanitis N, Bisdas T, Beropoulis E, Georgiadis GS, Matsagkas M, Xenos M. Studying the Interaction of Stent-Grafts and Treated Abdominal Aortic Aneurysms. J Endovasc Ther 2015; 22:413-20. [DOI: 10.1177/1526602815583494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the advent of endovascular repair of aortic aneurysms (EVAR), clinical focus has been on preventing loss of sealing at the level of the infrarenal neck, which leads to type I endoleak and repressurization of the aneurysm sac. Enhanced mechanisms for central fixation and seal have consequently lowered the incidence of migration and endoleaks. However, endograft limb thrombosis and its causal mechanisms have not been addressed adequately in the literature. This article reviews the pathophysiological mechanisms associated with limb thrombosis in order to facilitate better clinical judgment to prevent iliac adverse effects.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anastasios Raptis
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic Münster, Münster, Germany
| | - Efthymios Beropoulis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic Münster, Münster, Germany
| | - George S. Georgiadis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Miltiadis Matsagkas
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Michalis Xenos
- Department of Mathematics, University of Ioannina, Ioannina, Greece
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89
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Perrin D, Badel P, Orgéas L, Geindreau C, Dumenil A, Albertini JN, Avril S. Patient-specific numerical simulation of stent-graft deployment: Validation on three clinical cases. J Biomech 2015; 48:1868-75. [PMID: 25979382 DOI: 10.1016/j.jbiomech.2015.04.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/25/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms faces some adverse outcomes, such as kinks or endoleaks related to incomplete stent apposition, which are difficult to predict and which restrain its use although it is less invasive than open surgery. Finite element simulations could help to predict and anticipate possible complications biomechanically induced, thus enhancing practitioners' stent-graft sizing and surgery planning, and giving indications on patient eligibility to endovascular repair. The purpose of this work is therefore to develop a new numerical methodology to predict stent-graft final deployed shapes after surgery. The simulation process was applied on three clinical cases, using preoperative scans to generate patient-specific vessel models. The marketed devices deployed during the surgery, consisting of a main body and one or more iliac limbs or extensions, were modeled and their deployment inside the corresponding patient aneurysm was simulated. The numerical results were compared to the actual deployed geometry of the stent-grafts after surgery that was extracted from postoperative scans. We observed relevant matching between simulated and actual deployed stent-graft geometries, especially for proximal and distal stents outside the aneurysm sac which are particularly important for practitioners. Stent locations along the vessel centerlines in the three simulations were always within a few millimeters to actual stents locations. This good agreement between numerical results and clinical cases makes finite element simulation very promising for preoperative planning of endovascular repair.
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Affiliation(s)
- David Perrin
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, CNRS: UMR5307, LGF, F-42023 Saint-Etienne, France; CNRS, 3SR Lab, F-38000 Grenoble, France; Université Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France
| | - Pierre Badel
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, CNRS: UMR5307, LGF, F-42023 Saint-Etienne, France
| | - Laurent Orgéas
- CNRS, 3SR Lab, F-38000 Grenoble, France; Université Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France
| | - Christian Geindreau
- CNRS, 3SR Lab, F-38000 Grenoble, France; Université Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France
| | - Aurélien Dumenil
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France; Therenva, F-35000 Rennes, France
| | - Jean-Noël Albertini
- CHU Hôpital Nord Saint-Etienne, Department of CardioVascular Surgery, Saint-Etienne F-42055, France; Université Jean Monnet, GRT EA 3065, Saint-Etienne F-42023, France
| | - Stéphane Avril
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, CNRS: UMR5307, LGF, F-42023 Saint-Etienne, France.
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90
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Predictive factors for limb occlusions after endovascular aneurysm repair. J Vasc Surg 2015; 61:1138-45.e2. [DOI: 10.1016/j.jvs.2014.11.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/15/2014] [Indexed: 11/19/2022]
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91
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Trellopoulos G, Georgakarakos E, Pelekas D, Papachristodoulou A, Kalaitzi A, Asteri T. Initial single-center experience with the Ovation stent-graft system in the treatment of abdominal aortic aneurysms: application to challenging iliac access anatomies. Ann Vasc Surg 2015; 29:913-9. [PMID: 25728329 DOI: 10.1016/j.avsg.2014.11.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/11/2014] [Accepted: 11/29/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND To present our preliminary results with the Ovation(™) abdominal stent-graft system in abdominal aortic aneurysms (AAA) with narrow (≤7 mm) or angulated iliac vessels. METHODS From April 2012 to January 2014, 42 patients (97% men; mean age, 71 years; range, 55-89 years) with AAAs of 55.5 mm (50-79 mm) were treated with the Ovation device. Primary end points included technical success and freedom from early secondary interventions, any type of endoleak, and aneurysm-related death. Limb occlusion was studied with respect to iliac access diameter and angulation. Iliac angulation between 90° and 120° or <90° was considered moderate or severe, respectively. RESULTS The postoperative follow-up was 7.8 ± 4.6 months (mean ± standard deviation). Infrarenal neck angulation was 26° ± 26°. AAA neck length and diameter were 27.3 ± 10.5 and 24.1 ± 3.2 mm, respectively. Forty-five percent of patients had at least 1 vessel of ≤7-mm diameter, and almost half of patients (24 of 44) had at least 1 iliac artery of moderate or severe angulation. Technical and treatment success were 100% and 95%, respectively. No stent-graft migration or type I, III, or IV endoleaks occurred. Type II endoleaks were identified in 5 patients, leading to sac enlargement in 2 and necessitating an embolization attempt that was unsuccessful in 1 case. No limb occlusion occurred, irrespective of the iliac diameter or angulation. CONCLUSIONS Our 1-year results of the Ovation stent-graft system demonstrate excellent safety and effectiveness. The easy navigation through highly angulated and stenosed iliac vessels ensures high technical success in cases of challenging iliac anatomy. Follow-up is ongoing.
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Affiliation(s)
- George Trellopoulos
- First Surgical Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
| | - Dimitrios Pelekas
- First Surgical Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | | | - Anastasia Kalaitzi
- 2nd Intensive Care Unit, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - Theodora Asteri
- Department of Cardioanesthesiology, General Hospital "G. Papanikolaou", Thessaloniki, Greece
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92
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Ilyas S, Shaida N, Thakor A, Winterbottom A, Cousins C. Endovascular aneurysm repair (EVAR) follow-up imaging: the assessment and treatment of common postoperative complications. Clin Radiol 2015; 70:183-96. [DOI: 10.1016/j.crad.2014.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 09/04/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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93
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Mantas G, Antonopoulos C, Sfyroeras G, Moulakakis K, Kakisis J, Mylonas S, Liapis C. Factors Predisposing to Endograft Limb Occlusion after Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2015; 49:39-44. [DOI: 10.1016/j.ejvs.2014.09.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
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94
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Perrin D, Demanget N, Badel P, Avril S, Orgéas L, Geindreau C, Albertini JN. Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2015; 31:e02698. [PMID: 25399927 DOI: 10.1002/cnm.2698] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/16/2014] [Accepted: 11/10/2014] [Indexed: 06/04/2023]
Abstract
The mechanical behavior of aortic stent grafts plays an important role in the success of endovascular surgery for aneurysms. In this study, finite element analysis was carried out to simulate the expansion of five marketed stent graft iliac limbs and to evaluate quantitatively their mechanical performances. The deployment was modeled in a simplified manner according to the following steps: (i) stent graft crimping and insertion in the delivery sheath, (ii) removal of the sheath and stent graft deployment in the aneurysm, and (iii) application of arterial pressure. In the most curved aneurysm and for some devices, a decrease of stent graft cross-sectional area up to 57% was found at the location of some kinks. Apposition defects onto the arterial wall were also clearly evidenced and quantified. Aneurysm inner curve presented significantly more apposition defects than outer curve. The feasibility of finite element analysis to simulate deployment of marketed stent grafts in curved aneurysm models was demonstrated. The study of the influence of aneurysm tortuosity on stent graft mechanical behavior shows that increasing vessel curvature leads to stent graft kinks and inadequate apposition against the arterial wall. Such simulation approach opens a very promising way toward surgical planning tools able to predict intra and/or post-operative short-term stent graft complications.
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Affiliation(s)
- David Perrin
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, CNRS:UMR5307, LGF, F-42023, Saint Etienne, France; CNRS, 3SR Lab, F-38000, Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000, Grenoble, France
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95
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Polanczyk A, Podyma M, Stefanczyk L, Szubert W, Zbicinski I. A 3D model of thrombus formation in a stent-graft after implantation in the abdominal aorta. J Biomech 2014; 48:425-31. [PMID: 25543277 DOI: 10.1016/j.jbiomech.2014.12.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/22/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022]
Abstract
Here we present a 3D kinetic model of thrombus formation in an endovascular prosthesis after implantation in an abdominal aorta with an aneurysm. The computational fluid dynamic technique (CFD) was used to determine the process of thrombus formation and growth in the stent-graft on the basis of the medical data from computed tomography angiography and Doppler ultrasound examination of 10 patients. The Quemada model was used to describe rheological properties of blood. Results of the CFD simulations were validated based on actual data from patients with diagnosed thrombi in aortic implants. The results show that the elaborated CFD model correctly predicted thrombus formation, shape and deposition site in an endovascular prosthesis. The developed CFD model of thrombus growth can be applied to predict the risk of thrombus formation in stent-grafts and assist in selection of geometry of the endovascular prosthesis to reduce possible complications after stent-graft implantation using only basic medical data.
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Affiliation(s)
- Andrzej Polanczyk
- Lodz University of Technology, Faculty of Process and Environmental Engineering, Department of Heat and Mass Transfer, Poland.
| | - Marek Podyma
- Lodz University of Technology, Faculty of Process and Environmental Engineering, Department of Heat and Mass Transfer, Poland
| | - Ludomir Stefanczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Poland
| | - Wojciech Szubert
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Poland
| | - Ireneusz Zbicinski
- Lodz University of Technology, Faculty of Process and Environmental Engineering, Department of Heat and Mass Transfer, Poland
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96
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Taudorf M, Jensen L, Vogt K, Grønvall J, Schroeder T, Lönn L. Endograft Limb Occlusion in EVAR: Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA. Eur J Vasc Endovasc Surg 2014; 48:527-33. [DOI: 10.1016/j.ejvs.2014.04.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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97
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Freyrie A, Gallitto E, Gargiulo M, Faggioli G, Massoni CB, Mascoli C, Pini R, Stella A. Results of the endovascular abdominal aortic aneurysm repair using the Anaconda aortic endograft. J Vasc Surg 2014; 60:1132-1139. [PMID: 25441690 DOI: 10.1016/j.jvs.2014.04.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate early and late results of the Anaconda aortic endograft (Vascutek, Terumo, Inchinnan, Scotland) in a single-center experience. METHODS From September 2005 to March 2012, patients underwent endovascular aortic repair for abdominal aortic aneurysm (AAA) with Anaconda endograft were prospectively enrolled in a dedicated database. Demographic and aortoiliac morphological data were considered. Preoperative planning was based on thoracoabdominal and pelvic computed tomography angiography. Follow-up included duplex ultrasound or computed tomography angiography at 1, 6, and 12 months and yearly thereafter. Primary end points were technical success, early and late primary and primary assisted clinical success (CS), overall and AAA-related survival and freedom from reinterventions. Secondary end points were endoleaks (ELs), steno-obstructive iliac leg complications, and AAA shrinkage. RESULTS An Anaconda endograft was implanted in 177 patients (male 94%; mean age, 73.3 ± 7.4 years; American Society of Anesthesiologists class III-IV, 85% and 9%, respectively). The mean AAA diameter, neck length, and diameter were 55 ± 9.7 mm, 26.7 ± 10 mm, and 23 ± 2.3 mm, respectively. There was an aortic neck angle >60° in 44 (25%) patients. Iliac angles >90° were observed in 152 (43%) iliac axes. Technical success was 98.9%. Early CS was 96%. Mean follow-up was 33 ± 23.3 months. Late assisted CS was 97.7%. Survival at 12, 24, and 36 months was 96.4%, 89%, and 86.2%, respectively. There was only one case of late AAA-related mortality. Freedom from reintervention was 94%, 92%, and 85% at 12, 24, and 36 months, respectively. Three (1.7%) conversions occurred during follow-up. There were 14.1% ELs at the completion angiography (EL Ia, 1.1%; EL II, 13%). Late ELs were 20.2% (EL Ia, 1.1%; EL Ib, 2.2%; EL II, 16.9%). Iliac leg complications occurred in 5.6% of the cases. An AAA shrinkage >5 mm was observed in 130 (73.4%) patients. In 7 (4%) cases there was an AAA enlargement >5 mm. CONCLUSIONS Data in our series demonstrate that the Anaconda endograft has good early and late results in the treatment of AAAs.
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MESH Headings
- Aged
- Aged, 80 and over
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/mortality
- Aortic Aneurysm, Abdominal/surgery
- Aortography/methods
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/mortality
- Constriction, Pathologic
- Databases, Factual
- Disease-Free Survival
- Endoleak/etiology
- Endoleak/surgery
- Endovascular Procedures/adverse effects
- Endovascular Procedures/instrumentation
- Endovascular Procedures/mortality
- Female
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/surgery
- Humans
- Italy
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Prosthesis Design
- Reoperation
- Stents
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography, Doppler, Duplex
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Affiliation(s)
| | | | | | | | | | | | - Rodolfo Pini
- Vascular Surgery, University of Bologna, Bologna, Italy
| | - Andrea Stella
- Vascular Surgery, University of Bologna, Bologna, Italy
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98
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Coulston J, Baigent A, Selvachandran H, Jones S, Torella F, Fisher R. The impact of endovascular aneurysm repair on aortoiliac tortuosity and its use as a predictor of iliac limb complications. J Vasc Surg 2014; 60:585-9. [DOI: 10.1016/j.jvs.2014.03.279] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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99
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Thromboembolic Complications after Zenith® Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms. Cardiovasc Intervent Radiol 2014; 38:600-5. [DOI: 10.1007/s00270-014-0972-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/09/2014] [Indexed: 01/20/2023]
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100
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Georgakarakos E, Argyriou C, Schoretsanitis N, Ioannou CV, Kontopodis N, Morgan R, Tsetis D. Geometrical Factors Influencing the Hemodynamic Behavior of the AAA Stent Grafts: Essentials for the Clinician. Cardiovasc Intervent Radiol 2014; 37:1420-9. [DOI: 10.1007/s00270-014-0927-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/27/2014] [Indexed: 11/29/2022]
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