51
|
Madigan MC, Singh MJ, Chaer RA, Al-Khoury GE, Makaroun MS. Occult type I or III endoleaks are a common cause of failure of type II endoleak treatment after endovascular aortic repair. J Vasc Surg 2019; 69:432-439. [DOI: 10.1016/j.jvs.2018.04.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/20/2018] [Indexed: 10/28/2022]
|
52
|
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]
|
53
|
Gentsu T, Okada T, Yamaguchi M, Horinouchi H, Katayama N, Ueshima E, Koide Y, Sofue K, Gotake Y, Nomura Y, Tanaka H, Okita Y, Sugimoto K, Murakami T. Type II Endoleak After Endovascular Aortic Aneurysm Repair Using the Endurant Stent Graft System for Abdominal Aortic Aneurysm with Occluded Inferior Mesenteric Artery. Cardiovasc Intervent Radiol 2018; 42:505-512. [PMID: 30515534 DOI: 10.1007/s00270-018-2140-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the incidence of type II endoleak (EL-II) and aneurysm enlargement after endovascular aneurysm repair (EVAR) using the Endurant stent graft in patients with abdominal aortic aneurysm (AAA) with occluded inferior mesenteric artery (IMA). MATERIALS AND METHODS Between 2012 and 2017, 103 patients who underwent EVAR using the Endurant stent graft for AAA with occluded IMA (50 patients with prophylactic embolized IMA and 53 with spontaneous occluded IMA) were retrospectively reviewed. The incidence of EL-II and aneurysm enlargement was evaluated. Predictive factors for persistent EL-II were evaluated based on patient characteristics, preprocedural anatomical characteristics, intraprocedural details, and postprocedural complications. RESULTS Incidence rates of early EL-II and persistent EL-II were 6.8% (7/103 patients) and 4.9% (5/103 patients), respectively. Aneurysm enlargement was found in 10 patients (9.7%), including all 5 patients with persistent EL-II, 3 with de novo EL-II, and 2 with no EL-II. The rates of freedom from aneurysm enlargement at 1, 2, and 3 years were 98.7%, 97.0%, and 93.1% for the group without persistent EL-II, and 80.0%, 60.0%, and 20.0% for the group with persistent EL-II (p < 0.001), respectively. The maximum aneurysm diameter (odds ratio (OR), 1.16; 95% confidence interval (CI), 1.01-1.34; p = 0.0362) and the number of patent lumbar arteries (OR, 2.72; 95% CI, 1.07-6.90; p = 0.0357) were predictive of persistent EL-II. CONCLUSIONS The incidence of EL-II after EVAR using the Endurant stent graft for AAA with occluded IMA was low, but most early EL-II persisted and resulted in aneurysm enlargement. Level of Evidence Level 4, Case Series.
Collapse
Affiliation(s)
- Tomoyuki Gentsu
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroki Horinouchi
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Naoto Katayama
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yutaka Koide
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yasuko Gotake
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yoshikatsu Nomura
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.,Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, 520, Saisho-ko, Himeji, Hyogo, 670-0981, Japan
| | - Hiroshi Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.,Department of Cardiovascular Surgery, Takatsuki General Hospital, 1-3-13, Kosobe-chou, Takatsuki, Osaka, 569-1192, Japan
| | - Koji Sugimoto
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| |
Collapse
|
54
|
Rate of Secondary Intervention After Open Versus Endovascular Abdominal Aortic Aneurysm Repair. J Surg Res 2018; 232:99-106. [DOI: 10.1016/j.jss.2018.05.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
|
55
|
Ultee KHJ, Büttner S, Huurman R, Bastos Gonçalves F, Hoeks SE, Bramer WM, Schermerhorn ML, Verhagen HJM. Editor's Choice - Systematic Review and Meta-Analysis of the Outcome of Treatment for Type II Endoleak Following Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2018; 56:794-807. [PMID: 30104089 DOI: 10.1016/j.ejvs.2018.06.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/06/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The efficacy and need for secondary interventions for type II endoleaks following endovascular abdominal aortic aneurysm repair (EVAR) remain controversial. This systematic review aimed at investigating the clinical outcomes of different type II endoleak treatments in patients with a persistent type II endoleak after EVAR. DATA SOURCES Embase, Medline via Ovid, Web of Science Core Collection, the Cochrane CENTRAL, and Google Scholar. REVIEW METHODS This systematic review was performed in accordance with the PRISMA Statement. Outcomes of interest were technical and clinical success, change in sac diameter, complications, need for additional interventions, abdominal aortic aneurysm (AAA) rupture, and (AAA related) mortality. Meta-analyses were performed with random effects models. RESULTS A total of 59 studies were included, with a cumulative cohort of 1073 patients with persistent type II endoleak. Peri-operative complications following treatment of type II endoleaks occurred in 3.8% of patients (95% CI 2.7-5.2%), and AAA related mortality was 1.8% (95% CI 1.1-2.7%). Overall technical success was 87.9% (95% CI 83.1-92.1%), while clinical success was 68.4% (95% CI 61.2-75.1%). Among studies detailing sac dynamics, decrease or stable sac, with or without resolution, was achieved in 78.4% (95% CI 70.2-85.6%). Changes in sac diameter following type II endoleak treatment were documented in 157 patients to at least 24 months. Within this group an actual decrease in sac diameter was reported in only 27 of 40 patients. CONCLUSION There is little evidence supporting the efficacy of secondary intervention for type II endoleaks after EVAR. Although generally safe, the lack of evidence supporting the efficacy of type II endoleak treatment leads to difficulty in assessing its merits.
Collapse
Affiliation(s)
- Klaas H J Ultee
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Stefan Büttner
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Roy Huurman
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Frederico Bastos Gonçalves
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands; Hospital de Santa Marta, CHLC & NOVA Medical School, Lisbon, Portugal
| | - Sanne E Hoeks
- Department of Anaesthetics, Erasmus University Medical Centre, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, MA, USA
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
| |
Collapse
|
56
|
Transabdominal Direct Sac Puncture Embolization of Type II Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Interv Radiol 2018; 29:1167-1173. [DOI: 10.1016/j.jvir.2018.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022] Open
|
57
|
FUKUDA TETSUYA, MATSUDA HITOSHI, TANAKA HIROSHI, SANDA YOSHIHIRO, MORITA YOSHIAKI, SEIKE YOSHIMASA. Selective Inferior Mesenteric Artery Embolization during Endovascular Abdominal Aortic Aneurysm Repair to Prevent Type II Endoleak. THE KOBE JOURNAL OF MEDICAL SCIENCES 2018; 63:E130-E135. [PMID: 30617246 PMCID: PMC6345414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/07/2017] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of simultaneous IMA (s-IMA) embolization during the endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHOD From July 2007 to January 2011, 189 patients in the no embolization (NE) group underwent EVAR without the indication for s-IMA embolization. Since February 2011 to April 2014, 143 patients have undergone EVAR. Among these patients, 26 patients underwent s-IMA embolism under a predefined indication and constituted the simultaneous embolization (SE) group. The indications for s-IMA embolization were defined by preoperative computed tomography (CT) findings, as follows: (1) the diameter was greater than 2.5 mm and (2) no stenosis due to thrombus or calcification at its orifice. RESULTS The incidence of a type II endoleak from the IMA was 3.4% (5/143) in the SE group patients and 13.2% (25/189) in the NE group patients (p = 0.013), and the incidence of a type II endoleak from all branches (i.e., IMA, lumbar, medial sacral arteries) was 15.4% (22/143) in the SE group patients and 32.3% (61/189) in the NE group patients (p = 0.0003). During the follow-up period (range, 6-72 months; mean: 28 months), the reintervention rate for a type II endoleak from the IMA and/or other branches was 9.5% (18/189) in the NE group and 0.6% (1/143) in the SE group (p = 0.0001). CONCLUSION In selected patients, performing an s-IMA embolization, based on CT findings, decreased the incidence of a type II endoleak and reintervention from the IMA and from all branches.
Collapse
Affiliation(s)
- TETSUYA FUKUDA
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - HITOSHI MATSUDA
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - HIROSHI TANAKA
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - YOSHIHIRO SANDA
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - YOSHIAKI MORITA
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - YOSHIMASA SEIKE
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| |
Collapse
|
58
|
Spin JM, Li DY, Maegdefessel L, Tsao PS. Non-coding RNAs in aneurysmal aortopathy. Vascul Pharmacol 2018; 114:110-121. [PMID: 29909014 DOI: 10.1016/j.vph.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/21/2018] [Accepted: 06/09/2018] [Indexed: 02/07/2023]
Abstract
Aortic aneurysms represent a major public health burden, and currently have no medical treatment options. The pathophysiology behind these aneurysms is complex and variable, depending on location and underlying cause, and generally involves progressive dysfunction of all elements of the aortic wall. Changes in smooth muscle behavior, endothelial signaling, extracellular matrix remodeling, and to a variable extent inflammatory signaling and cells, all contribute to the dilation of the aorta, ultimately resulting in high mortality and morbidity events including dissection and rupture. A large number of researchers have identified non-coding RNAs as crucial regulators of aortic aneurysm development, both in humans and in animal models. While most work to-date has focused on microRNAs, intriguing information has also begun to emerge regarding the role of long-non-coding RNAs. This review summarizes the currently available data regarding the involvement of non-coding RNAs in aneurysmal aortopathies. Going forward, these represent key potential therapeutic targets that might be leveraged in the future to slow or prevent aortic aneurysm formation, progression and rupture.
Collapse
Affiliation(s)
- Joshua M Spin
- Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, USA
| | - Daniel Y Li
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lars Maegdefessel
- Vascular Biology Unit, Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technical University of Munich, Munich, Germany; Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Philip S Tsao
- Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, USA.
| |
Collapse
|
59
|
Translumbar Infusion of N-Butyl Cyanoacrylate for the Treatment of Type II Endoleaks. J Vasc Interv Radiol 2018; 29:826-832. [DOI: 10.1016/j.jvir.2018.01.788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 01/08/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
|
60
|
Carino D, Sarac TP, Ziganshin BA, Elefteriades JA. Abdominal Aortic Aneurysm: Evolving Controversies and Uncertainties. Int J Angiol 2018; 27:58-80. [PMID: 29896039 PMCID: PMC5995687 DOI: 10.1055/s-0038-1657771] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is defined as a permanent dilatation of the abdominal aorta that exceeds 3 cm. Most AAAs arise in the portion of abdominal aorta distal to the renal arteries and are defined as infrarenal. Most AAAs are totally asymptomatic until catastrophic rupture. The strongest predictor of AAA rupture is the diameter. Surgery is indicated to prevent rupture when the risk of rupture exceeds the risk of surgery. In this review, we aim to analyze this disease comprehensively, starting from an epidemiological perspective, exploring etiology and pathophysiology, and concluding with surgical controversies. We will pursue these goals by addressing eight specific questions regarding AAA: (1) Is the incidence of AAA increasing? (2) Are ultrasound screening programs for AAA effective? (3) What causes AAA: Genes versus environment? (4) Animal models: Are they really relevant? (5) What pathophysiology leads to AAA? (6) Indications for AAA surgery: Are surgeons over-eager to operate? (7) Elective AAA repair: Open or endovascular? (8) Emergency AAA repair: Open or endovascular?
Collapse
Affiliation(s)
- Davide Carino
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Timur P. Sarac
- Section of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
- Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
| | - John A. Elefteriades
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
61
|
Maeda K, Ohki T, Kanaoka Y. Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies. Int J Angiol 2018; 27:81-91. [PMID: 29896040 DOI: 10.1055/s-0038-1645881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.
Collapse
Affiliation(s)
- Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
62
|
Ajalat M, Williams R, Wilson SE. The natural history of type 2 endoleaks after endovascular aneurysm repair justifies conservative management. Vascular 2018; 26:524-530. [DOI: 10.1177/1708538118766103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Management of type 2 endoleaks after endovascular aneurysm repair has been controversial. Some advocate for conservative management, while others believe that intervention is indicated. This study investigated the natural history of type 2 endoleaks in order to derive direction in management. Methods Patients who had endovascular aneurysm repair at the Veterans Affairs Long Beach were retrospectively identified and computerized tomographic angiography was independently reviewed by a radiologist and a vascular surgeon. Type 2 endoleaks were analyzed for the following outcomes: rupture, duration of endoleak, spontaneous resolution, changes in the size of the aneurysm sac, and reintervention rates. Results Of the 160 patients who had completed required follow-up to date (mean 3 years) after endovascular aneurysm repair, 39 (24.4%) patients were identified as having a type 2 endoleak on computerized tomographic angiography imaging. 6 (15.4%) of these 39 patients required repair due to aneurysm sac growth >1 cm. 2 (5.13%) were repaired with an open procedure and 4 (10.3%) with an endovascular approach. Of these 6 aneurysm leaks requiring repair, 4 (66.7%) had a simultaneous endoleak (types 1 or 3) in addition to the identified type 2 endoleak. Spontaneous resolution of type 2 endoleaks occurred in 16 (41.0%) patients. 4 patients (10.3%) had delayed type 2 endoleaks that presented 4, 9, 12, and 23 months after their 30 day post op computed tomography was normal. None of the 4 patients with delayed type 2 endoleaks required reintervention and none had aneurysm sac growth greater than 5 mm. Conclusions Overall, we found that 85% of patients who had type 2 endoleaks did not require intervention after a mean follow-up time of 3 years. The association of a type 1 or 3 endoleak with a type 2 endoleak was more likely to require correction due to aneurysm expansion >1 cm, thus type 2 endoleaks associated with another type of endoleak require more aggressive management.
Collapse
Affiliation(s)
- Mark Ajalat
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
- Department of Surgery, VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Russell Williams
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
- Department of Surgery, VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Samuel E Wilson
- Department of Surgery, University of California Irvine Medical Center, Orange, CA, USA
- Department of Surgery, VA Long Beach Healthcare System, Long Beach, CA, USA
| |
Collapse
|
63
|
Bonardelli S, Nodari F, De Lucia M, Botteri E, Benenati A, Cervi E. Late open conversion after endovascular repair of abdominal aneurysm failure: Better and easier option than complex endovascular treatment. JRSM Cardiovasc Dis 2018; 7:2048004017752835. [PMID: 29568519 PMCID: PMC5858687 DOI: 10.1177/2048004017752835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022] Open
Abstract
AIM Conversion to open repair becomes the last option in case of endovascular repair of abdominal aneurysm failure, when radiological interventional procedures are unfeasible. While early conversion to open repair generally derives from technical errors, aetiopathogenesis and results of late conversion to open repair often remain unclear. METHODS We report data from our Institute's experience on late conversion to open repair. Twenty-two late conversion to open repairs out of 435 consecutive patients treated during a 18 years period, plus two endovascular repair of abdominal aneurysms performed in other centres, are analysed. The indication for conversion to open repair was aneurysm enlargement because of type I, type III, type II endoleak and endotension. Even if seven cases (23%) had shown an initial aneurysmal shrinkage, in a later phase, the sac began to enlarge again. In 12 patients, conversion to open repair was the last chance after unsuccessful secondary endovascular procedures. RESULTS Three cases (12.5%) were treated in emergency. Aortic cross-clamping was only infrarenal in 10 cases, only or temporarily suprarenal in 14 and temporarily supraceliac in 9 cases, for 19 total and 5 partial endograft excisions. Two patients died for Multiple Organ Failure (MOF), on 42nd (endovascular repair of abdominal aneurysm infection) and 66th postoperative day. No other conversion to open repair-related deaths or major complications were revealed by follow-up post-conversion to open repair (mean: 68 months ranging from 24 to 180 months). CONCLUSION Late conversion to open repair is often an unpredictable event. It represents a technical challenge: specifically, the most critical point is the proximal aortic clamping that often temporarily excludes the renal circulation. In our series, conversion to open repair can be performed with a low rate of complications. In response to an endovascular repair of abdominal aneurysm failure, before applying complex procedures of endovascular treatment, conversion to open repair should be taken into account.
Collapse
Affiliation(s)
- Stefano Bonardelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Nodari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maurizio De Lucia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emanuele Botteri
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alice Benenati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Edoardo Cervi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| |
Collapse
|
64
|
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]
|
65
|
Massara M, Notarstefano S, Gerardi P, Menna D, Cito D, Lillo A, Prunella R, Impedovo G. Endovascular and open surgical treatment of complications after endovascular aortic aneurysm repair: A single-center experience. Semin Vasc Surg 2018; 31:81-87. [PMID: 30876645 DOI: 10.1053/j.semvascsurg.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While endovascular aortic aneurysm repair (EVAR) has proven to be a safer alternative to open surgical repair for infrarenal abdominal aortic aneurysms (AAA) repair, the development of stent-graft complications mandates follow-up computed tomography imaging to minimize AAA-related mortality. In this single-institution report, adverse EVAR events identified in 150 consecutive patients are detailed. Early morbidity was low (<3%), with only 1 patient death on post-procedure day 2. After discharge (mean follow-up of 24 months), 2 patients died from cancer and one AAA-related mortality occurred after open conversion for stent-graft migration. Although computed tomography imaging detected no EVAR endoleak at 30 days, 19 patients developed an endoleak, including three Type I and four Type III leaks. Our institutional series review confirmed that EVAR of infrarenal AAA is a safe and valid alternative to open surgical repair, but sac embolization at the primary procedure in patients judged to be at high risk for Type II endoleak should be considered.
Collapse
Affiliation(s)
- Mafalda Massara
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy.
| | - Stefano Notarstefano
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy
| | - Pasquale Gerardi
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy
| | - Danilo Menna
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy
| | - Domenico Cito
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy
| | - Antonio Lillo
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy
| | - Roberto Prunella
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy
| | - Giovanni Impedovo
- Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via F. Bruno, Taranto, Italy
| |
Collapse
|
66
|
Risk factors of secondary intervention for type II endoleaks in endovascular aneurysm repair: An 8-year single institution study. Asian J Surg 2017; 42:106-111. [PMID: 29249391 DOI: 10.1016/j.asjsur.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/18/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES The natural history of type II endoleaks (T2ELs) is still not completely understood; however, it is widely accepted that those associated with aneurysmal sac growth are harmful. We aimed to review our experience with T2ELs in endovascular aneurysm repair (EVAR). METHODS We retrospectively reviewed electronic medical records of all patients who underwent EVAR for infrarenal-type abdominal aortic aneurysms (AAAs) at a single institution from August 2007 to November 2015. Demographic and clinical data were collected. Preoperative contrast computed tomography scans were reviewed to determine aneurysm morphology (the maximum AAA diameter, number of lumbar arteries that enter the AAA sac, size of the inferior mesenteric artery (IMA), proximal neck diameter, proximal neck angle, existence of thrombosis, presence of atheroma, and existence of rupture). RESULTS Sixty-two patients underwent EVAR; the follow-up duration was 35.82 ± 31.89 months. There were statistically significant differences in female sex (P = .040), number of lumbar arteries on preoperative computed tomography scans (P = .010), and non-smoking status (P = .031) between patients with and without T2ELs. There were statistically significant differences in the maximum AAA diameter (P = .034) and size of the IMA (P = .043) between patients with and without secondary intervention in T2EL. There was one mortality after EVAR but no mortality associated with T2ELs. CONCLUSIONS A more judicious approach that considers risk factors of T2ELs is needed before EVAR. The risk of secondary intervention in patients developing a T2EL after EVAR could increase with the maximum AAA diameter ≥7 cm or IMA ≥3 mm.
Collapse
|
67
|
van Schaik TG, Yeung KK, Verhagen HJ, de Bruin JL, van Sambeek MR, Balm R, Zeebregts CJ, van Herwaarden JA, Blankensteijn JD, Grobbee D, Blankensteijn J, Bak A, Buth J, Pattynama P, Verhoeven E, van Voorthuisen A, Blankensteijn J, Balm R, Buth J, Cuypers P, Grobbee D, Prinssen M, van Sambeek M, Verhoeven E, Baas A, Hunink M, van Engelshoven J, Jacobs M, de Mol B, van Bockel J, Balm R, Reekers J, Tielbeek X, Verhoeven E, Wisselink W, Boekema N, Heuveling L, Sikking I, Prinssen M, Balm R, Blankensteijn J, Buth J, Cuypers P, van Sambeek M, Verhoeven E, de Bruin J, Baas A, Blankensteijn J, Prinssen M, Buth J, Tielbeek A, Blankensteijn J, Balm R, Reekers J, van Sambeek M, Pattynama P, Verhoeven E, Prins T, van der Ham A, van der Velden J, van Sterkenburg S, ten Haken G, Bruijninckx C, van Overhagen H, Tutein Nolthenius R, Hendriksz T, Teijink J, Odink H, de Smet A, Vroegindeweij D, van Loenhout R, Rutten M, Hamming J, Lampmann L, Bender M, Pasmans H, Vahl A, de Vries C, Mackaay A, van Dortmont L, van der Vliet A, Schultze Kool L, Boomsma J, van Dop H, de Mol van Otterloo J, de Rooij T, Smits T, Yilmaz E, Wisselink W, van den Berg F, Visser M, van der Linden E, Schurink G, de Haan M, Smeets H, Stabel P, van Elst F, Poniewierski J, Vermassen F. Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2017; 66:1379-1389. [DOI: 10.1016/j.jvs.2017.05.122] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/18/2017] [Indexed: 11/30/2022]
|
68
|
Mewissen MW, Jan MF, Kuten D, Krajcer Z. Laser-Assisted Transgraft Embolization: A Technique for the Treatment of Type II Endoleaks. J Vasc Interv Radiol 2017; 28:1600-1603. [PMID: 29056193 DOI: 10.1016/j.jvir.2017.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022] Open
Abstract
A transgraft embolization (TGE) technique was performed in a patient to treat a type II endoleak. Using a transfemoral arterial approach, the endograft was punctured using a coronary laser catheter aimed toward the type II endoleak nidus, which was treated with Onyx (Medtronic, Minneapolis, Minnesota). TGE resulted in successful embolization, as demonstrated on 1-year follow-up CT angiography, which showed complete elimination of the type II endoleak and shrinkage of the aneurysmal sac. TGE is an alternative to transarterial embolization, translumbar embolization, and transcaval embolization.
Collapse
Affiliation(s)
- Mark W Mewissen
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 330, Milwaukee, WI 53215.
| | - M Fuad Jan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 330, Milwaukee, WI 53215
| | | | | |
Collapse
|
69
|
Systematic review of laparoscopic ligation of inferior mesenteric artery for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2017; 66:1878-1884. [PMID: 28822664 DOI: 10.1016/j.jvs.2017.07.066] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/07/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Type II endoleak after endovascular aneurysm repair (EVAR) is frequently caused by persistent flow from the inferior mesenteric artery (IMA). The aim of this study was to assess the perioperative and midterm efficacy of laparoscopic ligation of the IMA for treatment of endoleak. METHODS MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane databases and key references were searched with Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology for studies reporting on laparoscopic ligation of the IMA for treatment of type II endoleak after EVAR. RESULTS Eight case studies and one study of a retrospective nature were identified. In total, 20 patients (18 men; mean age, 73.6 ± 2 years; with a mean abdominal aortic aneurysm diameter of 64.3 ± 10 mm) who underwent post-EVAR laparoscopic ligation of the IMA for type II endoleak were analyzed. The mean time from EVAR until intervention ranged from 6 to 18 months. All but one patient were asymptomatic; in 9, the aneurysm sac was enlarged, and in 11, the endoleak was considered persistent without sac enlargement. The mean procedural duration was 99 ± 24 minutes, with technical success rate of 90% (18/20); in two cases, the patients were successfully reoperated on laparoscopically in 24 hours. The mean hospitalization was 3.6 ± 1.2 days, with 0% (0/20) perioperative and 30-day mortality. No patient underwent open conversion or showed signs of intestinal ischemia. During follow-up of 32.6 ± 12 months, 13 of 20 patients had aneurysm sac regression, whereas the rest had a stable sac diameter without evidence of persistent type II endoleak. CONCLUSIONS Laparoscopic ligation of the IMA for treatment of type II endoleak after EVAR is a feasible and safe technique in specialized centers with high technical success rate and good midterm outcomes.
Collapse
|
70
|
AAA Rupture and Psoas Hematoma due to Type II Endoleak from Inferior Mesenteric Artery "Unusual" Collaterals. Case Rep Vasc Med 2017. [PMID: 28634567 PMCID: PMC5467359 DOI: 10.1155/2017/8607437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although endovascular aneurysm repair (EVAR) in the abdominal aorta has reduced the perioperative mortality when compared with open repair, the need for reintervention after complications such as endoleak may be presented in up to 20% of the cases. Type II endoleak from branch vessels is often benign but can potentially be associated with progressive abdominal aortic aneurysm growth and sac expansion. We present a rare case of a patient who presented with sac expansion and psoas hematoma due to Type II endoleak from "unusual" collaterals of IMA and was treated successfully with endoleak microembolization and percutaneous decompression of the hematoma.
Collapse
|
71
|
Zhang X, Sun Y, Chen Z, Jing Y, Xu M. Management of Endovascular Aortic Aneurysm Complications via Retrograde Catheterization Through the Distal Stent-Graft Landing Zone. Vasc Endovascular Surg 2017; 51:390-393. [PMID: 28548006 DOI: 10.1177/1538574417710414] [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
OBJECTIVE A retrograde technique through the gap between the distal stent landing zone and the iliac artery wall has been applied to treat type II endoleak after endovascular aortic aneurysm repair (EVAR). In this study, we tried to investigate its efficacy in the management of type III endoleak and intraoperative accidental events. METHODS We reported 2 complications of EVAR that were difficult to treat with conventional methods. One patient had a sustained type III endoleak after EVAR, and the right renal artery was accidentally sealed by a graft stent in the other patient during the operation. RESULTS Both complications were managed by the retrograde technique from the distal stent landing zone. In the first case, the endoleak was easily embolized by the retrograde catheterization technique, and in the second case, a stent was implanted in the right renal artery using the retrograde technique to restore blood flow. CONCLUSION In some EVAR cases, the technique of retrograde catheterization through the distal stent-graft landing zone is feasible, safe, and easy to perform.
Collapse
Affiliation(s)
- Xicheng Zhang
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuan Sun
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhaolei Chen
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuanhu Jing
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Miao Xu
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| |
Collapse
|
72
|
Marcelin C, Le Bras Y, Petitpierre F, Midy D, Ducasse E, Grenier N, Cornelis F. Safety and efficacy of embolization using Onyx ® of persistent type II endoleaks after abdominal endovascular aneurysm repair. Diagn Interv Imaging 2017; 98:491-497. [PMID: 28196614 DOI: 10.1016/j.diii.2017.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To retrospectively evaluate the safety and efficacy of embolization of persistent type II endoleaks occurring after abdominal endovascular aneurysm repair (EVAR) using ethylene vinyl alcohol copolymer (Onyx®). MATERIAL AND METHODS Between 2008 and 2016, 28 consecutives patients (25 men, 3 women) with a mean age of 75.3years±9 (SD) (range: 59-90years) were treated for 29 persistent type II endoleaks with increasing aneurysm size>5mm occurring after EVAR. A total of 35 embolization procedures were performed using Onyx®, via a transarterial route (n=25) or direct puncture (n=10), with or without additional metallic coils. The endpoints were to evaluate the clinical efficacy, corresponding to the stabilization or decrease of aneurism size, and the technical efficacy, corresponding to the ability to complete the embolization. RESULTS No severe complications were observed during and after embolization. The primary and secondary clinical efficacies were 75% (21/28) and 96.4% (27/28), respectively. Overall primary technical efficacy rate was 58.6% (17/29), greater for transarterial technique (72.8%) than for direct puncture (14.3%) (P=0.01). Secondary technical efficacy was 72.4% (21/29), with no differences between transarterial (81.8%) and direct puncture (42.8%) (P=0.06). CONCLUSION Embolization with Onyx® of type II endoleaks after EVAR appears a safe and effective procedure.
Collapse
Affiliation(s)
- C Marcelin
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Y Le Bras
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Petitpierre
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - D Midy
- Department of vascular surgery, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - E Ducasse
- Department of vascular surgery, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - N Grenier
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Cornelis
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| |
Collapse
|
73
|
Piffaretti G, Franchin M, Botteri E, Boni L, Carrafiello G, Battaglia G, Bonardelli S, Castelli P. Operative Treatment of Type 2 Endoleaks Involving the Inferior Mesenteric Artery. Ann Vasc Surg 2017; 39:48-55. [DOI: 10.1016/j.avsg.2016.07.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 12/01/2022]
|
74
|
Treatment of Type II Endoleak and Aneurysm Expansion after EVAR. Ann Vasc Surg 2017; 39:56-66. [DOI: 10.1016/j.avsg.2016.08.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022]
|
75
|
Chitosan–Sodium Tetradecyl Sulfate Hydrogel: Characterization and Preclinical Evaluation of a Novel Sclerosing Embolizing Agent for the Treatment of Endoleaks. Cardiovasc Intervent Radiol 2017; 40:576-584. [DOI: 10.1007/s00270-016-1557-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
|
76
|
Kim MH, Park HS, Ahn S, Min SI, Min SK, Ha J, Lee T. Chronological Change of the Sac after Endovascular Aneurysm Repair. Vasc Specialist Int 2016; 32:150-159. [PMID: 28042554 PMCID: PMC5198761 DOI: 10.5758/vsi.2016.32.4.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate the potential risk factors of type II endoleak and sac growth after endovascular aneurysm repair (EVAR) and the outcomes of secondary interventions. Materials and Methods: Ninety seven patients underwent elective EVAR for infrarenal abdominal aortic aneurysms in two tertiary centers between April 2005 and July 2013. Clinical and imaging parameters were compared among sac growth (>5 mm) and non-growth groups. Risk factors associated with sac growth and persistent type II endoleak were analyzed. The outcomes of reinterventions for persistent type II endoleak were determined. Results: Sac growth was observed in 20 cases (20.6%) and endoleak was found in 90% of them compared to 28.6% (22/77) in the non-growth group (P<0.001). The majority of endoleaks were type II (36/40) and 80.5% were persistent. Sac diameter, neck diameter and number of patent accessory arteries were also statistically significant for sac growth. On multivariate analysis, grade of calcification at the neck, grade of mural thrombus at the inferior mesenteric artery and number of patent accessory arteries were risk factors of persistent type II endoleak. Twenty six reinterventions were done for 16 patients with persistent type II endoleak, with a technical success rate of 88.5%, yet 55.5% showed sac growth regardless of technical success. There were no ruptures during the follow-up period. Conclusion: Sac growth after EVAR was mostly associated with persistent type II endoleak. Secondary interventions using transarterial embolization is partially effective in achieving clinical success.
Collapse
Affiliation(s)
- Min Hyun Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sang-Il Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam
| |
Collapse
|
77
|
Improving the results of transarterial embolization of type 2 endoleaks with the embolic polymer Onyx. Wideochir Inne Tech Maloinwazyjne 2016; 11:259-267. [PMID: 28194246 PMCID: PMC5299085 DOI: 10.5114/wiitm.2016.64747] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/04/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction Type 2 endoleaks (T2E) occur in 10 to 20% of patients after endovascular abdominal aortic aneurysm repair (EVAR) and remain a significant clinical issue. Aim To evaluate the efficacy and clinical outcomes of transarterial treatment of persistent type II endoleaks after EVAR using the liquid embolic Onyx. Material and methods From February 2012 to August 2015 transarterial T2E embolization was attempted in 22 patients (21 men, median age: 73, range: 62–88 years). Indications for treatment included an increase in the diameter of the aneurysm sac above 5 mm and a persistent endoleak observed for more than 6 months. Mean time from EVAR to endoleak treatment was 43 months (range: 2–125 months). Results Primary technical success was achieved in 17 (77.3%) patients and secondary technical success in 81.8%, with 0% in-hospital mortality. The mean procedure time was 95 ±48 min, with an average fluoroscopy time of 54 ±25 min. The mean amount of Onyx used was 7.5 ±6.6 ml. Clinical success was seen in 17/21 patients with follow-up imaging (80.9%). Mean follow-up time was 17 months (range: 3–38 months). Conclusions Onyx has been shown to effectively stabilize previous aneurysm growth as a result of the T2E in the majority of our patients. Transarterial embolization of T2E can be significantly improved as compared to previously reported results by using liquid embolic polymers such as Onyx.
Collapse
|
78
|
Bredahl K, Taudorf M, Lönn L, Vogt K, Sillesen H, Eiberg J. Contrast Enhanced Ultrasound can Replace Computed Tomography Angiography for Surveillance After Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2016; 52:729-734. [DOI: 10.1016/j.ejvs.2016.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/06/2016] [Indexed: 11/25/2022]
|
79
|
Yang RY, Tan KT, Beecroft JR, Rajan DK, Jaskolka JD. Direct sac puncture versus transarterial embolization of type II endoleaks: An evaluation and comparison of outcomes. Vascular 2016; 25:227-233. [PMID: 27538929 DOI: 10.1177/1708538116663992] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To determine the outcomes of type II endoleak embolization with aneurysm sac obliteration and whether the approach - direct sac puncture or transarterial - affects outcome. Methods A retrospective review of patients who underwent endovascular aneurysm repairs and subsequent type II endoleak embolization over 10 years was performed. Twenty-three patients (median age: 73 years, range: 40-88 years) underwent 35 embolizations. Embolization was performed with the goal of obliterating both the endoleak sac and feeding vessels. Embolization agents used include cyanoacrylate glue only (48%), glue and coils (36%), coils only (13%), and other (3%). Results Mean follow-up was 21.8 months. Patients underwent an average of 1.5 embolizations, with 35% requiring more than one. Technical success rate was 89%. Freedom from aneurysm sac expansion was achieved in 91%. Freedom from type II endoleak was accomplished in 70%. There were no ruptured aneurysms during the follow-up period. Direct sac puncture and transarterial approaches had similar incidences of aneurysm sac growth ( p = 0.74), persistent type II endoleak ( p = 0.32), and complications ( p = 0.64). However, direct sac puncture had significantly shorter fluoroscopy ( p < 0.001) and total procedure times ( p < 0.001) than transarterial embolizations. Conclusion Direct sac puncture and transarterial embolization of type II endoleak with aneurysm sac obliteration are similarly effective for the prevention of aneurysm sac growth. However, direct sac puncture is our preferred approach given its significantly shorter fluoroscopic and procedural times.
Collapse
Affiliation(s)
- Roy Y Yang
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Kong T Tan
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - J Robert Beecroft
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Dheeraj K Rajan
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jeffrey D Jaskolka
- Division of Vascular & Interventional Radiology, Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
80
|
Barleben A, Inui T, Owens E, Lane JS, Bandyk DF. Intervention after endovascular aneurysm repair: Endosalvage techniques including perigraft arterial sac embolization and endograft relining. Semin Vasc Surg 2016; 29:41-49. [PMID: 27823589 DOI: 10.1053/j.semvascsurg.2016.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysm (AAA). However, persistent AAA sac endoleak following EVAR can result in sac diameter increase requiring re-intervention in up to one-third of cases and even result in aneurysm rupture. In this case review, we summarize and detail endovascular re-interventions for each type of endoleak. We also detail specific options including stent-graft relining for indeterminate, Type III, and Type IV endoleaks and perigraft arterial sac embolization to induce thrombosis and resolve acute Type I, II, or III endoleaks. Endograft relining involves placement of a new stent-graft-elevating the bifurcation and extending the repair from renal artery to hypogastric arteries; perigraft arterial sac embolization involves placement of a catheter into the excluded sac from common femoral artery access, characterization of the inflow and outflow of the endoleak, and inducing cessation of the blood flow into the sac by the administration of thrombogenic material. Endoleaks range from low-pressure endoleaks, which can be safely monitored in a surveillance program to high-pressure endoleaks, which mandate intervention when associated with AAA sac diameter increase to protect from rupture. The evaluation of new devices and techniques to treat endoleak after EVAR remains an important issue in patient care after EVAR.
Collapse
Affiliation(s)
- Andrew Barleben
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA.
| | - Tazo Inui
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
| | - Erik Owens
- Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
| | - John S Lane
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
| | - Dennis F Bandyk
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
| |
Collapse
|
81
|
Ogawa Y, Nishimaki H, Osuga K, Ikeda O, Hongo N, Iwakoshi S, Kawasaki R, Woodhams R, Yamaguchi M, Kamiya M, Kanematsu M, Honda M, Kaminou T, Koizumi J, Kichikawa K. A multi-institutional survey of interventional radiology for type II endoleaks after endovascular aortic repair: questionnaire results from the Japanese Society of Endoluminal Metallic Stents and Grafts in Japan. Jpn J Radiol 2016; 34:564-71. [PMID: 27262856 DOI: 10.1007/s11604-016-0558-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/26/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the current status of interventional radiology (IR) procedures for a type II endoleak (T2EL) in Japan, and to identify the technical aspects that affect treatment results. MATERIALS AND METHODS A retrospective survey was conducted by distributing questionnaires to 25 institutions. The eligibility criteria were endovascular aortic repair (EVAR) performed using commercial stent grafts and IR performed for T2EL between January 2007 and December 2013. Technical success was defined as disappearance of the EL on digital subtraction angiography immediately after embolization, and imaging success was defined as no EL on contrast-enhanced computed tomography within 6 months. Statistical comparisons of the number of involved branches, embolization level, embolic material, and changes in aneurysm size were made between the imaging success and imaging failure groups. The technical and imaging success rates were also compared between the initial therapy and repeat groups. RESULTS A total of 166 cases were investigated. Initial therapy was performed in 147 cases (88.6 %), with repeat therapy in 19 cases (11.4 %). Transcatheter arterial embolization (TAE) was used most frequently, in 161 cases (97 %), with direct puncture (DP) used in 5 cases (3 %). Both coil embolization for the branches and NBCA embolization for the sac were frequently chosen. The technical success rate was 83.2 % (TAE group), and the imaging success rate was 46.5 % (TAE + DP groups). Branch + sac embolization was performed more frequently in the imaging success group. There was no significant difference in the number of involved branches or embolic material between the imaging success and imaging failure groups. Enlargement of the aneurysm was more frequently seen in the imaging failure group. There were no significant differences in the technical success and imaging success rates between the initial therapy and repeat groups. CONCLUSION This is the first report of a multi-institutional questionnaire survey of IR procedures for T2EL after EVAR in Japan that was conducted to determine the current status. Enlargement of aneurysm size after embolization was more frequently seen in the imaging failure group. It is important to embolize both branch and sac to achieve imaging success, regardless of embolic material. Long-term outcomes need to be investigated.
Collapse
Affiliation(s)
- Yukihisa Ogawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan.
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keigo Osuga
- Department of Radiology, Osaka University, Suita, Japan
| | - Osamu Ikeda
- Department of Radiology, Kumamoto University, Kumamoto, Japan
| | - Norio Hongo
- Department of Radiology, Oita University, Yufu, Japan
| | | | - Ryota Kawasaki
- Department of Radiology, Hyogo Brain and Heart Center at Himeji, Himeji, Japan
| | - Reiko Woodhams
- Department of Radiology, Kitasato University, Sagamihara, Japan
| | | | - Mika Kamiya
- Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Masanori Honda
- Department of Radiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Toshio Kaminou
- Department of Radiology, Tottori University, Yonago, Japan
| | - Jun Koizumi
- Department of Radiology, Tokai University, Isehara, Japan
| | | |
Collapse
|
82
|
Evidence for Ethylene-Vinyl-Alcohol-Copolymer Liquid Embolic Agent as a Monotherapy in Treatment of Endoleaks. Eur J Vasc Endovasc Surg 2016; 51:810-4. [DOI: 10.1016/j.ejvs.2016.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/17/2016] [Indexed: 12/19/2022]
|
83
|
Selective Intra-procedural AAA sac Embolization During EVAR Reduces the Rate of Type II Endoleak. Eur J Vasc Endovasc Surg 2016; 51:632-9. [DOI: 10.1016/j.ejvs.2015.12.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/13/2015] [Indexed: 11/18/2022]
|
84
|
Ioannou CV, Kontopodis N, Peteinarakis I, Tsetis D. Noninvasive Estimation of Aneurysm Sac Pressurization Following Endovascular Aneurysm Repair Using M-Mode Ultrasonography to Evaluate Significance of Endoleaks: A Feasibility Study. J Endovasc Ther 2016; 23:606-13. [PMID: 27099286 DOI: 10.1177/1526602816645524] [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: 12/14/2022]
Abstract
PURPOSE To establish the feasibility of indirectly estimating aneurysm sac pressurization from recordings of aortic pulsatile wall motion (PWM) using M-mode ultrasonography before and after endovascular aneurysm repair (EVAR). METHODS Twenty consecutive patients (mean age 72 years; 19 men) scheduled for EVAR in a single institution underwent M-mode ultrasonography 1 day before EVAR to record PWM of the abdominal aortic aneurysm wall during the cardiac cycle, along with simultaneous blood pressure measurements. The recording was repeated the first postoperative day. Pressure-strain elastic modulus (Ep) was calculated from the preoperative displacement and pressure data. This value and the postoperative PWM were used to inverse estimate pulse pressure in the abdominal aortic aneurysm sac post EVAR. Immediate pressure reduction post EVAR was compared between groups of endoleak vs no endoleak and expansion vs no expansion during 6-month follow-up. RESULTS Intraobserver variability of the method presented a mean value of 0.04 mm with a 1.2-mm coefficient of variation (95% limits of agreement -1.16 to 1.24 mm). PWM was significantly reduced postoperatively (1.2 vs 0.3 mm, p<0.001) as was pulse pressure exerted on the aneurysm sac (67 vs 16 mm Hg, p<0.001). The pressure reduction was similar between the endoleak vs no endoleak groups (79% vs 75%, p=0.65), but it was significantly greater in the no expansion group (79.5%) vs the group with aneurysm expansion (50%, p=0.008). CONCLUSION M-mode ultrasonography may provide a useful adjunct during EVAR surveillance to noninvasively estimate sac pressurization and identify aneurysms at risk of enlargement.
Collapse
Affiliation(s)
- Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - Ioannis Peteinarakis
- Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece
| |
Collapse
|
85
|
Batagini NC, Hardy D, Clair DG, Kirksey L. Nellix EndoVascular Aneurysm Sealing System: Device description, technique of implantation, and literature review. Semin Vasc Surg 2016; 29:55-60. [PMID: 27823591 DOI: 10.1053/j.semvascsurg.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical outcome reports document that from 30% to 60% of endovascular aneurysm repair procedures are performed outside of US Food and Drug Administration-approved Instruction for Use, or "off label." Endovascular aneurysm repair performed outside of Instruction for Use has a significantly higher rate of device failure, potentially requiring device reintervention and even planned or emergent explant. The Nellix device has the potential to reduce the rate of aneurysm device failure through its novel design. The objective of this article was to introduce the Nellix EndoVascular Aneurysm Sealing System and indications for use and describe the technique of implantation. We describe various modes of endovascular aneurysm repair failure and how the Nellix system can reduce these unplanned adverse outcomes. Additional clinical applications and theoretical shortcomings of endovascular aneurysm sealing devices are detailed.
Collapse
Affiliation(s)
- Nayara Cioffi Batagini
- Vascular Surgery Department, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
| | - David Hardy
- Vascular Surgery Department, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Daniel G Clair
- Vascular Surgery Department, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Lee Kirksey
- Vascular Surgery Department, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| |
Collapse
|
86
|
Brown A, Saggu GK, Bown MJ, Sayers RD, Sidloff DA. Type II endoleaks: challenges and solutions. Vasc Health Risk Manag 2016; 12:53-63. [PMID: 27042087 PMCID: PMC4780400 DOI: 10.2147/vhrm.s81275] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Type II endoleaks are the most common endovascular complications of endovascular abdominal aortic aneurysm repair (EVAR); however, there has been a divided opinion regarding their significance in EVAR. Some advocate a conservative approach unless there is clear evidence of sac expansion, while others maintain early intervention is best to prevent adverse late outcomes such as rupture. There is a lack of level-one evidence in this challenging group of patients, and due to a low event rate of complications, large numbers of patients would be required in well-designed trials to fully understand the natural history of type II endoleak. This review will discuss the imaging, management, and outcome of patients with isolated type II endoleaks following infra-renal EVAR.
Collapse
Affiliation(s)
- Andrew Brown
- Department of Vascular Surgery, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Greta K Saggu
- Department of Vascular Surgery, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Matthew J Bown
- Department of Cardiovascular Sciences, National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| | - Robert D Sayers
- Department of Cardiovascular Sciences, National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| | - David A Sidloff
- Department of Vascular Surgery, Queens Medical Centre, University of Nottingham, Nottingham, UK; Department of Cardiovascular Sciences, National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
| |
Collapse
|
87
|
Fujimura N, Obara H, Matsubara K, Watada S, Shibutani S, Akiyoshi T, Harada H, Kitagawa Y. Characteristics and Risk Factors for Type 2 Endoleak in an East Asian Population From a Japanese Multicenter Database. Circ J 2015; 80:118-23. [PMID: 26567485 DOI: 10.1253/circj.cj-15-0850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinically distinct differences exist between East Asian and Caucasian subjects, but data for type 2 endoleak (T2EL) are limited in the East Asian population. The aim of this study was to analyze the characteristics of East Asian T2EL using a Japanese multicenter database. METHODS AND RESULTS Retrospective analysis of 832 endovascular aneurysm repairs performed from 2008 to 2014 were conducted. T2EL was observed in 234 cases (28.1%), and in 32 cases (3.8%) it led to sac expansion >5 mm caused by isolated T2EL (median follow-up, 35.6 months). On univariate and multivariate analysis, non-smoker status (odds ratio [OR], 2.216; P<0.001), Excluder stent graft (OR, 2.027; P<0.001), and T2EL at final angiogram (OR, 2.080; P<0.001) were risk factors for T2EL. On multivariate analysis for isolated T2EL with sac expansion, only non-smoker status remained (OR, 2.671; P<0.001). Other than T1EL, isolated T2EL was the most significant risk factor for sac expansion (OR, 18.486; P<0.001). Furthermore, out of 11 transarterial embolization procedures initiated, 4 led to rupture during follow-up. CONCLUSIONS East Asian T2EL had a strong relationship with non-smoker status. Also, T2EL was a significant risk factor for sac expansion, which sometimes led to rupture even after intervention. Along with the high prevalence of T2EL observed, East Asian T2EL may not always be benign.
Collapse
Affiliation(s)
- Naoki Fujimura
- Department of Surgery, Keio University School of Medicine
| | | | | | | | | | | | | | | |
Collapse
|
88
|
Phan DDN, Meyer F, Pech M, Halloul Z. Length of abdominal aortic aneurysm and incidence of endoleaks type II after endovascular repair. Wien Klin Wochenschr 2015; 127:851-857. [PMID: 26542129 DOI: 10.1007/s00508-015-0871-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 09/16/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the predicting factors for the development of endoleak type II, its frequency and influencing factors after elective endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA). METHODS Data were prospectively collected in a unicenter observational study (tertiary center of [endo-] vascular surgery) and retrospectively evaluated in patients who had undergone elective EVAR of AAA. Vascular (lumbar arteries (LA) and inferior mesenteric artery, aneurysm) and general patient (habits, medication, basic diseases) as well as procedural characteristics, were analyzed for their association with the development of endoleak type II. Pre and postinterventional computed tomography (CT) scans were evaluated for aneurysm anatomy, in particular, postinterventional growth or shrinkage as well detection of an endoleak of each type. RESULTS The study cohort included 82 patients (mean age, 72 (52-87) years; 77 men, 93.9%) throughout 36 months. The median follow-up period was 29.5 months (range, 1-57). Overall, 51 endoleaks type II (62.2%) were identified at any time during the postinterventional follow-up period. In the Cox regression, AAA length was the only significant predictor (P = 0.024; hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14). Thirteen patients (15.8%) underwent at least one secondary intervention. Aneurysm growth was observed in four patients because of an endoleak type II (4.9%). No AAA rupture occurred in association with an isolated endoleak type II. CONCLUSION The preoperative AAA length (correlating with the number of LA) can be considered a risk factor for postinterventional occurrence of endoleak type II prompting to greater attention and possible preemptive therapy.
Collapse
Affiliation(s)
- Dinh Dong Nghi Phan
- Division of Vascular Surgery, Department of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Frank Meyer
- Division of Vascular Surgery, Department of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital at Magdeburg, Magdeburg, Germany
| | - Zuhir Halloul
- Division of Vascular Surgery, Department of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| |
Collapse
|
89
|
Endofugas tipo 2 en una población tratada con endoprótesis Gore® Excluder: incidencia, persistencia y crecimiento del saco aneurismático. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2015.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
90
|
Fatimi A, Zehtabi F, Lerouge S. Optimization and characterization of injectable chitosan-iodixanol-based hydrogels for the embolization of blood vessels. J Biomed Mater Res B Appl Biomater 2015; 104:1551-1562. [DOI: 10.1002/jbm.b.33500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ahmed Fatimi
- École de technologie supérieure, Department of Mechanical Engineering; Montreal Québec H3C 1K3 Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM); Laboratoire de biomatériaux endovasculaires (LBeV); Montreal Québec H2X 0A9 Canada
| | - Fatemeh Zehtabi
- École de technologie supérieure, Department of Mechanical Engineering; Montreal Québec H3C 1K3 Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM); Laboratoire de biomatériaux endovasculaires (LBeV); Montreal Québec H2X 0A9 Canada
| | - Sophie Lerouge
- École de technologie supérieure, Department of Mechanical Engineering; Montreal Québec H3C 1K3 Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM); Laboratoire de biomatériaux endovasculaires (LBeV); Montreal Québec H2X 0A9 Canada
| |
Collapse
|
91
|
Hiraoka A, Chikazawa G, Ishida A, Miyake K, Totsugawa T, Tamura K, Sakaguchi T, Yoshitaka H. Impact of Age and Intraluminal Thrombus Volume on Abdominal Aortic Aneurysm Sac Enlargement after Endovascular Repair. Ann Vasc Surg 2015; 29:1440-6. [PMID: 26169457 DOI: 10.1016/j.avsg.2015.05.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 03/19/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Abdominal aneurysmal sac enlargement after endovascular aortic repair (EVAR) is a critical issue. However, the predictors have not yet been fully determined. Although unrecognized, intraluminal thrombus volume (ITV) is an important index. Therefore, we retrospectively evaluated the correlation among preoperative ITV, residual type II endoleak, and sac enlargement after EVAR, based on the long-term follow-up. METHODS Between 2006 and 2011, 151 consecutive patients underwent EVAR at a single cardiovascular institute. Emergency surgery was performed on 7 patients (4.7%). Of 148 patients excluding 3 patients with residual type I endoleak, sac enlargement (≥5 mm progression) after EVAR was observed in 24 patients (16.2%) and 8 patients required reintervention. The mean follow-up period was 2.4 ± 1.4 years. The outer volume and enhanced luminal volume were calculated from enhanced 1-mm slice computed tomography, and the difference was defined as ITV. RESULTS Age (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.04-1.20, P = 0.0007), outer volume (HR 1.04, 95% CI 1.01-1.07, P = 0.0118), percentage of ITV (HR 0.90, 95% CI 0.84-0.96, P = .0027), and type II endoleak (HR 10.15, 95% CI 3.55-31.10, P < 0.0001) were isolated as predictors of sac enlargement by multivariate analysis. Also, patent inferior mesenteric artery (odds ratio [OR] 4.45, 95% CI 1.38-20.07, P = 0.0105) and percentage of ITV < 30.1% (OR 3.52, 95% CI 1.32-10.30, P = 0.0112) were detected as independent risk factors for residual type II endoleaks. Additionally, in patients without endoleak, patient age (≥83 years) was an independent risk factor for sac enlargement after EVAR (P = 0.0056). CONCLUSION Age and ITV percentage had significantly great impact on sac enlargement and type II endoleak after EVAR.
Collapse
Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Atsuhisa Ishida
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Koichi Miyake
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| |
Collapse
|
92
|
Fabre D, Fadel E, Brenot P, Hamdi S, Gomez Caro A, Mussot S, Becquemin JP, Angel C. Type II endoleak prevention with coil embolization during endovascular aneurysm repair in high-risk patients. J Vasc Surg 2015; 62:1-7. [DOI: 10.1016/j.jvs.2015.02.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
|
93
|
Yamada M, Takahashi H, Tauchi Y, Satoh H, Matsuda H. Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR. Ann Vasc Dis 2015; 8:210-4. [PMID: 26421069 DOI: 10.3400/avd.oa.14-00133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/07/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSES Endovascular abdominal aortic aneurysm repair (EVAR) is an increasingly used method of repairing abdominal aortic aneurysm (AAA). However, the treatment of persistent type II endoleak is still a controversial issue. Five cases are reported here in which we performed open surgical repair of growing aneurysm due to persistent type II endoleak. METHOD Totally 128 EVAR cases were retrospectively reviewed, which were operated in our hospital from April 2008 to October 2013. These cases were followed by periodical contrast-enhanced computed tomography (CT) after EVAR. When persistent type II endoleak caused aneurysm sac growth, we performed surgical repair method for the first line treatment. In the operation, we incised the aneurysm sac by abdominal small median incision approach and sutured lumber arteries from inside of aneurysm sac and tied inferior mesenteric artery (IMA) in addition to aneurysmorrhaphy. Contrast-enhanced CT scanning was performed in a week after open repair for the confirmation of complete treatment. RESULTS Five of 128 cases (3.9%) were needed to be surgically repaired because of aneurysm sac growth (>5 mm), including two ruptured AAA cases. All patients recovered uneventfully. Contrast-enhanced CT scanning performed a week after these operations showed no endoleak and intact stent grafts and reduction of the aneurysm size. CONCLUSION We believe open surgical repair method of persistent type II endoleak with aneurysm expansion is secure method, and can be one of the preferable options for this life threatening complication after EVAR.
Collapse
Affiliation(s)
- Mitsutomo Yamada
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Hideki Takahashi
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Yuya Tauchi
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Hisashi Satoh
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Hikaru Matsuda
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| |
Collapse
|
94
|
Type II endoleak with or without intervention after endovascular aortic aneurysm repair does not change aneurysm-related outcomes despite sac growth. J Vasc Surg 2015; 62:551-61. [PMID: 26059094 DOI: 10.1016/j.jvs.2015.04.389] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 04/10/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE There is considerable controversy about the significance and appropriate treatment of type II endoleaks (T2Ls) after endovascular aneurysm repair (EVAR). We report our long-term experience with T2L management in a large multicenter registry. METHODS Between 2000 and 2010, 1736 patients underwent EVAR, and we recorded the incidence of T2L. Primary outcomes were mortality and aneurysm-related mortality (ARM). Secondary outcomes were change in aneurysm sac size, major adverse events, and reintervention. RESULTS During the follow-up (median of 32.2 months; interquartile range, 14.2-52.8 months), T2L was identified in 474 patients (27.3%). There were no late abdominal aortic aneurysm ruptures attributable to a T2L. Overall mortality (P = .47) and ARM (P = .26) did not differ between patients with and without T2L. Sac growth (median, 5 mm; interquartile range, 2-10 mm) was seen in 213 (44.9%) of the patients with T2L. Of these patients with a T2L and sac growth, 36 (16.9%) had an additional type of endoleak. Of all patients with T2L, 111 (23.4%) received reinterventions, including 39 patients who underwent multiple procedures; 74% of the reinterventions were performed in patients with sac growth. Reinterventions included lumbar embolization in 66 patients (59.5%), placement of additional stents in 48 (43.2%), open surgical revision in 14 (12.6%), and direct sac injection in 22 (19.8%). The reintervention was successful in 35 patients (31.5%). After patients with other types of endoleak were excluded, no difference in overall all-cause mortality (P = .57) or ARM (P = .09) was observed between patients with T2L-associated sac growth who underwent reintervention and those in whom T2L was left untreated. CONCLUSIONS In our multicenter EVAR registry, overall all-cause mortality and ARM were unaffected by the presence of a T2L. Moreover, patients who were simply observed for T2L-associated sac growth had aneurysm-related outcomes similar to those in patients who underwent reintervention. Our future work will investigate the most cost-effective ways to select patients for intervention besides sac growth alone.
Collapse
|
95
|
Habets J, Zandvoort HJA, Moll FL, Bartels LW, Vonken EPA, van Herwaarden JA, Leiner T. Magnetic Resonance Imaging with a Weak Albumin Binding Contrast Agent can Reveal Additional Endoleaks in Patients with an Enlarging Aneurysm after EVAR. Eur J Vasc Endovasc Surg 2015; 50:331-40. [PMID: 26036808 DOI: 10.1016/j.ejvs.2015.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES/BACKGROUND To examine the additional diagnostic value of magnetic resonance imaging (MRI) after administration of a weak albumin binding contrast agent in post-endovascular aneurysm repair (EVAR) patients with aneurysm growth with no or uncertain endoleak after computed tomography angiography (CTA). METHODS This was a prospective diagnostic cross sectional study carried out between April 2011 and August 2013. MRI was performed in all patients with aneurysm growth≥5 mm after EVAR implantation and no or uncertain endoleak on CTA, or the inability, on CTA, to identify the source of a visible endoleak. All MRI scans were performed on a 1.5 T clinical MRI scanner after administration of a weak albumin binding contrast agent. The presence of endoleaks was assessed by visually comparing pre- and post-contrast T1-weighted images with fat suppression. Post-contrast images were acquired 5 and 15 minutes after contrast administration. RESULTS Twenty-nine patients (26 men; 90%) with a median age of 74 years (interquartile range [IQR] 67-76) were included. The median interval between EVAR and MRI was 39 months (IQR 20-50). The median increase in maximum aneurysm diameter during total follow up after EVAR was 11 mm (IQR 6-17). At CTA, 16 patients (55%) had no detectable endoleak, five patients (17%) had suspected but uncertain endoleak, and eight patients had a definite endoleak (28%). On the post-contrast MRI images, endoleak was observed in 24 patients (83%). In all patients with uncertain endoleak on CTA, endoleak was detected with MRI. For type II endoleaks, feeding vessels were detected in 22/23 patients (96%) and these were all, except one, lumbar arteries. CONCLUSION In patients with enlarging aneurysms of unknown origin after EVAR, MRI with a weak albumin binding contrast agent has additional value for both the detection and determination of the origin of the endoleak.
Collapse
Affiliation(s)
- J Habets
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Gelre Hospitals, Apeldoorn, The Netherlands.
| | - H J A Zandvoort
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Bartels
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E P A Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
96
|
Patel D, Karcich J, Contractor S. Percutaneous embolization of a post-thoracic endovascular aortic repair aortic sac-bronchial fistula with N-butyl cyanoacrylate. J Vasc Interv Radiol 2015; 26:921-3. [PMID: 26003461 DOI: 10.1016/j.jvir.2015.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/18/2015] [Accepted: 01/19/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Dhruv Patel
- Rutgers New Jersey Medical School, H108, Newark, NJ 07101
| | - Jenika Karcich
- Rutgers New Jersey Medical School, H108, Newark, NJ 07101
| | - Sohail Contractor
- Department of Interventional Radiology, University Hospital, H108, Newark, NJ 07101
| |
Collapse
|
97
|
Evolución de endofugas tipo ii tras reparación endovascular de aneurismas aortoiliacos infrarrenales. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
98
|
Giles KA, Fillinger MF, De Martino RR, Hoel AW, Powell RJ, Walsh DB. Results of transcaval embolization for sac expansion from type II endoleaks after endovascular aneurysm repair. J Vasc Surg 2015; 61:1129-36. [DOI: 10.1016/j.jvs.2014.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/01/2014] [Indexed: 11/26/2022]
|
99
|
Wolosker N, Varella AYM, Teivelis MP, Mendes CDA, Garcia RG, Pfeferman E. Successful Image-Guided Percutaneous Embolization of a Ruptured Abdominal Aortic Aneurysm Sac due to Type II Endoleak after Endovascular Repair. Ann Vasc Surg 2015; 29:361.e1-4. [DOI: 10.1016/j.avsg.2014.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/09/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
|
100
|
Almeida BLD, Kambara AM, Rossi FH, Colli MBDO, Oliveira ESJD, Metzger PB, Beteli CB, Cavalcante SFA. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair. J Vasc Bras 2014. [DOI: 10.1590/1677-5449.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.
Collapse
|