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Oliveira NF, Gonçalves FB, Hoeks SE, Josee van Rijn M, Ultee K, Pinto JP, Raa ST, van Herwaarden JA, de Vries JPP, Verhagen HJ. Long-term outcomes of standard endovascular aneurysm repair in patients with severe neck angulation. J Vasc Surg 2018; 68:1725-1735. [DOI: 10.1016/j.jvs.2018.03.427] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
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Anatomic predictors for late mortality after standard endovascular aneurysm repair. J Vasc Surg 2018; 69:1444-1451. [PMID: 30477942 DOI: 10.1016/j.jvs.2018.07.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/29/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) management involves a decision process that takes into account anatomic characteristics, surgical risks, patients' preferences, and expected survival. Whereas larger AAA diameter has been associated with increased mortality after both standard endovascular aneurysm repair (EVAR) and open repair, it is unclear whether survival after EVAR is influenced by other anatomic characteristics. The purpose of this study was to determine the importance of baseline anatomic features on survival after EVAR. METHODS All patients treated at a tertiary teaching center with EVAR for intact standard infrarenal AAA from 2000 to 2014 were included. The civil data registry was queried to determine survival status; causes of death were obtained from death certificates. The primary study end point was to determine the impact of baseline morphologic features on all-cause and cardiovascular mortality after EVAR. RESULTS This study included 404 EVAR patients (12.1% women; mean age, 73 years) with a median follow-up of 5.8 years (interquartile range, 3.1-7.4 years). The 5- and 10-year overall survival rates for the entire population after EVAR were 70% (95% confidence interval [CI], 66%-75%) and 43% (95% CI, 37%-50%), respectively. Only AAA diameter >70 mm (hazard ratio [HR], 1.75; 95% CI, 1.20-3.56) was identified as an independent anatomic predictor of all-cause mortality. Death due to cardiovascular causes occurred in 60 (38.5%) patients. Aneurysm-related mortality was responsible for six of the cardiovascular-related deaths. In multivariable analysis, both neck diameter ≥30 mm (HR, 2.16; 95% CI, 1.05-4.43) and AAA diameter >70 mm (HR, 2.45; 95% CI, 1.34-4.46) were identified as independent morphologic risk factors for cardiovascular mortality, whereas >25% circumferential neck thrombus (HR, 0.32; 95% CI, 0.13-0.77) was protective. CONCLUSIONS This study suggests that patients with AAA diameters >70 mm are at increased risk of all-cause and cardiovascular mortality. In addition, patients with infrarenal neck diameters ≥30 mm have a greater risk of cardiovascular mortality, although AAA-related deaths were not more frequent in this group of patients. Consequently, a more aggressive management of cardiovascular medical comorbidities may be warranted to improve survival after standard EVAR in these patients.
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Soult MC, Cheng BT, Mansukhani NA, Rodriguez HE, Eskandari MK, Hoel AW. There Is Limited Value in the One Month Post Endovascular Aortic Aneurysm Repair Surveillance Computed Tomography Scan. Ann Vasc Surg 2018; 54:27-32. [PMID: 30253190 DOI: 10.1016/j.avsg.2018.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/06/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Endovascular aortic aneurysm repair (EVAR) is the preferred first-line treatment for abdominal aortic aneurysms. Current postprocedure surveillance recommendations by manufacturers are a 1-month computed tomography angiography (CTA) followed by a 12-month CTA in most circumstances. The objective of this study is to determine the utility of the 1-month CTA following elective EVAR and determine if initial surveillance at 6-month CTA is appropriate. METHODS A single-center retrospective chart review of all elective EVARs at a tertiary medical center over a 12-year period was conducted. Patients were excluded if postoperative surveillance imaging was not available. Data analysis encompassed demographics, chart review, and imaging including angiogram and cross-sectional imaging to asses for endoleaks and other findings. RESULTS There were 363 patients who underwent elective EVAR and had available postoperative imaging during the study period. Within the 1-month follow-up, a CTA group of 316 patients was detected with 98 (31%) endoleaks. Of these, 5 (1.5%) required intervention: 1 for infolding of an iliac limb and 4 for type I endoleak which was present on completion angiogram-3 in patients treated outside of instructions for use and 1 with a type Ib endoleak on intraoperative completion imaging. In the 158 patients with 1 and 3-month CTAs, there were 47 persistent endoleaks, 9 previously undetected endoleaks not seen in 1-month CTA, and 13 resolved endoleaks. Three patients (1.2%) underwent intervention for type II endoleak and aneurysm expansion. In 47 patients with only a 6-month CTA, there were 16 endoleaks not seen on completion angiography and 2 of which were treated with reintervention-1 for a type I endoleak and 1 for a type II endoleak. CONCLUSIONS There is limited utility to 1-month surveillance CTA in patients undergoing elective EVAR within the device instructions for use that has no evidence of type I endoleak on completion angiography. It is safe to start routine EVAR surveillance at 6 months in this patient population. This has implications when considering bundled and value-based payments in the longitudinal care of abdominal aortic aneurysm patients.
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Affiliation(s)
- Michael C Soult
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian T Cheng
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Neel A Mansukhani
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Partovi S, Trischman T, Rafailidis V, Ganguli S, Rengier F, Goerne H, Rajiah P, Staub D, Patel IJ, Oliveira G, Ghoshhajra B. Multimodality imaging assessment of endoleaks post-endovascular aortic repair. Br J Radiol 2018; 91:20180013. [PMID: 29658769 DOI: 10.1259/bjr.20180013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Endoleaks are a common complication of endovascular aortic repair (EVAR). As a result, patients require lifelong imaging surveillance following EVAR. In current clinical practice, evaluation for endoleaks is predominantly performed with CT angiography (CTA). Due to the significant cumulative radiation burden associated with repetitive CTA imaging, as well as the repeated administration of nephrotoxic contrast agent, contrast-enhanced ultrasound (CEUS) and magnetic resonance angiography (MRA) have evolved as potential modalities for lifelong surveillance post-EVAR. In this paper, multimodality imaging, including CTA, CEUS and MRA, for the surveillance of endoleaks is discussed. Further, new CTA techniques for radiation reduction are elaborated. Additionally, imagery for three cases of aortic endoleak detection using CTA and five cases using MRA are presented. Imaging for different types of endoleaks with CTA, MRA and CEUS are presented. For lifelong endoleak surveillance post-EVAR, CTA is still regarded as the imaging modality of choice. However, advancements in CEUS and MRA technique enable partial replacement of CTA in certain patients.
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Affiliation(s)
- Sasan Partovi
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University , Cleveland, OH , USA
| | - Thomas Trischman
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University , Cleveland, OH , USA
| | - Vasileios Rafailidis
- 2 Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Suvranu Ganguli
- 3 Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Fabian Rengier
- 4 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg , Heidelberg , Germany
| | - Harold Goerne
- 5 Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center , Dallas, TX , USA
| | - Prabhakar Rajiah
- 5 Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center , Dallas, TX , USA
| | - Daniel Staub
- 6 Department of Vascular Medicine, University Hospital Basel, University of Basel , Basel , Switzerland
| | - Indravadan J Patel
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University , Cleveland, OH , USA
| | - George Oliveira
- 3 Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Brian Ghoshhajra
- 3 Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Baderkhan H, Haller O, Wanhainen A, Björck M, Mani K. Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging. Br J Surg 2018; 105:709-718. [DOI: 10.1002/bjs.10766] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/13/2017] [Accepted: 10/22/2017] [Indexed: 02/01/2023]
Abstract
Abstract
Background
Lifelong postoperative surveillance is recommended following endovascular aneurysm repair (EVAR). Although the purpose is to prevent and/or identify complications early, it also results in increased cost and workload. This study was designed to examine whether it may be possible to identify patients at low risk of complications based on their first postoperative CT angiogram (CTA).
Methods
All patients undergoing EVAR in two Swedish centres between 2001 and 2012 were identified retrospectively and categorized based on the first postoperative CTA as at low risk (proximal and distal sealing zone at least 10 mm and no endoleak) or high risk (sealing zone less than 10 mm and/or presence of any endoleak) of complications.
Results
Some 326 patients (273 men) with a CTA performed less than 1 year after EVAR were included (low risk 212, 65·0 per cent; high risk 114, 35·0 per cent). There was no difference between the groups in terms of sex, age, co-morbidities, abdominal aortic aneurysm (AAA) diameter, preoperative AAA neck anatomy, stent-graft type or duration of follow-up (mean(s.d.) 4·8(3·2) years). Five-year freedom from AAA-related adverse events was 97·1 and 47·7 per cent in the low- and high-risk groups respectively (P < 0·001). The corresponding freedom from AAA-related reintervention was 96·2 and 54·1 per cent (P < 0·001). The method had a sensitivity of 88·3 per cent, specificity of 77·0 per cent and negative predictive value of 96·6 per cent to detect AAA-related adverse events. The number of surveillance imaging per AAA-related adverse event was 168 versus 11 for the low-risk versus high-risk group.
Conclusion
Two-thirds of patients undergoing EVAR have an adequate seal and no endoleak on the first postoperative CTA, and a very low risk of AAA-related events up to 5 years. Less vigilant follow-up after EVAR may be considered for these patients.
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Affiliation(s)
- H Baderkhan
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - O Haller
- Department of Radiology, Gävle Hospital, Gävle, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Schuurmann RCL, van Noort K, Overeem SP, van Veen R, Ouriel K, Jordan WD, Muhs BE, ‘t Mannetje YW, Reijnen MMPJ, Fioole B, Ünlü Ç, Brummel P, de Vries JPPM. Determination of Endograft Apposition, Position, and Expansion in the Aortic Neck Predicts Type Ia Endoleak and Migration After Endovascular Aneurysm Repair. J Endovasc Ther 2018; 25:366-375. [DOI: 10.1177/1526602818764616] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe the added value of determining changes in position and apposition on computed tomography angiography (CTA) after endovascular aneurysm repair (EVAR) to detect early caudal displacement of the device and to prevent type Ia endoleak. Methods: Four groups of elective EVAR patients were selected from a dataset purposely enriched with type Ia endoleak and migration (>10 mm) cases. The groups included cases of late type Ia endoleak (n=36), migration (n=9), a type II endoleak (n=16), and controls without post-EVAR complications (n=37). Apposition of the endograft fabric with the aortic neck, shortest distance between the fabric and the renal arteries, expansion of the main body (or dilatation of the aorta in the infrarenal sealing zone), and tilt of the endograft toward the aortic axis were determined on the first postoperative and the last available CTA scan without type Ia endoleak or migration. Differences in these endograft dimensions were compared between the first vs last scan and among the 4 groups. Results: No significant differences in endograft configurations were observed among the groups on the first postoperative CTA scan. On the last CTA scan before a complication arose, the position of the fabric relative to the renal arteries, expansion of the main body, and apposition of the fabric with the aortic neck were significantly different between the type Ia endoleak (median follow-up 15 months) and migration groups (median follow-up 23 months) compared with the control group (median follow-up 19 months). Most endograft dimensions had changed significantly compared with the first postoperative CTA scan for all groups. Apposition had increased in the control group but had decreased significantly in the type Ia endoleak and migration groups. Conclusion: Progressive changes in dimensions of the endograft within the infrarenal neck could be detected on regular CTA scans before the complication became urgent in many patients.
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Affiliation(s)
- Richte C. L. Schuurmann
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands
| | - Kim van Noort
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands
| | - Simon P. Overeem
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands
| | - Ruben van Veen
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Engineering, University of Twente, Enschede, the Netherlands
| | | | - William D. Jordan
- Department of Vascular Surgery, Emory University Hospital, Atlanta, GA, USA
| | | | | | | | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands
| | - Peter Brummel
- Department of Vascular Surgery, Franciscus Hospital, Roosendaal, the Netherlands
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57
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Grima MJ, Boufi M, Law M, Jackson D, Stenson K, Patterson B, Loftus I, Thompson M, Karthikesalingam A, Holt P. Editor's Choice - The Implications of Non-compliance to Endovascular Aneurysm Repair Surveillance: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2018; 55:492-502. [PMID: 29307756 PMCID: PMC6481561 DOI: 10.1016/j.ejvs.2017.11.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/27/2017] [Indexed: 10/25/2022]
Abstract
OBJECTIVE/BACKGROUND Increasingly, reports show that compliance rates with endovascular aneurysm repair (EVAR) surveillance are often suboptimal. The aim of this study was to determine the safety implications of non-compliance with surveillance. METHODS The study was carried out according to the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search was undertaken by two independent authors using Embase, MEDLINE, Cochrane, and Web of Science databases from 1990 to July 2017. Only studies that analysed infrarenal EVAR and had a definition of non-compliance described as weeks or months without imaging surveillance were analysed. Meta-analysis was carried out using the random-effects model and restricted maximum likelihood estimation. RESULTS Thirteen articles (40,730 patients) were eligible for systematic review; of these, seven studies (14,311 patients) were appropriate for comparative meta-analyses of mortality rates. Three studies (8316 patients) were eligible for the comparative meta-analyses of re-intervention rates after EVAR and four studies (12,995 patients) eligible for meta-analysis for abdominal aortic aneurysm related mortality (ARM). The estimated average non-compliance rate was 42.0% (95% confidence interval [CI] 28-56%). Although there is some evidence that non-compliant patients have better survival rates, there was no statistically significant difference in all cause mortality rates (year 1: odds ratio [OR] 5.77, 95% CI 0.74-45.14; year 3: OR 2.28, 95% CI 0.92-5.66; year 5: OR 1.81, 95% CI 0.88-3.74) and ARM (OR 1.47, 95% CI 0.99-2.19) between compliant and non-compliant patients in the first 5 years after EVAR. The re-intervention rate was statistically significantly higher in compliant patients from 3 to 5 years after EVAR (year 1: OR 6.36, 95% CI 0.23-172.73; year 3: OR 3.94, 85% CI 1.46-10.69; year 5: OR 5.34, 95% CI 1.87-15.29). CONCLUSION This systematic review and meta-analysis suggests that patients compliant with EVAR surveillance programmes may have an increased re-intervention rate but do not appear to have better survival rates than non-compliant patients.
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Affiliation(s)
- Matthew Joe Grima
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
| | - Mourad Boufi
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Aix-Marseille Université, CNRS, IRPHE UMR 7342, Marseille, France; APHM, Department of Vascular Surgery, University Hospital Nord, Marseille, France
| | - Martin Law
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Dan Jackson
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Kate Stenson
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Benjamin Patterson
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Ian Loftus
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Matt Thompson
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Alan Karthikesalingam
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Peter Holt
- St George's Vascular Institute, St George's Hospital, NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
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58
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Bastos Gonçalves F, Verhagen HJM. Commentary: New Tools on the Horizon to Assess the Accuracy of Aortic Stent-Graft Deployment. J Endovasc Ther 2017; 24:707-708. [PMID: 28925336 DOI: 10.1177/1526602817725060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Frederico Bastos Gonçalves
- 1 Angiology and Vascular Surgery Department, Hospital de Santa Marta, CHLC & NOVA Medical School, Lisbon, Portugal
| | - Hence J M Verhagen
- 2 Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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59
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Unexplained rupture after endovascular aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 3:126-128. [PMID: 29349398 PMCID: PMC5764860 DOI: 10.1016/j.jvscit.2017.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/28/2017] [Indexed: 12/03/2022]
Abstract
We present a case of a 70-year-old man who was admitted with rupture of an abdominal aneurysm 4 years after endovascular aneurysm repair. He was compliant with yearly follow-up computed tomography angiography. One month earlier, his computed tomography angiogram showed perfect exclusion of the aneurysm and no endoleak. We explanted the stent graft and confirmed effective sealing, and the graft was intact. We found no signs of infection during 2 years of follow-up. This rupture is nonpredictable and unexplained and illustrates that unremarkable imaging does not guarantee prevention of rupture. This case shows that the ultimate failure of endovascular aneurysm repair cannot be prevented despite surveillance protocols.
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60
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Schuurmann RCL, Overeem SP, Ouriel K, Slump CH, Jordan WD, Muhs BE, de Vries JPPM. A Semiautomated Method for Measuring the 3-Dimensional Fabric to Renal Artery Distances to Determine Endograft Position After Endovascular Aneurysm Repair. J Endovasc Ther 2017; 24:698-706. [DOI: 10.1177/1526602817719882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a methodology for 3-dimensional (3D) assessment of the stent-graft deployment accuracy after endovascular aneurysm repair (EVAR). Methods: A methodology was developed and validated to calculate the 3D distances between the endograft fabric and the renal arteries over the curve of the aorta. The shortest distance between one of the renal arteries and the fabric (SFD) and the distance from the contralateral renal artery to the fabric (CFD) were determined on the first postoperative computed tomography (CT) scan of 81 elective EVAR patients. The SFDs were subdivided into a target position (0–3 mm distal to the renal artery), high position (partially covering the renal artery), and low position (>3 mm distal to the renal artery). Data are reported as the median (interquartile range, IQR). Results: Intra- and interobserver agreements for automatic and manual calculation of the SFD and CFD were excellent (ICC >0.892, p<0.001). The median SFD was 1.4 mm (IQR −0.9, 3.0) and the median CFD was 8.0 mm (IQR 3.9, 14.2). The target position was achieved in 44%, high position in 30%, and low position in 26% of the patients. The median slope of the endograft toward the higher renal artery was 2.5° (IQR −5.5°, 13.9°). Conclusion: The novel methodology using 3D CT reconstructions enables accurate evaluation of endograft position and slope within the proximal aortic neck. In this series, only 44% of endografts were placed within the target position with regard to the lowermost renal artery.
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Affiliation(s)
- Richte C. L. Schuurmann
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Simon P. Overeem
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | | | - Cornelis H. Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - William D. Jordan
- Department of Vascular Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Patel SR, Allen C, Grima MJ, Brownrigg JRW, Patterson BO, Holt PJE, Thompson MM, Karthikesalingam A. A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance. Vasc Endovascular Surg 2017; 51:417-428. [PMID: 28656809 DOI: 10.1177/1538574417712648] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current surveillance protocols after endovascular aneurysm repair (EVAR) are ineffective and costly. Stratifying surveillance by individual risk of reintervention requires an understanding of the factors involved in developing post-EVAR complications. This systematic review assessed risk factors for reintervention after EVAR and proposals for stratified surveillance. METHODS A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting on risk factors predicting reintervention after EVAR and proposals for stratified surveillance. RESULTS Twenty-nine studies reporting on 39 898 patients met the primary inclusion criteria for reporting predictors of reintervention or aortic complications with or without suggestions for stratified surveillance. Five secondary studies described external validation of risk scores for reintervention or aortic complications. There was great heterogeneity in reporting risk factors identified at the pre-EVAR, intraoperative, and post-EVAR stages of treatment, although large preoperative abdominal aortic aneurysm diameter was the most commonly observed risk factor for reintervention after EVAR. CONCLUSION Existing data on predictors of post-EVAR complications are generally of poor quality and largely derived from retrospective studies. Few studies describing suggestions for stratified surveillance have been subjected to external validation. There is a need to refine risk prediction for EVAR failure and to conduct prospective comparative studies of personalized surveillance with standard practice.
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Affiliation(s)
- Shaneel R Patel
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Chris Allen
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Matthew J Grima
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Jack R W Brownrigg
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Benjamin O Patterson
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Peter J E Holt
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Matt M Thompson
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
| | - Alan Karthikesalingam
- 1 Department of Outcomes Research, St George's Vascular Institute, St George's Hospital NHS Trust, London, United Kingdom
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Oliveira NF, Bastos Gonçalves FM, Van Rijn MJ, de Ruiter Q, Hoeks S, de Vries JPP, van Herwaarden JA, Verhagen HJ. Standard endovascular aneurysm repair in patients with wide infrarenal aneurysm necks is associated with increased risk of adverse events. J Vasc Surg 2017; 65:1608-1616. [DOI: 10.1016/j.jvs.2016.09.052] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022]
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63
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Lalys F, Daoudal A, Gindre J, Göksu C, Lucas A, Kaladji A. Influencing factors of sac shrinkage after endovascular aneurysm repair. J Vasc Surg 2017; 65:1830-1838. [DOI: 10.1016/j.jvs.2016.12.131] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022]
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64
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Chen PL, Hsu HL, Chen IM, Chen YY, Chou KY, Kuo TT, Shih CC. The Impact of Aortic Tortuosity on Delayed Type I or III Endoleak after Endovascular Aortic Repair. Ann Vasc Surg 2017; 41:110-117. [DOI: 10.1016/j.avsg.2016.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/31/2016] [Accepted: 09/03/2016] [Indexed: 11/30/2022]
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Could Preoperative Neck Anatomy Influence Follow-up of EVAR? Ann Vasc Surg 2017; 43:127-133. [PMID: 28390913 DOI: 10.1016/j.avsg.2016.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/13/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of the study was to assess the clinical utility of strict CT scan surveillance after endovascular abdominal aneurysm repair (EVAR) and evaluate whether the anatomy of abdominal aortic aneurysm (AAA) neck (favorable/hostile) influences regular imaging control. METHODS A retrospective study of AAA patients who underwent EVAR with aortobi-iliac endoprostheses during 2006-2013 was conducted. Exclusion criteria included other types of devices. Variables analyzed were technical and clinical success, morbimortality, complications (such as endoleaks, sac enlargement), reinterventions, reintervention-free survival, and survival rate. Preoperative CT scans were performed and repeated at 1, 6 (in selective cases), 12, and 24 months postoperatively. Patients were divided into two groups according to preoperative anatomic characteristics: group I (favorable neck) and group II (hostile neck: angle > 60°, length < 15 mm, diameter > 28 mm, and calcification or circumference thrombus ≥50%). RESULTS A total of 127 patients with AAA (96.8% male) were included in the study. The mean age of the patients was 75.9 years (range: 51-90 years). The mean AAA diameter was 62.1 mm. Hostile neck was found in 52 patients (40.9%). The technical and clinical success rate was 100% and 30-day mortality was 0.8%. The reintervention-free survival rate was 97.6%, 96.1%, and 93.7% and the survival rate was 97.6%, 96.9%, and 91.3%, during follow-up at 6, 12, and 24 months, respectively. Accumulated complications in proximal sealing occurred in 0%, 0%, and 1.6% in group I and 1.9%, 6.1%, and 7.7% in group II at 1, 12, and 24 months, respectively. Type II endoleaks occurred in 24.3%, 14.3%, and 11.4% in group I and 9.8%, 6.3%, and 6.8% in group II at 1, 12, and 24 months, respectively. No increased diameter was detected at 6 and 12 months. No differences were observed in reinterventions and mortality rate depending on anatomy. CONCLUSIONS CT scans performed at 6 and 12 months postoperatively did not detect complications or need for reintervention in patients with favorable necks, even in the presence of endoleaks type II, and could therefore be omitted. Hostile necks may compromise proximal sealing and require regular imaging follow-ups.
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Hicks CW, Zarkowsky DS, Bostock IC, Stone DH, Black JH, Eldrup-Jorgensen J, Goodney PP, Malas MB. Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes. J Vasc Surg 2017; 65:1625-1635. [PMID: 28216362 DOI: 10.1016/j.jvs.2016.10.106] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/25/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Society for Vascular Surgery practice guidelines recommend 1- and 12-month follow-up with computed tomography imaging for the year after endovascular aneurysm repair (EVAR). We describe the incidence, risk factors, and outcomes of EVAR patients who are lost to follow-up (LTF). METHODS All patients undergoing elective EVAR in the Vascular Quality Initiative (VQI) data set (January 2003-December 2015) were stratified according to long-term follow-up method (in-person vs phone call vs LTF). Mortality was captured for all patients by linkage with the Social Security Death Index. Univariable statistics, Kaplan-Meier estimated survival curves, and Cox proportional hazard modeling were used to compare groups. Coarsened exact matching analysis was then performed to refine the association between LTF and risk of post-EVAR death. RESULTS During the study period, 11,309 patients underwent elective EVAR (78% in-person follow-up, 11% phone call follow-up, 11% LTF). On univariable analysis, LTF patients had larger baseline aneurysms, higher American Society of Anesthesiologists scores, more comorbidities, and worse baseline functional status compared to patients with in-person or phone call follow-up (P ≤ .05). Procedural factors (contrast material volume, blood transfusions, postoperative vasopressor use) were higher in the LTF group, as was the incidence of postoperative complications (P ≤ .05). Accordingly, LTF patients had longer postoperative lengths of stay and were less frequently discharged to home (P < .001). Five-year survival was lower for LTF vs phone call follow-up vs in-person follow-up (62% vs 68% vs 84%; P < .001). On multivariable analysis correcting for baseline differences between groups, there was a significantly higher risk of death for both the LTF group (hazard ratio, 6.45; 95% confidence interval, 4.89-8.51) and phone call follow-up group (hazard ratio, 3.48; 95% confidence interval, 2.66-4.57) compared with patients who followed up in person (P < .001). After coarsened exact matching on 30 preoperative and perioperative variables, 5-year survival after EVAR for LTF vs phone call follow-up vs in-person follow-up was 84.9% vs 84.8% vs 91.9%, respectively (log-rank, P < .001). Notably, patients with phone call follow-up had a lower prevalence of documented postoperative imaging compared with patients with in-person follow-up (56.1% vs 85.1%; P < .001). CONCLUSIONS EVAR patients with more comorbidities and a higher incidence of in-hospital complications tend to be more frequently LTF and ultimately have worse survival outcomes. In-person follow-up is associated with better post-EVAR survival and a higher rate of postoperative imaging. Phone follow-up confers a mortality risk equivalent to lack of follow-up, possibly as a result of inadequate postoperative imaging. Surgeons should stress the importance of office-based postoperative follow-up to all EVAR patients, particularly those with poor baseline health and functional status and more complicated perioperative courses.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, Md.
| | - Devin S Zarkowsky
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Ian C Bostock
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David H Stone
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, Md
| | - Jens Eldrup-Jorgensen
- Division of Vascular Surgery and Endovascular Therapy, Maine Medical Center, Portland, Me
| | - Philip P Goodney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mahmoud B Malas
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, Md
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Bastos Gonçalves F, Oliveira N, Josee van Rijn M, Ultee K, Hoeks S, Ten Raa S, Stolker R, Verhagen H. Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2017; 53:185-192. [DOI: 10.1016/j.ejvs.2016.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/03/2016] [Indexed: 11/30/2022]
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Aoki A, Maruta K, Hosaka N, Omoto T, Masuda T, Gokan T. Evaluation and Coil Embolization of the Aortic Side Branches for Prevention of Type II Endoleak after Endovascular Repair of Abdominal Aortic Aneurysm. Ann Vasc Dis 2017. [PMID: 29515695 PMCID: PMC5835439 DOI: 10.3400/avd.oa.17-00088] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: Aneurysm shrinkage after EVAR is the strong factor of favorable outcomes after endovascular abdominal aortic aneurysm repair (EVAR), and type II endoleaks is the risk factor of no aneurysm shrinkage or aneurysm enlargement in the long term. In this study, we evaluate the aortic side branches relate to early postoperative type II endoleak, and performed coil embolization for those vessels for prevention of type II endoleak. Methods: Patency and diameter of aortic side branches including inferior mesenteric artery (IMA) and lumbar artery (LA) were evaluated in 56 consecutive patients with abdominal aortic aneurysm who were scheduled for EVAR. Coil embolization with Interlock was performed in 24 patients during EVAR for all patent IMA and LA with maximal diameter more than 2.0 mm. Computed tomography was performed one week after EVAR for evaluation of endoleak. Results: In patients with IMA more than 2.5 mm in diameter, the frequency of type II endoleak was approximately 90% regardless of the number of patent LA. In case with patent IMA less than 2.5 mm or with 2 or more patent LA larger than 2.0 mm, the frequency of type II endoleak was 46 to 67%. Coil embolization for IMA was successfully performed in 15/16 patients (94%). Coil embolization of LA was performed for patent LA larger than 2.0 mm and 29 out of 45 LA (64%) were successfully occluded. There was no perioperative complication associated with coil embolization. The frequency of type II endoleak was significantly lower in patients with coil embolization than those without coil embolization (4.2% vs 58.9%, p<0.0001). Conclusion: Patent IMA and LA in diameter larger than 2.0 mm were associated with type II endoleak one week after EVAR, and coil embolization with Interlock during EVAR is safe and effective procedure to prevent type II endoleak. (This is a translation of Jpn J Vasc Surg 2016; 25: 321–328.)
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Affiliation(s)
- Atsushi Aoki
- Department of Cardiovascular Surgery, Showa University, Tokyo, Japan
| | - Kazuto Maruta
- Department of Cardiovascular Surgery, Showa University, Tokyo, Japan
| | | | - Tadashi Omoto
- Department of Cardiovascular Surgery, Showa University, Tokyo, Japan
| | - Tomoaki Masuda
- Department of Cardiovascular Surgery, Showa University, Tokyo, Japan
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Hammond CJ, Shah AH, Snoddon A, Patel JV, Scott DJA. Mortality and Rates of Secondary Intervention After EVAR in an Unselected Population: Influence of Simple Clinical Categories and Implications for Surveillance. Cardiovasc Intervent Radiol 2016; 39:815-23. [DOI: 10.1007/s00270-016-1303-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/05/2016] [Indexed: 12/01/2022]
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Management of Aortic Sac Enlargement Following Successful EVAR in a Frail Patient. Eur J Vasc Endovasc Surg 2016; 51:302-8. [DOI: 10.1016/j.ejvs.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022]
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Cassagnes L, Pérignon R, Amokrane F, Petermann A, Bécaud T, Saint-Lebes B, Chabrot P, Rousseau H, Boyer L. Aortic stent-grafts: Endoleak surveillance. Diagn Interv Imaging 2016; 97:19-27. [DOI: 10.1016/j.diii.2014.12.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
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Törnqvist P, Dias N, Sonesson B, Kristmundsson T, Resch T. Intra-operative Cone Beam Computed Tomography can Help Avoid Reinterventions and Reduce CT Follow up after Infrarenal EVAR. Eur J Vasc Endovasc Surg 2015; 49:390-5. [DOI: 10.1016/j.ejvs.2015.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
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Regarding "Remodeling of aortic aneurysm and aortic neck on follow-up after endovascular repair with suprarenal fixation". J Vasc Surg 2015; 61:840. [PMID: 25720938 DOI: 10.1016/j.jvs.2014.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022]
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Reply: To PMID 25153490. J Vasc Surg 2015; 61:840-1. [PMID: 25720939 DOI: 10.1016/j.jvs.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/13/2014] [Indexed: 11/23/2022]
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Oliveira N, Bastos Gonçalves F, de Vries JP, Ultee K, Werson D, Hoeks S, Moll F, van Herwaarden J, Verhagen H. Mid-Term Results of EVAR in Severe Proximal Aneurysm Neck Angulation. Eur J Vasc Endovasc Surg 2015; 49:19-27. [DOI: 10.1016/j.ejvs.2014.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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Gill HL, Ladowski S, Sudarshan M, Mackenzie KS, Corriveau MM, Abraham CZ, Obrand DI, Steinmetz OK. Predictive value of negative initial postoperative imaging after endovascular aortic aneurysm repair. J Vasc Surg 2014; 60:325-9. [DOI: 10.1016/j.jvs.2014.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
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Bastos Gonçalves F, Baderkhan H, Verhagen HJM, Wanhainen A, Björck M, Stolker RJ, Hoeks SE, Mani K. Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair. Br J Surg 2014; 101:802-10. [PMID: 24752772 PMCID: PMC4164270 DOI: 10.1002/bjs.9516] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance. METHODS Patients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6-18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks. RESULTS Some 597 EVARs (71.1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47.6 per cent), moderate shrinkage (5-9 mm) in 142 (23.8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28.6 per cent). Four years after the index imaging, the rate of freedom from complications was 84.3 (95 per cent confidence interval 78.7 to 89.8), 88.1 (80.6 to 95.5) and 94.4 (90.1 to 98.7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3.11; P < 0.001). Moderate compared with major shrinkage (HR 2.10; P = 0.022), early postoperative complications (HR 3.34; P < 0.001) and increasing abdominal aortic aneurysm baseline diameter (HR 1.02; P = 0.001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage. CONCLUSION Early change in aneurysm sac diameter is a strong predictor of late complications after EVAR. Patients with major sac shrinkage have a very low risk of complications for up to 5 years. This parameter may be used to tailor postoperative surveillance.
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Affiliation(s)
- F Bastos Gonçalves
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Tse DML, Tapping CR, Patel R, Morgan R, Bratby MJ, Anthony S, Uberoi R. Surveillance After Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2014; 37:875-88. [DOI: 10.1007/s00270-014-0916-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 04/03/2014] [Indexed: 02/05/2023]
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Surveillance Computed Tomographic Arteriogram Does Not Change Management before 3 Years in Patients Who Have a Normal Post-EVAR Study. Ann Vasc Surg 2014; 28:831-6. [DOI: 10.1016/j.avsg.2013.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/13/2013] [Accepted: 09/29/2013] [Indexed: 11/19/2022]
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Type II endoleak is an enigmatic and unpredictable marker of worse outcome after endovascular aneurysm repair. J Vasc Surg 2014; 59:930-7. [DOI: 10.1016/j.jvs.2013.10.092] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 11/21/2022]
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van de Luijtgaarden KM, Bastos Gonçalves F, Hoeks SE, Majoor-Krakauer D, Rouwet EV, Stolker RJ, Verhagen HJ. Familial abdominal aortic aneurysm is associated with more complications after endovascular aneurysm repair. J Vasc Surg 2014; 59:275-82. [DOI: 10.1016/j.jvs.2013.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
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Ambulatory percutaneous endovascular abdominal aortic aneurysm repair. J Vasc Surg 2014; 59:58-64. [DOI: 10.1016/j.jvs.2013.06.076] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 12/17/2022]
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Vallabhaneni R, Farber MA, Schneider F, Ricco JB. Debate: Whether young, good-risk patients should be treated with endovascular abdominal aortic aneurysm repair. J Vasc Surg 2013; 58:1709-15. [DOI: 10.1016/j.jvs.2013.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Part Two: Against the Motion. Young Patients with Good Risk Factors Should not be Treated with EVAR. Eur J Vasc Endovasc Surg 2013; 46:618-21. [DOI: 10.1016/j.ejvs.2013.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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