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Open Conversion After Endovascular Aortic Aneurysm Repair: A Single-Center Experience. Ann Vasc Surg 2013; 27:856-64. [DOI: 10.1016/j.avsg.2012.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/10/2012] [Accepted: 06/14/2012] [Indexed: 11/21/2022]
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152
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Short-term curative effect of endovascular stent-graft treatment for aortic diseases in China: a systematic review. PLoS One 2013; 8:e71012. [PMID: 23951070 PMCID: PMC3741387 DOI: 10.1371/journal.pone.0071012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), type A aortic dissection (type A AD) and type B aortic dissection (type B AD) in China. METHODS We performed a systematic analysis of 935 published series on retrograde endovascular treatment for aortic diseases in China from January 1996 to November 2010. Based on the inclusion criteria, 159 studies, involving a total of 5531 patients, were included. RESULTS There were no significant differences in procedural success among the studies (P>0.05). The rates of overall neurologic complications and stroke were significantly different in all two-group comparisons (P<0.01). The type A AD patients had the highest rates of neurologic complications (both 6.67±0.00%), and the AAA patients had the lowest rates (0.31±0.04% and 0.11±0.02%). Significant differences were noted in the rates of cardiac, renal, pulmonary and visceral complications, which were all higher in the type A AD patients than in the other three groups (P<0.01). The endoleak rate was highest in the TAA patients (19.27±5.74%) and was similar in the type A AD patients (P>0.05). A significant difference was noted between the 30-day mortality rate of the type A AD patients and the AAA or type B AD patients (P<0.05). CONCLUSION Endovascular stent-graft is a feasible and safe treatment for aortic diseases, with high procedural success and low incidences of post-procedural complications and short-term mortality. Endovascular treatment for AAA and type B AD is more efficient than for type A AD and TAA.
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153
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Ward TJ, Cohen S, Fischman AM, Kim E, Nowakowski FS, Ellozy SH, Faries PL, Marin ML, Lookstein RA. Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up. J Vasc Interv Radiol 2013; 24:49-55. [PMID: 23273697 DOI: 10.1016/j.jvir.2012.09.022] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To review the effect of preoperative embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) on subsequent endoleaks and aneurysm growth. MATERIALS AND METHODS Between August 2002 and May 2010, 108 patients underwent IMA embolization before EVAR. Coil embolization was performed in all patients in whom the IMA was successfully visualized and accessed during preoperative conventional angiography. In this cohort, the incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and repeat intervention were compared with a group of 158 consecutive patients with a patent IMA on preoperative computed tomography angiography but not on conventional angiography, who therefore did not undergo preoperative embolization. RESULTS The incidence of type II endoleak was significantly higher in patients not treated with embolization (49.4% [78 of 158] vs 34.3% [37 of 108]; P = .015). The incidence of secondary intervention for type II endoleak embolization was also significantly higher in those who did not undergo embolization (7.6% [12 of 158] vs 0.9% [one of 108]; P = .013). At 24 months, an increase in aneurysm sac volume was observed in 47% of patients in the nonembolized cohort (21 of 45), compared with 26% of patients in the embolized cohort (13 of 51; P = .03). No aneurysm ruptures or aneurysm-related deaths were observed in either group. One patient in the embolization group developed mesenteric ischemia and ultimately died. CONCLUSIONS Preoperative embolization of the IMA was associated with reduced incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and secondary intervention.
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Affiliation(s)
- Thomas J Ward
- Department of Interventional Radiology, Mount Sinai Medical Center, New York, NY 10029, USA
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154
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Perot C, Sobocinski J, Maurel B, Millet G, Guillou M, d’Elia P, Amiot S, Wattez H, Bohnert A, Azzaoui R, Haulon S. Comparison of Short- and Mid-Term Follow-Up Between Standard and Fenestrated Endografts. Ann Vasc Surg 2013; 27:562-70. [DOI: 10.1016/j.avsg.2011.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/14/2011] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
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155
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Millen A, Canavati R, Harrison G, McWilliams RG, Wallace S, Vallabhaneni SR, Fisher RK. Defining a role for contrast-enhanced ultrasound in endovascular aneurysm repair surveillance. J Vasc Surg 2013; 58:18-23. [DOI: 10.1016/j.jvs.2012.12.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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156
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Patel A, Edwards R, Chandramohan S. Surveillance of patients post-endovascular abdominal aortic aneurysm repair (EVAR). A web-based survey of practice in the UK. Clin Radiol 2013; 68:580-7. [DOI: 10.1016/j.crad.2012.11.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 12/11/2022]
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157
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Bastos Gonçalves F, van de Luijtgaarden KM, Hoeks SE, Hendriks JM, ten Raa S, Rouwet EV, Stolker RJ, Verhagen HJ. Adequate seal and no endoleak on the first postoperative computed tomography angiography as criteria for no additional imaging up to 5 years after endovascular aneurysm repair. J Vasc Surg 2013; 57:1503-11. [DOI: 10.1016/j.jvs.2012.11.085] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/20/2012] [Accepted: 11/21/2012] [Indexed: 11/27/2022]
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Abstract
Currently the majority of infrarenal abdominal aortic aneurysm repairs are endovascular procedures using a stent graft. This method continues to be questioned due to an up to 50 % incidence of endoleaks, i.e. the postinterventional persistence of blood flow outside the graft and within the aneurysm sac, potentially bearing the risk of a further increase of the aneurysm diameter and aneurysm rupture. Currently a total of five different endoleak types can be distinguished. Multiphase computed tomography (CT) is the standard imaging method for the detection and classification of endoleaks or alternatively contrast-enhanced ultrasound can be used. The different types of endoleak have very different therapeutic implications. In direct endoleaks (types I and III) the systemic blood pressure is directly transferred to the aneurysm wall which carries a high risk of rupture and in general an immediate intervention is indicated. Indirect endoleaks (types II, IV and V) take a more benign course and in the majority of cases treatment is only necessary when further aneurysm expansion occurs.
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Affiliation(s)
- O Dudeck
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke-Universität, Leipziger Str. 44, 39120 Magdeburg, Deutschland.
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159
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Filippi F, Tirotti C, Stella N, Rizzo L, Taurino M. Endotension-related aortic sac rupture treated by endograft relining. Vascular 2013; 21:113-5. [PMID: 23526100 DOI: 10.1177/1708538113478725] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endovascular aortic aneurysm repair is an effective alternative to open surgical repair in high risk patient. Endotension is an unpredictable late and rare complication of EVAR. Clinical significance and choice of technique for treatment are controversial. At present, there are no cases of endotension-related aneurysmal sac rupture reported in literature, altough it is frequently associated with late surgical conversion. In this case report is described a case of a patient treated with a first generation Gore Excluder(TM) endograft for abdominal aortic aneurysm, with late aneurysmal sac enlargement without evidence of endoleak and subsequent contained rupture without anemia and shock. We have successfully treated the patient by endovascular procedure, through bilateral percutaneous femoral approach, with relining technique. Three years CT scan follow-up showed the endograft patency and size sac reduction.
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Affiliation(s)
- F Filippi
- University of Roma La Sapienza, Sant'Andrea Hospital, Italy
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160
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Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg 2013; 57:1291-7. [PMID: 23465173 DOI: 10.1016/j.jvs.2012.10.118] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether type II endoleak (T2E) after endovascular repair of abdominal aorta (EVAR) is a benign condition (ie, not associated with growth, reintervention, rupture, or death). METHODS Data from patients who underwent EVAR for atherosclerotic infrarenal aortic aneurysms between June 1995 and May 2010 in the Vascular Surgery Department of Henri Mondor Hospital were prospectively collected. Data from patients presenting with at least one T2E on computed tomography scan during their follow-up were compared with those with no T2E. Three subcategories of T2E were studied according to time of occurrence (early or late), persistence (persistent or transient), and recurrence (recurrent or not recurrent). RESULTS Seven hundred patients were included with follow-up ranging from 1 month to 15 years (median, 31.3 months; range, 12.4-61.4); 201 (28.9%) had at least one T2E. Patients with T2Es were significantly older (P < .001), female (P = .015), had larger aneurysms (P = .019), and patent lumbar arteries (P = .003). Patients without T2Es had a higher incidence of current smoking (P < .001) and chronic obstructive pulmonary disease (P < .005). Multivariate analysis showed risk of T2E was increased in older patients (odds ratio [OR], 1.04; confidence interval [CI], 95% 1.02-1.06; P < .001) and in those with patent lumbar arteries (OR, 1.70; CI, 95% 1.16-2.50; P = .007), and was reduced in active smokers (OR, 0.16 CI, 95% 0.04-0.71; P = .015) or patients with coronary artery disease (OR, 0.65; CI, 95% 0.45-0.92; P = .016). Patients with T2Es had more complications (death, rupture, reintervention, or conversion) (P < .001) and greater aneurysm sac enlargement (>5 mm upon follow-up) (P < .001). Multivariate analysis showed T2E was a risk factor for aneurysm diameter growth >5 mm; this risk was increased if T2E persisted more than 6 months (hazard ratio [HR], 3.16; CI, 95% 2.55-6.03; P < .001), was recurrent (HR, 1.88; CI, 95% 1.18-3.01; P = .008), or associated with a type I or III endoleak (HR, 1.96; CI, 95% 1.41-2.73; P < .001). Recurrent T2E was associated with a higher rate of reintervention (P = .04) and conversion to open surgery (P = .028). CONCLUSIONS Not all T2Es are benign. Recurrent as well as persistent T2Es are prone to life-threatening complications.
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161
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Transcatheter Embolisation of Type 1 Endoleaks after Endovascular Aortic Aneurysm Repair with Onyx: When No Other Treatment Option is Feasible. Eur J Vasc Endovasc Surg 2013; 45:141-4. [DOI: 10.1016/j.ejvs.2012.11.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 11/11/2012] [Indexed: 11/20/2022]
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162
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Cornelissen SA, Verhagen HJ, van Herwaarden JA, Vonken EJP, Moll FL, Bartels LW. Lack of thrombus organization in nonshrinking aneurysms years after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 56:938-42. [DOI: 10.1016/j.jvs.2012.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/27/2012] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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163
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Sarmiento JM, Wisniewski PJ, Do NT, Slezak JM, Tayyarah M, Aka PK, Vo TD, Hsu JH. The Kaiser Permanente Experience With Ultrasound-Guided Percutaneous Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2012; 26:906-12. [DOI: 10.1016/j.avsg.2011.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 09/18/2011] [Accepted: 09/26/2011] [Indexed: 12/17/2022]
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164
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Composite stent-grafts are not associated with increased endoleak or reintervention rates after endovascular abdominal aneurysm repair. Ann Vasc Surg 2012; 27:274-81. [PMID: 22998790 DOI: 10.1016/j.avsg.2012.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 03/22/2012] [Accepted: 04/29/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although present-generation endografts have expanded the indications for endovascular abdominal aneurysm repair, arterial anatomy frequently dictates the use of a combination of commercially available endografts and components for successful aneurysm repair. This study sought to determine whether there was an increase in endoleak or secondary intervention rates in individuals treated with composite endografts compared with noncomposite, or standard, endografts. METHODS From 1999 to 2009, 421 endovascular abdominal aneurysm repairs were performed at a single institution. A total of 384 patients met criteria for inclusion, with at least one follow-up imaging study. Patients were then identified as having had a composite endograft, defined as any combination of two or more different commercially available endograft or stent components, versus a standard endograft. Primary outcomes measured were freedom from endoleak and secondary intervention. RESULTS During the study period, 60 composite endograftings and 324 standard endograftings were performed. The groups were well matched for demographics, including age, gender, comorbidities, emergent need for procedure, and 30-day mortality (1.64% vs. 1.54%, nonsignificant). Median follow-up was 16.3 months (range, 19 days to 8.5 years) and 10.2 months (range, 4 days to 8.7 years) for composite and standard endografts, respectively. There was no significant difference between the groups in either endoleak or secondary intervention rates. Median time to endoleak detection was 2.0 months (range, 2 days to 3.9 years) for composite endografts and 2.8 months (range, 2 days to 6.9 years) for standard endografts. Median time to secondary intervention was 7.0 months (range, 4 days to 6.9 years) for composite endografts and 6.7 months (range, 1 day to 6.7 years) for standard endografts. CONCLUSIONS Composite endografts, namely, the combination of different commercially available endografts or stents used for the treatment of aortic aneurysms, are not associated with increased mortality, endoleak, or secondary intervention rates compared with noncomposite endografts.
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165
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Nolz R, Teufelsbauer H, Asenbaum U, Beitzke D, Funovics M, Wibmer A, Plank C, Prusa AM, Lammer J, Schoder M. Type II endoleaks after endovascular repair of abdominal aortic aneurysms: fate of the aneurysm sac and neck changes during long-term follow-up. J Endovasc Ther 2012; 19:193-9. [PMID: 22545884 DOI: 10.1583/11-3803.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the frequency of type II endoleaks after endovascular aneurysm repair (EVAR) and to compare sac diameter and neck changes in patients with type II endoleak to endoleak-free patients with at least 3-year imaging follow-up. METHODS Among 407 consecutive EVAR patients, 109 patients (101 men; mean age 72.1 years, range 55-86) had at least 3-year computed tomography (CT) data and no type I or III endoleak. In this cohort, 49 patients presented with a type II endoleak at some time and 60 patients had no endoleak. Patients with type II endoleaks were further divided into subgroups based on the vessel origin and the perfusion status (persistent or transient). The course of the perfusion status of type II endoleaks and changes in the aneurysm sac diameters, neck diameters, and renal to stent-graft distances (RSD) were evaluated in the defined groups. Reintervention and death rates were also reported. RESULTS The mean follow-up was 68.1 ± 23.8 months. Compared to the no endoleak group, overall sac diameter increased significantly in the type II endoleak group (p = 0.007), but vessel origin did not have any influence. With regard to the perfusion status of type II endoleaks, aneurysm sac changes were significantly higher (p = 0.002) in the persistent endoleak group. During the study period, the increase in the proximal neck diameter was significantly higher in the no endoleak group compared to the type II endoleak group (p = 0.025). No significant difference was found in RSD changes between the defined groups. Reinterventions were performed in 20 (18.3%) patients (13 for type II endoleak); 2 (1.8%) patients without type II endoleak died of ruptured aneurysm. CONCLUSION Persistent type II endoleaks led to significant aneurysm sac enlargement, but without increased mortality or rupture rates.
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Affiliation(s)
- Richard Nolz
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Austria.
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166
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Rand T, Uberoi R, Cil B, Munneke G, Tsetis D. Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Intervent Radiol 2012; 36:35-45. [PMID: 22833173 DOI: 10.1007/s00270-012-0439-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.
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Affiliation(s)
- T Rand
- Department of Radiology, General Hospital Hietzing, Wolkersbergenstr1, 1130, Vienna, Austria.
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167
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Sala Almonacil VA, Zaragozá García JM, Gómez Palonés FJ, Plaza Martínez Á, Ortíz Monzón E. Endovascular repair of an iliac arteriovenous fistula secondary to perforation from a common iliac aneurysm in a patient with Ehler-Danlos syndrome. Ann Vasc Surg 2012; 26:861.e11-5. [PMID: 22794344 DOI: 10.1016/j.avsg.2012.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/02/2012] [Accepted: 01/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Type IV Ehler-Danlos syndrome (EDS) patients are prone to life-threatening vascular complications. Surgical management of those complications is challenging owing to vessel wall fragility, which may result in hemorrhagic events and high mortality rates. Here we report a case of left common iliac aneurysm perforation of the ipsilateral iliac vein repaired using endovascular technique in a patient with EDS. METHOD AND RESULTS A 54-year-old patient presented with heart failure symptoms that evolved over 1 week in association with left leg edema and steal syndrome due to a perforation of the left iliac vein caused by a left common iliac aneurysm. A thrombosed right common iliac aneurysm and several other visceral and peripheral aneurysms were discovered on computed tomographic scan at admission. An aortouniiliac stent graft was used to seal the fistula. After 18 months of follow-up, the patient remained asymptomatic. CONCLUSIONS We suggest that endovascular therapy is useful to manage vascular complications in patients with EDS.
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168
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Nagayama H, Sueyoshi E, Sakamoto I, Uetani M. Endovascular abdominal aortic aneurysm repair: surveillance of endoleak using maximum transverse diameter of aorta on non-enhanced CT. Acta Radiol 2012; 53:652-6. [PMID: 22777147 DOI: 10.1258/ar.2012.120018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. PURPOSE To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. MATERIAL AND METHODS CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. RESULTS Endoleaks were detected in 17 patients during the follow-up period. Mean Dmax changes for 6 months were significant between positive and negative endoleak cases (1.8 ± 1.9 vs. -1.1 ± 3.0 mm, P < 0.0001). When the Dmax change ≤ 0 mm for 6 months was used as the threshold for negative endoleak, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.5, 82.4, 96.1, and 35.9%, respectively. When Dmax change ≤-1 mm was used as the threshold, the sensitivity, specificity, PPV, and NPV were 38.8, 100, 100, and 22.1%, respectively. CONCLUSION Contrast-enhanced CT is not required for the evaluation of endoleaks when the Dmax decreases by at least 1 mm over 6 months after EVAR.
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Affiliation(s)
- Hiroki Nagayama
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Eijun Sueyoshi
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Ichiro Sakamoto
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
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169
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Gilabert R, Buñesch L, Real MI, García-Criado Á, Burrel M, Ayuso JR, Barrufet M, Montaña X, Riambau V. Evaluation of Abdominal Aortic Aneurysm after Endovascular Repair: Prospective Validation of Contrast-enhanced US with a Second-Generation US Contrast Agent. Radiology 2012; 264:269-77. [DOI: 10.1148/radiol.12111528] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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170
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Hahne J, Arndt C, Herrmann J, Schönnagel B, Adam G, Habermann C. Follow-up of abdominal aortic aneurysm after endovascular aortic repair: Comparison of volumetric and diametric measurement. Eur J Radiol 2012; 81:1187-91. [DOI: 10.1016/j.ejrad.2011.03.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 11/28/2022]
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171
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Funaki B, Birouti N, Zangan SM, Van Ha TG, Lorenz JM, Navuluri R, Skelly CL, Leef JA. Evaluation and treatment of suspected type II endoleaks in patients with enlarging abdominal aortic aneurysms. J Vasc Interv Radiol 2012; 23:866-72; quiz 872. [PMID: 22609291 DOI: 10.1016/j.jvir.2012.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 04/02/2012] [Accepted: 04/04/2012] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate angiographic diagnosis and embolotherapy of patients with enlarging abdominal aortic aneurysms and computed tomographic (CT) diagnosis of type II endoleak. MATERIALS AND METHODS A retrospective review was performed of all patients referred to a single vascular and interventional radiology section from January 1, 2003, to June 1, 2011, with a diagnosis of enlarging aneurysm and type II endoleak. Twenty-five patients underwent 40 procedures between 12 and 82 months after endograft insertion (mean, 48 mo) for diagnosis and/or treatment of endoleaks. RESULTS Type II endoleaks were treated with cyanoacrylate, coils, and ethylene vinyl alcohol copolymer in 16 patients. Technical success rate was 88% (14 of 16 patients) and clinical success rate was 100% (16 of 16 patients). Aneurysm growth was arrested in all cases over a mean follow-up of 27.5 months (range, 6-88 mo). Endoleaks in nine patients were misclassified on CT; two had type I endoleaks and seven had type III endoleaks. Four of the nine patients (two type I endoleaks and two type III endoleaks) were correctly classified after initial angiography. The other five type III endoleaks were correctly classified on CT after coil embolization of the inferior mesenteric artery. Direct embolization was performed via sac puncture with ethylene vinyl alcohol copolymer in two of the latter five patients and eliminated endoleaks in both. CONCLUSIONS Aneurysm growth caused by type II endoleaks was arrested by embolization. CT misclassification occurred relatively commonly; type III endoleaks purported to be type II endoleaks were found in 28% of patients (seven of 25).
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Affiliation(s)
- Brian Funaki
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, 5840 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
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172
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Gunasekaran S, Funaki B, Lorenz J. Ruptured aortic aneurysm from late type II endoleak treated by transarterial embolization. Cardiovasc Intervent Radiol 2012; 36:255-8. [PMID: 22484704 DOI: 10.1007/s00270-012-0381-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/20/2012] [Indexed: 11/24/2022]
Abstract
Endoleak is the most common complication after endovascular aneurysm repair. The most common type of endoleak, a type II endoleak, typically follows a benign course and is only treated when associated with increasing aneurysm size. In this case report, we describe a ruptured abdominal aortic aneurysm due to a late, type II endoleak occurring 10 years after endovascular aneurysm repair that was successfully treated by transarterial embolization.
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Affiliation(s)
- Senthil Gunasekaran
- Loyola University Medical Center Chicago, 2160 South First Avenue, Maywood, IL 60153, USA.
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173
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Karthikesalingam A, Thrumurthy SG, Jackson D, Choke E, Sayers RD, Loftus IM, Thompson MM, Holt PJ. Current Evidence Is Insufficient to Define an Optimal Threshold for Intervention in Isolated Type II Endoleak After Endovascular Aneurysm Repair. J Endovasc Ther 2012; 19:200-8. [DOI: 10.1583/11-3762r.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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174
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Rutherford RB. Open Versus Endovascular Stent Graft Repair for Abdominal Aortic Aneurysms: An Historical View. Semin Vasc Surg 2012; 25:39-48. [DOI: 10.1053/j.semvascsurg.2012.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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175
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Brenes RA, Panait L, Abbas HMA, Tapias L, Tripodi G, Ajemian MS, Macaron SH. Prevention of type II endoleak by laparoscopic inferior mesenteric artery ligation. Surg Innov 2012; 20:NP6-8. [PMID: 22333935 DOI: 10.1177/1553350611432720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abdominal aortic aneurysm repair by endovascular techniques have gained wide acceptance as a treatment option. A potential well-known complication of endovascular repair includes endoleak. Specifically, type II endoleak, which is described as retrograde flow into the aneurysm sac through collateral vessels, can occur in up to 30% of patients. Certain preoperative factors can predict which patients may develop type II endoleak. This article describes laparoscopic inferior mesenteric artery ligation prior to endovascular abdominal aortic aneurysm repair as a viable treatment option in the prevention of type II endoleak.
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Affiliation(s)
- Robert A Brenes
- Department of Surgery, Saint Mary’s Hospital, Waterbury, CT 06706, USA.
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176
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Koole D, Moll FL, Buth J, Hobo R, Zandvoort H, Pasterkamp G, van Herwaarden JA. The influence of smoking on endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 55:1581-6. [PMID: 22325665 DOI: 10.1016/j.jvs.2011.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The main purpose of this study was to evaluate the influence of smoking on perioperative outcomes of endovascular aneurysm repair (EVAR), aneurysm sac behavior, abdominal aortic aneurysm (AAA) neck growth after EVAR, and its effect on stent graft migration during follow-up. METHODS Baseline characteristics and follow-up data were collected prospectively by patient record forms. Follow-up visits were scheduled at 1, 3, 6, 12, 18, and 24 months, and annually thereafter and included a clinical examination and imaging studies. Patients were stratified in three groups according to their smoking status as nonsmokers, former smokers, and smokers. RESULTS This study analyzed the data for 4176 nonsmokers, 2406 former smokers, and 2056 smokers who were enrolled prospectively in the European Collaborators on Stent-Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) database. Compared with nonsmokers, smokers required more percutaneous transluminal angioplasty and stent placements during EVAR (P < .001), and stent graft migration occurred more often (hazard ratio, 1.45; 95% confidence interval, 1.03-2.05; P = .033). Nonsmokers had more late type II endoleaks than former smokers and smokers (58.5%, 55.9%, and 35.5%, respectively; P < .001). Smoking had no effect on aneurysm sac behavior or AAA neck growth after EVAR. CONCLUSIONS Smokers need more percutaneous transluminal angioplasty procedures and stents during EVAR. They have fewer late type II endoleaks during follow-up; however, smokers should be closely monitored because they have an increased risk of stent graft migration.
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Affiliation(s)
- Dave Koole
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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177
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Bartoli MA, Thevenin B, Sarlon G, Giorgi R, Albertini JN, Lerussi G, Branchereau A, Magnan PE. Secondary Procedures After Infrarenal Abdominal Aortic Aneurysms Endovascular Repair With Second-Generation Endografts. Ann Vasc Surg 2012; 26:166-74. [DOI: 10.1016/j.avsg.2011.02.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 02/23/2011] [Accepted: 02/26/2011] [Indexed: 11/27/2022]
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178
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Koole D, Moll FL, Buth J, Hobo R, Zandvoort HJ, Bots ML, Pasterkamp G, van Herwaarden JA. Annual rupture risk of abdominal aortic aneurysm enlargement without detectable endoleak after endovascular abdominal aortic repair. J Vasc Surg 2011; 54:1614-22. [DOI: 10.1016/j.jvs.2011.06.095] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
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179
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Effect of type II endoleaks and antiplatelet therapy on abdominal aortic aneurysm shrinkage after endovascular repair. J Vasc Surg 2011; 54:947-51. [DOI: 10.1016/j.jvs.2011.03.269] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/23/2011] [Accepted: 03/23/2011] [Indexed: 11/22/2022]
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180
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Lerouge S, Bonneviot MC, Salazkin I, Raymond J, Soulez G. Endothelial Denudation Combined With Embolization in the Prevention of Endoleaks After Endovascular Aneurysm Repair:An Animal Study. J Endovasc Ther 2011; 18:686-96. [DOI: 10.1583/11-3541.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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181
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Management of peripheral arterial disease: Role of computed tomography angiography and magnetic resonance angiography. Presse Med 2011; 40:e437-52. [DOI: 10.1016/j.lpm.2010.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 10/25/2010] [Indexed: 11/22/2022] Open
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182
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Knowles M, Pellisar T, Murphy EH, Stanley GA, Hashmi AF, Arko MZ, Arko FR. In Vitro Analysis of Type II Endoleaks and Aneurysm Sac Pressurization on Longitudinal Stent-Graft Displacement. J Endovasc Ther 2011; 18:601-6. [DOI: 10.1583/11-3469.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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183
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Franz RW, Nguyen TV. A unique case of a type II endoleak after EVAR caused by patent inferior mesenteric and accessory renal arteries. Vasc Endovascular Surg 2011; 45:651-3. [PMID: 21757496 DOI: 10.1177/1538574411414305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Type II endoleaks have been viewed as the Achilles' heel of endovascular repair of abdominal aortic aneurysms. This report describes a unique etiology to this common challenge and our approach to endovascular repair.
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Affiliation(s)
- Randall W Franz
- The Vascular and Vein Center at Grant Medical Center, 285 East State Street, Suite 260, Columbus, OH 43215, USA.
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184
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Burke CT. Iatrogenic Ureteral Injury during Translumbar Embolization of a Type II Endoleak. Semin Intervent Radiol 2011; 24:346-9. [PMID: 21326483 DOI: 10.1055/s-2007-985749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The persistence of flow within an aneurysm sac remains the so-called Achilles heel of endovascular aortic aneurysm repair. The management of type II endoleaks remains controversial, although aneurysm sac expansion is an accepted indication for intervention. The present case describes a patient with a type II endoleak following endovascular repair of an abdominal aortic aneurysm treated by translumbar embolization. The procedure was complicated by iatrogenic injury to the left ureter and nontarget embolization resulting in acute ureteral obstruction.
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Affiliation(s)
- Charles T Burke
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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185
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Evaluation of Potential Outcome Predictors in Type II Endoleak: A Retrospective Study With CT Angiography Feature Analysis. AJR Am J Roentgenol 2011; 197:234-40. [DOI: 10.2214/ajr.10.4566] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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186
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Late open conversion and explantation of abdominal aortic stent grafts. J Vasc Surg 2011; 54:42-6. [DOI: 10.1016/j.jvs.2010.12.042] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/08/2010] [Accepted: 12/09/2010] [Indexed: 11/19/2022]
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187
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Farley SM, Rigberg D, Jimenez JC, Moore W, Quinones-Baldrich W. A retrospective review of Palmaz stenting of the aortic neck for endovascular aneurysm repair. Ann Vasc Surg 2011; 25:735-9. [PMID: 21665423 DOI: 10.1016/j.avsg.2011.02.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/19/2011] [Accepted: 02/20/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND To review the aortic neck characteristics, graft types, and technical results of Palmaz stent placement as an adjunct to endovascular aneurysm repair (EVAR). METHODS A retrospective review of 110 consecutive EVAR cases identified 18 cases in which Palmaz stents were placed as an adjunct to EVAR. Graft types, hostile aortic neck features (neck diameter: >26 mm, length: <15 mm, angulation: >60°, reverse taper necks), and treatment success were identified. RESULTS Technical success in the placement of a proximal Palmaz stent was achieved in 17 of 18 cases. Palmaz stenting was attempted for the treatment of type I endoleak in 17 of 18 patients. One prophylactic stent was deployed in the setting of hostile neck anatomy. Proximal stent deployment resulted in immediate treatment success of type I endoleaks in 16 of 17 patients-one failure occurred in a patient who presented with a delayed type I endoleak. Analysis of aortic neck anatomy revealed that two of 18 patients had no criteria for a hostile neck, seven had one criterion, and nine met at least two criteria. With respect to stent-graft types, nine of 18 (50%) cases used the Endologix Powerlink, six used Gore Excluder, two used Cook Zenith, and one used Medtronic Talent. With a mean follow-up of 254 days, 16 of 17 type I endoleaks remain resolved. CONCLUSIONS With proper patient selection and additional adjunctive treatments, Palmaz stenting can effectively treat proximal type I endoleaks.
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Affiliation(s)
- Steven Michael Farley
- UCLA Gonda Vascular Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095, USA.
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188
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Canì A, Cotta E, Recaldini C, Lumia D, Fontana F, Carrafiello G, Colli V, Fugazzola C. Volumetric analysis of the aneurysmal sac with computed tomography in the follow-up of abdominal aortic aneurysms after endovascular treatment. Radiol Med 2011; 117:72-84. [PMID: 21643642 DOI: 10.1007/s11547-011-0687-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/30/2010] [Indexed: 11/29/2022]
Affiliation(s)
- A Canì
- Ospedale di Circolo e Fondazione Macchi, Scuola di Specializzazione in Radiodiagnostica, Università degli Studi dell'Insubria, Viale Borri 57, 21100, Varese, Italy.
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189
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Cornelissen SA, van der Laan MJ, Vincken KL, Vonken EJPA, Viergever MA, Bakker CJ, Moll FL, Bartels LW. Use of Multispectral MRI to Monitor Aneurysm Sac Contents After Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2011; 18:274-9. [DOI: 10.1583/10-3271.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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190
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AbuRahma AF, Mousa AY, Campbell JE, Stone PA, Hass SM, Nanjundappa A, Dean LS, Keiffer T. The relationship of preoperative thrombus load and location to the development of type II endoleak and sac regression. J Vasc Surg 2011; 53:1534-41. [DOI: 10.1016/j.jvs.2011.02.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/10/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
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191
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Ukovich L, Nikolakopoulos K, Biasion C, Cera C, Mucelli FP, Chiarandini S, Adovasio R. Ruptured abdominal aortic aneurysm: Endovascular treatment. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Aim
The elective endovascular treatment of abdominal aortic aneurysm (AAA) is nowadays a daily routine practice in selected patients. The traditional treatment of ruptured abdominal aortic aneurysm (rAAA) has a peri-operative mortality of 40–50% that has not changed in the last 20 years. Nowadays, the endovascular repair may reduce mortality, hospitalization and sanitary costs.
Methods
The study included 14 patients affected by AAA who came to the Emergency Department because of hemodynamic shock (nine patients) or back pain (five patients). All patients underwent a CT angiography before surgery. Forty-two percent of the patients presented with shock (systolic pressure ≤70 mm Hg) in the operating room, and they underwent an endovascular aortic repair (EVAR) as an emergency procedure. Five bifurcated endoprotesis and nine uniliac protesis making a femoro-femoral bypass to revascularize the excluded limb were made. Patients underwent a follow up with CT angiography one month and then six months after surgery and if no problems were detected, patients underwent a follow-up every year.
Results
Two cases were immediately converted to open surgery because of failed EVAR. Four patients (28%) died after surgery because of multi-organ failure (MOF). The mean hospitalization was 12 days (range 3–21 days). We observed only one case of first-type endoleak at the 1-month follow up and we successfully treated it with a proximal cuff.
Conclusion
In our experience, the intention-to-treat protocol for rAAA offered acceptable results in terms of mortality rates. Multicenter studies are necessary to establish the role of endovascular treatment in patients with rAAA.
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Affiliation(s)
- Laura Ukovich
- 1 Department of Vascular Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy
| | | | - Christian Biasion
- 1 Department of Vascular Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Chiara Cera
- 1 Department of Vascular Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Fabio Pozzi Mucelli
- 2 Department of Radiology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Stefano Chiarandini
- 1 Department of Vascular Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Roberto Adovasio
- 1 Department of Vascular Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy
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192
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Hogg ME, Morasch MD, Park T, Flannery WD, Makaroun MS, Cho JS. Long-term sac behavior after endovascular abdominal aortic aneurysm repair with the Excluder low-permeability endoprosthesis. J Vasc Surg 2011; 53:1178-83. [DOI: 10.1016/j.jvs.2010.11.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/30/2010] [Accepted: 11/01/2010] [Indexed: 11/30/2022]
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193
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Upchurch GR, Tracci MC. For what were the instructions for use intended? The case of pararenal AAA repair. J Endovasc Ther 2011; 18:197-8. [PMID: 21521059 DOI: 10.1583/10-3072c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Gilbert R Upchurch
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA 22908-0679, USA.
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194
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Bosman WMPF, Hinnen JW, van der Steenhoven TJ, de Vries AC, Brom HLF, Jacobs MJ, Hamming JF. Treatment of Types II–IV Endoleaks by Injecting Biocompatible Elastomer (PDMS) in the Aneurysm Sac: An In Vitro Study. J Endovasc Ther 2011; 18:205-13. [DOI: 10.1583/10-3251.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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195
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Non-contrast Computed Tomography is Comparable to Contrast-enhanced Computed Tomography for Aortic Volume Analysis after Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2011; 41:460-6. [DOI: 10.1016/j.ejvs.2010.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/27/2010] [Indexed: 11/22/2022]
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196
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Aracil Sanus E, Vila i Coll R, Leal J, Fontcuberta J, Riera Vázquez R, Merino Mairal O. Guía de seguimiento no invasivo del tratamiento endovascular del aneurisma de aorta abdominal. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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197
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Choi SY, Lee DY, Lee KH, Ko YG, Choi D, Shim WH, Won JY. Treatment of Type I Endoleaks after Endovascular Aneurysm Repair of Infrarenal Abdominal Aortic Aneurysm: Usefulness of N-butyl Cyanoacrylate Embolization in Cases of Failed Secondary Endovascular Intervention. J Vasc Interv Radiol 2011; 22:155-62. [DOI: 10.1016/j.jvir.2010.10.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 09/30/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022] Open
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198
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Prospective Comparative Analysis of Colour-Doppler Ultrasound, Contrast-enhanced Ultrasound, Computed Tomography and Magnetic Resonance in Detecting Endoleak after Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2011; 41:186-92. [DOI: 10.1016/j.ejvs.2010.10.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 10/02/2010] [Indexed: 11/18/2022]
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199
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Petersen J, Glodny B. The burden of hard atherosclerotic plaques does not promote endoleak development after endovascular aortic aneurysm repair: a risk stratification. Cardiovasc Intervent Radiol 2011; 34:918-25. [PMID: 21271249 DOI: 10.1007/s00270-010-0095-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To objectify the influence of the atherosclerotic burden in the proximal landing zone on the development of endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) using objective aortic calcium scoring (ACS). MATERIALS AND METHODS This retrospective observation study included 267 patients who received an aortic endograft between 1997 and 2010 and for whom preoperative computed tomography (CT) was available to perform ACS using the CT-based V600 method. The mean follow-up period was 2 ± 2.3 years. RESULTS Type I endoleaks persisted in 45 patients (16.9%), type II in 34 (12.7%), type III in 8 (3%), and type IV or V in 3 patients, respectively (1.1% each). ACS in patients with type I endoleaks was not increased: 0.029 ± 0.061 ml compared with 0.075 ± 0.1349 ml in the rest of the patients, (p > 0.05; Whitney-Mann U-Test). There were significantly better results for the indication "traumatic aortic rupture" than for the other indications (p < 0.05). In multivariate logistic regression analyses, age was an independent risk factor for the development of type I endoleaks in the thoracic aorta (Wald 9.5; p = 0.002), whereas ACS score was an independent protective factor (Wald 6.9; p = 0.009). In the abdominal aorta, neither age nor ACS influenced the development of endoleaks. CONCLUSION Contrary to previous assumptions, TEVAR and EVAR can be carried out without increasing the risk of an endoleak of any type, even if there is a high atherosclerotic "hard-plaque" burden of the aorta. The results are significantly better for traumatic aortic.
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Affiliation(s)
- Johannes Petersen
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
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200
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Metaxa V, Tsagourias M, Matamis D. The role of echocardiography in the early diagnosis of the complications of endovascular repair of blunt aortic injury. J Crit Care 2011; 26:434.e7-12. [PMID: 21255968 DOI: 10.1016/j.jcrc.2010.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 11/16/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Endovascular repair of traumatic aortic injury has been associated with severe procedural complications, including endoleaks, coverage of the left subclavian artery, stent collapse, access complications, and questionable durability. Echocardiography has proven to be a valuable tool in the intraoperative detection of these complications. In the current study, we report on the use of echocardiography as an early postoperative diagnostic technique for the evaluation of endovascular stent graft positioning in the intensive care setting. METHODS From January 2005 to January 2009, 14 patients who underwent endovascular repair of a blunt aortic injury were admitted in our intensive care unit. Transesophageal and/or transthoracic echocardiography were used as first-line diagnostic tools in the assessment of the endovascular graft position. RESULTS Twenty-eight percent of patients (4 of 14) developed a pressure gradient between upper and lower limbs (greater than 50 mm Hg), which presented with persistent hypertension, requiring antihypertensive therapy in high doses and difficult weaning. In all 4 patients, stent graft malposition was identified using echocardiography. The diagnosis was verified by computed tomography and aortography. CONCLUSION Noninvasive echocardiographic monitoring proved to be a valuable tool in the early diagnosis of postoperative stent graft malalignment. To our knowledge, this is the first time that echocardiography is described in the relevant literature as an early diagnostic technique in this setting.
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Affiliation(s)
- Victoria Metaxa
- Intensive Care Unit, Papageorgiou General Hospital, Thessaloniki, Greece.
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