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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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202
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Bastos RM, Razuk Filho A, Blasbalg R, Caffaro RA, Karakhanian WK, Rocha AJ. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair. Clinics (Sao Paulo) 2011; 66:2025-9. [PMID: 22189725 PMCID: PMC3226595 DOI: 10.1590/s1807-59322011001200005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/18/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.
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Londero H, Lev G, Bertoni H, Mendaro E, Santaera O, Martinez Riera L, Mendiz O. Safety and feasibility of balloon-expandable stent implantation for the treatment of type I endoleaks following endovascular aortic abdominal aneurysm repair. EUROINTERVENTION 2011; 6:740-3. [DOI: 10.4244/eijv6i6a125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lu Q, Feng J, Yang Y, Nie B, Bao J, Zhao Z, Feng X, Pei Y, Yuan L, Mei Z, Feng R, Jing Z. Treatment of Type I Endoleak After Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Success of Fibrin Glue Sac Embolization. J Endovasc Ther 2010; 17:687-93. [DOI: 10.1583/10-3084.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Smaka TJ, Cobas M, Velazquez OC, Lubarsky DA. Perioperative management of endovascular abdominal aortic aneurysm repair: update 2010. J Cardiothorac Vasc Anesth 2010; 25:166-76. [PMID: 21093297 DOI: 10.1053/j.jvca.2010.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Todd J Smaka
- Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Naughton PA, Garcia-Toca M, Rodriguez HE, Keeling AN, Resnick SA, Morasch MD, Eskandari MK. Endovascular Treatment of Delayed Type 1 and 3 Endoleaks. Cardiovasc Intervent Radiol 2010; 34:751-7. [PMID: 21107984 DOI: 10.1007/s00270-010-0020-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 10/05/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Peter A Naughton
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, #650, Chicago, IL 60611, USA
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Cho JS, Park T, Kim JY, Chaer RA, Rhee RY, Makaroun MS. Prior endovascular abdominal aortic aneurysm repair provides no survival benefits when the aneurysm ruptures. J Vasc Surg 2010; 52:1127-34. [DOI: 10.1016/j.jvs.2010.05.099] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/21/2010] [Accepted: 05/25/2010] [Indexed: 11/16/2022]
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Detection of Occult Endoleaks After Endovascular Treatment of Abdominal Aortic Aneurysm Using Magnetic Resonance Imaging With a Blood Pool Contrast Agent. Invest Radiol 2010; 45:548-53. [DOI: 10.1097/rli.0b013e3181e992ac] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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209
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Basoor A, Patel KC, Cotant JF, Halabi AR, Todorov M, Chughtai H, Choksi N, Diaczok B, Zonia S, Degregorio M. Endovascular abdominal aortic aneurysm repair by interventional cardiologists--a community-based experience. J Interv Cardiol 2010; 23:485-90. [PMID: 20796163 DOI: 10.1111/j.1540-8183.2010.00591.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Endovascular repair of abdominal aortic aneurysm (AAA) is a relatively recent technology. In comparison to the conventional open surgical treatment for AAA, endovascular AAA repair (EVAR) combines a less-invasive approach with lower morbidity and mortality. There have been few studies regarding the performance of this procedure in a community-based setting. We report our experience of EVAR performed primarily by interventional cardiologists in a community hospital. METHODS In our community hospital setting, between September 2005 and November 2007, we included all patients who underwent EVAR by interventional cardiologists, with available on-site vascular surgical support. Clinical and serial computed angiographic imaging outcomes were followed by a retrospective chart review. Data collection tools included demographic and clinical characteristics, anatomical aneurysm features, length of stay, peri- and postprocedural complications, and mortality. RESULTS A total of 71 consecutive patients had EVAR attempted. The endovascular stent placement was successful in 67 (93%) patients. Thirty-day mortality in this study was 1 of 71 (1.4%). All four procedural failures and the single periprocedural mortality occurred in women. Mean follow-up was 12 months. There were a total of six mortalities and among these four were women (P ≤ 0.001); however, multivariate analysis revealed loss of significant difference in mortality (P = 0.16). Major complications following EVAR were noted in 10 of 71 (14%) patients. CONCLUSION EVAR can be successfully performed by experienced interventional cardiologists with vascular surgical support in a community-based setting. In our experience, there is acceptable rate of complications and mortality in a carefully selected patient population.
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Affiliation(s)
- Abhijeet Basoor
- Department of Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan 48341, USA.
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Ronsivalle S, Faresin F, Franz F, Rettore C, Zanchetta M, Olivieri A. Aneurysm Sac “Thrombization” and Stabilization in EVAR: A Technique to Reduce the Risk of Type II Endoleak. J Endovasc Ther 2010; 17:517-24. [DOI: 10.1583/09-3004.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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211
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Laks S, Macari M, Chandarana H. Dual-Energy Computed Tomography Imaging of the Aorta After Endovascular Repair of Abdominal Aortic Aneurysm. Semin Ultrasound CT MR 2010; 31:292-300. [DOI: 10.1053/j.sult.2010.05.003] [Citation(s) in RCA: 18] [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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212
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Jim J, Sanchez LA. Abdominal Aortic Aneurysms: Endovascular Repair. ACTA ACUST UNITED AC 2010; 77:238-49. [DOI: 10.1002/msj.20180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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213
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Update on Multidetector Computed Tomography Angiography of the Abdominal Aorta. Radiol Clin North Am 2010; 48:283-309, viii. [PMID: 20609875 DOI: 10.1016/j.rcl.2010.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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214
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AAA stent-grafts: past problems and future prospects. Ann Biomed Eng 2010; 38:1259-75. [PMID: 20162359 DOI: 10.1007/s10439-010-9953-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
Endovascular aneurysm repair (EVAR) has quickly gained popularity for infrarenal abdominal aortic aneurysm repair during the last two decades. The improvement of available EVAR devices is critical for the advancement of patient care in vascular surgery. Problems are still associated with the grafts, many of which can necessitate the conversion of the patient to open repair, or even result in rupture of the aneurysm. This review attempts to address these problems, by highlighting why they occur and what the failings of the currently available stent grafts are, respectively. In addition, the review gives critical appraisal as to the novel methods required for dealing with these problems and identifies the new generation of stent grafts that are being or need to be designed and constructed in order to overcome the issues that are associated with the existing first- and second-generation devices.
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Inferior Mesenteric Artery Embolization before Endovascular Repair of an Abdominal Aortic Aneurysm: Effect on Type II Endoleak and Aneurysm Shrinkage. J Vasc Interv Radiol 2010; 21:181-5. [DOI: 10.1016/j.jvir.2009.10.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 10/07/2009] [Accepted: 10/15/2009] [Indexed: 11/20/2022] Open
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Park KM, Kim JY, Jung JE, Jeon YS, Cho SG, Choe YM, Choi SK, Heo YS, Lee KY, Kim SJ, Cho YU, Ahn SI, Shin SH, Kim KR, Hong KC. Clinical Experience of Endoleak after Endovascular Aortic Aneurysm Repair. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.4.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Keun Myoung Park
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Jang Young Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Ji Eun Jung
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University School of Medicine, Incheon, Korea
| | - Yun-Mee Choe
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Sun Keun Choi
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Yoon Seok Heo
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Keon Young Lee
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Sei-Joong Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Young Up Cho
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Seung Ik Ahn
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Seok Hwan Shin
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Kyung Rae Kim
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University School of Medicine, Incheon, Korea
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217
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Peirano MAM, Bertoni HG, Chikiar DS, Martínez JMP, Girella GA, Barone HD, Guzman R, Douville Y, Yin T, Nutley M, Zhang Z, Guidoin R. Size of the proximal neck in AAAs treated with balloon-expandable stent-grafts: CTA findings in mid- to long-term follow-up. J Endovasc Ther 2009; 16:696-707. [PMID: 19995110 DOI: 10.1583/09-2711.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the evolution of the proximal aortic neck diameter in mid- to long-term follow-up after endovascular aneurysm repair of abdominal aortic aneurysm (AAA) with a balloon-expandable stent-graft. METHODS Thirty patients (27 men; average age 71 years, range 56-87) with infrarenal AAAs were treated with the SETA-Latecba balloon-expandable stent-graft (6 aortomonoiliac and 24 bifurcated configurations). Follow-up ranged from 4 to 8 years (mean 73.4 months). Computed tomography was done systematically before the procedure, after implantation (1-3 months), at 1 year, and annually thereafter. The last follow-up scan was utilized to measure the proximal neck for purposes of comparison with baseline and the initial post-implant scans. RESULTS Five patients died during follow-up of causes unrelated to the procedure. No endoleaks or graft migrations were observed. The pre-deployment proximal neck diameter (a) averaged 23.4 mm (range 18-32), the diameter after deployment of the stent-graft (b) averaged 24.9 mm (range 18-34), and the most recent follow-up proximal neck measurement (c) averaged 23.8 mm (range 18-31). Comparing the last follow-up to the post-implant measurements (c-b), the neck diameter decreased in 15 (50%) patients [7 with short necks (i.e., <15 mm)] and remained unchanged (no variation) in 15 (50%) patients (4 with short necks). All patients treated with the SETA-Latecba balloon-expandable stent-graft showed stability of the proximal aortic neck diameter in mid- to long-term follow-up. CONCLUSION The study showed that the diameter reached at initial deployment did not increase further in the long term, which supports the safety and reliability of this modular balloon-expandable stent-graft and illustrates that this device does not produce dilatation of the proximal neck after deployment. Future dilatation of the aortic neck is unlikely, and consequently, migration or delayed type I endoleak are also unlikely.
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Rayt H, Sandford R, Salem M, Bown M, London N, Sayers R. Conservative Management of Type 2 Endoleaks is not Associated with Increased Risk of Aneurysm Rupture. Eur J Vasc Endovasc Surg 2009; 38:718-23. [DOI: 10.1016/j.ejvs.2009.08.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 08/21/2009] [Indexed: 11/25/2022]
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Gleason TG. Endoleaks After Endovascular Aortic Stent-Grafting: Impact, Diagnosis, and Management. Semin Thorac Cardiovasc Surg 2009; 21:363-72. [DOI: 10.1053/j.semtcvs.2009.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2009] [Indexed: 11/11/2022]
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Liaw J, Clark M, Gibbs R, Jenkins M, Cheshire N, Hamady M. Update: Complications and management of infrarenal EVAR. Eur J Radiol 2009; 71:541-51. [DOI: 10.1016/j.ejrad.2008.05.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 02/10/2008] [Accepted: 05/28/2008] [Indexed: 11/15/2022]
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Liu Z, Liu Y, Navia JA, Kassab GS. A Magnetic Approach to Decrease Stent Graft Endoleak: Ex-Vivo Validation. Ann Biomed Eng 2009; 37:1727-38. [DOI: 10.1007/s10439-009-9741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 06/10/2009] [Indexed: 11/29/2022]
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Cerna M, Köcher M, Utikal P, Bachleda P. Endotension after endovascular treatment of abdominal aortic aneurysm: Percutaneous treatment. J Vasc Surg 2009; 50:648-51. [DOI: 10.1016/j.jvs.2009.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/13/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
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Jonker FH, Aruny J, Muhs BE. Management of Type II Endoleaks: Preoperative versus Postoperative versus Expectant Management. Semin Vasc Surg 2009; 22:165-71. [DOI: 10.1053/j.semvascsurg.2009.07.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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225
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Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Intervent Radiol 2009; 33:278-84. [PMID: 19688365 DOI: 10.1007/s00270-009-9685-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 07/15/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to report our experience in treating type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms. Two hundred eighteen patients underwent EVAR with a Zenith stent-graft from January 2000 to December 2005. During a follow-up period of 4.5 + or - 2.3 years, solely type II endoleak was detected in 47 patients (22%), and 14 of them underwent secondary interventions to correct this condition. Ten patients had transarterial embolization, and four patients had translumbar/transabdominal embolization. The embolization materials used were coils, thrombin, gelatin, Onyx (ethylene-vinyl alcohol copolymer), and glue. Disappearance of the endoleak without enlargement of the aneurysm sac after the first secondary intervention was achieved in only five of these patients (5/13). One patient without surveillance imaging was excluded from analyses of clinical success. After additional interventions in four patients and the spontaneous disappearance of type II endoleak in two patients, overall clinical success was achieved in eight patients (8/12). One patient did not have surveillance imaging after the second secondary intervention. Clinical success after the first secondary intervention was achieved in two patients (2/9) in the transarterial embolization group and three patients (3/4) in the translumbar embolization group. The results of secondary interventions for type II endoleak are unsatisfactory. Although the small number of patients included in this study prevents reliable comparisons between groups, the results seem to favor direct translumbar embolization in comparison to transarterial embolization.
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Bley TA, Chase PJ, Reeder SB, François CJ, Shinki K, Tefera G, Ranallo FN, Grist TM, Pozniak M. Endovascular abdominal aortic aneurysm repair: nonenhanced volumetric CT for follow-up. Radiology 2009; 253:253-62. [PMID: 19703867 DOI: 10.1148/radiol.2531082093] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the clinical usefulness of volumetric analysis at nonenhanced computed tomography (CT) as the sole method with which to follow up endovascular abdominal aortic aneurysm repair (EVAR) and to identify endoleaks causing more than 2% volumetric increase from the previous volume determination. MATERIALS AND METHODS The study had institutional review board approval. Images were reviewed retrospectively in a HIPAA-compliant manner for 230 CT studies in 70 patients (11 women, 59 men; mean age, 74 years) who underwent EVAR. The scannning protocol consisted of three steps: (a) contrast material-enhanced CT angiography before endovascular stent placement, (b) contrast-enhanced CT angiography 0-3 months after repair to depict immediate complications, and (c) nonenhanced CT at 3, 6, and 12 months after repair. At each follow-up visit, immediate aortic volume analysis was performed. If the interval volumetric change was 2% or less, no further imaging was performed. If the volume increased by more than 2% on the nonenhanced CT image, contrast-enhanced CT angiography was performed immediately to identify the suspected endoleak. Confidence intervals (CIs) were obtained by using bootstrapping to account for repeated measurements in the same patients. RESULTS Mean volume decrease was -3.2% (95% CI: -4.7%, -1.9%) in intervals without occurrence of a clinically relevant endoleak (n = 183). Types I and III high-pressure endoleaks (n = 10) showed a 10.0% (95% CI: 5.0%, 18.2%) interval volumetric increase. Type II low-pressure endoleaks (n = 37) showed a 5.4% (95% CI: 4.6%, 6.2%) interval volumetric increase. Endoleaks associated with minimal aortic volume increase of less than 2% did not require any intervention. This protocol reduced radiation exposure by approximately 57%-82% in an average-sized patient. CONCLUSION Serial volumetric analysis of aortic aneurysm with nonenhanced CT serves as an adequate screening test for endoleak, causing volumetric increase of more than 2% from the volume seen at the previous examination.
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Affiliation(s)
- Thorsten A Bley
- Departments of Radiology, Statistics, and Vascular Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
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Diehm N, Dick F, Katzen BT, Do DD, Baumgartner I. Endovascular repair of abdominal aortic aneurysms: only a mechanical solution for a biological problem? J Endovasc Ther 2009; 16 Suppl 1:I119-26. [PMID: 19317573 DOI: 10.1583/08-2586.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endovascular aneurysm repair has matured significantly over the last 20 years and is becoming increasingly popular as a minimally invasive treatment option for patients with abdominal aortic aneurysms (AAA). Long-term durability of this fascinating treatment, however, is in doubt as continuing aneurysmal degeneration of the aortoiliac graft attachment zones is clearly associated with late adverse sequelae. In recent years, our growing understanding of the physiopathology of AAA formation has facilitated scrutiny of various potential drug treatment concepts. In this article we review the mechanical and biological challenges associated with endovascular treatment of infrarenal AAAs and discuss potential approaches to ongoing aneurysmal degeneration, which hampers long-term outcomes of this minimally invasive therapy.
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Affiliation(s)
- Nicolas Diehm
- Clinical and Interventional Angiology, Swiss Cardiovascular Center, Inselspital, University Hospital Bern, Switzerland.
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Sampaio SM, Shin SH, Panneton JM, Andrews JC, Bower TC, Cherry KJ, Duncan AA, Kalra M, Gloviczki P. Intraoperative Endoleak During EVAR: Frequency, Nature, and Significance. Vasc Endovascular Surg 2009; 43:352-9. [PMID: 19351648 DOI: 10.1177/1538574409333581] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Endoleaks are critical complications of endovascular abdominal aortic aneurysm repair (EVAR). This study sought to determine the frequency and nature of intraoperative endoleaks and their impact on postoperative endoleak-related events. Methods: A retrospective chart review was performed of all patients who underwent EVAR at our institution. The impact of intraoperative endoleaks on postoperative endoleak rates and endoleak-related reintervention rates were assessed. Results: From December 18, 1996, to May 21, 2003, 241 patients underwent EVAR. An endoleak was observed during 126 (52.3%) procedures. Type I endoleaks were observed in 63 (26.1%) cases: 35 proximal and 31 distal endoleaks (3 cases at both attachments). Angioplasty, additional cuff placement, or stenting corrected 59 (89.4%) of these endoleaks. A total of 71 type II intraoperative endoleaks (29.5%) and 8 type IV endoleaks (3.3%) were observed without any attempted corrective maneuvers. Ten type III endoleaks (4.2%) occurred but all resolved with angioplasty or additional cuff placement. In all, 86 (35.7%) endoleaks persisted on completion angiogram. Patients with a type I or type II intraoperative endoleak were more likely to have an endoleak at 1.5 years (31.4% vs. 21.6%, P = .018). Reinterventions were required more often after an intraoperative type I endoleak (10% vs. 4%, P = .003). Patients with intraoperative endoleaks demonstrated a trend toward less postoperative aneurysm diameter reduction at 2 years (43.8% vs. 74.5%, P = .104). Conclusion: The presence of a type I or a type II endoleak during EVAR significantly increases the likelihood of a postoperative endoleak and should prompt a high degree of suspicion during follow-up.
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Finnish Multicenter Study on the Midterm Results of Use of the Zenith Stent-Graft in the Treatment of an Abdominal Aortic Aneurysm. J Vasc Interv Radiol 2009; 20:448-54. [DOI: 10.1016/j.jvir.2008.12.410] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 12/02/2008] [Accepted: 12/07/2008] [Indexed: 11/30/2022] Open
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Endovascular Treatment of Ruptured Abdominal Aneurysm into the Inferior Vena Cava in Patient After Stent Graft Placement. Cardiovasc Intervent Radiol 2009; 32:776-80. [DOI: 10.1007/s00270-009-9525-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 12/08/2008] [Accepted: 01/16/2009] [Indexed: 11/30/2022]
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231
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Coppi G, Gennai S, Saitta G, Silingardi R, Tasselli S. Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment. J Vasc Surg 2009; 49:582-8. [DOI: 10.1016/j.jvs.2008.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 10/07/2008] [Accepted: 10/11/2008] [Indexed: 10/21/2022]
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232
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Garzón Moll G, Riera de Cubas L, Nistal Martín M, Gonzalo Orden J, Millan Varela L. Tratamiento de un aneurisma de aorta abdominal con prótesis endovascular y materiales embolizantes: estudio experimental. RADIOLOGIA 2009; 51:71-9. [DOI: 10.1016/s0033-8338(09)70408-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 01/14/2008] [Indexed: 10/21/2022]
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233
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Endofugas tipo II tras tratamiento endovascular de los aneurismas de aorta abdominal: incidencia, factores predisponentes, pruebas diagnósticas, indicaciones y alternativas terapéuticas. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)14003-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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234
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Varcoe RL, Laird MP, Frawley JE. A novel alternative to open conversion for type 1 endoleak resulting in ruptured aneurysm. Vasc Endovascular Surg 2008; 42:391-3. [PMID: 18728040 DOI: 10.1177/1538574408315203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, a novel technique for the treatment of ruptured abdominal aortic aneurysm secondary to proximal type 1 endoleak as a result of progressive neck dilatation after endovascular aneurysm repair is reported. A 74-year-old man with multiple comorbidities including severe ischemic heart disease, congestive cardiac failure, and chronic renal failure presented with a ruptured abdominal aortic aneurysm. He had an infrarenal endovascular aneurysm repair performed in 1999 and had subsequently developed a proximal type 1 endoleak. At open laparotomy, the placement of 4 nylon ties around the infrarenal aneurysm neck to refashion a seal and exclude the sac from systemic pressurization effectively treated the rupture. In the high-risk patient, ruptured proximal type 1 endoleak can be successfully treated with external banding avoiding the potential morbidity seen with the aortic clamping and blood loss of open conversion.
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Affiliation(s)
- Ramon L Varcoe
- Department of Vascular Surgery, Prince of Wales Hospital and University of New South Wales, Randwick, New South Wales, Australia.
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235
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236
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Barbiero G, Baratto A, Ferro F, Dall'Acqua J, Fittà C, Miotto D. Strategies of endoleak management following endoluminal treatment of abdominal aortic aneurysms in 95 patients: how, when and why. Radiol Med 2008; 113:1029-42. [PMID: 18795234 DOI: 10.1007/s11547-008-0317-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Accepted: 01/14/2008] [Indexed: 11/25/2022]
Affiliation(s)
- G Barbiero
- Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali, Sezione di Radiologia, Università di Padova, Padova, Italy.
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237
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Wagner M, Voshage G, Busch T, Landwehr P. [Infrarenal abdominal aortic aneurysm: endovascular repair with stent grafts]. Radiologe 2008; 48:881-98. [PMID: 18712339 DOI: 10.1007/s00117-008-1718-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As an alternative to surgery, endovascular therapy with stent grafts has become the second main treatment option for infrarenal abdominal aortic aneurysms. Unlike surgery, endovascular treatment with stent grafts is also applicable in patients unfit for open repair. Despite current improvements in endovascular repair devices, significant anatomic barriers still exclude this technique for a large number of patients. Computed tomography, magnetic resonance imaging, and ultrasound are essential for diagnostics, preintervention planning, and postintervention follow-up of abdominal aneurysms treated with stent grafts. This review covers etiology, pathology, and diagnostic aspects. Materials and methods for endovascular treatment of abdominal aortic aneurysms are presented in detail, and clinical results and complications are discussed.
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Affiliation(s)
- M Wagner
- Diakoniekrankenhaus Henriettenstiftung gGmbH, Klinik für diagnostische und interventionelle Radiologie, Gefässzentrum Hannover, Marienstrasse 72-90, 30171 Hannover, Deutschland.
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238
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Redefining postoperative surveillance after endovascular aneurysm repair: Recommendations based on 5-year follow-up in the US Zenith multicenter trial. J Vasc Surg 2008; 48:278-84; discussion 284-5. [DOI: 10.1016/j.jvs.2008.02.075] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 02/25/2008] [Accepted: 02/26/2008] [Indexed: 11/22/2022]
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239
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Management of endoleaks associated with endovascular treatment of descending thoracic aortic diseases. J Vasc Surg 2008; 48:69-73. [DOI: 10.1016/j.jvs.2008.02.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 02/13/2008] [Accepted: 02/17/2008] [Indexed: 11/20/2022]
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240
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Lange C, Aasland JK, Ødegård A, Myhre HO. The Durability of Evar — What are the Evidence and Implications on Follow-Up? Scand J Surg 2008; 97:205-12. [DOI: 10.1177/145749690809700227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of follow-up investigations, and how complications and secondary procedures influence cost-effectiveness. Material and Methods: 263 patients were treated by EVAR from february 1995-february 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program. Results: There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well. Conclusions: Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This follow-up regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.
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Affiliation(s)
- C. Lange
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
| | - J. K. Aasland
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
| | - A. Ødegård
- Department of Radiology, St. Olavs Hospital, University Hospital of Trondheim
| | - H. O. Myhre
- Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim
- Department of Circulation Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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241
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Monge M, Eskandari MK. Strategies for Ruptured Abdominal Aortic Aneurysms. J Vasc Interv Radiol 2008; 19:S44-50. [DOI: 10.1016/j.jvir.2008.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/11/2008] [Accepted: 02/11/2008] [Indexed: 11/16/2022] Open
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242
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Rafii BY, Abilez OJ, Benharash P, Zarins CK. Lateral Movement of Endografts Within the Aneurysm Sac Is an Indicator of Stent-Graft Instability. J Endovasc Ther 2008; 15:335-43. [DOI: 10.1583/08-2422.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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243
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Rosen RJ, Green RM. Endoleak Management following Endovascular Aneurysm Repair. J Vasc Interv Radiol 2008; 19:S37-43. [DOI: 10.1016/j.jvir.2008.01.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 01/15/2008] [Accepted: 01/15/2008] [Indexed: 10/22/2022] Open
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244
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Rodway A, Powell J, Brown L, Greenhalgh R. Do Abdominal Aortic Aneurysm Necks Increase in Size Faster after Endovascular than Open Repair? Eur J Vasc Endovasc Surg 2008; 35:685-93. [DOI: 10.1016/j.ejvs.2007.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022]
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245
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Kranokpiraksa P, Kaufman JA. Follow-up of Endovascular Aneurysm Repair: Plain Radiography, Ultrasound, CT/CT Angiography, MR Imaging/MR Angiography, or What? J Vasc Interv Radiol 2008; 19:S27-36. [DOI: 10.1016/j.jvir.2008.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 03/07/2008] [Accepted: 03/07/2008] [Indexed: 11/25/2022] Open
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246
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Laganà D, Mangini M, Fontana F, Nicotera P, Carrafiello G, Fugazzola C. Percutaneous Treatment of Sac Rupture in Abdominal Aortic Aneurysms Previously Excluded with Endovascular Repair (EVAR). Cardiovasc Intervent Radiol 2008; 32:178-83. [DOI: 10.1007/s00270-008-9358-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 03/24/2008] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
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247
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Hobo R, Sybrandy JEM, Harris PL, Buth J. Endovascular repair of abdominal aortic aneurysms with concomitant common iliac artery aneurysm: outcome analysis of the EUROSTAR Experience. J Endovasc Ther 2008; 15:12-22. [PMID: 18254666 DOI: 10.1583/07-2217.1] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare outcomes following endovascular repair in abdominal aortic aneurysm (AAA) patients with and without concomitant iliac artery aneurysm disease. METHODS Data on patient characteristics and risk factors, aneurysm morphology, interventional details, complications, and mortality were retrieved from the EUROSTAR registry database for the period from October 1996 to November 2006. AAA patients without concomitant iliac aneurysm disease (group I, n = 6286) were compared to 1268 patients with aneurysmal iliac vessels (group II) regarding mortality, device-related complications, and need for secondary interventions. Logistic regression and Cox proportional hazards model were performed to assess independent associations with outcome parameters in the study groups. RESULTS Group II had more patients classified as ASA III or IV (55.1% versus 50.3% in group I; p = 0.002); they were more frequently unfit for open aortic repair (30.3% versus 23.4%; p<0.0001) and had larger-diameter aneurysms (62.3 versus 60.7 mm; p<0.0001) and infrarenal necks (24.5 versus 24.1 mm; p<0.001). In addition, group II patients had a higher rate of internal iliac artery occlusion (11.4% versus 5.2%; p<0.0001) and more significant angulation of the aortic neck (30.8% versus 24.3%; p<0.0001) and iliac artery (48.3% versus 41.9%; p<0.0001). Group II patients had higher 5-year cumulative incidences of distal type I endoleaks (9.1% versus 4.3%; p<0.0001), iliac limb occlusion (5.9% versus 4.4%; p = 0.040), secondary transfemoral intervention (17.6% versus 8.9%; p = 0.019), and aneurysm rupture (4.5% versus 1.7%; p = 0.042). CONCLUSION Although aneurysm-related mortality and mortality from other causes were similar in both study groups, concomitant iliac artery aneurysms in AAA patients were associated with an increased incidence of distal type I endoleak, iliac limb occlusion, and aneurysm rupture. Therefore, caution is warranted, and efforts should be made to avoid procedural mishaps.
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Affiliation(s)
- Roel Hobo
- EUROSTAR Data Registry Centre, Catharina Hospital, Eindhoven, The Netherlands
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248
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Endovascular Abdominal Aortic Aneurysm Repair: 5-Year Follow-Up Results. Ann Vasc Surg 2008; 22:372-8. [DOI: 10.1016/j.avsg.2007.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 09/05/2007] [Accepted: 09/19/2007] [Indexed: 11/18/2022]
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249
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LeCroy CJ, Passman MA, Taylor SM, Patterson MA, Combs BR, Jordan WD. Should Endovascular Repair Be Used for Small Abdominal Aortic Aneurysms? Vasc Endovascular Surg 2008; 42:113-9; discussion 120-1. [DOI: 10.1177/1538574407312656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The outcomes of endovascular repair for small abdominal aortic aneurysm (4.0-4.9 cm) is reported. All patients undergoing endovascular abdominal aortic aneurysm repair between 2000 and 2006 with maximal diameter 4.0 to 4.9 cm form the small aneurysm study cohort. Data were analyzed retrospectively and life-table methods were used. Of 743 endovascular repairs, 132 (17.8%) were performed for small abdominal aortic aneurysm. Perioperative complication rate was 9.1%. Freedom from aneurysm expansion was 96% at 1 year, 86% at 3 years, and 77% at 5 years. Overall survival was 98%, 93%, and 84% at 1, 3, and 5 years, respectively. Perioperative 30-day mortality was 0.8% with an aneurysm-related mortality of 1.5% at 5 years. There were no deaths from delayed aneurysm rupture. Endovascular repair of small abdominal aortic aneurysm is associated with low perioperative morbidity and mortality compared with published results for open repair, and treatment threshold can be reduced to 4 cm in selected patients.
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Affiliation(s)
- Christopher J. LeCroy
- Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marc A. Passman
- Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama,
| | - Steven M. Taylor
- Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark A. Patterson
- Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bart R. Combs
- Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - William D. Jordan
- Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama
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250
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Outcome and Quality of Life in Patients Treated for Abdominal Aortic Aneurysms: A Single Center Experience. World J Surg 2008; 32:987-94. [DOI: 10.1007/s00268-008-9565-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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