1
|
Schanzer A. Endovascular infrarenal aortic aneurysm repair: Perhaps we've gone about it all wrong. J Vasc Surg 2022; 76:352-353. [PMID: 35870846 DOI: 10.1016/j.jvs.2022.03.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Andres Schanzer
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA.
| |
Collapse
|
2
|
Affiliation(s)
- Andres Schanzer
- From the Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester (A.S.); and the Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston (G.S.O.)
| | - Gustavo S Oderich
- From the Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester (A.S.); and the Division of Vascular and Endovascular Surgery, University of Texas Health Science Center, Houston (G.S.O.)
| |
Collapse
|
3
|
De Santis F, Notari MP, Chiappa R. Early periaortic hematoma development after EVAR in the presence of severely calcified and modestly conical-shaped aortic neck: A potential trigger for sudden aneurysm progression toward rupture. Vascular 2020; 29:667-671. [PMID: 33308108 DOI: 10.1177/1708538120978030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this report is to present a singular case of early post-endovascular aneurysm repair abdominal aortic aneurysm rupture and discuss the possible etiopathogenic mechanism promoting the sudden aneurysm progression toward rupture.Methods/Results: An 84-year-old man was submitted to endovascular aneurysm repair via second-generation endograft (Cordis-Incraft Stent-graft) during which, the left occluded common iliac artery was recanalized via balloon-expandable covered-stent-graft (Atrium-Advanta-V12). The aneurysm presented a severely calcified and modestly conical-shaped aortic-neck. The post-operative course was complicated by a broncho pneumonic infiltrate and a CT scan performed two weeks postoperatively accidentally revealed a relatively small hematoma surrounding the aortic wall. No active bleeding, endoleak, or aneurysm increase in diameter was documented. Nevertheless, the patient remained closely monitored. Three days later, he suffered from abdominal aortic aneurysm rupture. A CT scan revealed an arterial wall tear at the neck level. Intra-operatively the reanalyzed common iliac artery was intact and a good endograft-sealing was confirmed. Following this event, small lumbar arteries suture saccotomy was performed. The patient eventually died of multiorgan failure one month later. CONCLUSIONS The apparently "self-limiting" post-endovascular aneurysm repair CT-scan finding of periaortic hematoma may have represented a potential trigger for abdominal aortic aneurysm rupture. The possibility of developing undetected aortic lesions during endovascular aneurysm repair, specifically in the presence of potentially "at risk" anatomical conditions, should always be considered.
Collapse
Affiliation(s)
| | | | - Roberto Chiappa
- Department of Vascular Surgery, Sandro Pertini Hospital, Rome, Italy
| |
Collapse
|
4
|
Schanzer A, Beck AW, Eagleton M, Farber MA, Oderich G, Schneider D, Sweet MP, Crawford A, Timaran C. Results of fenestrated and branched endovascular aortic aneurysm repair after failed infrarenal endovascular aortic aneurysm repair. J Vasc Surg 2020; 72:849-858. [DOI: 10.1016/j.jvs.2019.11.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/03/2019] [Indexed: 01/13/2023]
|
5
|
Jetty P, Husereau D, Kansal V, Zhang T, Nagpal S. Variability in aneurysm sac regression after endovascular aneurysm repair based on a comprehensive registry of patients in Eastern Ontario. J Vasc Surg 2019; 70:1469-1478. [DOI: 10.1016/j.jvs.2019.01.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/22/2019] [Indexed: 12/01/2022]
|
6
|
Fenestrated/Branched Endovascular Aortic Aneurysm Repair Using a Supraceliac Aortic Proximal Seal Zone Versus an Infraceliac Aortic Proximal Seal Zone. Ann Vasc Surg 2019; 62:213-222. [PMID: 31382008 DOI: 10.1016/j.avsg.2019.04.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/08/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fenestrated/branched endovascular aneurysm repair (F/B-EVAR) achieves more extensive proximal seal than conventional infrarenal devices, thereby increasing aneurysm exclusion durability. Optimal seal zone length remains undefined. We assessed relative risks and benefits of extending the proximal seal above the celiac artery. METHODS The prospective database of all complex endovascular aortic aneurysm repairs at a single institution (institutional review board-approved, physician-sponsored investigational device exemption trial, 10/2010-6/2017) was used to classify repairs according to the number of target visceral-renal arteries incorporated: 4-vessel versus <4-vessel. Comparisons of aneurysm characteristics, perioperative details, and postoperative complications were performed, stratified by repair type. One-year survival, target artery patency, freedom from type 1 or 3 endoleak, and freedom from reintervention were estimated with Kaplan-Meier analysis. RESULTS Among 175 F/B-EVARs, 38% (n = 67) were 4-vessel and 62% (n = 108) were <4-vessel. Intraoperatively, there was no difference in mean contrast use (76 mL vs. 74 mL, P = non significant [NS]) or dose area product (63,428 mGy cm2 vs. 96,015 mGy cm2), but there was increased median procedure time (4.8 hr, interquartile range [IQR] = 4.1-5.8 versus 3.6 hr, IQR = 2.9-4.1, P < 0.0001) and mean operating room direct costs ($52,532, standard deviation [SD] = 18,640 versus $40,128, SD = 15,135, P < 0.0001) in 4-vessel repairs. There were no differences in mortality (1.9% vs. 4.5%), paraparesis (0% vs. 3.0%), or paralysis (0.9% vs. 0%), all P = NS. There were no differences in one-year survival, target artery patency, or freedom from reintervention. There was a lower 1-year freedom from type 1 or 3 endoleak with 4-vessel repairs (82% vs. 94%, log-rank P = 0.02), driven by an increased rate of type 3 endoleaks. Endoleak resolution after treatment was equivalent in both groups (4-vessel, 10 of 12, 83% resolved; <4-vessel, 7 of 7, 100% resolved, P = NS). CONCLUSIONS With F/B-EVAR, utilization of a supraceliac seal zone, compared with an infraceliac seal zone, is associated with statistical differences in operative characteristics/resource utilization, but with negligible clinical significance. Further innovation to eliminate type 3 endoleaks at fenestrations/branches remains an unmet need. To achieve adequate F/B-EVAR proximal seal zone length, one should have a low threshold to incorporate the celiac artery.
Collapse
|
7
|
Unsgård RG, Altreuther M, Lange C, Hammer T, Mattsson E. Five-year results of endovascular aortic repair used according to instructions for use give a good general outcome for abdominal aortic aneurysm. SAGE Open Med 2019; 7:2050312119853434. [PMID: 31205704 PMCID: PMC6535726 DOI: 10.1177/2050312119853434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives: The primary aim of this study was to investigate the rate of sac enlargement and secondary procedures after 5 years when instructions for use are strictly applied with endovascular aortic repair. The secondary aim was to investigate if strict indications with endovascular aortic repair, rendering more open operations, would change the general outcome of patients with abdominal aortic aneurysm. Materials and methods: Patients having their abdominal aortic aneurysm procedure in a single institution between 01 January 2002 and 31 December 2006 were included. Indications for endovascular aortic repair were as follows: aortic neck: length 15 mm or more, diameter 32 mm or less and straight configuration; iliac arteries: length > 10 mm, 7.5–20 mm in diameter. Sac enlargement was defined as an increase in diameter of 5 mm or more. Results: A total of 123 patients were intended to be treated electively with endovascular aortic repair from 2002 to 2007 using Cook Zenith stent grafts. In the same period, 147 patients were treated with elective open repair. At 5 years, 7.3% (N = 9) of the elective intended-to-treat patients with endovascular aortic repair had a sac enlargement. Thirty-five percent of the patients were registered with endoleaks, 13% of the patients had secondary procedures, 12.2% of the patients had early and 6.5% late complications during the follow-up period. Aneurysm rupture was seen in 1.6% of the patients. During the 5-year follow-up period, 34 (27.6%) of the endovascular aortic repair patients died. Five-year mortality for open repair was 23.8%, and 12.2% of the open repair patients had secondary procedures. Conclusion: Endovascular aortic repair for abdominal aortic aneurysm in accordance with instructions for use gives a low long-term risk for increased diameter and low rate of secondary procedures. There was similar mortality after elective endovascular aortic repair and open repair for abdominal aortic aneurysm. Applying endovascular aortic repair according to instructions for use does not seem to change the general outcome of patients with abdominal aortic aneurysm but improves the outcome with the method.
Collapse
Affiliation(s)
- Runa G Unsgård
- Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Martin Altreuther
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Conrad Lange
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tommy Hammer
- Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erney Mattsson
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
8
|
Choo XY, Hajibandeh S, Hajibandeh S, Antoniou GA. The Nellix endovascular aneurysm sealing system: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:65-79. [PMID: 30858738 PMCID: PMC6385777 DOI: 10.2147/mder.s155300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The Nellix endovascular aneurysm sealing (EVAS) system is a novel approach for the treatment of abdominal aortic aneurysm (AAA). We aimed to evaluate the efficacy of EVAS in the management of patients with AAA. Materials and methods We searched PubMed/MEDLINE, CINAHL, and bibliographic reference lists to identify studies reporting clinical outcomes in patients with asymptomatic, non-ruptured AAA treated with EVAS with the Nellix device. We pooled dichotomous outcome data using random-effects models. Results We identified 14 single-arm observational studies, reporting a total of 1,510 patients. The pooled estimate of technical success was 99% (95% CI =98–100; heterogeneity: P=0.869, I2=0%). Adjunctive procedures were carried out in 39% (95% CI =19–63; heterogeneity: P<0.0001, I2=88%). Two cases of aneurysm rupture were reported within 30 days of treatment (0.7%, 95% CI =0.3–1.6; heterogeneity: P=0.923, I2=0%) and another five cases of rupture occurred during follow-up (0.8%, 95% CI =0.4–1.6; heterogeneity: P=0.958, I2=0%). The pooled estimates of early (within 30 days) and late (during follow-up) type I endoleak were 2.8 % (95% CI =1.8–4.2; heterogeneity: P=0.254, I2=18%) and 1.9% (95% CI =1.3–2.8; heterogeneity: P=0.887, I2=0%), respectively. Sac enlargement was noted in 3.1% (95% CI =1.8–5.4; heterogeneity: P=0.419, I2=0%) and device migration in 2.1% (95% CI =0.8–5.3; heterogeneity: P=0.004, I2=65%). The early and late reintervention rates were 2.7% (95% CI =1.7–4.2; heterogeneity: P=0.183, I2=27%) and 3.5% (95% CI =2.3–5.5; heterogeneity: P=0.061, I2=42%), respectively. The pooled estimate of 30-day mortality was 1.5% (95% CI =0.9–2.6; heterogeneity: P=0.559, I2=0%) and the pooled estimate of aneurysm-related death during follow-up was 1.0% (95% CI =0.6–1.9; heterogeneity: P=0.872, I2=0%). Conclusion Reported outcomes of EVAS are acceptable. Type I endoleak, sac enlargement, device migration, and aneurysm rupture are recognized complications. High-level research is required to investigate potential advantages of EVAS over conventional treatments.
Collapse
Affiliation(s)
- Xin Y Choo
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK,
| | - Shahab Hajibandeh
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK,
| | - Shahin Hajibandeh
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK,
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK, .,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
9
|
Yang SS. Hybrid repair of abdominal aortic aneurysm in a patient with poliomyelitis-related deformities. J Vasc Surg 2018; 67:945-948. [DOI: 10.1016/j.jvs.2017.08.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/26/2017] [Indexed: 11/28/2022]
|
10
|
Deery SE, Ergul EA, Schermerhorn ML, Siracuse JJ, Schanzer A, Goodney PP, Cambria RP, Patel VI. Aneurysm sac expansion is independently associated with late mortality in patients treated with endovascular aneurysm repair. J Vasc Surg 2017; 67:157-164. [PMID: 28865980 DOI: 10.1016/j.jvs.2017.06.075] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms can exhibit variations in sac behavior ranging from complete regression to expansion. We evaluated the impact of sac behavior at 1-year follow-up on late survival. METHODS We used the Vascular Study Group of New England (VSGNE) registry from 2003 to 2011 to identify EVAR patients with 1-year computed tomography follow-up. Aneurysm sac enlargement ≥5 mm (sac expansion) and decrease ≥5 mm (sac regression) were defined per Society for Vascular Surgery guidelines. Predictors of change in sac diameter and impact of sac behavior on long-term mortality were assessed by multivariable methods. RESULTS Of 2437 patients who underwent EVAR, 1802 (74%) had complete 1-year follow-up data and were included in the study. At 1 year, 162 (9%) experienced sac expansion, 709 (39%) had a stable sac, and 931 (52%) experienced sac regression. Sac expansion was associated with preoperative renal insufficiency (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.5-8.0; P < .01), urgent repair (OR, 2.7; 95% CI, 1.4-5.1; P < .01), hypogastric coverage (OR, 1.7; 95% CI, 1.1-2.7; P = .02), and type I/III (OR, 16.8; 95% CI, 7.3-39.0; P < .001) or type II (OR, 2.9; 95% CI, 2.0-4.3; P < .001) endoleak at follow-up, and sac expansion was inversely associated with smoking (OR, 0.6; 95% CI, 0.4-0.96; P = .03) and baseline aneurysm diameter (OR, 0.7; 95% CI, 0.6-0.9; P < .001). Sac regression (vs expansion or stable sac) was associated with female gender (OR, 1.8; 95% CI, 1.4-2.4; P < .001) and larger baseline aneurysm diameter (OR, 1.4; 95% CI, 1.2-1.5; P < .001) and inversely associated with type I/III (OR, 0.2; 95% CI, 0.1-0.5; P < .01) or type II endoleak at follow-up (OR, 0.2; 95% CI, 0.2-0.3; P < .001). After risk-adjusted Cox regression, sac expansion was independently associated with late mortality (hazard ratio, 1.5; 95% CI, 1.1-2.0; P = .01), even with adjustment for reinterventions and endoleak during follow-up. Sac regression was associated with lower late mortality (hazard ratio, 0.6; 95% CI, 0.5-0.7; P < .001). Long-term survival was lower (log-rank, P < .001) in patients with sac expansion (98% 1-year and 68% 5-year survival) compared with all others (99% 1-year and 83% 5-year survival). CONCLUSIONS These data suggest that an abdominal aortic aneurysm sac diameter increase of at least 5 mm at 1 year, although infrequent, is independently associated with late mortality regardless of the presence or absence of endoleak and warrants close observation and perhaps early intervention.
Collapse
Affiliation(s)
- Sarah E Deery
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Emel A Ergul
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, Mass
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts Medical Center, Worcester, Mass
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard P Cambria
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Virendra I Patel
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | | |
Collapse
|
11
|
Png CYM, Tadros RO, Kang M, Beckerman WE, Tardiff ML, Vouyouka AG, Marin ML, Faries PL. The Protective Effects of Diabetes Mellitus on Post-EVAR AAA Growth and Reinterventions. Ann Vasc Surg 2017; 43:65-72. [DOI: 10.1016/j.avsg.2016.10.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
|
12
|
Malas MB, Hicks CW, Jordan WD, Hodgson KJ, Mills JL, Makaroun MS, Belkin M, Fillinger MF. Five-year outcomes of the PYTHAGORAS U.S. clinical trial of the Aorfix endograft for endovascular aneurysm repair in patients with highly angulated aortic necks. J Vasc Surg 2017; 65:1598-1607. [DOI: 10.1016/j.jvs.2016.10.120] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022]
|
13
|
de Bruin JL, Karthikesalingam A, Holt PJ, Prinssen M, Thompson MM, Blankensteijn JD, Grobbee D, Blankensteijn J, Bak A, Buth J, Pattynama P, Verhoeven E, van Voorthuisen A, Blankensteijn J, Balm R, Buth J, Cuypers P, Grobbee D, Prinssen M, van Sambeek M, Verhoeven E, Baas A, Hunink M, van Engelshoven J, Jacobs M, de Mol B, van Bockel J, Balm R, Reekers J, Tielbeek X, Verhoeven E, Wisselink W, Boekema N, Heuveling L, Sikking I, Prinssen M, Balm R, Blankensteijn J, Buth J, Cuypers P, van Sambeek M, Verhoeven E, de Bruin J, Baas A, Blankensteijn J, Prinssen M, Buth J, Tielbeek A, Blankensteijn J, Balm R, Reekers J, van Sambeek M, Pattynama P, Verhoeven E, Prins T, van der Ham A, van der Velden J, van Sterkenburg S, ten Haken G, Bruijninckx C, van Overhagen H, Tutein Nolthenius R, Hendriksz T, Teijink J, Odink H, de Smet A, Vroegindeweij D, van Loenhout R, Rutten M, Hamming J, Lampmann L, Bender M, Pasmans H, Vahl A, de Vries C, Mackaay A, van Dortmont L, van der Vliet A, Schultze Kool L, Boomsma J, van H, de Mol van Otterloo J, de Rooij T, Smits T, Yilmaz E, Wisselink W, van den Berg F, Visser M, van der Linden E, Schurink G, de Haan M, Smeets H, Stabel P, van Elst F, Poniewierski J, Vermassen F. Predicting reinterventions after open and endovascular aneurysm repair using the St George's Vascular Institute score. J Vasc Surg 2016; 63:1428-1433.e1. [DOI: 10.1016/j.jvs.2015.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/15/2015] [Indexed: 12/01/2022]
|
14
|
Mahajan A, Barber M, Cumbie T, Filardo G, Shutze WP, Sass DM, Shutze W. The Impact of Aneurysm Morphology and Anatomic Characteristics on Long-Term Survival after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2016; 34:75-83. [PMID: 27177698 DOI: 10.1016/j.avsg.2015.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/22/2015] [Accepted: 12/21/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hostile anatomic characteristics in patients undergoing endovascular abdominal aortic aneurysm repair (EVAR) and the placement of endografts not in concordance with the specific device anatomic guidelines (or instructions for use [IFU]) have shown decreased technical success of the procedure. But these factors have never been evaluated in regard to patient postoperative survival. We sought to assess the association between survival and (1) aneurysm anatomy and characteristics and (2) implantation in compliance with manufacturer's anatomic IFU guidelines in patients undergoing endovascular aortic aneurysm repair. METHODS The cohort included 273 consecutive patients who underwent EVAR at Baylor Heart and Vascular Hospital between January 1, 2002 and December 31, 2009 and had their preoperative computed tomography (CT) scan digitally retrievable. The CT scans and operative notes were then reviewed, and the anatomic severity grading (ASG) score, maximum aneurysm diameter, thrombus width, patency of aortic side branch vessels, and implantation in compliance with IFU guidelines were assessed. The unadjusted association between survival (assessed until November 1, 2011) and these variables was assessed with the Kaplan-Meier method. Moreover, propensity-adjusted (for a comprehensive array of clinical and nonclinical risk factors) proportional hazard models were developed to assess the adjusted associations. RESULTS Seven (2.56%) patients died within 30 days from EVAR, and 88 (30.04%) patients died during the study follow-up. Patient mean survival was 6.3 years. The unadjusted analysis showed a statistically significant association between survival and thrombus width (P = 0.007), ASG score (P = 0.004), and implantation in compliance with IFU guidelines (P = 0.007). However, the adjusted analysis revealed that none of the anatomic and compliance factors were significantly associated with long-term survival (ASG, P = 0.149; diameter, P = 0.836; thrombus, P = 0.639; patency, P = 0.219; and implantation compliance, P = 0.219). CONCLUSIONS Unfavorable aneurysm morphologic characteristics and endograft implantation not in compliance with IFU guidelines did not adversely affect patient survival after EVAR in this group of patients. This implies that unfavorable anatomy, even that which would necessitate implantation of the EVAR device outside of the IFU guidelines, should not necessarily contraindicate EVAR.
Collapse
Affiliation(s)
- Anuj Mahajan
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - Marcus Barber
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - Todd Cumbie
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - Giovanni Filardo
- Department of Epidemiology, Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, TX
| | - William P Shutze
- Texas Vascular Associates, The Heart Hospital Baylor Plano, Plano, TX
| | - Danielle M Sass
- Department of Vascular Surgery, Baylor University Medical Center, Dallas, TX
| | - William Shutze
- Texas Vascular Associates, The Heart Hospital Baylor Plano, Plano, TX
| |
Collapse
|
15
|
Paraskevas KI, Mikhailidis DP, Shearman CP. C-reactive protein levels and aortic aneurysmal disease progression after endovascular repair: The jury is still out. Int J Cardiol 2016; 203:1141. [PMID: 26603649 DOI: 10.1016/j.ijcard.2015.10.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, Southampton University Hospital, Southampton, UK
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
| | - Clifford P Shearman
- Department of Vascular Surgery, Southampton University Hospital, Southampton, UK
| |
Collapse
|
16
|
Wadgaonkar AD, Black JH, Weihe EK, Zimmerman SL, Fishman EK, Johnson PT. Abdominal aortic aneurysms revisited: MDCT with multiplanar reconstructions for identifying indicators of instability in the pre- and postoperative patient. Radiographics 2015; 35:254-68. [PMID: 25590402 DOI: 10.1148/rg.351130137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rupture of an abdominal aortic aneurysm is commonly a fatal event. Multidetector computed tomographic (CT) signs of frank aortic rupture are usually readily apparent and widely understood. However, diagnosing an impending aortic rupture on the basis of imaging findings can prove more difficult. CT is the primary modality used for serial imaging in patients with aortic aneurysm and may show findings indicative of aortic instability. Therefore, it is critical that radiologists be familiar with the CT findings of aortic instability to avert the potential complications of hemorrhage, end organ or limb ischemia, and death. Various preoperative CT indicators have been previously described in both research investigations and review articles. A large baseline aneurysm size and a rapid increase in size over time are associated with a higher risk for rupture. The importance of obtaining accurate measurements with multiplanar reconstructions and the role of new semiautomated tools for obtaining accurate, reproducible measurements are discussed. Additional CT findings that reflect aortic aneurysm instability include luminal expansion with lysis of thrombus, intramural hemorrhage (ie, the crescent sign), periaortic hemorrhage, a penetrating atherosclerotic ulcer, and contained rupture (ie, the draped aorta sign). After open or endovascular aneurysm repair, CT is routinely used to monitor for graft complications. In this setting, radiologists should understand that the presence of an endoluminal stent or surgical graft does not preclude aortic rupture. Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Ajay D Wadgaonkar
- From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N Caroline Street, Room 3140D, Baltimore, MD 21287
| | | | | | | | | | | |
Collapse
|
17
|
Sobocinski J, Briffa F, Holt PJ, Martin Gonzalez T, Spear R, Azzaoui R, Maurel B, Haulon S. Evaluation of the Zenith low-profile abdominal aortic aneurysm stent graft. J Vasc Surg 2015; 62:841-7. [PMID: 26243207 DOI: 10.1016/j.jvs.2015.04.452] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low-profile (LP) stent grafts are now commercially available in Europe for endovascular aortic aneurysm repair (EVAR). In this study the midterm outcomes and characteristics of patients treated with this last generation of stent grafts were compared with a cohort of patients treated with "standard-profile" (SP) stent grafts. METHODS The current study enrolled all patients treated for elective EVAR by the SP Zenith Flex stent graft (Cook Medical, Bloomington, Ind) between March 2010 and November 2011 and patients treated for elective EVAR by the Zenith LP stent graft (Cook Medical) between November 2011 and March 2013. All patients had a follow-up >18 months. Preoperative computed tomography angiograms were analyzed on a dedicated three-dimensional workstation. All data were prospectively collected in an electronic database and retrospectively analyzed. A comparative study was conducted. RESULTS The present study included 208 patients (107 SP and 101 LP). Patients' physiologic characteristics were similar in both groups. The iliac anatomy was considered "more challenging" in LP patients: respectively, 7% and 22% (P = .002) of SP and LP patients had bilateral external iliac diameter <7 mm; and 16% and 34% (P = .005) had a combination of an external iliac diameter <7 mm and an iliac tortuosity ratio index >1.5. No 30-day deaths were documented. The 24-month freedom from reintervention and overall survival rates after SP and LP were, respectively, 88% and 91% (P = .450) and 92% and 96% (P = .153). The 24-month rates for freedom from sac expansion and from limb occlusion were 96.4% and 98.7% (P = .320) and 92% and 95% (P = .293), respectively. One patient in each group presented with a type I endoleak during follow-up, and two LP patients presented with a type III endoleak (P = .235). CONCLUSIONS This study demonstrates that the last-generation LP stent grafts have favorable midterm outcomes similar to SP stent grafts despite being used to treat more patients with unfavorable iliac anatomy.
Collapse
Affiliation(s)
- Jonathan Sobocinski
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
| | - Florent Briffa
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Peter J Holt
- St George's Vascular Institute, University of London, London, United Kingdom
| | - Teresa Martin Gonzalez
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Rafaëlle Spear
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Richard Azzaoui
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Blandine Maurel
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Stéphan Haulon
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| |
Collapse
|
18
|
O'Callaghan A, Greenberg RK, Eagleton MJ, Bena J, Mastracci TM. Type Ia endoleaks after fenestrated and branched endografts may lead to component instability and increased aortic mortality. J Vasc Surg 2015; 61:908-14. [DOI: 10.1016/j.jvs.2014.10.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
|
19
|
Karthikesalingam A, Bahia SS, Patel SR, Azhar B, Jackson D, Cresswell L, Hinchliffe RJ, Holt PJ, Thompson MM. A systematic review and meta-analysis indicates underreporting of renal dysfunction following endovascular aneurysm repair. Kidney Int 2015; 87:442-51. [PMID: 25140912 PMCID: PMC5590709 DOI: 10.1038/ki.2014.272] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 06/08/2014] [Accepted: 06/13/2014] [Indexed: 01/20/2023]
Abstract
Deterioration in renal function has been described after endovascular repair of abdominal aortic aneurysms (EVRs). The etiology is multifactorial and represents an important therapeutic target. A need exists to quantitatively summarize incidence and severity of renal dysfunction after EVR to allow better-informed attempts to preserve renal function and improve life expectancy. Here a systematic search was performed using Medline and Embase for renal function after EVR applying PRISMA statements. Univariate and multivariate random-effects meta-analyses were performed to estimate pooled postoperative changes in serum creatinine and creatinine clearance at four time points after EVR. Clinically relevant deterioration in renal function was also estimated at 1 year or more after EVR. Pooled probability of clinically relevant deterioration in renal function at 1 year or more was 18% (95% confidence interval of 14-23%, I2 of 82.5%). Serum creatinine increased after EVR by 0.05 mg/dl at 30 days/1 month, 0.09 mg/dl at 1 month to 1 year, and 0.11 mg/dl at 1 year or more (all significant). Creatinine clearance decreased after EVR by 5.65 ml/min at 1 month-1 year and by 6.58 ml/min at 1 year or more (both significant). Thus, renal dysfunction after EVR is common and merits attention.
Collapse
Affiliation(s)
- Alan Karthikesalingam
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Sandeep S. Bahia
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Shaneel R. Patel
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Bilal Azhar
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Dan Jackson
- MRC Biostatistics Unit, University of Cambridge, MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR
| | - Lynne Cresswell
- MRC Biostatistics Unit, University of Cambridge, MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR
| | - Robert J. Hinchliffe
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Peter J.E. Holt
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| | - Matt M. Thompson
- Department of Outcomes Research, St George’s Vascular Institute, 4 Floor St James Wing, St George’s Hospital NHS Trust, Blackshaw Road, London SW17 0QT
| |
Collapse
|
20
|
Belchos J, Wheatcroft M, Moloney T. Multiple endovascular aortic aneurysm repair graft failures and re-interventions over 15 years. SAGE Open Med Case Rep 2015; 3:2050313X15608558. [PMID: 27489701 PMCID: PMC4857307 DOI: 10.1177/2050313x15608558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/01/2015] [Indexed: 11/24/2022] Open
Abstract
Re-intervention on abdominal aortic aneurysm treated by endovascular aortic aneurysm repair for complications such as endoleak, graft migration, and graft failure is relatively common. However, re-do endovascular aortic aneurysm repair can be complex, as the failed graft still resides within the vessel. In addition, some re-do endovascular aortic aneurysm repairs call for an advanced custom graft, which can further increase the complexity and technical skill required. We describe a case of a 15-year-old endovascular aortic aneurysm repair originally implanted in a 71-year-old man, followed by three separate complications requiring intervention. We describe important procedural decisions taken into consideration when presented with failure of an older graft.
Collapse
Affiliation(s)
- Jessica Belchos
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Mark Wheatcroft
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tony Moloney
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
21
|
Schanzer A, Messina LM, Ghosh K, Simons JP, Robinson WP, Aiello FA, Goldberg RJ, Rosen AB. Follow-up compliance after endovascular abdominal aortic aneurysm repair in Medicare beneficiaries. J Vasc Surg 2015; 61:16-22.e1. [PMID: 25441010 PMCID: PMC4276501 DOI: 10.1016/j.jvs.2014.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Lifelong imaging follow-up is essential to the safe and appropriate management of patients who undergo endovascular abdominal aortic aneurysm repair (EVAR). We sought to evaluate the rate of compliance with imaging follow-up after EVAR and to identify factors associated with being lost to imaging follow-up. METHODS We identified a 20% sample of continuously enrolled Medicare beneficiaries who underwent EVAR between 2001 and 2008. Using data through 2010 from Medicare Inpatient, Outpatient, and Carrier files, we identified all abdominal imaging studies that may have been performed for EVAR follow-up. Patients were considered lost to annual imaging follow-up if they did not undergo any abdominal imaging study within their last 2 years of follow-up. Multivariable models were constructed to identify independent factors associated with being lost to annual imaging follow-up. RESULTS Among 19,962 patients who underwent EVAR, the incidence of loss to annual imaging follow-up at 5 years after EVAR was 50%. Primary factors associated with being lost to annual imaging follow-up were advanced age (age 65-69 years, reference; age 75-79 years: hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.15-1.32; age 80-85 years: HR, 1.45; 95% CI, 1.35-1.55; age >85 years: HR, 2.03; 95% CI, 1.88-2.20) and presentation with an urgent/emergent intact aneurysm (HR, 1.27; 95% CI, 1.20-1.35) or ruptured aneurysm (HR, 1.84; 95% CI, 1.63-2.08). Additional independent factors included several previously diagnosed chronic diseases and South and West regions of the United States. CONCLUSIONS Annual imaging follow-up compliance after EVAR in the United States is significantly below recommended levels. Quality improvement efforts to encourage improved compliance with imaging follow-up, especially in older patients with multiple comorbidities and in those who underwent EVAR urgently or for rupture, are necessary.
Collapse
Affiliation(s)
- Andres Schanzer
- University of Massachusetts Medical School, Worcester, Mass.
| | | | - Kaushik Ghosh
- National Bureau of Economic Research, Cambridge, Mass
| | | | | | | | | | - Allison B Rosen
- University of Massachusetts Medical School, Worcester, Mass; National Bureau of Economic Research, Cambridge, Mass
| |
Collapse
|
22
|
Antonopoulos CN, Kakisis JD, Giannakopoulos TG, Andrikopoulos V, Antoniadis P, Bessias N, Dervisis K, Georgopoulos S, Giannoukas A, Kaperonis E, Kiskinis D, Klonaris C, Machairas A, Papavassiliou V, Saleptsis V, Saratzis N, Seretis K, Tampakis C, Liapis CD. Rupture After Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2014; 48:476-81. [DOI: 10.1177/1538574414561225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A total of 22 patients with ruptured abdominal aortic aneurysms (rAAAs) after previous endovascular aortic repair (EVAR; rAAAevar) were presented to 7 referral hospitals in Greece, between January 2006 and April 2012. Type Ia endoleak and endograft migration were identified in 72.7% and 50%, respectively. Compliance to follow-up protocol prior to rupture was 31.8%. In-hospital mortality was 36.4% (9.1% for those treated with secondary EVAR and 63.6% for those treated with open surgical repair, P = .02). An increase in the proportion of patients with rAAAevar among the total number of patients with rAAAs from 1.3% in 2007 to 18.2% in 2012 ( P for trend = .04) was recorded, corresponding to an annual increase of 2.8% (b = 2.84, P = .04). Rupture after EVAR seemed to be a clinical entity encountered with increasing frequency over the past years. Type I endoleak and endograft migration were most frequently observed, whereas compliance to follow-up was low.
Collapse
Affiliation(s)
| | - John D. Kakisis
- Department of Vascular Surgery, University General Hospital “Attikon”, Athens, Greece
| | | | - Vasilios Andrikopoulos
- Department of Vascular Surgery, General Hospital “Korgialenio—Benakio National Red Cross”, Athens, Greece
| | - Pavlos Antoniadis
- Department of Vascular Surgery, General Hospital “Konstantopoulio—Agia Olga”, Athens, Greece
| | - Nikolaos Bessias
- Department of Vascular Surgery, General Hospital “Korgialenio—Benakio National Red Cross”, Athens, Greece
| | - Konstantinos Dervisis
- Department of Vascular Surgery, General Hospital “Konstantopoulio—Agia Olga”, Athens, Greece
| | | | | | - Elias Kaperonis
- Department of Vascular Surgery, General Hospital “Sismanoglio”, Athens, Greece
| | - Dimitrios Kiskinis
- Department of Vascular Surgery, General Hospital of Thessaloniki “Papageorgiou”, Thessaloniki, Greece
| | - Christos Klonaris
- Department of Vascular Surgery, General Hospital “Laikon”, Athens, Greece
| | | | | | - Vasilios Saleptsis
- Department of Vascular Surgery, University Hospital of Larissa, Larissa, Greece
| | - Nikolaos Saratzis
- Department of Vascular Surgery, General Hospital of Thessaloniki “Papageorgiou”, Thessaloniki, Greece
| | | | - Charalambos Tampakis
- Department of Vascular Surgery, General Hospital “Konstantopoulio—Agia Olga”, Athens, Greece
| | - Christos D. Liapis
- Department of Vascular Surgery, University General Hospital “Attikon”, Athens, Greece
| |
Collapse
|
23
|
Candell L, Tucker LY, Goodney P, Walker J, Okuhn S, Hill B, Chang R. Early and delayed rupture after endovascular abdominal aortic aneurysm repair in a 10-year multicenter registry. J Vasc Surg 2014; 60:1146-1153. [PMID: 24957409 DOI: 10.1016/j.jvs.2014.05.046] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/21/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Rupture after abdominal endovascular aortic aneurysm repair (EVAR) is a function of graft maintenance of the seal and fixation. We describe our 10-year experience with rupture after EVAR. METHODS From 2000 to 2010, 1736 patients with abdominal aortic aneurysm (AAA) from 17 medical centers underwent EVAR in a large, regional integrated health care system. Preoperative demographic and clinical data of interest were collected and stored in our registry. We retrospectively identified patients with postoperative rupture, characterized as "early" and "delayed" rupture (≤30 days and >30 days after the initial EVAR, respectively), and identified predictors associated with delayed rupture. RESULTS The overall follow-up rate was 92%, and the median follow-up was 2.7 years (interquartile range, 1.2-4.4 years) in these 1736 EVAR patients. We identified 20 patients with ruptures; 70% were male, the mean age was 79 years, and mean AAA size at the initial EVAR was 6.3 cm. Six patients underwent initial EVAR for rupture (n = 2) or symptomatic presentation (n = 4). Of the 20 post-EVAR ruptures, 25% (five of 20) were early, all occurring within 2 days after the initial EVAR. Of these five patients, four had intraoperative adverse events leading directly to rupture, with one type I and one type III endoleak. Of the five early ruptures, four patients underwent endovascular repair and one received repair with open surgery, resulting in two perioperative deaths. Among the remaining 15 patients, the median time from initial EVAR to rupture was 31.1 months (interquartile range, 13.8-57.3 months). Most of these delayed ruptures (10 of 15) were preceded by AAA sac increases, including three patients with known endoleaks who underwent reintervention. At the time of delayed rupture, nine of 15 patients had new endoleaks. Among all 20 patients, six patients did not undergo repair (all delayed patients) and died, nine underwent repeated EVAR, and five had open repair. For patients who underwent repair for delayed rupture, mortality at 30 days and 1 year were 44.4% and 66.7%, respectively. Multivariable Cox regression analysis identified age 80 to 89 (hazard ratio, 3.3; 95% confidence interval, 1.1-9.4; P = .03), and symptomatic or ruptured initial indication for EVAR (hazard ratio, 7.4; 95% confidence interval, 2.2-24.8; P < .01) as significant predictors of delayed rupture. CONCLUSIONS Rupture after EVAR is a rare but devastating event, and mortality after repair exceeds 60% at 1 year. Most delayed cases showed late AAA expansion, thereby implicating late loss of seal and increased endoleaks as the cause of rupture in these patients and mandating vigilant surveillance.
Collapse
Affiliation(s)
- Leah Candell
- East Bay Surgical Residency Program, University of California, San Francisco, Oakland, Calif
| | | | - Philip Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Joy Walker
- General Surgery Residency Program, University of California, San Francisco, San Francisco, Calif
| | - Steven Okuhn
- Department of Vascular Surgery, Permanente Medical Group, San Francisco, Calif
| | - Bradley Hill
- Department of Vascular Surgery, Permanente Medical Group, Santa Clara, Calif
| | - Robert Chang
- Department of Vascular and Endovascular Surgery, Permanente Medical Group, South San Francisco, Calif.
| |
Collapse
|
24
|
Ambler G, Twine C, Shak J, Rollins K, Varty K, Coughlin P, Hayes P, Boyle J. Survival Following Ruptured Abdominal Aortic Aneurysm Before and During the IMPROVE Trial: A Single-centre Series. Eur J Vasc Endovasc Surg 2014; 47:388-93. [DOI: 10.1016/j.ejvs.2014.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
|
25
|
Kristmundsson T, Sonesson B, Dias N, Törnqvist P, Malina M, Resch T. Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm. J Vasc Surg 2014; 59:115-20. [PMID: 24011738 DOI: 10.1016/j.jvs.2013.07.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/01/2013] [Accepted: 07/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Björn Sonesson
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Nuno Dias
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Per Törnqvist
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Martin Malina
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Timothy Resch
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
26
|
Karthikesalingam A, Cobb RJ, Khoury A, Choke EC, Sayers RD, Holt PJ, Thompson MM. The morphological applicability of a novel endovascular aneurysm sealing (EVAS) system (Nellix) in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2013; 46:440-5. [PMID: 23911735 DOI: 10.1016/j.ejvs.2013.06.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 06/19/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Endovascular aneurysm sealing (EVAS) using the Nellix system is a promising alternative to endovascular repair (EVR) and open surgery for abdominal aortic aneurysms (AAA). The aim of this study was to investigate the proportion of patients with AAA who are morphologically suitable for treatment with Nellix. METHODS Patients presenting with AAA were investigated at two regionalised vascular units. Separate cohorts were identified, who had undergone infrarenal EVR, open aneurysm repair, fenestrated endovascular repair (FEVR) or non-operative management. Pre-operative morphology was quantified using three-dimensional computed tomography according to a validated protocol. Each aneurysm was assessed for compliance with the instructions for use (IFU) of Nellix RESULTS 776 patients were identified with mean age 75 ± 9 years. 730/776 (94.1%) had undergone infrarenal EVR, 6/776 (0.8%) open repair, 27/776 (3.5%) FEVR and 13/776 (1.7%) had been managed non-operatively. 544/776 (70.1%) of all AAA were morphologically suitable for Nellix. 533/730 (73.0%) of patients who had undergone infrarenal EVR were compliant with Nellix IFU, compared with 497/730 (68.1%), 379/730 (51.9%) and 214/730 (29.3%) with the IFU for Medtronic Endurant (p = .04) or Cook Zenith (p < .01) and Gore C3 Excluder (p < .01) endografts respectively. CONCLUSIONS Nellix technology appears widely applicable to contemporary infrarenal AAA practice, and may provide an option for patients that are outside current EVR device instructions for use. However, formal outcomes study is still required, and will ultimately dictate the clinical relevance of this feasibility study. The major limitation to anatomic suitability for Nellix is currently the maximum patent lumen diameter of large AAA.
Collapse
Affiliation(s)
- A Karthikesalingam
- Department of Outcomes Research, St George's Vascular Institute, London, UK.
| | | | | | | | | | | | | |
Collapse
|
27
|
Bahia SS, Karthikesalingam A, Thompson MM. Abdominal aortic aneurysms: endovascular options and outcomes - proliferating therapy, but effective? Prog Cardiovasc Dis 2013; 56:19-25. [PMID: 23993235 DOI: 10.1016/j.pcad.2013.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abdominal aortic aneurysm (AAA) has a reported prevalence rate of 1.4% in the US. AAA rupture accounts for an estimated 15,000 deaths per year, rendering it the 10th leading cause of death in men over the age of 55. Endovascular repair (EVR) has proliferated in the last two decades as an increasingly popular alternative to traditional open surgery, and is now the default treatment in the majority of centres worldwide. This review article outlines the evidence supporting this stance. The development of EVR is reviewed, alongside trends in utilisation of this therapy over time. The evidence for the relative short-term and long-term outcomes of EVR and open AAA repair is discussed, and ongoing controversies surrounding the use of EVR are considered.
Collapse
Affiliation(s)
- Sandeep S Bahia
- Department of Cardiovascular Sciences, St George's Vascular Institute, London.
| | | | | |
Collapse
|
28
|
Kuivaniemi H, Sakalihasan N, Lederle FA, Jones GT, Defraigne JO, Labropoulos N, Legrand V, Michel JB, Nienaber C, Radermecker MA, Elefteriades JA. New Insights Into Aortic Diseases: A Report From the Third International Meeting on Aortic Diseases (IMAD3). AORTA (STAMFORD, CONN.) 2013; 1:23-39. [PMID: 26798669 PMCID: PMC4682695 DOI: 10.12945/j.aorta.2013.13.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/08/2013] [Indexed: 12/11/2022]
Abstract
The current state of research and treatment on aortic diseases was discussed in the "3rd International Meeting on Aortic Diseases" (IMAD3) held on October 4-6, 2012, in Liège, Belgium. The 3-day meeting covered a wide range of topics related to thoracic aortic aneurysms and dissections, abdominal aortic aneurysms, and valvular diseases. It brought together clinicians and basic scientists and provided an excellent opportunity to discuss future collaborative research projects for genetic, genomics, and biomarker studies, as well as clinical trials. Although great progress has been made in the past few years, there are still a large number of unsolved questions about aortic diseases. Obtaining answers to the key questions will require innovative, interdisciplinary approaches that integrate information from epidemiological, genetic, molecular biology, and bioengineering studies on humans and animal models. It is more evident than ever that multicenter collaborations are needed to accomplish these goals.
Collapse
Affiliation(s)
- Helena Kuivaniemi
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania
| | | | - Frank A. Lederle
- Minneapolis Center for Epidemiological and Clinical Research, Department of Medicine (III-0), VA Medical Center, Minneapolis, Minnesota
| | | | | | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Victor Legrand
- Cardiology Departments, University Hospital of Liège, CHU, Liège, Belgium
| | | | | | | | | |
Collapse
|
29
|
|