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Paredes-Mariñas E, Llort-Pont C, Castro-Bolance F, Riambau-Alonso V. Endovascular Treatment of Thoracic Aortic Pseudoaneurysm Through a Subclavian Approach in Patient with Aortoiliac Occlusive Disease: A Case Report. EJVES Short Rep 2018; 39:47-49. [PMID: 29922726 PMCID: PMC6005811 DOI: 10.1016/j.ejvssr.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Thoracic endovascular aortic repair (TEVAR) has become the preferred option for treatment of thoracic aortic pathology, but lack of vascular access options is a common contraindication to TEVAR. Case report The authors report a case of a 67 year old male patient with multiple revascularisation procedures: bilateral axillofemoral bypass and thoracic aortofemoral bypass, both occluded. An anastomotic pseudoaneurysm of the thoracic aorta developed and detected on computed tomography angiography (CTA). A femoral artery approach could not be performed because of complete occlusion of both iliac arteries. A left subclavian artery approach was performed and through a Dacron prosthetic graft extension anastomosed to the proximal segment of the occluded axillofemoral bypass a distal component of a Zenith Alpha endograft (Cook®) was successfully deployed upside down. There was a good seal without endoleaks and no complications. Conclusion In patients with aortic bypass systematic follow up is important to detect anastomotic pseudoaneurysm and prevent its related complications. TEVAR may be offered for the treatment of thoracic aortic aneurysm pathology even in patients with a lack of vascular access. In the absence of a standard iliofemoral approach, use of an alternative subclavian approach may be considered. The reduction of the carrier system profiles allows performance of TEVAR with safety and efficiency. A femoral artery approach, the most common approach for TEVAR, cannot always be performed. Poor access is the leading cause of conversion to open repair. The use of an alternative subclavian approach may be considered. A dacron prosthesis extension can be used for introduction of TEVAR devices. The reduction of carrier system profiles allows performance of TEVAR safely and efficiently.
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2
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Laganà D, Guzzardi G, Petullà M, Martelli M, Ierardi AM, Del Sette B, Carrafiello GP. Endovascular Treatment of Aorto-Iliac-Femoral Anastomotic Pseudoaneurysms: A Multicentric Study. Ann Vasc Surg 2017; 45:213-222. [DOI: 10.1016/j.avsg.2017.05.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/28/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
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Trentadue M, Puppini G, Perandini S, Mezzetto L, Veraldi GF, Montemezzi S. Endovascular Repair of an Unusually Complex Anastomotic Pseudoaneurysm of an Aorto-Bisiliac Graft. Pol J Radiol 2017; 82:244-247. [PMID: 28533827 PMCID: PMC5424651 DOI: 10.12659/pjr.899825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/29/2016] [Indexed: 11/21/2022] Open
Abstract
Background Anastomotic pseudoaneurysm is an underestimated complication of aorto-iliac grafts. Case Report This case report describes an unusual presentation of a pseudoaneurysm with a particularly complex anatomy involving both the left iliac branches, which hindered the interpretation of diagnostic studies and therapeutic management in a patient with multiple comorbidities. Conclusions The manuscript describes a successful management of such a complication by means of an elective endovascular approach.
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Affiliation(s)
- Mirko Trentadue
- Department of Radiology - Interventional Radiology Unit, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy
| | - Giovanni Puppini
- Department of Radiology - Interventional Radiology Unit, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy
| | - Simone Perandini
- Department of Radiology - Interventional Radiology Unit, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy
| | - Stefania Montemezzi
- Department of Radiology - Interventional Radiology Unit, University Hospital of Verona, Polo Chirurgico "P. Confortini", Verona, Italy
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Gawenda M, Zaehringer M, Brunkwall J. Open versus Endovascular Repair of Para-Anastomotic Aneurysms in Patients Who Were Morphological Candidates for Endovascular Treatment. J Endovasc Ther 2016; 10:745-51. [PMID: 14533968 DOI: 10.1177/152660280301000410] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To compare the outcomes of open versus endovascular repair of para-anastomotic aneurysms (PAA) in the aortic and iliac arteries in a cohort of patients who fulfilled morphological criteria for endovascular repair. Methods: A retrospective review of 31 consecutive patients with PAA treated between 1985 and 2002 identified 26 (84%) patients who would have been candidates for endovascular repair based on preoperative computed tomography and angiography. Of these 26 patients, 10 (9 men; median age 65 years, range 60–75) underwent endovascular repair; the remaining 16 patients (14 men; median age 61.5 years, range 49–78) had open repair. The baseline data and outcome measures were compared between the treatment groups. Results: The patient groups were well matched for age, sex, weight, risk factors, comorbidities, aneurysm length, and elapsed time from initial graft placement. Both groups had technically successful PAA repairs; however, median blood loss (300 versus 1000 mL; p = 0.05) and procedural time (100 versus 215 minutes; p<0.001) were significantly reduced in the endovascular group. Median transfusion volume was significantly greater (1000 versus 0 mL; p = 0.01) in the surgically treated patients. The median stay in ICU was similar (18 versus 24 hours in the surgical cohort). Length of stay was significantly shorter in the endovascular group: 7.5 versus 17.0 days (p = 0.001) after the repair and 11 versus 22 days (p = 0.01) for overall hospitalization. One (10%) patient in the endovascular group died from a myocardial infarction on the third postoperative day. In the open group, there were 3 (19%) procedure-related deaths. Conclusions: Patients with PAA who were endograft candidates but who were treated with open repair experienced more morbidity and had more complications than patients treated with stent-grafts. If long-term follow-up demonstrates durable results, stent-graft repair may become the therapy of choice in PAAs.
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Affiliation(s)
- Michael Gawenda
- Division of Vascular Surgery, Medical Centre, University of Cologne, Germany.
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Jain V, Gruberg L, Bilfinger TV, Tassiopoulos AK, Loh SA. Coil Embolization of an Aortic Pseudoaneurysm after Open Repair of Type A Aortic Dissection. Ann Vasc Surg 2014; 28:1312.e1-5. [DOI: 10.1016/j.avsg.2013.12.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/28/2013] [Accepted: 12/28/2013] [Indexed: 11/26/2022]
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Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms. Clin Radiol 2012; 67:802-14. [PMID: 22341185 DOI: 10.1016/j.crad.2011.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 12/12/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
Abstract
Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.
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Affiliation(s)
- M Nayeemuddin
- Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent, UK
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7
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Ten Bosch JA, Waasdorp EJ, de Vries JPP, Moll FL, Teijink JA, van Herwaarden JA. The durability of endovascular repair of para-anastomotic aneurysms after previous open aortic reconstruction. J Vasc Surg 2011; 54:1571-8. [PMID: 21944919 DOI: 10.1016/j.jvs.2011.04.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/17/2011] [Accepted: 04/19/2011] [Indexed: 10/17/2022]
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8
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Endovascular Methods in the Treatment of Late Complications of Conventional Operations of Aneurysms At Aorto-Iliac Level. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Cerná M, Köcher M, Utíkal P, Koutná J, Drác P, Bachleda P, Burval S, Kozák J, Thomas RP. Endovascular treatment of abdominal aortic paraanastomotic pseudoaneurysms after surgical reconstruction. Eur J Radiol 2009; 71:333-7. [PMID: 18450399 DOI: 10.1016/j.ejrad.2008.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/26/2008] [Accepted: 03/20/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Marie Cerná
- Department of Radiology, University Hospital, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
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10
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Laganà D, Carrafiello G, Mangini M, Recaldini C, Lumia D, Cuffari S, Caronno R, Castelli P, Fugazzola C. Endovascular treatment of anastomotic pseudoaneurysms after aorto-iliac surgical reconstruction. Cardiovasc Intervent Radiol 2008; 30:1185-91. [PMID: 17508237 DOI: 10.1007/s00270-007-9047-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the effectiveness of endovascular treatment of anastomotic pseudoaneurysms (APAs) following aorto-iliac surgical reconstruction. MATERIALS We retrospectively evaluated 21 men who, between July 2000 and March 2006, were observed with 30 APAs, 13 to the proximal anastomosis and 17 to the distal anastomosis. The patients had had previous aorto-iliac reconstructive surgery with a bypass due to aneurysm (15/21) or obstructive disease (6/21). The following devices were used: 12 bifurcated endoprostheses, 2 aorto-monoiliac, 4 aortic extenders, 1 stent-graft leg, and 2 covered stents. Follow-up was performed with CT angiography at 1, 3, and 6 months after the procedure and yearly thereafter. RESULTS Immediate technical success was 100%. No periprocedural complications occurred. Four patients died during follow-up from causes not related to APA, and 1 (treated for prosthetic-enteric fistula) from sepsis 3 months after the procedure. During a mean follow-up of 19.7 months (range 1-72 months), 2 of 21 occlusions of stent-graft legs occurred 3 and 24 months after the procedure (treated with thrombolysis and percutaneous transluminal angioplasty and femorofemoral bypass, respectively) and 1 type I endoleak. Primary clinical success rate was 81% and secondary clinical success was 91%. CONCLUSION Endovascular treatment is a valid alternative to open surgery and can be proposed as the treatment of choice for APAs, especially in patients who are a high surgical risk. Further studies with larger series and longer follow-up are necessary to confirm the long-term effectiveness of this approach.
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Affiliation(s)
- Domenico Laganà
- Department of Radiology, University of Insubria, Viale Borri, 57, 21100 Varese, Italy.
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11
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Sfyroeras GS, Lioupis C, Bessias N, Maras D, Pomoni M, Andrikopoulos V. Endovascular treatment of a ruptured para-anastomotic aneurysm of the abdominal aorta. Cardiovasc Intervent Radiol 2008; 31 Suppl 2:S79-83. [PMID: 18214598 DOI: 10.1007/s00270-007-9206-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Revised: 08/13/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
Abstract
We report a case of a ruptured para-anastomotic aortic aneurysm treated with implantation of a bifurcated stent-graft. A 72-year-old patient, who had undergone aortobifemoral bypass for aortoiliac occlusive disease 16 years ago, presented with a ruptured para-anastomotic aortic aneurysm. A bifurcated stent-graft was successfully deployed into the old bifurcated graft. This is the first report of a bifurcated stent-graft being placed through an "end-to-side" anastomosed old aortobifemoral graft. Endovascular treatment of ruptured para-anastomotic aortic aneurysms can be accomplished successfully, avoiding open surgery which is associated with increased mortality and morbidity.
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Affiliation(s)
- Giorgos S Sfyroeras
- Department of Vascular Surgery, The Red Cross Hospital of Athens, Athens, Greece
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12
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Verhoeven ELG, Muhs BE, Zeebregts CJAM, Tielliu IFJ, Prins TR, Bos WTGJ, Oranen BI, Moll FL, van den Dungen JJAM. Fenestrated and Branched Stent-grafting After Previous Surgery Provides a Good Alternative to Open Redo Surgery. Eur J Vasc Endovasc Surg 2007; 33:84-90. [PMID: 16931071 DOI: 10.1016/j.ejvs.2006.06.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 06/21/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To present our experience using fenestrated and branched endoluminal grafts for Para-anastomotic aneurysms (PAA) following prior open aneurysm surgery, and after previous endovascular aneurysm repair (EVAR) complicated by proximal type I endoleak. METHODS Fenestrated and/or branched EVAR was performed on eleven patients. Indications included proximal type I endoleak after EVAR and short infrarenal neck (n=4), suprarenal aneurysm after open AAA (n=4), distal type I endoleak after endovascular TAA (n=1), proximal anastomotic aneurysm after open AAA (n=1), and an aborted open AAA repair due to bleeding around a short infrarenal neck. RESULTS The operative target vessel success rate was 100% (28/28) with aneurysm exclusion in all patients. Mean hospital stay was 6.0 days (range 2-12 days, SD 3.5 days). Thirty day mortality was 0%. All cause mortality during 18 months mean follow-up (range 5-44 months, SD 16.7 months) was 18% (2/11) with no deaths from aneurysm rupture. Cumulative visceral branch patency was 96% (27/28) at 42 months. Average renal function remained unchanged during the follow-up period. CONCLUSIONS Our report highlights the potential of fenestrated and branched technology to improve re-operative aortic surgical outcomes. The unique difficulties of increased graft on graft friction hindering placement, short working distance, and increased patient co-morbidities should be recognized.
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Affiliation(s)
- E L G Verhoeven
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
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13
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Aun R, Saliture Neto FT, Lederman A, Waksman H. Tratamento endoluminal de aneurismas anastomóticos na aorta abdominal: relato de dois casos. J Vasc Bras 2006. [DOI: 10.1590/s1677-54492006000100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os aneurismas anastomóticos que envolvem a anastomose proximal de reconstruções do território aorto-ilíaco são graves, e as operações convencionais para sua correção são complexas e passíveis de graves complicações. Apresentamos dois casos de aneurismas de anastomoses proximais de enxerto aorto-bifemoral que ocorreram após 15 e 18 anos, respectivamente, de evolução dos enxertos e que foram corrigidos pela técnica endoluminal. Ambos os pacientes evoluíram bem e foram submetidos a controle pela tomografia computadorizada com 12 e 6 meses de evolução, respectivamente, com exclusão do aneurisma.
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14
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Matsagas MI, Anagnostopoulos CE, Papakostas JC, DeRose JJ, Siminelakis S, Katsouras CS, Toumpoulis IK, Drossos GE, Michalis LK. Endovascular Stent-Graft Repair as a Late Secondary Procedure After Previous Aortic Grafts. Cardiovasc Intervent Radiol 2006; 29:655-8. [PMID: 16502174 DOI: 10.1007/s00270-005-0180-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thoracic and abdominal aortic endovascular procedures as alternatives to aortic reoperations were studied in three different cases. An anastomotic aneurysm after previous thoracic aortic graft for coarctation, a second-stage elephant trunk repair (descending thoracic aortic aneurysm), and a secondary aneurysm proximal to a previous abdominal aortic graft were successfully treated with endovascular stent-grafts. During the follow-up period no lethal events or major aortic or graft-related complications were observed, except a type II endoleak in the anastomotic aortic aneurysm case. An endovascular stent-graft can be safely deployed into a previously implanted vascular graft, avoiding repeat surgery.
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Affiliation(s)
- Miltiadis I Matsagas
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, University Avenue, 45500 Ioannina, Greece.
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15
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Zhou W, Bush RL, Bhama JK, Lin PH, Safaya R, Lumsden AB. Repair of Anastomotic Abdominal Aortic Pseudoaneurysm Utilizing Sequential AneuRx Aortic Cuffs in an Overlapping Configuration. Ann Vasc Surg 2006; 20:17-22. [PMID: 16378150 DOI: 10.1007/s10016-005-9282-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anastomotic aortic pseudoaneurysm is a known late complication following aortic repair and presents a considerable surgical challenge. We herein evaluate the endovascular alternative of using sequential AneuRx aortic cuffs to bridge the degenerative anastomotic pseudoaneurysms as a definitive treatment. Over a 3-year period, six patients with a mean age of 68.7 years (range 58-75) were identified who had proximal anastomotic aortic pseudoaneurysms secondary to previously implanted bifurcated aortic grafts (mean 15, range 12-20 years) following open surgical correction of aortoiliac occlusive disease. Five patients (83%) presented with concomitant palpable femoral anastomotic pseudoaneurysms and one patient (16%) had a pulsatile abdominal mass. All patients had computed tomographic (CT) scans confirming proximal anastomotic pseudoaneuryms without evidence of infection. The mean diameter of the pseudoaneurysms was 5.3 cm (range 4.0-7.0). Five patients were treated with endovascular methods, while one patient was not suitable for endovascular repair due to the diameter of the native aorta as seen on imaging study at the time of the procedure. AneuRx aortic extender cuffs (3.75 cm length) were deployed sequentially in five patients via a femoral approach. Devices were overlapped approximately 1.5 cm in order to achieve total exclusion of the pseudoaneurysms, and all concomitant femoral aneurysms were repaired surgically at the same time. Successful exclusion of the anastomotic pseudoaneurysm was achieved in four patients (80%) using a combination of two or three overlapping aortic cuffs. One patient had a small residual endoleak that had sealed by 1 month, evidenced by follow-up CT. The renal arteries were preserved in all patients. The average estimated blood loss and operative time were 355 +/- 25 cc and 84 +/- 21 min, respectively. The average length of hospital stay was 2.1 days, and there was no mortality or major morbidity. All patients underwent CT scanning surveillance at 6 and 12 months and yearly afterward. There was no evidence of late endoleak, aneurysmal expansion, or device migration during the mean follow-up of 10 months, ranging 6-27 months. Our study demonstrated that utilizing sequential AneuRx aortic cuffs applied in an overlapping configuration is an effective strategy for degenerative aortic anastomotic pseudoaneurysm from previously placed aortic grafts. Additionally, our study suggests this unique endovascular technique is an ideal alternative for creating a customized tube graft in challenging cases, particularly in high-risk patients.
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Affiliation(s)
- Wei Zhou
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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van Herwaarden JA, Waasdorp EJ, Bendermacher BLW, van den Berg JC, Teijink JAW, Moll FL. Endovascular repair of paraanastomotic aneurysms after previous open aortic prosthetic reconstruction. Ann Vasc Surg 2004; 18:280-6. [PMID: 15354628 DOI: 10.1007/s10016-004-0002-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study was to evaluate the effectiveness of endovascular repair of anastomotic and true aortic and iliac aneurysms occurring after prior polyester graft repair for abdominal aortic aneurysms (AAA) or aortoiliac obstructive disease. Between July 1999 and January 2003, 14 patients underwent endovascular treatment of aortic pseudoaneurysms (n = 6) or iliac aneurysms (2 patients with pseudoaneurysms and 6 patients with true aneurysms) occurring 4 to 18.4 years (mean, 8.8 years) after open aortic surgery. No patient had symptoms or positive parameters for infection of the original polyester graft. Eleven patients, including one patient with both a proximal anastomotic and a true iliac aneurysm, were treated with AneuRx (n = 8), Talent (n = 2), or Quantum LP (n = 1) bifurcated stent grafts. Three patients with an infrarenal anastomotic pseudoaneurysm were treated with a tube stent graft (Talent [n = 2] and AneuRx [n = 1]). Endovascular stent grafts were successfully inserted in all patients. Procedure-related complications or death was not seen. During a median follow-up of 12 months (range, 3-40) all anastomotic and/or true aneurysms treated with bifurcated stent grafts maintained excluded. However, two out of three patients, treated with a tube graft for proximal aneurysm exclusion, were converted. In both patients the tube stent graft did not migrate from the level of the renal arteries but fixation failed between the stent graft and the previous polyester graft, creating endotension in the thrombus of the aneurysm sac. In one of these patients the old anastomotic aneurysm ruptured 16 months after stent graft placement and the patient died 1 day after conversion because of mesenterial ischemia. At 1 year follow-up the second patient was converted successfully after enlargement of his anastomotic aneurysm due to similar disconnection between the stent graft and the polyester graft. From this experience with endovascular stent grafts, we conclude that these can be used successfully to exclude anastomotic or true aneurysms after open aortic surgery. Exclusion of aneurysms at the proximal anastomosis with tube stent grafts is apparently not durable because of the insecure distal fixation in polyester grafts. Endovascular repair with bifurcated stent grafts, however, seems to be effective at midterm follow-up.
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MESH Headings
- Aged
- Aged, 80 and over
- Anastomosis, Surgical
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/surgery
- Angiography, Digital Subtraction
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/pathology
- Aorta, Abdominal/surgery
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/surgery
- Aortic Rupture/diagnostic imaging
- Aortic Rupture/etiology
- Aortic Rupture/surgery
- Blood Vessel Prosthesis Implantation
- Follow-Up Studies
- Humans
- Iliac Aneurysm/diagnostic imaging
- Iliac Aneurysm/surgery
- Iliac Artery/diagnostic imaging
- Iliac Artery/pathology
- Iliac Artery/surgery
- Length of Stay
- Male
- Middle Aged
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/etiology
- Postoperative Complications/surgery
- Renal Artery/diagnostic imaging
- Renal Artery/injuries
- Renal Artery/surgery
- Reoperation
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures
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Affiliation(s)
- Joost A van Herwaarden
- Department of Vascular Surgery, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
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17
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Pothier D, Dodds S, Parnell A. Thrombosis of a proximal aortic false aneurysm following AAA repair by endovascular thrombin injection. Eur J Vasc Endovasc Surg 2003; 26:450-2. [PMID: 14512012 DOI: 10.1016/s1078-5884(03)00275-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D Pothier
- Department of Vascular Surgery, Good Hope Hospital NHS Trust, West Midlands, UK
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18
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Gawenda M, Zaehringer M, Brunkwall J. Open Versus Endovascular Repair of Para-Anastomotic Aneurysms in Patients Who Were Morphological Candidates for Endovascular Treatment. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0745:overop>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Magnan PE, Albertini JN, Bartoli JM, Ede B, Valerio N, Moulin G, Branchereau A. Endovascular Treatment of Anastomotic False Aneurysms of the Abdominal Aorta. Ann Vasc Surg 2003; 17:365-74. [PMID: 14670014 DOI: 10.1007/s10016-003-0024-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Conventional surgical treatment of anastomotic false abdominal aortic aneurysms (AFAA) is technically difficult. Morbidity-mortality rates are higher than those for surgery of infrarenal abdominal aortic aneurysm (AAA). Endovascular management without laparotomy or aortic clamping represents an attractive alternative. The purpose of this study was to determine the immediate and middle-term outcome of endovascular management of AFAA. Between 1998 and 2001, 10 patients were treated for AFAA by placement of an endograft. The initial procedure was aortobifemoral bypass for occlusive artery disease in eight cases and resection and grafting for AAA in two cases. Mean age was 70 years. Seven patients were classified ASA 3 or 4. Three patients presented cardiac insufficiency with left ventricular ejection fraction <40%. Eight patients were treated using an aortounilateral iliac artery endograft in association with crossover femorofemoral bypass (3 AneuRx, 2 Endologix, 1 Talent, 1 Zenith, 1 surgeon-made stent). Two patients were treated with an aortoaortic endograft (1 Talent, 1 surgeon-made stent). In two patients extraperitoneal exposure of the common iliac artery was required for introduction of the stent in one case and for surgical closure of the iliac artery in the other case. A total of nine patients underwent another surgical procedure in association with stenting. Four endografts were custom-made. Endograft deployment was successful in all cases. No patient died during the postoperative period. Postoperative computed tomography (CT) scan confirmed exclusion of the aneurysmal sac in all cases. The mean duration of hospitalization was 13 days (range, 5-28 days). During follow-up (mean duration, 17.7 months; range, 5-42 months), one patient died from heart-related causes. No direct or indirect endoleak was detected by CT scan follow-up and a significant reduction in AFAA diameter was noted in the eight patients with follow-up periods lasting 6 months or more. One patient developed occlusion of an aortounilateral iliac artery endograft and was treated by axillobifemoral bypass. In one patient stenosis of the distal end of an aortounilateral iliac endograft was discovered by duplex scan and successfully treated by dilatation. Endovascular treatment of AFAA is technically feasible but requires more complex procedures involving associated surgical procedures and use of custom-made endografts. The morbidity-mortality rate in this small series of high-risk patients was low. Immediate and middleterm exclusion of AFAA was good.
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Affiliation(s)
- P E Magnan
- Service de Chirurgie Vasculaire, Hôpital de la Timone, Marseille, France.
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Hong Chen F, Shim WH, Chang BC, Park SJ, Won JY, Lee DY. False Aneurysms at Both Ends of a Descending Thoracic Aortic Stent-Graft:Complication After Endovascular Repair of a Penetrating Atherosclerotic Ulcer. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0249:faabeo>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chen FH, Shim WH, Chang BC, Park SJ, Won JY, Lee DY. False aneurysms at both ends of a descending thoracic aortic stent-graft: complication after endovascular repair of a penetrating atherosclerotic ulcer. J Endovasc Ther 2003; 10:249-53. [PMID: 12877607 DOI: 10.1177/152660280301000214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the formation of false aneurysms at both ends of a stent-graft implanted in the descending thoracic aorta to repair a penetrating atherosclerotic ulcer. CASE REPORT A 66-year-old woman with a penetrating atherosclerotic ulcer was treated with a 34 x 70-mm homemade Gianturco-type stent covered with polytetrafluoroethylene graft. Four months later, she developed false aneurysms at both ends of the stent-graft. The patient refused further endovascular repairs, so the stent-graft was surgically removed and the aorta repaired. CONCLUSIONS This case demonstrates an unusual complication that should be anticipated when a stent-graft is deployed in the acute phase of thoracic aortic ulcer or its variants.
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Affiliation(s)
- Fang Hong Chen
- Department of Radiology, Zhejiang Provincial People's Hospital, Hang Zhou, China
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