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Long Term Outcomes of Endovascular Aortic Repair in Patients With Abdominal Aortic Aneurysm and Ectatic Common Iliac Arteries. Eur J Vasc Endovasc Surg 2020; 60:356-364. [DOI: 10.1016/j.ejvs.2020.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
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Impact of Compliance with Anatomical Guidelines of "Bell-Bottom" Iliac Stent Grafts for Ectatic or Aneurysmal Iliac Arteries. Cardiovasc Intervent Radiol 2020; 43:1143-1147. [PMID: 32409997 DOI: 10.1007/s00270-020-02489-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the impact of compliance with anatomical guidelines on outcomes of endovascular aortic aneurysm repair using "bell-bottom" stent grafts (BBSGs). METHODS This is a retrospective review from January 1999 to May 2012 of patients who underwent endovascular infrarenal abdominal aneurysm repair and whose iliac limbs were greater than 18 mm in diameter. Computed tomography angiography was utilized for compliance with anatomical guidelines as stated in manufacturer's instructions for use (IFU). The primary outcome observed was iliac limb events. The secondary outcome observed was the need for re-intervention due to BBSG failure. RESULTS Of the 376 BBSGs, 55 (15%) in 27 patients met IFU. Aneurysm exclusion was achieved in all patients. The mean follow-up was 44 ± 30 months. Twenty-eight patients (11%) had 29 iliac limb events (12 type 1b endoleaks, 4 aneurysm sac growth, 4 stenosis/kink, 4 retrograde migrations, 2 component separations, 2 ruptures and 1 limb occlusion); all among patients treated outside of IFU (p < 0.04). The rate of aneurysm sac enlargement was similar between both groups, at 56%, respectively, between those treated within and those treated outside of IFU. On multivariate regression analysis, larger common iliac artery (CIA) (HR 1.088, 95% CI 1.016-1.166, p = 0.016), greater CIA tortuosity (HR 2.352, 95% CI 1.004-5.509, p = 0.048) and limbs with more than two characteristics that did not meet IFU criteria (HR 3.84, 95% CI 1.15-12.83, p = 0.03) were associated with higher rates of BBSG events and re-interventions. CONCLUSIONS BBSGs effectively seal ectatic CIAs. But rates of iliac limb events and re-interventions are higher among patients who do not meet IFU criteria. The larger CIA diameter, the greater CIA tortuosity and more than two criteria not met by IFU were associated with BBSG failure and re-intervention.
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Volume Change after Endovascular Treatment of Common Iliac Arteries ≥ 17 mm Diameter: Assessment of Type 1b Endoleak Risk Factors. Eur J Vasc Endovasc Surg 2020; 59:51-58. [DOI: 10.1016/j.ejvs.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 11/24/2022]
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Francois CJ, Skulborstad EP, Majdalany BS, Chandra A, Collins JD, Farsad K, Gerhard-Herman MD, Gornik HL, Kendi AT, Khaja MS, Lee MH, Sutphin PD, Kapoor BS, Kalva SP. ACR Appropriateness Criteria ® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018; 15:S2-S12. [DOI: 10.1016/j.jacr.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/17/2022]
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Bastos Gonçalves F, Oliveira N, Josee van Rijn M, Ultee K, Hoeks S, Ten Raa S, Stolker R, Verhagen H. Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2017; 53:185-192. [DOI: 10.1016/j.ejvs.2016.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/03/2016] [Indexed: 11/30/2022]
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Dube B, Ünlü Ç, de Vries JPPM. Fate of Enlarged Iliac Arteries After Endovascular or Open Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2016; 23:803-8. [DOI: 10.1177/1526602816661832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the fate of untreated ectatic and aneurysmal common iliac arteries (CIAs) after open treatment and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: Databases of scientific literature were searched between January 1980 and February 2016 to identify publications on the follow-up of ectatic and aneurysmal CIAs after open or endovascular AAA repair. The primary outcome measure was the increase of iliac artery diameter during follow-up. The secondary outcome was the subsequent reintervention rate during follow-up. Results: Only 3 open AAA and 3 EVAR studies containing 1239 patients met the inclusion criteria for analysis. In the open AAA group, ectatic iliac arteries (defined as 12–18 mm) had a diameter progression of 1.7 to 1.8 mm during a follow-up period of 51.6 to 85.2 months. The aneurysmal iliac arteries (>18 mm) in the open repair group showed a faster growth (2.3–3.0 mm) in a follow-up period of 50.4 to 85.2 months. The pooled assessment of arteries ≥18 mm had a mean growth of 2.56 mm at 60 months of follow-up. In the entire open AAA cohort, the reintervention rate for CIA transformation was <1%. In the EVAR studies, arbitrary cutoff sizes of 16 to 20 mm for ectatic arteries and >20 mm for aneurysmal arteries were used. During a follow-up of 39.2 to 60 months, the diameter progression was 1.5 mm for the 16-mm iliac arteries and 2.7 mm for the 20-mm iliac arteries. The need for endovascular reinterventions was similar in patients with previously normal or enlarged CIAs. Conclusion: After open AAA repair, the overall size of CIA aneurysms grows slowly, but enlarged CIAs >20 mm in EVAR patients show faster growth during follow-up. However, the need for secondary interventions was similar in patients with normal or enlarged CIAs post EVAR.
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Affiliation(s)
- Bhekifa Dube
- Department of Vascular Surgery, Tertiary Livingstone Hospital, Port Elizabeth, South Africa
| | - Çağdaş Ünlü
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
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Falkensammer J, Hakaim AG, Oldenburg WA, Neuhauser B, Paz-Fumagalli R, McKinney JM, Hugl B, Biebl M, Klocker J. Natural History of the Iliac Arteries after Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone. J Endovasc Ther 2016; 14:619-24. [DOI: 10.1177/152660280701400503] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the natural history of dilated common iliac arteries (CIA) exposed to pulsatile blood flow after endovascular abdominal aortic aneurysm repair (EVAR) and the suitability of ectatic iliac arteries as sealing zones using flared iliac limbs. Methods: Follow-up computed tomograms of 102 CIAs in 60 EVAR patients were investigated. Diameter changes in CIAs ≤16 mm (group 1) were compared with changes in vessels where a dilated segment >16 mm in diameter continued to be exposed to pulsatile blood flow (group 2). Within group 2, cases in which the stent terminated proximal to the dilated artery segment (2a) were compared with those that had been treated with a flared limb (2b). Results: The mean CIA diameter increased by 1.0±1.0 mm in group 1 (p<0.001 versus immediately after EVAR) and by 1.5±1.7 mm in group 2 (p<0.001 versus immediately after EVAR) within an average follow-up of 43.6±18.0 months. Diameter increase was more pronounced in dilated CIAs (p=0.048), and it was not significantly different between groups 2a and 2b (p=0.188). No late distal type I endoleak or stent-graft migration associated with CIA ectasia was observed. Conclusion: Dilatation of the CIA is significant after EVAR, and it is more pronounced in ectatic iliac arteries. Although ectatic iliac arteries appear to be suitable sealing zones in the short term, continued follow-up is mandatory.
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Affiliation(s)
- Juergen Falkensammer
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Albert G. Hakaim
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
| | | | - Beate Neuhauser
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | | | - J. Mark McKinney
- Sections of Interventional Radiology, Mayo Clinic Jacksonville, Florida, USA
| | - Beate Hugl
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Matthias Biebl
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Josef Klocker
- Sections of 1 Vascular Surgery, Mayo Clinic Jacksonville, Florida, USA
- Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
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Griffin CL, Scali ST, Feezor RJ, Chang CK, Giles KA, Fatima J, Huber TS, Beck AW. Fate of Aneurysmal Common Iliac Artery Landing Zones Used for Endovascular Aneurysm Repair. J Endovasc Ther 2015; 22:748-59. [PMID: 26290584 DOI: 10.1177/1526602815602121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine outcomes of aneurysmal common iliac arteries (aCIA) used for landing zones (LZs) during endovascular aneurysm repair (EVAR). METHODS This single-center study retrospectively compared 57 EVAR patients (mean age 72±8 years; 56 men) with 70 aCIAs (diameter ≥20 mm) to 25 control EVAR subjects (mean age 73±7 years; 20 men) with 50 normal (≤15-mm) CIA LZs treated consecutively during the same time interval. The CIA LZ measurements were analyzed using random effects linear mixed models to determine diameter change over time. Life tables were used to estimate freedom from endoleak, reintervention, and all-cause mortality. RESULTS The mean maximum preoperative CIA diameter in the aCIA LZ group was 24.8±4.5 mm (range 20.0-47.3, median 23.9) vs 13.6±1.5 mm (range 9.2-15.0, median 13.9; p<0.001) in the controls. Nineteen aCIA LZs were treated outside the instructions for use of the device. Median follow-up in the aCIAs LZ cohort was 39.2 months [interquartile range (IQR) 15, 61] vs 49.3 months (IQR 36, 61) in the controls (p=0.06). The rate of aCIA LZ change (0.09 mm/mo, 95% CI 0.07 to 0.1) was significantly greater than controls (0.03 mm/mo, 95% CI -0.009 to 0.07; p<0.0001). No type Ib endoleaks developed in either group; however, aCIA LZ patients had 6 (11%) iliac limb-related reinterventions. There were significantly more endograft-related reinterventions in the aCIA LZ patients (n=10, 14%) compared with controls (n=2, 4%; p=0.06). There was no difference in mortality or freedom from any post-hospital discharge endoleak. CONCLUSION Aneurysmal CIA LZs used during EVAR experience greater dilatation compared with normal LZs, but no significant difference in outcome was noted in midterm follow-up. However, an increased incidence of graft limb complications or endograft-related reintervention may be encountered. Use of aCIA LZs appears to be safe; however, greater patient numbers and longer follow-up are needed to understand the clinical implications of morphologic changes in these vessels when used during EVAR.
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Affiliation(s)
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Catherine K Chang
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Kristina A Giles
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Javairiah Fatima
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
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Alvarez Marcos F, Garcia de la Torre A, Alonso Perez M, Llaneza Coto JM, Camblor Santervas LA, Zanabili Al Sibbai AA, Garcia-Cosio Mir JM, Vega Garcia F, Rodriguez Menendez JE. Use of aortic extension cuffs for preserving hypogastric blood flow in endovascular aneurysm repair with aneurysmal involvement of common iliac arteries. Ann Vasc Surg 2012; 27:139-45. [PMID: 22841756 DOI: 10.1016/j.avsg.2012.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 01/22/2012] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intentional hypogastric artery covering during endovascular repair of abdominal aortic aneurysms (EVAR) can carry a non-negligible rate of complications; to preserve pelvic blood flow, several approaches are in use, such as sandwich techniques, branched iliac devices, or the use of aortic extender cuffs in a bell-bottom configuration. We assess the performance of the latter for treatment of common iliac artery aneurysms during EVAR. METHODS Prospective gathering of data in 21 dilated common iliac arteries (18-25 mm) with coexisting abdominal aorta aneurysm, which were treated from 2005 to 2010 and received a GORE(®) Excluder endograft and one (n = 14) or several aortic extenders in a bell-bottom configuration. Control group consisted of 136 EVARs performed with the same device in the same time frame. Median follow-up was of 47 months, with contrast-enhanced computed tomography assessment 1 month after the procedure and yearly thereafter. RESULTS Age and comorbidities were homogeneously distributed among groups, although the aortic aneurysm diameter was lower in the bell-bottom group (50 mm vs. 58.2 mm, P < 0.001). There was no 30-day mortality registered in this group, and only one patient died during follow-up (5.3%), without relation with the aneurysmal disease. No significant differences were found in reintervention (15.8% vs. 14.7%, P = 0.707) or endoleak rates (36.8% vs. 38.9%, Fisher P = 1). There were no type I and four type II endoleaks, two of which precised treatment for sac growth. Endoleak-free survival (P = 0.994) and reintervention-free survival (P = 0.563) did not show differences either. CONCLUSION Bell-bottom technique is a feasible and safe alternative for preserving hypogastric blood flow, and does not imply a higher risk of reintervention or endoleak at 3-year follow-up.
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Affiliation(s)
- Francisco Alvarez Marcos
- Department of Angiology and Vascular Surgery, Asturias University Central Hospital, Oviedo, Spain.
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Kaladji A, Cardon A, Laviolle B, Heautot JF, Pinel G, Lucas A. Evolution of the upper and lower landing site after endovascular aortic aneurysm repair. J Vasc Surg 2012; 55:24-32. [DOI: 10.1016/j.jvs.2011.07.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 06/30/2011] [Accepted: 07/06/2011] [Indexed: 11/16/2022]
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Kirkwood ML, Saunders A, Jackson BM, Wang GJ, Fairman RM, Woo EY. Aneurysmal iliac arteries do not portend future iliac aneurysmal enlargement after endovascular aneurysm repair for abdominal aortic aneurysm. J Vasc Surg 2011; 53:269-73. [DOI: 10.1016/j.jvs.2010.08.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/18/2010] [Accepted: 08/23/2010] [Indexed: 10/18/2022]
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Albertini JN, Favre JP, Bouziane Z, Haase C, Nourrissat G, Barral X. Aneurysmal Extension to the Iliac Bifurcation Increases the Risk of Complications and Secondary Procedures After Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2010; 24:663-9. [DOI: 10.1016/j.avsg.2010.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 03/04/2009] [Accepted: 01/26/2010] [Indexed: 11/25/2022]
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Mayer D, Rancic Z, Pfammatter T, Hechelhammer L, Veith FJ, Donas K, Lachat M. Logistic Considerations for a Successful Institutional Approach to the Endovascular Repair of Ruptured Abdominal Aortic Aneurysms. Vascular 2010; 18:64-70. [DOI: 10.2310/6670.2010.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.
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Affiliation(s)
- Dieter Mayer
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Zoran Rancic
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Thomas Pfammatter
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Lukas Hechelhammer
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Frank J. Veith
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Konstantin Donas
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Mario Lachat
- *Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; †Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland; ‡The Cleveland Clinic and New York University Medical Center New York, NY, and University Hospital Zurich, Zurich, Switzerland; §Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center of Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
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Richards T, Dharmadasa A, Davies R, Murphy M, Perera R, Walton J. Natural history of the common iliac artery in the presence of an abdominal aortic aneurysm. J Vasc Surg 2009; 49:881-5. [DOI: 10.1016/j.jvs.2008.11.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 11/05/2008] [Accepted: 11/07/2008] [Indexed: 11/16/2022]
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Maleux G, Koolen M, Heye S, Nevelsteen A. Limb Occlusion after Endovascular Repair of Abdominal Aortic Aneurysms with Supported Endografts. J Vasc Interv Radiol 2008; 19:1409-12. [DOI: 10.1016/j.jvir.2008.07.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 06/19/2008] [Accepted: 07/05/2008] [Indexed: 12/01/2022] Open
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Greenberg RK, Chuter TA, Cambria RP, Sternbergh WC, Fearnot NE. Zenith abdominal aortic aneurysm endovascular graft. J Vasc Surg 2008; 48:1-9. [DOI: 10.1016/j.jvs.2008.02.051] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 02/22/2008] [Accepted: 02/23/2008] [Indexed: 11/29/2022]
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Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries. Cardiovasc Intervent Radiol 2008; 31:723-7. [DOI: 10.1007/s00270-008-9318-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 02/06/2008] [Accepted: 02/06/2008] [Indexed: 10/22/2022]
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McDonnell CO, Semmens JB, Allen YB, Jansen SJ, Brooks DM, Lawrence-Brown MMD. Large iliac arteries: a high-risk group for endovascular aortic aneurysm repair. J Endovasc Ther 2008; 14:625-9. [PMID: 17924726 DOI: 10.1177/152660280701400504] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine if the presence of large iliac arteries is a potential risk factor for the development of a type Ib endoleak (iliac sealing zone) or need for iliac artery-related secondary intervention in patients undergoing endovascular abdominal aortic aneurysm repair. METHODS The medical notes and all preoperative and postoperative plain abdominal radiographs and computer tomographic scans were reviewed for a consecutive series of 100 patients (89 men; mean age 75 years, range 56-91) with large iliac arteries (mean 19.7 mm, range 16-22) who had Zenith endovascular stent-grafts inserted for management of aortoiliac aneurysmal disease from January 1999 until September 2002. Endpoints were all-cause mortality, aneurysm-related death, endoleak, secondary intervention, secondary interventions, and stent-graft migration. RESULTS Mean follow-up was 30.1+/-8.3 months; at the last follow-up, 30% of patients were dead, 3% were aneurysm-related. Seven (7%) patients developed a type Ib endoleak, with the remainder being type II (29%), type Ia (2%), type III (1%), and type V (endotension, 1%). Eight (27.5%) type II endoleaks persisted, with the remainder closing spontaneously with sac shrinkage. The iliac artery-related secondary intervention rate was 10%, and the overall secondary intervention rate was 16%. CONCLUSION Iliac arteries between 16 and 22 mm in diameter may be treated with a cuff to the iliac limb with an expectation of 90% efficacy. Surveillance is required, with a high index of suspicion for type 1b endoleaks. Early secondary iliac intervention with extension to the external iliac artery is recommended if there is an increase in sac size after 6 months.
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Affiliation(s)
- Ciaran O McDonnell
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
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Falkensammer J, Hakaim AG, Oldenburg WA, Neuhauser B, Paz-Fumagalli R, McKinney JM, Hugl B, Biebl M, Klocker J. Natural History of the Iliac Arteries After Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone. J Endovasc Ther 2007. [DOI: 10.1583/1545-1550(2007)14[619:nhotia]2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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McDonnell CO, Semmens JB, Allen YB, Jansen SJ, Brooks DM, Lawrence-Brown MMD. Large Iliac Arteries:A High-Risk Group for Endovascular Aortic Aneurysm Repair. J Endovasc Ther 2007. [DOI: 10.1583/1545-1550(2007)14[625:liaahg]2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hassen-Khodja R, Feugier P, Favre JP, Nevelsteen A, Ferreira J. Outcome of common iliac arteries after straight aortic tube-graft placement during elective repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2006; 44:943-8. [PMID: 17000076 DOI: 10.1016/j.jvs.2006.06.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Accepted: 06/10/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine the relative rates of common iliac artery (CIA) expansion after elective straight aortic tube-graft replacement of infrarenal abdominal aortic aneurysms (AAA). METHODS Five participating centers in this 2004 study entered patients they had managed by an aortoaortic tube graft for elective AAA repair. The procedures took place between January 1995 and December 2003. Postoperative computed tomography (CT) scans were obtained for all patients in 2004 to assess changes in CIA diameter. Measurements on preoperative and postoperative CT scans were all made at the same level using the same technique. RESULTS Entered in the study were 147 patients (138 men, 9 women) with a mean age of 68 years. Mean follow-up from aortic surgery to verification of CIA diameter on the postoperative CT scan was 4.8 years. Mean preoperative CIA diameter was 13.6 mm vs 15.2 mm postoperatively. No patient developed occlusive iliac artery disease during follow-up. Three patients (2%) required repeat surgery during follow-up for a CIA aneurysm. The 147 patients were divided into three groups based on preoperative CIA diameter shown in CT scan: group A (n = 59, 40.1%), both CIA were of normal diameter; group B (n = 53, 36.1%), ectasia (diameter between 12 and 18 mm) of at least one CIA; group C (n = 35, 23.8%), an aneurysm (diameter >18 mm) of at least one CIA. CIA diameter increased by a mean of 1 mm (9.4%) over 5.5 years in group A vs 1.7 mm (12.1%) over 4.3 years in group B and 2.3 mm (12.7%) over 4.2 years in group C. The three patients who required repeat surgery for a CIA aneurysm during follow-up were all in group C. Four variables were associated with aneurysmal change in CIA: initial CIA diameter, celiac aorta diameter on the preoperative CT scan, a coexisting aneurysm site, and the follow-up duration. CONCLUSIONS Tube-graft placement during AAA surgery is justified even for moderate CIA dilatation (<18 mm). CIA aneurysms with a preoperative diameter > or =25 mm enlarge more rapidly and warrant insertion of a bifurcated graft during the same surgical session as AAA repair. The evolutive potential of CIA between 18 mm and 25 mm in diameter justifies a bifurcated graft when the celiac aorta diameter is >25 mm or the patient's life expectancy is > or =8 years.
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Affiliation(s)
- Réda Hassen-Khodja
- Department of Vascular Surgery at the University Hospital of Nice, Nice, France.
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Iezzi R, Cotroneo AR. Endovascular repair of abdominal aortic aneurysms: CTA evaluation of contraindications. ACTA ACUST UNITED AC 2006; 31:722-31. [PMID: 16447080 DOI: 10.1007/s00261-005-0399-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Endovascular aortic aneurysm repair (EVAR) is considered an acceptable alternative to open surgery in selected patients. Its feasibility depends mainly on anatomic factors that represent the important predictors of success and the most important exclusion criteria. Poor anatomic patient selection is generally associated with a higher risk for procedural complications and compromised long-term outcomes. Therefore pretreatment imaging is crucial for evaluating patient suitability for EVAR. Multidetector computed tomographic angiography represents the current standard of reference in the evaluation of the abdominal aorta and iliac axis anatomy because it provides all the details needed for selection of patients who are suitable for endograft and the choice of the appropriate device. This report identifies and reviews computed tomographic angiographic anatomic contraindications for EVAR.
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Affiliation(s)
- R Iezzi
- Department of Clinical Science and Bioimaging, Section of Radiology, University G. D'Annunzio, SS. Annunziata Hosp., Via dei Vestini, 66013, Chieti, Italy.
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Tratamiento endovascular de aneurisma de aorta abdominal en paciente con distrofia polianeurismática. ANGIOLOGIA 2005. [DOI: 10.1016/s0003-3170(05)79345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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