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Kontopodis N, Charalambous S, Galanakis N, Lioudaki S, Tzartzalou I, Kehagias E, Tsetis D, Ioannou CV. Late neck related adverse events are rare among patients with wide aortic neck undergoing endovascular aneurysm repair with the Ovation endograft. Ann Vasc Surg 2022; 88:337-345. [DOI: 10.1016/j.avsg.2022.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/17/2022]
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Gosslau Y, Warm TD, Foerch S, Zerwes S, Scheurig-Muenkler C, Hyhlik-Duerr A. Iatrogenic injury of the popliteal artery in orthopedic knee surgery: clinical results and development of a therapeutic algorithm. Eur J Trauma Emerg Surg 2022; 48:4169-4179. [PMID: 35359157 PMCID: PMC9532315 DOI: 10.1007/s00068-022-01961-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Intraoperative injury to the popliteal artery is a rare complication of orthopedic surgery, however, it can have serious consequences, including major amputation. Recommendations for a standard approach are lacking. The aim of this study was to develop an interdisciplinary therapeutic algorithm to assist in complication management. METHODS From 01/11 to 12/20, 16 arterial injuries after knee surgery were analyzed in a retrospective single-center study. Four cases involved recurrent orthopedic surgery. Procedures performed included eleven total knee arthoplasties (TKA), two TKA replacements, one arthroscopy, and two high tibial osteotomies. Clinical presentation of patients was hemorrhage (n = 2), ischemia (n = 7), the combination of both (n = 4), or pseudoaneurysm formation (n = 3). RESULTS Ten patients underwent endovascular treatment, some as combined procedures: (stent)-PTA (n = 6), aspiration thrombectomy (n = 5), thrombin injection (n = 1), and embolization (n = 1). Six patients were treated surgically: four with bypass/interposition and one with a patch plasty and one as a hybrid procedure, respectively. Only autologous great saphenous vein was used. All extremities could be preserved. Functional impairment remained in six cases. CONCLUSION Both endovascular and surgical procedures can be used to treat arterial injuries after knee surgery. Efficient standardized diagnosis and the involvement of vascular expertise are essential to prevent functional impairment or limb loss, as suggested in the algorithms.
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Affiliation(s)
- Yvonne Gosslau
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - Tobias Dominik Warm
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Stefan Foerch
- Trauma Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Sebastian Zerwes
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Christian Scheurig-Muenkler
- Diagnostic and interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Alexander Hyhlik-Duerr
- Vascular Surgery, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Blitti CM, Bamde CC, Alblowi A, Leboffe M, Rodrigues JG, Delpy JP, Steinmetz E. Combined Pull through and Balloon Anchoring Bailout Technique to Repair a Failed Bifurcated Endovascular Aortic Repair. Ann Vasc Surg 2020; 72:643-646. [PMID: 33373764 DOI: 10.1016/j.avsg.2020.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND To describe a bailout technique used to manage the left stump of a bifurcated endograft that was stuck above a narrowed distal aortic neck. METHODS An 80-year-old man with a suprarenal aneurysm was treated with a custom-made 4-vessel fenestration endograft. During the procedure, the left stump of the distal bifurcated graft module was chased out of a narrow distal aortic neck and became stuck horizontally at the bottom of the aortic aneurysmal sac. Through a femoral to left subclavian artery through-and-through percutaneous access, a balloon-anchoring technique was successfully used to return the endograft stump into the narrowed aortic neck and exclude the aneurysm. CONCLUSIONS The combined technique of a through-and-through and anchoring balloon was found to be suitable for introducing an endograft limb into a narrow distal aortic neck.
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Affiliation(s)
- Comlan Mawuko Blitti
- Department of cardiovascular and thoracic surgery, Dijon University Hospital, Dijon, France.
| | - Camil-Cassien Bamde
- Department of cardiovascular and thoracic surgery, Dijon University Hospital, Dijon, France
| | - Abdulrahman Alblowi
- Department of cardiovascular and thoracic surgery, Dijon University Hospital, Dijon, France
| | - Melanie Leboffe
- Department of cardiovascular and thoracic surgery, Dijon University Hospital, Dijon, France
| | - Jairo Garcia Rodrigues
- Department of cardiovascular and thoracic surgery, Dijon University Hospital, Dijon, France; Medical illustrations, Dijon, France
| | - Jean-Philippe Delpy
- Department of cardiovascular and thoracic surgery, Dijon University Hospital, Dijon, France
| | - Eric Steinmetz
- Department of cardiovascular and thoracic surgery, Dijon University Hospital, Dijon, France
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Coelho A, Nogueira C, Lobo M, Gouveia R, Campos J, Augusto R, Coelho N, Semião AC, Ribeiro JP, Canedo A. Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management. Eur J Vasc Endovasc Surg 2019; 58:681-689. [DOI: 10.1016/j.ejvs.2019.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 12/26/2022]
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Mazzaccaro D, Malacrida G, Amato B, Alessio Angileri S, Ierardi AM, Nano G. Preliminary experience with the use of ultra-low profile endografts. Diagn Interv Radiol 2018; 23:448-453. [PMID: 29097346 DOI: 10.5152/dir.2017.16523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to report a preliminary single-center experience of elective endovascular aortic repair (EVAR) using ultra-low profile (ULP) endografts of 14 F outer diameter. METHODS Data of 67 consecutive patients who underwent EVAR using either Ovation (group A, n=30) or Incraft (group B, n=37) endografts were retrospectively analyzed. RESULTS Aorto-iliac anatomy was significantly different between the two groups, as patients of group A had a greater thrombotic apposition on proximal aortic neck (thrombus thickness: 7.2±1 mm vs. 3.3±1.6 mm, P = 0.042; percentage of the circumference covered by thrombus: 45.2%±10.4% vs. 18.7%±10.6%, P = 0.0003), while patients of group B had a more angulated proximal neck in the coronal axis (35.9°±6.4° vs. 16.7°±5°, P = 0.012). Procedural success was 93.3% and 97.3%, respectively, in groups A and B. One patient in group A required an immediate conversion to open surgery for persistent occlusion of both iliac limbs. Another patient required implantation of a conical endograft with a femoro-femoral right-to-left bypass for occlusion of the contralateral gate during the cannulation. In group B, one intraoperative type Ia endoleak was immediately corrected. Neither deaths nor major adverse events were recorded within 30-days. During a median follow-up of 15.2 months (range, 1-56.7 months) two type Ia endoleaks in group A required open conversion after 12.1 and 40.5 months, respectively. Three patients in group B required a reintervention after 30 days. Neither deaths nor aortic ruptures were recorded during follow-up. CONCLUSION Both ULP endografts showed satisfying early and mid-term results.
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Affiliation(s)
- Daniela Mazzaccaro
- First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
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Kontopodis N, Papadopoulos G, Galanakis N, Tsetis D, Ioannou CV. Improvement of patient eligibility with the use of new generation endografts for the treatment of abdominal aortic aneurysms. A comparison study among currently used endografts and literature review. Expert Rev Med Devices 2017; 14:245-250. [DOI: 10.1080/17434440.2017.1281738] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - George Papadopoulos
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Greece
| | - Christos V. Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Greece
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Colvard B, Georg Y, Chakfe N, Swanstrom L. Current aortic endografts for the treatment of abdominal aortic aneurysms. Expert Rev Med Devices 2016; 13:475-86. [PMID: 26959727 DOI: 10.1586/17434440.2016.1162709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular Aneurysm Repair is a widely adopted method of treatment for patients with abdominal aortic aneurysms. The minimally invasive approach offered with EVAR has become popular not only among physicians and patients, but in the medical device industry as well. Over the past 25 years the global market for aortic endografts has increased rapidly, resulting in a wide range of devices from various companies. Currently, there are seven endografts approved by the FDA for the treatment of abdominal aortic aneurysms. These devices offer a wide range of designs intended to increase inclusion criteria while decreasing technical complications such as endoleak and migration. Despite advances in device design, secondary interventions and follow-up requirements remain a significant issue. New devices are currently being studied in the U.S. and abroad and may significantly reduce complications and secondary interventions.
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Affiliation(s)
| | - Yannick Georg
- b Department of Vascular Surgery , CHU Strasbourg , Strasbourg , France
| | - Nabil Chakfe
- b Department of Vascular Surgery , CHU Strasbourg , Strasbourg , France
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Georgakarakos E, Ioannou CV, Georgiadis GS, Storck M, Trellopoulos G, Koutsias S, Lazarides MK. The ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives. Expert Rev Med Devices 2016; 13:253-62. [DOI: 10.1586/17434440.2016.1147949] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ioannou CV, Kontopodis N, Kehagias E, Papaioannou A, Kafetzakis A, Papadopoulos G, Pantidis D, Tsetis D. Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia. Br J Radiol 2015; 88:20140735. [PMID: 25966288 DOI: 10.1259/bjr.20140735] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To present our experience with the Ovation Abdominal Stent Graft System (TriVascular Inc., Santa Rosa, CA) during endovascular aneurysm repair (EVAR) and compare results according to the type of anaesthesia. METHODS We conducted a single-centre retrospective study including patients who underwent EVAR using the Ovation endograft between May 2011 and July 2014. Outcome was evaluated regarding pre-, peri- and immediate postoperative and follow-up measures. Overall results are reported, while additional analysis was performed to compare the outcome between groups of patients undertaking either local or regional/general anaesthesia (LA vs RGA). RESULTS 66 patients were included. Median follow-up was 13 months (range, 1-39 months). Median age was 72 years and median abdominal aortic aneurysm diameter was 58 mm (range, 54-100 mm). Technical success was 63 (95%), while there were 2 (3%) conversions to open surgery. A total percutaneous approach was used in 50/66 (76%) cases. Overall, 9/66 (14%) subjects suffered from any kind of morbidity. Median hospitalization was 3 days (range, 1-16 days). Immediate and midterm mortality rate was 0%. No endoleak Type I, III, IV or stent migration was observed. There were 8 (13%) Type II endoleaks. Overall, additional endovascular procedures were required in 6 (9%), while surgery was performed in 4 (6%) patients. 44 (67%) patients underwent LA and 22 (23%) RGA. Differences between groups were significant for procedural time (85 vs 107 min; p < 0.001), percutaneous access (91% vs 45%; p < 0.001) and systematic complications (2.3% vs 14%; p = 0.05). CONCLUSION EVAR with the use of the Ovation endograft shows promising short-term and midterm results regarding safety and effectiveness. Completion of the procedures under LA using a total percutaneous approach seems advantageous and may be used in routine practice. ADVANCES IN KNOWLEDGE The Ovation Abdominal Stent Graft System is an ultra-low profile stent graft system that allows percutaneous deployment for EVAR and offers excellent overall efficacy and safety. Totally percutaneous EVAR under LA seems advantageous and may be used as a routine with this specific endograft.
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Affiliation(s)
- C V Ioannou
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - N Kontopodis
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - E Kehagias
- 2 Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece
| | - A Papaioannou
- 3 Anesthesiology Department, University of Crete Medical School, Heraklion, Crete, Greece
| | - A Kafetzakis
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - G Papadopoulos
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - D Pantidis
- 1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece
| | - D Tsetis
- 2 Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece
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