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Li X, Guo P, Wang L, Li Q, Zhang L, Qiu J, He H, Li J, Yang C, Shu C. Treatment strategies for endoleak after endovascular repair of the abdominal aortic aneurysm: A single center retrospective study. Asian J Surg 2023; 46:3748-3754. [PMID: 36732180 DOI: 10.1016/j.asjsur.2023.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) is the most frequently used treatment for aneurysm in abdominal aorta. The endoleak after EVAR causes the aneurysm sac to remain enlarged and risk for rupture. AIMS The purpose of the study was to assess the efficacy of strategies and techniques for endoleak treatment. METHODS This study was a single center retrospective study of 30 patients who had kinds of endoleak. The 30 patients were from a cohort of 597 patients who received EVAR from the Secondary Xiangya Hospital, Central South University between Jan 2014 to Dec 2021, what is follow-up well and diagnosed as endoleak. Data included basic clinical information, aspects of the endoleak treatment techniques, and follow-up findings. RESULTS The 30 patients with endoleak were diagnosed by computed tomography angiography or digital subtraction angiography. Age is 69 ± 7.9 yrs. 26 patients are male with only 4 female patients. Immediate endoleak after EVAR is 46.7%and delayed endoleak is 53.3%. The classification of endoleak is type Ⅰ:76.6%; type Ⅱ 26.7%; type Ⅲ:6.7%; type Ⅳ:6.7%; type Ⅴ:13.3%. Different treatment of endoleak includes: screening, endovascular re-intervention and open surgery. There are 3 patients (10.0%) underwent emergency EVAR due to their rupture condition of aneurysm. All the endoleak patients' CTA image characteristics has been reviewed. The follow-up rate is 93.3%. There are 6 patients (21.4%) died during follow-up. No aneurysm sac rupture death has been recorded. CONCLUSIONS Endoleak after EVAR is the most frequent complication that directly affects survival and re-intervention rates. Our findings suggested that different treatment strategies based on the individual patient's situation is important for their endoleak treating result.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Pengcheng Guo
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Lei Zhang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Jian Qiu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Chenzi Yang
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China.
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Institute of Vascular Diseases, Central South University, Changsha, Hunan, China; National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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The Impact of Iliac Artery Anatomy on Distal Landing Zone After EVAR During the 12-Month Follow-Up. Ann Vasc Surg 2022; 88:354-362. [PMID: 35779805 DOI: 10.1016/j.avsg.2022.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Proximal sealing zone has been the main interest in endovascular abdominal aortic aneurysm repair (EVAR), although the distal landing zone remodeling may also affect EVAR durability. The aim of this study was to assess iliac anatomy and its potential impact on distal landing zone adverse events after EVAR during the 12-month follow-up. METHODS A prospective data collection of patients treated with standard bifurcated EVAR devices for abdominal aortic aneurysm was undertaken between 2017 and 2019. Patients that received extension to the external iliac artery were excluded. Follow-up included computed tomography angiography (CTA) at the 1st and 12th month postoperatively. The common iliac artery (CIA) diameter was assessed in three levels: origin (just below the aortic bifurcation), distally (just above the iliac bifurcation) and the middle of the distance between these two landmarks. Iliac angle, tortuosity indexes, relining and oversizing were also analyzed. Distal landing zone-related adverse events were any limb related re-intervention, endoleak type Ib, graft migration, limb stenosis, or occlusion. RESULTS In total, 268 iliac limbs (134 patients) were included. In all three levels, the mean iliac artery diameters increased at 12-month follow-up. At the origin of the CIA, the diameter increased from 18.7 ± 10.5 mm to 19.9 ± 9.4 mm (P = 0.04), at the middle portion of the CIA, the diameter changed significantly from 15.5 ± 5.1 mm to 17.4 ± 5.4 mm (P < 0.001) and at the distal CIA, from 14.6 ± 3.3 mm to 15.1 ± 3.9 mm (P = 0.03). The iliac angle remained stable (P = 0.14) while the CIA index decreased significantly from 1.17 ± 0.13 to 1.11 ± 0.09 (P < 0.001). The mean value of oversizing was 21.5 ± 14.5% and affected distal iliac diameter increase (P < 0.001). The composite outcome of distal landing zone adverse events was not associated to diameter changes at any level. In 57 cases, a distal iliac diameter ≥18 mm was recorded. The estimated oversizing was lower (16.3 ± 11.8%) compared to <18 mm arteries (22.5 ± 14.9%, P = 0.01). At 12-month follow-up, iliac diameters remained stable in the ≥18 mm group. Endoleak type Ib was more common in iliac arteries ≥18 mm [3 (5.3%) vs. 1 (0.5%) (P = 0.04)] at 12-months. CONCLUSIONS Post-EVAR iliac artery dilation does not seem to have an impact on distal landing zone adverse events during the 12-month follow-up. Aggressive oversizing may be related to iliac dilation. EVAR patients with iliac arteries ≥18 mm are at higher risk for ET Ib.
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Gozzo C, Caruana G, Cannella R, Farina A, Giambelluca D, Dinoto E, Vernuccio F, Basile A, Midiri M. CT angiography for the assessment of EVAR complications: a pictorial review. Insights Imaging 2022; 13:5. [PMID: 35032231 PMCID: PMC8761205 DOI: 10.1186/s13244-021-01112-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Endovascular aneurysm repair (EVAR) is a minimally invasive treatment proposed as an alternative to open repair in patients with abdominal aortic aneurysms. EVAR consists in a stent-graft placement within the aorta in order to exclude the aneurysm from arterial circulation and reduce the risk of rupture. Knowledge of the various types of devices is mandatory because some stents/grafts are more frequently associated with complications. CT angiography is the gold standard diagnostic technique for preprocedural planning and postprocedural surveillance. EVAR needs long-term follow-up due to the high rate of complications. Complications can be divided in endograft device-related and systemic complications. The purpose of this article is to review the CT imaging findings of EVAR complications and the key features for the diagnosis.
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Affiliation(s)
- Cecilia Gozzo
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia". Catania, Italy, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Caruana
- Neuroradiology Section, Department of Radiology (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Roberto Cannella
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy
| | - Arduino Farina
- Vascular Surgery Unit ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - Dario Giambelluca
- Section of Radiology, Asp Siracusa, Ospedale Umberto I, Via Giuseppe Testaferrata 1, Siracusa, SR, Italy
| | - Ettore Dinoto
- Vascular Surgery Unit AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - Federica Vernuccio
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia". Catania, Italy, Via Santa Sofia 78, 95123, Catania, Italy
| | - Massimo Midiri
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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Murai Y, Tamura Y, Tanaka Y, Nakashima K, Miyaji K. Treatment of Complete Displacement of the Bilateral Legs into an Aortic Aneurysm Using an Iliac Branch Device. J Endovasc Ther 2021; 29:143-149. [PMID: 34384277 DOI: 10.1177/15266028211036484] [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
PURPOSE Migration is a major cause of reintervention after endovascular aneurysm repair (EVAR). In patients with common iliac artery (CIA) dilation due to proximal migration of the iliac limb, internal iliac blood flow can be preserved by implanting an iliac branch device (IBD). CASE REPORT In this report, we discuss the case of a patient in whom the bilateral limbs were completely displaced into the aortic aneurysm due to proximal migration of the iliac limb after EVAR. By taking advantage of the characteristics of this migration, we formed a pull-through wire through the native terminal aorta without passing through the flow divider of the stent graft, and the IBD was deployed safely. CONCLUSION The present case indicates that the preservation of at least 1 internal iliac artery is possible in patients with CIA dilation due to proximal migration of the iliac limb. However, the unique features of each case must be considered to determine the appropriate approach.
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Affiliation(s)
- Yuta Murai
- Department of Cardiovascular Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan
| | - Yukio Tamura
- Department of Cardiovascular Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan
| | - Yuki Tanaka
- Department of Cardiovascular Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Sirignano P, Silingardi R, Mansour W, Andreoli F, Migliari M, Speziale F. Unibody bifurcated aortic endograft: device description, review of the literature and future perspectives. Future Cardiol 2021; 17:793-804. [DOI: 10.2217/fca-2020-0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The unibody (Powerlink/AFX/AFX2) Endovascular AAA device (Endologix Inc., CA, USA) presents a unique design with its long main body and two innate limbs. The device is designed to be deployed and sits on the native aortoiliac bifurcation and represents the only one-piece bifurcated endograft designed to use anatomical fixation for endograft stabilization. According to published literature, the unibody device seems to represent a valid choice in the treatment of abdominal aortic aneurysms. This particular device would seem to satisfactorily perform even in the treatment of more compressed aneurysms (also in off-label association with parallel grafts) and in occlusive pathologies. Ongoing studies will provide new real-life data in a large and unselected patient population to better understand the device’s advantages and limitations.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular & Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
| | - Roberto Silingardi
- Department of Vascular Surgery, Ospedale Civile Sant’Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena & Reggio Emilia, Modena, Italy
| | - Wassim Mansour
- Vascular Surgery Unit, Department of Surgery Pietro Valdoni, Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
| | - Francesco Andreoli
- Department of Vascular Surgery, Ospedale Civile Sant’Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena & Reggio Emilia, Modena, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Ospedale Civile Sant’Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, University of Modena & Reggio Emilia, Modena, Italy
| | - Francesco Speziale
- Vascular & Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy
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Méndez Fernández A, Fernández Noya J, Mosquera Arochena NJ, Vidal Rey J, Calvin Álvarez P, Franco Meijide FJ, Villardefrancos Gil R. Results of the Galician registry in the treatment of complex aortoiliac aneurysms with GORE ® EXCLUDER ® Iliac Branch Endoprosthesis (GALIBER). Vascular 2021; 30:620-627. [PMID: 34114523 DOI: 10.1177/17085381211025173] [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: 11/16/2022]
Abstract
OBJECTIVE The objective of this study is to report the medium-term results of GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE, W. L. Gore & Associates, Flagstaff, Ariz) for the treatment of aortoiliac aneurysms by using the GALIBER registry. METHODS Patients with aortoiliac or isolated common iliac/hypogastric aneurysms treated with Iliac Branch Endoprosthesis device between January 2014 and May 2019 were prospectively collected from 5 centers. Demographic, clinical, and radiologic data were extracted from electronic databases. Technical success was defined as successful implantation of the Iliac Branch Endoprosthesis device with exclusion of aortoiliac aneurysm, as well as patency of Iliac Branch Endoprosthesis in the follow-up. Iliac Branch Endoprosthesis patency was evaluated by Doppler ultrasound and/or computed tomography based on the protocol of each participant center. Follow-up was 731 days +/- 499. RESULTS Between January 2014 and May 2019, 105 iliac arteries were treated with GORE® IBE device, in 81 patients (79 men, two women; mean age 71, range 52-91). Only seven patients (8.6%) were symptomatic. 60 patients (74%) had aortic and iliac enlargement. Thirty-three patients presented bilateral iliac aneurysms (40.7%): In twenty-four (29.6%) patients, an Iliac Branch Endoprosthesis device was implanted in both sides, and in nine patients (11.1%), one Iliac Branch Endoprosthesis was used with the embolization of the contralateral hypogastric artery. Technical success was achieved in the 99% (104/105 iliac branch device implanted). There were no procedural deaths or type I or III intraoperative endoleaks observed. During the follow-up (range 55-1789 days), 28 (34.5%) type II endoleaks were observed and one (1.2%) type Ia was observed. The patency of the hypogastric arteries treated with the iliac branch device was 98.1% during the follow-up (range 55-1789 days). In 30% of the patients with contralateral hypogastric embolization, some kind of complications was observed in the embolizated side: one developed ischemic colitis and two buttock claudication. CONCLUSIONS Preservation of internal iliac artery with the Iliac Branch Endoprosthesis device can be performed safely with excellent technical success and good medium-term patency rates. These results support hypogastric preservation whenever possible to prevent ischemic complications.
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Affiliation(s)
- Alba Méndez Fernández
- Department of Angiology and Vascular Surgery, 59535Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Jorge Fernández Noya
- Department of Angiology and Vascular Surgery, 59535Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Nilo J Mosquera Arochena
- Department of Angiology and Vascular Surgery, Complexo Hospitalario Universitario de Ourense, Ourense, Galicia, Spain
| | - Jorge Vidal Rey
- Department of Angiology and Vascular Surgery, Hospital Álvaro Cunqueiro, 96682Complexo Hospitalario Universitario de Vigo, Vigo, Galicia, Spain
| | - Pablo Calvin Álvarez
- Department of Angiology and Vascular Surgery, 16696Hospital Povisa, Vigo, Galicia, Spain
| | - Francisco José Franco Meijide
- Department of Angiology and Vascular Surgery, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - Rosa Villardefrancos Gil
- Department of Angiology and Vascular Surgery, Complexo Hospitalario Universitario de Ourense, Ourense, Galicia, Spain
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Wang J, Wang T, Zhao J, Ma Y, Huang B, Yang Y, Yuan D. Effect of limb oversizing on the risk of type Ib endoleak in patients after endovascular aortic repair. J Vasc Surg 2021; 74:1214-1221.e1. [PMID: 33813022 DOI: 10.1016/j.jvs.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We assessed the association between the degree of limb oversizing and the risk of type Ib endoleak (TIBEL) in different types of iliac landing zones after endovascular aortic aneurysm repair. METHODS We performed a retrospective cohort study of patients who had undergone endovascular aortic aneurysm repair with bifurcated and limb endografts in an academic center. The main exposure was the degree of limb oversizing. The primary outcome was the occurrence of TIBELs. The secondary outcomes included limb occlusion, reintervention, and overall survival. Subgroup analyses stratified by ectatic and normal iliac landing zones were performed. Multivariate Cox regression analysis and sensitivity analyses using marginal structure model were conducted to adjust for potential confounders. RESULTS A total of 750 patients with 1500 iliac limb endografts were included in our study (817 limbs with oversizing of ≤10% and 683 with oversizing >10%). The median 1-year freedom from TIBEL was 98.9% (interquartile range [IQR], 98.0%-99.8%) for limbs with oversizing of ≤10% and 99.6% (IQR, 99.0%-100%) for limbs with oversizing >10%. The median 3-year freedom from TIBEL was 95.6% (IQR, 93.1%-98.1%) and 98.2% (IQR, 96.5%-99.9%) for oversizing ≤10% and >10%, respectively. We found that limb oversizing >10% was associated with a significantly decreased risk of TIBEL (adjusted hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.19-0.76) in the overall population. After stratification by ectatic iliac landing zone, we found that limb oversizing >10% was associated with a significantly decreased risk of TIBEL in the ectatic iliac landing zones (adjusted HR, 0.38; 95% CI, 0.16-0.88). However, no significant difference was found in the limb endografts landing in normal iliac arteries (adjusted HR, 0.44; 95% CI, 0.13-1.45). In the subgroup of normal iliac arteries, we observed a significantly increased risk of limb occlusion in the limbs with distal oversizing >15% compared with the limbs with distal oversizing of ≤15% (adjusted HR, 4.66; 95% CI, 1.68-12.91). CONCLUSIONS Adequate limb oversizing >10% was associated with a significantly decreased risk of TIBEL in limbs with ectatic iliac landing zones. However, no additional benefit was observed for oversizing >10% in limb grafts landing in normal iliac arteries. Furthermore, excessive limb oversizing (>15%) in normal iliac landing zones can be associated with an increased risk of limb occlusion.
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Affiliation(s)
- Jiarong Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
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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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Park SC, Lee WR, Lee JS, Kim SD. Delayed type Ib endoleak leading to impending rupture of abdominal aorta after endovascular abdominal aortic aneurysm repair (EVAR). Asian J Surg 2020; 43:564-566. [PMID: 31932153 DOI: 10.1016/j.asjsur.2019.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Woo Ri Lee
- Division of Vascular and Transplant Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, 21431, South Korea
| | - Jong Seok Lee
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Sang Dong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea; Division of Vascular and Transplant Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, 21431, South Korea.
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