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Mazzaccaro D, Righini P, Giannetta M, Galligani M, Milani V, Modafferi A, Malacrida G, Nano G. Low profile endografts for the endovascular treatment of abdominal aortic aneurysms. Expert Rev Med Devices 2023; 20:753-767. [PMID: 37647354 DOI: 10.1080/17434440.2023.2239148] [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: 05/16/2023] [Accepted: 06/25/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Favorable midterm outcomes have been reported with the use of low-profile endografts (LPE), but long-term data is still needed. Furthermore, it is unclear if each of these LPE may have advantages over the other, which may, in turn, affect the outcomes. We systematically reviewed the literature about complications and reintervention rates of patients submitted to endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) using LPE. MATHERIALS AND METHODS A literature search was conducted including articles that reported 30-days and follow-up mortality, complications, and reintervention rates of patients treated with EVAR using Incraft (Cordis), Zenith LP/Alpha (Cook Medical Inc) and Ovation (Endologix) endografts. RESULTS 36 papers were evaluated, reporting results of 582 patients treated with Zenith device, 1211 with Incraft and 3449 with Ovation. During follow up, similar survival and freedom from reintervention rates were reported among the various types of endograft both at 1 and 3 years. The incidence of limb stenosis/kinking was significantly higher in patients treated with Zenith LP/Alpha (2.1%, P = 0.008), while the Incraft device had a significantly lower proportion of type III endoleaks (P < 0.001). CONCLUSIONS Long-term survival and freedom from reintervention rates were comparable among the three LPEs. The Cook Zenith device had the highest rates of limb stenosis/kinking, while the Incraft device had the lowest occurrence of type III endoleak. PROSPERO Registration number: CRD42022315875.
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Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Matteo Giannetta
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marina Galligani
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfredo Modafferi
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
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Mezzetto L, D’Oria M, Lepidi S, Mastrorilli D, Calvagna C, Bassini S, Taglialavoro J, Bruno S, Veraldi GF. A Scoping Review on the Incidence, Risk Factors, and Outcomes of Proximal Neck Dilatation after Standard and Complex Endovascular Repair for Abdominal Aortic Aneurysms. J Clin Med 2023; 12:jcm12062324. [PMID: 36983324 PMCID: PMC10054682 DOI: 10.3390/jcm12062324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/20/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background: To define proximal neck dilation (PND) after standard endovascular aneurysm repair (EVAR) and fenestrated EVAR (FEVAR), determining: incidence and risk factors; evidence base that links PND to outcomes of patients; recurring themes or gaps in the literature. Methods: We performed a scoping review and included only full-text English articles with follow-up focusing on PND in patients undergoing EVAR or FEVAR, published between 2000 and 2022. The following PICO question was used to build the search equation: in patients with abdominal-aortic-aneurysm (AAA) (Population) undergoing endovascular repair (Intervention), what are the incidence, risk factors and prognosis of radiologically defined PND (Comparison) on short-term and long-term outcomes (Outcomes)? Results: 15 articles were included after review. Measurement protocols for proximal aortic neck (PAN) varied among individual studies and the definition of PND resulted as heterogeneous. Rate of patients with a PND ranged between 0% and 41%. Large proximal neck (>28 mm) and excessive graft sizing (30%) were predictors for PND. New endografts with low outward radial forces and FEVAR seemed to be protective. Surgical conversion was the definitive option in the case of patients unfit for other endovascular treatments. Conclusions: PND is a frequent finding after EVAR and FEVAR. Excessive graft oversizing and large baseline PAN were predictors of neck enlargement, independently by the type of standard endograft used. FEVAR may be considered protective against complications, together with endografts using low outward radial forces. Lifelong radiological follow-up is mandatory.
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Affiliation(s)
- Luca Mezzetto
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
- Correspondence: ; Tel.: +39-045-812-2505
| | - Mario D’Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Davide Mastrorilli
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, 34129 Trieste, Italy
| | - Salvatore Bruno
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
| | - Gian Franco Veraldi
- Unit of Vascular Surgery, Integrated University Hospital and Trust of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
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Chatzelas DA, Loutradis CN, Pitoulias AG, Kalogirou TE, Pitoulias GA. A systematic review and meta-analysis of proximal aortic neck dilatation after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2023; 77:941-956.e1. [PMID: 35948244 DOI: 10.1016/j.jvs.2022.07.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/23/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To provide an updated systematic literature review summarizing current evidence on aortic neck dilatation (AND) after endovascular aortic aneurysm repair (EVAR) in patients with infrarenal abdominal aortic aneurysm. METHODS An extensive electronic search in major electronic databases was conducted between January 2000 and December 2021. Eligible for inclusion were observational studies that followed up with patients (n ≥ 20) undergoing EVAR with self-expanding endografts, for 12 or more months, evaluated AND with computed tomography angiography and provided data on relevant outcomes. The primary end point was the incidence of AND after EVAR, and the secondary end points were the occurrence of type Ia endoleak, stent graft migration, secondary rupture, and reintervention. RESULTS We included 34 studies with a total sample of 12,038 patients (10,413 men; median age, 71 years). AND was defined clearly in 18 studies, but significant differences in AND definition were evidenced. The pooled incidence of AND based on quantitative analysis of 16 studies with a total of 9201 patients (7961 men; median age, 72 years) was calculated at 22.9% (95% confidence interval [CI], 14.4-34.4) over a follow-up period ranging from 12 months to 14 years. The risk of a type Ia endoleak was significantly higher in AND patients compared with those without AND (odds ratio, 2.95; 95% CI, 1.10-7.93; P = .030). Similarly, endograft migration was more common in the AND group compared with the non-AND group (odds ratio, 5.95; 95% CI, 1.80-19.69; P = .004). The combined incidence of secondary rupture and reintervention did not differ significantly between the two groups, even though the combined effect was in favor of the non-AND group. CONCLUSIONS Proximal AND after EVAR is common and occurs in a large proportion of patients with infrarenal abdominal aortic aneurysm. AND can influence the long-term durability of proximal endograft fixation and is significantly related to adverse outcomes, often leading to reinterventions.
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Affiliation(s)
- Dimitrios A Chatzelas
- Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, 2nd Department of Surgery, Division of Vascular Surgery, "G. Gennimatas" Thessaloniki General Hospital, Thessaloniki, Greece.
| | - Charalampos N Loutradis
- Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, 2nd Department of Surgery, Division of Vascular Surgery, "G. Gennimatas" Thessaloniki General Hospital, Thessaloniki, Greece
| | - Apostolos G Pitoulias
- Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, 2nd Department of Surgery, Division of Vascular Surgery, "G. Gennimatas" Thessaloniki General Hospital, Thessaloniki, Greece
| | - Thomas E Kalogirou
- Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, 2nd Department of Surgery, Division of Vascular Surgery, "G. Gennimatas" Thessaloniki General Hospital, Thessaloniki, Greece
| | - Georgios A Pitoulias
- Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, 2nd Department of Surgery, Division of Vascular Surgery, "G. Gennimatas" Thessaloniki General Hospital, Thessaloniki, Greece
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Cuozzo S, Martinelli O, Brizzi V, Miceli F, Flora F, Sbarigia E, Gattuso R. Early Experience with Ovation Alto Stent-Graft. Ann Vasc Surg 2022; 88:346-353. [PMID: 36058461 DOI: 10.1016/j.avsg.2022.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Alto is the latest generation of the Ovation stent-graft platform for endovascular aneurysm repair (EVAR). Its ultra-low profile and its proximal sealing zone close to the lowest renal artery (≥7 mm), increase standard EVAR eligibility. We report early clinical and technical outcomes with the Alto stent-graft in our University Hospital Center, after CE Mark approval in August 2020. METHODS Seven patients (all male, mean age 76,1±6.2 years) underwent EVAR with Ovation Alto stent-graft between June 2021 and February 2022. All the EVAR procedures were performed by a team of vascular surgeons experienced on EVAR with previous generation of Ovation platform. Follow-up consisted of duplex ultrasounds examination (DUS) at 1, 3 and 6 months and of a 1-month control computed tomography angiography (CTA). Patients treated gave consent to participate in this case series and publication. A descriptive analysis of variables was performed. SPSS (Version 25; SPSS Inc, Chicago, IL, USA) and Excel (Microsoft Corporation, Redmond, WA, USA) were used for statistical analysis. RESULTS Most of patients had a fusiform AAA (n = 5; 71,4%). The median maximal transversal aortic diameter (DT) was 5,06 cm (range, 3,98 - 6,99). Due to hostile aortic neck anatomy, on-label EVAR was considered feasible only with Ovation Alto stent-graft. Narrow iliac arteries (<6 mm) were also present in 2 cases. All procedures were performed according to the instruction for use (IFU) of the device. Technical success was achieved in all cases. No type IA/IB/III endoleak occurred at completion angiography. No distal migration (>10 mm), but two distal displacements (≥ 2 mm) were observed at control CTA. During follow-up, DUS and CTA showed no type I/III endoleak, no stent-graft migration (>10 mm), and no proximal aortic neck variations (p=ns). 3 patients (42.8%) are under strict surveillance because of low-flow type II endoleak not associated with sac variations. CONCLUSION Our early experience shows promising technical and clinical success with Alto stent-graft. The proximal relocation of the proximal sealing rings and the ultra-low profile delivery system allow on-label EVAR in a wider range of aortic anatomies. Notwithstanding, further studies, metanalysis and prospective registries are mandatory to evaluate mid and long-term efficacy and safety of this latest Ovation platform.
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Affiliation(s)
- Simone Cuozzo
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy.
| | - Ombretta Martinelli
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Vincenzo Brizzi
- Vascular Surgery Department, CHU de Bordeaux, Bordeaux - France
| | - Francesca Miceli
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Federico Flora
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Enrico Sbarigia
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Roberto Gattuso
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
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