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Zuidema R, van Sambeek MRHM, Zwetsloot J, Heyligers JMM, Pratesi G, Reijnen MMPJ, de Vries JPPM, Schuurmann RCL. Geometric Analysis of the Gore Excluder Conformable Endoprosthesis in the Infrarenal Aortic Neck: One Year Results of the EXCeL Registry. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00362-9. [PMID: 38670221 DOI: 10.1016/j.ejvs.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/01/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE The Gore Excluder Conformable Endoprosthesis (CEXC) is designed to treat challenging infrarenal anatomy because of its active angulation control, repositionability, and enhanced conformability. This study evaluated 30 day and one year position and apposition of the CEXC in the infrarenal neck. METHODS Patients treated with the CEXC between 2018 and 2022 with an available 30 day computed tomography angiogram (CTA) were selected from four hospitals in a prospective registry. Endograft apposition (shortest apposition length [SAL]) and position (shortest fabric distance [SFD]) were assessed on the 30 day and one year CTAs. Maximum infrarenal aortic curvature was compared between the pre- and post-operative CTAs to evaluate conformability of the CEXC. RESULTS There were 87 patients with a 30 day CTA, and for 56 of these patients the one year CTA was available. Median (interquartile range [IQR]) pre-operative neck length was 22 mm (IQR 15, 32) and infrarenal angulation was 52° (IQR 31, 72). Median SAL was 21.2 mm (IQR 14.0, 29.3) at 30 days for all included patients. The SAL in 13 patients (15%) was < 10 mm at 30 days, and one patient had a SAL of 0 mm and a type Ia endoleak. There was no significant difference in SAL between patients within and outside instructions for use. The SAL significantly increased by 1.1 mm (IQR -2.3, 4.7; p = .042) at one year. The SAL decreased in seven patients (13%), increased in 13 patients (23%), and remained stable in 36 patients (64%). Median SFD was 2.0 mm (IQR 0.5, 3.6) at 30 days, which slightly increased by 0.3 mm (IQR -0.5, 1.8; p = .019) at one year. One patient showed migration (SFD increase ≥ 5 mm). Median endograft tilt was 15.8° (IQR 9.7, 21.4). Pre-operative maximum infrarenal curvature was 36 m-1 (IQR 26, 56) and did not significantly change thereafter. CONCLUSION In most patients, the CEXC was implanted close to the renal arteries, and sufficient (≥ 10 mm) post-operative apposition was achieved at 30 days, which slightly increased at one year. Post-operative endograft tilt was relatively low, and aortic geometry remained unchanged after implantation of the CEXC, probably due to its high conformability.
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Affiliation(s)
- Roy Zuidema
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands; and Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jenny Zwetsloot
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands; and Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jan M M Heyligers
- Department of Vascular Surgery, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Giovanni Pratesi
- Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy; and Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands; and Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, the Netherlands
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Brand M, Yoel B, Eichler E, Speter C, Halak M, Marom G. The effect of stent graft curvature on the hemodynamic displacement force after abdominal aortic aneurysm endovascular repair. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230563. [PMID: 37416831 PMCID: PMC10320339 DOI: 10.1098/rsos.230563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
Endovascular aortic aneurysm repair is a minimally invasive procedure with low mortality and morbidity. Clinical studies have revealed that a displacement force (DF) can cause stent graft (SG) migration in some circumstances requiring repeated intervention. This study aims to determine the relationship between the SG curvature and the calculated DF from four patient-specific computational fluid dynamics models. The SG's curvature was defined according to the centrelines of the implanted SG's branches. The centrelines were defined as either intersecting or separated lines. The centreline curvature (CLC) metrics were calculated based on the local curvature radii and the distances from the centrelines of idealized straight branches. The average CLC value and average variation were calculated to represent the entire graft's curvature. These CLC calculations were compared, and the method that gave the best correlation to the calculated DF was found. The optimal correlation is obtained from calculating the CLC average variation using separated centrelines and distance from straight lines, with an R2 = 0.89. Understanding the relationship between vascular morphology and DF can help identify at-risk patients before the procedure. In these cases, we can provide appropriate treatment and follow up with the patient to prevent future failure.
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Affiliation(s)
| | | | | | - Chen Speter
- Department of Vascular Surgery, The Chaim Sheba Medical Centre, Tel Hashomer, Israel
| | - Moshe Halak
- Department of Vascular Surgery, The Chaim Sheba Medical Centre, Tel Hashomer, Israel
| | - Gil Marom
- Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Fast and Accurate Computation of the Displacement Force of Stent Grafts after Endovascular Aneurysm Repair. Bioengineering (Basel) 2022; 9:bioengineering9090447. [PMID: 36134992 PMCID: PMC9495395 DOI: 10.3390/bioengineering9090447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: Currently, the displacement force of stent grafts is generally obtained using computational fluid dynamics (CFD), which requires professional CFD knowledge to perform the correct simulation. This study proposes a fast, simple, and clinician-friendly approach to calculating the patient-specific displacement force after endovascular aneurysm repair (EVAR). Methods: Twenty patient-specific post-EVAR computed tomography angiography images were used to reconstruct the patient-specific three-dimensional models, then the displacement forces were calculated using CFD and the proposed approaches, respectively, and their numerical differences were compared and analyzed. Results: Based on the derivation and simplification of the momentum theorem, the patient-specific displacement forces were obtained using the information of the patient-specific pressure, cross-sectional area, and angulation of the two stent graft ends, and the average relative error was no greater than 1.37% when compared to the displacement forces calculated by CFD. In addition, the linear regression analysis also showed good agreement between the displacement force values calculated by the new approach and CFD (R = 0.999). Conclusions: The proposed approach can quickly and accurately calculate the patient-specific displacement force on a stent graft and can therefore help clinicians quickly evaluate the post-EVAR displacement force.
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Schuurmann RCL, Kropman R, Ouriel K, Jordan WD, Muhs BE, 't Mannetje Y, Reijnen MMPJ, Fioole B, Ünlü Ç, Brummel P, de Vries JPPM. Remodeling of Abdominal Aortic Angulation and Curvature After Endovascular Aneurysm Repair in Patients With vs Without Late Type Ia Endoleak or Endograft Migration. J Endovasc Ther 2021; 28:342-351. [PMID: 33660575 DOI: 10.1177/1526602821995831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate aortic remodeling of the supra- and infrarenal aorta from preoperative to 1 month and midterm follow-up after endovascular aneurysm repair (EVAR) by analyzing changes in angulation and curvature in patients with vs without late type Ia endoleak or device migration. MATERIALS AND METHODS From a multicenter database, 35 patients (mean age 76±5 years; 31 men) were identified with late (>1 year) type Ia endoleak or endograft migration (≥10 mm) and defined as the complication group. The control group consisted of 53 patients (mean age 75±7 years; 48 men) with >1-year computed tomography angiography (CTA) follow-up and no evidence of endoleaks. Suprarenal and infrarenal angles were measured on centerline reconstructions of the preoperative, 1-month, and midterm CTA scans. The value and location relative to baseline of maximum suprarenal and infrarenal curvature were determined semiautomatically using dedicated software. Changes were determined at 1 month compared with the preoperative CTA and at midterm compared with 1 month. RESULTS Preoperative suprarenal angulation was significantly greater in the complication group compared to the controls (34°±18° vs 24°±17°, p=0.008). It decreased significantly at 1 month in the complication group (29°±16°, p=0.011) and at midterm follow-up in the controls (20°±19°, p<0.001). Preoperative infrarenal angulation was not significantly different (57°±15° vs 49°±24°, p=0.114). This measurement increased significantly through midterm follow-up in the complication group (63°±23°, p<0.001) but remained stable in the controls (46°±22°). Preoperative suprarenal curvature was not significantly different (38±22 m-1 vs 29±25 m-1, p=0.115). This variable increased significantly through midterm follow-up in the complication group (44±22 m-1) but remained constant in the controls (28±22 m-1). Preoperative infrarenal curvature was significantly greater in the complication group (77±29 m-1 vs 65±28 m-1, p=0.047) and decreased significantly in both groups during midterm follow-up (50±17 m-1 vs 41±19 m-1 p=0.033). The location of the maximum curvature with regard to baseline shifted significantly distally in the complication group (54±43 to 72±41 mm, p<0.001), while it remained stable in the controls (46±33 to 48±31 mm). CONCLUSION At midterm follow-up, significant differences in supra- and infrarenal angulation and curvature were observed between patients with vs without type Ia endoleak or migration. The location of the maximum curvature shifted distally in patients with complications. The aortic morphology is more stable during midterm follow-up in the patients without endoleaks.
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Affiliation(s)
- Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
| | - Rogier Kropman
- Department of Vascular Surgery, St Antonius Hospital Nieuwegein, the Netherlands
| | | | - William D Jordan
- Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, GA, USA
| | | | - Yannick 't Mannetje
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Michel M P J Reijnen
- Department of Vascular Surgery, Rijnstate, Arnhem, and Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Çağdaş Ünlü
- Department of Vascular Surgery, Northwest Hospital Group, Alkmaar, the Netherlands
| | - Peter Brummel
- Department of Vascular Surgery, Franciscus Hospital, Roosendaal, the Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
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Wang Y, Li C, Xin H, Li J, Wang H. Predisposing Factors for Migration of the Iliac Limb and Reintervention after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2019; 59:91-101. [DOI: 10.1016/j.avsg.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/15/2018] [Accepted: 01/01/2019] [Indexed: 12/17/2022]
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Nasr B, Savean J, Albert B, Badra A, Braesco J, Nonent M, Gouny P, Visvikis D, Fayad H. Thoracic Stent-Graft Migration: The Role of the Geometric Modifications of the Stent-Graft at 3 years. Ann Vasc Surg 2019; 58:16-23. [DOI: 10.1016/j.avsg.2018.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
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Wang L, Liang S, Xu X, Chen B, Jiang J, Shi Z, Tang X, Zhou X, Zhou M, Guo D, Fu W. A Comparative Study of the Efficacy by using Different Stent Grafts in Bell-Bottom Technique for the Treatment of Abdominal Aortic Aneurysm Concomitant with Iliac Artery Aneurysm. Ann Vasc Surg 2018; 52:41-48. [PMID: 29885433 DOI: 10.1016/j.avsg.2018.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/20/2018] [Accepted: 05/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bell-bottom technique (BBT) is one method to preserve the internal iliac artery during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) that extends to iliac artery. The data on the efficacy of this technique are still limited. We sought to evaluate the midterm efficacy of BBT by using different stent grafts in the treatment of AAA combined with iliac artery aneurysm (IAA). METHODS From January 2011 to December 2016, AAA patients with IAA using BBT to preserve the internal iliac artery were retrospectively analyzed in our institution. Patients were followed up at 3, 6, and then every 12 months after surgery. The outcomes among 3 types of stent grafts (Zenith, Excluder, and Endurant) were compared. BBT-related end points including type Ib endoleak, IAA sac expansion, distal neck expansion, and rupture during follow-up were compared. Other events including perioperative death, any other types of endoleak, and corresponding management were also documented. RESULTS A total of 125 patients with 141 IAAs were identified. Ninety-eight patients (78.4%) with 113 lesions (80.4%) received a median follow-up time of 38 months. The incidence of type Ib endoleak was 22.9%, 8.3%, 11.9%, and 14.2% (P = 0.19) in Zenith, Excluder, Endurant group, and total patients, respectively. The incidence of IAA sac enlargement was 17.1%, 5.6%, 7.1%, and 9.7% (P = 0.20). The incidence of IAA rupture was 8.6%, 0.0%, 0.0%, and 2.7% (P = 0.03). The incidence of IAA neck enlargement was 34.3%, 13.9%, 16.7%, and 21.2% (P = 0.07). Totally, 14 cases (10.7%) received further treatment for BBT-related issues. CONCLUSIONS Although BBT remains a safe and effective treatment option to preserve internal iliac artery during standard EVAR with acceptable complication rates in Asians, different IAA rupture rates were found among 3 different stent grafts. Our data for the first time revealed that the type of stent grafts has influence on the final clinical outcome. Based on that, iliac extension should be selected appropriately while treating AAA-IAA.
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Affiliation(s)
- Lixin Wang
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China; Vascular Surgery Department of Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Shuangchao Liang
- Department of Vascular Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xin Xu
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Bin Chen
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Junhao Jiang
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Zhenyu Shi
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Xiao Tang
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Xiushi Zhou
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Min Zhou
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Daqiao Guo
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China.
| | - Weiguo Fu
- Vascular Surgery Department of Zhongshan Hospital, Fudan University, Shanghai, China; Vascular Surgery Institute of Fudan University, Shanghai, China; Vascular Surgery Department of Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
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Georgakarakos E, Kratimenos T, Koutsoumpelis A, Georgiadis GS. The Bolton Treo endograft for treatment of abdominal aortic aneurysms: just another trimodular platform? Expert Rev Med Devices 2017; 15:5-14. [DOI: 10.1080/17434440.2018.1419864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theodoros Kratimenos
- Department of Interventional Radiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Early and Late Endograft Limb Proximal Migration with Resulting Type 1b Endoleak following an EVAR for Ruptured AAA. Case Rep Vasc Med 2017; 2017:4931282. [PMID: 28255495 PMCID: PMC5307129 DOI: 10.1155/2017/4931282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/09/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction. Seal zone failure after EVAR leads to type 1 endoleaks and increases the risk of delayed aortic rupture. Type 1b endoleaks, although rare, represent a true risk to the repair. Case Presentation. We report the case of a 65-year-old female who underwent emergent endovascular repair for a ruptured infrarenal abdominal aortic aneurysm and developed bilateral type 1b endoleaks following proximal migration of both endograft limbs. The right-side failure was diagnosed within 48 hours from the initial repair and the left side at the 1-year follow-up. Both sides were successfully treated with endovascular techniques. A review of the literature with an analysis of potential risk factors is also reported. Conclusion. For patients undergoing EVAR for ruptured AAA and with noncalcified iliac arteries, more aggressive oversizing of the iliac limbs is recommended to prevents distal seal zone failures.
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Predisposing Factors for Re-interventions with Additional Iliac Stent Grafts After Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2017; 53:89-94. [DOI: 10.1016/j.ejvs.2016.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/20/2016] [Indexed: 11/20/2022]
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Roos H, Tokarev M, Chernoray V, Ghaffari M, Falkenberg M, Jeppsson A, Nilsson H. Displacement Forces in Stent Grafts: Influence of Diameter Variation and Curvature Asymmetry. Eur J Vasc Endovasc Surg 2016; 52:150-6. [DOI: 10.1016/j.ejvs.2016.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
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Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:124. [PMID: 27267131 PMCID: PMC4895810 DOI: 10.1186/s12872-016-0309-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background Early morbidity and mortality are generally lower after endovascular aortic repair (EVAR), than after open repair but re-interventions and late complications are more common. The aim of the present study was to make a detailed description of re-interventions after EVAR-including incidence, indications, procedures, and outcome-with special reference to non-access-related re-interventions. Methods This is a retrospective single-center cohort study of re-interventions after standard EVAR with special reference to non-access-related re-interventions. Consecutive patients (n = 405) treated with standard EVAR for non-ruptured (n = 337) or ruptured (n = 68) infrarenal aneurysms between 2005 and 2013 were analysed. Median follow-up was 29 months (range 0–108). Results Eighty-nine patients (22 %) underwent 113 re-interventions during follow-up. Twenty-seven patients (7 %) had 28 access related re-intervention, 65 patients (16 %) had 85 non-access related reinterventions. Non-access related re-interventions were more common in ruptured aneurysms than in unruptured aneurysms (22 vs. 15 %, p = 0.002). The most frequent indications were endoleak type I (n = 19), type II (n = 21), or type III (n = 5); stent graft migration (n = 9); and thrombosis (n = 14). The most frequent procedures were embolization of endoleak type II (n = 21), additional iliac stent graft (n = 19), proximal extension (n = 12), thrombolysis (n = 8), iliac limb bare-metal stenting (n = 6), and stent graft relining (n = 7). Endovascular technique was used in 83 % of re-interventions. Thirty-day mortality after non-access-related re-interventions was 15 % when initiated from symptoms (rupture or infection) and 0 % when initiated from follow-up findings (p = 0.014). Cumulative survival five years after EVAR was 72 % in patients with a re-intervention and 59 % in patients without (p = 0.21). Conclusions Non-access-related re-intervention rates are still considerable after EVAR and more frequent after ruptured aneurysms. Endoleak embolization is the most frequent procedure, followed by additional iliac stent grafts. Outcomes after re-interventions are generally good, except when initiated by rupture or infection.
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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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Georgakarakos E, Raptis A, Schoretsanitis N, Bisdas T, Beropoulis E, Georgiadis GS, Matsagkas M, Xenos M. Studying the Interaction of Stent-Grafts and Treated Abdominal Aortic Aneurysms. J Endovasc Ther 2015; 22:413-20. [DOI: 10.1177/1526602815583494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the advent of endovascular repair of aortic aneurysms (EVAR), clinical focus has been on preventing loss of sealing at the level of the infrarenal neck, which leads to type I endoleak and repressurization of the aneurysm sac. Enhanced mechanisms for central fixation and seal have consequently lowered the incidence of migration and endoleaks. However, endograft limb thrombosis and its causal mechanisms have not been addressed adequately in the literature. This article reviews the pathophysiological mechanisms associated with limb thrombosis in order to facilitate better clinical judgment to prevent iliac adverse effects.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Anastasios Raptis
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic Münster, Münster, Germany
| | - Efthymios Beropoulis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic Münster, Münster, Germany
| | - George S. Georgiadis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Miltiadis Matsagkas
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Michalis Xenos
- Department of Mathematics, University of Ioannina, Ioannina, Greece
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