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Fenelli C, Gargiulo M, Prendes CF, Faggioli G, Stavroulakis K, Gallitto E, Stana J, Spath P, Rantner B, Tsilimparis N. Effect of iliac tortuosity on outcomes after iliac branch procedures. J Vasc Surg 2022; 76:714-723.e1. [PMID: 35227802 DOI: 10.1016/j.jvs.2022.01.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report a two-centers evaluation of the effects of iliac axis tortuosity on iliac branch device (IBD) results. METHODS From 2015 to 2021, all IBD procedures performed at two European centers were analyzed retrospectively. The preoperative pelvic tortuosity index (PTI), external tortuosity index (ETI), and double iliac sign (DIS) were assessed for each iliac axis submitted to IBD. The primary endpoints were technical success, early and mid-term IBD complications (occlusion, stenosis, endoleaks [ELs]) and reinterventions, and the association with the PTI, ETI, and DIS. The 30-day mortality, survival, freedom from complications and freedom from reinterventions (FFR) were the secondary endpoints. RESULTS During the study period, 224 patients had undergone 256 IBD procedures for 165 (64.5%) aortoiliac aneurysms, 44 (17.2%) isolated iliac aneurysms, 11 (4.3%) abdominal aortic aneurysms with a short iliac landing zone, and 36 (14.1%) type Ib ELs. IBD was planned with endovascular aortic aneurysm repair for 158 (61.7%), fenestrated/branched endovascular aortic aneurysm repair for 45 (7.6%), and isolated for 53 (20.7%) cases. Technical success and 30-day mortality were 99.2% (254 of 256) and 0.9% (2 of 224), respectively. A PTI >1.4, an ETI >1.7, and the DIS were tested to identify the risk factors for the endpoints. No ELs and 9 (3.5%) IBD occlusions, requiring five reinterventions (2%), had occurred within 30 days. No association with the PTI, ETI, or DIS was identified; IBD oversizing of ≥25% on the external iliac artery was independently related to occlusion (odds ratio, 4.3; 95% confidence interval [CI], 1-18.1; P = .045). The mean follow-up was 31 ± 27 months, with 11 IBD occlusions, 14 ELs, and 21 reinterventions. At 1, 3, and 5 years of follow-up survival, IBD patency, and FFR were 95%, 89%, and 80%; 93%, 91%, and 90%; and 93%, 89%, and 83%, respectively. The risk factors for overall complications (n = 34; 13.3%) and reinterventions (n = 26; 10.2%) were an ETI >1.7 (P = .037 and P = .019), a PTI >1.4 (P = .016 and P = .012), and a type Ib EL as the indication (P = .025 and P = .001), respectively. Cox regression confirmed PTI >1.4 as an independent predictor of overall complications and reinterventions (hazard ratio [HR], 2.3; 95% CI, 1.1-4.4; P = .018; and HR, 3 95% CI, 1.3-6.8; P = .018, respectively) and ETI >1.7 as an independent risk factor for ELs (HR 6; 95% CI, 2.1-17.5; P = .001). The freedom from complications and FFR were significantly lower with a PTI >1.4 at 3 years (73% vs 92% [log-rank P = .01] and 77% vs 93% [log-rank P = .001], respectively). CONCLUSIONS We found IBDs to be safe and effective in the treatment of aortoiliac aneurysms. Early complications are uncommon and related to endograft oversizing rather than anatomic characteristics in the present study. Iliac tortuosity is a risk factor for overall complications and reinterventions, in particular for IBD-related ELs.
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Affiliation(s)
- Cecilia Fenelli
- Department of Vascular Surgery, Ludwig-Maximilians University Hospital, Munich, Germany; Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Enrico Gallitto
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Jan Stana
- Department of Vascular Surgery, Ludwig-Maximilians University Hospital, Munich, Germany
| | - Paolo Spath
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Barbara Rantner
- Department of Vascular Surgery, Ludwig-Maximilians University Hospital, Munich, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians University Hospital, Munich, Germany.
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De Paulis S, Arlotta G, Calabrese M, Corsi F, Taccheri T, Antoniucci ME, Martinelli L, Bevilacqua F, Tinelli G, Cavaliere F. Postoperative Intensive Care Management of Aortic Repair. J Pers Med 2022; 12:jpm12081351. [PMID: 36013300 PMCID: PMC9410221 DOI: 10.3390/jpm12081351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved in recent years, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy. The intensive care physician must be aware that aortic repair surgery has an impact on every organ system, and the importance of early recognition of organ failure cannot be overemphasized.
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Affiliation(s)
- Stefano De Paulis
- Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | | | | | - Filippo Corsi
- Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
| | | | | | - Lorenzo Martinelli
- Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Giovanni Tinelli
- Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Franco Cavaliere
- Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Zarkowsky DS, Stonko DP. Artificial intelligence's role in vascular surgery decision-making. Semin Vasc Surg 2021; 34:260-267. [PMID: 34911632 DOI: 10.1053/j.semvascsurg.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022]
Abstract
Artificial intelligence (AI) is the next great advance informing medical science. Several disciplines, including vascular surgery, use AI-based decision-making tools to improve clinical performance. Although applied widely, AI functions best when confronted with voluminous, accurate data. Consistent, predictable analytic technique selection also challenges researchers. This article contextualizes AI analyses within evidence-based medicine, focusing on "big data" and health services research, as well as discussing opportunities to improve data collection and realize AI's promise.
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Affiliation(s)
- Devin S Zarkowsky
- Division of Vascular Surgery and Endovascular Therapy, University of Colorado School of Medicine, 12615 E 17(th) Place, AO1, Aurora, CO, 80045.
| | - David P Stonko
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
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Geraedts ACM, Mulay S, Vahl A, Wisselink W, Koelemay MJW, Balm R. Secondary Interventions and Long-term Follow-up after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2020; 71:381-391. [PMID: 32768546 DOI: 10.1016/j.avsg.2020.07.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early morbidity and mortality are low after endovascular abdominal aneurysm repair (EVAR), but secondary interventions and late complications are common. The aim of the present multicenter cohort study is to detail the frequency and indication for interventions after EVAR and the impact on long-term survival. METHODS A retrospective multicenter cohort study of secondary interventions after elective EVAR for an infrarenal abdominal aortic aneurysm was conducted. Consecutive patients (n = 349) undergoing EVAR between January 2007 and January 2012 were analyzed, with long-term follow-up until December 2018. Those requiring intervention were classified in accordance with the indications and specific nature of the intervention and treatment. The primary study end point was overall survival classified for patients with and without intervention. Kaplan-Meier analysis was used to estimate overall survival for those who did and who did not undergo secondary interventions. Univariable and multivariable Cox regression were performed to identify independent variables associated with mortality. RESULTS Some 56 patients (16%) underwent 72 secondary interventions after EVAR during a median (interquartile range) follow-up period of 53.2 months (60.1). Some 45 patients (80.4%) underwent one intervention. Indications for intervention included mainly endograft kinking/outflow obstruction and type II endoleak. An endovascular technique was used in 40.3% of interventions. Median time to secondary intervention was 24.1 months. In 93 patients with abnormalities on imaging, no intervention was performed mainly because the abnormality had disappeared on follow-up imaging (43%). Kaplan-Meier curves showed no difference in survival for patients with and without secondary interventions (P = 0.153). Age (hazard ratio [HR]: 1.089, 95% confidence interval [CI]: 1.063-1.116), ASA classification (ASA III, IV HR: 1.517, 95% CI: 1.056-2.178) were significantly related to mortality. CONCLUSIONS Secondary intervention rates are still considerable after EVAR. Endograft kinking/outflow obstruction and endoleak type II are the most common indications for a secondary intervention. Secondary interventions did not adversely affect long-term overall survival after EVAR.
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Affiliation(s)
- Anna C M Geraedts
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Sana Mulay
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Anco Vahl
- OLVG, Department of Surgery, Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mark J W Koelemay
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ron Balm
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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Tenorio ER, Oderich GS, Sandri GA, Ozbek P, Kärkkäinen JM, Vrtiska T, Macedo TA, Gloviczki P. Prospective nonrandomized study to evaluate cone beam computed tomography for technical assessment of standard and complex endovascular aortic repair. J Vasc Surg 2020; 71:1982-1993.e5. [DOI: 10.1016/j.jvs.2019.07.080] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/19/2019] [Indexed: 11/27/2022]
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Maldonado TS, Ranson ME, Rockman CB, Pua B, Cayne NS, Jacobowitz GR, Adelman MA. Decreased Ischemic Complications After Endovascular Aortic Aneurysm Repair With Newer Devices. Vasc Endovascular Surg 2019; 41:192-9. [PMID: 17595384 DOI: 10.1177/1538574407300915] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ischemic complications after endovascular abdominal aortic aneurysm repair (EVAR) are well-recognized and have been reported to be as high as 9%. The goal of our study was to examine the incidence, management, and outcome of ischemic complications at our institution after EVAR and to compare complications according to graft type and time period. This is a retrospective review of all EVARs performed at our institution from 1993 through 2005 (n = 430). EVAR was performed in asymptomatic patients in most cases. Follow-up consisted of a computed tomography scan and office visit at 1, 6, and 12 months and yearly thereafter. Ischemic complications after EVAR have decreased significantly with the advent of lower-profile devices with easier delivery systems and supported limbs. Simultaneous coil embolization of internal iliac artery at the time of EVAR implant does not appear to increase the risk of pelvic or lower-extremity ischemia, can be done safely, and does not need to be staged.
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Affiliation(s)
- Thomas S Maldonado
- Department of Surgery, Division of Vascular Surgery, New York University School of Medicine, New York, New York 10016, USA.
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Catanese V, Sangiorgi G, Sotgiu G, Saderi L, Settembrini A, Donelli C, Martelli E. Clinical and anatomical variables associated in the literature to limb graft occlusion after endovascular aneurysm repair compared to the experience of a tertiary referral center. MINERVA CHIR 2019; 75:51-59. [PMID: 31663308 DOI: 10.23736/s0026-4733.19.08199-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Limb graft occlusion (LGO) is the third reason for hospital readmission after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. We reviewed the clinical features, incidence, anatomical and devices related predictive factors for LGO after EVAR, and compared them with our experience. EVIDENCE ACQUISITION EVAR between 2010-2017 were included. Patients with LGO (LGO group) were matched for age and type of endograft with the rest of the entire cohort without LGO (control group). Clinical, anatomical, operative, outcome, and follow-up data were collected. EVIDENCE SYNTHESIS Two hundred seventy-six EVAR, (30 aorto-uniliac), 276 patients. The incidence of LGO was 2.5% (seven limbs, seven patients) at 27±24.6 days. Symptomatic patients were successfully treated. No mortality, limb loss, critical limb ischemia or residual claudication due to LGO was observed. Fifty patients resulted from the matching. Among the predictive factors of LGO between the two groups, significant differences were observed in graft limb oversizing ≥15% (57.1% vs. 8%, P=0.005), or kinking (42.9% vs. 2%, P=0.01), and diameter of the aortic bifurcation <20 mm (71.4% vs. 20%, P=0.01). Logistic regression analysis showed that these three variables increased the risk of LGO (P=0.003, P=0.006, and P=0.01, respectively). CONCLUSIONS The strongest predictive factors of LGO issued from our review were: extension in the external iliac artery, or small diameter; tortuous, angled, and calcific iliac axis; excessive oversizing of the limb graft, or kinking; use of old generation devices; EVAR performed outside the instructions for use. Limb graft oversizing >15%, or kinking, and aortic bifurcation <20 mm appear to be independent predictive factors of LGO.
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Affiliation(s)
- Vincenzo Catanese
- Division and Residency Program in Vascular Surgery, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Sangiorgi
- Division and Residency Program in Vascular Surgery, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,Division of Cardiology, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alberto Settembrini
- Division of Vascular Surgery, Maggiore Polyclinic Hospital, Ca' Granda IRCCS and Foundation, Milan, Italy
| | - Carlotta Donelli
- Division and Residency Program in Vascular Surgery, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Eugenio Martelli
- Division and Residency Program in Vascular Surgery, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy -
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Banerjee S, Campbell B, Rising J, Coukell A, Sedrakyan A. Long-term active surveillance of implantable medical devices: an analysis of factors determining whether current registries are adequate to expose safety and efficacy problems. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2019; 1:e000011. [PMID: 35047775 PMCID: PMC8749330 DOI: 10.1136/bmjsit-2019-000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Samprit Banerjee
- Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
| | | | - Josh Rising
- Health Care Programs, The Pew Charitable Trusts, Washington, DC, USA
| | - Allan Coukell
- Health Care Programs, The Pew Charitable Trusts, Washington, DC, USA
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
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Iantorno M, Buchanan KD, Bernardo NL, Torguson R, Waksman R. Overview of the 2018 US Food and Drug Administration Circulatory System Devices Panel meeting on the INCRAFT AAA Stent Graft System. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:403-408. [DOI: 10.1016/j.carrev.2019.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
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Amin S, Schnabel J, Eldergash O, Chavan A. [Endovascular aneurysm repair (EVAR) : Complication management]. Radiologe 2018; 58:841-849. [PMID: 30083939 DOI: 10.1007/s00117-018-0437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A variety of complications may be experienced during or after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). Acute procedure-related complications include injury to the access vessels, improper endograft placement, ischaemic and systemic complications as well as the postimplantation syndrome. Femoral pseudoaneurysms, endograft migration, kinking or occlusion, endoleaks and endograft infection are complications that have been observed at follow-up. Meticulous patient selection and preprocedural work-up can reduce the incidence of these complications. The majority of the complications, acute as well those at follow-up, can be dealt with endoluminally. It is of essence, however, that a wide variety of catheters, guidewires, stents, stent-grafts and embolics are readily available in the repertoire of the interventionalist. In a small number of patients with endograft occlusion or infection or with bleeding complications/pseudoaneurysms of the access vessels, open surgical intervention may become necessary. To obtain optimal results, close interdisciplinary co-operation, especially between the interventionist, the vascular surgeon and the anaesthetist is mandatory.
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Affiliation(s)
- S Amin
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - J Schnabel
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - O Eldergash
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland
| | - A Chavan
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, 26133, Oldenburg, Deutschland.
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Endovascular Aneurysm Sealing (EVAS) Alone or in Combination with Chimney Grafts (chEVAS) for Treating Complications of Previous Endovascular Aneurysm Repair (EVAR) Procedures. Cardiovasc Intervent Radiol 2018; 41:1015-1020. [DOI: 10.1007/s00270-018-1952-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
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Baderkhan H, Haller O, Wanhainen A, Björck M, Mani K. Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging. Br J Surg 2018; 105:709-718. [DOI: 10.1002/bjs.10766] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/13/2017] [Accepted: 10/22/2017] [Indexed: 02/01/2023]
Abstract
Abstract
Background
Lifelong postoperative surveillance is recommended following endovascular aneurysm repair (EVAR). Although the purpose is to prevent and/or identify complications early, it also results in increased cost and workload. This study was designed to examine whether it may be possible to identify patients at low risk of complications based on their first postoperative CT angiogram (CTA).
Methods
All patients undergoing EVAR in two Swedish centres between 2001 and 2012 were identified retrospectively and categorized based on the first postoperative CTA as at low risk (proximal and distal sealing zone at least 10 mm and no endoleak) or high risk (sealing zone less than 10 mm and/or presence of any endoleak) of complications.
Results
Some 326 patients (273 men) with a CTA performed less than 1 year after EVAR were included (low risk 212, 65·0 per cent; high risk 114, 35·0 per cent). There was no difference between the groups in terms of sex, age, co-morbidities, abdominal aortic aneurysm (AAA) diameter, preoperative AAA neck anatomy, stent-graft type or duration of follow-up (mean(s.d.) 4·8(3·2) years). Five-year freedom from AAA-related adverse events was 97·1 and 47·7 per cent in the low- and high-risk groups respectively (P < 0·001). The corresponding freedom from AAA-related reintervention was 96·2 and 54·1 per cent (P < 0·001). The method had a sensitivity of 88·3 per cent, specificity of 77·0 per cent and negative predictive value of 96·6 per cent to detect AAA-related adverse events. The number of surveillance imaging per AAA-related adverse event was 168 versus 11 for the low-risk versus high-risk group.
Conclusion
Two-thirds of patients undergoing EVAR have an adequate seal and no endoleak on the first postoperative CTA, and a very low risk of AAA-related events up to 5 years. Less vigilant follow-up after EVAR may be considered for these patients.
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Affiliation(s)
- H Baderkhan
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - O Haller
- Department of Radiology, Gävle Hospital, Gävle, Sweden
| | - A Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - M Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - K Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Rahimi S, Nassiri N, Huntress L, Crystal D, Thomas J, Shafritz R. An Institution-Wide Algorithm for Treatment of Type II Endoleak Following Endovascular Aneurysm Repair (EVAR). Vasc Endovascular Surg 2018; 52:249-254. [DOI: 10.1177/1538574418761269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Multiple endovascular techniques have been described for the treatment of persistent type II endoleaks (pT2ELs) causing aneurysm sac growth following endovascular aneurysm repair (EVAR). In the event of a failed endovascular procedure and a pT2EL, a consensus regarding further treatment is lacking, and the literature suggests repeated endovascular attempts are rarely successful. Herein, we propose an algorithm for definitive management of pT2ELs with persistent sac growth following EVAR. Methods: A retrospective review of 29 patients who underwent treatment of persistent sac growth in the setting of pT2ELs was performed. Intervention methods were determined at the discretion of the operating surgeon. Aneurysmal sac enlargement was defined as a diameter increase > 5 mm, and persistent endoleak was defined as lasting greater than 6 months. Results: From 2000 to 2015, 917 EVAR procedures were performed at our institution. Isolated pT2ELs with sac enlargement were identified in 29 patients. Twenty-five patients underwent direct translumbar sac puncture and coiling and/or Onyx (Onyx, Plymouth, Minnesota) embolization of the culprit vessels. Thirteen (52%) of 25 patients had pT2EL after first endovascular intervention, and 10 (40%) of 25 patients failed 2 endovascular treatments. Of those 10, 7 displayed persistent aneurysmal sac growth and underwent a third embolization procedure. Type II endoleaks persisted in 6 patients; 3 patients were subsequently treated with laparotomy, ligation of lumbar vessels, sac exploration, and sac plication around the endograft. Technical success for this technique was 100%. During a mean follow-up of 38.4 months, no recurrent T2ELs, stent graft migration, and/or disjunction were observed. Conclusions: We propose a new algorithm for the management of pT2ELs. If 2 endovascular procedures fail to control of the endoleak, repeat endovascular attempts are not recommended. Endovascular failure should be followed by laparotomy with surgical ligation of culprit feeding vessels followed by sac exploration and plication of the sac, and endoaneurysmorrhaphy.
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Affiliation(s)
- Saum Rahimi
- Division of Vascular Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Naiem Nassiri
- Division of Vascular Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Lauren Huntress
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dustin Crystal
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jones Thomas
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Randy Shafritz
- Division of Vascular Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Bargay Juan P, Plaza Martínez Á, Ramírez Montoya M, Sala Almonacil V, Molina Nácher V, Gómez Palonés F. Factores de riesgo de la trombosis de rama en el tratamiento endovascular aórtico infrarrenal: nuestra experiencia. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bargay Juan P, Plaza Martínez A, Pepén Moquete L, Ramírez Montoya M, Molina Nacher V, Gómez Palonés F. Sellado distal en ilíaca externa: ramificación ilíaca frente a la exclusión de la arteria hipogástrica. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort. Exp Ther Med 2017; 14:1763-1768. [PMID: 28810647 DOI: 10.3892/etm.2017.4658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR. A total of 61 bifurcated grafts and 5 aortauniilac grafts (127 limbs in total) were used. Physical examination, ankle-brachial-index and computer tomographic angiography were performed at 10 days, at 3, 6 and 12 months and annually thereafter. It was found that 7 limbs in 7 patients (10.6% of patients, 5.5% of limbs) were occluded between 20 days and 12 months (average, 7.8±5.3 months) after EVAR. Acute and severe ischemia was found in 2 cases, claudication was in found 3 cases, asthenia in both legs was found in 1 case and 1 case was asymptomatic. Femoral-femoral bypass, femoral-femoral bypass and stenting, aorto-iliac/femoral bypass, thrombectomy and conservative treatment were performed in 1 patient each and thrombectomy together with stenting was performed in 2 cases. Limb graft occlusion was not rare after EVAR. Treatment of this complication included surgery and endovascular therapy such as bypass, thrombectomy and thrombolysis. In conclusion, aggressive pre-emptive treatment including angioplasty and stenting prevented occlusion in certain cases.
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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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Abstract
Background: The aim of the study was to assess the long term results of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms at the Helsinki University Central Hospital 1996–2004 with a special emphasis on elective conversion procedures and their outcome. Methods: Treatment results and follow-up data of all 110 elective EVAR procedures performed in our institution were gathered prospectively and evaluated. Results: Conversion to open surgery was performed in 23 (21%) of 110 EVAR patients. 30-day mortality after elective stent-graft deployment was 0% as it was also on elective conversions (n = 20). Secondary elective conversions were performed due to infection in two and after failing stent-graft treatment in 12 patients. Six of the conversions were performed primarily. Three urgent conversions (3% overall) were performed: two of these patients died, corresponding to an overall mortality of 9% (2/23) in all conversions. Five-year aneurysm-related mortality after EVAR among patients with elective conversion was 0% and 19% in patients with secondary procedures other than elective conversions. Conclusions: As conversions seem to be hazardous only when performed in urgent situations, elective conversion could be an alternative treatment method in complex failing first-generation stent-grafts as it may reduce mortality associated with urgent conversions or repeated attempts to maintain graft integrity with endovascular procedures.
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Affiliation(s)
- P S Aho
- Department of Vascular Surgery, Helsinki University Central Hospital, Finland.
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Halak M, McDonnell CO, Muhlmann MD, Baker SR. Open Surgical Treatment of Aneurysmal Sac Expansion following Endovascular Abdominal Aneurysm Repair: Solution for an Unresolved Clinical Dilemma. Vascular 2016; 15:201-4. [PMID: 17714635 DOI: 10.2310/6670.2007.00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The advantages of endovascular aneurysm repair (EVAR) are probably related to the avoidance of the three major physiological insults associated with open abdominal aortic aneurysm (AAA) repair: laparotomy, aortic cross-clamping and ischemia reperfusion injury. Continuing aneurysm expansion indicates a failure to exclude the AAA from the circulation. We describe our experience with open surgery of post-EVAR sac expansion. A consecutive series of 68 EVAR patients was followed up. Endovascular and minimally invasive procedures were the initial treatment option. Failure of these attempts to curtail AAA sac expansion or type 2 large endoleaks (EL) resulted in opening of the aneurysm sac. The procedure includes positioning of a deflated occlusion balloon proximal to the stent graft (SG). Laparotomy with opening of the eneurysm sac was then performed. The thrombus was removed and backbleeding vessels oversewn. The aneurysm sac was then plicated over the SG. Four patients (5.9%) were diagnosed as having either persistent large type 2 EL or sac enlargement. In all patients the procedure was accomplished successfully. One patient died from acute myocardial infarction perioperatively. Three patients recovered uneventfully and follow-up computed tomography confirmed the absence of endoleak and a disappearance of the AAA. We believe that whenever EVAR fails to exclude the aneurysm from the circulation, open exploration without graft replacement should be considered.
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Affiliation(s)
- Moshe Halak
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
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Amplatzer Plug to Occlude the Internal Iliac Artery During Endovascular Aortic Aneurysm Repair: A Large Multicenter Study. Eur J Vasc Endovasc Surg 2016; 51:641-6. [DOI: 10.1016/j.ejvs.2015.12.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 12/12/2015] [Indexed: 11/18/2022]
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Hye RJ, Inui TS, Anthony FF, Kiley ML, Chang RW, Rehring TF, Nelken NA, Hill BB. A multiregional registry experience using an electronic medical record to optimize data capture for longitudinal outcomes in endovascular abdominal aortic aneurysm repair. J Vasc Surg 2015; 61:1160-6. [PMID: 25725597 DOI: 10.1016/j.jvs.2014.12.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/18/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Registries have been proven useful to assess clinical outcomes, but data entry and personnel expenses are challenging. We developed a registry to track patients undergoing endovascular aortic aneurysm repair (EVAR) in an integrated health care system, leveraging an electronic medical record (EMR) to evaluate clinical practices, device performance, surgical complications, and medium-term outcomes. This study describes the registry design, data collection, outcomes validation, and ongoing surveillance, highlighting the unique integration with the EMR. METHODS EVARs in six geographic regions of Kaiser Permanente were entered in the registry. Cases were imported using a screening algorithm of inpatient codes applied to the EMR. Standard note templates containing data fields were used for surgeons to enter preoperative, postoperative, and operative data as part of normal workflows in the operating room and clinics. Clinical content experts reviewed cases and entered any missing data of operative details. Patient comorbidities, aneurysm characteristics, implant details, and surgical outcomes were captured. Patients entered in the registry are followed up for life, and all relevant events are captured. RESULTS Between January 2010 and June 2013, 2112 procedures were entered in the registry. Surgeon compliance with data entry ranges from 60% to 90% by region but has steadily increased over time. Mean aneurysm size was 5.9 cm (standard deviation, 1.3). Most patients were male (84%), were hypertensive (69%), or had a smoking history (79%). The overall reintervention rate was 10.8%: conversion to open repair (0.9%), EVAR revision (2.6%), other surgical intervention (7.3%). Of the reinterventions, 27% were for endoleaks (I, 34.3%; II, 56.9%; III, 8.8%; IV and V, 0.0%), 10.5% were due to graft malfunction, 3.4% were due to infection, and 2.3% were due to rupture. CONCLUSIONS Leveraging an EMR provides a robust platform for monitoring short-term and midterm outcomes after abdominal aortic aneurysm repair. Use of standardized templates in the EMR allows data entry as part of normal workflow, improving compliance, accuracy, and data capture using limited but expert personnel. Assessment of patient demographics, device performance, practice variation, and postoperative outcomes benefits clinical decision-making by providing complete and adjudicated event reporting. The findings from this large, community-based EVAR registry augment other studies limited to perioperative and short-term outcomes or small patient cohorts.
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Affiliation(s)
- Robert J Hye
- Department of Surgery, Southern California Permanente Medical Group, San Diego, Calif.
| | - Tazo S Inui
- Department of Surgery, UC San Diego, San Diego, Calif
| | - Faith F Anthony
- Surgical Outcomes and Analysis, Southern California Permanente Medical Group, San Diego, Calif
| | - Mary-Lou Kiley
- Surgical Outcomes and Analysis, Southern California Permanente Medical Group, San Diego, Calif
| | - Robert W Chang
- Department of Surgery, The Permanente Medical Group, South San Francisco, Calif
| | - Thomas F Rehring
- Department of Vascular Surgery, Colorado Permanente Medical Group, Denver, Colo
| | - Nicolas A Nelken
- Department of Vascular Therapy, Hawaii Permanente Medical Group, Honolulu, Hawaii
| | - Bradley B Hill
- Department of Surgery, The Permanente Medical Group, Santa Clara, Calif
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Hughes K, Abdulrahman H, Prendergast T, Rose DA, Ongu'ti S, Tran D, Cornwell EE, Obisesan T, Amankwah KS. Abdominal Aortic Aneurysm Repair in Nonagenarians. Ann Vasc Surg 2015; 29:183-8. [DOI: 10.1016/j.avsg.2014.07.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/12/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
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Góes Junior AMDO, Jeha SAH, Franco RSM. Hybrid treatment of arteriovenous fistula between popliteal vessels. J Vasc Bras 2014. [DOI: 10.1590/1677-5449.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors describe treatment of a patient who presented an arteriovenous fistula between the popliteal vessels more than 20 years after a gunshot wound. The patient underwent endovascular treatment using Viabahn (Gore®) stent grafts, but, because of the large disparity in popliteal artery diameters proximal and distal of the fistula, the endovascular treatment was unsuccessful. The superficial femoral artery was then banded around the stent graft that was deployed previously. This improvised strategy allowed an open surgical approach to be performed far from the fistula site, reducing the risks of operating in a region with anatomic distortions and significant enlargement of the surrounding venous structures, which would certainly have increased the likelihood of iatrogenic injuries.
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Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications. AJR Am J Roentgenol 2014; 203:W358-72. [PMID: 25247965 DOI: 10.2214/ajr.13.11736] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure. CONCLUSION A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.
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Gandini R, Chiocchi M, Loreni G, Del Giudice C, Morosetti D, Chiaravalloti A, Simonetti G. Treatment of Type II Endoleak After Endovascular Aneurysm Repair: The Role of Selective vs. Nonselective Transcaval Embolization. J Endovasc Ther 2014; 21:714-22. [DOI: 10.1583/14-4571mr.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Coulston J, Baigent A, Selvachandran H, Jones S, Torella F, Fisher R. The impact of endovascular aneurysm repair on aortoiliac tortuosity and its use as a predictor of iliac limb complications. J Vasc Surg 2014; 60:585-9. [DOI: 10.1016/j.jvs.2014.03.279] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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Thromboembolic Complications after Zenith® Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms. Cardiovasc Intervent Radiol 2014; 38:600-5. [DOI: 10.1007/s00270-014-0972-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/09/2014] [Indexed: 01/20/2023]
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Ullery BW, Lee JT. Considerations for patients undergoing endovascular abdominal aortic aneurysm repair. Anesthesiol Clin 2014; 32:723-34. [PMID: 25113729 DOI: 10.1016/j.anclin.2014.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endovascular aneurysm repair has taken over open surgery as the primary strategy for treatment of patients with abdominal and thoracic aneurysms. The minimally invasive nature of these techniques requires alterations in preoperative workup, intraoperative management, and familiarity with unique complications that can occur. Familiarity from the anesthetic standpoint of endovascular techniques, including treatment of patients with fenestrated, chimney, snorkel, and periscope grafts, is necessary for the contemporary cardiac anesthesiologist.
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Affiliation(s)
- Brant W Ullery
- Division of Vascular Surgery, Stanford University Medical Center, 300 Pasteur Drive, H3600, Stanford, CA 94305, USA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, 300 Pasteur Drive, H3600, Stanford, CA 94305, USA.
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Piffaretti G, Mariscalco G, Riva F, Fontana F, Carrafiello G, Castelli P. Abdominal aortic aneurysm repair: long-term follow-up of endovascular versus open repair. Arch Med Sci 2014; 10:273-82. [PMID: 24904660 PMCID: PMC4042047 DOI: 10.5114/aoms.2014.42579] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 01/17/2013] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION To compare early and long-term outcomes of endovascular abdominal aortic aneurysm repair (EVAR) versus open repair (OPEN). DESIGN Prospective observational, per protocol, non-randomized, with retrospective analyses. MATERIAL AND METHODS Between 2000 and 2005, a total of 311 patients having EVAR or OPEN repair of infrarenal abdominal aortic aneurysms were identified and included in this prospective single-center observational study. A propensity score-based optimal-matching algorithm was employed, and 138 patients undergoing EVAR procedures were matched (1: 1) to OPEN repair. RESULTS Open repair showed higher hospital mortality (17% vs. 6%, p = 0.004), respiratory failure (p < 0.026), transfusion requirement (p < 0.001), and intensive care unit admission (27% vs. 7%, p < 0.001), and longer hospitalization (p < 0.001). Median follow-up was 70 months (25(th) to 75(th) percentile, 24 to 101). Actuarial survival estimates at 1, 5 and 10 years were 93%, 74%, 49% for the OPEN group compared to 89%, 69%, 59% for the EVAR group (p = 0.465). A significant difference between groups was observed in younger patients (< 75 years) only (p < 0.044). Late complication and re-intervention rates were significantly higher in EVAR patients (p < 0.001 and p = 0.002, respectively). Freedom from late complications at 1, 5 and 10 years was 96%, 92%, 86%, and 84%, 70%, 64% for OPEN and EVAR procedures, respectively. CONCLUSIONS Our experience confirms the excellent results of the EVAR procedures, offering excellent early and long-term results in terms of safety and reduction of mortality. Patients < 75 years seem to benefit from EVAR not only in the immediate postoperative period but even in a long-term perspective.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Giovanni Mariscalco
- Cardiac Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | | | - Federico Fontana
- Interventional Radiology, Department of Radiology Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology, Department of Radiology Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Patrizio Castelli
- Vascular Surgery, Department of Surgery and Morphological Sciences Circolo University Hospital, University of Insubria School of Medicine, Varese, Italy
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Waiting J, Dias A, Patel T, Pencavel T, Rosenfeld K, Sarin S. Successful thrombolysis of a late acute thrombotic occlusion of an aortic prosthesis after endovascular aneurysm repair. Ann Vasc Surg 2014; 28:1791.e1-4. [PMID: 24632314 DOI: 10.1016/j.avsg.2014.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 02/16/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
A 79-year-old man with a previous endovascular aneurysm repair (EVAR) for a 5.4-cm abdominal aortic aneurysm presented 3 years after the procedure with sudden onset lower limb paralysis and pain. The diagnosis of acute aortic thrombosis within the aortic prosthesis graft was made and confirmed on computed tomography. Thrombolysis delivered into the graft via a radiologically placed catheter successfully dissolved the thrombus and resulted in improvement of the patient's symptoms. We discuss the presentation of, and role in management of thrombolysis in, this rare complication of aneurysm repair.
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Affiliation(s)
- James Waiting
- Department of Vascular Surgery, Watford General Hospital, Watford, Hertfordshire, UK.
| | - Abigail Dias
- Department of Vascular Surgery, Watford General Hospital, Watford, Hertfordshire, UK
| | - Tulsi Patel
- Department of Vascular Surgery, Watford General Hospital, Watford, Hertfordshire, UK
| | - Tim Pencavel
- Department of Vascular Surgery, Watford General Hospital, Watford, Hertfordshire, UK
| | - Kevin Rosenfeld
- Department of Vascular Surgery, Watford General Hospital, Watford, Hertfordshire, UK
| | - Sanjeev Sarin
- Department of Vascular Surgery, Watford General Hospital, Watford, Hertfordshire, UK
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Roos H, Ghaffari M, Falkenberg M, Chernoray V, Jeppsson A, Nilsson H. Displacement Forces in Iliac Landing Zones and Stent Graft Interconnections in Endovascular Aortic Repair: An Experimental Study. Eur J Vasc Endovasc Surg 2014; 47:262-7. [DOI: 10.1016/j.ejvs.2013.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
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Pratesi C, Piffaretti G, Pratesi G, Castelli P. ITalian Excluder Registry and results of Gore Excluder endograft for the treatment of elective infrarenal abdominal aortic aneurysms. J Vasc Surg 2014; 59:52-7.e1. [DOI: 10.1016/j.jvs.2013.06.067] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/14/2013] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
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Reinterventions for Type 2 Endoleaks with Enlargement of the Aneurismal Sac after Endovascular Treatment of Abdominal Aortic Aneurysms. Ann Vasc Surg 2014; 28:192-200. [DOI: 10.1016/j.avsg.2012.10.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 11/19/2022]
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Georgiadis GS, Georgakarakos EI, Antoniou GA, Trellopoulos G, Argyriou C, Nikolopoulos ES, Charalampidis D, Schoretsanitis NG, Lazarides MK. Clinical Outcomes After Crossed-Limb vs. Conventional Endograft Configuration in Endovascular AAA Repair. J Endovasc Ther 2013; 20:853-62. [DOI: 10.1583/13-4286mr.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Currently the majority of infrarenal abdominal aortic aneurysm repairs are endovascular procedures using a stent graft. This method continues to be questioned due to an up to 50 % incidence of endoleaks, i.e. the postinterventional persistence of blood flow outside the graft and within the aneurysm sac, potentially bearing the risk of a further increase of the aneurysm diameter and aneurysm rupture. Currently a total of five different endoleak types can be distinguished. Multiphase computed tomography (CT) is the standard imaging method for the detection and classification of endoleaks or alternatively contrast-enhanced ultrasound can be used. The different types of endoleak have very different therapeutic implications. In direct endoleaks (types I and III) the systemic blood pressure is directly transferred to the aneurysm wall which carries a high risk of rupture and in general an immediate intervention is indicated. Indirect endoleaks (types II, IV and V) take a more benign course and in the majority of cases treatment is only necessary when further aneurysm expansion occurs.
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Affiliation(s)
- O Dudeck
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke-Universität, Leipziger Str. 44, 39120 Magdeburg, Deutschland.
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Chang RW, Goodney P, Tucker LY, Okuhn S, Hua H, Rhoades A, Sivamurthy N, Hill B. Ten-year results of endovascular abdominal aortic aneurysm repair from a large multicenter registry. J Vasc Surg 2013; 58:324-32. [PMID: 23683376 DOI: 10.1016/j.jvs.2013.01.051] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/25/2013] [Accepted: 01/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess outcomes after endovascular abdominal aortic aneurysm repair (EVAR) in an integrated health care system. METHODS Between 2000 and 2010, 1736 patients underwent EVAR at 17 centers. Demographic data, comorbidities, and outcomes of interest were collected. EVAR in patients presenting with ruptured or symptomatic aneurysms was categorized as urgent; otherwise, it was considered elective. Primary outcomes were mortality and aneurysm-related mortality (ARM). Secondary outcomes were change in aneurysm sac size, endoleak status, major adverse events, and reintervention. RESULTS Overall, the median age was 76 years (interquartile range, 70-81 years), 86% were male, and 82% were Caucasian. Most cases (93.8%) were elective, but urgent use of EVAR increased from 4% in the first 5 years to 7.3% in the last 5 years of the study period. Mean aneurysm size was 5.8 cm. Patients were followed for an average of 3 years (range, 1-11 years); 8% were lost to follow-up. Intraoperatively, 4.5% of patients required adjunctive maneuvers for endoleak, fixation, or flow-limiting issues. The 30-day mortality rate was 1.2%, and the perioperative morbidity rate was 6.6%. Intraoperative type I and II endoleaks were uncommon (2.3% and 9.3%, respectively). Life-table analysis at 5 years demonstrated excellent overall survival (66%) and freedom from ARM (97%). Postoperative endoleak was seen in 30% of patients and was associated with an increase in sac size over time. Finally, the total reintervention rate was 15%, including 91 instances (5%) of revisional EVAR. The overall major adverse event rate was 7.9% and decreased significantly from 12.3% in the first 5 years to 5.6% in the second 5 years of the study period (P < .001). Overall ARM was worse in patients with postoperative endoleak (4.1% vs 1.8%; P < .01) or in those who underwent reintervention (7.6% vs 1.6%; P < .001). CONCLUSIONS Results from a contemporary EVAR registry in an integrated health care system demonstrate favorable perioperative outcomes and excellent clinical efficacy. However, postoperative endoleak and the need for reintervention continue to be challenging problems for patients after EVAR.
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Marone E, Mascia D, Coppi G, Tshomba Y, Bertoglio L, Kahlberg A, Chiesa R. Delayed Open Conversion after Endovascular Abdominal Aortic Aneurysm: Device-specific Surgical Approach. Eur J Vasc Endovasc Surg 2013; 45:457-64. [DOI: 10.1016/j.ejvs.2012.12.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/27/2012] [Indexed: 11/25/2022]
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Scali ST, Vlada A, Chang CK, Beck AW. Transcaval embolization as an alternative technique for the treatment of type II endoleak after endovascular aortic aneurysm repair. J Vasc Surg 2013; 57:869-74. [PMID: 23312838 DOI: 10.1016/j.jvs.2012.09.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 09/12/2012] [Accepted: 09/15/2012] [Indexed: 11/26/2022]
Abstract
The purpose of this report is to highlight our experience with transcaval embolization (TCE) for the management of type II endoleaks (T2Es) as well as to provide a technical description of how to improve procedural safety and success. All patients underwent transfemoral venous access with transcaval puncture into the excluded aneurysm sac with coil placement and selective thrombin injection. Six patients (100% male; mean age [standard deviation] 72.7 [10.8] years) underwent TCE. Technical success was 100% with no postoperative complications. At median follow-up of 8.1 months (range, 2-22 months), two patients had persistent T2Es, with one requiring repeat TCE and the other having cessation of aneurysm growth. The TCE provides a practical alternative to transarterial or translumbar access for the management of T2E, with high degrees of technical and clinical success in this small case series. Larger patient numbers and longer-term follow-up are needed to define procedural efficacy and durability.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL, USA.
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39
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Comparison of outcomes with coils versus vascular plug embolization of the internal iliac artery for endovascular aortoiliac aneurysm repair. J Vasc Surg 2012; 56:1239-45. [DOI: 10.1016/j.jvs.2012.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/24/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022]
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Midulla M, Perini P, Sundareyan R, Lazguet Y, Dehaene A, Goyault G, Martinelli T, Haulon S. Transcatheter Transcaval Embolization of a Type II Endoleak After EVAR Using a Transseptal Needle-Sheath System. Vasc Endovascular Surg 2012; 46:410-3. [DOI: 10.1177/1538574412448683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. The purpose of this study is to present an alternative technique for management of a type II endoleak associated with aneurysm sac enlargement. Technique. We report the use of a transseptal needle-sheath system for a transcatheter transcaval embolization (TTE) in a 3-staged treatment of a persistent type II endoleak after abdominal EVAR. Inferior vena cava is cannulated through a femoral venous access, and aneurysmal sac access is gained with a puncture through the walls of the 2 vessels at the site where the vein is adjacent to the aneurysm. The whole system (sheath–dilator–needle) is then advanced across the vascular walls into the aortic sac. Thus, embolization with glue is performed. Conclusion. The TTE using a transseptal needle-sheath system demonstrated to be feasible and effective to treat a persistent type II endoleak after failure of 2 attempts of transarterial embolization of the feeding vessels.
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Affiliation(s)
- Marco Midulla
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Paolo Perini
- Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France
| | - Ramanivas Sundareyan
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Younes Lazguet
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Aurelie Dehaene
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Gilles Goyault
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Thomas Martinelli
- Cardiovascular and Interventional Radiology, Hôpital Cardiologique, CHRU de Lille, France
| | - Stéphan Haulon
- Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France
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41
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Naughton PA, Park MS, Kheirelseid EAH, O’Neill SM, Rodriguez HE, Morasch MD, Madhavan P, Eskandari MK. A comparative study of the bell-bottom technique vs hypogastric exclusion for the treatment of aneurysmal extension to the iliac bifurcation. J Vasc Surg 2012; 55:956-62. [PMID: 22226182 PMCID: PMC3319281 DOI: 10.1016/j.jvs.2011.10.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A significant proportion of patients undergoing endovascular aneurysm repair (EVAR) have common iliac artery aneurysms (CIAA). Aneurysmal involvement at the iliac bifurcation potentially undermines long-term durability. METHODS Patients with CIAA who underwent EVAR were identified in two teaching hospitals. Bell-bottom technique (BBT; iliac limb ≥20 mm) or internal iliac artery embolization and limb extension to the external iliac artery (IIE + EE) were used. Outcome between these two approaches was compared. RESULTS We identified 185 patients. Indication for EVAR included asymptomatic abdominal aortic aneurysm (AAA) in 157, symptomatic or ruptured aneurysm in 19, and CIAA in nine. Mean AAA diameter was 59 mm. Among 260 large CIAAs that were treated, BBT was used to treat 166 CIAA limbs, and 94 limbs underwent IIE + EE. Total reintervention rates were 11% for BBT (n = 19) and 19.1% for IIE + EE (n = 18; P = .149). Rates of reintervention for type Ib or III endoleak were 4% for BBT (n = 7) and 4% for IIE + EE (n = 4; P > .99). The difference in limb patency rates was not significant. The 30-day mortality rate was 1%. Median follow-up was 22 months. Complications did not differ significantly between the two groups; however, the combined incidence of perioperative complications and reinterventions was higher in the IIE + EE group (49% vs 22%; P = .002). CONCLUSIONS The combined incidence of perioperative complications and reinterventions is significantly higher with IIE + EE than with BBT; therefore, when feasible, BBT is desirable.
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Affiliation(s)
- Peter A. Naughton
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Michael S. Park
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - EAH Kheirelseid
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Sean M. O’Neill
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Heron E. Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark D. Morasch
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Prakash Madhavan
- Department of Vascular Surgery, St. James Hospital, Dublin, Ireland
| | - Mark K. Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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42
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Bartoli MA, Thevenin B, Sarlon G, Giorgi R, Albertini JN, Lerussi G, Branchereau A, Magnan PE. Secondary Procedures After Infrarenal Abdominal Aortic Aneurysms Endovascular Repair With Second-Generation Endografts. Ann Vasc Surg 2012; 26:166-74. [DOI: 10.1016/j.avsg.2011.02.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 02/23/2011] [Accepted: 02/26/2011] [Indexed: 11/27/2022]
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43
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Ballard DJ, Filardo G, Graca BD, Powell JT. Clinical practice change requires more than comparative effectiveness evidence: abdominal aortic aneurysm management in the USA. J Comp Eff Res 2012; 1:31-44. [DOI: 10.2217/cer.11.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adoption of healthcare innovations frequently outpaces the evidence of effectiveness. Endovascular repair (EVAR) for abdominal aortic aneurysms in the USA demonstrates how comparative effectiveness research without evidence-based reimbursement changes may fail to influence clinical practice. Randomized controlled trials for small abdominal aortic aneurysms demonstrate no lasting benefits of EVAR or open surgical repair (OSR) compared with surveillance, and for large abdominal aortic aneurysms demonstrate no lasting survival benefit of EVAR over OSR, and do show poorer durability and higher costs for EVAR. Nonetheless, >50% of elective abdominal aortic aneurysm repairs in the USA use EVAR. Factors that may be driving the high use of EVAR include patient preference, surgeons’ desire to appear ‘up-to-date’ in the procedures they offer, higher hourly surgeon reimbursement for EVAR than OSR, and the expansion of physician specialties able to perform abdominal aortic aneurysm repair from only vascular surgeons with OSR, to vascular surgeons and interventional radiologists/cardiologists with EVAR. By comparison, in Canada, where government health insurance restricts EVAR coverage to high surgical risk patients, only approximately 25% of abdominal aortic aneurysm repairs are performed using EVAR. Country-specific cost studies and a prospective population-based study collecting detailed clinical data to identify patient subgroups that truly benefit from a particular management strategy are needed to inform policy regarding EVAR availability and reimbursement.
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Affiliation(s)
| | - Giovanni Filardo
- Institute for Health Care Research & Improvement, Baylor Health Care System, 8080 North Central Expressway, Suite 500, Dallas, TX 75206, USA
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
- Department of Infectious Diseases, University of Louisville, Louisville, KY, USA
| | - Briget da Graca
- Institute for Health Care Research & Improvement, Baylor Health Care System, 8080 North Central Expressway, Suite 500, Dallas, TX 75206, USA
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44
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Sarac TP, Gibbons C, Vargas L, Liu J, Srivastava S, Bena J, Mastracci T, Kashyap VS, Clair D. Long-term follow-up of type II endoleak embolization reveals the need for close surveillance. J Vasc Surg 2012; 55:33-40. [DOI: 10.1016/j.jvs.2011.07.092] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 04/26/2011] [Accepted: 07/26/2011] [Indexed: 10/15/2022]
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45
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Outcome of elective endovascular abdominal aortic aneurysm repair in nonagenarians. J Vasc Surg 2011; 54:287-94. [DOI: 10.1016/j.jvs.2010.12.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 09/29/2010] [Accepted: 12/16/2010] [Indexed: 11/22/2022]
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46
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Grande W, Stavropoulos SW. Treatment of complications following endovascular repair of abdominal aortic aneurysms. Semin Intervent Radiol 2011; 23:156-64. [PMID: 21326759 DOI: 10.1055/s-2006-941446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Endovascular aneurysm repair (EVAR) is an important treatment option for abdominal aortic aneurysms, with lower perioperative morbidity and mortality rates than open surgical aneurysm repair. However, EVAR is associated with several unique complications that are not encountered with surgical repair such as endoleaks, graft migration, and renal artery occlusion. Preservation of the morbidity and mortality advantages of EVAR relies on the successful treatment of these complications by minimally invasive, endovascular approaches. Some of the techniques used to treat EVAR complications include balloon dilation and stenting, deployment of additional stent-graft pieces, coil embolization, and thrombolysis. Although the employment of these endovascular salvage techniques is common, data regarding their intermediate- to long-term efficacy is sparse, and further studies are needed to determine their efficacy in preventing conversion to open aneurysm repair and aneurysm rupture.
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Affiliation(s)
- William Grande
- Department of Radiology, Division of Interventional Radiology, Hospital of University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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47
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Linsen MAM, Daniels L, Cuesta MA, Wisselink W. Endoscopic type 2 endoleak repair following endovascular aortic aneurysm repair: acute results and follow-up experience. Vascular 2011; 19:121-5. [DOI: 10.1258/vasc.2010.oa0274] [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 purpose of this study was to evaluate immediate and long-term results of endoscopic type 2 endoleak repair (EER) following endovascular abdominal aortic aneurysm repair. The basic methods include a retrospective review of electronic and paper medical records of patients admitted or referred to our institution for EER. Between July 1999 and October 2007, eight consecutive patients underwent EER. Mean operative time was 190 (104–355) min. One patient died preoperatively, due to profuse venous bleeding . One procedure was redone due to a missed pair of lumbar arteries. Mean hospital stay was five days (2–10). During mean follow-up, 50 months (29–91), one patient required additional coil embolization for a persistent type 2 endoleak. Four patients were diagnosed with a type 1 and one with a type 3 endoleak; three of these patients required an additional procedure. In conclusion, in this small series EER proved not to be beneficial.
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Affiliation(s)
- Matteus A M Linsen
- Department of Surgery, VU University Medical Center, Amsterdam
- Department of Surgery, Spaarne Hospital, Hoofddorp, The Netherlands
| | | | - Miguel A Cuesta
- Department of Surgery, VU University Medical Center, Amsterdam
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48
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Park EJ, Kim HT, Cho WH, Kim YH. Type I Endoleak Five Year after Endovascular Repair of Abdominal Aortic Aneurysm. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.2.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ei Jun Park
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyoung Tae Kim
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Won Hyun Cho
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Mattes J, Chemelli A, Wick M, Soimu D, Pontow C, Lopez A, Netzer M, Chemelli-Steingruber IE. Evaluation of a new computerized analysis system developed for the processing of CT follow-up scans after EVR of infrarenal aneurysm. Eur J Radiol 2011; 81:496-501. [PMID: 21300491 DOI: 10.1016/j.ejrad.2010.12.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 12/27/2010] [Accepted: 12/28/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this retrospective study was to present a new computerized analysis system developed for the evaluation of follow-up CT scans after endovascular repair (EVR) of infrarenal aneurysm and to compare it to the conventional evaluation method as regards preciseness and ease of application. The system is based on the extraction of the surface of the stent-graft (SG) and that of the spinal canal and the overlay of surfaces obtained at different points in time. MATERIALS AND METHODS A total of 116 CT follow-up data sets obtained from 49 patients after EVR of infrarenal aneurysm were evaluated using both, the conventional method and the new computerized system. Two parameters were analyzed: SG length and the distance between the most ventral point of the SG and the vertebral column. The correlation between the results of the two methods and the correlation between the results obtained by two independent observers (radiologist and lay person) using the new system were assessed by statistical analysis. RESULTS Comparison of the two methods yielded a very high correlation for both parameters, (correlation coefficients of around 0.9 and p<0.001). Comparison of the results obtained by the two observers yielded an equally high correlation (correlation coefficients of around 0.9 and p<0.001). CONCLUSION Our results show that the new computerized system is as precise and reliable as the conventional method, but allows better visualization and quantification of SG changes by surface overlay. Moreover, it is easier to apply and less time-consuming and can be easily integrated into existing systems.
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Affiliation(s)
- J Mattes
- Einzelunternehmen Dr. Julian Mattes and Software Competence Center Hagenberg GmbH, Softwarepark 35, Hagenberg, Austria
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50
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Long-term outcomes of secondary procedures after endovascular aneurysm repair. J Vasc Surg 2010; 52:1442-9. [PMID: 20724099 DOI: 10.1016/j.jvs.2010.06.110] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/07/2010] [Accepted: 06/09/2010] [Indexed: 11/22/2022]
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