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Basra M, Hussain P, Li M, Kulkarni S, Stather PW, Armon M, Choksy S. Factors Related to Limb Occlusion After Endovascular Abdominal Aortic Aneurysm Repair (EVAR). Ann Vasc Surg 2024; 99:312-319. [PMID: 37858668 DOI: 10.1016/j.avsg.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/03/2023] [Accepted: 08/25/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Limb occlusion is a potentially serious consequence of endovascular abdominal aortic aneurysm (EVAR). This case-control study identifies factors that predispose to limb occlusion. METHODS A consecutive series of patients from 2 centers undergoing EVAR over an 11-year period 2007-2017 were identified retrospectively. Patient records were interrogated allowing collations of demographics, intraoperative and perioperative data and surveillance data. The preoperative computed tomography angiogram was analyzed to determine EVAR relevant anatomical data. The primary outcome was occlusion of the iliac limb of the implanted EVAR. Raw data are presented as percentages, with comparative data analyzed using Mann-Whitney U-test and binomial logistic regression. RESULTS A total of 787 patients (702 males; median age 78 years, range 53-94 years old) were analyzed. Fifty patients reached the primary outcome, resulting in an overall limb occlusion rate of 6.35%. Factors predictive of limb occlusion were oversizing by >10% native vessel diameter, with oversizing of >20% in 50% of those that occluded. External iliac artery landing zone (12/50 limb occlusions) 24% and postoperative kinking (5/50 limb occlusions) 10% were also more common in those that occluded. Fifty randomly selected controls with similar baseline characteristics were studied. Oversizing of the iliac endograft was found to be significantly greater in the limb occlusion group compared to the controls (P < 0.001) which remained significant on regression analysis. There was no correlation with iliac tortuosity. The Cook stent graft had a 9% limb occlusion rate across sites. Medtronic and Vascutek endografts had 2.4% and 2.5% limb occlusion rates respectively. CONCLUSIONS Oversizing of iliac limbs by >20% could be a contributing factor to limb occlusion after EVAR and judicious oversizing should be used.
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Affiliation(s)
- Melvinder Basra
- Vascular Surgery Department, Colchester University Hospital Foundation Trust, Colchester, UK; Vascular Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK.
| | - Parvez Hussain
- Vascular Surgery Department, Colchester University Hospital Foundation Trust, Colchester, UK
| | - Mimi Li
- Vascular Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Shreya Kulkarni
- Vascular Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Philip W Stather
- Vascular Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich, UK
| | - Matthew Armon
- Vascular Surgery Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sohail Choksy
- Vascular Surgery Department, Colchester University Hospital Foundation Trust, Colchester, UK
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Simonte G, Isernia G, Pecoraro F, Antonello M, Guzzardi G, Dinoto E, Feriani G, Migliara B. Rotational Mechanical Thrombectomy to Treat Iliac Limb Occlusion after Endovascular Aortic Aneurysm Repair: The Rotational Mechanical Thrombectomy Italian Study. J Vasc Interv Radiol 2024; 35:25-31. [PMID: 37776993 DOI: 10.1016/j.jvir.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/23/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023] Open
Abstract
PURPOSE To assess the safety and effectiveness of a rotational mechanical atherothrombectomy device in patients with symptomatic iliac limb occlusion after abdominal endovascular aneurysm repair (EVAR). MATERIALS AND METHODS A retrospective analysis was conducted on patients who underwent rotational mechanical thrombectomy using the Rotarex S device for symptomatic acute, subacute, or chronic graft limb thrombosis at 5 vascular centers between 2017 and 2021. This study comprised 23 male patients with a mean age of 74.5 years (SD ± 7.2) at the time of the procedure. The clinical presentation of the patients varied, with 1 patient experiencing acute limb ischemia and 11 patients (47.8%) experiencing disabling intermittent claudication. The remaining patients developed chronic limb-threatening ischemia after iliac limb occlusion. Early outcomes included technical success, postprocedural complications, and periprocedural mortality. Follow-up evaluations encompassed primary patency, patient survival, freedom from reintervention, and the need for surgical conversion. RESULTS Technical success was achieved in all cases, with no occurrences of distal embolization during or after the procedure, and no periprocedural deaths were reported. Endograft relining was performed in 82.6% of patients to establish a new, nonthrombogenic surface within the graft. Over a median follow-up period of 8 months (interquartile range, 3-16 months), 2 patients experienced iliac limb reocclusion. No deaths or other reinterventions occurred during the observational follow-up period. CONCLUSIONS Rotational mechanical thrombectomy for iliac limb occlusion after EVAR appears to be both safe and effective. This technique may uncover intraluminal defects contributing to graft occlusion and enable their resolution within the same procedure.
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Affiliation(s)
- Gioele Simonte
- Vascular and Endovascular Surgery Unit, S. Maria Della Misericordia University Hospital, Perugia, Italy.
| | - Giacomo Isernia
- Vascular and Endovascular Surgery Unit, S. Maria Della Misericordia University Hospital, Perugia, Italy
| | - Felice Pecoraro
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Vascular Surgery Unit, Azienda Ospedaliera Universitaria Policlinico 'P. Giaccone, Palermo, Italy
| | - Michele Antonello
- Vascular and Endovascular Surgery Unit, University of Padua, Padova, Italy
| | - Giuseppe Guzzardi
- Interventional Radiology Unit, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Ettore Dinoto
- Vascular Surgery Unit, Azienda Ospedaliera Universitaria Policlinico 'P. Giaccone, Palermo, Italy
| | - Giovanni Feriani
- Vascular and Endovascular Surgery Unit, Pederzoli Hospital, Peschiera del Garda (VR), Italy
| | - Bruno Migliara
- Vascular and Endovascular Surgery Unit, Pederzoli Hospital, Peschiera del Garda (VR), Italy
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Simonte G, Fino G, Casali F, Parlani G, Lenti M, Isernia G. Effectiveness of the Rotarex Excisional Atherectomy System in Both Subacute and Chronic Aortoiliac Endograft Thrombosis: An Innovative Option for the Modern Endovascular Surgeon Toolkit. J Endovasc Ther 2023; 30:957-963. [PMID: 35735194 DOI: 10.1177/15266028221105177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a successful revascularization case using the Rotarex™S atherothrombectomy system in a recent iliac limb thrombosis, and chronic hypogastric stent obstruction after previous aortoiliac aneurysm endovascular repair (EVAR). CASE REPORT A 72-year-old patient was treated for recent right iliac limb thrombosis and left iliac branch chronic hypogastric stent occlusion, 5 years after EVAR. A total endovascular approach, using both upper extremity and femoral vascular access, was settled with 2 Rotarex™S (6Fr and 10Fr) devices. The Rotarex™S catheters removed most of the intraluminal material, allowing additional endografts and bare metal stents to be deployed to support a new healthy lumen surface. CONCLUSION The total endovascular approach provided by the Rotarex™S device appears to be safe and effective in treating aortoiliac endografts occlusions, both in subacute and chronic phases. Larger studies could highlight differences and eventual advantages compared with more traditional solutions.
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Affiliation(s)
- Gioele Simonte
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
- Unit of Vascular Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gianluigi Fino
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Francesco Casali
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Gianbattista Parlani
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Massimo Lenti
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Giacomo Isernia
- Vascular and Endovascular Surgery Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Oguslu U, Uyanik SA, Çevik Cenkeri H, Atli E, Yilmaz B, Gümüş B. Endovascular recanalization and remodeling of abdominal aorta stent graft chronic total occlusion after failed extra-anatomic bypass surgery. Vascular 2021; 30:1008-1012. [PMID: 34406103 DOI: 10.1177/17085381211040905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Chronic total occlusion (CTO) of the EVAR graft is a rare and serious complication. Traditionally, surgical intervention with prosthetic graft replacement or bypass graft implantation is performed. However, there are limited data in endovascular era. METHODS We present a case of a 68-year-old male with a history of late EVAR graft occlusion treated with multiple surgical interventions (femorofemoral crossover, extra-anatomic bypass surgery, and thrombectomy) five years ago. Color Doppler ultrasound (CDUS) and computed tomography (CT) angiography revealed thrombosis of the entire bypass graft. Endovascular recanalization and remodeling of the abdominal stent graft CTO was performed with a combination of bare stents and stent grafts. Rupture of the stent graft occurred on the right limb. A second covered stent was placed. RESULTS At 12-month follow-up, the patient was symptom free. Color Doppler ultrasound surveillance showed patent aortic stent graft and downstream arteries. CONCLUSIONS Endovascular recanalization of aortic stent graft CTO is a viable option in patients with failed bypass graft.
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Affiliation(s)
- Umut Oguslu
- Department of Radiology, Okan University Hospital, Istanbul, Turkey
| | - Sadık A Uyanik
- Department of Radiology, Okan University Hospital, Istanbul, Turkey
| | | | - Eray Atli
- Department of Radiology, Okan University Hospital, Istanbul, Turkey
| | - Birnur Yilmaz
- Department of Radiology, Okan University Hospital, Istanbul, Turkey
| | - Burçak Gümüş
- Department of Radiology, Okan University Hospital, Istanbul, Turkey
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Response to letter to the Editor re ‘Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion - Etiology, Early Diagnosis and Management'. Eur J Vasc Endovasc Surg 2020; 59:850. [DOI: 10.1016/j.ejvs.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
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Inaba Y, Yoshitake A, Hayashi K, Ito T, Hachiya T, Shimizu H. Effect of the Terminal Aortic Diameter on the Patency Rate of Iliac Limbs after Endovascular Aortic Repair. Ann Vasc Dis 2019; 12:519-523. [PMID: 31942211 PMCID: PMC6957905 DOI: 10.3400/avd.oa.19-00080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Endograft limb occlusion (ELO) is a complication of endovascular aneurysm repair (EVAR). In this study, we investigated the mechanism and anatomical features of ELO. Materials and Methods: We retrospectively reviewed 227 consecutive patients with abdominal aortic aneurysm who underwent EVAR between 2007 and 2017. We then analyzed the preoperative risk factors and anatomical features of patients with ELO. Results: A total of nine patients had ELO (4.0%). The diameter of the terminal aorta was significantly smaller in patients with ELO than in patients without ELO (18.0 mm vs. 22.3 mm, p=0.039). We measured the diameter of each limb near the terminal aorta. The smaller limb (SL) was occluded in all patients with occlusion. The difference between the larger limb (LL) and the SL (LL-SL) was significantly larger in patients with ELO than in patients without ELO (4.0 mm vs. 1.7 mm, p<0.001). The following were considered risk factors for ELO: younger age, narrow terminal aorta, severe calcification at the terminal aorta, and use of an Endurant device. Conclusion: ELO occurs when the diameter of one side of the stent graft limb is small compared with the diameter of the other side owing to the narrow terminal aorta and calcification.
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Affiliation(s)
- Yu Inaba
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kanako Hayashi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Ito
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Hachiya
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
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Coelho A, Nogueira C, Lobo M, Gouveia R, Campos J, Augusto R, Coelho N, Semião AC, Ribeiro JP, Canedo A. Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management. Eur J Vasc Endovasc Surg 2019; 58:681-689. [DOI: 10.1016/j.ejvs.2019.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 12/26/2022]
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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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Spencer B, Aziz F. Excessive tortuosity of the iliac arteries is an indication for open abdominal aortic aneurysm repair. J Vasc Surg 2019; 70:272-273. [PMID: 31230645 DOI: 10.1016/j.jvs.2019.04.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/03/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Brianna Spencer
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pa
| | - Faisal Aziz
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, Pa.
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Spiliopoulos S, Moulakakis K, Palialexis K, Konstantos C, Reppas L, Kakisis I, Lazaris A, Geroulakos G, Brountzos E. Long-Term Outcomes of Percutaneous Stenting of Aortic Endograft Limb Occlusion. Ann Vasc Surg 2019; 54:226-232. [PMID: 30092436 DOI: 10.1016/j.avsg.2018.05.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION To investigate the safety and efficacy of percutaneous stenting for the management of chronic ischemia caused by endograft limb occlusion following endovascular aortic aneurysm repair (EVAR). METHODS This is a retrospective, single-center study investigating all patients who underwent percutaneous endovascular covered or bare metal stent placement for the management of intermittent claudication (IC) or critical limb ischemia following EVAR limb occlusion, between January 2010 and October 2017. Cases suffering from acute limb ischemia were treated surgically and were excluded from the analysis. Primary outcome measures were technical success and symptoms-free interval. Secondary outcome measures included clinically driven target-lesion reintervention (TLR)-free survival, primary patency, and complication rates. RESULTS Of 29 limb occlusions, 11 limbs (11 patients; 100% male; mean age: 71.6 ± 6.9 years) were treated percutaneously and were included in the study. The majority suffered from IC (10/11; 90.9%) with a single case of rest pain. Technical success was obtained in 10 patients (90%). No major complications occurred. Mean follow-up time was 37.6 ± 25.7 months. Stent grafts were mainly used, while and in 2 cases (18.18%), only nitinol bare stents were deployed. According to Kaplan-Meier analysis, both symptoms-free interval and primary patency were 83.33% in up to 5 years follow-up. TLR-free survival was 100% at 5 years, as 2 cases of claudication relapse were managed conservatively. CONCLUSIONS Percutaneous stenting for the management chronic ischemia due to EVAR limb occlusion is feasible and safe, with satisfactory long-term outcomes. Careful patient selection warrants clinical success.
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Affiliation(s)
- Stavros Spiliopoulos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
| | - Konstantinos Moulakakis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Palialexis
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Chrysostomos Konstantos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Lazaros Reppas
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioannis Kakisis
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Meta-analysis and meta-regression analysis of iliac limb occlusion after endovascular aneurysm repair. J Vasc Surg 2018; 68:1916-1924.e7. [DOI: 10.1016/j.jvs.2018.08.153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/07/2018] [Indexed: 11/20/2022]
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12
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Lareyre F, Mialhe C, Dommerc C, Raffort J. Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts. J Endovasc Ther 2018; 26:72-75. [PMID: 30395489 DOI: 10.1177/1526602818811915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). CASE REPORT A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. CONCLUSION While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.
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Affiliation(s)
- Fabien Lareyre
- 1 Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco.,2 Université Côte d'Azur, CHU, Inserm, C3M, Nice, France
| | - Claude Mialhe
- 1 Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
| | - Carine Dommerc
- 1 Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
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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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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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Bargay Juan P, Plaza Martínez Á, Ramírez Montoya M, Sala Almonacil V, Molina Nácher V, Gómez Palonés F. Resultados tras el cambio de estrategia en el sellado distal de endoprótesis aórticas infrarrenales. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Shirasugi T, Kimura N, Yuri K, Nomura Y, Yamaguchi A, Adachi H, Morita H. Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass. Ann Vasc Dis 2016; 8:314-7. [PMID: 26730257 DOI: 10.3400/avd.cr.15-00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/28/2015] [Indexed: 11/13/2022] Open
Abstract
We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.
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Affiliation(s)
- Takehiro Shirasugi
- Department of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Yohei Nomura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideki Morita
- Department of Cardiovascular Surgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan
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17
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Vinha AJ, Sampaio S. Correção de aneurisma por via endovascular: fatores de risco para oclusão de ramo. ANGIOLOGIA E CIRURGIA VASCULAR 2015. [DOI: 10.1016/j.ancv.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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18
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Predictive factors for limb occlusions after endovascular aneurysm repair. J Vasc Surg 2015; 61:1138-45.e2. [DOI: 10.1016/j.jvs.2014.11.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/15/2014] [Indexed: 11/19/2022]
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19
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Mantas G, Antonopoulos C, Sfyroeras G, Moulakakis K, Kakisis J, Mylonas S, Liapis C. Factors Predisposing to Endograft Limb Occlusion after Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2015; 49:39-44. [DOI: 10.1016/j.ejvs.2014.09.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
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20
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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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21
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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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A New Management for Limb Graft Occlusion after Endovascular Aneurysm Repair Adding a Vollmar Ring Stripper: The Unclogging Technique. Ann Vasc Surg 2013; 27:1216-22. [DOI: 10.1016/j.avsg.2013.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 01/26/2013] [Accepted: 02/01/2013] [Indexed: 11/20/2022]
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23
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Wu IH, Chan CY, Chen YS, Huang SC, Wang SS, Chi NH. Crossover Chimney Technique to Preserve the Internal Iliac Artery in Abdominal Aortic Aneurysm With Common Iliac Artery Aneurysms. J Endovasc Ther 2013; 20:298-302. [DOI: 10.1583/13-4219r.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Incidence and treatment results of Endurant endograft occlusion. J Vasc Surg 2013; 57:1246-54; discussion 1254. [DOI: 10.1016/j.jvs.2012.11.069] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/16/2012] [Accepted: 11/16/2012] [Indexed: 11/17/2022]
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25
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First-in-human study of the INCRAFT endograft in patients with infrarenal abdominal aortic aneurysms in the INNOVATION trial. J Vasc Surg 2013; 57:906-14. [DOI: 10.1016/j.jvs.2012.09.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 09/28/2012] [Accepted: 09/29/2012] [Indexed: 11/21/2022]
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26
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Oliveira FAC, Campedelli FL, Amorelli CEDS, Costa Filho JED, Gibbon DR, Barreto JC, Silva PMD. Tratamento endovascular da oclusão de ramo ilíaco de endoprótese bifurcada de aorta abdominal: trombectomia rotativa e aspirativa seguida de angioplastia com stent primário. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000300008] [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
A oclusão de ramo ilíaco de endoprótese bifurcada de aorta surge como complicação decorrente da correção endovascular do aneurisma de aorta abdominal e várias abordagens terapêuticas têm sido empregadas para o tratamento dessa complicação em casos de isquemia de membro inferior. Apresentamos dois casos de tratamento totalmente percutâneo da oclusão de ramo ilíaco de endoprótese de aorta abdominal com dispositivo de trombectomia rotativa e aspirativa seguida de angioplastia com stent primário, sem complicações operatórias.
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Conway AM, Modarai B, Taylor PR, Carrell TWG, Waltham M, Salter R, Bell RE. Stent-Graft Limb Deployment in the External Iliac Artery Increases the Risk of Limb Occlusion Following Endovascular AAA Repair. J Endovasc Ther 2012; 19:79-85. [PMID: 22313206 DOI: 10.1583/11-3550.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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28
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Helmick RA, Mesh CL. The importance of antegrade completion angiography in aortobifemoral bypass limb revision. J Vasc Surg 2012; 55:1141-4. [PMID: 22236884 DOI: 10.1016/j.jvs.2011.10.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 10/27/2011] [Accepted: 10/27/2011] [Indexed: 11/28/2022]
Abstract
Aortobifemoral bypass is a durable arterial reconstruction with well-defined failure modes. Management of graft limb thrombosis requires restoration of inflow and correction of any causative outflow lesions. Successful, minimally invasive inflow restoration with catheter thrombectomy can become problematic if assessment of technical adequacy is deficient or reveals causal lesions within the graft body. We describe a case illustrating the potential shortfall of retrograde graft limb completion angiography in depicting neointimal flaps, the benefit of antegrade angiography in depicting these flaps, and a novel utilization of a standard endovascular method to correct flaps that involve the graft body.
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Affiliation(s)
- Ryan A Helmick
- Department of Surgery, Mercy Jewish Hospital, Cincinnati, OH, USA
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29
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Stambo GW, Gabriel Y. Endovascular treatment of a chronically occluded limb of endograft with combination TNK pharmacological and EKOS thrombolytic catheter system. Radiography (Lond) 2011. [DOI: 10.1016/j.radi.2010.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Endovascular Methods in the Treatment of Late Complications of Conventional Operations of Aneurysms At Aorto-Iliac Level. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Endovascular management of delayed complete graft thrombosis after endovascular aneurysm repair. Cardiovasc Intervent Radiol 2009; 33:840-3. [PMID: 20033161 DOI: 10.1007/s00270-009-9780-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 12/03/2009] [Indexed: 10/20/2022]
Abstract
Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series. When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not an option and a greater volume of thrombus is present, thus making thrombolysis more difficult. We present two cases of delayed thrombosis after EVAR involving the entire stent-graft. These were successfully treated by a combined surgical and endovascular technique, and patency has been maintained in both cases to date.
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32
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Karthikesalingam A, Hinchliffe RJ, Holt PJE, Boyle JR, Loftus IM, Thompson MM. Endovascular aneurysm repair with preservation of the internal iliac artery using the iliac branch graft device. Eur J Vasc Endovasc Surg 2009; 39:285-94. [PMID: 19962329 DOI: 10.1016/j.ejvs.2009.11.018] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 11/17/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Aortoiliac aneurysms comprise up to 43% of the specialist endovascular caseload. In such cases endovascular aneurysm repair (EVAR) requires distal extension of the aortoiliac endograft beyond the ostium of the internal iliac artery (IIA) and into the external iliac artery, conventionally necessitating the embolisation of one or both IIA. This has been associated with a wide range of complications, and the use of an Iliac Branch-graft Device (IBD) offers an appealing endovascular solution. DESIGN Medline, trial registries, conference proceedings and article reference lists were searched to identify case series reporting IBD use. Data were extracted for review. RESULTS Nine series have reported the use of IBD in a total of 196 patients. Technical success was 85-100%. Median operating times were 101-290min and median contrast dose was 58-208g, with no aneurysm-related mortality. Claudication developed in 12/24 patients after IBD occlusion. One type I endoleak and two type III endoleaks occurred and were managed endovascularly. Re-occlusion occurred in 24/196 patients. CONCLUSION IBD was performed with high technical success rates and encouraging mid-term patency. Formalised risk stratification and morphological data are required to identify the group of patients who will benefit most. Cost-effectiveness appraisals are needed for this technique.
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33
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Roche-Nagle GM, Barry MC. Images in vascular medicine. Endograft limb collapse. Vasc Med 2009; 14:403-4. [PMID: 19808729 DOI: 10.1177/1358863x09105375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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34
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Hingorani AP, Ascher E, Marks N, Shiferson A, Patel N, Gopal K, Jacob T. Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: An underdiagnosed entity. J Vasc Surg 2009; 50:505-9; discussion 509. [DOI: 10.1016/j.jvs.2009.03.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/25/2009] [Accepted: 03/28/2009] [Indexed: 10/20/2022]
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35
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Amato ACM, Melissano G, Liu X, Civilini E, Chiesa R. Endovascular approach for isolated common iliac aneurysm and severe kyphoscoliosis. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000300017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
We report the case of a 72-year-old patient presenting with an isolated common iliac aneurysm with occlusion of contralateral common iliac artery and severe kyphoscoliosis. Because of high risk for open surgery due to chronic obstructive pulmonary disease, this patient was treated with an endovascular approach using an aortomonoiliac stent graft, followed by a femoro-femoral crossover bypass. This report illustrates the usefulness of a minimally invasive approach, and feasibility even for patients with difficult anatomy.
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36
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Tsang JS, Naughton PA, Wang TT, Keeling AN, Moneley DS, Lee MJ, Kelly CJ, Leahy AL. Endovascular Repair of Para-Anastomotic Aortoiliac Aneurysms. Cardiovasc Intervent Radiol 2009; 32:1165-70. [PMID: 19629588 DOI: 10.1007/s00270-009-9653-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/17/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
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37
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Maleux G, Koolen M, Heye S, Heremans B, Nevelsteen A. Mural Thrombotic Deposits in Abdominal Aortic Endografts Are Common and Do Not Require Additional Treatment at Short-term and Midterm Follow-up. J Vasc Interv Radiol 2008; 19:1558-62. [DOI: 10.1016/j.jvir.2008.08.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 08/07/2008] [Accepted: 08/07/2008] [Indexed: 11/25/2022] Open
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38
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Freyrie A, Gargiulo M, Rossi C, Losinno F, Testi G, Mauro R, Faggioli G, Stella A. Preliminary Results of Anaconda™ Aortic Endografts: A Single Center Study. Eur J Vasc Endovasc Surg 2007; 34:693-8. [PMID: 17669669 DOI: 10.1016/j.ejvs.2007.05.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 05/18/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the peri-operative results of Anaconda endograft in the first 49 cases treated in a single centre. METHODS The study was carried out prospectively on cases of infrarenal abdominal aortic aneurysm (AAA) treated with Anaconda endograft. The characteristics of the proximal aortic neck and of the iliac access vessels were considered. The following operative results were assessed: the main body oversizing, the need to correct the positioning of the main body, the use of iliac extensions, the use of ballooning, the covering of patent hypogastric arteries, the presence of endoleaks and the need for conversion. Peri-operative (30 days) mortality and morbidity were also considered. RESULTS Of the 49 cases treated, 44 were males with a mean age of 73 years (range: 55-89 yrs; SD+/-7 yrs). The mean diameter of the AAA was 56 mm (range 45-91 mm; SD+/-11); 4 cases had common iliac aneurysms with a diameter >3 cm. The mean neck diameter and length were 23 mm (range 19-28 mm; SD+/-3) and 25 mm (range 15-50 mm; SD+/-10) respectively. An aortic neck angle between 40 degrees and 70 degrees was present in 10 cases (20%) (mean 58 degrees; SD+/-15 degrees), and 20 cases (41%) had iliac tortuosity with an angle greater than 60 degrees (mean 85 degrees; SD+/-25 degrees). There were no cases of conversion or intra-operative death. One (2%) peri-operative death occurred, for reasons not related to the endograft. There were two cases of iliac limb thrombosis. CT at one month showed 12 cases (25%) of type II endoleak. There were no cases of type I or type III endoleaks. CONCLUSIONS The preliminary data of this series demonstrates that the Anaconda endograft has good peri-operative results in the treatment of infrarenal AAAs with a neck length not less than 15 mm.
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Affiliation(s)
- A Freyrie
- Vascular Surgery, Policlinico S. Orsola, University of Bologna, Italy.
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39
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Sachdev U, Baril DT, Morrissey NJ, Silverberg D, Jacobs TS, Carroccio A, Ellozy S, Marin ML. Endovascular repair of para-anastomotic aortic aneurysms. J Vasc Surg 2007; 46:636-41. [PMID: 17764881 DOI: 10.1016/j.jvs.2007.05.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 05/09/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Para-anastomotic aneurysms involving the aorta and iliac arteries can occur years after aortic surgery and are at risk for rupture and erosion into surrounding structures. We report on our continued experience with patients who have been treated for these lesions with endovascular management as an alternative to traditional open repair. METHODS Patients who underwent endovascular repair of para-anastomotic aneurysms involving the distal aortic arch, descending thoracic aorta, abdominal aorta, or iliac arteries were prospectively followed up in a database. Patient comorbidities, initial aortic pathology, initial graft configuration, aneurysm characteristics, evidence of infection, type and configuration of endograft used, and follow-up were analyzed. RESULTS From 1997 to 2006, 53 patients with 65 para-anastomotic aneurysms were treated with endovascular stent grafts. Patients who were originally treated for aortoiliac occlusive disease presented significantly later than those treated for aneurysmal disease (15.8 vs 8.9 years, P < .01) The initial technical success rate was 98%. Endoleaks were identified in six patients (11%) < or =1 month of surgery, and three required reintervention, including open conversions. Endoleak complications were significantly associated with patients who had symptomatic para-anastomotic aneurysms (P = .01). Perioperative mortality after endovascular repair was 3.8%. Overall mortality within a mean follow-up of 18 months was 49% and was significantly associated with older age at the time of endovascular treatment (P = .03). CONCLUSION Endovascular repair of para-anastomotic aneurysms involving the aorta and iliac arteries is technically feasible and is associated with a low perioperative morbidity and mortality. Close follow-up is required to identify endoleaks. Long-term survival is limited in older patients. We recommend endovascular stent graft repair for para-anastomotic aneurysms in anatomically suitable patients.
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Affiliation(s)
- Ulka Sachdev
- Department of Surgery, Mt Sinai Medical Center, New York, NY 10029, USA
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40
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Cochennec F, Becquemin JP, Desgranges P, Allaire E, Kobeiter H, Roudot-Thoraval F. Limb Graft Occlusion Following EVAR: Clinical Pattern, Outcomes and Predictive Factors of Occurrence. Eur J Vasc Endovasc Surg 2007; 34:59-65. [PMID: 17400004 DOI: 10.1016/j.ejvs.2007.01.009] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 01/16/2007] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We reviewed our experience with limb occlusion after EVAR in order (1) to assess the clinical pattern and treatment options (2) to assess outcomes and (3) to identify predictive factors of occurrence. MATERIALS AND METHOD Between 1995 and 2005, 460 AAA patients were electively treated with a variety of commercially available stent grafts. There were 369 bifurcated and 91 aortouniiliac grafts (829 limbs). Follow-up included physical examination, plain X-ray, Duplex ultrasonography, and spiral computed tomographic scans at 1, 6, 12 months and annually thereafter. All pertinent data were collected prospectively and analysed retrospectively. The follow-up period ranged from Day 0 to 104 months, with a median follow-up of 23.4 months. RESULTS 36 limbs in 33 patients (7.2%) occluded between Day 0 and 71 months (average: 9.5 months) after EVAR. Presentation was acute ischemia in 11 cases, rest pain in 9, claudication in ten. Four occlusions remained asymptomatic and two occurred intraoperatively. Treatment was femoro-femoral cross-over graft in 19 cases, axillo-femoral bypass in three, thrombectomy and stent in three, thrombolysis and stent in nine, and conservative in two. One patient (3%) died of multiple organ failure after thrombolysis. There was no amputation. Reocclusions occurred in two patients (6.1%). Multivariate logistic regression showed that kinking (odds ratio [OR] 11.9; confidence interval [CI] 3.39-42.1; p=0.0001), first graft generation (OR 2.87; CI 1.25-6.62; p=0.017) and younger age (OR 1.05; CI 1.00-1.09; p=0.034) were independently related to the occurrence of graft limb occlusion. CONCLUSION Acute graft limb occlusion is not rare after EVAR. The frequency of limb occlusion has declined with current stent grafts generation. Although surgery and endovascular treatments are efficient and safe, development of a graft limb kink should lead to aggressive pre-emptive treatment to prevent occlusion.
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Affiliation(s)
- F Cochennec
- Department of Vascular Surgery, Henri Mondor Hospital, AP/HP, University Paris Val de Marne, Creteil 94000, Paris, France
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41
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Analysis of Early and Distant Results Following Endovascular Repair of the Descending and Abdominal Aorta. POLISH JOURNAL OF SURGERY 2007. [DOI: 10.2478/v10035-007-0031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Sivamurthy N, Schneider DB, Reilly LM, Rapp JH, Skovobogatyy H, Chuter TAM. Adjunctive primary stenting of Zenith endograft limbs during endovascular abdominal aortic aneurysm repair: Implications for limb patency. J Vasc Surg 2006; 43:662-70. [PMID: 16616217 DOI: 10.1016/j.jvs.2005.11.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 11/28/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Endograft limb occlusion is an infrequent but serious complication of endovascular abdominal aortic aneurysm (AAA) repair. The insertion of additional stents within the endograft limb may prevent future occlusion. This study evaluates limb patency with and without adjunctive stenting of endograft limbs at the time of endovascular AAA repair. METHODS We performed a retrospective review of 248 patients who underwent endovascular abdominal aortic aneurysm repair with the Zenith AAA endovascular graft between 1999 and 2004. Among these patients, two groups were identified: 64 patients with adjunctive stents placed in 85 limbs and 184 patients without additional bare stent placement in endograft limbs at the time of endovascular AAA repair. RESULTS Women comprised 23% of stented and 11% of unstented patients (P = .02). The mean length of follow-up in the stented and unstented groups was 2.0 years. There were 13 instances of limb thrombosis in 13 patients (5.2% of patients, 2.7% of limbs), all in the unstented group. No limb occlusions occurred in the presence of adjunctive bare metal stents. Seventy-three percent of the occlusions occurred < or = 6 months of endovascular AAA repair. Two patients (15%) had no symptoms of lower-extremity ischemia despite graft limb occlusion and did not undergo intervention. The others underwent thrombectomy (n = 2), thrombectomy with bare stent placement (n = 3), femoral-femoral bypass (n = 4), thrombolysis (n = 1), and thrombolysis with bare stent placement (n = 1). Of the seven who underwent thrombectomy or thrombolysis, three had no additional stents placed at the secondary procedure, and two of these three went on to rethrombose. By life-table analysis, primary patency at 3 years in the stented and nonstented limbs was 100% +/- 0% and 94% +/- 3%, respectively (P = .05). CONCLUSIONS The intraoperative insertion of additional bare metal stents appeared to eliminate the risk of thrombosis and was without complication. Of the 85 stented limbs in this series, not one occluded. The overall rate of limb thrombosis was low, with most limb occlusions occurring < or = 6 months of stent-graft insertion, and would probably have been even lower had we been able to identify all high-risk cases for prophylactic adjunctive stenting. Limb occlusion denotes an underlying problem with the graft, which if left untreated after thrombectomy or thrombolysis will lead to rethrombosis. Postoperative imaging was of little value in detecting impending limb occlusion. Based on these findings, we believe one should identify and stent any limbs that appear to be at risk for thrombosis, but this study lacks the data to predict which limbs need stenting.
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Affiliation(s)
- Nayan Sivamurthy
- Division of Vascular Surgery, University of California San Francisco Medical Center, 94143-0222, USA
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