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Single centre experience with Excluder ® stent graft; 17-year outcome. Radiol Oncol 2022; 56:156-163. [PMID: 35417109 PMCID: PMC9122300 DOI: 10.2478/raon-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair (EVAR) has become a mainstay of abdominal aorta aneurysm treatment. Long term follow-up on specific stent grafts is needed. PATIENTS AND METHODS This study included 123 patients (104 men; mean age 73.0 years, range 51-89) with abdominal aorta aneurysm, treated with Excluder® stent graft between October 2002 and June 2008. Periprocedural and follow-up data were retrieved by reviewing the records of our institution, while time and cause of death were retrieved from the National Institute of Public Health. If an abdominal aortic aneurysm rupture was listed as the cause of death, records were retrieved from the institution that issued the death certificate. Our primary goal was to assess the primary technical success rate, type 1 and type 2 endoleak, reintervention free survival, 30-day mortality, the overall survival and aneurysm rupture-free survival. RESULTS The median follow-up was 9.7 years (interquartile range, 4.6-13.8). The primary technical success was 98.4% and the 30-day mortality accounted for 0.8%. Secondary procedures were performed in 29 (23.6%) patients during the follow-up period. The one-, five-, ten-, fifteen- and seventeen-year overall survival accounted for 94.3%, 74.0%, 47.2%, 35.8% and 35.8%, while the aneurysm-related survival was 98.4%, 96.3%, 92.6%, 92.6%, 92.6%. In seven (5.7%) patients, abdominal aortic rupture was found as the primary cause of death during follow-up. CONCLUSIONS Our data showed that EVAR with Excluder® stent graft offers good long-term results. More than 75% of patients can be treated completely percutaneously. Late ruptures do occur in the first ten years, raising awareness about regular medical controls.
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Clinical Comparison between Early and Late Spontaneous Sac Shrinkage after Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2021; 75:420-429. [PMID: 33812942 DOI: 10.1016/j.avsg.2021.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Early spontaneous shrinkage (ESS) of abdominal aortic aneurysm (AAA) within 1 year after endovascular aortic aneurysm repair (EVAR) could be a predictor of durable success. However, late spontaneous shrinkage (LSS) during longer follow-up has not been well addressed. We compared late complications of ESS and LSS. METHODS Our series of elective EVAR for infrarenal AAA from June 2007 to December 2017 was reviewed. Patients with ≥1 year of follow-up with computed tomography (CT) studies were included. Patients with any reintervention within 1 year were excluded. Spontaneous shrinkage (SpS) was defined as a diameter reduction ≥10 mm without any reintervention. ESS was defined as SpS within 1 year, and LSS was defined as SpS occurring after 1 year of follow-up. Aneurysms that became larger than the original size after SpS were defined as re-expansion. Late complications (re-expansion, reintervention, and aneurysm-related death) and related factors were compared between ESS and LSS. RESULTS A total of 495 patients were enrolled. Median follow-up was 43 months [24-67, interquartile range (IQR)]. Among patients, 126 ESS and 55 LSS occurred. The cumulative rates of SpS were 25.7±2.0%, 37.4±2.4%, and 47.3±3.7% at 1, 3, and 7 years, respectively. There was 1 re-expansion and 6 reinterventions during further follow-up after SpS. The rates of freedom from late complications at 5 years were not significantly different between ESS (89.2±4.0%) and LSS (95.8±4.1%) (P = 0.465). Regression analysis revealed that the Zenith device was significantly related to ESS compared to the Excluder (P = 0.006) and Endurant (P = 0.040) . More than 6 preoperative patent lumbar arteries negatively correlated with ESS (P = 0.023). However, these factors had no significant impact on LSS. CONCLUSIONS The rates of late complications after SpS were comparable between ESS and LSS. Patients with delayed sac shrinkage with a reduction in diameter ≥10 mm should expect the same durable success as patients with quick shrinkage.
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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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Quan C, Oh YK, Park SC, Won YS, Yun SS, Suh YJ, Kim JY. Efficacy of volumetric analysis of aorta as surveillance tool after EVAR. Asian J Surg 2019; 42:746-754. [DOI: 10.1016/j.asjsur.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/05/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
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Paraskevas KI. Alert for High Long-term Device Migration Rates Following Endovascular Aneurysm Sealing Procedures. J Endovasc Ther 2018; 25:655-656. [PMID: 30203726 DOI: 10.1177/1526602818794662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kosmas I Paraskevas
- 1 Department of Vascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
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Draczyński Z, Gąsiorowski T, Kolesińska B, Boguń M, Sujka W. Analysis of structure and properties of antibacterial vascular patch used in abdominal aorta aneurysm surgeries. J Appl Biomater Funct Mater 2018; 17:2280800018793818. [PMID: 30176747 DOI: 10.1177/2280800018793818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Biocompatible materials are used for treatment of blood circulatory system diseases, especially abdominal aortic aneurysms. The most popular and often used are knitted and polymer vascular patches. The aim of this study was to optimize the manufacturing process of implantable materials, ensuring antibacterial activity useful for treating abdominal aorta aneurysms. METHODS The vascular patch was manufactured from Trevira® yarn. The parameters of the intermediate product and vascular patch were tested according to standard procedures. RESULTS The vascular patch, manufactured from microsilver-containing yarn, with crimps on the surface of the patch, has been found useful for treatment of abdominal aorta aneurysms. Introducing crimps on the surface of the patch resulted in reduction of water permeability and enabled cutting of the graft at various angles without fraying at the cut ends of the biomaterial. The final vascular patch was marked by a gradual release of silver within 48 hours. CONCLUSIONS On the basis of the performed test, it has been demonstrated that an implantable material for the treatment of abdominal aorta aneurysms was obtained, and that it can be considered as an alternative for currently used vascular patches. The final vascular patch was marked by a gradual release of silver during the first period of incubation. The antibacterial properties of the final product were confirmed by observation of a significant reduction in the number of Staphylococcus aureus and Klebsiella pneumoniae bacterial colonies.
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Affiliation(s)
- Zbigniew Draczyński
- 1 Lodz University of Technology, Department of Material, and Commodity Sciences and Textile Metrology, Lodz, Poland
| | | | - Beata Kolesińska
- 3 Lodz University of Technology, Institute of Organic Chemistry, Lodz, Poland
| | - Maciej Boguń
- 1 Lodz University of Technology, Department of Material, and Commodity Sciences and Textile Metrology, Lodz, Poland
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Lalys F, Daoudal A, Gindre J, Göksu C, Lucas A, Kaladji A. Influencing factors of sac shrinkage after endovascular aneurysm repair. J Vasc Surg 2017; 65:1830-1838. [DOI: 10.1016/j.jvs.2016.12.131] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022]
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Schoretsanitis N, Georgakarakos E, Argyriou C, Ktenidis K, Georgiadis GS. A critical appraisal of endovascular stent-grafts in the management of abdominal aortic aneurysms. Radiol Med 2017; 122:309-318. [DOI: 10.1007/s11547-017-0724-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
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Nagpal AD, Forbes TL, Novick TV, Lovell MB, Kribs SW, Lawlor DK, Harris KA, DeRose G. Midterm Results of Endovascular Infrarenal Abdominal Aortic Aneurysm Repair in High-Risk Patients. Vasc Endovascular Surg 2016; 41:301-9. [PMID: 17704332 DOI: 10.1177/1538574407301430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Short-term and midterm clinical outcomes after endovascular repair of abdominal aortic aneurysms (AAAs) have been well documented. Evaluation of longer term outcomes is now possible. Here we describe our initial 100 high-risk patients treated with endovascular aneurysm repair (EVAR), all with a minimum of 5 years of follow-up. A retrospective review of prospectively recorded data in a departmental database was undertaken for the first 100 consecutive EVAR patients with a minimum of 5 years (range, 60-105 months) of follow-up performed between December 1997 and June 2001. Information was obtained from surgical follow-up visits and family doctors' offices. Endovascular repair of AAA in high-risk patients can be achieved with acceptably low postoperative mortality and morbidity. Longer term results in this high-risk cohort suggest that EVAR is effective in preventing aneurysm-related deaths at 5 years and beyond. All late mortalities were due to patients' comorbid diseases.
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Affiliation(s)
- A David Nagpal
- Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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Lin PH, El Sayed HF, Kougias P, Zhou W, LeMaire SA, Coselli JS. Endovascular Repair of Thoracic Aortic Disease: Overview of Current Devices and Clinical Results. Vascular 2016; 15:179-90. [PMID: 17714632 DOI: 10.2310/6670.2007.00041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endovascular repair of thoracic aortic aneurysm has become an important treatment modality in patients who are at increased risk for open surgical repair. Since the US Food and Drug Administration (FDA) approved the clinical application of this technology in the thoracic aorta in 2005, there has been a rapid growth in this treatment modality as numerous endovascular devices have been introduced in the application of thoracic aortic pathology. Although thoracic aortic aneurysm is the only FDA-approved treatment indication for endovascular repair, this technology may lead to a broader clinical applicability in other thoracic pathologies. This article reviews the current endovascular devices designed for the treatment of thoracic aortic pathology. These devices are described, and the current clinical results are discussed.
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Affiliation(s)
- Peter H Lin
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
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't Mannetje YW, Broos PPHL, van Poppel RFA, van Sambeek MRHM, Teijink JAW, Cuypers PWM. Late single-center outcome of the Talent Abdominal Stent Graft after a decade of follow-up. J Vasc Surg 2016; 64:557-62. [PMID: 26994956 DOI: 10.1016/j.jvs.2016.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Lifelong yearly surveillance is advised after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. This follow-up requires a substantial amount of health care resources. The aim of this paper was to assess the occurrence of stent graft-related complications and secondary interventions during a minimum 10-year follow-up after elective EVAR. METHODS Patients who were treated in a high-volume endovascular center in The Netherlands with the Talent infrarenal stent graft (Medtronic Vascular, Santa Rosa, Calif) between June 1999 and February 2005 were included. Patients with previous aortic surgery or emergency interventions were excluded. Our primary outcome was clinical success up to 10 years. Secondary end points were technical success and survival. RESULTS A total of 149 patients were included; 91.9% were male. The mean age was 70.2 ± 7.8 years. A stent graft was implanted in 98% of patients; technical success was achieved in 89.9%. Clinical success after 30 days, 1 year, 5 years, and 10 years was 81.1%, 74.3%, 70.3%, and 65.5%, respectively. In 30 patients (20.7%), a secondary intervention was required; 80.0% of first secondary interventions occurred within the first 5 years. Six late conversions were necessary because of stent graft infection (2), migration (2), or persisting endoleak (2). The 5- and 10-year overall survival rates were 55.2% and 38.6%, respectively. CONCLUSIONS The risk of EVAR-related complication is highest in the first 5 years. Consequently, the main focus should be on that period; further follow-up must not be neglected, as complications occur up to 10 years after treatment.
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Affiliation(s)
- Yannick W 't Mannetje
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands
| | - Pieter P H L Broos
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands
| | - Roy F A van Poppel
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands
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Spanos K, Karathanos C, Saleptsis V, Giannoukas AD. Systematic review and meta-analysis of migration after endovascular abdominal aortic aneurysm repair. Vascular 2015; 24:323-36. [DOI: 10.1177/1708538115590065] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim To identify patients who are under higher threat for migration because of an old generation stent graft application. Methods A systematic review and meta-analysis of the literature was undertaken to identify all studies which included older generation endografts and data reporting on graft migration after EVAR. Outcome data were pooled and combined, and were calculated using fixed or random effects models. Results From 2000 to 2014, 22 retrospective studies were identified reporting on stent- graft migration after EVAR (8.6%). From those patients, 39% received re-intervention with the mean time of identification ranging from 12 to 36 months. Six of these retrospective nonrandomized studies were eligible for meta-analysis. AAA diameter (AAA diameter: 0.719 mm; 95% confidence interval [CI]: 0.00065–1.4384 mm; p = 0.00497) and neck length (neck length: 4.36 mm; 95% CI: 1.3277–7.394; p = 0.0048) were the only significant factors associated with stent- graft migration. Neck diameter and neck angulation did not have any important influence on stent-graft migration. Conclusions Patients with large AAA and short necks who were treated with older generation stent grafts such as AneurX and Talent are in higher risk for endograft migration than others. Stent- graft migration consists of an insidious and underestimated threat.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vasileios Saleptsis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Soler RJ, Bartoli MA, Mancini J, Lerussi G, Thevenin B, Sarlon-Bartoli G, Magnan PE. Aneurysm Sac Shrinkage after Endovascular Repair: Predictive Factors and Long-Term Follow-Up. Ann Vasc Surg 2015; 29:770-9. [DOI: 10.1016/j.avsg.2014.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/09/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
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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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Kauffmann C, Douane F, Therasse E, Lessard S, Elkouri S, Gilbert P, Beaudoin N, Pfister M, Blair JF, Soulez G. Source of Errors and Accuracy of a Two-Dimensional/Three-Dimensional Fusion Road Map for Endovascular Aneurysm Repair of Abdominal Aortic Aneurysm. J Vasc Interv Radiol 2015; 26:544-51. [DOI: 10.1016/j.jvir.2014.12.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 10/23/2022] Open
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Dudeck O, Schnapauff D, Herzog L, Löwenthal D, Bulla K, Bulla B, Halloul Z, Meyer F, Pech M, Gebauer B, Ricke J. Can early computed tomography angiography after endovascular aortic aneurysm repair predict the need for reintervention in patients with type II endoleak? Cardiovasc Intervent Radiol 2014; 38:45-52. [PMID: 24809755 DOI: 10.1007/s00270-014-0901-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/21/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was designed to identify parameters on CT angiography (CTA) of type II endoleaks following endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), which can be used to predict the subsequent need for reinterventions. METHODS We retrospectively identified 62 patients with type II endoleak who underwent early CTA in mean 3.7 ± 1.9 days after EVAR. On the basis of follow-up examinations (mean follow-up period 911 days; range, 373-1,987 days), patients were stratified into two groups: those who did (n = 18) and those who did not (n = 44) require reintervention. CTA characteristics, such as AAA, endoleak, as well as nidus dimensions, patency of the inferior mesenteric artery, number of aortic branch vessels, and the pattern of endoleak appearance, were recorded and correlated with the clinical outcome. RESULTS Univariate and receiver operating characteristic curve regression analyses revealed significant differences between the two groups for the endoleak volume (surveillance group: 1391.6 ± 1427.9 mm(3); reintervention group: 3227.7 ± 2693.8 mm(3); cutoff value of 2,386 mm(3); p = 0.002), the endoleak diameter (13.6 ± 4.3 mm compared with 25.9 ± 9.6 mm; cutoff value of 19 mm; p < 0.0001), the number of aortic branch vessels (2.9 ± 1.2 compared with 4.2 ± 1.4 vessels; p = 0.001), as well as a "complex type" endoleak pattern (13.6 %, n = 6 compared with 44.4 %, n = 8; p = 0.02). CONCLUSIONS Early CTA can predict the future need for reintervention in patients with type II endoleak. Therefore, treatment decision should be based not only on aneurysm enlargement alone but also on other imaging characteristics.
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Affiliation(s)
- O Dudeck
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany,
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Zandvoort HJ, Gonçalves FB, Verhagen HJ, Werson DA, Moll FL, de Vries JPP, van Herwaarden JA. Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft. J Vasc Surg 2014; 59:1195-202. [DOI: 10.1016/j.jvs.2013.12.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/09/2013] [Accepted: 12/15/2013] [Indexed: 11/29/2022]
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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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Relining of an abdominal aortic aneurysm stent graft 9 years after placement. Ann Vasc Surg 2013; 28:489.e5-9. [PMID: 24084269 DOI: 10.1016/j.avsg.2013.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 03/06/2013] [Accepted: 03/20/2013] [Indexed: 11/22/2022]
Abstract
We describe a case of delayed failure with an aortic stent graft 104 months after the graft was initially placed. This case details an endovascular strategy of dealing with the loss of stent graft integrity and underscores the importance of continued follow-up of patients with aortic stent grafts.
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Endoleak Detection After Endovascular Repair of Thoracic Aortic Aneurysm Using Dual-Source Dual-Energy CT: Suitable Scanning Protocols and Potential Radiation Dose Reduction. AJR Am J Roentgenol 2013; 200:451-60. [DOI: 10.2214/ajr.11.8033] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Smeds MR, Westfall SG, Pennell RC, Mantese VA. Suprarenal stent perforation after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 56:1110-3. [DOI: 10.1016/j.jvs.2012.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/16/2012] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
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Mensel B, Kühn JP, Träger T, Dührkoop M, von Bernstorff W, Rosenberg C, Hoene A, Puls R. Technical and clinical outcome of Talent versus Endurant endografts for endovascular aortic aneurysm repair. PLoS One 2012; 7:e38468. [PMID: 22715384 PMCID: PMC3371003 DOI: 10.1371/journal.pone.0038468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/06/2012] [Indexed: 11/18/2022] Open
Abstract
Objective The technical evolution of endografts for the interventional management of infrarenal abdominal aortic aneurysms (AAA) has allowed a continuous expansion of indications. This study compares the established Talent endograft with its successor, the Endurant endograft, taking individual aortoiliac anatomy into account. Methods From June 2007 to December 2010, 35 patients with AAA were treated with a Talent endograft (33 men) and 36 patients with an Endurant endograft (34 men). Aortoiliac anatomy was evaluated in detail using preinterventional computed tomography angiography. The 30-day outcome of both groups were compared regarding technical and clinical success as well as complications including endoleaks. Results The Endurant group included more patients with unfavorable anatomy (kinking of pelvic arteries, p = 0.017; shorter proximal neck, p = 0.084). Primary technical success was 91.4% in the Talent group and 100% in the Endurant group (p = 0.115). Type 1 endoleaks occurred in 5.7% of patients in the Talent group and in 2.8% of those in the Endurant group (p = 0.614). Type 3 endoleaks only occurred in the Talent group (2.9% of patients; p = 0.493). Type 2 endoleaks were significantly less common in the Endurant group than in the Talent group (8.3% versus 28.6%; p = 0.035). Rates of major and minor complications were not significantly different between both groups. Primary clinical success was significantly better in the Endurant group (97.2%) than in the Talent group (80.0%) (p = 0.028). Conclusion Endurant endografts appear to have better technical and clinical outcome in patients with difficult aortoiliac anatomy, significantly reducing the occurrence of type 2 endoleaks.
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Affiliation(s)
- Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany.
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Dzieciuchowicz L, Espinosa G, Diaz CV, Lavilla Roya FJ, Lostao JA. Renal Function in Patients Treated With Abdominal Aortic Stentgraft Implantation With an Intentional Occlusion of Accessory Renal Artery. Ann Vasc Surg 2012; 26:299-305. [DOI: 10.1016/j.avsg.2011.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 08/09/2011] [Accepted: 08/16/2011] [Indexed: 10/14/2022]
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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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Kalteis M, Haller F, Artmann A, Ratzenböck M, Hartl P, Lugmayr H. Experience and outcomes after a decade of endovascular abdominal aortic aneurysm repair: a retrospective study from a community-based single center. Ann Vasc Surg 2012; 26:330-7. [PMID: 22285344 DOI: 10.1016/j.avsg.2011.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 04/04/2011] [Accepted: 06/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study is to report the results of endovascular abdominal aortic aneurysm treatment based on the Zenith stent-graft from a community-based single center over a period of 9 years. METHODS We retrospectively analyzed immediate technical and clinical results as well as long-term outcomes in patients treated with endovascular aneurysm repair between 2001 and 2010. The study was performed in accordance with the recommendations of the ad hoc committee for standardized reporting practice in vascular surgery. RESULTS A total of 106 patients were treated in a period of 9 years. A Zenith stent-graft was used in 95% of cases. No deaths occurred during the first 30 days postsurgery. The complication rate was 4.7% (n = 5). The overall clinical and technical success rate at 30 days was 93.4%. After a mean follow-up period of 52 months (range, 13-112 months), the overall mortality rate was 25.4%. Aneurysm-related mortality was 2.1%. Rupture of the aneurysm occurred in four cases (4.3%). The final clinical failure rate was 13.8%. During the follow-up period, the mean diameter of the aneurysm decreased from 58.0 to 52.3 mm. However, expansion of the aneurysm was registered in 10 cases. Eleven patients had a primary endoleak, and another 11 secondary endoleaks occurred during the follow-up. The reintervention rate was 16.3%. The main reasons for repeat interventions were iliac limb occlusion (n = 5) and type 3 endoleak/limb disconnection (n = 4). Graft migration occurred in 3% of cases. A negative impact on sexual function after endovascular repair was reported by 20% of patients. CONCLUSION Endovascular repair is the treatment of choice for high-risk patients. A small but significant number of clinical failures were observed during the long-term follow-up.
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Affiliation(s)
- Manfred Kalteis
- Departments of Cardiac, Vascular and Thoracic Surgery, Klinikum Wels-Grieskirchen, Wels, Austria.
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Management of peripheral arterial disease: Role of computed tomography angiography and magnetic resonance angiography. Presse Med 2011; 40:e437-52. [DOI: 10.1016/j.lpm.2010.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 10/25/2010] [Indexed: 11/22/2022] Open
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Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model. J Vasc Surg 2011; 54:644-53. [DOI: 10.1016/j.jvs.2011.03.217] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/04/2011] [Accepted: 03/04/2011] [Indexed: 11/19/2022]
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Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft. J Vasc Surg 2011; 54:48-57.e2. [DOI: 10.1016/j.jvs.2010.12.068] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 12/13/2010] [Accepted: 12/28/2010] [Indexed: 11/15/2022]
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Jim J, Rubin BG, Geraghty PJ, Sanchez LA. Long-term outcomes of endovascular aneurysm repair for challenging aortic necks using the Talent endograft. Vascular 2011; 19:132-40. [PMID: 21652665 DOI: 10.1258/vasc.2011.oa0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the present paper is to evaluate the long-term outcomes of endovascular aneurysm repair (EVAR) for challenging aortic necks. Subgroup analyses were performed on 156 patients from the prospective multicenter Talent eLPS (enhanced Low Profile Stent Graft System) trial. Patients with high-risk aortic necks (length < 15 mm or diameter ≥28 mm) were compared with the remaining patients. Patients with high-risk (n = 86) and low-risk necks (n = 70) had similar age and gender distribution. Despite similar prevalences of co-morbidities, the high-risk group had higher Society for Vascular Surgery scores. The high-risk group also had larger maximum aneurysm diameters (56.6 versus 53.0 mm, P < 0.02). There were lower freedoms from major adverse events (MAEs) for the high-risk group at 30 days (84.9 versus 95.7%; P < 0.04) and 365 days (73.4 versus 89.2%; P = 0.02). Effectiveness endpoints at 12 m showed no significant differences. Freedom from all-cause mortality at 30 days (96.5 versus 100%) and aneurysm-related mortality at 365 days (96.0 versus 100%) were similar. At five years, there were no differences in endoleaks or change in aneurysm diameter. All migrations occurred in the high-risk group. The five-year freedom from aneurysm-related mortality for the high- and low-risk groups was 93.2 and 100%, respectively. In conclusion, despite a higher rate of MAEs within the first year and higher migration rates at five years, EVAR in aneurysms with challenging aortic necks can be treated with acceptable long-term results.
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Affiliation(s)
- Jeffrey Jim
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8109, St Louis, MO 63110, USA
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Canì A, Cotta E, Recaldini C, Lumia D, Fontana F, Carrafiello G, Colli V, Fugazzola C. Volumetric analysis of the aneurysmal sac with computed tomography in the follow-up of abdominal aortic aneurysms after endovascular treatment. Radiol Med 2011; 117:72-84. [PMID: 21643642 DOI: 10.1007/s11547-011-0687-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/30/2010] [Indexed: 11/29/2022]
Affiliation(s)
- A Canì
- Ospedale di Circolo e Fondazione Macchi, Scuola di Specializzazione in Radiodiagnostica, Università degli Studi dell'Insubria, Viale Borri 57, 21100, Varese, Italy.
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Cornelissen SA, van der Laan MJ, Vincken KL, Vonken EJPA, Viergever MA, Bakker CJ, Moll FL, Bartels LW. Use of Multispectral MRI to Monitor Aneurysm Sac Contents After Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2011; 18:274-9. [DOI: 10.1583/10-3271.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stollwerck PL, Kozlowski B, Sandmann W, Grabitz K, Pfeiffer T. Long-term dilatation of polyester and expanded polytetrafluoroethylene tube grafts after open repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2011; 53:1506-13. [PMID: 21536404 DOI: 10.1016/j.jvs.2011.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Revised: 02/07/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Since 1995, expanded polytetrafluoroethylene (ePTFE) grafts have been implemented in open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and are supposed to show less dilatation than polyester grafts. This study examined differences in graft dilatation and clinical outcome. METHODS This single-center long-term, prospective randomized study monitored 99 consecutive patients after OSR of AAA. Implanted were 90 tube ePTFE Gore-Tex Stretch grafts, 56 tube Dacron grafts (Uni-Graft KDV, polyester, B. Braun, knitted), and 51 tube Dacron grafts (Gelseal Plus, polyester, Vascutek, triaxial knitted). Follow-up with ultrasound examination was performed at discharge, at 12 months, and at 6 years. RESULTS Patients were a mean age of 67 years. Thirty-day mortality was 2.5% (n = 5 of 199), without significant differences among the groups. The Kaplan-Meier analysis showed 5-year survivals of 0.82 (ePTFE/Gore), 0.81 (polyester/Braun), and 0.83 (polyester/Vascutek). Mean ± standard deviation dilatation of the midgraft segment was 1% ± 5% (ePTFE/Gore), 10% ± 9% (polyester/Braun), and 7% ± 8% (polyester/Vascutek) (P ≤ .001) at discharge; 8% ± 11% (ePTFE/Gore), 24% ± 7% (polyester/Braun), and 20% ± 13% (polyester/Vascutek; P ≤ .001) after 12 months; and 19% ± 21% (ePTFE/Gore), 33% ± 22% (polyester/Braun), and 23% ± 19% (polyester/Vascutek; (P ≤ .001) after 6 years. No graft failure or rupture occurred. Graft patency was 100%. CONCLUSIONS After a mean implantation of 6 years, the ePTFE/Gore, polyester/Braun, and polyester/Vascutek tube grafts presented with significant differences. The ePTFE grafts showed a stronger resistance against dilatation than the two types of polyester grafts. Owing to similar perioperative and postoperative courses, no advantage could be identified in any group concerning the overall outcome. Vascular implants for OSR of AAA made of ePTFE and polyester are safe, even after a long implantation time. Therefore, the choice of the suitable graft does not depend on its postimplantation dilative characteristics. The outcome is not likely to be connected with dilatation of the implanted graft, because a causal connection between graft dilatation and death cannot be made. The study does not offer a basis for the preference of one of the three graft types. Nevertheless, continuous ultrasound examinations should be performed after implantation of an aortic tube graft to identify possible problems arising from changes in the graft and the residual vascular branches over time.
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Affiliation(s)
- Peter L Stollwerck
- Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine University, University Hospital, Düsseldorf, Germany
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Outcome of Endovascular Repair of Small and Large Abdominal Aortic Aneurysms. Ann Vasc Surg 2011; 25:306-14. [DOI: 10.1016/j.avsg.2010.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/25/2010] [Indexed: 11/21/2022]
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Verhoeven BA, Waasdorp EJ, Gorrepati ML, van Herwaarden JA, Vos JA, Wille J, Moll FL, Zarins CK, de Vries JPP. Long-term results of Talent endografts for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2011; 53:293-8. [DOI: 10.1016/j.jvs.2010.08.078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 08/25/2010] [Accepted: 08/26/2010] [Indexed: 10/18/2022]
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Mehta M, Paty PS, Roddy SP, Taggert JB, Sternbach Y, Kreienberg PB, Chang BB, Darling RC. Treatment options for delayed AAA rupture following endovascular repair. J Vasc Surg 2011; 53:14-20. [DOI: 10.1016/j.jvs.2010.07.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 06/16/2010] [Accepted: 07/08/2010] [Indexed: 11/16/2022]
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Gawenda M. Commentary: Endovascular treatment of abdominal aortic aneurysms with large diameter proximal necks: a European experience. J Endovasc Ther 2010; 17:585-8. [PMID: 20939712 DOI: 10.1583/10-3140c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michael Gawenda
- Department of Vascular Surgery, University of Cologne, Germany.
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Jim J, Rubin BG, Geraghty PJ, Criado FJ, Fajardo A, Sanchez LA. A 5-Year Comparison of EVAR for Large and Small Aortic Necks. J Endovasc Ther 2010; 17:575-84. [DOI: 10.1583/10-3140.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Torsello G, Schönefeld E, Osada N, Austermann M, Pennekamp C, Donas KP. Endovascular Treatment of Common Iliac Artery Aneurysms Using the Bell-Bottom Technique: Long-term Results. J Endovasc Ther 2010; 17:504-9. [DOI: 10.1583/10-3112.1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Five-year results for the Talent enhanced Low Profile System abdominal stent graft pivotal trial including early and long-term safety and efficacy. J Vasc Surg 2010; 51:537-544, 544.e1-2. [PMID: 20206803 DOI: 10.1016/j.jvs.2009.09.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Revised: 09/15/2009] [Accepted: 09/16/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The pivotal trial of the Talent enhanced Low Profile System (eLPS; Medtronic Vascular, Santa Rosa, Calif) stent graft evaluated short and long-term safety and efficacy of endovascular aneurysm repair (EVAR). These data and a confirmatory group assessing the performance of the CoilTrac delivery system supported the United States premarket approval application for the device. METHODS The pivotal trial was a prospective, nonrandomized study conducted at 13 sites from February 2002 to April 2003. The study group (n = 166) underwent EVAR using the Talent eLPS stent graft. The control group (n = 243) underwent open surgical AAA repair. Data for this group were obtained from the Society for Vascular Surgery Endovascular AAA Surgical Controls project. Outcomes were compared at 30 days and 12 months. Additional 5-year follow-up was obtained for the eLPS group. A single-center cohort of 137 patients was the confirmatory group for the assessment of the clinical performance of the CoilTrac delivery system, with analysis of outcomes <or=30 days from the procedure. RESULTS AAA anatomy with neck length as short as 3 mm and maximum neck diameter of 32 mm were included in the eLPS group. EVAR was superior to open repair for periprocedural outcomes, including mean procedure duration (167.3 vs 196.4 minutes, P < .001), blood transfusion (18.2% vs 56.8%, P < .001), median intensive care unit stay (19.3 vs 74.3 hours, P < .001), and mean hospital stay (3.6 vs 8.2 days, P < .001). Freedom from major adverse events was 89.2% for EVAR at 30 days vs 44.0% (P < .001) and 81.3% vs 42.4% at 1 year (P < .001). Freedom from all-cause mortality and aneurysm-related mortality (ARM) was 93.7% and 98.2% for EVAR vs 92.4% and 96.7% for the controls. Through 5 years for the EVAR group, rates of freedom from all-cause mortality, ARM, aneurysm rupture, and conversion to surgery were 69.8%, 96.5%, 98.2%, and 99.1%, respectively, with one conversion to surgery, 25 secondary reinterventions, and five site-reported instances of stent graft migration. The technical success rate for the CoilTrac confirmatory group was 100%, with no aneurysm rupture or conversion to open repair at 30 days. The 30-day all-cause mortality rate was 1.5% (2 of 137). CONCLUSIONS In a population with challenging anatomic characteristics, EVAR with the Talent eLPS and use of the CoilTrac delivery system compared favorably with open repair through 1 year. Sustained protection from ARM, with minimal reinterventions, was attained through 5 years.
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AAA stent-grafts: past problems and future prospects. Ann Biomed Eng 2010; 38:1259-75. [PMID: 20162359 DOI: 10.1007/s10439-010-9953-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
Endovascular aneurysm repair (EVAR) has quickly gained popularity for infrarenal abdominal aortic aneurysm repair during the last two decades. The improvement of available EVAR devices is critical for the advancement of patient care in vascular surgery. Problems are still associated with the grafts, many of which can necessitate the conversion of the patient to open repair, or even result in rupture of the aneurysm. This review attempts to address these problems, by highlighting why they occur and what the failings of the currently available stent grafts are, respectively. In addition, the review gives critical appraisal as to the novel methods required for dealing with these problems and identifies the new generation of stent grafts that are being or need to be designed and constructed in order to overcome the issues that are associated with the existing first- and second-generation devices.
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Infection of an aortic stent graft with suprarenal fixation. Ann Vasc Surg 2009; 24:418.e1-6. [PMID: 20036496 DOI: 10.1016/j.avsg.2009.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 08/20/2009] [Accepted: 08/26/2009] [Indexed: 11/21/2022]
Abstract
We report a case of an elderly man admitted with abdominal pain and fever, 5 months after endovascular aortic aneurysm repair of a suspected inflammatory abdominal aortic aneurysm. He underwent successful explantation of an infected stent graft with suprarenal fixation following extra-anatomic revascularization. After a prolonged hospitalization, he was discharged on antibiotics and at follow-up has returned to baseline activity level. Although explantation of an infected prosthesis following endovascular aortic aneurysm repair has been previously reported, our case prompted a review of the literature to evaluate mode of presentation, putative factors, and management decisions associated with reduced morbidity and mortality.
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Endovascular Abdominal Aortic Aneurysm Repair: Part I. Ann Vasc Surg 2009; 23:799-812. [DOI: 10.1016/j.avsg.2009.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 03/21/2009] [Indexed: 12/20/2022]
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Perdikides T, Georgiadis GS, Avgerinos ED, Fotis T, Verikokos C, Hopkinson BR, Lagios K. The Aorfix Stent-Graft to Treat Infrarenal Abdominal Aortic Aneurysms With Angulated Necks and/or Tortuous Iliac Arteries:Midterm Results. J Endovasc Ther 2009; 16:567-76. [DOI: 10.1583/09-2822.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zipfel B, Buz S, Düsterhöft V, Hetzer R. Initial Experience With Abdominal Aneurysm Repair Using the E-vita Abdominal Stent-Graft:A Single-Center Study. J Endovasc Ther 2009; 16:577-89. [DOI: 10.1583/09-2824.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bley TA, Chase PJ, Reeder SB, François CJ, Shinki K, Tefera G, Ranallo FN, Grist TM, Pozniak M. Endovascular abdominal aortic aneurysm repair: nonenhanced volumetric CT for follow-up. Radiology 2009; 253:253-62. [PMID: 19703867 DOI: 10.1148/radiol.2531082093] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the clinical usefulness of volumetric analysis at nonenhanced computed tomography (CT) as the sole method with which to follow up endovascular abdominal aortic aneurysm repair (EVAR) and to identify endoleaks causing more than 2% volumetric increase from the previous volume determination. MATERIALS AND METHODS The study had institutional review board approval. Images were reviewed retrospectively in a HIPAA-compliant manner for 230 CT studies in 70 patients (11 women, 59 men; mean age, 74 years) who underwent EVAR. The scannning protocol consisted of three steps: (a) contrast material-enhanced CT angiography before endovascular stent placement, (b) contrast-enhanced CT angiography 0-3 months after repair to depict immediate complications, and (c) nonenhanced CT at 3, 6, and 12 months after repair. At each follow-up visit, immediate aortic volume analysis was performed. If the interval volumetric change was 2% or less, no further imaging was performed. If the volume increased by more than 2% on the nonenhanced CT image, contrast-enhanced CT angiography was performed immediately to identify the suspected endoleak. Confidence intervals (CIs) were obtained by using bootstrapping to account for repeated measurements in the same patients. RESULTS Mean volume decrease was -3.2% (95% CI: -4.7%, -1.9%) in intervals without occurrence of a clinically relevant endoleak (n = 183). Types I and III high-pressure endoleaks (n = 10) showed a 10.0% (95% CI: 5.0%, 18.2%) interval volumetric increase. Type II low-pressure endoleaks (n = 37) showed a 5.4% (95% CI: 4.6%, 6.2%) interval volumetric increase. Endoleaks associated with minimal aortic volume increase of less than 2% did not require any intervention. This protocol reduced radiation exposure by approximately 57%-82% in an average-sized patient. CONCLUSION Serial volumetric analysis of aortic aneurysm with nonenhanced CT serves as an adequate screening test for endoleak, causing volumetric increase of more than 2% from the volume seen at the previous examination.
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Affiliation(s)
- Thorsten A Bley
- Departments of Radiology, Statistics, and Vascular Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
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Pitton MB, Scheschkowski T, Ring M, Herber S, Oberholzer K, Leicher-Düber A, Neufang A, Schmiedt W, Düber C. Ten-Year Follow-Up of Endovascular Aneurysm Treatment with Talent Stent-Grafts. Cardiovasc Intervent Radiol 2009; 32:906-17. [DOI: 10.1007/s00270-009-9599-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 03/05/2009] [Accepted: 03/16/2009] [Indexed: 11/24/2022]
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Espinosa G, Ribeiro Alves M, Ferreira Caramalho M, Dzieciuchowicz L, Santos SR. A 10-Year Single-Center Prospective Study of Endovascular Abdominal Aortic Aneurysm Repair With the Talent Stent-Graft. J Endovasc Ther 2009; 16:125-35. [DOI: 10.1583/08-2686.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cairols-Castellote M, Salmerón-Febres L, Fernández-Samos R, Iborra-Ortega E, Vaquero-Puerta C, Marco-Luque M, Doblas-Domínguez M, Riera de Cubas L, Reparaz-Asensio L, Fernández-Valenzuela V, Crespo C, Rodríguez J. Análisis coste-efectividad del tratamiento del aneurisma de aorta abdominal mediante prótesis endovascular en España. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)12001-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Coppi G, Silingardi R, Tasselli S, Gennai S, Saitta G, Veraldi GF. Endovascular treatment of abdominal aortic aneurysms with the Powerlink Endograft System: Influence of placement on the bifurcation and use of a proximal extension on early and late outcomes. J Vasc Surg 2008; 48:795-801. [DOI: 10.1016/j.jvs.2008.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 04/24/2008] [Accepted: 05/04/2008] [Indexed: 11/26/2022]
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50
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Maleux G, Koolen M, Heye S, Nevelsteen A. Limb Occlusion after Endovascular Repair of Abdominal Aortic Aneurysms with Supported Endografts. J Vasc Interv Radiol 2008; 19:1409-12. [DOI: 10.1016/j.jvir.2008.07.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 06/19/2008] [Accepted: 07/05/2008] [Indexed: 12/01/2022] Open
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