1
|
Smorenburg SPM, de Bruin JL, Zeebregts CJ, Reijnen MMPJ, Verhagen HJM, Heyligers JMM. Long Term Outcomes of the Gore Excluder Low Permeability Endoprosthesis for the Treatment of Infrarenal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2024; 68:18-27. [PMID: 38527519 DOI: 10.1016/j.ejvs.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE This study evaluated the long term outcomes of endovascular aneurysm repair using the Gore Excluder Low Permeability (LP) endoprosthesis across high volume Dutch hospitals. METHODS A retrospective analysis was conducted of patients treated with the Excluder LP for infrarenal abdominal aortic aneurysm (AAA) in four hospitals between 2004 and 2017. Primary outcomes were overall survival, freedom from re-interventions (overall, inside and outside instructions for use, IFU), and AAA sac dynamics: growth (> 5 mm), stabilisation, and regression (< 5 mm). Secondary outcomes were technical success (device deployment), procedural parameters, and re-interventions. Follow up visits were extracted from patient files, with imaging assessed for complications and AAA diameter. RESULTS Five hundred and fourteen patients were enrolled, with a median (IQR) follow up of 5.0 (2.9, 6.9) years. Survival rates were 94.0% at one year, 73.0% at five years, and 37.0% at 10 years, with freedom from re-interventions of 89.0%, 79.0%, and 71.0%, respectively. 37.9% were treated outside IFU, leading to significantly more re-interventions over 10 years compared with those treated inside IFU (36.0% vs. 25.0%, respectively; p = .044). The aneurysm sac regressed by 53.5% at one year, 65.8% at five years, and 77.8% at 10 years, and grew by 9.8%, 14.3%, and 22.2%, respectively. Patients with one year sac growth had significantly worse survival (p = .047). Seven patients (1.4%) had a ruptured aneurysm during follow up. Over 15 years, type 1a endoleak occurred in 5.3%, type 1b in 3.1%, type 3 in 1.9%, type 4 in 0.2%, and type 2 in 35.6% of patients. CONCLUSION This multicentre study of real world endovascular aneurysm repair data using the Gore Excluder LP endoprosthesis demonstrated robust long term survival and re-intervention rates, despite 37.9% of patients being treated outside IFU, with type 4 endoleak being rare. Treatment outside IFU significantly increased re-intervention rates and one year sac growth was associated with statistically significantly worse survival.
Collapse
Affiliation(s)
- Stefan P M Smorenburg
- Department of Surgery, Amsterdam University Medical Centres location Vrije Universiteit, Amsterdam, the Netherlands
| | - Jorg L de Bruin
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, University of Twente, Enschede, the Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jan M M Heyligers
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
| |
Collapse
|
2
|
Jubouri M, Surkhi AO, Tan SZ, Bailey DM, Williams IM, Bashir M. Correlative effect between sac regression and patient longevity following endovascular solution for abdominal aortic aneurysms: an international analysis. Asian Cardiovasc Thorac Ann 2023; 31:557-564. [PMID: 36168205 DOI: 10.1177/02184923221129983] [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: 11/15/2022]
Abstract
INTRODUCTION Since the introduction of endovascular aortic repair (EVAR) it has become the mainstay treatment for abdominal aortic aneurysms. Several EVAR devices exist commercially, yet, the Terumo Aortic Fenestrated Anaconda™ endograft has demonstrated outstanding results. Evidence in the literature suggests that sac regression could be linked to patient survival and longevity. The main scope of this study is to evaluate sac regression and survival achieved using the Fenestrated Anaconda™ endograft and to discuss relevant literature. MATERIALS AND METHODS The current study represents a nine-year cross-sectional international analysis of custom-made Fenestrated Anaconda™ device. For the statistical analysis, SPSS 28 for Windows and R were utilised. Pearson chi-square analysis was used to assess differences in cumulative distribution frequencies between select variables. Statistical significance for all two-tailed tests was set at p < 0.05. RESULTS A total of 5,058 patients received the Fenestrated Anaconda™ in this study, either due to unsuitable/complex anatomy for competitor devices (n = 3,891) or based on surgeon preference (n = 1,167). A sac regression of 0-30% was observed in 4,772 (94.3%) over the first four years post-EVAR. Here, 99.6% of patients receiving the Fenestrated Anaconda™ due to unsuitable/complex anatomy for competitor devices and 76.8% based on surgeon preference had 0-30% sac regression. During years 5-9 of follow-up, all patients had 20-45% sac regression. Patient survival during the first six years post-EVAR was 100% but dropped to 77.1% in years 7-9. Survival differed between categorical patient subsets based on the indication. DISCUSSION The Fenestrated Anaconda™ has been proven to be a highly effective EVAR endograft. Evidence in the literature clearly demonstrates that sac regression is an accurate prognostic factor for patient survival and longevity.
Collapse
Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | | | - Sven Zcp Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
- Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, UK
| |
Collapse
|
3
|
Van Gool F, Houthoofd S, Mufty H, Bonne L, Fourneau I, Maleux G. Long-term outcome results after endovascular aortoiliac aneurysm repair with the bifurcated EXCLUDER Endoprosthesis. J Vasc Surg 2021; 75:1882-1889.e2. [PMID: 34627959 DOI: 10.1016/j.jvs.2021.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report the long-term outcome of patients presenting with an aortic, aortoiliac, or isolated common iliac aneurysm treated with the bifurcated EXCLUDER Endoprosthesis. Furthermore, potential differences in late outcome results between the original- and low-permeability endoprosthesis were analyzed. METHODS A retrospective analysis of prospectively collected data of 182 patients who underwent endovascular aneurysm repair with the EXCLUDER Endoprosthesis between June 1998 and October 2015 in an academic, tertiary care center for aortic disease was performed. Patient follow-up was from 3 to 20 years (mean follow-up of 6.9 years). Primary end points were overall survival and reintervention-free survival. Secondary end points were device-related complications, endoleaks, and reinterventions. RESULTS Overall survival at 5, 10, and 15 years was 72.8%, 42.1%, and 12.2%, respectively, with no aneurysm-related mortality and no difference in overall survival between the original- vs low-permeability endoprosthesis group (P = .617). Freedom from type I endoleak at 5 years was 94.8%. No new type I endoleak was detected beyond the 5-year follow-up mark. No type III endoleak was identified. Reintervention-free survival was 83.6%, 66.7%, and 66.7% at 5-, 10-, and 15-year follow-up, respectively. There was a significant difference in intervention-free survival between the original- vs low-permeability endoprosthesis group (P = .029) and after the 5-year follow-up mark. In addition, patients with the low-permeability endoprosthesis showed significantly fewer device-related complications (P = .002) and endoleaks (P = .005). CONCLUSIONS Endovascular aneurysm repair using the EXCLUDER Endoprosthesis is effective and durable on long-term follow-up, with acceptably low device-related complications and reinterventions. The low-permeability endoprosthesis was associated with significantly fewer new device-related complications and endoleaks after 5 years of follow-up.
Collapse
Affiliation(s)
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
4
|
Torres-Blanco Á, Miralles-Hernández M. Endotension: twenty years of a controversial term. CVIR Endovasc 2021; 4:46. [PMID: 34089419 PMCID: PMC8179872 DOI: 10.1186/s42155-021-00238-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
Use of the term endotension in the treatment of aortic aneurysm is currently controversial. Initially it was proposed to define the circumstance in which there is an enlargement of the aneurysm sac after endovascular repair without a demonstrable endoleak. The term was established with the aim of transmitting the possibility of causes other than pressure applying stress to the aneurysm wall. Twenty years have passed since the proposal of this terminology was published. The literature is reviewed with the purpose of providing an update on advances in the knowledge of the possible etiological mechanisms. The experimental studies call into question that causes other than pressure determine the increase of the aneurysm. On the basis of this review, the term `Sac Expansion Without Evident Leak´ (SEWEL) is proposed as a more accurate and precise denomination for what is aimed to be defined. Evidence suggests that the more likely mechanisms of persistent pressurization of the aneurysm sac are an unidentified endoleak (likely type I or low-flow Type II) or thrombus occluding wide and short channels that connects with the excluded aneurysm sac (at the attachment sites of the stent-graft or at the branch vessels orifices).
Collapse
Affiliation(s)
- Álvaro Torres-Blanco
- Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario y Politécnico La Fe, Av/ Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | | |
Collapse
|
5
|
King AH, Ambani RN, Harth KC, Kashyap VS, Kumins NH, Wong VL, Baele HR, Cho JS. Frequency of perigraft hygroma after open aortic reconstruction. J Vasc Surg 2020; 72:154-161. [DOI: 10.1016/j.jvs.2019.10.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/07/2019] [Indexed: 11/15/2022]
|
6
|
Salata K, Syed M, Hussain MA, de Mestral C, Greco E, Mamdani M, Tu JV, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Statins Reduce Abdominal Aortic Aneurysm Growth, Rupture, and Perioperative Mortality: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 7:e008657. [PMID: 30371297 PMCID: PMC6404894 DOI: 10.1161/jaha.118.008657] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background There are no recognized pharmacological treatments for abdominal aortic aneurysms (AAA), although statins are suggested to be beneficial. We sought to summarize the literature regarding the effects of statins on human AAA growth, rupture, and 30‐day mortality. Methods and Results We conducted a systematic review and meta‐analysis of randomized and observational studies using the Cochrane CENTRAL database, MEDLINE, and EMBASE up to June 15, 2018. Review, abstraction, and quality assessment were conducted by 2 independent reviewers, and a third author resolved discrepancies. Pooled mean differences and odds ratios with 95% confidence intervals were calculated using random effects models. Heterogeneity was quantified using the I2 statistic, and publication bias was assessed using funnel plots. Our search yielded 911 articles. One case‐control and 21 cohort studies involving 80 428 patients were included. The risk of bias was low to moderate. Statin use was associated with a mean AAA growth rate reduction of 0.82 mm/y (95% confidence interval 0.33, 1.32, P=0.001, I2=86%). Statins were also associated with a lower rupture risk (odds ratio 0.63, 95% confidence interval 0.51, 0.78, P<0.0001, I2=27%), and preoperative statin use was associated with a lower 30‐day mortality following elective AAA repair (odds ratio 0.55, 95% confidence interval 0.36, 0.83, P=0.005, I2=57%). Conclusions Statin therapy may be associated with reduction in AAA progression, rupture, and lower rates of perioperative mortality following elective AAA repair. These data argue for widespread statin use in AAA patients. Clinical Trial Registration URL: http://www.crd.york.ac.uk. Unique identifier: CRD42017056480.
Collapse
Affiliation(s)
- Konrad Salata
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Muzammil Syed
- 3 Faculty of Science McMaster University Hamilton Ontario Canada
| | - Mohamad A Hussain
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Charles de Mestral
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Elisa Greco
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Muhammad Mamdani
- 4 Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART) Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.,5 Leslie Dan Faculty of Pharmacy University of Toronto Ontario Canada.,6 Department of Medicine Faculty of Medicine University of Toronto Ontario Canada.,7 Institute of Health Policy, Management and Evaluation Dalla Lana Faculty of Public Health University of Toronto Ontario Canada.,8 Institute for Clinical Evaluative Sciences at Sunnybrook Hospital Toronto Ontario Canada
| | - Jack V Tu
- 7 Institute of Health Policy, Management and Evaluation Dalla Lana Faculty of Public Health University of Toronto Ontario Canada.,8 Institute for Clinical Evaluative Sciences at Sunnybrook Hospital Toronto Ontario Canada.,9 Division of Cardiology Department of Medicine Schulich Heart Program Sunnybrook Hospital Toronto Ontario Canada.,10 Schulich Heart Research Program Sunnybrook Research Institute at Sunnybrook Hospital Toronto Ontario Canada
| | - Thomas L Forbes
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,11 Division of Vascular Surgery Toronto General Hospital Toronto Ontario Canada
| | - Deepak L Bhatt
- 12 Brigham and Women's Hospital Heart and Vascular Center Boston MA.,13 Harvard Medical School Boston MA
| | - Subodh Verma
- 14 Division of Cardiac Surgery Department of Surgery University of Toronto Ontario Canada.,15 Division of Cardiac Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Mohammed Al-Omran
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada.,16 Department of Surgery King Saud University Riyadh Kingdom of Saudi Arabia
| |
Collapse
|
7
|
Bewley BR, Servais AB, Salehi P. The evolution of stent grafts for endovascular repair of abdominal aortic aneurysms: how design changes affect clinical outcomes. Expert Rev Med Devices 2019; 16:965-980. [DOI: 10.1080/17434440.2019.1684897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Payam Salehi
- Tufts University School of Medicine, Boston, MA, USA
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
8
|
Jetty P, Husereau D, Kansal V, Zhang T, Nagpal S. Variability in aneurysm sac regression after endovascular aneurysm repair based on a comprehensive registry of patients in Eastern Ontario. J Vasc Surg 2019; 70:1469-1478. [DOI: 10.1016/j.jvs.2019.01.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/22/2019] [Indexed: 12/01/2022]
|
9
|
Plá Sánchez F, Martínez López I, Hernández Mateo MM, Marqués de Marino P, Ucles Cabeza O, Baturone Blanco A, Serrano Hernando FJ. Prognostic Value of Initial Aneurysmal Sac Regression after EVAR. Ann Vasc Surg 2019; 64:109-115. [PMID: 31629125 DOI: 10.1016/j.avsg.2019.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/11/2019] [Accepted: 09/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the impact of initial aneurysmal sac reduction after endovascular aneurysm repair on the evolution of aneurysmal sac over follow-up. METHODS A retrospective cohort study was made of patients subjected to elective treatment between January 2005 and December 2014, with a minimum follow-up of 18 months. An analysis was made of the evolution of the aneurysmal sac according to its condition one year after surgery, defining of two groups: A (sac reduction) and B (stable sac). Follow-up by computed tomography (CT) angiography was made after one month and then every 6 months or annually, depending on the presence of endoleak. RESULTS A total of 128 patients were included. Fifty-one patients (39.8%) showed a significant decrease in diameter during the first year (group A), whereas 77 patients (60.2%) showed no initial decrease (group B). Preoperative CT angiography showed the patients in group A to have larger aneurysms (63.5 mm vs. 59.25; P = 0.048), a greater presence of posterior thrombus (68.6% vs. 30.7%; P < 0.001), and fewer patent lumbar vessels (56.9% vs. 83.1%; P = 0.001). The prevalence of endoleak at some point during follow-up was lower in group A (31.4% vs. 74% in group B; P < 0.001), and 100% of all aneurysmal growths were associated to the presence of endoleak. After 5 years, significant differences were observed in the growth-free rate (96.9% in group A vs. 85.2% in group B; hazard ratio [HR] 4.8 [1.1-21.4; P = 0.036]) and in the reintervention-free rate (95,7% vs. 84.6%; HR 6.6 [0.8-52.4; P = 0.07]). No reoperation in group A was due to type II endoleak. CONCLUSIONS The aneurysmal sac can be expected to take a favorable course in those cases characterized by initial aneurysmal sac reduction. These findings may imply a change in the follow-up protocol, even in cases with type II endoleak.
Collapse
Affiliation(s)
- Ferrán Plá Sánchez
- Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid, Spain.
| | - Isaac Martínez López
- Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid, Spain
| | | | | | - Oscar Ucles Cabeza
- Angiology and Vascular Surgery Department, San Carlos Clinical Hospital, Madrid, Spain
| | | | | |
Collapse
|
10
|
The structural atrophy of the aneurysm wall in secondary expanding aortic aneurysms with endoleak type II. J Vasc Surg 2019; 70:1318-1326.e5. [DOI: 10.1016/j.jvs.2018.10.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/04/2018] [Indexed: 01/09/2023]
|
11
|
Clinical and Morphological Outcomes in Endovascular Aortic Repair of Abdominal Aortic Aneurysm Using GORE C3 EXCLUDER: Comparison between Patients Treated within and Outside Instructions for Use. Ann Vasc Surg 2019; 59:54-62. [DOI: 10.1016/j.avsg.2018.12.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
|
12
|
Torres Blanco Á, Gómez Palonés F. Endotensión. Revisión de un término controvertido. ANGIOLOGIA 2018. [DOI: 10.1016/j.angio.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
13
|
Third- versus Second-Generation Stent Graft for Endovascular Aneurysm Repair: A Device-Specific Analysis. Ann Vasc Surg 2017; 44:67-76. [DOI: 10.1016/j.avsg.2017.03.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/01/2017] [Indexed: 01/16/2023]
|
14
|
Sudiono DR, Hoencamp R, Ottevanger J, Eefting D, van der Linden E. Aortic Aneurysm Rupture After Urokinase Treatment for Acute Limb Ischemia in Two Patients After EVAR. Cardiovasc Intervent Radiol 2017; 40:1641-1644. [PMID: 28470393 DOI: 10.1007/s00270-017-1671-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/24/2017] [Indexed: 11/30/2022]
Abstract
Endovascular aneurysm repair (EVAR) is first-choice treatment for many patients with abdominal aortic aneurysms. Complications unique to endovascular treatment include endoleak and endotension, which can eventually lead to rupture. We present two cases of late aortic rupture after EVAR, where both patients had recent preceding catheter-directed thrombolysis with urokinase for acute limb ischemia. These cases suggest a relation between thrombolytic therapy and aortic rupture after EVAR, and we should therefore be aware of this possible complication.
Collapse
Affiliation(s)
- Davy R Sudiono
- Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, PO Box 432, 3000 CA, Den Haag, The Netherlands.
| | - Rigo Hoencamp
- Ministry of Defence, Department of Surgery, Alrijne Medical Center, Simon Smitweg 1, Leiderdorp, The Netherlands
| | - Jaap Ottevanger
- Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, PO Box 432, 3000 CA, Den Haag, The Netherlands
| | - Daniel Eefting
- Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, Den Haag, The Netherlands
| | - Edwin van der Linden
- Department of Radiology, Haaglanden Medical Center, Lijnbaan 32, PO Box 432, 3000 CA, Den Haag, The Netherlands
| |
Collapse
|
15
|
Anatomic characteristics of abdominal aortic aneurysms presenting with delayed rupture after endovascular aneurysm repair. J Vasc Surg 2016; 64:1629-1632. [DOI: 10.1016/j.jvs.2016.04.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/24/2016] [Indexed: 11/23/2022]
|
16
|
Outcomes of type II endoleaks after endovascular abdominal aortic aneurysm (AAA) repair: a single-center, retrospective study. Clin Imaging 2016; 40:875-9. [PMID: 27179957 DOI: 10.1016/j.clinimag.2016.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/16/2016] [Accepted: 04/12/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE This study aims to determine incidence and outcomes of type II endoleaks (T2E) after endovascular abdominal aortic aneurysm repair (EVAR). METHODS A retrospective review of procedural angiograms, computed tomography angiography, and medical records of 202 patients who underwent EVAR with the Gore Excluder stent graft was performed to determine presence and outcomes of T2E. RESULTS Median follow-up time for 163 patients meeting inclusion criteria [136 males (83%)] was 24.7 months (range=0.5-85.2 months). T2E occurred in 66/163 patients (40.5%). Aneurysm sac size was unchanged in 32/66 patients (48.5%), decreased in 22/66 (33.3%), and increased in 12/66 (18.2%). No aneurysm ruptures, conversion to open repair, or aneurysm-related deaths occurred. CONCLUSION T2E are a common occurrence after EVAR, often with benign outcome. However, routine surveillance should be performed, particularly in patients with persistent endoleak or sac growth.
Collapse
|
17
|
Colvard B, Georg Y, Chakfe N, Swanstrom L. Current aortic endografts for the treatment of abdominal aortic aneurysms. Expert Rev Med Devices 2016; 13:475-86. [PMID: 26959727 DOI: 10.1586/17434440.2016.1162709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular Aneurysm Repair is a widely adopted method of treatment for patients with abdominal aortic aneurysms. The minimally invasive approach offered with EVAR has become popular not only among physicians and patients, but in the medical device industry as well. Over the past 25 years the global market for aortic endografts has increased rapidly, resulting in a wide range of devices from various companies. Currently, there are seven endografts approved by the FDA for the treatment of abdominal aortic aneurysms. These devices offer a wide range of designs intended to increase inclusion criteria while decreasing technical complications such as endoleak and migration. Despite advances in device design, secondary interventions and follow-up requirements remain a significant issue. New devices are currently being studied in the U.S. and abroad and may significantly reduce complications and secondary interventions.
Collapse
Affiliation(s)
| | - Yannick Georg
- b Department of Vascular Surgery , CHU Strasbourg , Strasbourg , France
| | - Nabil Chakfe
- b Department of Vascular Surgery , CHU Strasbourg , Strasbourg , France
| | | |
Collapse
|
18
|
Ikoma A, Nakai M, Sato M, Sato H, Minamiguchi H, Sonomura T, Nishimura Y, Okamura Y. Systolic Sac Pressure Index for the Prediction of Persistent Type II Endoleak for 12 Months After Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2015; 39:522-9. [PMID: 26353899 DOI: 10.1007/s00270-015-1191-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/19/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the relationship between the systolic sac pressure index (SPI) and the presence of endoleaks 12 months after endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS We performed a single-center prospective trial of consecutively treated patients. SPI (calculated as systolic sac pressure/systolic aortic pressure) was measured by catheterization immediately after EVAR. Contrast-enhanced computed tomography was scheduled 12 months after EVAR to detect possible endoleaks. RESULTS Data were available for 34 patients who underwent EVAR for an AAA. Persisting type II endoleak was found in 8 patients (endoleak-positive group) but not in the other 26 patients (endoleak-negative group). The mean ± standard deviation SPI was significantly greater in the endoleak-positive group than in the endoleak-negative group (0.692 ± 0.048 vs. 0.505 ± 0.081, respectively; P = .001). Receiver-operating characteristic curve analysis revealed that an SPI of 0.638 was the optimum cutoff value for predicting a persistent endoleak at 12 months with high accuracy (0.971; 33/34), sensitivity (1.00), and specificity (0.962) values. The mean change in AAA diameter was -4.28 ± 5.03 mm and 2.22 ± 4.54 mm in patients with SPI of <0.638 or ≥0.638, respectively (P = .002). CONCLUSION Patients with an SPI of ≥0.638 immediately after EVAR were more likely to have a persistent type II endoleak at 12 months with an accuracy of 0.971, and showed increases in aneurysm sac diameter compared with patients with an SPI of <0.638.
Collapse
Affiliation(s)
- Akira Ikoma
- Departments of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| | - Motoki Nakai
- Departments of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| | - Morio Sato
- Departments of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| | - Hirotatsu Sato
- Departments of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| | - Hiroki Minamiguchi
- Departments of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| | - Tetsuo Sonomura
- Departments of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| | - Yoshiharu Nishimura
- Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| | - Yoshitaka Okamura
- Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
| |
Collapse
|
19
|
Stather PW, Rhema IA, Sidloff DA, Sayers RD, Bown MJ, Choke E. Short-Term Outcomes of Management of Endovascular Aneurysm Repair in Patients With Dilated Iliacs. Vasc Endovascular Surg 2015; 49:75-8. [PMID: 26145754 DOI: 10.1177/1538574415593761] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aims to evaluate outcomes following endovascular aneurysm repair (EVAR) in patients with dilated but not aneurysmal common iliac arteries. METHODS Data prospectively collected from 342 elective EVARs were analyzed retrospectively. Dilated common iliac anatomy was defined as 21 to 24 mm. Patients with iliac aneurysms or external iliac artery (EIA) extension were excluded. Patients were followed up using clinical review, plain radiographs, duplex imaging, and selective computed tomography scanning. RESULTS Median age was 75 years with a mean follow-up of 3.6 years. In all, 33 patients had dilated common iliac arteries (DCIAs) and 309 had non-dilated common iliac arteries (NDCIA). There was no difference in aneurysm diameter or neck characteristics (length, diameter, angulation, thrombus, and flare) between the subgroups. There was no significant difference in technical success, 30-day mortality, late mortality, aneurysm-related mortality, 30-day reinterventions, stent graft migration, limb occlusion, sac expansion, graft rupture, type 1 endoleaks, type 3 endoleaks, and total reinterventions (all Ps > .05). There was a significant decrease in type II endoleaks in patients with DCIA compared to NDCIA (NDCIA 12.9% and DCIA 0.0%; P = .02). CONCLUSION Patients presenting with abdominal aortic aneurysms with DCIA can be successfully treated with EVAR with no increase in complications without extension into the EIA.
Collapse
Affiliation(s)
- P W Stather
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - I A Rhema
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
| | - D A Sidloff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - R D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - M J Bown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom NIHR Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - E Choke
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
20
|
Clemens MS, Scott DJ, Stull MC, Hislop SJ, Propper BW, Arthurs ZM. A technique for endograft relining of a type IV endoleak using a surgeon-modified internal gate. Ann Vasc Surg 2014; 29:123.e13-7. [PMID: 25220344 DOI: 10.1016/j.avsg.2014.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/23/2014] [Accepted: 07/27/2014] [Indexed: 11/19/2022]
Abstract
Type IV endoleaks represent a rare etiology of late endograft failure; however, depending on the location, they can be extremely challenging to repair with endovascular solutions. We present a method of endograft relining that preserves antegrade limb perfusion, avoids extra-anatomic reconstructions, and ensures complete endograft exclusion.
Collapse
Affiliation(s)
- Michael S Clemens
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX.
| | - Daniel J Scott
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Mamie C Stull
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Sean J Hislop
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Brandon W Propper
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Zachary M Arthurs
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| |
Collapse
|
21
|
Verhoeven E, Katsargyris A, Bachoo P, Larzon T, Fisher R, Ettles D, Boyle J, Brunkwall J, Böckler D, Florek HJ, Stella A, Kasprzak P, Verhagen H, Riambau V. Real-world Performance of the New C3 Gore Excluder Stent-Graft: 1-year Results from the European C3 Module of the Global Registry for Endovascular Aortic Treatment (GREAT). Eur J Vasc Endovasc Surg 2014; 48:131-7. [DOI: 10.1016/j.ejvs.2014.04.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
|
22
|
Lynch B, Nelson J, Kavanagh EG, Walsh SR, McGloughlin TM. A Review of Methods for Determining the Long Term Behavior of Endovascular Devices. Cardiovasc Eng Technol 2013. [DOI: 10.1007/s13239-013-0168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Stather PW, Wild JB, Sayers RD, Bown MJ, Choke E. Endovascular Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy. J Endovasc Ther 2013; 20:623-37. [DOI: 10.1583/13-4320mr.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
24
|
Yao T, Choules BD, Rust JP, King MW. The development of anin vitrotest method for predicting the abrasion resistance of textile and metal components of endovascular stent grafts. J Biomed Mater Res B Appl Biomater 2013; 102:488-99. [PMID: 24115449 DOI: 10.1002/jbm.b.33026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/20/2013] [Accepted: 08/01/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Tong Yao
- College of Textiles; North Carolina State University; Raleigh North Carolina 27695
| | | | - Jon P. Rust
- College of Textiles; North Carolina State University; Raleigh North Carolina 27695
| | - Martin W. King
- College of Textiles; North Carolina State University; Raleigh North Carolina 27695
- College of Textiles; Donghua University; Shanghai 201620 People's Republic of China
| |
Collapse
|
25
|
Aortic aneurysm patients are not fit! Eur J Vasc Endovasc Surg 2013; 46:320. [PMID: 23791679 DOI: 10.1016/j.ejvs.2013.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 11/24/2022]
|
26
|
Sangawa K, Aoki A. Endovascular treatment of perigraft seroma after open abdominal aortic aneurysm repair: report of a case. Ann Vasc Dis 2013; 6:218-20. [PMID: 23825508 DOI: 10.3400/avd.cr.13-00021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/25/2013] [Indexed: 11/13/2022] Open
Abstract
Perigraft seroma is a rare complication after open abdominal aortic aneurysm (AAA) repair. We successfully treated large seroma after expanded polytetrafluoroethylene (ePTFE) aortobiiliac graft repair endovascularly. The patient was an 81-year-old lady with the history of five times laparotomy. She could not take any food because of vomiting. Contrast enhanced computed tomography (CT) revealed giant seroma compressing small intestine. Total relining of the graft with a Excluder(TM) endoprosthesis and open drainage of the seroma was performed. After the surgery, she became asymptomatic and seroma disappeared by CT 2 years later. This modality would be a good option for this rare complication.
Collapse
Affiliation(s)
- Kenji Sangawa
- Department of Cardiovascular Surgery, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | | |
Collapse
|
27
|
Láinez Rube R, Dóiz Artázcoz E, Rodríguez Piñero M. Comportamiento del saco aneurismático después del tratamiento endovascular (EVAR). Revisión de una serie de casos (periodo 2009-2012). ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2012.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Stather PW, Sayers RD, Cheah A, Wild JB, Bown MJ, Choke E. Outcomes of endovascular aneurysm repair in patients with hostile neck anatomy. Eur J Vasc Endovasc Surg 2012; 44:556-61. [PMID: 23122183 DOI: 10.1016/j.ejvs.2012.10.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/01/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aims to evaluate outcomes following EVAR in patients with hostile neck anatomy (HNA). METHODS Data prospectively collected from 552 elective EVARs were analysed retrospectively. Data regarding neck morphology was obtained from aneurysm stent plans produced prior to EVAR. HNA was defined as any of; neck diameter >28 mm, neck angulation >60°, neck length <15 mm, neck thrombus, or neck flare. RESULTS 552 patients underwent EVAR. Mean age 73.9 years, mean follow-up 4.1 years. 199 patients had HNA, 353 had favourable neck anatomy (FNA). There was a significant increase in late type I endoleaks (FNA 4.5%, HNA 9.5%; P = 0.02) and total reinterventions (FNA 11.0%, HNA 22.8%; P < 0.01), and a significant decrease in late type II endoleaks in patients with HNA (FNA 16.7%, HNA 10.6%; P < 0.05). There was no significant difference in technical success (FNA 0.6%, HNA 2.0%; p = 0.12), 30-day re-intervention (FNA 2.8%, HNA 5.0%; P = 0.12), 30-day mortality (FNA 1.1%, HNA 0.5%; P = 0.45), 30-day type I endoleaks (FNA 0.8%, HNA 2.5%; P = 0.12), 5-year mortality (FNA 15.1%, HNA 14.6%; P = 0.86), aneurysm-related mortality (FNA 1.7% versus HNA 2.0%; P = 0.79), stent-graft migration (FNA 2.5%, HNA 3.0%; P = 0.75), sac expansion (FNA 13.0%, HNA 9.5%; P = 0.22), or graft rupture (FNA 1.1%, HNA 3.5%; P = 0.05). Binary logistic regression of individual features of HNA revealed secondary intervention (P = 0.009), technical failure (P = 0.02), and late type I endoleaks (P = 0.002), were significantly increased with increased neck diameter. CONCLUSIONS HNA AAAs can be successfully treated with EVAR. However, surveillance is necessary to detect and treat late type I endoleaks in HNA patients.
Collapse
Affiliation(s)
- P W Stather
- Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK.
| | | | | | | | | | | |
Collapse
|
29
|
Clinical significance of endoleaks characterized by computed tomography during aortography performed immediately after endovascular abdominal aortic aneurysm repair: prediction of persistent endoleak. Jpn J Radiol 2012; 31:16-23. [DOI: 10.1007/s11604-012-0137-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
|
30
|
Bastos Gonçalves F, Jairam A, Voûte MT, Moelker AD, Rouwet EV, ten Raa S, Hendriks JM, Verhagen HJ. Clinical outcome and morphologic analysis after endovascular aneurysm repair using the Excluder endograft. J Vasc Surg 2012; 56:920-8. [DOI: 10.1016/j.jvs.2012.03.263] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/23/2012] [Accepted: 03/24/2012] [Indexed: 12/01/2022]
|
31
|
Chung TL, Mukherjee D. Successful endovascular management of an aortic rupture following stent placement for severe atherosclerotic stenosis: A case report. Int J Angiol 2012; 16:73-6. [PMID: 22477277 DOI: 10.1055/s-0031-1278253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Aortic rupture during endovascular procedures is a devastating complication that mandates expedient intervention. The present report describes a case in which endovascular treatment was used to successfully manage an aortic rupture following placement of a covered stent graft for severe infrarenal aortic stenosis. Successful management of this case was the result of the procedure being performed in an operating room under appropriate anesthesia and close hemodynamic monitoring. Bilateral common femoral arterial access and use of covered aortic stent grafts also contributed to a favourable outcome.
Collapse
|
32
|
Ten Years of Experience with the GORE EXCLUDER® Stent-Graft for the Treatment of Aortic and Iliac Aneurysms: Outcomes from a Single Center Study. Cardiovasc Intervent Radiol 2011; 35:498-507. [DOI: 10.1007/s00270-011-0235-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
|
33
|
Schanzer A, Greenberg RK, Hevelone N, Robinson WP, Eslami MH, Goldberg RJ, Messina L. Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair. Circulation 2011; 123:2848-55. [DOI: 10.1161/circulationaha.110.014902] [Citation(s) in RCA: 527] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andres Schanzer
- From the University of Massachusetts Medical School, Worcester (A.S., W.P.R., M.H.E., R.J.G., L.M.); Cleveland Clinic Foundation, Cleveland, OH (R.K.G.); and Harvard School of Public Health, Boston, MA (N.H.)
| | - Roy K. Greenberg
- From the University of Massachusetts Medical School, Worcester (A.S., W.P.R., M.H.E., R.J.G., L.M.); Cleveland Clinic Foundation, Cleveland, OH (R.K.G.); and Harvard School of Public Health, Boston, MA (N.H.)
| | - Nathanael Hevelone
- From the University of Massachusetts Medical School, Worcester (A.S., W.P.R., M.H.E., R.J.G., L.M.); Cleveland Clinic Foundation, Cleveland, OH (R.K.G.); and Harvard School of Public Health, Boston, MA (N.H.)
| | - William P. Robinson
- From the University of Massachusetts Medical School, Worcester (A.S., W.P.R., M.H.E., R.J.G., L.M.); Cleveland Clinic Foundation, Cleveland, OH (R.K.G.); and Harvard School of Public Health, Boston, MA (N.H.)
| | - Mohammad H. Eslami
- From the University of Massachusetts Medical School, Worcester (A.S., W.P.R., M.H.E., R.J.G., L.M.); Cleveland Clinic Foundation, Cleveland, OH (R.K.G.); and Harvard School of Public Health, Boston, MA (N.H.)
| | - Robert J. Goldberg
- From the University of Massachusetts Medical School, Worcester (A.S., W.P.R., M.H.E., R.J.G., L.M.); Cleveland Clinic Foundation, Cleveland, OH (R.K.G.); and Harvard School of Public Health, Boston, MA (N.H.)
| | - Louis Messina
- From the University of Massachusetts Medical School, Worcester (A.S., W.P.R., M.H.E., R.J.G., L.M.); Cleveland Clinic Foundation, Cleveland, OH (R.K.G.); and Harvard School of Public Health, Boston, MA (N.H.)
| |
Collapse
|
34
|
Baril DT, Cho JS, Chaer RA, Makaroun MS. Thoracic aortic aneurysms and dissections: endovascular treatment. ACTA ACUST UNITED AC 2011; 77:256-69. [PMID: 20506451 DOI: 10.1002/msj.20178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256-269, 2010. (c) 2010 Mount Sinai School of Medicine.
Collapse
Affiliation(s)
- Donald T Baril
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | | | | | | |
Collapse
|
35
|
Hogg ME, Morasch MD, Park T, Flannery WD, Makaroun MS, Cho JS. Long-term sac behavior after endovascular abdominal aortic aneurysm repair with the Excluder low-permeability endoprosthesis. J Vasc Surg 2011; 53:1178-83. [DOI: 10.1016/j.jvs.2010.11.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/30/2010] [Accepted: 11/01/2010] [Indexed: 11/30/2022]
|
36
|
Weale A, Balasubramaniam K, Macierewicz J, Hardman J, Horrocks M. Outcome and Safety of Aorfix™ Stent Graft in Highly Angulated Necks – A Prospective Observational Study (Arbiter 2). Eur J Vasc Endovasc Surg 2011; 41:337-43. [DOI: 10.1016/j.ejvs.2010.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 11/07/2010] [Indexed: 10/18/2022]
|
37
|
Wolff T, Koller MT, Eugster T, Rouden C, Marti R, Gürke L, Stierli P. Endarterectomy of the Aneurysm Sac in Open Abdominal Aortic Aneurysm Repair Reduces Perigraft Seroma and Improves Graft Incorporation. World J Surg 2010; 35:905-10. [DOI: 10.1007/s00268-010-0921-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
38
|
Detection of Occult Endoleaks After Endovascular Treatment of Abdominal Aortic Aneurysm Using Magnetic Resonance Imaging With a Blood Pool Contrast Agent. Invest Radiol 2010; 45:548-53. [DOI: 10.1097/rli.0b013e3181e992ac] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
39
|
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.
Collapse
|
40
|
Zarins CK, Taylor CA. Endovascular device design in the future: transformation from trial and error to computational design. J Endovasc Ther 2009; 16 Suppl 1:I12-21. [PMID: 19317584 DOI: 10.1583/08-2640.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endovascular devices have been designed by trial and error, with bench and animal testing followed by human clinical trials to determine whether the devices are safe and effective. Despite remarkable advances over the past 15 years, there are persistent concerns regarding the long-term durability of endovascular devices. This may be due to deficiencies in device design, which has lagged behind other industries in adopting computational methods that are now routinely used to design, develop, and test new aircraft and automobiles. Similar computational design and failure mode simulations that evaluate performance under stress conditions have not been widely applied in the development of endovascular devices. Advances in medical imaging and computational modeling now allow simulation of physiological conditions in patient-specific 3-dimensional vascular models, which can provide a framework to design and test the next generation of endovascular devices. This modeling will allow the prospective design of devices that can withstand the force variations in the cardiovascular system that occur during bending, coughing, and varying degrees of exercise, as well as the extremes encountered during sudden impact in contact sports. Utilization of computational design methodology that takes into consideration the physiology of the cardiovascular system will improve future endovascular devices so that they are safer and more effective and durable.
Collapse
Affiliation(s)
- Christopher K Zarins
- Stanford University School of Medicine and School of Engineering, Stanford, California, USA.
| | | |
Collapse
|
41
|
Liaw J, Clark M, Gibbs R, Jenkins M, Cheshire N, Hamady M. Update: Complications and management of infrarenal EVAR. Eur J Radiol 2009; 71:541-51. [DOI: 10.1016/j.ejrad.2008.05.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 02/10/2008] [Accepted: 05/28/2008] [Indexed: 11/15/2022]
|
42
|
Durability of abdominal aortic endograft with the Talent Unidoc stent graft in common practice: Core lab reanalysis from the TAURIS multicenter study. J Vasc Surg 2009; 49:859-65. [DOI: 10.1016/j.jvs.2008.11.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/04/2008] [Accepted: 11/11/2008] [Indexed: 11/18/2022]
|
43
|
Kelso RL, Lyden SP, Butler B, Greenberg RK, Eagleton MJ, Clair DG. Late conversion of aortic stent grafts. J Vasc Surg 2009; 49:589-95. [DOI: 10.1016/j.jvs.2008.10.020] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/06/2008] [Accepted: 10/11/2008] [Indexed: 11/28/2022]
|
44
|
Zimmerman PM, Cherr GS, Angelos GC, Gona J, Dosluoglu HH. Is F 18 Fluorodeoxyglucose Positron Emission Tomography Too Sensitive for the Diagnosis of Vascular Endograft Infection? Vascular 2008; 16:346-9. [DOI: 10.2310/6670.2008.00049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of a false positive fluorodeoxyglucose positron emission tomography (FDG-PET) scan in a patient who presented with abdominal pain, and gastrointestinal bleeding accompanied by elevation of inflammatory markers, seven weeks after a proximal type I endoleak repair with a cuff extension. Aortoenteric fistula and endograft infection was ruled out by laparotomy. FDG-PET image may have a role in diagnosis of infection, but false positive results are possible and caution is necessary if other data are non-confirmatory.
Collapse
Affiliation(s)
- Pamela M. Zimmerman
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - Gregory S. Cherr
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - George C. Angelos
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - Jayakumari Gona
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - Hasan H. Dosluoglu
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| |
Collapse
|
45
|
Abstract
Abstract Endovascular aneurysm repair (EVAR) is a new and minimally invasive alternative to open repair for patients with abdominal aortic aneurysm (AAA). Soon after its introduction in 1990, it was recognized that EVAR had potential and distinct advantages in the elective and emergency settings. However, long-term follow-up has shown enlargement of the AAA in a substantial percentage of patients who underwent EVAR with the original-permeability Excluder. Of interest is that sac expansion frequently occurs in the absence of endoleak, often referred to as endotension. The pathophysiology of endoleak is beginning to be elucidated and its management is ready to be established, while controversy still exists about the etiology and clinical consequences of endotension. Fortunately, the incidence of endotension is decreasing and it appears that AAA expansion after EVAR with the original Excluder can be arrested by endovascular relining with a low-permeability Excluder endoprosthesis. The aim of this brief review is to provide historical perspective and a good understanding of the etiology, diagnosis, and management of endotension.
Collapse
Affiliation(s)
- Naoki Toya
- Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuji Fujita
- Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
46
|
Abstract
It is now more than 20 years since the first report of stent graft insertion in the human arterial system was published. The first "homemade" devices proved that the technique was possible but could not show any durability. Using these devices, it was possible to get a good seal but not a good anchorage. Not even the first generation of commercially available stent grafts proved to be durable. First after gaining knowledge about the forces acting on the stent graft, it was realized that attachment was important for the durability and the hooks and barbs or a longitudinal stability are needed to minimise the risk for distal migration. Not much of a difference in the overall performance is noticed between the ePTFE graft or the polyester graft or when comparing stainless steel stents with those made out of nitinol. The systems are made much more flexible and hydrophilic leading to a better performance and a greater chance of percutaneous approach. The optimal stent graft is not out on the market yet, but hopefully will come with further development.
Collapse
Affiliation(s)
- J Brunkwall
- Department of Vascular Surgery, University Clinics, Cologne, Germany.
| |
Collapse
|
47
|
Wang GJ, Carpenter JP. The Powerlink system for endovascular abdominal aortic aneurysm repair: Six-year results. J Vasc Surg 2008; 48:535-45. [DOI: 10.1016/j.jvs.2008.04.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 04/09/2008] [Accepted: 04/10/2008] [Indexed: 10/21/2022]
|
48
|
Hackmann AE, Rubin BG, Sanchez LA, Geraghty PA, Thompson RW, Curci JA. A randomized, placebo-controlled trial of doxycycline after endoluminal aneurysm repair. J Vasc Surg 2008; 48:519-26; discussion 526. [PMID: 18632241 DOI: 10.1016/j.jvs.2008.03.064] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 03/21/2008] [Accepted: 03/31/2008] [Indexed: 01/01/2023]
Abstract
BACKGROUND The late durability of endovascular aneurysm repair (EVAR) has been limited by progressive aortic degeneration believed to be mediated by matrix metalloproteases (MMP). The goal of this study was to evaluate the effect of a MMP inhibitor, doxycycline, on EVAR. METHODS Patients undergoing EVAR were randomized to doxycycline (100 mg twice daily) or placebo for 6 months following the procedure. Clinical data, blood samples, and computed tomography (CT) scans were obtained preoperatively, postoperatively (blood only), and at 1- and 6-month follow-up. Forty-four subjects were analyzed based on intention-to-treat. RESULTS Plasma MMP-9 decreased significantly below baseline in the doxycycline (N = 20) treated patients at 6 months (-16.4% +/- 20.7%, P < .05) while there was a nonsignificant increase in the placebo (N = 24) group (128.1% +/- 73.5%). This was primarily related to changes between 1 and 6 months. In patients with endoleaks at 6 months, plasma MMP-9 increased in 83% of the placebo treated patients, but in only 14% of the doxycycline treated group (P < .03). Among endoleak-free patients with AneuRx or Excluder endografts, doxycycline treatment resulted in greater decreases in maximum aortic diameter than placebo treatment (-13.3% +/- 3.3% vs -3.8% +/- 3.0%, P < .05). Furthermore, doxycycline treatment significantly reduced the aortic neck dilatation at 6 months in Excluder treated patients. CONCLUSION There is evidence of persistent MMP release representing ongoing aortic degradation after endografting which can be inhibited by doxycycline therapy. In analyses based on the endograft used, treatment with doxycycline also demonstrated evidence of increased aortic dimensional stability, a surrogate marker for long-term success of EVAR. Although encouraging, these results require confirmation in larger patient populations. Doxycycline should undergo more thorough evaluation as a potential adjuvant treatment to improve the results of EVAR, particularly in certain subgroups.
Collapse
Affiliation(s)
- Amy E Hackmann
- Department of Surgery (Section of Vascular Surgery), Washington University School of Medicine, St. Louis, Mo
| | | | | | | | | | | |
Collapse
|
49
|
Tan JWC, Yeo KK, Laird JR. Food and Drug Administration–approved Endovascular Repair Devices for Abdominal Aortic Aneurysms: A Review. J Vasc Interv Radiol 2008; 19:S9-S17. [DOI: 10.1016/j.jvir.2007.12.452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 12/10/2007] [Accepted: 12/10/2007] [Indexed: 11/24/2022] Open
|
50
|
Makaroun MS, Dillavou ED, Wheatley GH, Cambria RP. Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms. J Vasc Surg 2008; 47:912-8. [DOI: 10.1016/j.jvs.2007.12.006] [Citation(s) in RCA: 328] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 11/29/2007] [Accepted: 12/03/2007] [Indexed: 11/26/2022]
|