1
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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2
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King B, Rockman C, Han S, Siracuse JJ, Patel VI, Johnson WS, Chang H, Cayne N, Maldonado T, Jacobowitz G, Garg K. Aortobifemoral reconstruction in open abdominal aortic aneurysm repair is associated with increased morbidity and mortality. J Vasc Surg 2023; 78:77-88.e3. [PMID: 36918104 DOI: 10.1016/j.jvs.2023.03.019] [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: 09/29/2022] [Revised: 02/23/2023] [Accepted: 03/05/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Much attention has been given to the influence of anatomic and technical factors, such as maximum abdominal aortic aneurysm diameter and proximal clamp position, in open abdominal aortic aneurysm repair (OSR). However, no studies have rigorously examined the correlation between site of distal anastomosis and OSR outcomes despite conventional wisdom that more proximal sites of anastomosis are preferrable when technically feasible. This study aimed to test the association between sites of distal anastomosis and clinical outcomes for patients undergoing primary elective OSR. METHODS Our study included 5683 patients undergoing primary elective OSR at 233 centers from 2014 to 2020. Using a variety of statistical methods to account for potential confounders, including multivariable logistic regression and Cox proportional hazards modeling, as well as subgroup analysis, we examined the association between site of distal anastomosis and clinical outcomes in elective OSR. Primary outcomes were major in-hospital complication rate, 30-day mortality, and long-term survival. RESULTS Patients undergoing elective aortobifemoral reconstruction (n = 672) exhibited significantly increased rates of smoking, chronic obstructive pulmonary disease, and peripheral artery disease in comparison to patients undergoing elective OSR with distal anastomosis to the aorta (n = 2298), common iliac artery (n = 2163), or external iliac artery (n = 550). Patients undergoing aorto-aortic tube grafting were significantly less likely to exhibit iliac aneurysmal disease and significantly more likely to be undergoing elective OSR with a suprarenal or supraceliac proximal clamp position. Using multivariable logistic regression and Cox proportional hazards analysis to control for important confounders, such as age, smoking status, and medical history, we found that distal anastomosis to the common femoral artery was associated with increased odds of major in-hospital complications (adjusted odds ratio, 1.79; 95% confidence interval, 1.46-2.18; P < .001) and reduced long-term survival (adjusted hazard ratio, 1.44; 95% confidence interval, 1.09-1.89; P = .010). We observed no significant differences in 30-day mortality across sites of distal anastomosis in our study population. CONCLUSIONS It is generally accepted that more proximal sites of distal anastomosis should be selected in OSR when technically feasible. Our findings support this hypothesis by demonstrating that distal anastomosis to the common femoral artery is associated with increased perioperative morbidity and reduced long-term survival. Careful diligence regarding optimization of preoperative health status, perioperative care, and long-term follow-up should be applied to mitigate major complications in this patient population.
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Affiliation(s)
- Benjamin King
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Caron Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Sukgu Han
- Comprehensive Aortic Center, Division of Vascular and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Virendra I Patel
- Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian Hospital/Columbia University Irving Medical Center/Columbia University College of Physicians and Surgeons, New York, NY
| | - William S Johnson
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Heepeel Chang
- Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Neal Cayne
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Thomas Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Grossman School of Medicine, New York, NY.
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3
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 424] [Impact Index Per Article: 212.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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4
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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5
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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6
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Davidovic LB, Maksic M, Koncar I, Ilic N, Dragas M, Fatic N, Markovic M, Banzic I, Mutavdzic P. Open Repair of AAA in a High Volume Center. World J Surg 2016; 41:884-891. [DOI: 10.1007/s00268-016-3788-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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7
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Dube B, Ünlü Ç, de Vries JPPM. Fate of Enlarged Iliac Arteries After Endovascular or Open Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2016; 23:803-8. [DOI: 10.1177/1526602816661832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the fate of untreated ectatic and aneurysmal common iliac arteries (CIAs) after open treatment and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). Methods: Databases of scientific literature were searched between January 1980 and February 2016 to identify publications on the follow-up of ectatic and aneurysmal CIAs after open or endovascular AAA repair. The primary outcome measure was the increase of iliac artery diameter during follow-up. The secondary outcome was the subsequent reintervention rate during follow-up. Results: Only 3 open AAA and 3 EVAR studies containing 1239 patients met the inclusion criteria for analysis. In the open AAA group, ectatic iliac arteries (defined as 12–18 mm) had a diameter progression of 1.7 to 1.8 mm during a follow-up period of 51.6 to 85.2 months. The aneurysmal iliac arteries (>18 mm) in the open repair group showed a faster growth (2.3–3.0 mm) in a follow-up period of 50.4 to 85.2 months. The pooled assessment of arteries ≥18 mm had a mean growth of 2.56 mm at 60 months of follow-up. In the entire open AAA cohort, the reintervention rate for CIA transformation was <1%. In the EVAR studies, arbitrary cutoff sizes of 16 to 20 mm for ectatic arteries and >20 mm for aneurysmal arteries were used. During a follow-up of 39.2 to 60 months, the diameter progression was 1.5 mm for the 16-mm iliac arteries and 2.7 mm for the 20-mm iliac arteries. The need for endovascular reinterventions was similar in patients with previously normal or enlarged CIAs. Conclusion: After open AAA repair, the overall size of CIA aneurysms grows slowly, but enlarged CIAs >20 mm in EVAR patients show faster growth during follow-up. However, the need for secondary interventions was similar in patients with normal or enlarged CIAs post EVAR.
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Affiliation(s)
- Bhekifa Dube
- Department of Vascular Surgery, Tertiary Livingstone Hospital, Port Elizabeth, South Africa
| | - Çağdaş Ünlü
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
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8
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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9
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Alonso-Argüeso G, Martinez-Mira C, Fernández-Samos Gutierrez R, Sanz-Pastor N, Ortega-Martín J, Vaquero-Morillo F. Reparación endovascular de aneurismas iliacos aislados. Nuestra experiencia en los últimos 10 años. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Coscas R, Capdevila C, Goeau-Brissonniere O, Coggia M. Bitubular graft as an adjunct for laparoscopic hybrid repair of an abdominal aortic aneurysm. J Vasc Surg 2013; 58:254-7. [PMID: 23706618 DOI: 10.1016/j.jvs.2013.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 11/16/2022]
Abstract
Laparoscopic repair (LR) of abdominal aortic aneurysms (AAAs) has been developed as a less invasive alternative to open repair. LR in the setting of diseased (ectatic, aneurysmal, calcified) aortic bifurcation or common iliac arteries (CIAs) is more challenging than LR of AAAs limited to the infrarenal aorta. In such cases, a bifurcated graft is necessary with an increased procedural time, more blood loss, and challenging distal anastomoses. We here present a new surgical technique using a custom-made bitubular graft (BTG), which allows LR of AAAs with diseased aortic bifurcation or CIAs while performing an aorto-aortic LR. During the same or a later intervention, covered stent grafts can be distally mated with the BTG using percutaneous femoral accesses to treat an extension of the disease to the aortic bifurcation and/or the CIAs. The BTG represents an interesting option for patients subjected to LR and presenting with an AAA associated with ectatic/aneurysmal proximal CIAs or heavily calcified aortic bifurcation.
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Affiliation(s)
- Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, France
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11
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Pieper CC, Meyer C, Rudolph J, Verrel F, Schild HH, Wilhelm KE. Interventional Exclusion of Iliac Artery Aneurysms Using the Flow-Diverting Multilayer Stent. Cardiovasc Intervent Radiol 2013; 36:917-25. [DOI: 10.1007/s00270-013-0639-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/12/2013] [Indexed: 11/24/2022]
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12
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Massière B, von Ristow A, Vescovi A, Pedron C, Fonseca LMB. Management of aortoiliac aneurysms by retrograde endovascular hypogastric artery preservation. Vascular 2013; 22:116-20. [PMID: 23518835 DOI: 10.1177/1708538112474256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We evaluated the outcome of the retrograde endovascular hypogastric artery preservation (REHAP) technique for the treatment of complex aortoiliac aneurysms (AIAs). Perioperative and long-term outcomes were assessed for 12 patients (mean age 77 years, range 64-86 years) who underwent elective endovascular AIA repair via aortouniiliac endografting and REHAP between January 2004 and January 2011. Preoperative images obtained by computed tomography were used for planning. Postoperative images were obtained one and six months after surgery, and once a year thereafter. Technical success was achieved in all cases. No patients exhibited endoleak related to the endoprosthesis, occlusion of implanted components, hip and/or buttock claudication, or colon or spinal cord ischemia during follow-up. This hybrid procedure illustrates the potential of REHAP in the treatment of AIA cases.
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Affiliation(s)
- Bernardo Massière
- Department of Vascular Surgery, CENTERVASC-RIO, Catholic University of Rio de Janeiro, Rio de Janeiro 22271-110, Brazil
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13
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Pieper CC, Meyer C, Verrel F, Schild HH, Wilhelm KE. Using the Multilayer Stent as a Supplement to EVAR in Combined Abdominal Aortic Aneurysm and Iliac Artery Aneurysm With Inadequate Distal Landing Zone—A Case Report. Vasc Endovascular Surg 2012; 46:565-9. [DOI: 10.1177/1538574412456306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Combined abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) is a common condition. The recently approved Cardiatis Multilayer stent (Cardiatis, Isnes, Belgium) is an innovative stent system for peripheral aneurysm management that has been applied in several clinical cases. After deployment, the unique stent design reduces mean velocity and vorticity within the aneurysm sac, causing thrombus formation and thus exclusion of the aneurysm while the vessels branching from the aneurysm remain patent. We describe a case of combined AAA and IAA with successful endovascular aneurysm repair of the AAA and treatment of the internal iliac artery with the Cardiatis Multilayer stent at 12 months of follow-up.
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Affiliation(s)
| | - Carsten Meyer
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Frauke Verrel
- Department of Surgery, University of Bonn, Bonn, Germany
| | - Hans H. Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - Kai E. Wilhelm
- Department of Radiology, University of Bonn, Bonn, Germany
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14
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Woo IT, Yun WS, Cho J, Lee KK, Kim HK, Kim J, Huh S. Change of Common Iliac Artery after Abdominal Aortic Aneurysm Repair Using a Tube Graft. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- In-Teak Woo
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea,
| | - Woo-Sung Yun
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu,Korea
| | - Jayun Cho
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea,
| | - Kyung Keun Lee
- Department of Surgery, Pohang St. Mary's Hospital, Pohang, Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea,
| | - Jihye Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea,
| | - Seung Huh
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea,
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15
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Melas N, Saratzis A, Dixon H, Saratzis N, Lazaridis J, Perdikides T, Kiskinis D. Isolated Common Iliac Artery Aneurysms:A Revised Classification to Assist Endovascular Repair. J Endovasc Ther 2011; 18:697-715. [PMID: 21992642 DOI: 10.1583/11-3519.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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16
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Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJE, van Keulen JW, Rantner B, Schlösser FJV, Setacci F, Ricco JB. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011; 41 Suppl 1:S1-S58. [PMID: 21215940 DOI: 10.1016/j.ejvs.2010.09.011] [Citation(s) in RCA: 996] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/12/2010] [Indexed: 12/11/2022]
Affiliation(s)
- F L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
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17
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Sena Ruiz F, Lozano Vilardell P, Merino Mairal O, Riera Vázquez R. Evolución del diámetro iliaco tras resección de aneurisma aórtico e interposición de injerto aorto-aórtico. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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18
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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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19
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Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009; 50:S2-49. [PMID: 19786250 DOI: 10.1016/j.jvs.2009.07.002] [Citation(s) in RCA: 453] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Elliot L Chaikof
- Department of Surgery, Emory University, Atlanta, Ga 30322, USA.
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20
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Plaza-Martínez A, Gómez-Palonés F, Zaragozá-García JM, Martínez-Parreño C, AlRaies-Bolaños B, Ortiz-Monzón E. Endovascular treatment of a ruptured iliac aneurysm previously excluded. Ann Vasc Surg 2009; 23:785.e13-6. [PMID: 19748221 DOI: 10.1016/j.avsg.2009.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 01/22/2009] [Accepted: 02/12/2009] [Indexed: 11/26/2022]
Abstract
We report a case of an isolated ruptured iliac artery aneurysm that had previously been treated, 25 months before, with iliac endovascular exclusion. Urgent computed tomographic (CT) scan showed the retroperitoneal hematoma and a type IA endoleak. On an emergency basis, at the operating room, an aortouni-iliac graft and femorofemoral crossover bypass were performed, successfully. This is a very rare but serious complication and requires careful indication and close follow-up with CT. In isolated common iliac artery aneurysms, the common iliac artery and distal aorta may tend to enlarge with failure of the endograft proximal attachment site and migration, thus leading to a late aneurysm rupture. A safe length and width, especially of the proximal sealing zone, should be accurately defined and closely followed up, or otherwise complete exclusion of the aortoiliac arteries should be considered.
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Affiliation(s)
- Angel Plaza-Martínez
- Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitario Dr. Peset, Valencia, Spain.
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Abstract
Iliac artery aneurysms are a frequent finding in patients with abdominal aortic aneurysms. The decision of whether to perform a tubular or bifurcated repair rests on a balance between the natural history of the iliac arteries during the lifetime of the patient versus the risk of symptomatic pelvic ischemia and the increased complexity of a bifurcated repair. The relatively recent increase in the use of cross-sectional imaging, especially in the setting of long-term endograft surveillance, has provided useful data on which to base these clinical decisions. A tube graft repair appears to be safe and durable in patients undergoing open aneurysm repair, when suitable distal aortic anatomy and normal iliac arteries are present. A bifurcated graft should be considered in younger patients with moderate sized iliac aneurysms (<30 mm in diameter), as well as in almost all patients with larger iliac aneurysms.
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Affiliation(s)
- Kevin J Bruen
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL 32610-0286, USA
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Richards T, Dharmadasa A, Davies R, Murphy M, Perera R, Walton J. Natural history of the common iliac artery in the presence of an abdominal aortic aneurysm. J Vasc Surg 2009; 49:881-5. [DOI: 10.1016/j.jvs.2008.11.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 11/05/2008] [Accepted: 11/07/2008] [Indexed: 11/16/2022]
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van Groenendael L, Zeebregts CJ, Verhoeven ELG, van Sterkenburg SMM, Reijnen MMPJ. External-to-internal iliac artery endografting for the exclusion of iliac artery aneurysms: an alternative technique for preservation of pelvic flow? Catheter Cardiovasc Interv 2009; 73:156-60. [PMID: 19156879 DOI: 10.1002/ccd.21763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to describe an alternative endovascular procedure to exclude iliac artery aneurysms, preserving perfusion to the internal iliac artery. CASES Two patients, considered unfit for open repair, underwent endovascular repair of iliac artery aneurysms. One of these occurred after previous placement of a bifurcated prosthesis. In both cases the aneurysms were excluded using a nitinol stent covered with expanded polytetrafluoroethylene from the external to the internal iliac artery. Using this technique, the internal iliac arteries were perfused in a retrograde manner. Both interventions were technically successful. The external-to-internal endograft remained patent after 6 and 16 months, respectively. CONCLUSION Endovascular placement of a stent-graft from the external iliac artery into the internal iliac artery may offer an alternative and minimal invasive alternative for the management of common and internal iliac artery aneurysms. With the use of this technique, pelvic perfusion is preserved. Further studies are warranted to appraise the advantages and risk of this approach for iliac artery aneurysms.
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Affiliation(s)
- Laura van Groenendael
- Division of Vascular Surgery, Department of Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, The Netherlands
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Da Rocha M, Adriani D, Leon F, Riambau VA. Endovascular occlusion of a common iliac artery aneurysm after open repair of an abdominal aortic aneurysm. Interact Cardiovasc Thorac Surg 2009; 8:491-2. [PMID: 19139029 DOI: 10.1510/icvts.2008.194936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Endovascular therapy is a safe alternative to treat the late complications of open aortic surgery. Here we report the endoluminal treatment of a recurrent common iliac aneurysm. A 68-year-old man, who submitted five years previously to an aorto bifemoral in order to exclude a juxta renal aortic aneurysm, developed a recurrent aneurysm of the left common iliac artery. He underwent an occlusion of the external iliac artery with a self-expandable nitinol mesh occlusion device and the aneurysm was embolized with detachable coils, with a good outcome. Endoluminal therapy does not expose patients to elevated risks, and may be indicated in selected cases to treat the complications of open surgery.
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Affiliation(s)
- Marcio Da Rocha
- Division of Vascular Surgery, Hospital Clinic, Thorax Institute, University of Barcelona, Barcelona, Spain
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Leon LR, Mills JL. Successful endovascular exclusion of a common iliac artery aneurysm: off-label use of a reversed Cook Zenith extension limb stent-graft. Vasc Endovascular Surg 2008; 43:76-82. [PMID: 19022804 DOI: 10.1177/1538574408322661] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Open iliac aneurysm repair has been historically associated with major morbidity and mortality. The introduction of endovascular devices and techniques has expanded the armamentarium available to treat these aneurysms, and several methods have been reported. However, the off-label use of a commercially available, flared extension limb stent-graft to treat a common iliac artery aneurysm (CIA) by preliminary extracorporeal predeployment, endograft reversal, and reinsertion into the delivery sheath to fashion a tapered endograft has not been previously reported. A case report of a CIA aneurysm diagnosed 9 years after transperitoneal tube graft abdominal aortic aneurysm repair treated with ipsilateral hypogastric artery occlusion with an Amplatzer plug and placement of a reversed, tapered extension limb stent-graft is herein presented.
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Affiliation(s)
- Luis R Leon
- Vascular Surgery Section, Southern Arizona Veteran Affairs Health Care System, Tucson 85723, USA.
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Ballotta E, Da Giau G, Gruppo M, Mazzalai F, Toniato A. Natural history of common iliac arteries after aorto-aortic graft insertion during elective open abdominal aortic aneurysm repair: A prospective study. Surgery 2008; 144:822-6. [DOI: 10.1016/j.surg.2008.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 07/07/2008] [Indexed: 11/16/2022]
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Davies RSM, Henderson JM, Scriven MJ, Adam DJ. Hybrid open endovascular repair of para-anastomotic common iliac artery aneurysm in the presence of bilateral external iliac artery occlusions. Ann Vasc Surg 2008; 23:410.e13-6. [PMID: 18504108 DOI: 10.1016/j.avsg.2008.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Revised: 03/10/2008] [Accepted: 03/12/2008] [Indexed: 11/30/2022]
Abstract
We describe a successful hybrid open endovascular repair of a large tender para-anastomotic common iliac artery aneurysm arising after previous open abdominal aortic aneurysm repair in a high-risk patient with bilateral chronic total external iliac artery occlusions.
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Affiliation(s)
- Robert S M Davies
- Department of Vascular Surgery, Heart of England NHS Foundation Trust, University of Birmingham, Solihull Hospital, Birmingham, UK.
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The Treatment of Isolated Iliac Artery Aneurysm in Patients with Non-aneurysmal Aorta. Eur J Vasc Endovasc Surg 2008; 35:585-9. [DOI: 10.1016/j.ejvs.2007.11.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 11/19/2007] [Indexed: 11/19/2022]
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Menezes FH, Luccas GC, Matsui IA. Sobrevida tardia de pacientes submetidos à correção aberta eletiva de aneurisma de aorta abdominal. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000300004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXTO: Os autores fazem uma revisão dos pacientes operados em hospital privado para determinar a causa da mortalidade tardia, a evolução dos demais segmentos da aorta e as complicações relacionadas à prótese. OBJETIVOS: Relatar o seguimento tardio de uma série de 76 casos operados eletivamente para a correção de aneurisma de aorta abdominal, no período de março de 1995 a janeiro de 2007. MÉTODOS: Convocação dos pacientes para uma consulta de retorno e daqueles que não puderam comparecer pessoalmente através de contato telefônico. RESULTADOS: A mortalidade operatória em 30 dias foi de 5,3%. A sobrevida tardia obtida por curva atuarial foi de 95% em 1 ano, 88% em 3 anos e 72% em 8 anos. As doenças cardiovasculares foram a principal causa de mortalidade tardia, seguidas das neoplasias malignas. A dilatação de segmento de aorta proximal à correção cirúrgica ocorreu em 9,7% dos pacientes operados, e as complicações relacionadas à prótese ocorreram em quatro casos (5,3%), sendo uma infecção de prótese, um pseudo-aneurisma proximal, um pseudo-aneurisma em ilíaca e uma oclusão de ramo. CONCLUSÃO: A cirurgia aberta para correção do aneurisma de aorta abdominal apresenta bom resultado em longo prazo, semelhante ao da literatura nacional e internacional, sendo uma boa opção para o paciente que tenha um baixo risco cirúrgico.
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Leon LR, Mills JL, Psalms SB, Goshima K, Duong ST, Ukatu C. A novel hybrid approach to the treatment of common iliac aneurysms: antegrade endovascular hypogastric stent grafting and femorofemoral bypass grafting. J Vasc Surg 2007; 45:1244-8. [PMID: 17543689 DOI: 10.1016/j.jvs.2007.01.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 01/18/2007] [Indexed: 11/24/2022]
Abstract
A progressively enlarging left common iliac artery aneurysm developed in a 72-year-old man 7 years after open abdominal aortic aneurysm repair with a bifurcated Dacron graft. Because both the right hypogastric and inferior mesenteric arteries had been ligated at the initial operation, preservation of left hypogastric flow was critical to avoid pelvic or intestinal ischemia. He was a poor open surgical candidate owing to obesity, a hostile abdomen, and multiple medical comorbidities. Therefore, a novel hybrid approach was used consisting of left transbrachial selective left hypogastric artery catheterization, followed by deployment of two, overlapping, antegrade, covered stent grafts extending from the proximal left graft limb into the left hypogastric artery. A right-to-left femorofemoral crossover bypass was added to perfuse the left lower extremity and was performed in end-to-end fashion to the left common femoral artery to exclude and prevent retrograde flow into the iliac aneurysm. Also presented are potential procedural pitfalls and a detailed review of open, endovascular and hybrid options to preserve hypogastric flow when treating iliac aneurysms in complex, high-risk patients.
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Affiliation(s)
- Luis R Leon
- Southern Arizona Veteran Affairs Health Care System-Vascular Surgery Section, University of Arizona Health Science Center, Tucson, AZ 85723, USA.
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