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Hinterseher I, Miszczuk M, Corvinus F, Zimmermann C, Estrelinha M, Smelser DT, Kuivaniemi H. Do Hernias Contribute to Increased Severity of Aneurysmal Disease among Abdominal Aortic Aneurysm Patients? AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 9:9-20. [PMID: 34082466 PMCID: PMC8489993 DOI: 10.1055/s-0040-1719113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Connective tissue disorders could contribute to the pathogenesis of both abdominal aortic aneurysms (AAA) and hernias. We tested the hypothesis that hernias in AAA patients contribute to increased severity of the aneurysmal disease.
Methods
A questionnaire was used to collect information from 195 AAA patients divided into four groups: (1) survivors (
n
= 22) of ruptured AAA, (2) patients (
n
= 90) after elective open repair, (3) patients (
n
= 43) after elective endovascular repair (EVAR), and (4) patients (
n
= 40) under surveillance of AAA. The control group consisted of 100 patients without AAA whose abdominal computed tomography (CT) scans were examined for the presence of hernias. Mann–Whitney
U
-test, Chi-squared (
χ2
) test, or Fisher's exact test (as appropriate) were used for statistical analyses. Multivariate logistic regression was used to control for potential confounding variables such as sex and age.
Results
The prevalence of inguinal hernias was significantly higher in the AAA than the control group (25 vs. 9%,
p
= 0.001) and did not differ between the AAA subgroups (9, 24, 35, and 23% in subgroups 1 through 4, respectively,
p
= 0.15) based on univariate analysis. The prevalence of inguinal hernias did not differ (
p
= 0.15) between the two open surgery groups (groups 1 and 2), or when comparing all three operative procedures as a combined group to group 4 (
p
= 0.73). The prevalences of incisional hernias were 18 and 24% for groups 1 and 2, respectively, with no significant difference (
p
= 0.39). Inguinal hernia demonstrated a significant association with AAA on multivariate analysis (
p
= 0.006; odds ratio [OR] = 4.00; 95% confidence interval [CI] = 1.49–10.66).
Conclusions
Our study confirms previous observations that patients with AAA have a high prevalence of hernias. Our results suggest that hernias do not contribute to increased severity of the aneurysmal disease.
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Affiliation(s)
- Irene Hinterseher
- Vascular Surgery Clinic, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Milena Miszczuk
- Vascular Surgery Clinic, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Florian Corvinus
- Department of General, Visceral and Transplant Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Carolin Zimmermann
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | - Diane T Smelser
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, Pennsylvania
| | - Helena Kuivaniemi
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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2
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Sultan S, Heskin L, Oaikhinan K, Hynes N, Akhter Y, Courtney D. Endovascular Repair of Early Rupture of Dacron Aortic Graft. Vasc Endovascular Surg 2016; 39:183-90. [PMID: 15806280 DOI: 10.1177/153857440503900208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70–100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital, Galway, Ireland.
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3
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Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms. Clin Radiol 2012; 67:802-14. [PMID: 22341185 DOI: 10.1016/j.crad.2011.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 12/12/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
Abstract
Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.
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Affiliation(s)
- M Nayeemuddin
- Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent, UK
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4
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Uberoi R, Tsetis D, Shrivastava V, Morgan R, Belli AM. Standard of Practice for the Interventional Management of Isolated Iliac Artery Aneurysms. Cardiovasc Intervent Radiol 2010; 34:3-13. [PMID: 21161661 DOI: 10.1007/s00270-010-0055-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/15/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Raman Uberoi
- Department of Interventional Radiology, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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5
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van Herwaarden JA, Waasdorp EJ, Bendermacher BLW, van den Berg JC, Teijink JAW, Moll FL. Endovascular repair of paraanastomotic aneurysms after previous open aortic prosthetic reconstruction. Ann Vasc Surg 2004; 18:280-6. [PMID: 15354628 DOI: 10.1007/s10016-004-0002-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study was to evaluate the effectiveness of endovascular repair of anastomotic and true aortic and iliac aneurysms occurring after prior polyester graft repair for abdominal aortic aneurysms (AAA) or aortoiliac obstructive disease. Between July 1999 and January 2003, 14 patients underwent endovascular treatment of aortic pseudoaneurysms (n = 6) or iliac aneurysms (2 patients with pseudoaneurysms and 6 patients with true aneurysms) occurring 4 to 18.4 years (mean, 8.8 years) after open aortic surgery. No patient had symptoms or positive parameters for infection of the original polyester graft. Eleven patients, including one patient with both a proximal anastomotic and a true iliac aneurysm, were treated with AneuRx (n = 8), Talent (n = 2), or Quantum LP (n = 1) bifurcated stent grafts. Three patients with an infrarenal anastomotic pseudoaneurysm were treated with a tube stent graft (Talent [n = 2] and AneuRx [n = 1]). Endovascular stent grafts were successfully inserted in all patients. Procedure-related complications or death was not seen. During a median follow-up of 12 months (range, 3-40) all anastomotic and/or true aneurysms treated with bifurcated stent grafts maintained excluded. However, two out of three patients, treated with a tube graft for proximal aneurysm exclusion, were converted. In both patients the tube stent graft did not migrate from the level of the renal arteries but fixation failed between the stent graft and the previous polyester graft, creating endotension in the thrombus of the aneurysm sac. In one of these patients the old anastomotic aneurysm ruptured 16 months after stent graft placement and the patient died 1 day after conversion because of mesenterial ischemia. At 1 year follow-up the second patient was converted successfully after enlargement of his anastomotic aneurysm due to similar disconnection between the stent graft and the polyester graft. From this experience with endovascular stent grafts, we conclude that these can be used successfully to exclude anastomotic or true aneurysms after open aortic surgery. Exclusion of aneurysms at the proximal anastomosis with tube stent grafts is apparently not durable because of the insecure distal fixation in polyester grafts. Endovascular repair with bifurcated stent grafts, however, seems to be effective at midterm follow-up.
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MESH Headings
- Aged
- Aged, 80 and over
- Anastomosis, Surgical
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/surgery
- Angiography, Digital Subtraction
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/pathology
- Aorta, Abdominal/surgery
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/surgery
- Aortic Rupture/diagnostic imaging
- Aortic Rupture/etiology
- Aortic Rupture/surgery
- Blood Vessel Prosthesis Implantation
- Follow-Up Studies
- Humans
- Iliac Aneurysm/diagnostic imaging
- Iliac Aneurysm/surgery
- Iliac Artery/diagnostic imaging
- Iliac Artery/pathology
- Iliac Artery/surgery
- Length of Stay
- Male
- Middle Aged
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/etiology
- Postoperative Complications/surgery
- Renal Artery/diagnostic imaging
- Renal Artery/injuries
- Renal Artery/surgery
- Reoperation
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures
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Affiliation(s)
- Joost A van Herwaarden
- Department of Vascular Surgery, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
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6
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Karkos CD, Oshodi TO, Vimalachandran D, Abraham JS, Adiseshiah M. Internal Iliac Aneurysm Rupture Into the Rectum Following Endovascular Exclusion:An Unusual Cause of Massive Lower Gastrointestinal Bleeding. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0907:iiarit>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Karkos CD, Oshodi TO, Vimalachandran D, Abraham JS, Adiseshiah M. Internal iliac aneurysm rupture into the rectum following endovascular exclusion: an unusual cause of massive lower gastrointestinal bleeding. J Endovasc Ther 2002; 9:907-11. [PMID: 12546595 DOI: 10.1177/152660280200900627] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a rare iliorectal fistula following endovascular treatment of an internal iliac aneurysm. CASE REPORT A 76-year-old man developed lower gastrointestinal bleeding 3 months after successful endovascular exclusion of a left internal iliac aneurysm with coil embolization, attempted stent-grafting, ligation of the distal external iliac artery, and a femorofemoral crossover bypass. Aortography showed no clear intestinal bleeding point, but demonstrated recanalization and continued perfusion of the aneurysm. At laparotomy, an iliorectal fistula was detected. The common iliac artery was ligated proximally, the aneurysm sac was opened, and the back-bleeding internal iliac artery branches were oversewn. The rectum was closed primarily. He made an uneventful recovery. CONCLUSIONS An iliorectal fistula is an extremely rare and unlikely complication of coil occlusion of an iliac aneurysm. A high index of suspicion for the diagnosis is of paramount importance. Periodic imaging in these patients is required to detect recanalization and continuing aneurysm expansion.
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Affiliation(s)
- Christos D Karkos
- Lancaster and Lake District Vascular Unit, Royal Lancaster Infirmary, Lancaster, UK.
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8
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Cormier F, Al Ayoubi A, Laridon D, Melki JP, Fichelle JM, Cormier JM. Endovascular treatment of iliac aneurysms with covered stents. Ann Vasc Surg 2000; 14:561-6. [PMID: 11128449 DOI: 10.1007/s100169910104] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this retrospective, single-institution study was to analyze the results of endovascular treatment of iliac aneurysm using covered stents. Since January 1, 1996, a total of 34 iliac aneurysms have been treated with covered endovascular stents. The series included 9 isolated aneurysms, 29 aneurysms following repair of aortic aneurysm, and 3 false anastomotic aneurysms. The mean diameter of aneurysm was 42 mm (range, 21 to 120 mm). The aneurysm was either symptomatic or complicated in 11 cases. Three procedures were carried out under emergency conditions after acute rupture. Stent deployment was successful in 33 cases (technical success rate, 97.6%). Exclusion of the aneurysm was obtained in all cases with one (n = 26) or two overlapping (n = 7) covered stents. Mean procedure duration was 45 min (range, 25 to 75 min). The internal iliac artery was patent in 28 cases, but patency was preserved in only 4 cases. In the remaining 24 cases the internal iliac artery was excluded either preoperatively by embolization using Gianturco coils (n = 15) or intraoperatively by placement of the stent (n = 9). Endovascular treatment of iliac aneurysm with covered stents achieves good short- and middle-term results but usually requires exclusion of the internal iliac artery.
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MESH Headings
- Aged
- Aged, 80 and over
- Aneurysm/diagnostic imaging
- Aneurysm/therapy
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/therapy
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/therapy
- Angiography
- Angioplasty, Balloon
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/surgery
- Coated Materials, Biocompatible
- Female
- Humans
- Iliac Artery/diagnostic imaging
- Male
- Middle Aged
- Postoperative Complications/diagnostic imaging
- Postoperative Complications/therapy
- Retrospective Studies
- Stents
- Tomography, X-Ray Computed
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Affiliation(s)
- F Cormier
- Service de Chirurgie, Cliniques de la Défense, Nanterre, et Bizet, Paris, France
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10
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Abstract
PURPOSE To describe an endovascular approach for residual common iliac artery (CIA) aneurysm. METHODS AND RESULTS A residual CIA was discovered in a 73-year-old man during routine examination following straight interposition graft placement for a ruptured abdominal aortic aneurysm (AAA). An aortobifemoral bypass was performed with ligation of both aneurysmal iliac arteries. A year later, aneurysms of both CIA stumps were found. On each side, a Hemobahn stent-graft was percutaneously positioned from the external to the internal iliac artery via the superficial femoral artery. Control angiography at 2 months and spiral computed tomographic angiography at 6 and 18 months confirmed exclusion of the aneurysms and patency of the endoprostheses. CONCLUSIONS Successful endovascular treatment of residual CIA aneurysm is possible with flexible stent-grafts.
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Affiliation(s)
- A Derom
- Department of Surgery, Hospital De Honte, Terneuzen, The Netherlands
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11
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Beese RC, Tomlinson MA, Buckenham TM. Endoluminal embolization of bilateral atherosclerotic common iliac aneurysms with fibrin tissue glue (Beriplast). Cardiovasc Intervent Radiol 2000; 23:239-41. [PMID: 10821905 DOI: 10.1007/s002700010054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The standard surgical approach to nonleaking iliac aneurysms found at repair of a leaking abdominal aortic aneurysm is to minimize the operative risk by repairing the abdominal aorta only. This means that the bypassed iliac aneurysms may have to be repaired later. As this population of patients are usually elderly with coexisting medical problems, interventional radiology is being used to embolize these aneurysms, thus avoiding the morbidity and mortality associated with further general anesthesia and surgery. Various materials and stents have been reported to be effective in the treatment of iliac aneurysms. We report the successful use of endoluminal fibrin tissue glue (Beriplast) to treat two large iliac aneurysms in a patient who had had a previous abdominal aortic aneurysm repair. We discuss the technique involved and the reasons why we used tissue glue in this patient.
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Affiliation(s)
- R C Beese
- Department of Radiology, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
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12
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Kalliafas S, Whitaker SC, Hopkinson BR. Use of a bifurcated graft for endovascular repair of a common iliac aneurysm after previous open aortic aneurysm surgery. Eur J Vasc Endovasc Surg 2000; 19:428-9. [PMID: 10801379 DOI: 10.1053/ejvs.1999.1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Kalliafas
- Division of Vascular Surgery, Nottingham University Hospital, Nottingham, United Kingdom
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13
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Abstract
OBJECTIVE To assess our experience with isolated iliac artery aneurysms and to assess the blood transfusion requirement in patients undergoing surgery for iliac artery aneurysms. MATERIAL AND METHODS The case records of 12 patients who underwent 12 arterial reconstructive procedures for isolated iliac aneurysms from January 1989 to December 1995 were identified from our prospective vascular database and reviewed. Only patients with aneurysms limited to the common, external, or internal iliac arteries were included. RESULTS Eleven patients had symptoms and rupture occurred in five patients. Aneurysmorrhaphy with graft interposition was the most common procedure. There was no perioperative mortality. The median transfusion requirement was 11 units per operation (range 1-30 units). The median intraoperative blood loss was 4700 ml (range < 500-13,000 ml). CONCLUSIONS Isolated iliac aneurysm is a dangerous condition. A low perioperative mortality is possible only if large volumes of blood are available.
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Affiliation(s)
- N Levi
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
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