1
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Damme HV, Sakalihasan N, Vazquez C, Desiron Q, Limet R. Abdominal Aortic Aneurysms in Octogenarians. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- H. Van Damme
- Department of Cardiovascular, CHU Liège, Belgium
| | | | - C. Vazquez
- Department of Cardiovascular, CHU Liège, Belgium
| | - Q. Desiron
- Department of Cardiovascular, CHU Liège, Belgium
| | - R. Limet
- Department of Cardiovascular, CHU Liège, Belgium
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2
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Abstract
Conventional aortic surgery carries a significant mortality and morbidity. Transfemoral endoluminal aortic management (TEAM) offers a minimally invasive alternative. This article reports seven cases of TEAM for aortoiliac disease and abdominal aortic aneurysms with a patency rate of 100% at 24 months. Our data suggests that primary stenting can achieve excellent physiologic results and restoration of blood flow in selected patients with aortoiliac disease. Long-term study and follow-up is essential to determine the place of TEAM in the field of vascular surgery.
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Affiliation(s)
| | | | | | | | - Gregor Shanik
- Department of Vascular Surgery, St. James's Hospital, Dublin, Ireland
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3
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Thompson MM, Smith J, Naylor AR, Nasim A, Sayers RD, Boyle JR, Tinkler K, Goodall S, Evans D, Bell PR. Ultrasound-Based Quantification of Emboli during Conventional and Endovascular Aneurysm Repair. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To differentiate and quantify the type and number of lower limb emboli occurring during endovascular aneurysm repair, as compared to conventional surgery. Methods: Thirty-eight patients underwent elective infrarenal aneurysm repair using a conventional surgical approach in 18 and an endovascular procedure in 20. Emboli were detected using a Doppler ultrasound system with a 2-MHz transducer interrogating the mid superficial femoral artery. Lower limb emboli were differentiated as particulate or gaseous based on the physical distance traversed by the embolic signal. Results: Significantly more particulate (median 108 versus 59, p = 0.015) and gaseous (134 versus 46, p = 0.008) emboli were detected during endovascular aneurysm repair as compared to conventional surgery. Clinically, no case of massive microembolization occurred in either group, but one patient in the conventional group required a femoral embolectomy, and three patients undergoing endovascular repair developed self-limiting trash feet postoperatively. In patients undergoing endovascular aortomonoiliac aneurysm repair, there was only a poor correlation between the number of particulate emboli and either procedural duration or operator experience. Conclusions: The apparent lack of a relationship between particulate embolization and operative time or technical experience suggests that manipulation of endoluminal devices within the aneurysm sac may not be the sole determinant of intraprocedural embolization. Other as yet undetermined factors may predict patients at high risk for massive embolization.
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Affiliation(s)
| | - Julie Smith
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - A. Ross Naylor
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Ahktar Nasim
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Robert D. Sayers
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Jonathan R. Boyle
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Kerry Tinkler
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Steve Goodall
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - David Evans
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Peter R.F. Bell
- Department of Surgery, University of Leicester, Leicester, United Kingdom
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4
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Diethrich EB. A Safe, Simple Alternative for Pressure Reduction during Aortic Endograft Deployment. J Endovasc Ther 2016. [DOI: 10.1177/152660289600300305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Edward B. Diethrich
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, and the Cardiovascular Center of Excellence, Columbia Medical Center Phoenix, Phoenix, Arizona, USA
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5
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Lindh M, Malina M, Ivancev K, Brunkwall J, Lindblad B. Endovascular Stent-Anchored Aortic Grafts: A Comparison between Self-Expanding and Balloon-Expandable Stents in Minipigs. J Endovasc Ther 2016; 3:284-9. [PMID: 8800231 DOI: 10.1177/152660289600300307] [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: 11/16/2022]
Abstract
Purpose: To study endovascular graft attachment with self-expanding Gianturco Z-stents and balloon-expanded Palmaz stents and the effect of these devices on the renal ostia. Methods: Ten stent-grafts were constructed, 5 with Gianturco Z-stents and 5 with Palmaz stents. The endografts were implanted under fluoroscopic guidance into the abdominal aorta of 10 pigs so that the uncovered portion of the proximal stent extended over the renal artery orifices. Distal aortic blood pressure and flow were measured before and after graft placement and 1 hour postprocedure. The aorta was then exposed surgically, and the central portion of the stent-graft was inspected through an aortotomy to assess perigraft leakage. Results: Stent-graft implantation was accurate and hemostatic in all cases, despite longitudinal folding of the graft due to oversizing. However, transverse folds produced pressure gradients (> 15 mmHg) between the ends of the graft in two cases. In another case, a pressure gradient resulted from partial thrombosis of the graft. In two cases, renal artery occlusion and thrombosis occurred due to coverage by the graft material. In two other animals, one of the renal arteries was entirely uncovered by a stent. The remaining 16 renal arteries were covered by the proximal stent but not the graft, as intended. One (6.25%) of these arteries thrombosed, but the remainder were grossly patent when the animals were sacrificed at 1 hour. Conclusions: Both Palmaz and Gianturco Z-stents produced hemostatic endovascular graft attachment, even in the presence of moderate graft oversizing. The risk of acute renal artery occlusion from juxtarenal stenting does not appear to be prohibitive, but longer term observations are needed.
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Affiliation(s)
- M Lindh
- Department of Diagnostic Radiology, Malmö University Hospital, Lund University, Sweden
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6
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Moore WS. The EVT Tube and Bifurcated Endograft Systems: Technical Considerations and Clinical Summary. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular exclusion of abdominal aortic aneurysms (AAAs) is an investigational technique under scrutiny around the world. The tube and bifurcated versions of the Endovascular Grafting System (EGS) developed by Endovascular Technologies are the subjects of FDA-approved multicenter trials in the United States (US). Similar studies are under way in Europe, Australia, and the United Kingdom. This review details the implantation techniques for the EGS device and summarizes the important clinical findings published through 1996. Although the EGS was voluntarily removed from the US trial when fractures were discovered in the graft attachment system, subsequent experience with the re-engineered EGS has been positive. Successfully implanted EGS tube grafts have been associated with aneurysm shrinkage after 1 year in AAAs initially excluded or with sealed endoleaks. Aneurysm enlargement has been seen in EGS tube grafts with persistent endoleak.
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Affiliation(s)
- Wesley S. Moore
- Department of Surgery, UCLA School of Medicine, Los Angeles, California, USA
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7
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Blum U, Voshage G, Beyersdorf F, Töllner D, Spillner G, Morgenroth A, Nagel G, Schiensack C, Langer M. Two-Center German Experience with Aortic Endografting. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400205] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the results of a two-center study of endovascular abdominal aortic aneurysm (AAA) exclusion using a polyester-covered nitinol stent-graft. Methods: Candidates were evaluated with arteriography and computed tomography. Criteria for endovascular therapy were a proximal aortic neck > 10 mm in length and < 25 mm in diameter, no bilateral internal iliac artery involvement in the aneurysm, no markedly tortuous common iliac arteries (CIAs) or CIAs < 7 mm in diameter, and no superior mesenteric artery occlusive disease. Patients were treated with the Mialhe Stentor and Vanguard stent-grafts in either tube or bifurcated versions. Results: Between August 1994 and November 1996, 149 patients (mean age 67 years, range 49 to 90) were admitted to the study. Overall primary technical success (aneurysm exclusion without endoleak) was 87% (130 patients): 78% (7 patients) for tube grafts and 88% (123 patients) for bifurcated endografts. The rate of local, remote, or systemic complications was 10.8%, with a 30-day mortality rate of 0.7%. During an average 13.5-month follow-up, there were no late deaths. Four of 20 endoleaks sealed spontaneously, 14 were treated with endoluminal techniques, and 2 remain untreated by patient request. Three graft limb thromboses occurred; one was treated surgically, one with lytic therapy, and one was untreated. Secondary patency was 96%. Conclusions: Endoluminal repair of infrarenal AAAs using straight or bifurcated grafts is a feasible alternative to conventional surgical repair. Longer follow-up and more experience with refined endograft models will elucidate the durability of this endovascular approach to treating AAAs.
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Affiliation(s)
| | - Götz Voshage
- Department of Radiology, Henriettenstiftung Hanover, Hanover, Germany
| | | | - Dirck Töllner
- Department of Radiology, Henriettenstiftung Hanover, Hanover, Germany
| | - Gerhard Spillner
- Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg
| | | | - Gudrun Nagel
- Department of Surgery, Henriettenstiftung Hanover, Hanover, Germany
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8
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May J, White GH, Yu W, Waugh R, Stephen MS, Sieunarine K, Chaufour X, Harris JP. Endoluminal Repair of Abdominal Aortic Aneurysms: Strengths and Weaknesses of Various Prostheses Observed in a 4.5-Year Experience. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To summarize the results of endovascular abdominal aortic aneurysm (AAA) treatment using several endograft designs over a 4.5-year experience and offer comparisons on the various devices. Methods: From May 1992 to August 1996, 121 AAA patients meeting the criteria for an endoluminal repair were treated with 1 of 5 endograft designs in three configurations. The endografts were implanted in the operating room under fluoroscopic control. Follow-up included contrast-enhanced computed tomography within 10 days of operation, 6 months postoperatively, and annually thereafter. Results: Endografts were successfully deployed in 106 patients (88%). Fifteen cases were converted to open repair. Six procedure-related deaths occurred within 30 days owing to myocardial infarction (3), combined renal failure and septicemia (2), and multisystem failure (1). There were 36 local/vascular complications (30%) and 18 systemic/remote complications (15%). Of the 121 patients undergoing endoluminal AAA repair, 93 (77%) are currently alive and well with their AAAs excluded from the circulation. Conclusions: Trends in endoluminal AAA repair and prosthetic design point toward simpler devices and earlier treatment of smaller aneurysms once the long-term outcome of aortic endografting has been determined.
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Affiliation(s)
| | | | | | - Richard Waugh
- Department of Interventional Radiology, Royal Prince Alfred Hospital, Sydney, Australia
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9
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Schumacher H, Eckstein HH, Kallinowski F, Allenberg JR. Morphometry and Classification in Abdominal Aortic Aneurysms: Patient Selection for Endovascular and Open Surgery. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate the anatomic morphology of abdominal aortic aneurysms (AAAs) and compose a classification system to facilitate patient selection for endovascular graft (EVG) repair. Methods: Data on 242 consecutive AAA patients evaluated on a nonemergent basis in a 3.5-year period to July 1996 were prospectively entered into a registry. Patients were examined using sequential intravenous spiral computed tomographic angiography and intraarterial digital subtraction angiography. The data collected and analyzed included: diameters of the supra- and infrarenal aorta, aneurysm, aortoiliac bifurcation, and iliac arteries; lengths of the proximal neck, distal cuff, and aneurysm; degrees of iliac artery tortuosity; and occlusion of the visceral, renal, or iliac arteries. Results: The 242 aneurysms could be easily grouped into three distinctive categories related to the extent of the aneurysmal disease. Type I AAAs (11.2%) had nondilated, thrombus-free infrarenal (15 mm) necks and distal (10 mm) cuffs appropriate for EVG anchoring. In type II and its subgroups (72.3%), a sufficient proximal neck was present, but the aneurysm extended into the iliac arteries; 56% of these were eligible for a bifurcated endograft. In type III (16.5%), a sufficient proximal neck was missing, independent of distal involvement. In all, 51.7% were good EVG candidates based on AAA morphology. Taking into consideration relevant concomitant vascular diseases, proximal iliac kinking, and iliac, renal, or visceral occlusive disease, only 30.2% of the population were potential candidates for an efficient and secure EVG repair using the devices currently available. Conclusions: In contrast to classical open repair, detailed preoperative measurements are recommended for EVG planning. The use of liberal EVG indications may lead to a higher incidence of complications, whereas restrictive morphology-based selection criteria may offer excellent results.
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Affiliation(s)
- Hardy Schumacher
- Department of Surgery, Division of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Hans H. Eckstein
- Department of Surgery, Division of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Friedrich Kallinowski
- Department of Surgery, Division of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Jens Rainer Allenberg
- Department of Surgery, Division of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
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10
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White GH, May J, Waugh RC, Yu W. Type I and Type II Endoleaks: A More Useful Classification for Reporting Results of Endoluminal AAA Repair. J Endovasc Ther 2016; 5:189-91. [PMID: 9633961 DOI: 10.1177/152660289800500212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Dorros G, Conn JM. Adenosine-Induced Transient Cardiac Asystole Enhances Precise Deployment of Stent-Grafts in the Thoracic or Abdominal Aorta. J Endovasc Ther 2016. [DOI: 10.1177/152660289600300303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To present a cardiac asystole technique that assists in the accurate deployment of stent-grafts during endovascular repair of thoracic or abdominal aortic aneurysms. Technique: In the anesthetized patient, trial doses of intravenous adenosine are delivered until a ≥ 20-second period of asystole is recorded. The endograft procedure then proceeds until the device is ready for deployment. The predetermined dose of adenosine is administered, and the device is deployed during asystole. Adenosine-induced transient asystole has been utilized in 16 patients undergoing balloon-expandable endograft exclusion of 6 thoracic aortic and 10 abdominal aortic aneurysms. Asystole lasted for 20 to 30 seconds, during which time the devices were accurately deployed without interference from the aortic flow. There were no clinical sequelae of this technique in any patient. Conclusions: Pharmacologically induced transient asystole appears to be a safe maneuver to preclude endograft movement by systolic blood flow. The technique permits precise placement of balloon-expandable stent-grafts and is applicable to self-expanding devices as well. Interventionists may wish to incorporate adenosine-induced asystole into their aortic aneurysm exclusion procedures.
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Affiliation(s)
- Gerald Dorros
- St. Luke's Medical Center and The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation Ltd., Milwaukee, Wisconsin, USA
| | - Joel M. Conn
- St. Luke's Medical Center and The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation Ltd., Milwaukee, Wisconsin, USA
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12
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Diethrich EB. Will Contrast Aortography Become Obsolete in the Preoperative Evaluation of Abdominal Aortic Aneurysm for Endovascular Exclusion? J Endovasc Ther 2016. [DOI: 10.1177/152660289700400103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Edward B. Diethrich
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, Arizona, USA
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13
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Boyle JR, Thompson MM, Clode-Baker EG, Green J, Bolia A, Fishwick G, Bell PR. Torsion and Kinking of Unsupported Aortic Endografts: Treatment by Endovascular Intervention. J Endovasc Ther 2016. [DOI: 10.1177/152660289800500305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To describe the management strategies used to deal with twisted aortic endografts. Methods and Results: Two patients with successfully excluded aortic aneurysms developed symptoms referable to previously undetected twists in their endografts (one EndoVascular Technologies [EVT] and one customized aortomonoiliac device). The limb graft occlusion in the EVT graft was treated surgically with a femorofemoral bypass, but the aortomonoiliac endograft was salvaged with percutaneous implantation of a Wallstent. During another aortomonoiliac procedure, suboptimal flow through the endograft was traced to contortion of the endograft as it passed over an angulated proximal aneurysm neck. An X-large Palmaz stent was deployed to support the graft at this point. Conclusions: Unsupported aortic endografts may develop twists and kinks during deployment that can lead to low outflow and graft occlusion. Endovascular techniques are available to repair these defects postoperatively, although more precise intraoperative assessment tools may identify these problems so that they can be corrected at the initial intervention.
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Affiliation(s)
- Jonathan R. Boyle
- Department of Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
| | | | | | - Jeremy Green
- Department of Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Amman Bolia
- Department of Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Guy Fishwick
- Department of Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Peter R.F. Bell
- Department of Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
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14
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Umscheid T, Stelter WJ. Time-Related Alterations in Shape, Position, and Structure of Self-Expanding, Modular Aortic Stent-Grafts: A 4-year Single-Center Follow-up. J Endovasc Ther 2016. [DOI: 10.1177/152660289900600105] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report the nature and ramifications of structural and positional changes over time in tube and modular bifurcated aortic stent-grafts. Methods: Two hundred ninety-one patients received endovascular aortic grafts (primarily Stentor/Vanguard) between August 1994 and August 1998. Follow-up surveillance (clinical and laboratory examination, biplanar noncontrast radiography, and contrast-enhanced computed tomography) has been maintained on all patients for 4 years. Changes in the configuration and position of endografts have been noted and their sequelae charted. Results: Three types of endograft shape changes have been documented: mild — slight distortions visible on plain radiographs (n = 90, 31.0%), significant — angulations reaching 60° to 90° (n = 65, 22.3%), and severe — angulations ≥ 90° (n = 10, 3.4%). Changes in position never gave rise to late migration at the proximal attachment site, whereas at the distal ends, the endograft easily retracted from the iliac arteries (n = 8). Structural alterations (rupture of the stent frame, sutures, or fabric, and total graft disintegration) were more common in the original Stentor model. Shape, position, and structural alterations were mutually dependent and led to secondary endoleaks (n = 26) and graft limb thrombosis (n = 37). Late surgical conversion was necessary in 3 (1.0%) patients. Conclusions: Tortuosity of the native vessels is a source of complication in long-term follow-up just as it is during implantation. Given the late appearance of complications in this patient cohort, it would seem that the durability of an endograft cannot be evaluated with < 3 years of follow-up.
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Affiliation(s)
- Thomas Umscheid
- Department of Surgery, Städtische Kliniken Frankfurt-Höchst, Frankfurt, Germany
| | - Wolf J. Stelter
- Department of Surgery, Städtische Kliniken Frankfurt-Höchst, Frankfurt, Germany
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15
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Heilberger P, Schunn C, Ritter W, Weber S, Raithel D. Postoperative Color Flow Duplex Scanning in Aortic Endografting. J Endovasc Ther 2016; 4:262-71. [PMID: 9291051 DOI: 10.1177/152660289700400305] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report the feasibility and sensitivity of duplex sonography compared to computed tomography (CT) for aortic endograft follow-up surveillance. Methods: In a 26-month period, 113 aortic aneurysm patients received 79 tube and 34 bifurcated stent-grafts. Follow-up used contrast-enhanced CT scanning and duplex sonography with an intravenous ultrasound contrast agent (Levovist). Results: Eleven patients (9.7%) were converted to open repair; 1 died from hemorrhagic shock secondary to retroperitoneal hematoma. The mean follow-up time was 7.2 months (range 1 to 24), during which 5 patients died of unrelated causes. Sixteen primary (within 30 days) and 5 secondary endoleaks were detected by duplex after tube graft implantation. Among 5 endoleaks due to retrograde side-branch perfusion, 3 were detected only with contrast-enhanced duplex scanning. Iliac artery occlusion was also documented using duplex; however, 2 stent fractures could not be seen with ultrasound. Ten primary endoleaks were detected in bifurcated stent-graft patients. One endoleak originating from the distal iliac limb anchoring site was missed by duplex owing to bowel gas. Graft limb thrombosis was clearly identified by lack of a flow signal on duplex. Conclusions: Duplex sonography could be a valuable, reliable, and economical surveillance tool for endovascular aortic reconstructions. The adjunctive use of an intravenous ultrasound contrast agent increased the sensitivity for detecting endoleak to a level comparable to contrast-enhanced CT scanning. However, stent fractures may not be seen on ultrasound, and bowel gas can interfere with obtaining an adequate image.
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Affiliation(s)
- P Heilberger
- Department of Vascular Surgery, Klinikum Nürnberg Süd, Germany
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16
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Boyle JR, Thompson MM, Sayers RD, Nasim A, Healey P, Bell PR. Changes in Referral Practice, Workload, and Operative Mortality after Establishment of an Endovascular Abdominal Aortic Aneurysm Program. J Endovasc Ther 2016. [DOI: 10.1177/152660289800500303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine the change in referral practice following establishment of an endovascular abdominal aortic aneurysm (AAA) program. Methods: A prospective audit of all elective admissions for AAA was established in January 1994 at the initiation of an endovascular AAA program. A comparison was made between this cohort and the elective AAA repairs performed between 1981 and 1993. Results: Since January 1994, 213 AAA patients (177 men; median age 73 years, range 54 to 88) have been referred for potential endovascular aneurysm repair. To date, 142 patients have undergone elective surgery (41 endovascular and 101 conventional). Between 1981 and 1993, 304 patients (255 men; median age 69 years, range 45 to 86) had elective aneurysm repair. Comparison of the two time periods has revealed significant increases in the number of tertiary referrals (41.8% versus 9.5%, p < 0.01), annual operations (50 versus 23, p < 0.05), and overall mortality (12% versus 6.7%, p < 0.05), the latter attended by a significant increase in cardiorespiratory comorbidity. Conclusions: The higher elective AAA mortality rate since the establishment of an endovascular program reflects a change in referral practice and may be directly attributable to an increase in the number of high-risk patients. An endovascular AAA program has clinical and financial implications for the hospital concerned.
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Affiliation(s)
- Jonathan R. Boyle
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | | | - Robert D. Sayers
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Ahktar Nasim
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Patricia Healey
- Department of Surgery, University of Leicester, Leicester, United Kingdom
| | - Peter R.F. Bell
- Department of Surgery, University of Leicester, Leicester, United Kingdom
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17
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Aadahl P, Lundbom J, Hatlinghus S, Myhre HO. Regional Anesthesia for Endovascular Treatment of Abdominal Aortic Aneurysms. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To investigate the feasibility of regional anesthesia for endovascular repair of abdominal aortic aneurysms (AAAs). Methods: Since February 1995, 21 patients (17 men and 4 women; median age 67 years, range 49 to 80) have been treated with endovascular technique for true infrarenal AAA using Mialhe Stentor bifurcated grafts. A single dose of spinal anesthesia combined with epidural anesthesia was used in all procedures. Electrocardiography and arterial blood pressure were monitored. Results: No cases of emboli, hematoma, or graft migration were seen, and there were no reoperations or conversions to open operation. Arterial blood pressure was stable at a satisfactory level from induction of anesthesia throughout the procedure, and there was no period of clinically significant hypotension during any implantation. One patient died on the second postoperative day from cardiac and renal insufficiency. Three endoleaks were observed during the procedure; one healed spontaneously within 5 weeks, and the other two were repaired by endovascular techniques after 1 and 4 months, respectively. During follow-up, one patient died at 6 months from pancreatic carcinoma. Conclusions: The application of regional anesthesia is feasible for endovascular treatment of AAA. The arterial blood pressure remained stable throughout the procedure, and all patients, with two exceptions, were mobilized on the first day and placed on a regular diet. Based on these early results, it appears that regional anesthesia is feasible, effective, and safe for endovascular AAA repair.
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Affiliation(s)
| | - Jan Lundbom
- Department of Surgery, University Hospital, Trondheim, Norway
| | | | - Hans O. Myhre
- Department of Surgery, University Hospital, Trondheim, Norway
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18
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Lie T, Lundbom J, Hatlinghus S, Grønningsaeter A, Ommedal S, Aadahl P, Sæther OD, Myhre HO. Ultrasound Imaging during Endovascular Abdominal Aortic Aneurysm Repair Using the Stentor Bifurcated Endograft. J Endovasc Ther 2016. [DOI: 10.1177/152660289700400306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To evaluate different ultrasound modalities during implantation and follow-up of endovascular grafts for abdominal aortic aneurysm (AAA) exclusion. Methods: Between February 1995 and May 1996, 18 patients (14 men; aged 49 to 80 years, mean 67) were treated with endovascular intervention for infrarenal AAA. Seventeen patients received Mialhe Stentor bifurcated grafts, while one patient was treated with a straight graft for pseudoaneurysm. During and after the implantation, 3.25- and 5-MHz annular array ultrasound probes were used for transabdominal visualization of the endograft. Intravascular ultrasound was applied in combination with angiography for postoperative control. Results: Intraprocedurally, transabdominal two-dimensional (2D) ultrasound successfully monitored guidewire passage from the groin into the main part of the bifurcated endograft for implantation of the second limb. All implantation procedures were technically successful, but four endoleaks were identified intraprocedurally by 2D ultrasound and angiography. One healed spontaneously, two were treated with endovascular techniques at 1 and 4 months, and the last leak was scheduled for repair when the patient died of probable myocardial infarction at 2 months. During follow-up, 2D ultrasound successfully visualized all the endografts; no endoleaks were found in up to 18 months of surveillance. Conclusions: Transabdominal ultrasound imaging could be valuable in bifurcated endograft deployment both for guiding guidewire insertion and for controlling wire position before the second graft limb is connected to the main graft. Provided that satisfactory visualization of the entire endograft can be obtained, ultrasound examination may possibly replace arteriography and computed tomographic scanning as a follow-up investigation.
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Affiliation(s)
| | - Jan Lundbom
- SINTEF Unimed and the Department of Surgery, University Hospital of Trondheim, Trondheim, Norway
| | - Staal Hatlinghus
- SINTEF Unimed and the Department of Radiology, University Hospital of Trondheim, Trondheim, Norway
| | | | | | - Petter Aadahl
- SINTEF Unimed and the Department of Anesthesiology, University Hospital of Trondheim, Trondheim, Norway
| | - Ola D. Sæther
- SINTEF Unimed and the Department of Surgery, University Hospital of Trondheim, Trondheim, Norway
| | - Hans O. Myhre
- SINTEF Unimed and the Department of Surgery, University Hospital of Trondheim, Trondheim, Norway
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Cuypers P, Buth J, Harris PL, Gevers E, Lahey R. Reprinted article "Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry". Eur J Vasc Endovasc Surg 2011; 42 Suppl 1:S63-71. [PMID: 21855026 DOI: 10.1016/j.ejvs.2011.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/1999] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The outcomes for patients after endovascular treatment of abdominal aortic aneurysm (AAA) are determined primarily by the endpoints of death and endoleaks, the latter representing continued risk of rupture. The data of a multicentre registry were analysed with regard to the early outcome of stent-graft procedures for AAA and the complications associated with this treatment. In addition, the results during follow-up were analysed by determining mortality and endoleak development as separate endpoints and as a combined endpoint defined as endoleak-free survival. SETTING 38 European institutions of Vascular Surgery collaborating in a multicentre registry project. PATIENTS AND METHODS 899 patients with AAA underwent between May 1994 and March 1998 elective endovascular repair (818 men and 81 women; mean age 69 years). 80 (8.9%) of the patients had medical conditions that excluded them from open repair. 818 (91%) of patients had a bifurcated device, 63 (7%) had a straight tube graft, and only 18 (2%) had an aorto-uni-iliac device. Clinical examination and contrast-enhanced computed tomography was performed at fixed follow-up intervals to assess increase or decrease of the maximum transverse diameter (MTD). Endoleaks observed at follow-up were discriminated into persistent endoleak and temporary endoleak. The latter is defined as single time observed endoleaks or with two or more negative imaging studies between observed endoleaks. Life-table analyses were used to calculate the rates of freedom-from-endoleak (no endoleak at any time), freedom-from-persistent endoleak (no persistent endoleak), patient survival, and persistent-endoleak-free-survival. RESULTS The median follow-up of this patient series was 6.2 months. The ratio between observed and expected follow-up data was 82% for the overall follow-up period. However, at 18 months of follow-up this rate was only 45%. The number of patients followed during this period was sufficient to allow statistically meaningful assessment. The MTD in patients with temporary endoleaks demonstrated a significant decrease at 6 to 12 months compared to preoperative values (mean 57 and 53 respectively, p = 0.004). In patients with persistent endoleaks there was no change between the preoperative and 6-month MTD (mean 57 and 60 mm respectively). At 6 and 18 months freedom-from-endoleak was 83% and 74% and freedom-from-persistent endoleak was 93% and 90%, respectively. The 18-month cumulative patient survival was 88% and the main outcome measure, the persistent endoleak-free-survival was 79%. CONCLUSIONS The MTD decreases in patients with temporary endoleak, but not in patients with persistent endoleak. Therefore, the use of the rate of freedom-from-persistent endoleak, reflecting absence of persisting endoleaks to estimate the prognosis with regard to the AAA, is justified. Determining persistent endoleak-free survival appears a rational approach to provide a realistic outlook for patients with stent-grafted AAA. The observed 18-month endoleak-free survival reflects a satisfactory mid-term result.
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Affiliation(s)
- Ph Cuypers
- EUROSTAR Data Registry Centre, Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
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20
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High-dose adenosine-induced asystole assisting accurate deployment of thoracic stent grafts in conscious patients. Ann Vasc Surg 2008; 22:602-7. [PMID: 18504103 DOI: 10.1016/j.avsg.2008.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 12/11/2007] [Accepted: 02/13/2008] [Indexed: 11/22/2022]
Abstract
Adenosine has been used to induce asystole and assist deployment of endoluminal grafts. However, application of high-dose adenosine in conscious patients has not been described. In this prospective study, we administered high-dose adenosine in patients undergoing thoracic stent grafting. Asystole duration in relationship to the dosage of adenosine, safety, and side effect profiles was investigated. All patients who underwent thoracic stent grafting between 1998 and 2006 were the potential study subjects. They received monitored anesthesia care and local anesthesia unless contraindicated. Adenosine was given via rapid intravenous bolus immediately prior to the deployment of the stent graft. Every patient received a dose of 36 mg. If needed, a second dose of 18 mg was given. Duration of asystole was recorded after each administration. Patients' vital signs before and after administration were also documented. Side effect profiles were collected intra- and postoperatively. A total of 46 patients received adenosine (34 men, 12 women). Mean age was 60.4 +/- 17.5 years. American Society of Anesthesiologists scores were II in one patient (2%), III in six patients (13%), and IV in 39 patients (85%). Eighteen patients received a single dose of 36 mg adenosine, 15 were given a second dose of 18 mg, and 13 received nonstandard dosages. Asystole durations were 18.8 +/- 8.8 and 11.6 +/- 5.5 sec for 36 and 18 mg, respectively. Technical success was achieved in all cases. The differences achieved statistical significance (p = 0.0009). There were no severe cardiac or pulmonary complications. High-dose adenosine can be given safely in conscious patients. The dose-response was predictable and reproducible. The dosages used in our study induce sufficient duration of asystole, which ensured accurate deployment of thoracic stent grafts.
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Maffra R, Anene AU, Sands M, Dong YH, Davros W, Brennecke LH, Dolmatch BL. Sealing of type III endoleaks with ethylene vinyl alcohol copolymer in a canine model. J Vasc Interv Radiol 2007; 18:763-9. [PMID: 17538139 DOI: 10.1016/j.jvir.2007.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To test ethylene vinyl alcohol copolymer (EVOH) as a sealing agent for persistent abdominal aortic aneurysm (AAA) endograft leaks. MATERIALS AND METHODS Twelve dogs underwent creation of AAAs with a Palmaz P4014 stent. A 10-mm x 5-cm Wallgraft endoprosthesis with a 4-mm-diameter hole cut into its side was deployed within the AAA. One week later, computed tomography (CT) and angiography were performed and the aneurysm sac was catheterized through the 4-mm hole. Then, EVOH was injected into the sac and lumbar arteries. Four weeks thereafter, all surviving animals underwent repeat CT scanning and angiography and were then euthanized. The AAA underwent gross and microscopic study. RESULTS Three dogs died from aortic rupture within 24 hours of AAA creation and the remaining nine dogs survived to receive EVOH. All nine dogs had persistent flow into the sac and lumbar arteries at the time of EVOH delivery. Seven dogs survived to the end of the experiment, and all aneurysm sacs and lumbar arteries remained occluded on angiography and CT. Histologic examination revealed EVOH and thrombus admixed, with thrombus in varying stages of organization filling the aneurysm sac and lumbar arteries. CONCLUSIONS Embolization of type III endoleaks with EVOH proved to be feasible in a canine model. Further work is warranted to determine its therapeutic utility.
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Affiliation(s)
- Romualdo Maffra
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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Murray D, Ghosh J, Khwaja N, Murphy MO, Baguneid MS, Walker MG. Access for Endovascular Aneurysm Repair. J Endovasc Ther 2006; 13:754-61. [PMID: 17154706 DOI: 10.1583/06-1835.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite advancement in stent-graft technology, access-related problems continue to occur during endovascular repair of aortic aneurysms. Various techniques have been adopted to overcome difficult access situations, however. To survey these developments in arterial access, we performed a systematic literature review from 1994 through 2005 to identify relevant articles pertaining to endovascular access techniques and complications. Excessive iliac tortuosity, circumferential vessel wall calcification, significant occlusive disease, and small caliber vessels account for the majority of access problems, most of which are readily apparent with adequate baseline imaging. Even with careful preoperative assessment, however, some access problems may not be foreseen; nonetheless, the majority can be overcome using today's array of ancillary procedures, such as an iliac conduit, a brachiofemoral wire, or arterial reconstruction. Alternatively, other approach routes, such as the common carotid artery or direct aortic access, may be used to facilitate endovascular aneurysm repair.
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Affiliation(s)
- David Murray
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester M13 9WL, UK
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Abstract
BACKGROUND Endovascular repair of abdominal aortic aneurysm has become widely used. Supporters claim high success rates, few complications and a dramatically reduced hospital stay. However, endoleak, endotension and reports of endoprosthesis rupture are causes of concern. METHODS A Medline search was undertaken to identify articles on endovascular repair of abdominal aortic aneurysm. Additional papers were identified by manual scanning of the references from key articles. RESULTS AND CONCLUSION Endoleak is a potentially serious complication of the endovascular technique and occurs in a significant proportion of patients. It is still not possible to judge whether the presence of an endoleak alone signifies failure of treatment, and the long-term durability of prosthetic covered stents is unknown. However, endovascular repair does appear to confer a degree of protection from rupture although patients must be advised of the need for life-long imaging surveillance and, perhaps, further intervention.
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Affiliation(s)
- T J Gorham
- Radiology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Bounoua F, Sanchez B, Dunn J, Cisek P. Essential techniques for intraoperative composite endograft (CEG) formation in the treatment of abdominal aortic aneurysm. Ann Vasc Surg 2004; 18:38-41. [PMID: 14727164 DOI: 10.1007/s10016-003-0092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The development of an ideal aortic stent graft continues to progress. New devices and techniques are expanding the use of endovascular repair in the treatment of abdominal aortic aneurysms (AAA). We present data with intraoperative composite endograft (CEG) techniques evaluating immediate and short-term compatibility of components and patients outcome. Twenty-five of 66 patients (38%) received intraoperative CEGs for AAA treatment. A total of 50 components were used to treat type I endoleaks, prevent graft limb kinking or treat associated iliac aneurysm. Nine of the components were used to manage type I proximal endoleaks. Forty-one components were used at the iliac limb for distal type I endoleak, hostile iliac anatomy, or graft limb support or to treat an associated iliac aneurysm. Two patients were left with a type I endoleaks at the iliac attachment site on completion of graft placement. With a mean follow-up of 11 months. Two of 25 patients had a type II endoleak at 6 months. One patient had type I endoleak at 1 year follow-up. CEGs are essential to treat endoleaks with a high technical success rate and expand the indications for treating infrarenal AAA. The component's short-term compatibility makes this method of stent graft placement safe.
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Affiliation(s)
- Farida Bounoua
- Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, CA 93105, USA.
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25
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Ingle H, Fishwick G, Thompson MM, Bell PRF. Endovascular repair of wide neck AAA--preliminary report on feasibility and complications. Eur J Vasc Endovasc Surg 2002; 24:123-7. [PMID: 12389233 DOI: 10.1053/ejvs.2002.1694] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To assess the feasibility of endovascular repair (EVR) of wide neck abdominal aortic aneurysms (AAA). STUDY DESIGN Retrospective. METHOD A cohort of patient was identified who had an AAA neck diameter of 28 mm or more and underwent EVR. These patients undergo regular follow-up by 6 monthly CT scan of abdominal aorta. Two independent observers quantified the diameter of the suprarenal aorta, the top of the neck, the bottom of the neck, the length of the neck and the transverse diameter of the AAA. RESULTS The study cohort comprised 16 patients. Bland Altman Analysis determined that the 95% interobserver limits of agreement were -4.7 to 3.3 mm. The mean preoperative diameter of the suprarenal aorta, the top of the neck and bottom of the neck all were 31 mm. On the follow-up CT scan on average after 12 months the suprarenal aorta measured 29 mm, the top of the neck 28 mm and the bottom of the neck 30 mm. There was a statistically significant decrease in the size of the top of the neck (p = 0.03). CONCLUSION This preliminary report suggests that the endovascular repair of AAA with a wide neck is feasible with available commercial devices. The necks do not appear to increase in size and there is no increased incidence of proximal endoleak.
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Affiliation(s)
- H Ingle
- Department of Vascular Surgery, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, U.K
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26
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van Marrewijk C, Buth J, Harris PL, Norgren L, Nevelsteen A, Wyatt MG. Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience. J Vasc Surg 2002; 35:461-73. [PMID: 11877693 DOI: 10.1067/mva.2002.118823] [Citation(s) in RCA: 352] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the incidence, risk factors, and consequences of endoleaks after endovascular repair of abdominal aortic aneurysm. METHODS Data on 2463 patients were collected from 87 European centers and recorded in a central database. Preoperative data were compared for patients with collateral retrograde perfusion (type II) endoleak (group A), patients with device-related (type I and III) endoleaks (group B), and patients in whom no endoleak was detected (group C). Only endoleaks observed after the first postoperative month of follow-up were taken into consideration. Regression analysis was performed to investigate statistical relationships between the occurrence and type of endoleak and preoperative patient and morphologic characteristics, operative details, type of device, and experience of the operating team. In addition, postoperative changes in aneurysmal morphology, the need for secondary interventions, conversions to open repair, aneurysmal rupture, and mortality during follow-up were compared between these study groups. RESULTS Patients in group A had a higher prevalence of a patent inferior mesenteric artery compared with patients without endoleak. Patients in group B were treated more frequently than patients in group C by an operating team with experience of less than 30 procedures. The mean follow-up period was 15.4 months. Secondary interventions were needed in 13% of the patients. Rupture of the aneurysm during follow-up occurred in 0.52% (1/191) in group A, 3.37% (10/297) in group B, and 0.25% (5/1975) in group C. Life table analysis comparing the three study groups demonstrated a significantly higher rate of rupture in group B than in group C (P =.002). The incidence of conversion to open repair during follow-up was higher in group B than in the other two study groups (P <.01). Death was related to the aneurysm or to endovascular repair of the aneurysm in 7% of patients. Secondary outcome success, defined as absence of rupture and conversion, was significantly higher in group A and C compared with that in group B (P =.006 and P =.0001, respectively). CONCLUSIONS The presence of device-related endoleaks correlated with a higher risk of aneurysmal rupture and conversion compared with patients without type I or III endoleaks. Type II endoleak was not associated more often with these events. Consequently, intervention in type II endoleak should only be performed in case of increase of aneurysm size.
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Vos AWF, Wisselink W, Marcus JT, Manoliu RA, Rauwerda JA. Aortic aneurysm pulsatile wall motion imaged by cine MRI: a tool to evaluate efficacy of endovascular aneurysm repair? Eur J Vasc Endovasc Surg 2002; 23:158-61. [PMID: 11863334 DOI: 10.1053/ejvs.2001.1558] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to evaluate cine MRI as a means of determining the two-dimensional pulsatile wall motion (2D-PWM) of abdominal aortic aneurysm (AAA). DESIGN prospective study of 21 patients with AAA. 2D-PWM was defined as change in cross-sectional area. RESULTS the median diastolic area was 28 cm(2) (intraquartile range, IQR, 22-31 cm(2)) and the median (IQR) 2D-PWM was 0.25 (0.10-0.40) cm(2). Assuming that the AAA is circular in cross-section this represents a median (IQR) diameter increase of 0.3 (0.1-0.4) mm. However, local wall displacements up to 2 mm were present in varying directions, without significant change in surface area. CONCLUSION AAA PWM is negligible and may not therefore be a potential tool to assess efficacy of endovascular aneurysm exclusion.
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Affiliation(s)
- A W F Vos
- Department of Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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Bölke E, Jehle PM, Storck M, Braun C, Schams S, Steinbach G, Orth K, Görich J, Scharrer-Pamler R, Sunder-Plassmann L. Endovascular stent-graft placement versus conventional open surgery in infrarenal aortic aneurysm: a prospective study on acute phase response and clinical outcome. Clin Chim Acta 2001; 314:203-7. [PMID: 11718696 DOI: 10.1016/s0009-8981(01)00694-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND For the treatment of aortic aneurysm, stent-graft implantation is an alternative method to open surgery. There is no study comparing both methods with regard to endotoxaemia, the acute phase cascade, and clinical outcome. METHODS In this prospective study, we enrolled 40 patients (34 males, 6 females; mean age 72.1+/-7.5 [58-92] years) with infrarenal abdominal aortic aneurysm who underwent aortic surgery. Comparable groups of patients were treated with open (n=20) or endovascular (n=20) stent-graft implantation. To characterize the inflammatory response, plasma levels of endotoxin, endotoxin-neutralizing capacity (ENC), interleukin-6 (IL-6), C-reactive protein (CRP), and white blood cell count were determined. In all patients, measurements were performed on admission, skin suture, 4 h and from the first to fifth postoperative day. As parameters for the clinical outcome, we assessed daily temperature, lung function, pain, duration of postoperative hospital stay, and morbidity. Wilcoxon rank test was used for statistical analysis. RESULTS In both groups, a significant increase of endotoxin plasma levels and a decrease of ENC was found already after skin incision. IL-6 levels peaked 4 h postoperatively in both groups, whereas CRP rose at the first postoperative day, reaching a maximum at day 2. Conventionally operated patients had significantly higher plasma levels of endotoxin, IL-6, and CRP and lower ENC during and after surgery than patients with stent-graft implantation. Moreover, patients with endovascular stent grafting had significant less postoperative pain, less restriction of total vital capacity, a shorter hospital stay, and a lower morbidity. CONCLUSIONS Endovascular stent grafting of infrarenal aortic aneurysm seems to be superior not only in terms of the inflammatory response but also in overall clinical outcome.
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Affiliation(s)
- E Bölke
- Department of Thoracic and Vascular Surgery, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany.
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Tutein Nolthenius RP, van Herwaarden JA, van den Berg JC, van Marrewijk C, Teijink JA, Moll FL. Three year single centre experience with the AneuRx aortic stent graft. Eur J Vasc Endovasc Surg 2001; 22:257-64. [PMID: 11506520 DOI: 10.1053/ejvs.2001.1440] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To report the mid-term single-centre experience with the AneuRx self-expandable nitinol stentgraft for endovascular aneurysm repair. PATIENTS AND METHODS Between December 1996 and January 2000 a total of 128 patients were treated with an AneuRx bifurcated stentgraft. Of these, 77 patients had a minimum follow-up of 12 months. Patient operative and follow-up data were prospectively gathered. RESULTS Two (3%) conversions were necessary. Median hospital stay was 3 days. One superficial wound infection occurred. Periprocedural (30 days) mortality was 5% (four patients). Three graft occlusions were noted of which two required treatment. Fifteen patients developed 18 endoleaks (six type 1, eight type 2 and four type 3). Type 1 and type 3 endoleaks were treated by extension cuffs. Four type 2 endoleaks were treated with embolisation or direct lumbar puncture. Two-year freedom from endoleak was 76%. Graft migration occurred in six cases, resulting in a 2-year freedom from migration of 90%, kinking only once. CONCLUSIONS endovascular AAA treatment is feasible and so far mid-term results are without major problems. Extensive follow-up is essential as secondary problems may occur later. Long-term results are to be awaited.
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Liewald F, Scharrer-Pamler R, Görich J, Kapfer X, Seifarth H, Halter G, Sunder-Plassmann L. Intraoperative, perioperative and late complications with endovascular therapy of aortic aneurysm. Eur J Vasc Endovasc Surg 2001; 22:251-6. [PMID: 11506519 DOI: 10.1053/ejvs.2001.1417] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To describe the incidence and management of the intraoperative, perioperative and late complications of endovascular aortic aneurysm repair. METHODS Endovascular aneurysm repair was attempted in 130 patients between October, 1995 and January, 2000. Follow-up including computed tomography (CT) was performed in the immediate postoperative period and then at 3, 6, 9 and 12 months and biannually thereafter. The median follow-up period was 20 months. RESULTS Intra- and perioperative problems occurred in 26 patients (20%). Conversion to open surgery was required in five cases (4%). The primary technical success rate was 86%. Three patients (2%) died within the first 30 postoperative days. Late problems occurred in 28 patients (26%). These included: endoleaks (type I: 5%; type II: 10%; type III: 1%) and limb occlusion (3%). The cumulative rate of freedom from secondary intervention was in the first 65 patients treated: 86% and 65% after 1 and 3 years, respectively, and in the last 65 patients: 90% at 1 year. CONCLUSIONS Endovascular aneurysm repair is associated with a higher complication rate than open surgery.
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Affiliation(s)
- F Liewald
- Department of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany
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d'Audiffret A, Desgranges P, Kobeiter DH, Becquemin JP. Follow-up evaluation of endoluminally treated abdominal aortic aneurysms with duplex ultrasonography: validation with computed tomography. J Vasc Surg 2001; 33:42-50. [PMID: 11137922 DOI: 10.1067/mva.2001.112215] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A growing number of patients with abdominal aortic aneurysms are currently being offered endoluminal treatment. However, the incidence of endoleaks, stenosis, and thrombosis is around 25% to 30%. As a result, a strict post procedure imaging surveillance protocol is necessary. The purpose of this study was to compare duplex ultrasonography (DU) and computed tomography (CT) for the follow-up of endoluminally treated aortic aneurysms. METHODS A total of 89 patients were followed up with serial CT and DU at 1, 3, 6, 12, and 24 months after endoluminal treatment. Special attention was directed toward the presence of endoleaks and aneurysm diameter evolution. Preoperative CT and DU were also reviewed to assess aneurysm diameter correlation. RESULTS With DU, 14 type I and 21 type II endoleaks were identified. In one case the DU did not visualize a type II endoleak present on CT, and CT did not confirm three type II leaks identified with DU. There was only one false positive for type I endoleak with DU. The sensitivity of DU was 96% with a specificity of 94%, when compared with CT. A linear regression analysis of the diameters obtained with DU and CT revealed a good correlation. However, variability was high, indicating poor agreement. Regarding diameter evolution, the range was identical in 45%, and the trend was similar in 73%. However, in 9% of the cases, DU showed a decrease in diameter, whereas CT showed a significant increase. CONCLUSION DU is an accurate tool for the diagnosis of endoleaks, but is less valuable for diameter measurements, when compared with CT. Currently, DU is a useful tool, but CT remains a key part of the postoperative evaluation after endoluminal treatment of abdominal aortic aneurysms. At institutions where DU is used for follow-up, researchers should perform quality control studies to avoid potentially significant errors.
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Affiliation(s)
- A d'Audiffret
- Department of Vascular Surgery, Centre Hospitalier Universitaire Henri-Mondor, AP/HP University Paris XII, Créteil, France
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Complicaciones y resultados de las endoprótesis en el tratamiento de los aneurismas de aorta abdominal. ANGIOLOGIA 2001. [DOI: 10.1016/s0003-3170(01)74688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Liewald F, Kapfer X, Görich J, Halter G, Tomczak R, Scharrer-Pamler R. Endograft treatment of anastomotic aneurysms following conventional open surgery for infrarenal aortic aneurysms. Eur J Vasc Endovasc Surg 2001; 21:46-50. [PMID: 11170877 DOI: 10.1053/ejvs.2000.1242] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to evaluate the use of endograft therapy for treating anastomotic aneurysm following open surgical repair of infrarenal aneurysms of the abdominal aorta. METHODS four male patients (age 47-75 years) at high surgical risk (ASA IV n=3, ASA III n=1) developed secondary aneurysms at the site of the central (four aneurysms) and additional peripheral (two aneurysms) anastomosis of their tube or bifurcation prosthesis an average of 13 years (range 1-23 years) after conventional open surgical correction of infrarenal aneurysm of the abdominal aorta. In two patients, there was covered rupture of the aneurysm sac. The aneurysm diameter was 4.8 cm, 8.0 cm, 7.4 cm, 7.0 cm, respectively (mean 6.8 cm). Follow-up included helical CT imaging at 1 week, 3 months and 6 months postoperatively. RESULTS anastomotic aneurysm was successfully treated in all four cases. No evidence of endoleak was observed during the follow-up period. Two patients died 14 and 18 days after surgery due to myocardial infarction and cerebrovascular accident. The endovascular repair of the two patients who died was intact. CONCLUSION although no long-term results are available, the use of a graft-in-graft method to repair anastomotic aneurysms following conventional implantation of tube or bifurcation prostheses appears to be effective, particularly in patients at high surgical risk.
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Affiliation(s)
- F Liewald
- Department of Thoracic and Vascular Surgery, University of Ulm, Steinhövelstr. 9, 89075 Ulm, Germany
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Lundbom J, Hatlinghus S, Wirsching J, Amundsen S, Staxrud LE, GjŁlberg T, Hafsahl G, Oskarsson W, Krohg-SŁrensen K, Brekke M, Myhre HO. Endovascular treatment of abdominal aortic aneurysms in Norway: the first 100 patients. Eur J Vasc Endovasc Surg 1999; 18:506-9. [PMID: 10637147 DOI: 10.1053/ejvs.1999.0944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to present the first 100 consecutive endograft implantations for abdominal aortic aneurysms (AAAs) in Norway. DESIGN retrospective study of 100 consecutive graft implantations, performed at five University Hospitals during 1995 to 1997. MATERIAL one hundred patients with a median age of 70 years were included. In all patients the Vanguard modular system (Boston Scientific Corp.) was used. Ninety-four of the 100 patients were treated under regional anaesthesia. A completion angiography was done to evaluate the position of the graft and whether endoleaks were present. RESULTS two patients died within 30 days, one due to cardiac insufficiency and another due to haemorrhage during the procedure. There were four early conversions to open repair. At discharge eight patients had an endoleak, while retrograde flow into the aneurysmal sac was observed in four patients. During the follow-up period one conversion to open repair became necessary due to graft migration. Four late leaks were all repaired successfully using endovascular techniques. Five cases of retrograde filling were detected and embolisation with coils was performed in two cases, while three were observed. Seven graft-limb occlusions occurred during the follow-up period and four of these required treatment. CONCLUSIONS endovascular AAA repair should be regarded as an experimental treatment, although the short term results are promising. Close follow-up of patients with CT scans or arteriography is necessary.
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Affiliation(s)
- J Lundbom
- Department of Surgery, University Hospital of Trondheim, Norway
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Seelig MH, Oldenburg WA, Hakaim AG, Hallett JW, Chowla A, Andrews JC, Cherry KJ. Endovascular repair of abdominal aortic aneurysms: where do we stand? Mayo Clin Proc 1999; 74:999-1010. [PMID: 10918865 DOI: 10.4065/74.10.999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms has evolved dramatically within the past few years. In light of the potential to reduce morbidity and mortality associated with open surgical repair, endoluminal grafting offers therapeutic options to patients who are not surgical candidates because of comorbidities. With the development of bifurcated devices, more complex aneurysms may be treated by endovascular grafting. Although successful placement of endovascular grafts requires a pronounced learning curve, including appropriate patient selection, midterm results seem consistent with those of traditional open repair of aneurysms. This review describes the current indications, minimal requirements, different devices and associated techniques, and potential complications of endoluminal repair of abdominal aortic aneurysms. Future aspects of endoluminal grafting are also discussed.
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Affiliation(s)
- M H Seelig
- Department of Surgery, Mayo Clinic Jacksonville, FL 32224, USA
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May J, White GH, Harris JP. Techniques for surgical conversion of aortic endoprosthesis. Eur J Vasc Endovasc Surg 1999; 18:284-9. [PMID: 10550261 DOI: 10.1053/ejvs.1999.0898] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J May
- Department of Surgery, University of Sydney, Sydney, Australia
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Makaroun M, Zajko A, Sugimoto H, Eskandari M, Webster M. Fate of endoleaks after endoluminal repair of abdominal aortic aneurysms with the EVT device. Eur J Vasc Endovasc Surg 1999; 18:185-90. [PMID: 10479624 DOI: 10.1053/ejvs.1998.0807] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE we aim to describe our medium-term follow-up of 20 patients with an endoleak following repair of their abdominal aortic aneurysms (AAA) using the Endovascular Technologies (EVT) device. DESIGN the experience of one centre in a prospective multicentre phase II trial. MATERIALS AND METHODS 55 patients with an endovascular repair of their AAA and at least 6 months>> follow-up were reviewed. Intraoperative angiograms, next day duplex scans and computed tomography (CT) images were used to detect endoleaks. Follow-up with CT and duplex was performed at 3, 6, 12 and 24 months. Persistent endoleaks at 6 months were evaluated by angiography and treated by endovascular coiling. RESULTS there were three immediate conversions to open procedures. Twenty of 52 (38%) patients had an endoleak identified initially. One patient died from a myocardial infarction and three were not evident any longer by discharge CT. Sixteen endoleaks (31%) were present at discharge. Nine resolved spontaneously by 3-6 months and seven were still persistent at 6 months (14%). Six patients underwent coiling of their leak, all with successful radiographic seal after 1-3 sessions. CONCLUSIONS endoleaks are frequent after endovascular AAA repair, but the majority close spontaneously. Coiling of the leaks and radiographic seal can be achieved in all cases still persistent at 6 months. Whether this method is clinically effective awaits further follow-up.
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Affiliation(s)
- M Makaroun
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Patel ST, Haser PB, Bush HL, Kent KC. The cost-effectiveness of endovascular repair versus open surgical repair of abdominal aortic aneurysms: A decision analysis model. J Vasc Surg 1999; 29:958-72. [PMID: 10359930 DOI: 10.1016/s0741-5214(99)70237-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Endovascular repair (EVR) is a less-invasive method for the treatment of abdominal aortic aneurysms (AAAs) as compared with open surgical repair (OSR). The potential benefits of EVR include increased patient acceptance, less resource utilization, and cost savings. This study was designed to determine whether the EVR of AAAs is a cost-effective alternative to OSR. METHODS A cost-effectiveness analysis was performed using a Markov decision analysis model to compute long-term survival rates in quality-adjusted life years and lifetime costs for a hypothetical cohort of patients who underwent either OSR or EVR. Probability estimates of the different outcomes of the two alternative strategies were made on the basis of a review of the literature. The average costs of (1) the immediate hospitalization ($16,016 for OSR, $20,083 for EVR), (2) the complications that resulted from each procedure, (3) the subsequent interventions, and (4) the surveillance protocol were determined on the basis of average resource utilization as reported in the literature and from our hospital's cost accounting system. Our measure of outcome was the cost-effectiveness ratio. RESULTS For our base-case analysis (70-year-old men with 5-cm AAAs), EVR was cost-effective with a cost-effectiveness ratio of $22,826-society usually is willing to pay for interventions with cost-effectiveness ratios of less than $60,000 (eg, cost-effectiveness ratios for coronary artery bypass grafting and dialysis are $9500 and $54,400, respectively). This conclusion did not vary significantly with increases in procedural costs for EVR (ie, if the cost of the endograft increased from $8000 to $12,000, EVR remained cost-effective with a cost-effectiveness ratio of $32,881). The cost-effectiveness of EVR was critically dependent on EVR producing a large reduction in the combined mortality and long-term morbidity rate (stroke, dialysis-dependent renal failure, major amputation, myocardial infarction) as compared with OSR (ie, a reduction in the combined mortality and long-term morbidity rate of OSR from 9.1% to 4.7% made EVR no longer cost-effective). CONCLUSION Despite the high cost of new technology and the need for close postoperative surveillance, EVR is a cost-effective alternative for the repair of AAAs. However, the cost-effectiveness of this new technology is critically dependent on its potential to reduce morbidity and mortality rates as compared with OSR. EVR may not be cost-effective in medical centers where OSR can be performed with low risk.
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Affiliation(s)
- S T Patel
- Department of Surgery, Division of Vascular Surgery, New York Presbyterian Hospital, Cornell University Medical College, New York 10021, USA
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Cuypers P, Buth J, Harris PL, Gevers E, Lahey R. Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry. Eur J Vasc Endovasc Surg 1999; 17:507-16. [PMID: 10377023 DOI: 10.1053/ejvs.1999.0836] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE the outcomes for patients after endovascular treatment of abdominal aortic aneurysm (AAA) are determined primarily by the endpoints of death and endoleaks, the latter representing continued risk of rupture. The data of a multicentre registry were analysed with regard to the early outcome of stent-graft procedures for AAA and the complications associated with this treatment. In addition, the results during follow-up were analysed by determining mortality and endoleak development as separate endpoints and as a combined endpoint defined as endoleak-free survival. SETTING 38 European institutions of Vascular Surgery collaborating in a multicentre registry project. PATIENTS AND METHODS 899 patients with AAA underwent between May 1994 and March 1998 elective endovascular repair (818 men and 81 women; mean age 69 years). 80 (8.9%) of the patients had medical conditions that excluded them from open repair. 818 (91%) of patients had a bifurcated device, 63 (7%) had a straight tube graft, and only 18 (2%) had an aorto-uni-iliac device. Clinical examination and contrast-enhanced computed tomography was performed at fixed follow-up intervals to assess increase or decrease of the maximum transverse diameter (MTD). Endoleaks observed at follow-up were discriminated into persistent endoleak and temporary endoleak. The latter is defined as single time observed endoleaks or with two or more negative imaging studies between observed endoleaks. Life-table analyses were used to calculate the rates of freedom-from-endoleak (no endoleak at any time), freedom-from-persistent endoleak (no persistent endoleak), patient survival, and persistent-endoleak-free-survival. RESULTS the median follow-up of this patient series was 6.2 months. The ratio between observed and expected follow-up data was 82% for the overall follow-up period. However, at 18 months of follow-up this rate was only 45%. The number of patients followed during this period was sufficient to allow statistically meaningful assessment. The MTD in patients with temporary endoleaks demonstrated a significant decrease at 6 to 12 months compared to preoperative values (mean 57 and 53 respectively, p =0.004). In patients with persistent endoleaks there was no change between the preoperative and 6-month MTD (mean 57 and 60 mm respectively). At 6 and 18 months freedom-from-endoleak was 83% and 74% and freedom-from-persistent endoleak was 93% and 90%, respectively. The 18-month cumulative patient survival was 88% and the main outcome measure, the persistent endoleak-free-survival was 79%. CONCLUSIONS the MTD decreases in patients with temporary endoleak, but not in patients with persistent endoleak. Therefore, the use of the rate of freedom-from-persistent endoleak, reflecting absence of persisting endoleaks to estimate the prognosis with regard to the AAA, is justified. Determining persistent endoleak-free survival appears a rational approach to provide a realistic outlook for patients with stent-grafted AAA. The observed 18-month endoleak-free survival reflects a satisfactory mid-term result.
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Affiliation(s)
- P Cuypers
- EUROSTAR Data Registry Centre, Department of Vascular Surgery, Eindhoven, The Netherlands
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van Essen JA, Gussenhoven EJ, van der Lugt A, Huijsman PC, van Muiswinkel JM, van Sambeek MR, van Dijk LC, van Urk H. Accurate assessment of abdominal aortic aneurysm with intravascular ultrasound scanning: validation with computed tomographic angiography. J Vasc Surg 1999; 29:631-8. [PMID: 10194490 DOI: 10.1016/s0741-5214(99)70308-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to assess the accuracy of intravascular ultrasound (IVUS) parameters of abdominal aortic aneurysm, used for endovascular grafting, in comparison with computed tomographic angiography (CTA). METHODS This study was designed as a descriptive study. Between March 1997 and March 1998, 16 patients with abdominal aortic aneurysms were studied with angiography, IVUS (12.5 MHz), and CTA. The length of the aneurysm and the length and lumen diameter of the proximal and distal neck obtained with IVUS were compared with the data obtained with CTA. The measurements with IVUS were repeated by a second observer to assess the reproducibility. Tomographic IVUS images were reconstructed into a longitudinal format. RESULTS IVUS results identified 31 of 32 renal arteries and four of five accessory renal arteries. A comparison of the length measurements of the aneurysm and the proximal and distal neck obtained with IVUS and CTA revealed a correlation of 0.99 (P <.001), with a coefficient of variation of 9%. IVUS results tended to underestimate the length as compared with the CTA results (0.48 +/- 0.52 cm; P <.001). A comparison of the lumen diameter measurements of the proximal and distal neck derived from IVUS and CTA showed a correlation of 0.93 (P <.001), with a coefficient of variation of 9%. IVUS results tended to underestimate aneurysm neck diameter as compared with CTA results (0.68 +/- 1.76 mm; P =.006). Interobserver agreement of IVUS length and diameter measurements showed a good correlation (r = 1.0; P <.001), with coefficients of variation of 3% and 2%, respectively, and no significant differences (0.0 +/- 0.16 cm and 0.06 +/- 0.36 mm, respectively). The longitudinal IVUS images displayed the important vascular structures and improved the spatial insight in aneurysmal anatomy. CONCLUSION Intravascular ultrasound scanning results provided accurate and reproducible measurements of abdominal aortic aneurysm. The longitudinal reconstruction of IVUS images provided additional knowledge on the anatomy of the aneurysm and its proximal and distal neck.
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Affiliation(s)
- J A van Essen
- Departments of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Umscheid T, Stelter WJ. Time-related alterations in shape, position, and structure of self-expanding, modular aortic stent-grafts: a 4-year single-center follow-up. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1999; 6:17-32. [PMID: 10088887 DOI: 10.1583/1074-6218(1999)006<0017:traisp>2.0.co;2] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the nature and ramifications of structural and positional changes over time in tube and modular bifurcated aortic stent-grafts. METHODS Two hundred ninety-one patients received endovascular aortic grafts (primarily Stentor/Vanguard) between August 1994 and August 1998. Follow-up surveillance (clinical and laboratory examination, biplanar noncontrast radiography, and contrast-enhanced computed tomography) has been maintained on all patients for 4 years. Changes in the configuration and position of endografts have been noted and their sequelae charted. RESULTS Three types of endograft shape changes have been documented: mild -- slight distortions visible on plain radiographs (n = 90, 31.0%), significant -- angulations reaching 60 degrees to 90 degrees (n = 65, 22.3%), and severe -- angulations > or = 90 degrees (n = 10, 3.4%). Changes in position never gave rise to late migration at the proximal attachment site, whereas at the distal ends, the endograft easily retracted from the iliac arteries (n = 8). Structural alterations (rupture of the stent frame, sutures, or fabric, and total graft disintegration) were more common in the original Stentor model. Shape, position, and structural alterations were mutually dependent and led to secondary endoleaks (n = 26) and graft limb thrombosis (n = 37). Late surgical conversion was necessary in 3 (1.0%) patients. CONCLUSIONS Tortuosity of the native vessels is a source of complication in long-term follow-up just as it is during implantation. Given the late appearance of complications in this patient cohort, it would seem that the durability of an endograft cannot be evaluated with < 3 years of follow-up.
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Affiliation(s)
- T Umscheid
- Department of Surgery, Städtische Kliniken Frankfurt-Höchst, Frankfurt, Germany.
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Eurostar Registry Results 1994–1998. J Vasc Interv Radiol 1999. [DOI: 10.1016/s1051-0443(99)71053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Deaton DH, Bogey WM, Chiang K, Brigham D, Powell CS. Bifurcated endovascular grafting for abdominal aortic aneurysm. Ann Vasc Surg 1999; 13:23-31. [PMID: 9878653 DOI: 10.1007/s100169900216] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Endovascular grafting represents a minimally invasive approach to prosthetic aortic grafting for abdominal aortic aneurysms (AAA). We reviewed our initial experience with a bifurcated endovascular graft that shares with conventional grafts the characteristics of discrete transaortic fixation and unitary unsupported woven polyester construction. Twenty-eight patients (26 male, 2 female; age: 58-93) with infrarenal aortic aneurysms between 41 and 82 mm in greatest diameter (x = 55.4 mm) underwent bifurcated endovascular grafting (Guidant/EVT, Menlo Park, CA) over an 18-month period. We concluded that bifurcated endovascular grafting with the EVT(R) device provides reliable and reproducible aneurysm exclusion with short hospital recovery and low morbidity.
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Affiliation(s)
- D H Deaton
- Section of Vascular Surgery, East Carolina University, Greenville, NC 27858, USA
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45
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Cleveland TJ, Gaines P. Aortic stent–grafts. MINIM INVASIV THER 1999. [DOI: 10.3109/13645709909153153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McCrory C, Hughes N. An interesting case of shunting. J Cardiothorac Vasc Anesth 1998; 12:565-6. [PMID: 9801982 DOI: 10.1016/s1053-0770(98)90105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- C McCrory
- Department of Anaesthesia and Intensive Care, St James Hospital, Dublin, Ireland
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Boyle JR, Thompson MM, Sayers RD, Nasim A, Healey P, Bell PR. Changes in referral practice, workload, and operative mortality after establishment of an endovascular abdominal aortic aneurysm program. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1998; 5:201-5. [PMID: 9761570 DOI: 10.1583/1074-6218(1998)005<0201:cirpwa>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the change in referral practice following establishment of an endovascular abdominal aortic aneurysm (AAA) program. METHODS A prospective audit of all elective admissions for AAA was established in January 1994 at the initiation of an endovascular AAA program. A comparison was made between this cohort and the elective AAA repairs performed between 1981 and 1993. RESULTS Since January 1994, 213 AAA patients (177 men; median age 73 years, range 54 to 88) have been referred for potential endovascular aneurysm repair. To date, 142 patients have undergone elective surgery (41 endovascular and 101 conventional). Between 1981 and 1993, 304 patients (255 men; median age 69 years, range 45 to 86) had elective aneurysm repair. Comparison of the two time periods has revealed significant increases in the number of tertiary referrals (41.8% versus 9.5%, p < 0.01), annual operations (50 versus 23, p < 0.05), and overall mortality (12% versus 6.7%, p < 0.05), the latter attended by a significant increase in cardiorespiratory comorbidity. CONCLUSIONS The higher elective AAA mortality rate since the establishment of an endovascular program reflects a change in referral practice and may be directly attributable to an increase in the number of high-risk patients. An endovascular AAA program has clinical and financial implications for the hospital concerned.
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Affiliation(s)
- J R Boyle
- Department of Surgery, University of Leicester, United Kingdom
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Boyle JR, Thompson MM, Clode-Baker EG, Green J, Bolia A, Fishwick G, Bell PR. Torsion and kinking of unsupported aortic endografts: treatment by endovascular intervention. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1998; 5:216-21. [PMID: 9761572 DOI: 10.1583/1074-6218(1998)005<0216:takoua>2.0.co;2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe the management strategies used to deal with twisted aortic endografts. METHODS AND RESULTS Two patients with successfully excluded aortic aneurysms developed symptoms referable to previously undetected twists in their endografts (one EndoVascular Technologies [EVT] and one customized aortomonoiliac device). The limb graft occlusion in the EVT graft was treated surgically with a femorofemoral bypass, but the aortomonoiliac endograft was salvaged with percutaneous implantation of a Wallstent. During another aortomonoiliac procedure, suboptimal flow through the endograft was traced to contortion of the endograft as it passed over an angulated proximal aneurysm neck. An X-large Palmaz stent was deployed to support the graft at this point. CONCLUSIONS Unsupported aortic endografts may develop twists and kinks during deployment that can lead to low outflow and graft occlusion. Endovascular techniques are available to repair these defects postoperatively, although more precise intraoperative assessment tools may identify these problems so that they can be corrected at the initial intervention.
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Affiliation(s)
- J R Boyle
- Department of Surgery, Leicester Royal Infirmary, United Kingdom
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May J, Woodburn K, White G. Endovascular treatment of infrarenal abdominal aortic aneurysms. Ann Vasc Surg 1998; 12:391-5. [PMID: 9676939 DOI: 10.1007/s100169900174] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J May
- Department of Surgery, University of Sydney, New South Wales, Australia
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Brewster DC, Geller SC, Kaufman JA, Cambria RP, Gertler JP, LaMuraglia GM, Atamian S, Abbott WM. Initial experience with endovascular aneurysm repair: comparison of early results with outcome of conventional open repair. J Vasc Surg 1998; 27:992-1003; discussion 1004-5. [PMID: 9652461 DOI: 10.1016/s0741-5214(98)70002-3] [Citation(s) in RCA: 222] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine the safety, effectiveness, and problems encountered with endovascular repair of abdominal aortic aneurysm (AAA). Initial experience with endoluminal stent grafts was examined and compared with outcome for a matched concurrent control group undergoing conventional operative repair of AAA. METHODS Over a 3-year period, 30 patients underwent attempts at endovascular repair of infrarenal AAA. Of the 28 (93%) successfully implanted endografts, 8 were tube endografts, 8 bifurcated grafts, and 12 aortouniiliac grafts combined with femorofemoral bypass. Most of the procedures were performed in the past year because the availability of bifurcated and aortoiliac endografts markedly expanded the percentage of patients with AAA who might be treated with endoluminal methods. The follow-up period ranged from 1 to 44 months, with a mean value of 11 months. RESULTS Endovascular procedures demonstrated significant advantages with respect to reduced blood loss (408 versus 1287 ml), use of an intensive care unit (0.1 versus 1.75 days), length of hospitalization (3.9 versus 10.3 days), and quicker recovery (11 versus 47 days). Although the total number of postoperative complications was identical for the two groups, the nature of the complications differed considerably. Local and vascular complications characteristic of endovascular repair could frequently be corrected at the time of the procedure and tended to be less severe than systemic or remote complications, which predominated among the open surgical repair group. On an intent-to-treat basis, 23 (77%) of the 30 AAAs were successfully managed with endoluminal repair. The seven (23%) failures were attributable to two immediate conversions caused by access problems, three persistent endoleaks, one late conversion caused by AAA expansion, and one late rupture. CONCLUSIONS Although less definitive than those for conventional operations, these early results suggest that endovascular AAA repair offers considerable benefits for appropriate patients. The results justify continued application of this method of AAA repair, particularly in the treatment of older persons at high risk.
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Affiliation(s)
- D C Brewster
- Division of Vascular Surgery, Massachusetts General Hospital, Boston, USA
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