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Wanken ZJ, Barnes JA, Trooboff SW, Columbo JA, Jella TK, Kim DJ, Khoshgowari A, Riblet NB, Goodney PP. A systematic review and meta-analysis of long-term reintervention after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2020; 72:1122-1131. [DOI: 10.1016/j.jvs.2020.02.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/03/2020] [Indexed: 01/12/2023]
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Väärämäki S, Salenius J, Pimenoff G, Uurto I, Suominen V. Overall outcome after endovascular aneurysm repair with a first-generation stent graft (Vanguard): A 20-year single-center experience. J Vasc Surg 2020; 72:896-903. [PMID: 32139310 DOI: 10.1016/j.jvs.2019.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/03/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The problems with first-generation stent grafts for endovascular aneurysm repair are well known, but their long-term outcome remains to be established. The purpose of the study was to characterize the outcome of patients treated for abdominal aortic aneurysm (AAA) with a first-generation stent graft, Vanguard (Boston Scientific, Natick, Mass), in a single academic center with a follow-up of up to 20 years. METHODS There were 48 AAA patients electively treated with a Vanguard stent graft between February 1997 and November 1999. The patients were monitored annually until the end of 2018. The outcomes were overall survival and the number of graft-related complications and reinterventions. RESULTS The mean age was 70 years (range, 54-85 years), and the mean follow-up was 107 months (range, 6-262 months). All stent grafts were successfully implanted, but 90% of the patients encountered graft-related complications during follow-up. The most common complications were endoleaks (type I, 27%; type II, 29%; type III, 31%), stent fracture (46%), graft thrombosis (31%), and migration (40%). A total of 40 (83%) patients required a secondary procedure during long-term follow-up. The endovascular method for treating the complication was successful in 73 (87%) of 84 cases. There were no primary conversions, but 10 patients (21%) required a late conversion. In five cases, the complications required relining with a newer device. There were four AAA ruptures (8.3%), two of them fatal. The cumulative overall survival rates were 94%, 69%, 33%, 15%, and 13% at 1 year, 5 years, 10 years, 15 years, and 20 years, respectively. CONCLUSIONS The use of the Vanguard, a first-generation stent graft, was associated with multiple graft-related complications. However, these complications could mainly be treated by endovascular means. The Vanguard stent graft is a good example of how new technology can cause unpredictable problems that can magnify the workload and endanger the patient's well-being even decades after the initial procedure.
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Affiliation(s)
- Suvi Väärämäki
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland.
| | - Juha Salenius
- Division of Vascular Surgery, Department of Surgery, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Georg Pimenoff
- Division of Interventional Radiology, Department of Radiology, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Ilkka Uurto
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Velipekka Suominen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
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Sanderson A, Bhamidipaty V, Rhodes A, Pond F. Re-pressurization and rupture of common iliac artery aneurysms. ANZ J Surg 2016; 86:948-950. [PMID: 25060666 DOI: 10.1111/ans.12801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew Sanderson
- Department of Vascular Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Venu Bhamidipaty
- Department of Vascular Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Alex Rhodes
- Department of Interventional Radiology, Western Hospital, Melbourne, Victoria, Australia
| | - Franklin Pond
- Department of Vascular Surgery, Western Hospital, Melbourne, Victoria, Australia
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Väärämäki S, Suominen V, Pimenoff G, Saarinen J, Uurto I, Salenius J. Long-Term Experience of Endovascular Repair for Thoracic Aortic Aneurysms and Dissections. Vasc Endovascular Surg 2016; 50:335-42. [DOI: 10.1177/1538574416652244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report the long-term results of thoracic endovascular aortic repair (TEVAR) in both elective and emergency cases of thoracic aortic aneurysm (TAA) and type B dissection. Material and Methods: A prospective single-center study of 78 TEVAR patients treated between February 1998 and February 2013. Stent-graft implantation was performed in 51 (65%) patients for TAA (43 elective and 8 emergency cases) and in 27 (35%) patients for type B dissection (11 elective and 16 emergency cases). Short- and long-term results were evaluated, and a subgroup of patients with left subclavian artery (LSA) coverage was also analyzed. Results: The patients were followed for a mean of 55 months (1-160 months). The technical success rate was 81% and 30-day mortality 6.4% (n = 5). The stroke rate was 7.7% (n = 6) and permanent paraparesis 2.6% ( n = 2). In follow-up, there were 28 (36%) primary (15 type I and 13 type II) and 10 secondary endoleaks (8 type I and 2 type II). Multivariate analysis showed no significant predictive factors for developing a type I endoleak. Secondary interventions were required in 24% of the patients. There was 1 late thoracic aortic rupture and 1 late conversion (1.3%). Patients with LSA coverage had a higher incidence of stroke (12.5% vs 4.3%, P = .18) and paraparesis (3.1% vs 2.2%, P = .79) compared to those without LSA coverage, although this difference was not statistically significant. Stroke rates were significantly higher in patients treated in an emergency setting ( P = .048). Conclusion: Thoracic endovascular aortic repair is a relatively safe and effective therapy for different aortic pathologies with good long-term success. The risk of stroke and paraparesis is notable whether the LSA is covered, and strokes clearly accumulate in the emergency setting. A type I endoleak is the most common complication, but there are no predictive factors for its development.
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Affiliation(s)
- Suvi Väärämäki
- Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
- Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Velipekka Suominen
- Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Georg Pimenoff
- Department of Radiology, Division of Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jukka Saarinen
- Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
| | - Ilkka Uurto
- Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | - Juha Salenius
- Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
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Mousa AY, Bozzay J, Broce M, Yacoub M, Stone PA, Najundappa A, Bates MC, AbuRahma AF. Novel Risk Score Model for Prediction of Survival Following Elective Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2016; 50:261-9. [PMID: 27114446 DOI: 10.1177/1538574416638760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to identify significant predictors of long-term mortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS We included all cases with elective EVAR based on a national data set from the Society for Vascular Surgery Patient Safety Organization. Clinical and anatomic variables were analyzed with a Kaplan-Meier and Cox-regression model to determine predictors of mortality and develop a score equation to categorize patients into low, medium, and high long-term mortality risk. RESULTS A total of 5678 patients with EVAR were included with an average age of 73.6 ± 8.2 years. The majority were male (81.6%) with a history of smoking (86.1%). There were 3 deaths within 30 days (0.1%). Several factors were associated with poor survival: unstable angina (hazard ratio [HR], 2.8; P = .008), dialysis (HR, 3.7; P < .001), estimated glomerular filtration rate (eGFR) <30 (HR, 1.7; P = .044), eGFR 30 to 59 (HR, 1.4; P = .002), age >80 (HR, 3.2; P < .001), age 75 to 79 (HR, 2.2; P < .001), chronic obstructive pulmonary disease on oxygen (HR, 3.3; P < .001), aortic diameter >5.8 cm (HR, 1.2; P = .043), and high risk for surgery (HR, 1.4; P = .043). Preoperative aspirin use and body mass index 25 to 35 were both found to be protective (HR, 0.78; P = .017 and HR, 0.8; P = .024, respectively). With our scoring model, 5- and 10-year survival rates for patients with low, medium, and high risk were 89.2%, 80.7%, and 64.1% and 77.2%, 60.1%, and 40.1%, respectively (P < .001). CONCLUSION Ten-year survival following EVAR in patients with a high-risk score utilizing the model provided was 40.1%. Patients with multiple comorbidities at risk for decreased long-term survival can be identified with our model, which is more applicable for high-volume contemporary institutions.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Joseph Bozzay
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Mike Broce
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Michael Yacoub
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Patrick A Stone
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Aravinda Najundappa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Mark C Bates
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Vascular Center of Excellence, Charleston Area Medical Center, Charleston, WV, USA
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McBride EL, Paap C, Murray-Krezan C, Goff JM. Long-term follow-up of endovascular abdominal aortic aneurysm repair in a rural veteran patient population. Am J Surg 2012; 204:e39-43. [PMID: 23022249 DOI: 10.1016/j.amjsurg.2012.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 07/13/2012] [Accepted: 07/18/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The endovascular repair of abdominal aortic aneurysms (EVARs) requires follow-up to detect and treat late complications. METHODS Two hundred eleven patients underwent EVAR for infrarenal, nonruptured abdominal aortic aneurysms from 1999 to 2010 at the Raymond G. Murphy VA Medical Center, Albuquerque, NM. A retrospective review examined patient demographics, comorbidities, the distance the patient lived from the facility, early and late complications, and the device implanted. Statistical analysis included the chi-square test for independence, the Fisher exact test, and the 2-sample Mann-Whitney U test for means. RESULTS The mean time from the operation to the first complication was 21 months (standard deviation = 20 months) with a mean follow-up of 48 months (standard deviation = 36 months). The late complication rate was 22.8% (54 patients). Sixteen percent did not require any reinterventions, 57% were treated with percutaneous interventions, and 27% required an open surgical procedure. No single comorbidity, combination of comorbidities, distance the patient lived from the facility, or device implanted was predictive of complications. CONCLUSIONS EVAR follow-up is essential to detect complications. When complications occur, the majority occur well after the initial treatment, and most can be treated with minimally invasive percutaneous techniques.
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Affiliation(s)
- Erica L McBride
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Väärämäki S, Suominen V, Pimenoff G, Saarinen J, Salenius J. Long-Term Experience of Endovascular Aneurysm Repair With Zenith Prosthesis: Diminishing Graft-Related Complications Over Time. Ann Vasc Surg 2012; 26:845-51. [DOI: 10.1016/j.avsg.2012.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 01/17/2012] [Accepted: 01/28/2012] [Indexed: 11/15/2022]
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Santos Junior EPD, Batista RRAM, Oliveira MBD, Alves RF, Blois RR. Pseudoaneurisma de carótida comum secundário a trauma contuso: opção de tratamento por cirurgia a céu aberto. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Relato de caso de paciente feminina, com 44 anos de idade, vítima de trauma cervical em acidente de trânsito, que apresentou massa cervical dolorosa, rouquidão e disfagia associados, três semanas após o trauma. Exames complementares identificaram pseudoaneurisma de carótida comum em zona II. Optou-se pelo tratamento por meio de cirurgia convencional a céu aberto com excelente resultado imediato. Foi realizado um exame de controle após sete meses do procedimento cirúrgico, e os resultados confirmaram o sucesso terapêutico.
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Wibmer A, Nolz R, Teufelsbauer H, Kretschmer G, Prusa AM, Funovics M, Lammer J, Schoder M. Complete ten-year follow-up after endovascular abdominal aortic aneurysm repair: survival and causes of death. Eur J Radiol 2011; 81:1203-6. [PMID: 21524867 DOI: 10.1016/j.ejrad.2011.03.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/22/2011] [Accepted: 03/30/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the hazard and causes of death after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms during a complete ten year follow-up. METHODS This is a retrospective clinical study of 130 consecutive patients undergoing EVAR between 1995 and 1998. One-hundred twenty-one patients (93.1%) were treated with first-generation stentgrafts and nine patients (6.9%) received second-generation devices. All patients completed a follow-up of at least 10 years, unless death occurred before then. Time and causes of death were provided by the Austrian central register of deaths. RESULTS The median follow-up was 7.6 years, and the 130 patients had 968.5 person-years of follow-up. The ten-year mortality rate was 62.3%. Cardiovascular events were the most frequent causes of death, with a 3.9 incidence rate per 100 person-years. Cancer death and death due to other causes occurred in 2.1 and 1.8 cases per 100 person-years, respectively. Lethal late aneurysm rupture happened in 4.6% (n=6), which corresponds to an annual incidence rate of 0.6 per 100 person-years. All of those patients had been treated with first-generation devices. CONCLUSIONS Cardiovascular events were the most frequent cause of death after EVAR, followed by malignancy and other diseases. The risk of dying from secondary rupture was clearly lower than that of death due to other reasons during ten years after EVAR, even in patients with first-generation stentgrafts.
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Affiliation(s)
- Andreas Wibmer
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Mestres G, Zarka Z, García-Madrid C, Riambau V. Early Abdominal Aortic Endografts: A Decade Follow-up Results. Eur J Vasc Endovasc Surg 2010; 40:722-8. [DOI: 10.1016/j.ejvs.2010.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 08/14/2010] [Indexed: 10/19/2022]
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Iatrogenous superficial femoral artery pseudoaneurysm: treatment with a PFNA nail. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/s1988-8856(09)70173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Navarrete F, Longares J. Pseudoaneurisma iatrogénico de la arteria femoral superficial con clavo PFNA. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/j.recot.2008.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
It is now more than 20 years since the first report of stent graft insertion in the human arterial system was published. The first "homemade" devices proved that the technique was possible but could not show any durability. Using these devices, it was possible to get a good seal but not a good anchorage. Not even the first generation of commercially available stent grafts proved to be durable. First after gaining knowledge about the forces acting on the stent graft, it was realized that attachment was important for the durability and the hooks and barbs or a longitudinal stability are needed to minimise the risk for distal migration. Not much of a difference in the overall performance is noticed between the ePTFE graft or the polyester graft or when comparing stainless steel stents with those made out of nitinol. The systems are made much more flexible and hydrophilic leading to a better performance and a greater chance of percutaneous approach. The optimal stent graft is not out on the market yet, but hopefully will come with further development.
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Affiliation(s)
- J Brunkwall
- Department of Vascular Surgery, University Clinics, Cologne, Germany.
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