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Warmerdam BW, van Rijswijk CS, Droop A, Lucassen CJ, Hamming JF, van Schaik J, van der Vorst JR. The association between sarcopenia and adverse outcomes after complex endovascular aortic repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:256-264. [PMID: 37987737 DOI: 10.23736/s0021-9509.23.12821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Sarcopenia is identified as a predictive factor for adverse outcomes after complex endovascular aortic repair (complex EVAR). Consensus on preferred parameters for sarcopenia is not yet reached. The current study compares three CT-assessed parameters on their association with adverse outcomes after complex EVAR. METHODS This was a single-center retrospective cohort study. Psoas Muscle Index (PMI), Skeletal Muscle Index (SMI), and lean psoas muscle area (LPMA) were examined by CT-segmentation. PMI, SMI, and LPMA were analyzed as continuous variables. In addition, cut-off values from previous research were used to diagnose patients as sarcopenic or non-sarcopenic. Outcomes were: all-cause mortality, major adverse events (MAE), length of hospital stay, and non-home discharge. A sub-analysis was made for severe sarcopenia; sarcopenia combined with low physical performance (gait speed, Time Up and Go test, Metabolic Equivalent of Task-score). RESULTS We included 101 patients. A higher PMI (HR=0.590, CI: 0.374-0.930, P=0.023), SMI (HR=0.453, CI: 0.267-0.768, P=0.003), and LPMA (HR=0.559, CI: 0.333-0.944, P=0.029) were associated with a lower risk of mortality. Sarcopenia based on cut-off values for PMI and LPMA was not significantly associated with survival. Sarcopenia based on SMI did present a higher mortality risk (P=0.017). A sub-analysis showed that severely sarcopenic patients were at even higher risk of mortality (P=0.036). None of the parameters were significantly associated with the other outcomes. CONCLUSIONS SMI had a slightly stronger association with mortality compared to PMI and LPMA. High-risk patients were selected by adding physical performance scores. Future research could focus on complex EVAR-specific PMI and LPMA cut-off values.
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Affiliation(s)
- Britt W Warmerdam
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carla S van Rijswijk
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anneke Droop
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Claudia J Lucassen
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Grima MJ, Wanhainen A, Lindström D. In Situ Laser Fenestration Technique: Bench-Testing of Aortic Endograft to Guide Clinical Practice. J Endovasc Ther 2024; 31:126-131. [PMID: 36000361 PMCID: PMC10773159 DOI: 10.1177/15266028221119315] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE In situ laser fenestration (ISLF) is a recently introduced technology that offers the potential to perform total endovascular treatment of aortic arch and thoracoabdominal aortic pathologies in the acute setting. This experiment's aim was to assess ISLF in some currently common aortic endografts and bridging stent-grafts. MATERIALS AND METHODS Three different aortic endografts were evaluated: (1) Zenith Alpha, (2) Zenith TX2, and (3) Conformable GORE TAG. Each endograft was submerged in 37°C saline to create fenestrations using the 308 nm CVX-300 Excimer Laser System fitted with a 2.3 mm diameter Turbo-Elite laser atherectomy catheter compatible with a 0.018″ guidewire. Three different 8 mm bridging stent-grafts were evaluated: (1) BeGraft peripheral, (2) BeGraft peripheral plus, and (3) GORE VIABAHN VBX Balloon Expandable. All bridging stent-grafts were deployed and exposed to different balloon sizes and pressures. The ISLFs and bridging stent-grafts were then evaluated for any tears, stenoses, and seal. RESULTS A laser fenestration was consistently rapidly obtained in the Zenith Alpha and the Zenith TX2 endografts while it proved difficult to achieve a timely fenestration in the C-TAG. No fabric tears were noted in the Zenith Alpha and Zenith TX2 when inflating Armada (Abbott) 8 mm balloon in the fenestrations with pressures up to 15 atmospheres (rated burst pressure) nor when flaring bridging stent-grafts with balloons up to 12 mm in diameter at 10 atmospheres, while major tears were frequently noted in the C-TAG when the Armada 8 mm balloons were inflated. BeGraft Peripheral and BeGraft Peripheral Plus were all firmly attached to the fenestrations showing good seal on manual testing, while every sixth VBX bridging stent-graft displayed poorer attachment to the fenestration before dilatation at high pressure. Commonly, significant stenoses remained in the bridging stent-grafts after dilatation at nominal pressure, which could only be eradicated with high-pressure balloons. CONCLUSION In this limited bench-test, Dacron endografts responded well to the ISLF technology. Satisfactory deployment of the bridging stent was noted only after inflation and/or flaring with high-pressure balloons. Further work with different types of commercially-available bridging stent-grafts and endografts to assess the durability of in situ fenestration (ISF) and bridging stents in ISF is recommended. CLINICAL IMPACT This report on experimental in situ laser fenestration provide important insights for clinicians considering using in situ laser fenestration of aortic stentgrafts in vivo. In particular, different laser settings were tested together with a selection of aortic stentgrafts. Also, the target pressure needed in PTA balloons to dilate the fenestrations and any subsequent tears in the fabric were noted. This was followed by deployment of assorted balloon-expandable stentgrafts with estimation of residual stenosis and seal.
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Affiliation(s)
- Matthew Joe Grima
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
- Faculty of Medicine and Surgery, University of Malta, L-iMsida, Malta
- Department of General Surgery, Vascular Unit, Mater Dei Hospital, L-iMsida, Malta
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - David Lindström
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Agarwal G, Hamady M. Complex abdominal aortic aneurysms: a review of radiological and clinical assessment, endovascular interventions, and current evidence of management outcomes. BJR Open 2024; 6:tzae024. [PMID: 39267950 PMCID: PMC11392563 DOI: 10.1093/bjro/tzae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 08/09/2024] [Accepted: 08/18/2024] [Indexed: 09/15/2024] Open
Abstract
Endovascular aortic aneurysm repair (EVAR) is an established approach to treating abdominal aortic aneurysms, however, challenges arise when the aneurysm involves visceral branches with insufficient normal segment of the aorta to provide aneurysm seal without excluding those vessels. To overcome this, a range of technological developments and solutions have been proposed including fenestrated, branched, physician-modified stents, and chimney techniques. Understanding the currently available evidence for each option is essential to select the most suitable procedure for each patient. Overall, the evidence for fenestrated endovascular repair is the most comprehensive of these techniques and shows an early post-operative advantage over open surgical repair (OSR) but with a catch-up mortality in the mid-term period. In this review, we will describe these endovascular options, pre- and post-procedure radiological assessment and current evidence of outcomes.
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Affiliation(s)
- Girija Agarwal
- Department of Interventional Radiology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom
| | - Mohamad Hamady
- Department of Interventional Radiology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Warmerdam B, Oomen F, Hilt A, Melles M, Eefting D, Hamming J, van der Vorst J, van Schaik J. Perspectives of Patients and Professionals on Patient Education in Complex Endovascular Aortic Repair. Ann Vasc Surg 2024; 98:87-101. [PMID: 37355016 DOI: 10.1016/j.avsg.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Misinterpretation of patient preferences in perioperative education can lead to an undesired treatment decision. This explorative interview study presents differences in perspectives of patients and professionals on patient education in complex endovascular aortic aneurysm management. METHODS Using convenience sampling, a cross-sectional interview study was performed among patients who were in various stages of the decision-making process for complex endovascular aortic repair. Five physicians were interviewed, representing the main providers of clinical information. Interviews were transcribed verbatim and analyzed inductively. RESULTS Twelve patients (mean age 76.6 [standard deviation: 6.4], 83% male) were interviewed. Ten (83%) felt like they had no other realistic option besides undergoing surgery, whereas all professionals (5/5) stressed the importance of delicate patient selection. Five patients out of 10 (50%) who commented on their preferred decisional role considered the professional's advice as decisive. All but 1 patient (11/12) reported that the information was easy to understand, whereas 4 out of 5 professionals (80%) doubted whether patients could fully comprehend everything. Patients experienced a lack of information on the recovery process, although professionals stated that this was addressed during consultation. CONCLUSIONS Several differences were found in the perspectives of patients and professionals on education in complex aortic aneurysm management. In order to optimize patient involvement in decision-making, professionals should be aware of these possible discrepancies and address them during consultation. Future research could focus on these differences in more detail by including more patients depending on their treatment and decision stages.
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Affiliation(s)
- Britt Warmerdam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Floor Oomen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alexander Hilt
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Daniël Eefting
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost van der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Warmerdam BWCM, Stevens M, van Rijswijk CSP, Eefting D, van der Meer RW, Putter H, Hamming JF, van der Vorst JR, van Schaik J. Learning Curve Analysis of Complex Endovascular Aortic Repair. Ann Vasc Surg 2023:S0890-5096(23)00057-2. [PMID: 36773932 DOI: 10.1016/j.avsg.2023.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND When introducing new techniques, attention must be paid to learning curve. Besides quantitative outcomes, qualitative factors of influence should be taken into consideration. This retrospective cohort study describes the quantitative learning curve of complex endovascular aortic repair (EVAR) in a nonhigh-volume academic center and provides qualitative factors that were perceived as contributors to this learning curve. With these factors, we aim to aid in future implementation of new techniques. METHODS All patients undergoing complex EVAR in the Leiden University Medical Center (LUMC) between July 2013 and April 2021 were included (n = 90). Quantitative outcomes were as follows: operating time, blood loss, volume of contrast, hospital stay, major adverse events (MAE), 30-day mortality, and complexity. Patients were divided into 3 temporal groups (n = 30) for dichotomous outcomes. Regression plots were used for continuous outcomes. In 2017, the treatment team was interviewed by an external researcher. These interviews were reanalyzed for factors that contributed to successful implementation. RESULTS Length of hospital stay (P = 0.008) and operating time (P = 0.010) decreased significantly over time. Fewer cardiac complications occurred in the third group (3: 0% vs. 2: 17% vs. 1: 17%, P = 0.042). There was a trend of increasing complexity (P = 0.076) and number of fenestrations (P = 0.060). No significant changes occurred in MAE and 30-day mortality. Qualitative factors that, according to the interviewees, positively influenced the learning curve were as follows: communication, mutual trust, a shared sense of responsibility and collective goals, clear authoritative structures, mutual learning, and team capabilities. CONCLUSIONS In addition to factors previously identified in the literature, new learning curve factors were found (mutual learning and shared goals in the operating room (OR)) that should be taken into account when implementing new techniques.
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Affiliation(s)
| | - Merieke Stevens
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University, PA Rotterdam, the Netherlands
| | | | - Daniël Eefting
- Department of Surgery, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Rutger W van der Meer
- Department of Radiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, RC Leiden, the Netherlands
| | | | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, RC Leiden, the Netherlands.
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Dachs TM, Hauck SR, Kern M, Klausenitz C, Funovics MA. Fenestrierte und verzweigte endovaskuläre Aortenprothesen. DIE RADIOLOGIE 2022; 62:586-591. [PMID: 35726073 PMCID: PMC9242898 DOI: 10.1007/s00117-022-01019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Hintergrund Komplexe abdominelle aortale Pathologien, welche die Abgänge der Viszeralarterien miterfassen und bei denen kein adäquater proximaler Hals gegeben ist, können heute mittels fortgeschrittener FEVAR/BEVAR-Technik („fenestrated/branched endovascular aneurysm repair“) mit ähnlicher Sicherheit und vergleichbaren Erfolgsraten behandelt werden wie infrarenale Pathologien mit konventionellem EVAR. Methodische Innovationen und Probleme Zur Versorgung der Viszeralarterien können Fenestrierungen (bei Abgang der Viszeralarterie aus der nichtdilatierten Aorta) oder Verzweigungen (bei Abgang aus der dilatierten Aorta) verwendet werden. Beide Arten von Öffnungen werden mit Verbindungsstentgrafts (VSG) zu den Viszeralarterien abgedichtet. Mehrere Hersteller bieten fenestrierte oder verzweigte Endoprothesen an, wobei diese nur in Einzelfällen CE-zertifiziert und überwiegend in Europa als individuelle Sonderanfertigungen patientenbezogen erhältlich sind. Dies setzt eine entsprechende Lieferzeit voraus, was die Behandlung akuter Patienten mit solchen Prothesen unmöglich macht. Es liegen allerdings zwei Produkte von vierfach verzweigten Endoprothesen vor, die einen größeren Bereich der anatomischen Gegebenheiten bei thorakoabdominellen Aneurysmen auch im Akutfall abdecken und behandelbar machen. Sämtliche FEVAR- und BEVAR-Hauptkörper benötigen VSG, die durchgehend von Fremdherstellern stammen und von denen gegenwärtig noch kein einziges Produkt für diese Anwendung zertifiziert ist. Empfehlungen Da Probleme an Verbindungsstentgrafts eine wesentliche Ursache für Reinterventionen sind, sollte in der Nachsorge Knickbildungen und Brüchen an diesen Verbindungsstents besonderes Augenmerk geschenkt und von der Verwendung einschichtiger Designs beim BEVAR abgesehen werden.
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Affiliation(s)
- Theresa-Marie Dachs
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Sven Rudolf Hauck
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Maximilian Kern
- Institut für Radiologie, Klinik Floridsdorf, Wien, Österreich
| | - Catharina Klausenitz
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Martin A Funovics
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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De Guerre LEVM, O'Donnell TFX, Varkevisser RRB, Swerdlow NJ, Li C, Dansey K, van Herwaarden JA, Schermerhorn ML, Patel VI. The Association between Device Instructions for Use Adherence and Outcomes after Elective Endovascular Aortic Abdominal Aneurysm Repair. J Vasc Surg 2022; 76:690-698.e2. [PMID: 35276256 DOI: 10.1016/j.jvs.2022.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Aortic neck anatomy has a significant impact on the complexity of endovascular aortic aneurysm repair (EVAR), with concern that neck characteristics outside of instructions for use (IFU) may result in worse outcomes. Therefore, this study determined the impact of neck characteristics outside of IFU on perioperative and one-year outcomes and mid-term survival after EVAR. METHODS We identified all patients undergoing elective infrarenal EVAR from December 2014 to May 2020 in the Vascular Quality Initiative database. Neck characteristics outside of IFU were determined based the specific device IFU neck characteristics (Neck diameter, length, and angulation). Patients without one-year follow-up were excluded for the 1-year outcomes analyses (n=6,138 (40%)). We used multivariable adjusted logistic regression and Cox proportional hazard models to identify the independent associations between neck characteristics outside of IFU and our outcomes. RESULTS Of the 15,448 patients identified, 22.1% had neck characteristics outside of IFU, including 6.6% with a infrarenal angle, 6.8% with a neck length, 10.4% with a neck diameter, and 1.1% with a suprarenal angulation outside of IFU. Of these, 2.4% had more than one neck characteristic outside of IFU. Patients with neck characteristics outside of IFU were more often female (27.9% vs. 15.0%, P<.001) and were older (median age 75 vs. 73, P<.001). EVAR patients with neck characteristics outside of IFU had higher rates of type Ia endoleaks at completion (4.8% vs. 2.5%, P<.001), perioperative mortality (1.2% vs. 0.6%, P<.001), one-year sac expansion (7.1% vs. 5.3%, P=.017), and one-year reinterventions (4.4% vs. 3.2%, P=.03). In multivariable adjusted analyses, neck characteristics outside of IFU were independently associated with type Ia completion endoleaks (OR 1.6, [1.3-2.0], P<.001), perioperative mortality (OR 1.8; [1.2-2.7]; P=.005), one-year sac expansion (OR 1.4; [1.0-1.8]; P=.025) and one-year reinterventions (OR 1.4; [1.0-1.9]; P=.039). Unadjusted mid-term survival was lower for patients with neck characteristics outside of IFU than for patients without (5-year survival 84.0% vs. 86.7%, log-rank<.001). However, after adjustment, survival was similar for patients with neck characteristics outside of IFU to those within (HR: 1.1; [1.0-1.3]; P=.22). CONCLUSION Neck characteristics outside of IFU are independently associated with completion type Ia endoleaks, perioperative mortality, one-year sac expansion and one-year reinterventions among patients undergoing elective EVAR. These results indicate that continued effort is needed to improve the proximal seal in patients with neck characteristics outside of IFU undergoing EVAR. Also, in patients with severe hostile neck characteristics, alternative approaches such as open repair, use of a fenestrated or branched device, or endoanchors should be considered.
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Affiliation(s)
- Livia E V M De Guerre
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA; Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Thomas F X O'Donnell
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Rens R B Varkevisser
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nicholas J Swerdlow
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Chun Li
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kirsten Dansey
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Marc L Schermerhorn
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Virendra I Patel
- Division of Vascular and Endovascular Surgery, New York Presbyterian/Columbia University Irving Medical Center/ Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032.
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Howard C, Ponnapalli A, Shaikh S, Idhrees M, Bashir M. Non-A non-B aortic dissection: A literature review. J Card Surg 2021; 36:1806-1813. [PMID: 33547714 DOI: 10.1111/jocs.15349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 01/16/2023]
Abstract
Non-A non-B aortic dissections are an infrequent occurrence and represent a small proportion of aortic dissections. Treating this life-threatening medical emergency often requires surgeons to undertake some one of the most challenging surgical or endovascular cases in medicine. This literature review aims to define and classify non-A non-B dissections, describe their epidemiology as well as their pathology. This review also aims to discuss the range of surgical techniques employed in their treatment and management and to investigate the patient outcomes associated with each technique.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK
| | - Anuradha Ponnapalli
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK
| | - Safwan Shaikh
- Dentistry and Biomedical Sciences, Queen's University Belfast School of Medicine, Queen's University Belfast, Belfast, UK
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Mohammad Bashir
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
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Charitable JF, Li C, Maldonado TS. Use of Gore C-TAG with active control to treat a complex infrarenal abdominal aortic aneurysm. J Vasc Surg 2020; 73:2140-2143. [PMID: 33157188 DOI: 10.1016/j.jvs.2020.11.001] [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: 05/19/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
Complex abdominal aortic aneurysms (AAAs) can preclude the use of endovascular aortic repair. In patients unable to undergo open surgical repair (OSR), the use of endografts outside the instructions for use might be the only option. We present the case of a woman with a highly angulated infrarenal AAA neck who was unsuitable for OSR and was successfully treated using a Gore C-TAG conformable thoracic stent graft (W.L. Gore and Associates, Inc, Flagstaff, Ariz) with active control, Medtronic Heli-FX EndoAnchors (Medtronic Vascular, Minneapolis, Minn), and a bifurcated Gore Excluder endoprosthesis W.L. Gore and Associates). The repair was successful without evidence of an endoleak. Using a thoracic endograft outside of the instructions for use to treat infrarenal AAAs might be feasible for patients unable to undergo OSR.
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Affiliation(s)
- John F Charitable
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY
| | - Chong Li
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY
| | - Thomas S Maldonado
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
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10
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WITHDRAWN: The Use of Gore C-TAG with Active Control to Treat A Complex Infrarenal Abdominal Aortic Aneurysm. J Vasc Surg Cases Innov Tech 2020. [DOI: 10.1016/j.jvscit.2020.10.013] [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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11
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Meertens MM, Lemmens CC, Oderich GS, Schurink GWH, Mees BME. Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2020; 43:186-195. [PMID: 31591688 PMCID: PMC6965343 DOI: 10.1007/s00270-019-02330-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/26/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study was to review the risk of developing cerebrovascular complications from upper extremity access during endovascular treatment of complex aortic aneurysms. METHODS A systematic review and meta-analysis were conducted according to the PRISMA guideline. An electronic search of the public domains Medline (PubMed), Embase (Ovid), Web of Science and Cochrane Library was performed to identify studies related to the treatment of aortic aneurysms involving upper extremity access. Meta-analysis was used to compare the rate of cerebrovascular event after left, right and bilateral upper extremity access. Results are presented as relative risk (RR) and 95% confidence intervals (CIs). RESULTS Thirteen studies including 1276 patients with complex endovascular treatment of aortic aneurysms using upper extremity access were included in the systematic review. Left upper extremity access (UEA) was used in 1028 procedures, right access in 148 and bilateral access in 100 procedures. The rate of cerebrovascular complications for patients treated through left UEA was 1.7%, through right UEA 4% and through bilateral UEA 5%. In the meta-analysis, we included seven studies involving 645 patients treated with a left upper extremity access, 87 patients through a right and 100 patients through a bilateral upper extremity access. Patients, who underwent right-sided (RR 5.01, 95% CI 1.51-16.58, P = 0.008) or bilateral UEA (RR 4.57, 95% CI 1.23-17.04, P = 0.02), had a significantly increased risk of cerebrovascular events compared to those who had a left-sided approach. CONCLUSION Left upper extremity access is associated with a significantly lower rate of cerebrovascular complications as compared to right or bilateral upper extremity access.
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Affiliation(s)
- Max M Meertens
- Department of Vascular Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Charlotte C Lemmens
- Department of Vascular Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Gustavo S Oderich
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Geert W H Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
- European Vascular Center Aachen-Maastricht, Maastricht, The Netherlands
| | - Barend M E Mees
- Department of Vascular Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- European Vascular Center Aachen-Maastricht, Aachen, Germany.
- European Vascular Center Aachen-Maastricht, Maastricht, The Netherlands.
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12
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Salomon du Mont L, Rinckenbach S, Besch G, Steinmetz E, Kretz B. Evolution of Practices in Treatment of Abdominal Aortic Aneurysm in France between 2006 and 2015. Ann Vasc Surg 2019; 58:38-44. [DOI: 10.1016/j.avsg.2018.12.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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13
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Yapa SM, Sieunarine K. Late renal artery stent fracture with pseudoaneurysm after fenestrated endovascular abdominal aortic aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:149-151. [PMID: 31065610 PMCID: PMC6495218 DOI: 10.1016/j.jvscit.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Abstract
We report the case of an 81-year-old man incidentally found to have a complete transverse stent fracture of a left renal artery covered stent associated with a pseudoaneurysm while being investigated with digital subtraction angiography for an arterial cause of a nonhealing ulcer on his right great toe. He had a fenestrated endovascular abdominal aortic aneurysm repair 11 years ago with covered stenting of both renal arteries. Although he was asymptomatic, a second left renal artery covered stent was successfully placed across the fractured stent to eliminate the risk of rupture. Follow-up imaging showed patent stent and exclusion of the aneurysm. This case highlights another complication of fenestrated endovascular aneurysm repair that needs to be ruled out on surveillance imaging.
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Affiliation(s)
- Shanil M Yapa
- Department of Vascular and Endovascular Surgery, Hollywood Hospital, Perth, Western Australia, Australia
| | - Kishore Sieunarine
- Department of Vascular and Endovascular Surgery, Hollywood Hospital, Perth, Western Australia, Australia.,Department of Vascular and Endovascular Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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14
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XiaoHui M, Li W, Wei G, XiaoPing L, Xin J, Hongpeng Z, Lijun W. Comparison of supra-arch in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery. Vascular 2018; 27:153-160. [PMID: 30319067 DOI: 10.1177/1708538118807013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Endovascular intervention involving the aortic arch, particularly in thoracic aortic dissection, remains challenging and controversial at current time when there is no commercially suitable grafts on most of the international markets. This study compared two endovascular treatments that maintain left subclavian artery perfusion using two modified techniques for type-B aortic dissection patients. Methods Consecutive cases utilizing chimney or in situ fenestration techniques to preserve left subclavian artery in type B AD from 2006 to 2015 in our single institution were retrospectively reviewed. Statistical analyses were performed with Student t-test, Wilcoxon rank sum, and Fisher exact tests when appropriate. Significant statistical differences were determined with p < 0.05. Results A total of 85 cases, including 67 (79.8%) with chimney and 18 (21.2%) with in situ fenestration techniques were identified in this retrospective study. In chimney group, there were 18 (26.9%) acute, 29 (43.3%) sub-acute, and 20 (29.9%) chronic aortic dissections. We implanted 24 Zenith and 43 Talent aortic endografts along with 55 balloon-expandable bare stents and 12 self-expanding covered stents in chimney group. Whereas in in situ fenestration group, there were four (22.2%) acute, six (33.3%) subacute, and eight (44.5%) chronic aortic dissections, all of which received Zenith endografts with 11 balloon-expandable covered and seven self-expanding covered stents, respectively. Demographic variables were similarly distributed with 100% intraoperative technical overall success in both groups. Comparing to in situ fenestration group, chimney group has shorter procedural and fluoroscopy time, less blood loss, and contrast volume used. All patients were followed-up to 52 months (median 38, range 24–52). Overall group mortality is 3.6% (3/84). All deaths were from chimney group. There was no procedure-related stroke observed within the study series. Primary patency was maintained while aortic remodeling with complete false lumen was achieved in all patients except that there were three (4.55%) Type-I endoleak cases in early post-operative period and one (1.5%) stent compression at 3-months follow-up in chimney group. There were no stent-related complications observed in in situ fenestration group. Conclusion Although there were previous studies describing the similar techniques, this study appears to be the first study to compare in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery according to the MEDLINE search. Although we are unable to establish the superiority between two approaches due to small sample size and relative short period of follow-up, in situ fenestration may represent a more favorable option, especially among aortic dissections with short proximal landing zones in the study.
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Affiliation(s)
- Ma XiaoHui
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Wei Li
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, NY, USA
| | - Guo Wei
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Liu XiaoPing
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Jia Xin
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Zhang Hongpeng
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Wang Lijun
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
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15
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Wang L, Huang Y, Guo D, Xu X, Chen B, Jiang J, Yang J, Shi Z, Zhu T, Dong Z, Shi Y, Tang X, Yue J, Hong X, Chen G, Chen Y, Zhou X, Fu W, Wang Y. Application of triple-chimney technique using C-TAG and Viabahn or Excluder iliac extension in TEVAR treatment of aortic arch dilation diseases. J Thorac Dis 2018; 10:3783-3790. [PMID: 30069377 DOI: 10.21037/jtd.2018.06.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To report the experience of a single centre regarding the application of the triple-chimney technique using C-TAG with Viabahn or Excluder iliac extension devices for the endovascular management of aortic arch dilation diseases. Methods From July 2016 to August 2017, 7 patients (5 men; mean age 56.1±10.8 years) with aortic arch dilation diseases were treated with the triple-chimney technique. All patients were followed up at 1, 3, and 6 months and every 6 months thereafter. Results Six innominate arteries were deployed with Excluder iliac extensions and one with a Viabahn cover-stent. All the left common carotid arteries and left subclavian arteries were placed with Viabahn. Reverse chimney technique was applied in four patients. Three (42.0%) type I endoleaks were found on the final angiogram. Two were apparently reduced, and one disappeared after balloon dilation. The mean follow-up time was 15.7 months (9-20 months). All the type I endoleak was found disappeared within 3 months. One patient died of myocardial infarction at 6 months after discharge. No other complications such as stent-graft migration, occlusion, type II endoleak or neurological stroke occurred. Conclusions The use of C-TAG coupled with Viabahn or Excluder iliac extension is feasible and effective for the treatment of aortic arch dilatation diseases. However, more patients and longer follow-up time are required to verify its long-term safety and efficacy.
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Affiliation(s)
- Lixin Wang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Yulong Huang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Daqiao Guo
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Xin Xu
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Bin Chen
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Junhao Jiang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Jue Yang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Ting Zhu
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Zhihui Dong
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Yun Shi
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Xiao Tang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Jianing Yue
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Xiang Hong
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Gang Chen
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Yihui Chen
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Xiushi Zhou
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
| | - Weiguo Fu
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Yuqi Wang
- Department of Vascular Surgery, Fudan University, Shanghai 200032, China.,Institute of Vascular Surgery, Fudan University, Shanghai 200032, China
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16
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Endovascular Chimney Technique for Aortic Arch Pathologies Treatment: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2018; 47:305-315. [DOI: 10.1016/j.avsg.2017.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/04/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022]
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17
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Boersen JT, Donselaar EJ, Groot Jebbink E, Starreveld R, Overeem SP, Slump CH, de Vries JPP, Reijnen MM. Benchtop quantification of gutter formation and compression of chimney stent grafts in relation to renal flow in chimney endovascular aneurysm repair and endovascular aneurysm sealing configurations. J Vasc Surg 2017; 66:1565-1573.e1. [DOI: 10.1016/j.jvs.2016.10.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/02/2016] [Indexed: 11/29/2022]
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18
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Pecoraro F, Corte G, Dinoto E, Badalamenti G, Bruno S, Bajardi G. Cinical outcomes of Endurant II stent-graft for infrarenal aortic aneurysm repair: comparison of on-label versus off-label use. Diagn Interv Radiol 2017; 22:450-4. [PMID: 27460283 DOI: 10.5152/dir.2016.15418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to compare the outcomes of the Endurant II (Medtronic) stent-graft used under instructions for use versus off-label in high-risk patients considered unfit for conventional surgery. METHODS Data from patients treated with the Endurant II stent-graft between December 2012 and March 2015 were retrospectively analyzed. Sixty-four patients were included. Patients were assigned to group A if treated under instructions for use (n=34, 53%) and to group B if treated off-label (n=30, 47%). Outcome measures included perioperative mortality and morbidity, survival, freedom from reintervention, endoleak incidence, in-hospital length of stay, and mean stent-graft component used. Mean follow-up was 22.61±12 months (median, 21.06 months; range, 0-43 months). RESULTS One perioperative mortality (1.6%) and one perioperative complication (1.6%) occurred in group B. At two months follow-up, one iliac limb occlusion (1.6%) occurred in group A. No type I/III endoleaks were recorded. A type II endoleak was identified in three cases (4.7%). Overall survival at three years was 89% (97% for group A, 82% for group B; P = 0.428). Reintervention-free survival at three years was 97% for both groups (P = 0.991). A longer in-hospital stay was observed in group B (P = 0.012). CONCLUSION The Endurant II (Medtronic) new generation device was safe in off-label setting at mid-term follow-up. The off-label use of the Endurant II (Medtronic) is justified in patients considered unfit for conventional surgery. Larger studies are required in this subgroup of patients.
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Affiliation(s)
- Felice Pecoraro
- Vascular Surgery Unit, AOUP "P. Giaccone", University of Palermo, Palermo, Italy.
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19
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Could Preoperative Neck Anatomy Influence Follow-up of EVAR? Ann Vasc Surg 2017; 43:127-133. [PMID: 28390913 DOI: 10.1016/j.avsg.2016.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/13/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of the study was to assess the clinical utility of strict CT scan surveillance after endovascular abdominal aneurysm repair (EVAR) and evaluate whether the anatomy of abdominal aortic aneurysm (AAA) neck (favorable/hostile) influences regular imaging control. METHODS A retrospective study of AAA patients who underwent EVAR with aortobi-iliac endoprostheses during 2006-2013 was conducted. Exclusion criteria included other types of devices. Variables analyzed were technical and clinical success, morbimortality, complications (such as endoleaks, sac enlargement), reinterventions, reintervention-free survival, and survival rate. Preoperative CT scans were performed and repeated at 1, 6 (in selective cases), 12, and 24 months postoperatively. Patients were divided into two groups according to preoperative anatomic characteristics: group I (favorable neck) and group II (hostile neck: angle > 60°, length < 15 mm, diameter > 28 mm, and calcification or circumference thrombus ≥50%). RESULTS A total of 127 patients with AAA (96.8% male) were included in the study. The mean age of the patients was 75.9 years (range: 51-90 years). The mean AAA diameter was 62.1 mm. Hostile neck was found in 52 patients (40.9%). The technical and clinical success rate was 100% and 30-day mortality was 0.8%. The reintervention-free survival rate was 97.6%, 96.1%, and 93.7% and the survival rate was 97.6%, 96.9%, and 91.3%, during follow-up at 6, 12, and 24 months, respectively. Accumulated complications in proximal sealing occurred in 0%, 0%, and 1.6% in group I and 1.9%, 6.1%, and 7.7% in group II at 1, 12, and 24 months, respectively. Type II endoleaks occurred in 24.3%, 14.3%, and 11.4% in group I and 9.8%, 6.3%, and 6.8% in group II at 1, 12, and 24 months, respectively. No increased diameter was detected at 6 and 12 months. No differences were observed in reinterventions and mortality rate depending on anatomy. CONCLUSIONS CT scans performed at 6 and 12 months postoperatively did not detect complications or need for reintervention in patients with favorable necks, even in the presence of endoleaks type II, and could therefore be omitted. Hostile necks may compromise proximal sealing and require regular imaging follow-ups.
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20
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Orr NT, Davenport DL, Minion DJ, Xenos ES. Comparison of perioperative outcomes in endovascular versus open repair for juxtarenal and pararenal aortic aneurysms: A propensity-matched analysis. Vascular 2016; 25:339-345. [DOI: 10.1177/1708538116681911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective Endoluminal aortic aneurysm repair is suitable within certain anatomic specifications. This study aims to compare 30-day outcomes of endovascular versus open repairs for juxtarenal and pararenal aortic aneurysms (JAA/PAAs). Methods The ACS-NSQIP database was queried from 2012 to 2015 for JAA/PAA repairs. Procedures characterized as emergent were included in the study; however, failed prior repairs and ruptured aneurysms were excluded. The preoperative and perioperative patient characteristics, operative techniques, and outcome variables were compared between the open aortic repair and the endovascular aortic repair groups. Propensity scoring was performed to clinically match open aortic repair and endovascular aortic repair groups on preoperative risk and select perioperative factors that differed significantly in the unmatched groups. Outcome comparisons were then performed between matched groups. Results A total of 1005 (789 JAAs and 216 PAAs) aneurysm repairs were included in the study. Of these, there were 395 endovascular aortic repairs and 610 open aortic repairs. Propensity scoring created a matched group of 263 endovascular aortic repair and 263 open aortic repair patients. There was no statistically significant difference in 30-day mortality rates between matched endovascular aortic repair and open aortic repair patients (2.7% vs. 5.7%). The endovascular aortic repair group had a shorter ICU length of stay and overall hospital stay. The 30-day morbidity significantly favored endovascular aortic repair over open aortic repair (16% vs. 35%, p < 0.001). The main drivers of morbidity for endovascular aortic repair versus open aortic repair included return to the OR (6.8% vs. 15%, p < 0.001), rate of cardiac or respiratory failure (7.6% vs. 21%, p = 0.001), rate of renal insufficiency or failure (3.8% vs. 9.9%, p = 0.009), and rate of pneumonia (1.5% vs. 6.8%, p = 0.004). Conclusions There is no difference in mortality rates between endovascular aortic repair versus open aortic repair when repairing JAAs/PAAs. There is a significant difference in overall morbidity, and ICU and hospital length of stay favoring endovascular aortic repair over open aortic repair. This supports the expanded applicability and efficacy of endovascular repair for complex aneurysms.
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Affiliation(s)
- Nathan T Orr
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | | | - David J Minion
- Department of Surgery, University of Kentucky, Lexington, KY, USA
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21
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Hernández Mateo MM, Martínez López I, Revuelta Suero S, Marqués de Marino P, Cernuda Artero I, Cabrero Fernández M, Serrano Hernando FJ. Impact of the Repositionable C3 Excluder System on the Endovascular Treatment of Abdominal Aortic Aneurysms With Unfavorable Neck Anatomy. J Endovasc Ther 2016; 23:593-8. [DOI: 10.1177/1526602816646550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To analyze the midterm clinical outcomes among patients with favorable and unfavorable neck morphology for endovascular aneurysm repair (EVAR), specifically the impact of the repositionable C3 Excluder stent-graft on type I endoleak in patients with unfavorable neck. Methods: A retrospective review was conducted of 249 patients (mean age 74.3 years; 241 men) who underwent successful EVAR from January 2000 to December 2014 using either the traditional Excluder (n=140) or the C3 repositionable system (n=109). Unfavorable proximal aortic neck anatomy was defined by length <15 mm, angulation >60°, >50% circumferential thrombus, or >50% neck calcification. By these criteria, unfavorable neck anatomy was present in 71 (28.5%) patients (41 traditional Excluder and 30 C3 Excluder). The main endpoint was the incidence of type Ia endoleak and the need for a proximal cuff according to the type of neck anatomy. Comparisons between groups are reported as the odds ratio (OR) and 95% confidence interval (CI). Results: A proximal extension cuff for type Ia endoleak was needed in 4 (2.2%) patients with favorable neck anatomy compared to 7 (9.9%) patients with unfavorable neck (OR 4.76, 95% CI 1.3 to 16.8, p=0.014). Among the patients with unfavorable neck, a proximal cuff was implanted in 6/41 (14.6%) traditional Excluder stent-grafts vs 1/30 (3.3%) in the C3 Excluder group (OR 4.39, 95% CI 0.55 to 34.58, p=0.23). Median follow-up was 30.5 and 38 months for favorable vs unfavorable neck groups, respectively (p=0.29). Only 1 case of type Ia endoleak was registered at 6.5 years’ follow-up (traditional Excluder), with no device migration. Conclusion: Both Excluder stent-grafts provide good midterm clinical outcomes after EVAR in patients with unfavorable neck anatomy. Investigation of a larger cohort will be needed to identify if the C3 Excluder device offers any improvement over the traditional Excluder in terms of freedom from endoleaks.
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Affiliation(s)
| | - Isaac Martínez López
- Department of Angiology and Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Sergio Revuelta Suero
- Department of Angiology and Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Iñaki Cernuda Artero
- Department of Angiology and Vascular Surgery, Hospital Clínico San Carlos, Madrid, Spain
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22
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de Bruijn MT, Tournoij E, van den Heuvel DAF, de Vries-Werson D, Wille J, de Vries JPPM. Endovascular treatment of complex abdominal aortic aneurysms by combining different types of endoprostheses. Vascular 2016; 24:425-9. [DOI: 10.1177/1708538116652763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To describe an off-the-shelf method for the treatment of abdominal aortic aneurysms with hostile (large, >30 mm) neck and/or small (<20 mm) aortic bifurcation. Case report We describe five patients with large aortic necks and/or small aortic bifurcations, which were treated by combining an AFX endoprosthesis with a Valiant Captiva endograft, and additional proximal endoanchors when deemed necessary. Initial technical success was 100%. Follow-up ranged from 228 to 875 days. One patient suffered a type 1A and 1B endoleak at 446 days follow-up, which were successfully treated by endovascular means. Conclusion Combining the AFX and Valiant Captiva endografts is an off-the-shelf solution for treatment of large diameter aortic necks and small aortic bifurcations in patients deemed unfit for open repair or declined for fenestrated endografts. Longer follow-up is required to assess the long-term safety with special focus on aortic neck dilation.
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Affiliation(s)
- Menno T de Bruijn
- Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Erik Tournoij
- Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Jan Wille
- Department Of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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Zhang T, Jiang W, Lu H, Liu J. Thoracic Endovascular Aortic Repair Combined with Assistant Techniques and Devices for the Treatment of Acute Complicated Stanford Type B Aortic Dissections Involving Aortic Arch. Ann Vasc Surg 2016; 32:88-97. [DOI: 10.1016/j.avsg.2015.10.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 08/30/2015] [Accepted: 10/06/2015] [Indexed: 01/03/2023]
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24
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Dingemans SA, Jonker FHW, Moll FL, van Herwaarden JA. Aneurysm Sac Enlargement after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2015; 31:229-38. [PMID: 26627324 DOI: 10.1016/j.avsg.2015.08.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/20/2015] [Accepted: 08/08/2015] [Indexed: 10/22/2022]
Abstract
The aim of this study is to give an overview of current knowledge regarding abdominal aortic aneurysm (AAA) growth after endovascular aortic aneurysm repair (EVAR) that could potentially lead to aortic rupture. A search on Pubmed was performed. A total of 705 articles were found after initial search, of which 49 were included in the final selection. Reports on the incidence of aneurysm enlargement after EVAR vary between 0.2% and 41%. Continuous growth could lead to rupture of the aneurysm sac. There are several supposed risk factors for growth after EVAR. Endoleaks remain a hot topic as these could lead to persistent pressurization of the aneurysm sac causing growth. Various types of endoleak exist, of which each kind requires an individual treatment approach, other risk factors for aneurysm growth include endotension and the use of EVAR outside instructions for use (IFU). Reinterventions after EVAR are common; however, it is unclear how frequently these are required because of aneurysm enlargement. Aneurysm enlargement after EVAR remains a subject of debate, as this could lead to aortic rupture. This emphasizes the need for life-long radiologic surveillance during follow-up. Aortic growth after EVAR is often a result of endoleak; however, in some cases, no endoleak is detectable. Endoleak in combination with aortic growth >5 mm generally requires reintervention. A cause of concern is the liberal use of endovascular devices outside the IFU that may result in increased risk of AAA growth after EVAR.
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Affiliation(s)
- Siem A Dingemans
- Department of Surgery, University Medical Center Utrecht, Amsterdam, the Netherlands.
| | | | - Frans L Moll
- Department of Surgery, University Medical Center Utrecht, Amsterdam, the Netherlands
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25
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Inoue Y, Matsuda H, Fukuda T, Sanda Y, Morita Y, Oda T, Iba Y, Tanaka H, Sasaki H, Minatoya K, Kobayashi J. Utility of Chimney Stentgraft Technique for Patients with Short Zone 1. Ann Vasc Dis 2015; 8:302-6. [PMID: 26730255 DOI: 10.3400/avd.oa.15-00043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/08/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Arch aneurysm combined with insufficient Zone 1 length remains challenging. While a chimney stentgraft with supra-aortic bypass is a recognized solution for arch aneurysm, no definite strategy has been established yet. The aim of this study was to investigate efficacy of chimney stentgraft for patients with zone 1 of insufficient length. METHODS Between 2011 and 2013, 10 consecutive patients with aortic arch aneurysm who were treated with a chimney stentgraft were retrospectively reviewed. The minimum length of zone 1 and length of landing zone inside zone 0 were measured on pre-/post-operative 3D-CT. RESULTS Neither in-hospital mortality nor postoperative stroke was encountered. The minimum median length of zone 1 (zone 2 for bovine aortic arch of two patients) on preoperative 3D-CT was 10.1 mm [range: 3.9-15.3]. On postoperative 3D-CT, the median proximal landing length on a major curvature proximal to brachio-cephalic artery was 37.5 [range: 20.9-63.9] mm. Type Ia endoleak was observed in two patients with a landing length along the major curvature of less than 30 mm. CONCLUSION For patients with insufficient length of zone 1, aneurysm exclusion could be achieved with a chimney stentgraft ensuring sufficient length (>30 mm) of the landing zone inside the ascending aorta along major curvature.
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Affiliation(s)
- Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Sanda
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tatsuya Oda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Malas MB, Jordan WD, Cooper MA, Qazi U, Beck AW, Belkin M, Robinson W, Fillinger M. Performance of the Aorfix endograft in severely angulated proximal necks in the PYTHAGORAS United States clinical trial. J Vasc Surg 2015; 62:1108-17. [PMID: 26321596 DOI: 10.1016/j.jvs.2015.05.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 05/27/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared the performance of the Aorfix endograft (Lombard Medical, Oxfordshire, United Kingdom) in standard (<60°), highly angled (60°-90°), and severely angled (>90°) aortic necks in the PYTHAGORAS study and evaluated changes in neck morphology over time. METHODS PYTHAGORAS is a prospective nonrandomized clinical trial of the Aorfix endograft. We divided the endovascular aneurysm repair (EVAR) cohort into groups by standard, high, and severe neck angle. The primary control group was patients concurrently undergoing open repair. Mortality at 30 days, 1 year, and 2 years and 30-day freedom from Society for Vascular Surgery major adverse events for the EVAR groups was compared with the open control. Aneurysm sac change, type I and III endoleaks, graft migration, and the reintervention rate at 1 and 2 years was compared between the standard, highly, and severely angled populations. The relative risk of graft complications with a neck diameter increase >10% was also calculated. At predetermined anatomic points, the effect of oversizing on aortic diameter was evaluated by calculating oversize percentage ([1 - outer aortic diameter measured at a given time/stent graft diameter] × 100%) preoperatively and at 3 years. In addition, the average oversizing percentage at 30 days and annually at 1 to 5 years was compared with the preoperative oversizing percentage. Finally, complication rates with ≥30% vs <30% planned oversizing were compared. RESULTS The adverse event rate was lower for every EVAR group than the open control. In addition, the mortality rates at 30 days, 1 year, and 2 years were similar between the standard-angle (1.5%, 3.0%, 4.5%), high-angle (0.9%, 7.3%, 13.8%), and severe-angle (4.8%, 9.5%, 14.3%) EVAR groups and the open control groups (1.3, 6.6%, 10.5%). At 1 and 2 years, there was no difference in graft complications among the EVAR groups. However, with neck dilatation of >10% at 5 mm above the proximal renal and 1 mm below the distal renal, there was an increased risk of graft migration (relative risk, 4.38 [P = .01] and 4.33 [P = .002], respectively). For all predetermined anatomic points, the oversizing percentage decreased over time. The rate of oversize percentage decrease was faster at more distal aortic locations, reaching <10% at 30 days 15 mm below the renal, at 2 years 7 mm below the renal, and at 5 years 1 mm below the renal (P < .001 for all). Half the oversize percentage achieved at the index procedure remained at 3 years (Pearson correlation coefficient = 0.5). However, there was no difference in complications between the ≥30% and <30% planned oversize groups. CONCLUSIONS The Aorfix endograft has performed well in excluding aneurysms with standard and highly angled aortic neck anatomy.
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Affiliation(s)
- Mahmoud B Malas
- Department of Vascular Surgery, Center for Surgical Trials, The Johns Hopkins Medical Institutions, Baltimore, Md.
| | - William D Jordan
- Department of Vascular Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Michol A Cooper
- Department of Vascular Surgery, Center for Surgical Trials, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Umair Qazi
- Department of Vascular Surgery, Center for Surgical Trials, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Adam W Beck
- Department of Vascular Surgery, University of Florida College of Medicine, Gainesville, Fla
| | - Michael Belkin
- Department of Vascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | - William Robinson
- Department of Vascular Surgery, UMass Memorial Medical Center, Worcester, Mass
| | - Mark Fillinger
- Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Jordan WD, Mehta M, Ouriel K, Arko FR, Varnagy D, Joye J, Moore WM, de Vries JPPM. One-year results of the ANCHOR trial of EndoAnchors for the prevention and treatment of aortic neck complications after endovascular aneurysm repair. Vascular 2015; 24:177-86. [DOI: 10.1177/1708538115590727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives EndoAnchors have been used to address proximal aortic neck complications including type Ia endoleaks and endograft migration after endovascular aortic aneurysm repair (EVAR). Methods The study population included 100 patients with one-year follow-up in the ANCHOR study. A primary cohort ( N = 73) comprised patients who underwent EndoAnchor implantation at the time of an initial EVAR and a Revision cohort ( N = 27) included patients treated remote from EVAR. A hostile neck was defined for neck length <10 mm, neck diameter >28 mm, angulation >60°, conical configuration or significant mural thrombus or calcium. Results Baseline anatomy included neck length of 17 ± 14 mm, diameter of 27 ± 5 mm, and angulation of 35 ± 18°; 83% of patients had hostile necks. Over 18 ± 4 months of clinical follow-up, six patients (6%) underwent aneurysm-related reinterventions. There were no aneurysm ruptures. Over 13 ± 2 months of imaging follow-up, freedom from type Ia endoleak was 95% in the Primary Arm and 77% in the Revision Arm ( P = .006). Aneurysm sacs regressed > 5 mm within one year in 45% of the Primary cases and in 25% of the Revisions. Aneurysm expansion > 5 mm occurred in one revision patient. Conclusion Despite a high frequency of hostile neck anatomy, proximal neck complications were relatively infrequent after EndoAnchor use.
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Affiliation(s)
| | | | | | | | - David Varnagy
- Vascular Institute of Central Florida, Orlando, FL, USA
| | - James Joye
- El Camino Hospital, Mountain View, CA, USA
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Standard and fenestrated endograft sizing in EVAR planning: Description and validation of a semi-automated 3D software. Comput Med Imaging Graph 2015; 50:9-23. [PMID: 25747803 DOI: 10.1016/j.compmedimag.2015.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/26/2014] [Accepted: 01/14/2015] [Indexed: 11/23/2022]
Abstract
An abdominal aortic aneurysm (AAA) is a pathological dilation of the abdominal aorta that may lead to a rupture with fatal consequences. Endovascular aneurysm repair (EVAR) is a minimally invasive surgical procedure consisting of the deployment and fixation of a stent-graft that isolates the damaged vessel wall from blood circulation. The technique requires adequate endovascular device sizing, which may be performed by vascular analysis and quantification on Computerized Tomography Angiography (CTA) scans. This paper presents a novel 3D CTA image-based software for AAA inspection and EVAR sizing, eVida Vascular, which allows fast and accurate 3D endograft sizing for standard and fenestrated endografts. We provide a description of the system and its innovations, including the underlying vascular image analysis and visualization technology, functional modules and user interaction. Furthermore, an experimental validation of the tool is described, assessing the degree of agreement with a commercial, clinically validated software, when comparing measurements obtained for standard endograft sizing in a group of 14 patients.
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XiaoHui M, Wei G, ZhongZhou H, XiaoPing L, Jiang X, Xin J. Endovascular Repair with Chimney Technique for Juxtarenal Aortic Aneurysm: A Single Center Experience. Eur J Vasc Endovasc Surg 2015; 49:271-6. [DOI: 10.1016/j.ejvs.2014.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/22/2014] [Indexed: 11/17/2022]
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Walker J, Tucker LY, Goodney P, Candell L, Hua H, Okuhn S, Hill B, Chang RW. Adherence to endovascular aortic aneurysm repair device instructions for use guidelines has no impact on outcomes. J Vasc Surg 2015; 61:1151-9. [PMID: 25659454 DOI: 10.1016/j.jvs.2014.12.053] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Prior reports have suggested unfavorable outcomes after endovascular aortic aneurysm repair (EVAR) performed outside of the recommended instructions for use (IFU) guidelines. We report our long-term EVAR experience in a large multicenter registry with regard to adherence to IFU guidelines. METHODS Between 2000 and 2010, 489 of 1736 patients who underwent EVAR had preoperative anatomic measurements obtained from the M2S, Inc, imaging database (West Lebanon, NH). We examined outcomes in these patients with regard to whether they had met the device-specific IFU criteria. Primary outcomes were all-cause mortality and aneurysm-related mortality. Secondary outcomes were endoleak status, adverse events, reintervention, and aneurysm sac size change. RESULTS The median follow-up for the 489 patients was 3.1 years (interquartile range, 1.6-5.0 years); 58.1% (n = 284) had EVAR performed within IFU guidelines (IFU-adherent group), and 41.9% (n = 205) had EVAR performed outside of IFU guidelines (IFU-nonadherent group). Preoperative anatomic data showed that 62.4% of the IFU-nonadherent group had short neck length, 10.2% had greater angulation than recommended, 7.3% did not meet neck diameter criteria, and 20% had multiple anatomic issues. A small portion (n = 49; 10%) of the 489 patients were lost to follow-up because of leaving membership enrollment (n = 28), moving outside the region (n = 10), or discontinuing image surveillance (n = 11). There was no significant difference in any of the primary or secondary outcomes between the IFU-adherent and IFU-nonadherent groups. Aneurysm sac size change at any time point during follow-up also did not differ significantly between the two groups. A Cox proportional hazard model showed that IFU nonadherence was not predictive of all-cause mortality (hazard ratio, 1.0; P = .91). Similarly, IFU nonadherence was not identified as a risk factor for aneurysm-related mortality or adverse events in stepwise Cox proportional hazards models. CONCLUSIONS In our cohort of EVAR patients with detailed preoperative anatomic information and long-term follow-up, overall mortality and aneurysm-related mortality were unaffected by IFU adherence. In addition, rates of endoleak and reintervention after initial EVAR were similar, suggesting that lack of IFU-based anatomic suitability was not a driver of outcomes.
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Affiliation(s)
- Joy Walker
- Division of Surgery, University of California, San Francisco, San Francisco, Calif
| | | | - Philip Goodney
- Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Leah Candell
- Division of Surgery, University of California, San Francisco-East Bay Medical Center, Oakland, Calif
| | - Hong Hua
- Division of Vascular Surgery, The Permanente Medical Group, San Francisco, Calif
| | - Steven Okuhn
- Division of Vascular Surgery, The Permanente Medical Group, San Francisco, Calif
| | - Bradley Hill
- Division of Vascular Surgery, The Permanente Medical Group, Santa Clara, Calif
| | - Robert W Chang
- Division of Vascular Surgery, The Permanente Medical Group, South San Francisco, Calif.
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Results of the ANCHOR prospective, multicenter registry of EndoAnchors for type Ia endoleaks and endograft migration in patients with challenging anatomy. J Vasc Surg 2014; 60:885-92.e2. [DOI: 10.1016/j.jvs.2014.04.063] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/22/2014] [Indexed: 11/19/2022]
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32
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Zhou W, Zhou W, Qiu J, Zeng Q. Hybrid procedure to treat aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery aneurysm (Case Report). J Cardiothorac Surg 2014; 9:3. [PMID: 24387673 PMCID: PMC3898389 DOI: 10.1186/1749-8090-9-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/30/2013] [Indexed: 11/14/2022] Open
Abstract
Aortic arch aneurysm is a rare condition but carries a high risk of rupture. We report one case of aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery aneurysm, which is extremely rare. Left internal carotid artery aneurysm resection and revascularization, carotid and carotid graft bypass combined with endovascular stent graft and embolization with coils were successfully performed. There were no any complaints and complications at 8 months follow-up. The follow-up CTA demonstrated thrombus formation in the aneurysm lumen, no endoleak and the aortic arch and bypass graft were all patent. We feel that hybrid procedure may be a valuable therapeutic alternative when treating this type of lesion. However, long-term clinical efficacy and safety have yet to be confirmed.
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Affiliation(s)
- Weimin Zhou
- Department of Vascular Surgery, the second affiliated hospital of Nanchang University, No 1#, Minde Road, Nanchang, China.
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Casula E, Lonjedo E, Cerverón M, Ruiz A, Gómez J. Review of pre- and post-treatment multidetector computed tomography findings in abdominal aortic aneurysms. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2012.11.001] [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]
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34
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Schiro A, Antoniou GA, Ormesher D, Pichel AC, Farquharson F, Serracino-Inglott F. The Chimney Technique in Endovascular Aortic Aneurysm Repair: Late Ruptures After Successful Single Renal Chimney Stent Grafts. Ann Vasc Surg 2013; 27:835-43. [DOI: 10.1016/j.avsg.2012.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/11/2012] [Accepted: 08/18/2012] [Indexed: 10/27/2022]
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35
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Hogendoorn W, Schlösser FJ, Moll FL, Sumpio BE, Muhs BE. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg 2013; 58:502-11. [DOI: 10.1016/j.jvs.2013.03.043] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/08/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
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36
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Fukuda T, Matsuda H, Doi S, Sugiyama M, Morita Y, Yamada M, Yokoyama H, Minatoya K, Kobayashi J, Naito H. Evaluation of Automated 2D-3D Image Overlay System Utilizing Subtraction of Bone Marrow Image for EVAR: Feasibility Study. Eur J Vasc Endovasc Surg 2013; 46:75-81. [DOI: 10.1016/j.ejvs.2013.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/04/2013] [Indexed: 11/25/2022]
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Lin J, Wang L, Guidoin R, Nutley M, Song G, Zhang Z, Du J, Douville Y. Stent fabric fatigue of grafts supported by Z-stents versus ringed stents: An in vitro buckling test. J Biomater Appl 2013; 28:965-77. [DOI: 10.1177/0885328213488228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stent-grafts externally fitted with a Z-shaped stents were compared to devices fitted with ringed stents in an in vitro oscillating fatigue machine at 200 cycles per minute and a pressure of 360 mmHg for scheduled durations of up to 1 week. The devices fitted with Z-stents showed a considerably lower endurance limit to buckling compared to the controls. The contact between the apexes of adjacent Z-stents resulted in significant damage to the textile scaffolds and polyester fibers due to the sharp angle of the Z-stents. The ringed stents did not cause any fraying in the textile scaffolds.
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Affiliation(s)
- Jing Lin
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Lu Wang
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Robert Guidoin
- Department of Surgery, Laval University and Québec Biomaterials Institute, Quebec City, QC, Canada
| | - Mark Nutley
- Section of Vascular Surgery, Peter Lougheed Health Center, University of Calgary, Calgary, AB, Canada
| | - Ge Song
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Ze Zhang
- Department of Surgery, Laval University and Québec Biomaterials Institute, Quebec City, QC, Canada
| | - Jia Du
- Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Yvan Douville
- Department of Surgery, Laval University and Québec Biomaterials Institute, Quebec City, QC, Canada
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Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization. Cardiovasc Intervent Radiol 2013; 37:251-6. [DOI: 10.1007/s00270-013-0622-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/10/2013] [Indexed: 11/26/2022]
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Zhou W, Zhou W, Qiu J. Endovascular repair of an aortic arch pseudoaneurysm with double chimney stent grafts: a case report. J Cardiothorac Surg 2013; 8:80. [PMID: 23577875 PMCID: PMC3648365 DOI: 10.1186/1749-8090-8-80] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
Aortic arch pseudoaneurysm is a rare condition but carries a high risk of rupture. We report a case of a 45-year-old man with aortic arch pseudoaneurysm between left common carotid artery (LCCA) and left subclavian artery (LSA), in which a endovascular stent graft combined with double chimneys covered stents were successfully placed. There were no any complaints and complications after 12 months follow-up. The CTA demonstrated thrombus formation in the pseudoaneurysm lumen, no endoleak and the aortic arch, LCCA and LSA were all patent. We feel that the combined endovascular and double chimneys may be a valuable therapeutic alternative when treating aortic arch lesion. However, long-term clinical efficacy and safety have yet to be confirmed.
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Affiliation(s)
- Weimin Zhou
- Department of Vascular Surgery, Nanchang University, Nanchang, China.
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40
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[Review of pre- and post-treatment multidetector computed tomography findings in abdominal aortic aneurysms]. RADIOLOGIA 2013; 56:16-26. [PMID: 23489768 DOI: 10.1016/j.rx.2012.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/21/2022]
Abstract
The increase in the frequency of abdominal aortic aneurysms (AAA) and the widely accepted use of endovascular aneurysm repair (EVAR) as a first-line treatment or as an alternative to conventional surgery make it necessary for radiologists to have thorough knowledge of the pre- and post-treatment findings. The high image quality provided by multidetector computed tomography (MDCT) enables CT angiography to play a fundamental role in the study of AAA and in planning treatment. The objective of this article is to review the cases of AAA in which CT angiography was the main imaging technique, so that radiologists will be able to detect the signs related to this disease, to diagnose it, to plan treatment, and to detect complications in the postoperative period.
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Yang J, Xiong J, Liu X, Jia X, Zhu Y, Guo W. Endovascular chimney technique of aortic arch pathologies: a systematic review. Ann Vasc Surg 2013; 26:1014-21. [PMID: 22944571 DOI: 10.1016/j.avsg.2012.05.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 01/10/2012] [Accepted: 05/08/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this review was to determine the safety and efficacy of endovascular chimney technique for aortic arch pathologies by performing a systematic and pooled analysis of the relevant literature. METHODS Electronic searches were performed in database Medline between 1994 and 2011 to identify studies on endovascular chimney technique for aortic arch pathology. The extracted variables and outcomes were synthesized through pooled analyses. RESULTS Eight articles with 51 patients who underwent endovascular chimney technique for aortic arch pathologies met the inclusion criteria. Chimney grafts were deployed in innominate (n = 11), left common carotid (n = 32), and left subclavian (n = 12) arteries. Single-stent chimney in the deployed artery was used in 37 patients, whereas double-stent chimney was utilized in 14 patients. The overall technical success rate was 90.2%. The overall perioperative mortality and morbidity were 5.9% and 13.7%, respectively. The stroke rate was 7.8%, and the fatal stroke rate accounted for 50%. The rates of primary early endoleaks and type-Ia endoleaks were 21.6% and 11.8%, respectively. The overall late mortality and morbidity were 4.4% and 15.5%, respectively. Of 5 late endoleaks, no secondary type-Ia endoleak occurred. No studies had adequate follow-up to reliably evaluate the long-time durability. CONCLUSIONS Endovascular chimney technique is technically feasible with the high initial technical success rate and relatively favorable rates of perioperative outcomes for aortic arch pathologies. However, further establishment of the role of endovascular chimney necessitates the accumulation of more cases and comparative study with other management as well as prolonged follow-up.
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Affiliation(s)
- Jian Yang
- Department of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
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42
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Antoniou GA, Georgiadis GS, Antoniou SA, Kuhan G, Murray D. A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg 2012; 57:527-38. [PMID: 23265584 DOI: 10.1016/j.jvs.2012.09.050] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND An increasing number of abdominal aortic aneurysms with unfavorable proximal neck anatomy are treated with standard endograft devices. Skepticism exists with regard to the safety and efficacy of this practice. METHODS A systematic review of the literature was undertaken to identify all studies comparing the outcomes of endovascular aneurysm repair (EVAR) in patients with hostile and friendly infrarenal neck anatomy. Hostile neck conditions were defined as conditions that were not consistent with the instructions for use of the endograft devices employed in the selected studies. Outcome data were pooled, and combined overall effect sizes were calculated using fixed or random effects models. RESULTS Seven observational studies reporting on 1559 patients (hostile anatomy group, 714 patients; friendly anatomy group, 845 patients) were included. Patients with hostile anatomy required an increased number of adjunctive procedures to achieve proximal seal compared with patients with friendly anatomy (odds ratio [OR], 3.050; 95% confidence interval [CI], 1.884-4.938). Although patients with unfavorable neck anatomy had an increased risk of developing 30-day morbidity (OR, 2.278; 95% CI, 1.025-5.063), no significant differences in the incidence of type I endoleak and reintervention rates within 30 days of treatment between the two groups were identified (OR, 2.467 and 1.082; 95% CI, 0.562-10.823 and 0.096-12.186). Patients with hostile anatomy had a fourfold increased risk of developing type I endoleak (OR, 4.563; 95% CI, 1.430-14.558) and a ninefold increased risk of aneurysm-related mortality within 1 year of treatment (OR, 9.378; 95% CI, 1.595-55.137). CONCLUSIONS Insufficient high-level evidence for or against performing standard EVAR in patients with hostile neck anatomy exists. Our analysis suggests EVAR should be cautiously used in patients with anatomic neck constraints.
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Affiliation(s)
- George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom.
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Oikonomou K, Botos B, Bracale UM, Verhoeven EL. Proximal Type I Endoleak After Previous EVAR With Palmaz Stents Crossing the Renal Arteries: Treatment Using a Fenestrated Cuff. J Endovasc Ther 2012; 19:672-6. [DOI: 10.1583/jevt-12-3901r.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lee KN, Lee HC, Park JS, Kim BW, Cha KS, Kim SP, Lee CW, Kim HK. The modified chimney technique with a thoracic aortic stent graft to preserve the blood flow of the left common carotid artery for treating descending thoracic aortic aneurysm and dissection. Korean Circ J 2012; 42:360-5. [PMID: 22701139 PMCID: PMC3369971 DOI: 10.4070/kcj.2012.42.5.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/17/2011] [Accepted: 10/25/2011] [Indexed: 12/03/2022] Open
Abstract
While thoracic endovascular aortic repair is an effective treatment option for descending thoracic aorta pathology, it does have limitations. The main limitation is related to the anatomical difficulties when disease involves the aortic arch. A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture. Furthermore, these devices cannot be used in an emergency setting. We report two patients with massive descending thoracic aortic aneurysm and ruptured aortic dissection very near the aortic arch who underwent a procedure which we named the modified chimney technique. The modified chimney technique can be used as a treatment option in such an emergency situation or as a rescue procedure when aortic pathology is involved near the supra-aortic vessels.
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Affiliation(s)
- Kyung Nam Lee
- Department of Cardiology, Pusan National University College of Medicine, Busan, Korea
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Natrella M, Castagnola M, Navarretta F, Cristoferi M, Fanelli G, Meloni T, Peinetti F. Treatment of Juxtarenal Aortic Aneurysm With the Multilayer Stent. J Endovasc Ther 2012; 19:121-4. [DOI: 10.1583/11-3398.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Shu C, Luo MY, Li QM, Li M, Wang T, He H. Early results of left carotid chimney technique in endovascular repair of acute non-a-non-B aortic dissections. J Endovasc Ther 2011; 18:477-84. [PMID: 21861733 DOI: 10.1583/11-3401.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To report our early experience with endovascular repair of acute non-A-non-B aortic dissections using chimney grafts to preserve blood flow to a left common carotid artery (LCCA) located in the proximal landing zone. METHODS From June 2009 to May 2010, 8 patients (7 men; mean age 49 years, range 29-75) with acute non-A-non-B aortic dissection and no adequate proximal sealing zones underwent thoracic endovascular aortic repair (TEVAR). Covered stents were placed parallel to the aortic stent-grafts to restore flow to the LCCAs while extending the proximal fixation zones; the left subclavian arteries were intentionally covered after carefully cerebrovascular assessment. Follow-up examinations included computed tomography (CT) at 2 weeks, 3 months, 6 months, 12 months, and yearly thereafter. RESULTS All the procedures were completed successfully, with one main aortic stent-graft deployed and one chimney graft implanted in the LCCA. Two retrograde type II endoleaks identified intraoperatively were left untreated but followed closely using CT. There were no instances of puncture site complications, stroke, paralysis, or death during the hospital stay. The 30-day mortality was 0%. During the mean 11.4-month follow-up (range 6-15), there was no mortality, and duplex ultrasound and CT showed patency of all stent-grafts, enlargement of the true lumen, and compression of the false lumen. One type II endoleak disappeared in 2 weeks postoperatively, while the other gradually faded until it was nearly gone at 11 months postoperatively. During follow-up, no renal insufficiency, new late endoleaks, endograft migration, fracture, stent-graft related complications, or deaths were observed. CONCLUSION In short-term follow-up, TEVAR combined with the chimney technique seems promising for aortic dissections that involve the aortic arch with inadequate proximal sealing zones. More cases and long-term results are needed to evaluate the safety and efficiency of this alternative endovascular technique.
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Affiliation(s)
- Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
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Keese M, Niedergethmann M, Schoenberg S, Diehl S. Placement of an aortomonoiliac stent graft without femorofemoral revascularization in endovascular aneurysm repair: a case report. J Med Case Rep 2011; 5:365. [PMID: 21838906 PMCID: PMC3179456 DOI: 10.1186/1752-1947-5-365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 08/12/2011] [Indexed: 12/02/2022] Open
Abstract
Introduction Endovascular aortic repair, if technically feasible, is the treatment of choice for patients with a contained ruptured aortic aneurysm who are unfit for open surgery. Case presentation We report the case of an 80-year-old Caucasian man who presented with an unusually configured, symptomatic infrarenal aortic aneurysm. His aneurysm showed an erosion of the fourth lumbar vertebra and a severely arteriosclerotic pelvic axis. A high thigh amputation of his right leg had been performed 15 months previously. On his right side, occlusion of his external iliac artery, common femoral artery, and deep femoral artery had occurred. His aneurysm was treated by a left-sided aortomonoiliac stent graft without femorofemoral revascularization, resulting in occlusions of both internal iliac arteries. No ischemic symptoms appeared, although perfusion of his right side was maintained only over epigastric collaterals. Conclusions The placement of aortomonoiliac stent grafts for endovascular treatment of infrarenal aortic aneurysms without contralateral revascularization is a feasible treatment option in isolated cases. In this report, access problems and revascularization options in endovascular aneurysm repair are discussed.
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Affiliation(s)
- Michael Keese
- Surgical Clinic, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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Bertoni HG, Girela G, Peirano M, Leguizamõn JH, de la Vega A, Barone HD, Nutley M, Zhang Z, Douville Y, Guidoin R. A branched, balloon-deployable, Aortomonoiliac stent-graft for treatment of AAA in a patient with a solitary intrapelvic kidney. J Endovasc Ther 2010; 17:261-5. [PMID: 20426652 DOI: 10.1583/09-2888.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the use of a branched, balloon-deployable stent-graft to treat abdominal aortic aneurysm (AAA) in the setting of a solitary kidney. CASE REPORT A 72-year-old man with a solitary intrapelvic kidney and multiple comorbid conditions was diagnosed with an asymptomatic 5.3-cm abdominal aortic aneurysm (AAA); the renal artery emerged from the aneurysm sac. A customized branched, balloon-deployable, aortomonoiliac stent-graft was utilized to exclude the AAA and preserve perfusion to the single renal artery. A synthetic bypass was then implanted to restore perfusion to the contralateral limb. The diameter of the aneurysm decreased from 5.3 to 2.7 cm at 18 months. The renal artery was patent without evidence of stenosis; renal function was normal. CONCLUSION The deployment of a novel branched stent-graft represents an interesting alternative approach to the treatment of a juxtarenal aneurysm.
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Affiliation(s)
- Hernán G Bertoni
- Departments of Interventional Radiology and Cardiovascular Surgery, University of Buenos Aires, Argentina
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Chisci E, Kristmundsson T, de Donato G, Resch T, Setacci F, Sonesson B, Setacci C, Malina M. The AAA With a Challenging Neck: Outcome of Open Versus Endovascular Repair With Standard and Fenestrated Stent-Grafts. J Endovasc Ther 2009; 16:137-46. [DOI: 10.1583/08-2531.1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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