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Kano M, Nishibe T, Iwahashi T, Maekawa K, Nakano Y, Matsumoto R, Fujiyoshi T, Ogino H, Kato N, Dardik A. Association of simple renal cysts to aneurysm sac shrinkage in true thoracic aortic aneurysms after thoracic endovascular aortic repair. J Vasc Surg 2023; 78:624-632. [PMID: 37116594 DOI: 10.1016/j.jvs.2023.02.031] [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: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND An increased prevalence of thoracic aortic aneurysms (TAA) has been demonstrated in patients with simple renal cysts (SRC); patients with SRC have a less elastic aortic wall than those without SRC. The purpose of this study was to evaluate aneurysm sac shrinkage after thoracic endovascular aortic repair (TEVAR) for true TAA in patients with and without SRC. METHODS One hundred three patients with true aneurysms of the thoracic aorta who underwent TEVAR at our university hospital from November 2013 to December 2021 were included in this study. Aneurysm sac size was compared between that on baseline preoperative computed tomography and that on postoperative computed tomography scans at 1 year. A change in aneurysm sac size ≥5 mm was considered to be significant, whether due to expansion or shrinkage. RESULTS The patients were divided into two groups: those with SRC (46 patients [45%]) and those without SRC (57 patients [55%]). At 1 year, there was a significant difference in the proportion of aneurysm sac shrinkage between patients with SRC and those without SRC (23.9% vs 59.6%; P < .001). Patients with SRC showed significantly less aneurysm sac shrinkage than those without SRC (-1.8 ± 5.6 mm vs -5.1 ± 6.6 mm; P = .009). Univariable and multivariable analyses showed that the initial sac diameter (odds ratio, 1.08; 95% confidence interval, 1.03-1.14; P = .002) and the presence of SRC (odds ratio, 0.15; 95% confidence interval, 0.06-0.40; P < .001) were positively and negatively associated with aneurysm sac shrinkage after TEVAR, respectively. CONCLUSIONS The presence of a SRC was independently associated with failure of aneurysm sac shrinkage after TEVAR for true TAA. This suggests that the presence of a SRC may be a predictor for the failure of aneurysm sac shrinkage after TEVAR.
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Affiliation(s)
- Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan; Faculty of Medical Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Koki Maekawa
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yu Nakano
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Ryumon Matsumoto
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Nobuhiko Kato
- Faculty of Medical Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
| | - Alan Dardik
- Department of Surgery, Yale University School of Medicine, New Haven, CT
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Nishibe T, Kano M, Matsumoto R, Ogino H, Koizumi J, Dardik A. Prognostic Value of Nutritional Markers for Long-Term Mortality in Patients Undergoing Endovascular Aortic Repair. Ann Vasc Dis 2023; 16:124-130. [PMID: 37359098 PMCID: PMC10288122 DOI: 10.3400/avd.oa.22-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/24/2023] [Indexed: 06/28/2023] Open
Abstract
Objective: The relationship between nutritional status and morbidity and death in a number of diseases and disorders has garnered considerable attension. In patients having endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA), we assessed the prognostic value of nutritional markers of albumin (ALB), body mass index (BMI), and geriatric nutritional risk index (GNRI) for long-term mortality. Materials and Methods: Retrospective data analysis was done on patients who had undergone elective EVAR for AAA more than 5 years earlier. Results: A total of 176 patients underwent EVAR for AAA between March 2012 and April 2016. The optimal cutoff value of ALB, BMI, and GNRI for predicting long-term mortality was calculated as 3.75 g/dL (area under the curve [AUC] 0.64), 21.4 kg/m2 (AUC 0.65), and 101.4 (AUC 0.70), respectively. Low ALB, low BMI, and low GNRI as well as age ≥75 years, chronic obstructive pulmonary disease, chronic kidney disease, and active cancer were independent risk factors for long-term mortality. Conclusion: Malnutrition, which is measured by ALB, BMI, and GNRI, is an independent risk factor for long-term mortality in patients receiving EVAR for AAA. Of the nutritional markers, the GNRI can be the most reliable nutritional indicator to identify a potentially high-risk group of mortality after EVAR.
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Affiliation(s)
- Toshiya Nishibe
- Department of Medical Management and Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryumon Matsumoto
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Koizumi
- Department of Radiology, Chiba University School of Medicine, Chiba, Chiba, Japan
| | - Alan Dardik
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Nishibe T, Dardik A, Maekawa K, Kano M, Akiyama S, Nukaga S, Koizumi J, Ogino H. The Presence of Simple Renal Cysts Is Associated With Increased Arterial Stiffness in Patients With Abdominal Aortic Aneurysm. Angiology 2022; 73:863-868. [PMID: 35466709 DOI: 10.1177/00033197221087781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Simple renal cysts (SRC) are associated with the development of abdominal aortic aneurysms (AAA). We hypothesized that patients with AAA and SRC have increased arterial stiffness (AS) compared with patients without SRC. Patients (n=223) with an infrarenal AAA undergoing pulse wave analysis were recruited. Brachial-ankle pulse wave velocity (PWV) was measured (automated oscillometric method) as an index of AS. Participants were categorized into those with increased AS and those with normal/borderline AS (threshold: 1800 cm/s); 134 patients (60.1%) had increased AS and 89 (39.9%) patients had normal/borderline AS. Multivariable analyses showed that age ≥75 years (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.51-5.72; P=.002), systolic blood pressure ≥140 mmHg (OR, 5.05; 95% CI, 2.35-10.83; P<.001), hypertension (OR, 2.28; 95% CI, 1.08-4.79; P=.030), and presence of SRC (OR, 1.89; 95% CI, 1.03-3.46; P=.040) were independent risk factors for increased AS. The presence of SRC is an independent risk factor for increased AS in patients with an AAA. This association suggests that patients with SRC may have severe aortic wall degeneration and thus the presence of SRC may be pathologically linked to the development of AAA.
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Affiliation(s)
- Toshiya Nishibe
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Alan Dardik
- Department of Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Koki Maekawa
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Masaki Kano
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Shinobu Akiyama
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Saori Nukaga
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Jun Koizumi
- Department of Radiology, 47708Chiba University School of Medicine, Chiba, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
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Fleischmann D, Afifi RO, Casanegra AI, Elefteriades JA, Gleason TG, Hanneman K, Roselli EE, Willemink MJ, Fischbein MP. Imaging and Surveillance of Chronic Aortic Dissection: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2022; 15:e000075. [PMID: 35172599 DOI: 10.1161/hci.0000000000000075] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
All patients surviving an acute aortic dissection require continued lifelong surveillance of their diseased aorta. Late complications, driven predominantly by chronic false lumen degeneration and aneurysm formation, often require surgical, endovascular, or hybrid interventions to treat or prevent aortic rupture. Imaging plays a central role in the medical decision-making of patients with chronic aortic dissection. Accurate aortic diameter measurements and rigorous, systematic documentation of diameter changes over time with different imaging equipment and modalities pose a range of practical challenges in these complex patients. Currently, no guidelines or recommendations for imaging surveillance in patients with chronic aortic dissection exist. In this document, we present state-of-the-art imaging and measurement techniques for patients with chronic aortic dissection and clarify the need for standardized measurements and reporting for lifelong surveillance. We also examine the emerging role of imaging and computer simulations to predict aortic false lumen degeneration, remodeling, and biomechanical failure from morphological and hemodynamic features. These insights may improve risk stratification, individualize contemporary treatment options, and potentially aid in the conception of novel treatment strategies in the future.
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Kano M, Nishibe T, Dardik A, Iwahashi T, Ogino H. Association of High-Sensitivity C-Reactive Protein With Aneurysm Sac Shrinkage in Patients Undergoing Endovascular Abdominal Aneurysm Repair. J Endovasc Ther 2021; 29:866-873. [PMID: 34969319 DOI: 10.1177/15266028211067738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The factors associated with aneurysm sac shrinkage after endovascular aneurysm repair (EVAR) are not well established. As inflammation is implicated in aneurysm pathophysiology, we hypothesized that high-sensitivity C-reactive protein (hsCRP) was associated with aneurysm sac shrinkage after EVAR and compared the preoperative level of hsCRP between patients with and without postoperative aneurysm sac shrinkage after EVAR. METHODS From November 2013 to April 2019, 143 patients undergoing EVAR using Gore C3 Excluder (W. L. Gore & Associates, Inc, Flagstaff, Arizona) at our university hospital were included in this study. Aneurysm sac size was compared between that on baseline preoperative computed tomography (CT) and that on postoperative CT scans. A change in aneurysm sac size ≥5 mm was considered to be significant, whether due to enlargement or shrinkage. RESULTS Aneurysm sac size showed a significant decrease from 50.6 ± 9.8 mm to 47.1 ± 10.3 mm at 1 year. At 1 year postoperatively, aneurysm sac shrinkage (≥5 mm) was observed in 48 patients (34%), a stable aneurysm sac was noted in 93 patients (65%), and aneurysm sac enlargement was noted in 2 patients (1.4%). The mean preoperative hsCRP was 0.33 ± 0.54 mg/dL. Univariable analysis showed that preoperative hsCRP (p=0.029) and the presence of a renal cyst (p=0.002) were associated with aneurysm sac shrinkage. Multivariable analysis showed that preoperative hsCRP [>0.19mg/dL] (odds ratio [OR] = 0.22; 95% confidence interval [CI] = 0.05-0.96; p=0.042), and the presence of a renal cyst (OR = 0.31; 95% CI = 0.15-0.67; p=0.002) were independent risk factors for aneurysm sac shrinkage after EVAR. CONCLUSIONS The level of preoperative hsCRP was independently associated with aneurysm sac shrinkage after EVAR in patients with abdominal aortic aneurysms. These data suggest that the high level of hsCRP can be a negative predictor for aneurysm sac shrinkage after EVAR.
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Affiliation(s)
- Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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6
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Nishibe T, Kano M, Maekawa K, Akiyama S, Nukaga S, Koizumi J, Dardik A, Ogino H. Association of preoperative pulse wave velocity to aneurysm sac shrinkage after endovascular aneurysm repair. INT ANGIOL 2021; 40:409-415. [PMID: 34236153 DOI: 10.23736/s0392-9590.21.04691-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Arterial stiffness may be the underlying cause of the divergent sac behavior after endovascular aortic repair (EVAR). We evaluated arterial stiffness using pulse wave velocity (PWV) in patients undergoing EVAR for abdominal aortic aneurysm (AAA) and demonstrated that arterial stiffness is a predictor for determining sac behavior after EVAR. METHODS AND RESULTS One hundred nineteen patients with infrarenal AAA undergoing EVAR between November 2013 and July 2019 were included in this study. Preoperative brachial-ankle PWV was measured using an automated oscillometric method at our vascular laboratory. PWV and other risk factors were assessed with respect to being a risk factor for sac shrinkage at 2 years postoperatively. Univariate and multivariable analyses revealed preoperative PWV (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.79-0.98; p = 0.045) and the incidence of operative type II endoleak (OR 0.68; 95% CI 0.10-0.81; p = 0.048) as an independent risk factor for sac shrinkage at 2 year postoperatively. The receiver-operating characteristic curve analysis showed that the optimal cutoff value for predicting sac shrinkage was 17.79 m/s, and significantly predicted sac shrinkage. CONCLUSIONS Preoperative PWV was independently associated with sac shrinkage after EVAR, suggesting that arterial stiffness may be one of the key factors for determining sac behavior after EVAR.
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Affiliation(s)
- Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan -
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koki Maekawa
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shinobu Akiyama
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Saori Nukaga
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Koizumi
- Department of Radiology, Chiba University School of Medicine, Chiba, Japan
| | - Alan Dardik
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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7
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Simple renal cyst and its association with sac shrinkage after endovascular aneurysm repair for abdominal aortic aneurysms. J Vasc Surg 2020; 71:1890-1898.e1. [DOI: 10.1016/j.jvs.2019.05.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/18/2019] [Indexed: 11/20/2022]
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8
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Clinical and Morphological Outcomes in Endovascular Aortic Repair of Abdominal Aortic Aneurysm Using GORE C3 EXCLUDER: Comparison between Patients Treated within and Outside Instructions for Use. Ann Vasc Surg 2019; 59:54-62. [DOI: 10.1016/j.avsg.2018.12.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
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9
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Nishibe T, Iwahashi T, Kamiya K, Takahashi S, Kawago K, Maruno K, Fujiyoshi T, Iwahori A, Suzuki S, Koizumi N, Koizumi J, Ogino H. Four-year experience with the Endurant stent-graft for abdominal aortic and common iliac artery aneurysms in 50 consecutive Japanese patients. INT ANGIOL 2019; 38:108-114. [DOI: 10.23736/s0392-9590.19.04023-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Bodell BD, Taylor AC, Patel PJ. Thoracic Endovascular Aortic Repair: Review of Current Devices and Treatments Options. Tech Vasc Interv Radiol 2018; 21:137-145. [DOI: 10.1053/j.tvir.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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11
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Aicher BO, Mukhopadhyay S, Lu X, Muratoglu SC, Strickland DK, Ucuzian AA. Quantitative Micro-CT Analysis of Aortopathy in a Mouse Model of β-aminopropionitrile-induced Aortic Aneurysm and Dissection. J Vis Exp 2018. [PMID: 30059027 DOI: 10.3791/57589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aortic aneurysm and dissection is associated with significant morbidity and mortality in the population and can be highly lethal. While animal models of aortic disease exist, in vivo imaging of the vasculature has been limited. In recent years, micro-computerized tomography (micro-CT) has emerged as a preferred modality for imaging both large and small vessels both in vivo and ex vivo. In conjunction with a method of vascular casting, we have successfully used micro-CT to characterize the frequency and distribution of aortic pathology in β-aminopropionitrile-treated C57/Bl6 mice. Technical limitations of this method include variations in the quality of the perfusion introduced by poor animal preparation, the application of proper methodologies for vessel size quantification, and the non-survivability of this procedure. This article details a methodology for the intravascular perfusion of a lead-based radiopaque silicone rubber for the quantitative characterization of aortopathy in a mouse model of aneurysm and dissection. In addition to visualizing aortic pathology, this method may be used for examining other vascular beds in vivo or vascular beds removed post-mortem.
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Affiliation(s)
- Brittany O Aicher
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine;
| | - Subhradip Mukhopadhyay
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine
| | - Xin Lu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
| | - Selen C Muratoglu
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine
| | - Dudley K Strickland
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine
| | - Areck A Ucuzian
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine; Division of Vascular Surgery, University of Maryland School of Medicine
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12
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Boos J, Brook OR, Fang J, Temin N, Brook A, Raptopoulos V. What Is the Optimal Abdominal Aortic Aneurysm Sac Measurement on CT Images during Follow-up after Endovascular Repair? Radiology 2017; 285:1032-1041. [DOI: 10.1148/radiol.2017161424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Johannes Boos
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Olga R. Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Jieming Fang
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Nathaniel Temin
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Vasillios Raptopoulos
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
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13
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Seike Y, Tanaka H, Fukuda T, Itonaga T, Morita Y, Oda T, Inoue Y, Sasaki H, Minatoya K, Kobayashi J. Influence of warfarin therapy on the occurrence of postoperative endoleaks and aneurysm sac enlargement after endovascular abdominal aortic aneurysm repair. Interact Cardiovasc Thorac Surg 2017; 24:615-618. [PMID: 28108574 DOI: 10.1093/icvts/ivw383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/26/2016] [Indexed: 12/16/2022] Open
Abstract
Objectives This study aims to determine whether warfarin therapy influences the occurrence of endoleaks or aneurysm sac enlargement after endovascular aortic repair (EVAR). Methods A total of 367 patients who underwent EVAR for abdominal aortic aneurysm between 2007 and 2013 were recruited for this study. Satisfactory follow-up data including completed computed tomography scan follow-up for more than 2 years were available for 209 patients, and the mean follow-up time was 37 ± 12 months. Twenty-nine (16%) patients were on warfarin therapy (warfarin group), whereas 180 (84%) patients were not on warfarin therapy (control group). Results Two- and four-year freedom rates for persistent type II endoleaks were significantly lower in patients of the warfarin group compared with the control group (85 and 49% vs 93 and 91%, respectively; P = 0.0001). Similarly, 2- and 4-year freedom rates for sac enlargement (>5 mm) were significantly lower in patients of the warfarin group compared with the control group (83 and 61% vs 92 and 82%, respectively; P = 0.0036). Using Cox regression analysis, the warfarin therapy was identified to be an independent positive predictor of sac enlargement after EVAR [hazard ratio (HR): 2.4; 95% confidence interval (CI): 1.08-5.40; P = 0.032], together with persistent type II endoleak. Warfarin therapy was also an independent predictor for persistent type II endoleak (HR: 3.7; 95% CI: 1.81-7.41; P < 0.0001) together with the number of patent lumbar arteries. Conclusions Results suggested that warfarin therapy was significantly associated with an increased risk for persistent II endoleak and sac enlargement after EVAR.
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Affiliation(s)
- Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tatsuya Itonaga
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tatsuya Oda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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14
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Lau C, Feldman DN, Girardi LN, Kim LK. Imaging for surveillance and operative management for endovascular aortic aneurysm repairs. J Thorac Dis 2017; 9:S309-S316. [PMID: 28540074 DOI: 10.21037/jtd.2017.03.89] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Endovascular aortic aneurysm repairs rely heavily on radiologic imaging modalities for preoperative surveillance, intraoperative management, and postoperative follow-up. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography all have utility at different stages of management. Often one imaging modality compliments another by providing supplementary information. Data from the imaging exams must be synthesized into one coherent plan for managing patients with aortic aneurysms.
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Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Dmitriy N Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Luke K Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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15
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Novak K, Polzer S, Krivka T, Vlachovsky R, Staffa R, Kubicek L, Lambert L, Bursa J. Correlation between transversal and orthogonal maximal diameters of abdominal aortic aneurysms and alternative rupture risk predictors. Comput Biol Med 2017; 83:151-156. [PMID: 28282590 DOI: 10.1016/j.compbiomed.2017.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/07/2017] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE There is no standard for measuring maximal diameter (Dmax) of abdominal aortic aneurysm (AAA) from computer tomography (CT) images although differences between Dmax evaluated from transversal (axialDmax) or orthogonal (orthoDmax) planes can be large especially for angulated AAAs. Therefore we investigated their correlations with alternative rupture risk indicators as peak wall stress (PWS) and peak wall rupture risk (PWRR) to decide which Dmax is more relevant in AAA rupture risk assessment. MATERIAL AND METHODS The Dmax values were measured by a trained radiologist from 70 collected CT scans, and the corresponding PWS and PWRR were evaluated using Finite Element Analysis (FEA). The cohort was ordered according to the difference between axialDmax and orthoDmax (Da-o) quantifying the aneurysm angulation, and Spearman's correlation coefficients between PWS/PWRR - orthoDmax/axialDmax were calculated. RESULTS The calculated correlations PWS/PWRR vs. orthoDmax were substantially higher for angulated AAAs (with Da-o≥3mm). Under this limit, the correlations were almost the same for both Dmax values. Analysis of AAAs divided into two groups of angulated (n=38) and straight (n=32) cases revealed that both groups are similar in all parameters (orthoDmax, PWS, PWRR) with the exception of axialDmax (p=0.024). CONCLUSIONS It was confirmed that orthoDmax is better correlated with the alternative rupture risk predictors PWS and PWRR for angulated AAAs (DA-O≥3mm) while there is no difference between orthoDmax and axialDmax for straight AAAs (DA-O<3mm). As angulated AAAs represent a significant portion of cases it can be recommended to use orthoDmax as the only Dmax parameter for AAA rupture risk assessment.
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Affiliation(s)
- Kamil Novak
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Czech Republic.
| | - Stanislav Polzer
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Czech Republic
| | - Tomas Krivka
- Department of Medical Imaging, St. Anne´s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Vlachovsky
- 2(nd) Department of Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Staffa
- 2(nd) Department of Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lubos Kubicek
- 2(nd) Department of Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jiri Bursa
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Czech Republic
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16
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Olin JW, Jang J, Jaff MR, Beckman JA, Rooke T. Vascular Imaging: An Unparalleled Decade. J Endovasc Ther 2016; 11 Suppl 2:II21-31. [PMID: 15760260 DOI: 10.1177/15266028040110s618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vascular imaging techniques, such as catheter angiography, ultrasound, computed tomography (CT), and magnetic resonance (MR), have all undergone unprecedented innovation and incredible technological leaps in the last 10 years. Ultrasound, CT, and MR have progressed in acquisition speed, resolution, and accuracy to the point that they have now supplanted the former mainstay, invasive catheter-based angiography, despite the advent of digitized angiographic image recording. This review explores the advantages and shortcomings of each technique and how they have changed the diagnosis and assessment of the cardiovascular system for endovascular intervention.
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Affiliation(s)
- Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
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17
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Reutersberg B, Haller B, Mariss J, Eckstein HH, Ockert S. Measurements After Image Post-processing Are More Precise in the Morphometric Assessment of Thoracic Aortic Aneurysms: An Intermodal and Intra-observer Evaluation. Eur J Vasc Endovasc Surg 2016; 52:509-517. [PMID: 27545857 DOI: 10.1016/j.ejvs.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Precise pre-procedural anatomical analysis of aneurysmal anatomy is essential for successful thoracic endovascular aortic repair (TEVAR). Since surgeons and radiologists have to perform multiple measurements in the same patient, high intra-observer reliability of any imaging method is mandatory. Commercially available three dimensional (3D) post-processing techniques are expected to be superior to conventional two dimensional multiplanar reconstructions (MPRs) derived from computed tomography angiograms (CTAs). However, few data exist to support this view. This study aims to evaluate the intermodal and intra-observer differences using 3D software (3surgery) in descending thoracic aortic aneurysms (dTAAs). METHODS Pre-operative CTAs (performed between 2004 and 2010) of 30 dTAAs (mean maximum diameter 61.4 ± 13 mm) were assessed by three independent investigators with different experience in the measurement of aortic pathologies. Intra-observer reliability and intermodal differences (3D vs. 2D) were investigated using pre-specified measurement points (distances of total length, maximum diameter, proximal and distal landing zones). Statistical analyses were performed using the Bland-Altman method and a mixed regression model. RESULTS Intermodal comparison showed that 2D measurements significantly underestimate the measured distances (maximum diameter 3.7 mm [95% CI -5.3 to -2.1] and landing zone maximum 1.4 mm [95% CI -2.0 to -0.2] shorter with 2D, p < .05). In almost all 3D measurements, all investigators showed lower variability comparing the intra-observer differences, most notably in the measuring point total length (reduction of the SD up to 7.9 mm). CONCLUSIONS These data show that both techniques led to significant measurement disparity. This occurs especially at the point of indication (maximum diameter) and the total length of the aneurysm (important for correct stent graft selection). But overall the variability is reduced with the 3D technique, which also tends to measure greater distances. The use of post-processing software therefore leads to more precise device selection for TEVAR in TAA.
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Affiliation(s)
- B Reutersberg
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - B Haller
- Institute for Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - J Mariss
- Radiologie Nordhessen, Fritzlar, Germany; Department for Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H-H Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - S Ockert
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department for Heart-, Thoracic- and Vascular-Surgery, Cantonal Hospital, Lucerne, Switzerland
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18
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Gharahi H, Zambrano BA, Lim C, Choi J, Lee W, Baek S. On growth measurements of abdominal aortic aneurysms using maximally inscribed spheres. Med Eng Phys 2015; 37:683-91. [PMID: 26004506 DOI: 10.1016/j.medengphy.2015.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/26/2014] [Accepted: 04/25/2015] [Indexed: 11/25/2022]
Abstract
The maximum diameter, total volume of the abdominal aorta, and its growth rate are usually regarded as key factors for making a decision on the therapeutic operation time for an abdominal aortic aneurysm (AAA) patient. There is, however, a debate on what is the best standard method to measure the diameter. Currently, two dominant methods for measuring the maximum diameter are used. One is measured on the planes perpendicular to the aneurism's central line (orthogonal diameter) and the other one is measured on the axial planes (axial diameter). In this paper, another method called 'inscribed-spherical diameter' is proposed to measure the diameter. The main idea is to find the diameter of the largest sphere that fits within the aorta. An algorithm is employed to establish a centerline for the AAA geometries obtained from a set of longitudinal scans obtained from South Korea. This centerline, besides being the base of the inscribed spherical method, is used for the determination of orthogonal and axial diameter. The growth rate parameters are calculated in different diameters and the total volume and the correlations between them are studied. Furthermore, an exponential growth pattern is sought for the maximum diameters over time to examine a nonlinear growth pattern of AAA expansion both globally and locally. The results present the similarities and discrepancies of these three methods. We report the shortcomings and the advantages of each method and its performance in the quantification of expansion rates. While the orthogonal diameter measurement has an ability of capturing a realistic diameter, it fluctuated. On the other hand, the inscribed sphere diameter method tends to underestimate the diameter measurement but the growth rate can be bounded in a narrow region for aiding prediction capability. Moreover, expansion rate parameters derived from this measurement exhibit good correlation with each other and with growth rate of volume. In conclusion, although the orthogonal method remains the main method of measuring the diameter of an abdominal aorta, employing the idea of maximally inscribed spheres provides both a tool for generation of the centerline, and an additional parameter for quantification of aneurysmal growth rates.
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Affiliation(s)
- H Gharahi
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA
| | - B A Zambrano
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA
| | - C Lim
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
| | - J Choi
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA; Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - W Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - S Baek
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA.
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19
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Lim S, Halandras PM, Park T, Lee Y, Crisostomo P, Hershberger R, Aulivola B, Cho JS. Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients. J Vasc Surg 2015; 61:862-8. [DOI: 10.1016/j.jvs.2014.11.081] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/25/2014] [Indexed: 11/24/2022]
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20
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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:119-82. [DOI: 10.1016/j.echo.2014.11.015] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Kaladji A, Lucas A, Kervio G, Haigron P, Cardon A. Sizing for endovascular aneurysm repair: clinical evaluation of a new automated three-dimensional software. Ann Vasc Surg 2011; 24:912-20. [PMID: 20831992 DOI: 10.1016/j.avsg.2010.03.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 03/23/2010] [Accepted: 03/25/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND To assess the reproducibility and accuracy of the sizing procedure before aortic endograft implantation using new sizing automated software as compared with standard radiological procedures. METHODS On the basis of original spiral-computed tomography images, the sizing of 32 patients with abdominal aortic aneurysm treated by endovascular aneurysm repair (EVAR) was retrospectively compared. The first sizing was performed by a radiologist using a standard workstation (General electrics) and software (Advanced vessel analysis). The second was performed twice by two surgeons using a personal computer with automatic three-dimensional sizing software (Endosize; Therenva, Rennes, France). All diameters and lengths required before EVAR were measured (17 items). Moreover, 13 qualitative criteria regarding EVAR feasibility, including neck length, were compared. Intra- and interobserver variability with Endosize, as well as the variability between the two measurement methods were analyzed using the intraclass correlation coefficient (ICC) and Bland and Altman's method. Qualitative variables were analyzed using Fischer's exact test and kappa coefficient. RESULTS Intraobserver variability with Endosize proved to be efficient. None of the ICCs were lower than 0.9, and more than 90% of the absolute differences between two measurements were less than 2 mm. Interobserver variability with Endosize was assessed in a similar manner. Measurement variability of vessel diameters was less marked than that of vessel lengths. This trend was observed for all datasets. Comparison of the two measurement methods demonstrated a good correlation (minimum ICC = 0.697; maximum ICC = 0.974), although less so than that observed using Endosize. Mean time consumption using Endosize was 13.1 ± 4.53 minutes (range: 7.2-32.7). Analysis of the alarm sets demonstrated a high agreement between observers (kappa coefficient = 0.81). CONCLUSIONS Sizing using the Endosize software is as reliable as conventional radiological procedures. Sizing by surgeons using an automated, user-friendly, and mobile tool appears to be reproducible.
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Affiliation(s)
- Adrien Kaladji
- Vascular Surgery Unit, Pontchaillou Hospital, Rennes, France.
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22
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Kim HC, Park SW, Nam KW, Choi H, Choi EJ, Jin S, Kim MG, Sun K. Determination of accurate stent graft configuration in abdominal aortic aneurysm using computed tomography: a preliminary study. Clin Imaging 2010; 34:255-62. [DOI: 10.1016/j.clinimag.2009.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 05/22/2009] [Accepted: 06/06/2009] [Indexed: 11/30/2022]
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Go MR, Barbato JE, Rhee RY, Makaroun MS. What is the clinical utility of a 6-month computed tomography in the follow-up of endovascular aneurysm repair patients? J Vasc Surg 2008; 47:1181-6; discussion 1186-7. [DOI: 10.1016/j.jvs.2008.01.056] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 01/28/2008] [Accepted: 01/29/2008] [Indexed: 10/22/2022]
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Haider SEA, Najjar SF, Cho JS, Rhee RY, Eskandari MK, Matsumura JS, Makaroun MS, Morasch MD. Sac behavior after aneurysm treatment with the Gore Excluder low-permeability aortic endoprosthesis: 12-month comparison to the original Excluder device. J Vasc Surg 2006; 44:694-700. [PMID: 16926082 DOI: 10.1016/j.jvs.2006.06.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The original Gore Excluder endoprosthesis (OGE) used both during and briefly after clinical trials was associated with less sac regression and more sac growth than some other devices, even without apparent endoleaks, presumably because of transmural movement of serous fluid across the expanded polytetrafluoroethylene material. In July 2004, the device was modified to decrease graft permeability. This study evaluated the efficacy of the new Excluder Low-Permeability Device (ELPD) at 1 year and compared it with the OGE and the Cook Zenith device (ZEN). METHODS From Food and Drug Administration approval of the Excluder in November 2002 until June 2005, 283 patients underwent endovascular repair of abdominal aortic aneurysms with the Gore Excluder or the ZEN. Postoperative surveillance included computed tomographic scans at 1 and 12 months; 181 (64%) patients completed both scans. The 1-month computed tomographic scan served as a baseline, and the minor axis diameter, measured at the largest axial cut of the abdominal aortic aneurysm, was compared with the same measurement at 1 year. A sac size change of 5 mm or more was considered significant. Sixty patients treated with the OGE were compared with 72 patients treated with the ELPD. Forty-nine patients treated during the same time period with the ZEN, known for early sac shrinkage, were used as a reference. All measurements were performed by one observer from a digital workstation. Wilcoxon signed rank tests (pairwise) or Kruskal-Wallis tests (three groups) were used for intergroup comparison of continuous variables, whereas chi2 statistics or Fisher exact tests were used to compare categorical variables. RESULTS Patient age and sex and mean maximum aneurysm diameter at baseline were similar among groups (P = .59, .27, and .46, respectively). Graft migration, stent fractures, acute surgical conversion, late abdominal aortic aneurysm rupture, or aneurysm-related deaths were not observed. Type II endoleak rates were similar between ELPD and ZEN (23.6% and 20.4%; P = .68). Although a higher rate of endoleaks was seen with OGE (36.7%), this was not significant when compared with the other two devices (P = .11). At 1 year, patients treated with ELPD had a sac regression rate that was significantly higher than that for patients treated with OGE (63.9% vs 25%; P < 0.001) and was similar to that for patients treated with ZEN (65.3%). Significant sac expansion was not observed with ELPD. CONCLUSIONS At 1 year, similar to ZEN, significant aneurysm sac regression and minimal sac expansion were noted after endovascular repair of abdominal aortic aneurysms with ELPD. Low-porosity fabric used in the construction of endoprostheses seems to be an important factor in early aneurysm sac shrinkage. Long-term efficacy regarding the prevention of sac enlargement remains unclear, and further follow-up is suggested.
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Abstract
Vascular imaging techniques, such as catheter angiography, ultrasound, computed tomography (CT), and magnetic resonance (MR), have all undergone unprecedented innovation and incredible technological leaps in the last 10 years. Ultrasound, CT, and MR have progressed in acquisition speed, resolution, and accuracy to the point that they have now supplanted the former mainstay, invasive catheter-based angiography, despite the advent of digitized angiographic image recording. This review explores the advantages and shortcomings of each technique and how they have changed the diagnosis and assessment of the cardiovascular system for endovascular intervention.
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Affiliation(s)
- Allan W Reid
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
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26
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Cho JS, Dillavou ED, Rhee RY, Makaroun MS. Late abdominal aortic aneurysm enlargement after endovascular repair with the excluder device. J Vasc Surg 2004; 39:1236-41; discussion 2141-2. [PMID: 15192562 DOI: 10.1016/j.jvs.2004.02.038] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Behavior of the abdominal aortic aneurysm (AAA) sac after endovascular abdominal aortic aneurysm repair (EVAR) is graft-dependent. The Excluder endograft has been associated with less sac regression than some other stent grafts. Long-term follow-up has not been reported. METHODS Between May 1999 and July 2002, 50 patients underwent EVAR with the Excluder bifurcated endoprosthesis. These patients were followed up prospectively with computed tomography (CT) at 1, 6, and 12 months and yearly thereafter. One immediate conversion to open surgery and three deaths occurred within 6 months. One additional patient was lost to follow-up. The remaining 45 patients, 35 men and 10 women, were followed up for at least 1 year, and form the basis for this report. Their mean age was 73 +/- 5.5 years. The minor axis diameter at the largest area of the AAA on CT examination was compared with the baseline measurement at 1 month and to the smallest size previously recorded during follow-up. Change in sac size of 5 mm or greater was considered significant. Mean follow-up was 2.7 +/- 1.2 years (range, 1-4 years). Nominal variables were compared with the chi(2) test, and continuous variables with the Student t test. RESULTS A significant decrease in average AAA sac diameter was observed at 6-month, 1-year, and 2-year follow-up. These differences were lost by the 3-year evaluation, because of delayed sac growth (n = 9) and re-expansion of once shrunken aneurysms (n = 3). The probability of freedom from sac growth or re-expansion at 4 years was only 43%. At last follow-up, sac expansion occurred in the absence of active endoleak in nine patients. Type II endoleak was associated with sac expansion in three patients (P =.003), resulting in one conversion to open surgery after the 4-year follow-up. No graft migrations, AAA ruptures, or aneurysm-related deaths were noted. CONCLUSIONS Late aneurysm sac growth or re-expansion after EVAR with the Excluder device is common, even in the absence of endoleak. Although the incidence of important clinical sequelae is low at this point, the incidence of aneurysm expansion should be taken into consideration during the risk-benefit assessment before EVAR repair with the Excluder device.
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Affiliation(s)
- Jae-Sung Cho
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Presbyterian University Hospital A1011, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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