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Tanaka S, Kato N, Oue K, Noda Y, Kato H, Miyake Y. Aortic Valve Perforation During Endovascular Repair of an Abdominal Aortic Aneurysm-A Case Report. Vasc Endovascular Surg 2020; 55:183-185. [PMID: 32885727 DOI: 10.1177/1538574420953950] [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: 11/17/2022]
Abstract
Although complications associated with endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms are rarely observed above the diaphragm, they could lead to catastrophic outcomes once they develop. Aortic valve perforation is one of those rare and major adverse events. In this report, we describe a case of an 82-year-old woman who suffered aortic valve perforation during EVAR caused by the wire-push technique. Her hemodynamics became unstable during the procedure and did not improve thereafter. Echocardiography performed 8 days after EVAR revealed aortic valve perforation. Surgical intervention was abandoned because her general condition was poor. The patient died 4 months after EVAR due to heart failure. It should be reminded that inadvertent manipulation of the wire can cause aortic valve perforation even during EVAR.
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Affiliation(s)
- Satofumi Tanaka
- Department of Cardiothoracic Surgery, 47717Kochi Health Sciences Center, Japan
| | - Noriyuki Kato
- Department of Radiology, 38072Mie University Hospital, Japan
| | - Kensuke Oue
- Department of Cardiothoracic Surgery, 47717Kochi Health Sciences Center, Japan
| | - Yoshihiro Noda
- Department of Radiology, 47717Kochi Health Sciences Center, Japan
| | - Hiroaki Kato
- Department of Radiology, 38072Mie University Hospital, Japan
| | - Yoichiro Miyake
- Department of Cardiothoracic Surgery, 47717Kochi Health Sciences Center, Japan
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The incidence and effect of noncylindrical neck morphology on outcomes after endovascular aortic aneurysm repair in the Global Registry for Endovascular Aortic Treatment. J Vasc Surg 2018; 68:1714-1724. [DOI: 10.1016/j.jvs.2018.03.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 03/09/2018] [Indexed: 11/20/2022]
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Jeon YS, Cho YK, Song MG, Seo TS, Kim JH, Song SY, Lee SY. Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy: A Korean Multicenter Retrospective Study. Cardiovasc Intervent Radiol 2017; 41:554-563. [PMID: 29279976 DOI: 10.1007/s00270-017-1867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/14/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal® stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle > 60°). MATERIALS AND METHODS We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32-87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan-Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. RESULTS The primary technical success rate (success within 24 h after EVAR) was 100% (24/24). The survival rate was 96 ± 8% at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18% at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001). CONCLUSION Kilt-based EVAR with Seal® stent-grafts for AAAs with a severely angulated neck (angle > 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.
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Affiliation(s)
- Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Young Kwon Cho
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 150 Seongan-ro Gangdong-gu, Seoul, 134-701, Korea.
| | - Myung Gyu Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Seok Seo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jeong Ho Kim
- Department of Radiology, Gachon University Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Soon-Young Song
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Sam Yeol Lee
- Department of Surgery, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
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Wartman SM, Woo K, Brewer M, Weaver FA. Management of a Large Abdominal Aortic Aneurysm in Conjunction with a Massive Inguinal Hernia. Ann Vasc Surg 2017; 42:302.e7-302.e10. [PMID: 28389284 DOI: 10.1016/j.avsg.2017.03.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 03/08/2017] [Accepted: 03/26/2017] [Indexed: 11/28/2022]
Abstract
The majority of inguinal hernias that are concomitant with abdominal aortic aneurysms (AAAs) are clinically insignificant. However, management of AAA associated with a complex hernia can be challenging. We report a case of a 72-year-old male with a 7-cm AAA and a massive inguinal hernia involving loss of abdominal domain. Using a multidisciplinary approach, a staged hybrid endovascular and open repair of the AAA was performed followed by hernia repair.
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Affiliation(s)
- Sarah M Wartman
- Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Michael Brewer
- Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
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Quatromoni JG, Orlova K, Foley PJ. Advanced Endovascular Approaches in the Management of Challenging Proximal Aortic Neck Anatomy: Traditional Endografts and the Snorkel Technique. Semin Intervent Radiol 2015; 32:289-303. [PMID: 26327748 DOI: 10.1055/s-0035-1558825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Advances in endovascular technology, and access to this technology, have significantly changed the field of vascular surgery. Nowhere is this more apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which endovascular aneurysm repair (EVAR) has replaced the traditional open surgical approach in patients with suitable anatomy. However, approximately one-third of patients presenting with AAAs are deemed ineligible for standard EVAR because of anatomic constraints, the majority of which involve the proximal aneurysmal neck. To overcome these challenges, a bevy of endovascular approaches have been developed to either enhance stent graft fixation at the proximal neck or extend the proximal landing zone to allow adequate apposition to the aortic wall and thus aneurysm exclusion. This article is composed of two sections that together address new endovascular approaches for treating aortic aneurysms with difficult proximal neck anatomy. The first section will explore advancements in the traditional EVAR approach for hostile neck anatomy that maximize the use of the native proximal landing zone; the second section will discuss a technique that was developed to extend the native proximal landing zone and maintain perfusion to vital aortic branches using common, off-the-shelf components: the snorkel technique. While the techniques presented differ in terms of approach, the available clinical data, albeit limited, support the notion that they may both have roles in the treatment algorithm for patients with challenging proximal neck anatomy.
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Affiliation(s)
- Jon G Quatromoni
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ksenia Orlova
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Paul J Foley
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Igari K, Kudo T, Uchiyama H, Toyofuku T, Inoue Y. Early experience with the endowedge technique and snorkel technique for endovascular aneurysm repair with challenging neck anatomy. Ann Vasc Dis 2014; 7:46-51. [PMID: 24719662 DOI: 10.3400/avd.oa.13-00110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 01/21/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study was evaluating the outcomes of endovascular aneurysm repair (EVAR) using the endowedge technique (EnT) and/or snorkel technique (SnT) for abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS The patients treated with EnT and/or SnT were retrospectively reviewed between January 2010 and June 2013. All patients underwent EVAR under general anesthesia. Bilateral femoral arterial access was obtained through bilateral femoral cut-down to place the stent graft mainbody, and brachial arterial access was obtained percutaneously to perform the EnT and/or SnT. RESULTS Three patients were treated with unilateral EnT, 1 with unilateral SnT, two with bilateral SnT, and two with combined EnT/SnT. A total of 12 renal arteries was attempted to preserve, and could be successfully performed by these techniques in 11 renal arteries. After complete deployment of the endograft, intraoperative angiography showed no type Ia EL. During the median follow-up of 11 months (range: 2-22 months), no deaths nor aneurysm enlargement occurred, and all treated renal arteries were patent without further intervention. CONCLUSIONS Our findings suggest that the management of AAAs by EVAR with EnT and/or SnT could achieve an adequate proximal seal, and preserve renal artery perfusion in patients with unfavorable neck anatomy.
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Affiliation(s)
- Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidetoshi Uchiyama
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Navarro TP, Bernardes RDC, Procopio RJ, Leite JO, Dardik A. Treatment of Hostile Proximal Necks During Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:28-36. [PMID: 26798712 DOI: 10.12945/j.aorta.2014.13-030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/06/2014] [Indexed: 11/18/2022]
Abstract
Endovascular aneurysm repair (EVAR) is a therapy that continues to evolve rapidly as advances in technology are incorporated into new generations of devices and surgical practice. Although EVAR has emerged as a safe and effective treatment for patients with favorable anatomy, treatment of patients with unfavorable anatomy remains controversial and is still an off-label indication for endovascular treatment with some current stent-grafts. The proximal neck of the aneurysm remains the most hostile anatomic barrier to successful endovascular repair with long-term durability. Open surgery for unfavorable necks is still considered the gold standard treatment in contemporary practice, despite the increased mortality and morbidity attributed to suprarenal cross-clamping, particularly in high-risk patients. Evolving technology may overcome the obstacles preventing endovascular treatment of unfavorable proximal neck anatomy; current approaches include purely endovascular as well as hybrid approaches, and generally include strategies that either extend the length of the short neck, move the proximal neck more proximally, or keep the short neck intact. These approaches include the use of debranching techniques, banding, chimneys, fenestrated and branched devices, filling the sac with endobags, endoanchors, and other novel devices. These newer-generation devices appear to have promising short- and midterm results. However, lack of good evidence of efficacy with long-term results for these newer approaches still precludes wide dissemination of endovascular solutions for the hostile proximal neck.
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Affiliation(s)
- Tulio Pinho Navarro
- Federal University of Minas Gerais, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo de Castro Bernardes
- Madre Teresa Hospital Aortic Center, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil; and
| | - Ricardo Jayme Procopio
- Federal University of Minas Gerais, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Jose Oyama Leite
- Federal University of Minas Gerais, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Alan Dardik
- Yale University School of Medicine, New Haven, Connecticut
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Aortic dissection occurring 18 months after successful endovascular repair in an anatomically difficult case of abdominal aortic aneurysm. Case Rep Vasc Med 2013; 2013:412708. [PMID: 24303225 PMCID: PMC3834608 DOI: 10.1155/2013/412708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 09/25/2013] [Indexed: 11/17/2022] Open
Abstract
We report an autopsy case of aneurysm dissection that occurred 18 months after the implantation of a Zenith stent graft. A 94-year-old woman, who had undergone an endovascular repair with postoperative reintervention, died of shock due to retroperitoneal hematoma. An autopsy indicated that the stent graft remained firmly fixed to the native aorta, whereas the dissection occurred near the proximal edge of the stent graft but not at the point of attachment between the suprarenal stent hook and the aorta. The luminal surface of the stent graft was almost completely covered with a transparent film with an endothelial cell lining, which might reflect the tissue regeneration observed on histological examination. This was a rare case of acute aortic dissection that occurred 18 months after EVAR, in which the autopsy indicated interesting microscopic findings and the mechanisms underlying the aortic dissection. We believe that aggressive reintervention at the proximal site in elderly women might cause the dissection of the native aorta.
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Navarro TP. Approaching challenging necks by EVAR. J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ogino H, Watanabe K, Ikegaya Y, Kawachi J, Shimoyama R, Isogai N. Protocol-based strategy for endovascular repair of ruptured abdominal aortic aneurysms. Ann Vasc Dis 2013; 6:169-74. [PMID: 23825497 DOI: 10.3400/avd.oa.12.00085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/09/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Compared with conventional open surgery (COS), endovascular aneurysm repair (EVAR) has been reported to decrease the 30-day mortality rate in patients with ruptured abdominal aortic aneurysms (rAAAs). We developed an EVAR-first strategy for rAAAs that incorporates the Shonan ruptured abdominal aortic aneurysm protocol (SRAP). We describe short-term results with this protocol at our institution and compare them with outcomes in patients who underwent COS. METHODS The records of all 57 patients in whom a rAAA was repaired during a 7-year period were reviewed retrospectively. Patients in the COS group (n = 30) were treated between January 2005 and December 2009; those in the SRAP group (n = 27) were treated between January 2010 and March 2012. The two groups were compared with respect to patient characteristics at admission, including severity of condition; operative and in-hospital variables; and 30-day mortality. RESULTS The baseline patient characteristics in the COS and SRAP groups were similar except that the SRAP group had a significantly higher rate of cerebrovascular disease. The 30-day mortality rate was significantly higher in the COS group (43% vs. 19%), as were the intraoperative mortality rate (27% vs. 5%) and the in-hospital mortality rate (57% vs. 26%; P < 0.05 for all comparisons). The technical success rate for EVAR was 96%; no conversions to open surgery were required. CONCLUSIONS Use of the SRAP is a promising strategy for improving initial outcomes in patients with rAAAs.
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Affiliation(s)
- Hidemitsu Ogino
- Division of Vascular Surgery, Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
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Georgakarakos E, Xenakis A, Manopoulos C, Georgiadis GS, Tsangaris S, Lazarides M. Geometric Factors Affecting the Displacement Forces in an Aortic Endograft With Crossed Limbs: A Computational Study. J Endovasc Ther 2013; 20:191-9. [DOI: 10.1583/1545-1550-20.2.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ren S, Fan X, Ye Z, Liu P. Long-term outcomes of endovascular repair versus open repair of abdominal aortic aneurysm. Ann Thorac Cardiovasc Surg 2012; 18:222-7. [PMID: 22790994 DOI: 10.5761/atcs.oa.11.01847] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the long-term outcomes of endovascular repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA). DESIGN We retrospectively reviewed consecutive AAA patients treated with EVAR (n = 89) or open repair (n = 136) from January 1998 to December 2008. RESULTS More patients in the open repair group had a longer duration of hospital stay. The operation time was significantly longer in open surgery than in EVAR (p <0.001), and the percentage of patients requiring a transfusion was higher in the open repair group than in EVAR. Patients in the open repair group had a higher incidence of cardiac insufficiency after surgery than did those in the EVAR group. Kaplan-Meier analysis indicated that the proportion of patients without complications in the EVAR group was significantly less than that in the open repair group (68.1% vs. 91.1%; p <0.0001), and the long-term survival rate in EVAR group was similar to open surgery group (87.5% vs. 91.1%; p = 0.555). Thrombosis was found inside of the aneurysm; postoperative complications in the EVAR group included ischemic legs, graft stenosis, and endoleaks that required further endoluminal treatment. CONCLUSIONS Endovascular repair of abdominal aortic aneurysm causes less trauma in patients with AAAs in the short term, and patients treated with EVAR have similar survival rate with open repair in the long term, but have postoperative complications requiring further interventional treatment.
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Affiliation(s)
- Shiyan Ren
- Vascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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