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Milligan JM, Dayama A, El Sayed HF, Panneton JM. Current technology for endovascular repair of the aortic arch. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Shin JB, Park MH, Jeong SH, Kwon SW, Shin SH, Woo SI, Park SD. A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair. Vasc Specialist Int 2016; 32:26-8. [PMID: 27051658 PMCID: PMC4816023 DOI: 10.5758/vsi.2016.32.1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/21/2015] [Accepted: 01/19/2016] [Indexed: 11/20/2022] Open
Abstract
Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years. We realigned the endograft kink by percutaneous transluminal angioplasty.
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Affiliation(s)
- Jong-Beom Shin
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Mi-Hwa Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sang-Ho Jeong
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sung Woo Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sung-Hee Shin
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seong-Ill Woo
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sang-Don Park
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms. J Vasc Surg 2015; 62:868-75. [PMID: 26141699 DOI: 10.1016/j.jvs.2015.04.454] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/29/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Junctional component separation producing type IIIa endoleak after endovascular abdominal aortic aneurysm repair (EVAR) is an uncommon but serious complication requiring unanticipated reinterventions. This retrospective study analyzed main-body EVAR component uncoupling and type IIIa endoleaks encountered with Powerlink and AFX (Endologix Inc, Irvine, Calif) endografts during an 8-year period. METHODS Type IIIa endoleaks were identified from a database of secondary interventions and clinical surveillance. Operative reports, medical records, and computed tomography studies were reviewed. Clinical and imaging characteristics were analyzed over time, and differences were compared at appropriate follow-up intervals. RESULTS Since 2006, 701 patients underwent primary EVAR using Endologix Powerlink (352 patients, 2006-2011) or AFX (349 patients, 2011-2014) endografts. Endoleaks required 32 secondary interventions (4.6%), including type Ia in 4 patients (1 proximal extension and 3 explants); type Ib in 8 patients (all distal extensions for enlarging iliac aneurysms); type II in 1 patient (explant); type IIIa in 17 patients (2.4%), who were the subject of this report; and type IIIb in 2 patients (both EVAR relining). The 17 patients with type IIIa endoleak were an average age of 71 years, and 14 (82%) were men. The mean preoperative abdominal aortic aneurysm (AAA) diameter was 70 ± 18 mm. The repair was elective in 16 patients and an emergency in one. Ten cases were performed with Powerlink and seven with AFX. Analysis of serial computed tomography scans found significant changes in AAA diameter; renal-to-bifurcation straight-line, centerline, and greater curvature lengths; EVAR angulation; and loss of EVAR component overlap. The average time from EVAR to reintervention was 32 months. Three patients returned with a ruptured AAA and three with AAA thrombosis, and three of these patients (18%) died ≤30 days of the emergency reintervention. Secondary procedures included EVAR relining with additional bridging components in 14 patients (82%), explant in 2, and axillobifemoral bypass in 1. No new cases of endograft uncoupling have been identified in patients treated with AFX since December 2012 after adoption of revised instructions for use. CONCLUSIONS Although a small number of secondary interventions were needed after EVAR with the Endologix Powerlink or AFX endografts, most were undertaken for late main-body component uncoupling and type IIIa endoleak, which can occur after sideways displacement of the endograft in large and angulated AAAs. Patients treated before 2013 under the old instructions for use should be evaluated for signs of impending component separation and monitored annually, noting that expected indicators of endograft failure, such as increasing AAA diameter and endoleak, may be absent.
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Ilyas S, Shaida N, Thakor A, Winterbottom A, Cousins C. Endovascular aneurysm repair (EVAR) follow-up imaging: the assessment and treatment of common postoperative complications. Clin Radiol 2015; 70:183-96. [DOI: 10.1016/j.crad.2014.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 09/04/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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Lee K, Leci E, Forbes T, Dubois L, DeRose G, Power A. Endograft Conformability and Aortoiliac Tortuosity in Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2014; 21:728-34. [DOI: 10.1583/14-4663mr.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Centerline is Not as Accurate as Outer Curvature Length to Estimate Thoracic Endograft Length. Eur J Vasc Endovasc Surg 2013; 46:82-6. [DOI: 10.1016/j.ejvs.2013.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 04/04/2013] [Indexed: 11/17/2022]
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Joo YS, Park KH. Preoperative Endovascular Abdominal Aortic Aneurysm Repair Planning with Centerline Measurement. Vasc Specialist Int 2013. [DOI: 10.5758/kjves.2013.29.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yoon Sung Joo
- Department of Vascular and Endovascular Surgery, Good Gang-An Hospital, Busan, Korea
| | - Ki Hyuk Park
- Division of Vascular Surgery, Department of General Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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O'Flynn PM, O'Sullivan G, Pandit AS. Methods for Three-Dimensional Geometric Characterization of the Arterial Vasculature. Ann Biomed Eng 2007; 35:1368-81. [PMID: 17431787 DOI: 10.1007/s10439-007-9307-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 03/30/2007] [Indexed: 11/27/2022]
Abstract
Complex vascular anatomy often affects endovascular procedural outcome. Accurate quantitative assessment of three-dimensional (3D) in-vivo arterial morphology is therefore vital for endovascular device design, and preoperative planning of percutaneous interventions. The aim of this work was to establish geometric parameters describing arterial branch origin, trajectory, and vessel curvature in 3D space that eliminate the errors implicit in planar measurements. 3D branching parameters at visceral and aortic bifurcation sites, as well as arterial tortuosity were determined from vessel centerlines derived from magnetic resonance angiography data for three subjects. Errors in coronal measurements of 3D branching angles for the right and left renal arteries were 3.1 +/- 3.4 degrees and 7.5 +/- 3.7 degrees , respectively. Distortion of the anterior visceral branching angles from sagittal measurements was less pronounced. Asymmetry in branching and planarity of the common iliac arteries was observed at aortic bifurcations. The renal arteries possessed considerably greater 3D curvature than the abdominal aorta and common iliac vessels with mean average values of 0.114 +/- 0.015 and 0.070 +/- 0.019 mm(-1) for the left and right, respectively. In conclusion, planar projections misrepresented branch trajectory, vessel length, and tortuosity proving the importance of 3D geometric characterization for possible applications in planning of endovascular interventional procedures and providing parameters for endovascular device design.
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Affiliation(s)
- Padraig M O'Flynn
- Department of Mechanical and Biomedical Engineering, National University of Ireland, University Road, Galway, Ireland
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Whittaker DR, Dwyer J, Fillinger MF. Prediction of altered endograft path during endovascular abdominal aortic aneurysm repair with the Gore Excluder. J Vasc Surg 2005; 41:575-83. [PMID: 15874919 DOI: 10.1016/j.jvs.2005.01.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE During endovascular abdominal aortic aneurysm (AAA) repair (EVAR), the rapid deployment of the Gore Excluder endograft may be associated with anatomic shortening of the endograft path. This shortened path may result in coverage of the hypogastric artery origin or overly conservative graft length selection that may lead to unnecessary extensions. We quantified the degree of path alteration with this endograft and developed an algorithm to predict it. METHODS Preoperative and postoperative three-dimensional (3D) computed tomographic (CT) scans were evaluated for 50 consecutive patients with Gore Excluder endografts by using 21 anatomic measurements and 6 calculated indices. Measurements were evaluated as if only 3D lumen centerline measurements were available, rather than complete 3D computer-aided measurement and "virtual graft" simulation. Tortuosity was quantitated from the renal artery to the hypogastric origin, using the difference between a straight line and the lumen centerline. RESULTS The endograft was deployed successfully in all cases. The graft end points were typically quite close to the preoperative plan: mean renal artery-to-graft distance was within 2.0 +/- .5 mm, and the limb end point-to-hypogastric origin differed by an average of only 1.8 +/- 1.6 mm. Although accurate in most cases, the actual graft path shortened 1 cm or more relative to the centerline in 11% of limbs. On univariate analysis, determinants of alteration of >1 cm in the graft deployment path were (1) aortoiliac tortuosity (renal-to-hypogastric artery, P < .002), (2) the degree of planned graft rotation (73% of cases altered >10 mm were in the rotated position, P < .05), and (3) the insertion side (73% of alterations >or=10 mm were ipsilateral to the main device, P < .05). On multivariate analysis, the renal-to-hypogastric artery tortuosity index (RHTI) was significant ( P < .004), and device type and rotation approached significance ( P < .08). We developed a classification scheme based on RHTI to predict the risk of alteration of the graft path >or=1 cm (low risk, 0%; medium risk, 10%; high risk, 25%) and an algorithm to predict the degree of alteration of the anatomy that reduced the number of cases shortening >or=1 cm to zero. CONCLUSIONS The graft deployment path will be altered significantly in a minority of cases with the Gore Excluder endograft, but this can cause hypogastric occlusion or other problems. Anatomic shortening is predictable from morphologic features such as tortuosity, graft insertion side, and rotation. We developed an algorithm based on a tortuosity index that quantitates the risk and degree of shortening associated with endograft deployment.
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Affiliation(s)
- David R Whittaker
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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Alerci M, Wyttenbach R, Bogen M, von Segesser LK, Gallino A, Inglese L. Endovascular Treatment of Proximal Bilateral Iliac Limb Dislocation and Kinking following Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2005; 28:521-5. [PMID: 15886941 DOI: 10.1007/s00270-004-0186-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report the case of a 69-year-old man with a late type 1b endoleak due to proximal migration of both iliac limbs 5 years after endovascular repair of an abdominal aortic aneurysm. The endovascular method used to correct bilaterally this condition is described. Final angiographic control shows patency of the stent-graft without signs of endoleak.
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Affiliation(s)
- Mario Alerci
- Department of Radiology, Ospedale San Giovanni, 6500 Bellinzona, Switzerland
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Fransen GAJ, Desgranges P, Laheij RJF, Harris PL, Becquemin JP. Frequency, Predictive Factors, and Consequences of Stent-Graft Kink Following Endovascular AAA Repair. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0913:fpfaco>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lee JT, Lee J, Aziz I, Donayre CE, Walot I, Kopchok GE, Heilbron M, Lippmann M, White RA. Stent-Graft Migration Following Endovascular Repair of Aneurysms With Large Proximal Necks: Anatomical Risk Factors and Long-term Sequelae. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0652:sgmfer>2.0.co;2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tutein Nolthenius RP, van Herwaarden JA, van den Berg JC, van Marrewijk C, Teijink JA, Moll FL. Three year single centre experience with the AneuRx aortic stent graft. Eur J Vasc Endovasc Surg 2001; 22:257-64. [PMID: 11506520 DOI: 10.1053/ejvs.2001.1440] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To report the mid-term single-centre experience with the AneuRx self-expandable nitinol stentgraft for endovascular aneurysm repair. PATIENTS AND METHODS Between December 1996 and January 2000 a total of 128 patients were treated with an AneuRx bifurcated stentgraft. Of these, 77 patients had a minimum follow-up of 12 months. Patient operative and follow-up data were prospectively gathered. RESULTS Two (3%) conversions were necessary. Median hospital stay was 3 days. One superficial wound infection occurred. Periprocedural (30 days) mortality was 5% (four patients). Three graft occlusions were noted of which two required treatment. Fifteen patients developed 18 endoleaks (six type 1, eight type 2 and four type 3). Type 1 and type 3 endoleaks were treated by extension cuffs. Four type 2 endoleaks were treated with embolisation or direct lumbar puncture. Two-year freedom from endoleak was 76%. Graft migration occurred in six cases, resulting in a 2-year freedom from migration of 90%, kinking only once. CONCLUSIONS endovascular AAA treatment is feasible and so far mid-term results are without major problems. Extensive follow-up is essential as secondary problems may occur later. Long-term results are to be awaited.
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Lobato AC, Rodriguez-Lopez J, Malik A, Vranic M, Vaughn PL, Douglas M, Diethrich EB. Impact of endovascular repair for abdominal aortic aneurysms in octogenarians. Ann Vasc Surg 2001; 15:525-32. [PMID: 11665435 DOI: 10.1007/s100160010120] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A total of 50 consecutive patients (86% male; median age, 82 years) underwent endovascular repair of abdominal aortic aneurysms (AAAs) ranging from 4.0 to 9.0 cm (median, 5.2 cm). Efficacy of aneurysm exclusion was assessed by angiography, duplex scan, and/or contrast-enhanced computed tomography (CT). Acute technical success was 82%. Access failed in one patient, and immediate conversion to open operation was required in two patients. Improper deployment of the endoluminal graft (ELG) across the renal arteries occurred in one patient. The median operation time, estimated blood loss, packed red blood cells received, contrast volume, and length of intensive care and hospital stay were 128 min, 200 mL, 0.1 unit, 297 mL, 0.9 days, and 3 days, respectively. ELG limb thrombosis was seen in one patient. There were 4 (8%) early endoleaks, and 2 endoleaks were discovered in other patients at 3 and 6 months. Local/vascular and remote/systemic postoperative complications were seen in 13 (26%) and 9 (18%) patients, respectively. At a median follow-up of 11 months (range 2 to 36 months), clinical success was 78%. The aneurysm sac diameter (n = 49) decreased from a preoperative median of 5.2 to 4.7 cm (p = 0.0001). Technical success was high, and results at 11 months were satisfactory. Long-term outcomes require further study.
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Affiliation(s)
- A C Lobato
- Department of Cardiovascular Surgery, Arizona Heart Institute and Foundation, Arizona Heart Hospital, 2632 North 20th Street, Phoenix, AZ 85006, USA
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Fairman RM, Velazquez O, Baum R, Carpenter J, Golden MA, Pyeron A, Criado F, Barker C. Endovascular repair of aortic aneurysms: critical events and adjunctive procedures. J Vasc Surg 2001; 33:1226-32. [PMID: 11389422 DOI: 10.1067/mva.2001.115003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to define the learning curve relative to the incidence and range of intraoperative problems and to establish guidelines for troubleshooting during the endovascular repair of infrarenal aortic aneurysms. METHODS We prospectively evaluated our first 75 consecutive cases over a 12-month period and focused on perioperative critical events and adjunctive procedures as categorical outcome measures collected during the operation. Patients were separated into three groups on the basis of the date of their operation, such that group 1 consisted of our first 25 cases, group 2 our next 25 cases, and group 3 our last 25 cases. RESULTS At least one critical event and adjunctive procedure marked 67 (89%) of 75 cases. In 51%, there were at least two critical events and adjunctive procedures. There were no immediate open conversions or intraoperative deaths. Access problems occurred in 28% of the 75 cases and were addressed by use of brachial-femoral artery access (30%), iliac artery/aortic bifurcation balloon angioplasty (8%), and iliofemoral conduits (4%). Graft foreshortening was the most common deployment event (44%), necessitating distal covered extensions. Iliac graft limb twists and kinks occurred in 12% of cases and were managed with balloon angioplasty and uncovered stents. General incidents included balloon ruptures (10%), arterial dissections (6%), iliac artery rupture (2.6%), and lower extremity ischemia (4%). The two cases of iliac artery rupture were managed with distal covered extensions, and there were no cases of atheroemboli. Intraoperative endoleaks were encountered in 44% of the cases and included proximal attachment sites (15%), distal attachment sites (9%), type 2 sources, and "blushes." Management of intraoperative endoleaks included proximal/distal covered extensions and re-ballooning. Our 30-day endoleak rate was 20%. The incidence of critical events did not decrease in the latter one third compared with the first two thirds of cases. CONCLUSIONS Critical events occur frequently during endovascular repair of aortic aneurysms. The intraoperative problems range from the common endoleaks, access and deployment issues, and balloon ruptures, to rare but life-threatening complications such as iliac artery rupture. A toolbox of accessories that includes wires, catheters, large balloons, covered proximal and distal extensions, and uncovered stents is essential given the frequency of adjunctive procedures. Successful aortic endografting requires more than mere familiarity with basic endovascular techniques.
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Affiliation(s)
- R M Fairman
- Division of Vascular Surgery at the University of Pennsylvania and Union Memorial Hospital, Philadelphia 19105, USA.
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Minimally Invasive Approaches to Vascular Disease. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Singh-Ranger R, McArhur T, Lees W, Adiseshiah M. A prospective study of changes in aneurysm and graft length after endovascular exclusion of AAA using balloon and self-expanding endograft systems. Eur J Vasc Endovasc Surg 2000; 20:90-5. [PMID: 10906305 DOI: 10.1053/ejvs.2000.1136] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Longitudinal shrinkage of aneurysms post-endovascular repair, employing unvalidated measurement techniques has been held to account for endograft disruption. In this study we record changes in aneurysm length, diameter and volume using the gold standard of calibrated spiral CT angiography (SCTA). METHOD From 179 patients with AAA scanned by SCTA, 68 were selected for endografting. Twenty-seven had PTFE home-made prostheses while 41 patients had Talent endografts. SCTA was performed on the fifth postoperative day and 6-monthly intervals thereafter. The distance between the lowest renal artery and the aortic bifurcation (VBL - vertical body length) and the luminal centre line length (LCL) were measured. Maximal sac diameters and volumes were recorded using 3DCT reconstruction. RESULTS Significant increase was noted in VBL (3.2) mm for PTFE-treated patients accompanied by an increase in sac volume at day 5 (12.5 ml). No changes in LCL or maximal diameters were evident. At 1.5 years further lengthening of both VBL (6.4 mm) and LCL (9.3 mm) was unaccompanied by sac diameter/volume changes. Talent patients - no changes in VBL or LCL were evident. Volumes and maximal AP and transverse diameters showed marked shrinkage: AP -11. 2 mm; transverse -2.6 mm; volumes by -35.5 ml at 6 months. CONCLUSION With PTFE increase in VBL but not graft length, without concurrent changes in maximal diameters at day 5, is commensurate with increase in sac volume; after 1.5 years graft lengthening overtakes aortic lengthening. In Talent patients VBL/graft length remained unchanged. There is no evidence for longitudinal aneurysmal contracture. Volumes and maximal diameters for the Talent endograft but not for PTFE show shrinkage.
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Affiliation(s)
- R Singh-Ranger
- The UCL Endovascular Unit, University College Hospital, London, UK
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Myers KA. COMMENTARY: How Will Endoluminal Grafting for Aneurysms Be Judged?. J Endovasc Ther 2000. [DOI: 10.1583/1545-1550(2000)007<0101:hwegfa>2.3.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
A review is given of endovascular treatment for AAA, thoracic aortic aneurysms, dissections as well as complications following previous aortic surgery. In several of these conditions endovascular treatment has advantages like a reduced operative trauma, shorter stay in hospital, and the possibility of treating patients who would have been unfit for open surgery. On the other hand, problems like endoleak, deformation of the endoprosthesis, retrograde filling of the aneurysmal sack, and graft limb occlusion need to be solved before the place of endovascular treatment can be defined. It is possible that the steadily improving quality of the implants as well as the introducer systems will widen the indications for endovascular surgery, but randomised clinical trials are warranted and a longer follow-up period is necessary to draw final conclusions.
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May J. Symposium on distortion and structural deterioration of endovascular grafts used to repair abdominal aortic aneurysms. Introduction. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1999; 6:1-3. [PMID: 10088884 DOI: 10.1583/1074-6218(1999)006<0001:sodasd>2.0.co;2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J May
- Department of Vascular Surgery, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
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