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Sen I, Kanzafarova I, Yonkus J, Mendes BC, Colglazier JJ, Shuja F, DeMartino RR, Kalra M, Rasmussen TE. Clinical presentation, operative management, and long-term outcomes of rupture after previous abdominal aortic aneurysm repair. J Vasc Surg 2023; 77:396-405.e7. [PMID: 36272507 DOI: 10.1016/j.jvs.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the presentation trends, intervention, and survival of patients who had been treated for late abdominal aortic aneurysm rupture (LAR) after open repair (OR) or endovascular aortic aneurysm repair (EVAR). METHODS We reviewed the clinical data from a single-center, retrospective database for patients treated for LAR from 2000 to 2020. The end points were the 30-day mortality, major postoperative complication, and survival. The outcomes between LAR managed with EVAR (group I) vs OR were compared (group II). RESULTS Of 390 patients with infrarenal aortic rupture, 40 (10%) had experienced aortic rupture after prior aortic repair and comprised the LAR cohort (34 men; age 78 ± 8 years). LAR had occurred before EVAR in 30 and before OR in 10 patients. LAR was more common in the second half of the study with 32 patients after 2010. LAR after prior OR was secondary to ruptured para-anastomotic pseudoaneurysms. After initial EVAR, LAR had occurred despite reintervention in 17 patients (42%). The time to LAR was shorter after prior EVAR than after OR (6 ± 4 vs 12 ± 4 years, respectively; P = .003). Treatment for LAR was EVAR for 25 patients (63%; group I) and OR for 15 (37%, group II). LAR after initial OR was managed with endovascular salvage for 8 of 10 patients. Endovascular management was more frequent in the latter half of the study period. In group I, fenestrated repair had been used for seven patients (28%). Salvage for the remaining cases was feasible with EVAR, aortic cuffs, or limb extensions. The incidence of free rupture, time to treatment, 30-day mortality (8% vs 13%; P = .3), complications (32% vs 60%; P = .1), and disposition were similar between the two groups. Those in group I had had less blood loss (660 vs 3000 mL; P < .001) and less need for dialysis (0% vs 33%; P < .001) than those in group II. The median follow-up was 21 months (interquartile range, 6-45 months). The overall 1-, 3-, and 5-year survival was 76%, 52%, and 41%, respectively, and was similar between groups (28 vs 22 months; P = .48). Late mortality was not related to the aorta. CONCLUSIONS LAR after abdominal aortic aneurysm repair has been encountered more frequently in clinical practice, likely driven by the frequency of EVAR. However, most LARs, including those after previous OR, can now be salvaged with endovascular techniques with lower morbidity and mortality.
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Affiliation(s)
- Indrani Sen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
| | - Irina Kanzafarova
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jennifer Yonkus
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Todd E Rasmussen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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Schoretsanitis N, Georgakarakos E, Argyriou C, Lazarides M, Ktenidis K, Papanas N, Deftereos S, Georgiadis GS. The Incraft stent graft for the treatment of abdominal aortic aneurysms: an iliac-friendly device with an effective conventional proximal sealing mechanism. Expert Rev Med Devices 2021; 19:37-41. [PMID: 34937480 DOI: 10.1080/17434440.2022.2020096] [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: 10/19/2022]
Abstract
INTRODUCTION The Incraft aortic stent graft (Cordis, Bridgewater, NJ, USA) is a trimodular endovascular stent graft with a conventional suprarenal active fixation specifically designed to overcome the anatomic limitation of small, stenotic, and tortuous iliac vessels. AREAS COVERED The present article provides a complete description of the Incraft stent graft, its clinical performance, its technical characteristics as well as a comparison with other competitive endografts. EXPERT OPINION The Incraft stent graft is an EVAR ultra low-profile device initially designed for overcoming the limitation of the hostile iliac anatomy. Recently, the device is being increasingly used in real-world conditions and not only in complex iliac anatomies with good mid-term results. Whether it remains a useful EVAR toolbox or will become a workhorse endograft is yet to be determined.
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Affiliation(s)
- Nikolaos Schoretsanitis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Miltos Lazarides
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Kiriakos Ktenidis
- Vascular Surgery Unit, 1st Propaedeutic Surgical Department, Ahepa University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Savas Deftereos
- Radiology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Nguyen D, Lee A, Leon LR, Pacanowski JP, Berman SS. Hybrid Approach with Angiography and Limited Open Exposure to Treat Type Ia Endoleaks after Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2021; 73:500-507. [PMID: 33549778 DOI: 10.1016/j.avsg.2021.01.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Type Ia endoleaks after endovascular aortic repair (EVAR) almost always mandate secondary percutaneous reinterventions. Several patients, however, will require conversion to open surgical repair with complete graft explant, which is associated with significant morbidity and mortality. We herein present 3 cases of hybrid surgical repair for type Ia endoleaks, using a limited open exposure for proximal stent graft edge revision to achieve graft preservation and effective aneurysm sac exclusion. METHODS Angiography was used to confirm type Ia endoleak in 3 patients (2 males) who had previous EVAR between October 2017 and October 2019. Time to the endoleak after the index EVAR was immediate in 1 patient during repair of a ruptured aneurysm, 2 months in 1 patient and 2 years in 1 patient. The aorta was exposed through a limited transabdominal (n = 1) or retroperitoneal (n = 2) approach and circumferential aortic control was achieved below the renal arteries. A row of interrupted horizontal mattress sutures of 3-0 polypropylene reinforced with Teflon pledgets was placed along the aortic neck circumference. Multi-planar angiography was then repeated to verify the absence of sac filling and successful type Ia endoleak exclusion. Follow-up abdominal duplex was obtained for all 3 patients after discharge to monitor the stent graft and confirm endoleak resolution. Furthermore, there were no instances of acute renal failure. RESULTS In the period of review, 77 patients underwent EVAR. In the 3 patients described, we were able to achieve complete aneurysm sac exclusion and stent graft preservation in all cases. Follow-up imaging was available on 2 patients at 4-6 weeks after surgery demonstrating sustained exclusion of the endoleak. Two patients died during follow-up: one from a myocardial infarction 7 weeks after surgery and one from metastatic lung cancer at 8 months after surgery. Follow up duplex imaging at one year on the single survivor demonstrated sac shrinkage and absence of endoleak. CONCLUSIONS Type Ia endoleaks represent a significant source of morbidity and mortality after EVAR and typically require repair to avoid aneurysm rupture. Our use of limited proximal revision without explant provides an alternative approach to resolve the endoleaks while reducing the magnitude of physiological stress when compared to an open explant. It represents a feasible option for high-risk patients.
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Affiliation(s)
- Daniel Nguyen
- Pima Heart and Vascular, Tucson, AZ; The University of Arizona School of Medicine, Tucson, AZ
| | - Ashton Lee
- Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Luis R Leon
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - John P Pacanowski
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ
| | - Scott S Berman
- Pima Heart and Vascular, Tucson, AZ; Section of Vascular Surgery, The University of Arizona, Tucson, AZ.
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Georgakarakos E, Papatheodorou N, Argyriou C, Tasopoulou KM, Doukas D, Georgiadis GS. An update on the ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives. Expert Rev Med Devices 2020; 17:1249-1256. [PMID: 33166478 DOI: 10.1080/17434440.2020.1848539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: The Ovation stent-graft has presented satisfactory mid-term results in the management of abdominal aortic aneurysms (AAA). Its unique design with uncoupling of fixation and sealing and the lowest profile in the market has expanded the treatment in AAA with challenging neck anatomies and, especially, in the females presenting mostly with narrow iliac access vessels. Morever, a new design modification, the Ovation Alto was recently introduced in the Market, while certain off-label uses of the Ovation in treating either juxtarenal- or short-necked AAA have been proposed. Areas covered: Aim of this article was to present the current articles with the long-term results of the Ovation endograft and discuss the new developments and modifications in its use. Expert commentary: the Ovation stent-graft exhibits very satisfactory clinical long-term results in AAA treated within the instructions-for-use, expands significantly the treatment of AAA in females and overcomes reliably challenging anatomical issues of the infrarenal neck that would render these cases ineligible for treatment with any other endograft. Εxperience with the specific, unique technical features of Ovation as well as careful selection of patients and meticulous preoperative study of the AAA anatomy are key-elements to the successful performance of this endograft.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Nikolaos Papatheodorou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Kalliopi-Maria Tasopoulou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Damianos Doukas
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
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Lessons Learned from Open Surgical Conversion after Failed Previous EVAR. Ann Vasc Surg 2020; 71:356-369. [PMID: 32890649 DOI: 10.1016/j.avsg.2020.08.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Delayed open conversion (OpC) after endovascular aortic aneurysm repair (EVAR) is becoming increasingly common worldwide. We reviewed our experience to characterize the perioperative spectrum of OpC repairs. MATERIALS AND METHODS A retrospective analysis of a prospectively maintained institutional database to identify patients who underwent late OpC after failed EVAR was performed. Patient and aneurysm baseline characteristics, mechanism of failure, perioperative details, including type of repair/complications/survival, and late outcomes were examined. RESULTS From January 2003 to January 2020, 38 male patients (mean age, 75 ± 7 years; range, 60-90) required late OpC. Interval time from initial EVAR to OpC was 63.6 ± 33.8 months (range, 17-120). Mean diameter of the aneurysms was 82.2 ± 22.1 mm before OpC compared with 62.9 ± 13 mm before endograft implantation. Mechanisms of failure were type Ia, Ib, II, and III endoleaks in 14 (36.8%), 9 (23.7%), 4 (10.5%), and 1 (2.6%) patient(s), respectively; infection in 3 (7.9%), leg ischemia in 2 (5.3%), and multiple causes in 5 (13.2%) patients. We observed 4 (10.5%) asymptomatic, 16 (42.1%) symptomatic, and 18 (47.3%) ruptured aneurysms. Four patients (10.5%) had stable contained ruptures, whereas the remaining 13 (34.2%) and 1 additional patient (2.6%) with aortoenteric fistula presented with hemorrhagic shock (class ≥II). Total endograft explantation, endograft preservation, or proximal/distal partial graft removal was performed in 16 (42.1%), 10 (26.3%), and 2 (5.2%)/9 (23.7%) of patients, respectively. Technical success was 100%, excluding an early postaortic clamping death. Overall, 30-day mortality was 21.1% (8 of 38) and significantly higher in patients with hemorrhagic shock or hemodynamic instability at presentation (P = 0.04 and P = 0.009, respectively) and in patients who had endografts with hooks/barbs or experiencing higher postoperative complication rate (P = 0.02 and P = 0.006, respectively). By definition, procedure success was 81.1%. Mean follow-up was 37.6 ± 39.8 months. By the end of the study, we recorded 11 deaths (2 were aneurysm related). CONCLUSIONS Despite high technical success, OpC has a significant mortality in patients presenting with hemorrhagic shock and had active fixation endografts or experiencing high complication rate. Many other confounding factors may play a role.
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Cannavale A, Lucatelli P, Corona M, Nardis P, Cannavale G, De Rubeis G, Santoni M, Maher B, Catalano C, Bezzi M. Current assessment and management of endoleaks after advanced EVAR: new devices, new endoleaks? Expert Rev Cardiovasc Ther 2020; 18:465-473. [PMID: 32634069 DOI: 10.1080/14779072.2020.1792294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION In recent years there has been an increasing application of advanced EVAR techniques to tackle complex clinical and anatomical scenarios. In a bid to overcome the limitations of the traditional stent-grafts, newer EVAR endografts and techniques have been developed and introduced into clinical practice, permitting endovascular management of difficult infrarenal, juxta-renal and thoracoabdominal aneurysms for which previously there was no endovascular solution. As a consequence, we are now confronted with unique patterns of endoleak requiring customized clinical-radiological assessment and treatment. Despite the increasing body of evidence regarding new EVAR techniques and related endoleaks, current guidelines do not specifically address these issues. OBJECTIVES Our review aims to assess risk factors, development, and management strategies of these endoleaks, in the most recent infrarenal EVAR devices and in more complex fenestrated EVAR (FEVAR) and Chimney EVAR (Ch-EVAR). EXPERT OPINION Most new devices have demonstrated types of endoleaks that need specific imaging and treatment, as in EVAS, FEVAR, and ChEVAR. Knowledge of specific stent-graft characteristics and the nature of endoleaks associated with the various procedures facilitates the application of relevant useful imaging. In addition, it should aid development of a customized and practically relevant approach to patient management during intervention and follow-up.
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Affiliation(s)
- Alessandro Cannavale
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome , Rome, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome , Rome, Italy
| | - Mario Corona
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome , Rome, Italy
| | - Piergiorgio Nardis
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome , Rome, Italy
| | - Giuseppe Cannavale
- Department of Radiological Sciences, "Sapienza" University of Rome , Rome, Italy
| | - Gianluca De Rubeis
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome , Rome, Italy
| | - Mariangela Santoni
- Department of Radiological Sciences, "Sapienza" University of Rome , Rome, Italy
| | - Ben Maher
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust , Southampton, UK
| | - Carlo Catalano
- Department of Radiological Sciences, "Sapienza" University of Rome , Rome, Italy
| | - Mario Bezzi
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome , Rome, Italy
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Gao Y, Miserlis D, Garg N, Pipinos I. Novel open technique for repair of endograft migration. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:88-90. [PMID: 31193434 PMCID: PMC6529646 DOI: 10.1016/j.jvscit.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/16/2018] [Indexed: 11/16/2022]
Abstract
Widespread adoption of endovascular aneurysm repair has led to increased incidence of late complications, such as endograft migration. Treatment options have to be tailored to the patient's health, quality of proximal aorta, and extent of migration. Complete or partial endograft removal is associated with significant morbidity and mortality. We describe a case in which open repair with endograft preservation was employed, with the additional benefit of a sutured proximal anastomosis.
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Affiliation(s)
- Yue Gao
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Dimitrios Miserlis
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Nitin Garg
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Iraklis Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb.,Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, Neb
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Koutsoumpelis A, Georgakarakos E, Tasopoulou KM, Kontopodis N, Argyriou C, Georgiadis GS. A clinical update on the mid-term clinical performance of the Ovation endograft. Expert Rev Med Devices 2018; 16:57-62. [PMID: 30518270 DOI: 10.1080/17434440.2019.1555467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The Ovation stent-graft uncouples the steps of fixation and sealing via a pair of polymer-filled inflatable rings. Apart from the well-documented early results, newer data emerged for mid-term results of Ovation and are presented in this review. AREAS COVERED Aim of this article was to report all current studies with the mid-term results of the particular endograft, the incidence of complications and failure, and discuss their management. EXPERT COMMENTARY The Ovation stent-graft exhibits very satisfactory clinical mid-term results in abdominal aortic aneurysms treated within the instructions-for-use. It can also have a very promising role in challenging neck anatomies with conical shape and presence of thrombus or calcification. However, this should be not considered a panacea and long-term results are needed to validate this intriguing aspect.
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Affiliation(s)
- Andreas Koutsoumpelis
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Efstratios Georgakarakos
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Kalliopi-Maria Tasopoulou
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Nikolaos Kontopodis
- b Department of Vascular Surgery , University of Crete Medical School , Heraklion , Greece
| | - Christos Argyriou
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - George S Georgiadis
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
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Mazzaccaro D, Malacrida G, Amato B, Alessio Angileri S, Ierardi AM, Nano G. Preliminary experience with the use of ultra-low profile endografts. Diagn Interv Radiol 2018; 23:448-453. [PMID: 29097346 DOI: 10.5152/dir.2017.16523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to report a preliminary single-center experience of elective endovascular aortic repair (EVAR) using ultra-low profile (ULP) endografts of 14 F outer diameter. METHODS Data of 67 consecutive patients who underwent EVAR using either Ovation (group A, n=30) or Incraft (group B, n=37) endografts were retrospectively analyzed. RESULTS Aorto-iliac anatomy was significantly different between the two groups, as patients of group A had a greater thrombotic apposition on proximal aortic neck (thrombus thickness: 7.2±1 mm vs. 3.3±1.6 mm, P = 0.042; percentage of the circumference covered by thrombus: 45.2%±10.4% vs. 18.7%±10.6%, P = 0.0003), while patients of group B had a more angulated proximal neck in the coronal axis (35.9°±6.4° vs. 16.7°±5°, P = 0.012). Procedural success was 93.3% and 97.3%, respectively, in groups A and B. One patient in group A required an immediate conversion to open surgery for persistent occlusion of both iliac limbs. Another patient required implantation of a conical endograft with a femoro-femoral right-to-left bypass for occlusion of the contralateral gate during the cannulation. In group B, one intraoperative type Ia endoleak was immediately corrected. Neither deaths nor major adverse events were recorded within 30-days. During a median follow-up of 15.2 months (range, 1-56.7 months) two type Ia endoleaks in group A required open conversion after 12.1 and 40.5 months, respectively. Three patients in group B required a reintervention after 30 days. Neither deaths nor aortic ruptures were recorded during follow-up. CONCLUSION Both ULP endografts showed satisfying early and mid-term results.
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Affiliation(s)
- Daniela Mazzaccaro
- First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
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Explante quirúrgico de endoprótesis aorto-bi-ilíaca por fuga tipo Ia por crecimiento de aorta visceral. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Siani A, Accrocca F, De Vivo G, Mounayergi F, Siani LM, Antonelli R. Anaphylactic Reaction during Implantation of Ovation Abdominal Stent Graft in Patients with Abdominal Aortic Aneurysm. Ann Vasc Surg 2016; 39:289.e1-289.e4. [PMID: 27671457 DOI: 10.1016/j.avsg.2016.06.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
The Ovation Abdominal Stent Graft System is a trimodular endoprosthesis planned to overcome the limitations of currently available stent grafts, allowing complex iliac and femoral access and providing a proximal seal in challenge infrarenal neck morphology. The proximal sealing is achieved by means of a network of inflatable rings filled with low-viscosity radiopaque polyethylene glycol-based polymer during stent-graft deployment. The leakage of polymer outside the channel to fill the rings into the vascular system may induce an hypersensitivity reaction and anaphylactic shock. We report a case of anaphylactic reaction during Ovation Abdominal Stent Graft System implantation. The endovascular procedure was successfully concluded.
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Affiliation(s)
- Andrea Siani
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy.
| | - Federico Accrocca
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
| | - Gennaro De Vivo
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
| | | | - Luca Maria Siani
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
| | - Roberto Antonelli
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
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Mazzaccaro D, Stegher S, Occhiuto MT, Malacrida G, Nano G. Immediate and Late Open Conversion after Ovation Endograft. Ann Vasc Surg 2015; 29:1450.e5-9. [PMID: 26122420 DOI: 10.1016/j.avsg.2015.04.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/28/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
The risk of intraoperative open conversion during endovascular aortic repair (EVAR) still remains a main issue, albeit in a small percentage of cases. Open conversion can be extremely demanding and risky in relation to the type of the stent graft implanted and can be somehow challenging even for the most experienced vascular surgeons. We discuss a case of immediate conversion and 1 case of late conversion in patients previously treated with EVAR using the Ovation stent graft. The design of the endograft and its proximal sealing allowed the partial preservation of the graft and its use for proximal and distal anastomosis with a Dacron graft in both presented cases.
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Affiliation(s)
- Daniela Mazzaccaro
- First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Silvia Stegher
- First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maria T Occhiuto
- First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; University of Milan, Italy
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