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Verelst H, Bonne L, Mufty H, Claus E, Houthoofd S, Verhamme P, Fourneau I, Maleux G. Direct puncture versus contralateral femoral artery approach for catheter-directed thrombolysis of occluded infra-inguinal arterial bypass grafts. Clin Radiol 2023; 78:e1001-e1009. [PMID: 37806817 DOI: 10.1016/j.crad.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
AIM To compare the safety, effectiveness, and clinical outcome of percutaneous direct puncture approach versus contralateral femoral native vessel approach for catheter-directed thrombolysis of occluded infra-inguinal bypass grafts. MATERIALS AND METHODS A retrospective analysis was performed comprising a cohort of patients who underwent catheter-directed thrombolysis procedures of occluded infra-inguinal bypass grafts between January 2013 and January 2022, with a follow-up period until June 2022. This included 55 procedures via the native vessel approach and 18 procedures via the direct puncture approach. Primary outcomes were technical success and procedural safety; secondary outcomes included re-intervention rate, limb salvage, and mortality as assessed by log-rank testing and Kaplan-Meier curves. RESULTS There were no differences between the two groups with regard to patient demographics, except for the number of previous vascular procedures (n=6.83 ± 3.07 direct approach versus n=4.96 ± 2.79 native vessel approach, p=0.025). Thrombolysis was comparably successful in both groups (n=13/18; 72% direct approach versus n=42/55; 76%, p=0.723). There were no differences in the duration of thrombolysis administration. The rate of adverse events was slightly lower in the direct approach group, but without significance (p=0.092). There were no adverse events related to the puncture site in the direct approach group. No differences were found between the time-to-event values for re-occlusion, re-intervention, amputation, or mortality respectively (p=0.662; p=0.520; p=0.816; p=0.462). CONCLUSION The direct puncture approach seems to be a safe and efficient approach for catheter-directed thrombolysis procedures in infra-inguinal occluded bypass grafts, with clinical outcomes comparable to the native vessel approach.
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Affiliation(s)
- H Verelst
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - L Bonne
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - H Mufty
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - E Claus
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - S Houthoofd
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - P Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiology and Vascular Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - I Fourneau
- Department of Vascular Surgery, University Hospital KU Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - G Maleux
- Department of Radiology, University Hospitals KU Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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Demeuleneere A, Lambert J, Demeestere J, Lemmens R, Fourneau I, Houthoofd S, Schauwvlieghe PP, Jacob J, Cassiman C. A rare presentation of a common carotid artery occlusion. GMS Ophthalmol Cases 2023; 13:Doc20. [PMID: 38111470 PMCID: PMC10726582 DOI: 10.3205/oc000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Background A common carotid artery occlusion (CCAO) is very rare and the clinical features of CCAO have rarely been described. Since the blood supply of the eye and orbit is derived from the internal carotid artery, a CCAO may present with various ophthalmological symptoms, ranging from incidental findings to complete visual loss but also other neuro-ophthalmological abnormalities. Case report A 61-year-old woman presented with acute monocular vision loss and an elevation deficit of the right eye. Fluorescein angiography showed delayed filling of both the retinal and choroidal vasculature, without occlusion/embolisms of the retinal arteries. Vascular imaging showed a right CCAO. Conclusion CCAO has a variable presentation. In patients with acute unilateral visual loss a CCAO should be considered, especially when ocular motility deficits are present. Fluorescein angiography examination can aid in the localization and diagnosis of the vascular insult. Urgent referral for a systemic work-up is essential.
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Affiliation(s)
| | - Julie Lambert
- Radiology Department, University Hospitals Leuven, Belgium
| | | | - Robin Lemmens
- Neurology Department, University Hospitals Leuven, Belgium
| | - Inge Fourneau
- Vascular Surgery Department, University Hospitals Leuven, Belgium
| | | | | | - Julie Jacob
- Ophthalmology Department, University Hospitals Leuven, Belgium
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Vandenbulcke R, Houthoofd S, Laenen A, Buyck PJ, Mufty H, Fourneau I, Maleux G. Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up. Diagn Interv Radiol 2023; 29:331-341. [PMID: 36987998 PMCID: PMC10679712 DOI: 10.4274/dir.2022.22352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/13/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the technical, radiological, and clinical outcomes after type 2 endoleak (T2EL) embolization in patients with a growing aneurysm sac after endovascular aortic aneurysm repair (EVAR). Additionally, to determine clinical and imaging-based factors for outcome prediction after embolization of a T2EL. METHODS A single-institution, retrospective analysis was performed of 60 patients who underwent a T2EL embolization procedure between September 2005 and August 2016 to treat a growing aneurysm sac diameter following EVAR. The patients' electronic medical records and all available pre- and post-embolization imaging were reviewed. Statistical analysis methods included logistic regression models for binary outcomes, proportional odds models for ordinal outcomes, and linear regression models for continuous outcomes. The Kaplan-Meier method was used to estimate the overall survival probability. RESULTS Technical, radiological, and clinical success rates after T2EL embolization were 95% (n = 57), 26.7% (n = 16), and 76.7% (n = 46), respectively. Persistent aneurysm sac expansion was found in 31 patients (51.7%). Unsharp or blurred T2EL delineation on pre-interventional computed tomography (CT) was a predictive factor for a post-embolization persistent visible endoleak and persistent growth of the aneurysm sac (P = 0.025). Median survival after T2EL embolization was 5.35 years, with no difference observed between patients with persistent sac expansion compared with patients with stable or decreased sac diameter. CONCLUSION Progression of the aneurysm sac diameter was observed in half the study patients, despite technically successful T2EL embolization. Unsharp or blurred T2EL delineation on pre-interventional CT seemed to be an imaging-based predictor for a persistent T2EL and progressive aneurysm sac growth after embolization.
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Affiliation(s)
- Ruben Vandenbulcke
- Department of Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Biostatistics, Interuniversity Institute for Biostatistics and Statistical Bioinformatics Centre, Leuven, Belgium
| | - Pieter-Jan Buyck
- Department of Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Wen W, Mufty H, Katsargyris A, Maleux G, Daenens K, Houthoofd S, Fourneau I, Verhoeven E. The influence of narrow aortic bifurcation on limb graft patency: a two-center retrospective study. J Cardiovasc Surg (Torino) 2022; 63:708-715. [PMID: 35913034 DOI: 10.23736/s0021-9509.22.12007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Narrow aortic bifurcation (NAB) has been considered as a potential risk factor for graft limb thrombosis after endovascular aortic repair (EVAR). The aim of this study was to compare mid- and long-term outcome of EVAR in patients with NAB and standard aortic bifurcation (SAB). METHODS Data from patients receiving EVAR were prospectively collected and retrospectively analyzed. In case of angiographic limb stenosis (>50%), additional stenting was performed. Patients with a NAB (≤20mm) were included in the NAB group, the remaining patients in the SAB group. Primary endpoints were limb thrombosis rate and technical success. RESULTS A total of 902 patients were included; 18.3% (N.=165/902) in the NAB and 81.7% (N.=737/902) in the SAB group. Mean follow-up time was 43 months (range 0-198 months). Bilateral stenting of the aortic bifurcation was performed in 2.7% (N.=27/902), 8.5% (N.=14/165) in the NAB and 1.4% (N.=10/737) in the SAB group (P=0.001). Limb thrombosis was found in 2.8% (N.=25/902), 3.6% (N.=6/165) in the NAB and 2.6% (N.=19/737) in the SAB group (P=0.55). Technical success was 97.8%, 98.8% in the NAB and 97.6% in the SAB group (P=0.33). Device related reintervention rate was 16% (N.=144/902), 15.2% in the NAB and 16.1% in the SAB group (P=0.75). CONCLUSIONS Standard EVAR could safely be performed in patients with NAB (≤20mm) when a low threshold for additional stenting was applied. This resulted in no significant higher incidence of limb thrombosis. Additional stent deployment did not increase the complication rate.
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Affiliation(s)
- Wen Wen
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium -
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, General Hospital and Paracelsus Medical University, Nuremberg, Germany
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eric Verhoeven
- Department of Vascular and Endovascular Surgery, General Hospital and Paracelsus Medical University, Nuremberg, Germany
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Maleux G, Houthoofd S, Mufty H. Renal artery thrombo-embolism during fenestrated endovascular aneurysm repair managed with stent retriever. J Vasc Interv Radiol 2022; 33:1260-1261. [PMID: 35850454 DOI: 10.1016/j.jvir.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/30/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Deltomme M, Van den Berge S, Mufty H, Laenen A, Houthoofd S, Fourneau I, Maleux G. A Five-Year Computed Tomography Follow-up Study of Proximal Aortic Neck Dilatation After Endovascular Aortic Repair Using Four Contemporary Types of Endograft. Cardiovasc Intervent Radiol 2021; 45:272-273. [PMID: 34739586 DOI: 10.1007/s00270-021-02986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mathieu Deltomme
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Steven Van den Berge
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversitary Institute for Biostatistics and Statistical Bioinformatics, U Hasselt & KU Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Van Gool F, Houthoofd S, Mufty H, Bonne L, Fourneau I, Maleux G. Long-term outcome results after endovascular aortoiliac aneurysm repair with the bifurcated EXCLUDER Endoprosthesis. J Vasc Surg 2021; 75:1882-1889.e2. [PMID: 34627959 DOI: 10.1016/j.jvs.2021.09.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report the long-term outcome of patients presenting with an aortic, aortoiliac, or isolated common iliac aneurysm treated with the bifurcated EXCLUDER Endoprosthesis. Furthermore, potential differences in late outcome results between the original- and low-permeability endoprosthesis were analyzed. METHODS A retrospective analysis of prospectively collected data of 182 patients who underwent endovascular aneurysm repair with the EXCLUDER Endoprosthesis between June 1998 and October 2015 in an academic, tertiary care center for aortic disease was performed. Patient follow-up was from 3 to 20 years (mean follow-up of 6.9 years). Primary end points were overall survival and reintervention-free survival. Secondary end points were device-related complications, endoleaks, and reinterventions. RESULTS Overall survival at 5, 10, and 15 years was 72.8%, 42.1%, and 12.2%, respectively, with no aneurysm-related mortality and no difference in overall survival between the original- vs low-permeability endoprosthesis group (P = .617). Freedom from type I endoleak at 5 years was 94.8%. No new type I endoleak was detected beyond the 5-year follow-up mark. No type III endoleak was identified. Reintervention-free survival was 83.6%, 66.7%, and 66.7% at 5-, 10-, and 15-year follow-up, respectively. There was a significant difference in intervention-free survival between the original- vs low-permeability endoprosthesis group (P = .029) and after the 5-year follow-up mark. In addition, patients with the low-permeability endoprosthesis showed significantly fewer device-related complications (P = .002) and endoleaks (P = .005). CONCLUSIONS Endovascular aneurysm repair using the EXCLUDER Endoprosthesis is effective and durable on long-term follow-up, with acceptably low device-related complications and reinterventions. The low-permeability endoprosthesis was associated with significantly fewer new device-related complications and endoleaks after 5 years of follow-up.
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Affiliation(s)
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
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Van Slambrouck J, Mufty H, Maleux G, Houthoofd S, Devooght A, Slots C, Daenens K, Fourneau I. The impact of type 1a endoleak on the long-term outcome after EVAR. Acta Chir Belg 2021; 121:333-339. [PMID: 32644007 DOI: 10.1080/00015458.2020.1794337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Endoleaks remains a major determinant of outcome after endovascular aortic repair (EVAR) for infrarenal abdominal aortic aneurysms. The objective of this study is to evaluate the long-term impact of proximal type 1 endoleak encountered at the case end of the EVAR procedure or during follow-up. METHODS All patients treated with EVAR between February 2001 and August 2017 in our institution were included. Data were collected retrospectively. A descriptive analysis of subgroups with type 1a endoleak at case end or with type 1a endoleak first encountered during follow-up was performed. RESULTS In total, 468 patients were included for analysis. At the case end of the EVAR procedure, in 5.3% (25/468) of patients, a type 1a endoleak was seen. In 72% of cases (18/25) the type 1a endoleak spontaneously disappeared on the first follow-up computed tomography angiography and never recurred. At the end of the follow-up period, no patient in this subgroup died with a type 1a endoleak on follow-up. In 3.4% (16/468) of all cases, a type 1a endoleak was encountered for the first time during follow-up. In 87.5% (14/16) of these cases, reintervention was performed. Two patients died with a persisting type 1a endoleak during follow-up. CONCLUSIONS Clinicians should differentiate between the type 1a endoleak at the case end and the type 1a endoleak first occurring during follow-up. For type 1a endoleak at the case end, expectant management can be adopted. Delayed type 1a endoleak seen during follow-up rarely seals spontaneously and needs reintervention in the majority of cases.
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Affiliation(s)
- Jan Van Slambrouck
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Anne Devooght
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Slots
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Aerden LK, Wuite S, Houthoofd S, Matricali GA. Reviving the debate: Articular cartilage preservation during disarticulation at the lower limb? A systematic review. Foot Ankle Surg 2021; 27:246-251. [PMID: 33388250 DOI: 10.1016/j.fas.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/25/2020] [Accepted: 12/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The need for preservation(P) or removal(R) of articular cartilage during disarticulations remains unanswered. METHODS Medline database was used to conduct a systematic review regarding all types of minor disarticulations and some types of major disarticulations in patients with diabetes mellitus, peripheral arterial disease or trauma related disarticulations. Fisher-exact statistical test was used to perform calculations for the entire group as for subgroups. RESULTS A total of 444 disarticulations at the Chopart joint, ankle and knee were included (P = 255 vs. R = 189). There was no difference in wound healing, functionality and mortality. Reamputation rate was lower in the P-group (9.4% vs. 16.9%). Infection rate was not significantly different. Differences in reamputations (R = 10.6% vs. P = 1.0%) and infections (R = 4.4% vs. P = 22.6%) were only present for the ankle subgroup. CONCLUSIONS There is no difference in wound healing, functionality and mortality between the preservation and removal of articular cartilage in the lower limb.
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Affiliation(s)
- Laurens K Aerden
- Departement of Orthopeadic Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Sander Wuite
- Departement of Orthopeadic Surgery, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Diabetic Footclinic, University Hospitals Leuven, Leuven, Belgium; Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium.
| | - Sabrina Houthoofd
- Multidisciplinary Diabetic Footclinic, University Hospitals Leuven, Leuven, Belgium; Departement of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Giovanni A Matricali
- Departement of Orthopeadic Surgery, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Diabetic Footclinic, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Heverlee, Belgium; Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium.
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Mufty H, Houthoofd S, Daenens K, Fourneau I. Late hematogenous seeding and infection of a femoropopliteal Omniflow II bypass. Vascular 2020; 29:720-722. [PMID: 33241775 DOI: 10.1177/1708538120974151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Omniflow II is promoted as an infection-resistant vascular graft. It is used to treat vascular graft infection; nevertheless, early graft infection has been reported.Report: A 71-year-old patient was treated with an Omniflow II bypass for a non-healing diabetic foot ulcer. Seven months postoperatively, late infection occurred secondary to hematogenous spread from a persistent foot infection. CONCLUSION We report on the first case of late infection of an Omniflow II vascular graft caused by hematogenous spread. Despite promising results of the Omniflow II graft in the treatment of vascular graft infection, late infection may not be avoided.
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Affiliation(s)
- Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Van Maele M, Mufty H, Maleux G, Houthoofd S, Daenens K, Fourneau I. Predictive Factors of Operative Need in Medically Managed Type B Aortic Dissections. Ann Vasc Surg 2020; 71:437-443. [PMID: 32890644 DOI: 10.1016/j.avsg.2020.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Aneurysmal degeneration of medically managed type B aortic dissection (TBAD) can be a life-threatening condition. Preventive thoracic endovascular aorta repair (TEVAR) in patients at risk could potentially be beneficial. The aim of this study was to examine the predictors for late aneurysmal dilatation after TBAD. METHODS A retrospective study was conducted on 82 patients with medically managed acute TBAD for a minimum of 14 days. Relevant demographic, biochemical, and radiographic variables at presentation were studied. The aortic dissection risk calculator tool developed by Sailer et al., predicting the risk of adverse events after aortic dissection based on demographic and radiographic variables at presentation, was tested retrospectively. RESULTS With a median follow-up of 36 months (range 13-68), 25 (30.5%) patients underwent surgery (92% TEVAR). A larger initial aortic and false lumen diameter as well as a greater distal extension of the dissection was associated with higher need for surgery (respectively, P = 0.003, P = 0.004, and P = 0.001). We observed higher growth rates of maximum aortic diameter in patients with a greater distal extension of the dissection, larger false lumen diameters and false lumen outflow, and entry tears located at the inner aortic arch (respectively, P = 0.001, P = 0.005, P = 0.001 and P = 0.014). No significant correlations could be found for the risks provided by the calculator tool. CONCLUSIONS The initial maximum aortic diameter of TBAD is a key predictor for aortic growth. Furthermore, the distal extension of the dissection also seems to play an important role in late aneurysmal degeneration. However, we were not able to confirm the added value of the risk calculator tool in our study group.
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Affiliation(s)
- Margaux Van Maele
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Wübbeke L, Telgenkamp B, van Boxtel T, Bolt L, Houthoofd S, Vriens P, Bouwman L, Mees B, Daemen J. Gentamicin Containing Collagen Implants and Groin Wound Infections in Vascular Surgery: A Prospective Randomised Controlled Multicentre Trial. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Coster BD, Houthoofd S, Laenen A, Fourneau I, Maleux G. Overall survival and factors predicting long-term outcome after thoracic aortic endovascular repair. Scand J Surg 2020; 110:386-394. [PMID: 32126933 DOI: 10.1177/1457496920910004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSES To assess overall survival and to determine factors predicting outcome after thoracic endovascular aortic repair. MATERIALS AND METHODS A Retrospective analysis was performed on a cohort of 212 consecutive patients (165 men and 47 women; mean age 64 years) who underwent thoracic endovascular aortic repair in a tertiary referral center for aortic disease. Main indications were true thoracic aortic aneurysm (n = 58; 27.6%), traumatic aortic rupture (n = 33; 15.7%), anastomotic pseudoaneurysms (n = 23; 10.9%), chronic type B aortic dissection (n = 22; 10.5%), and symptomatic, acute type B dissection (n = 21; 10.0%). In 79 patients (37.3%), a hybrid procedure, including supra-aortic rerouting, was performed. Kaplan-Meier estimates were used for overall survival and Cox regression models were used for univariable analysis of the association between risk factors and survival. RESULTS Proximal landing zones were predominantly zone 3 (n = 66; 31.3%), zone 2 (n = 63; 29.9%), and zone 1 (n = 38; 18%). In-hospital mortality was n = 18 (8.5%). Overall survival was 79.6%, 65.9%, and 51.1% at 2, 5, and 10 years, respectively; better overall survival was shown for traumatic aortic rupture, anastomotic pseudoaneurysms, and chronic posttraumatic pseudoaneurysms (p < 0.05). Clinical risk factors influencing overall survival include prior coronary bypass surgery, atrial flutter, arterial hypertension, renal failure, chronic obstructive pulmonary disease, and associated abdominal aortic aneurysm (p < 0.05). CONCLUSIONS Thoracic endovascular aortic repair is an effective treatment option for various thoracic aortic diseases with highest survival rates for traumatic aortic rupture and anastomotic pseudoaneurysms. Several clinical parameters are identified as risk factors for overall survival.
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Affiliation(s)
- Bruno De Coster
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and Universiteit Hasselt, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
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Wübbeke L, van Boxtel T, Bolt L, Telgenkamp B, Houthoofd S, Vriens P, Bouman L, Mees B, Daemen J. Prevention of Surgical Site Infections Using Gentamicin-containing Collagen Implants Following Inguinal Incision for Vascular Surgery: A Prospective Randomized Controlled Multicenter Trial. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mufty H, Houthoofd S, Daenens K, Fourneau I, Maleux G. Mid-to Long-term Outcome Results of the Ovation Stent-graft. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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De Vloo C, Matton T, Meersseman W, Maleux G, Houthoofd S, Op de Beeck K, Laleman W, Van Malenstein H, Nevens F, Verbeke L, Van der Merwe S, Verslype C. Thrombosis of a portal vein aneurysm: a case report with literature review. Acta Clin Belg 2019; 74:115-120. [PMID: 30147008 DOI: 10.1080/17843286.2018.1511298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Portal vein aneurysm is an unusual vascular dilatation of the portal vein. The etiology, diagnosis and management are ill-defined. METHODS A case of a portal vein aneurysm complicated with complete thrombosis is presented with a literature review providing an overview of the etiology, clinical presentation and management. RESULTS Portal venous aneurysms represent approximately 3% of all venous aneurysms with a reported prevalence of 0.06%. The reported incidence is on the rise with increasing use of modern imaging techniques in clinical practice. Usually, portal vein aneurysms are incidental findings and patients are asymptomatic. They can be congenital or acquired and portal hypertension represents the most frequent cause of the acquired version. Various complications such as biliary tract compression, portal vein thrombosis, and rupture can occur. Treatment options are conservative management or surgery. Surgical treatment is currently reserved for symptomatic patients with severe abdominal pain, symptoms of pressure effect or with expanding aneurysms, and/or complications such as thrombosis or rupture. CONCLUSION Conservative management seems the best option in the majority of patients. A multidisciplinary approach discussing the best option on a case-by-case base in light of their individual underlying risk and symptoms is advised.
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Affiliation(s)
- Charlotte De Vloo
- Department of Gastroenterology & Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Tom Matton
- Radiology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Wouter Meersseman
- General Internal Medicine, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Geert Maleux
- Interventional Radiology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Vascular surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Katya Op de Beeck
- Radiology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Wim Laleman
- Department of Gastroenterology & Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Hannah Van Malenstein
- Department of Gastroenterology & Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology & Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Len Verbeke
- Department of Gastroenterology & Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Schalk Van der Merwe
- Department of Gastroenterology & Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Chris Verslype
- Department of Gastroenterology & Hepatology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
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Vanheer R, Laenen A, Bonne L, Cornelissen S, Verhamme P, Houthoofd S, Fourneau I, Maleux G. A comprehensive report of long-term outcomes after catheter-directed thrombolysis for occluded infrainguinal bypass grafts. J Vasc Surg 2019; 70:1205-1216. [PMID: 30922746 DOI: 10.1016/j.jvs.2018.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to assess the technical and short- and long-term clinical outcomes of catheter-directed thrombolysis (CDT) with urokinase for occluded infrainguinal bypass grafts. In addition, factors associated with technical success and amputation-free survival were assessed. METHODS A retrospective analysis of a cohort of patients treated with catheter-directed urokinase-based thrombolysis for occluded infrainguinal bypass grafts was conducted between January 2000 and December 2015. Demographics, procedural data, and short- and long-term outcome data, including patency rates of the bypasses, limb salvage, and overall survival, were collected. Statistical models for clustered data were applied to assess predictive factors. RESULTS In 177 patients, 251 CDTs were performed on 204 bypasses. In 209 procedures (83.3%), the occluded bypass was reopened; clinical disappearance of ischemic symptoms occurred after 157 procedures (62.6%). Premature cessation of thrombolysis occurred in 33 procedures (13.2%), and periprocedural and postprocedural complications were noted in 91 patients (36.3%). Factors associated with long-term limb salvage are fewer vascular interventions before CDT (P = .0003), higher number of patent outflow vessels before start of CDT (P < .0001), and higher number of patent outflow vessels after CDT (P < .0001). The 1- and 5-year patency rates of bypasses after successful CDT were 64.6% and 48.9%; amputation-free survival after 1 year, 5 years, and 7 years was 81.5%, 71.3%, and 70.5%, respectively. CONCLUSIONS Clinical success after CDT was observed in 62% of procedures with an associated complication rate of 36%. Patent outflow vessels before and after CDT are factors associated with long-term limb salvage. Amputation-free survival after 5 years is 71.3%.
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Affiliation(s)
- Ruben Vanheer
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven, Leuven, Belgium; Interuniversity Centre for Biostatistics and Statistical Bioinformatics, University Hasselt, Hasselt, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Sandra Cornelissen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiology and Vascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium.
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Mufty H, Maleux G, Houthoofd S, Cornelissen SA, Daenens K, Bonne L, Fourneau I. The effect of TEVAR for blunt traumatic thoracic aortic injury on maximal aortic diameter: Mid- and long-term outcome. Vascular 2019; 27:411-416. [PMID: 30871442 DOI: 10.1177/1708538119836333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Thoracic endovascular aortic repair (TEVAR) has become the standard of care for blunt thoracic aortic injury (BTAI). Long-term effects of TEVAR on the aortic diameter are not well studied. This study evaluates the effect of TEVAR for BTAI on the aortic diameter in mid- and long-term follow-up. Methods All patients treated with TEVAR for BTAI between August 2000 and May 2016 were included. Maximum aortic diameter was measured at four predetermined thoracic aortic levels in the preoperative and first postoperative CT angiography (CTa) and in the last control CTa or MR angiography: 1 cm proximal (D1) and 1 cm distal to the left subclavian artery (D2), 3 cm distal to the left subclavian artery (D3) and 3 cm proximal to the celiac trunk (D4). Results A total of 27 patients (20 men, mean age 40 years (±17.55) were included. Mean follow-up time was 90 months (±48.36)). No re-interventions were needed. Mean growth of aortic diameter at level D1, D2, D3 and D4 was 0.22 mm ± 3.66, 1.79 mm ± 3.82, 0.73 mm ± 4.18 and –1.06 mm ± 2.82, respectively, when comparing last follow-up to the preoperative imaging without any statistical significant differences. When comparing the preoperative diameter with the first postoperative CT, only a statistical significant growth of 2.81 mm ± 2.69 was seen at level of D2 ( p < 0.05) Conclusion During mid- to long-term follow-up, a temporary significant increase of the maximum aortic diameter was seen at level D2 in the direct postoperative phase This increase was not associated with clinical events and suggests long-term efficacy of TEVAR after BTAI.
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Affiliation(s)
- Hozan Mufty
- 1 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- 2 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- 1 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Kim Daenens
- 1 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- 2 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- 1 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Mufty H, Daenens K, Houthoofd S, Fourneau I. Endovascular Treatment of Isolated Degenerative Superficial Femoral Artery Aneurysm. Ann Vasc Surg 2018; 49:311.e11-311.e14. [DOI: 10.1016/j.avsg.2017.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Mufty H, Katsargyris A, Houthoofd S, Fourneau I, Verhoeven E, Maleux G. Technical Note: Dissection Flap Perforation with Use of a TIPS-Needle During Fenestrated Endografting for Post-dissection Thoracoabdominal Aneurysms. Cardiovasc Intervent Radiol 2018; 41:964-967. [PMID: 29511868 DOI: 10.1007/s00270-018-1922-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Fenestrated/branched thoracic endovascular aneurysm repair (F/Br-TEVAR) is a new minimal invasive treatment option for patients with post-dissection thoracoabdominal aortic aneurysms. This specific pathology is challenging to F/Br-TEVAR, especially when target vessels originate from the false lumen. Crossing from the true lumen into the false lumen to catheterize such target vessels may prove cumbersome in the usually thickened dissection flap. TECHNIQUE We describe a bailout technique when standard catheterization techniques fail, by using a transjugular intrahepatic portosystemic shunt (TIPS)-needle to perforate the dissection flap. The fenestration is subsequently dilated using balloon angioplasty to allow for insertion and deployment of the bridging stent graft. CONCLUSION When other catheterization techniques fail in vessel originating from the false lumen, TIPS-needle perforation of the dissection flap is a useful bailout tool.
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Affiliation(s)
- Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, General Hospital Nuremberg, Breslauerstr. 201, 90471, Nuremberg, Germany
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Eric Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, General Hospital Nuremberg, Breslauerstr. 201, 90471, Nuremberg, Germany
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
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Maleux G, Houthoofd S, Poorteman L, Fourneau I. Atypical Endoleak Associated With Inadvertent Cannulation of the Ipsilateral Gate in an Ovation Trimodular Stent-Graft. Vasc Endovascular Surg 2017; 52:135-137. [PMID: 29162025 DOI: 10.1177/1538574417742286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report on a 54-year-old man who presented with an atypical, proximal, intraoperative endoleak after endovascular aortic repair with an Ovation endograft for a 65-mm-diameter abdominal aortic aneurysm. The endografting was complicated by inadvertent bilateral iliac limb insertion into the right gate without cannulation of the left gate. The endoleak was treated by brachial approach: Through the open left gate, the outflow inferior mesenteric artery was coil embolized and the inflow left gate was closed with an Amplatzer plug. Follow-up computed tomography over 3 years showed absence of any endoleak and a stable diameter of the excluded abdominal aortic aneurysm.
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Affiliation(s)
- Geert Maleux
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,2 Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- 3 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lien Poorteman
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,2 Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- 3 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Terry C, Houthoofd S, Maleux G, Fourneau I. Explantation of an Infected Fenestrated Abdominal Endograft with Autologous Venous Reconstruction. EJVES Short Rep 2017; 34:21-23. [PMID: 28856328 PMCID: PMC5576164 DOI: 10.1016/j.ejvssr.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/31/2016] [Accepted: 01/29/2017] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Infectious complications after FEVAR cause significant problems, with radical surgery considered to be the last resort for treatment. CASE REPORT A 72 year old man presented with infection 1 month after FEVAR. Conservative therapy with percutaneous abscess drainage and antibiotics suppressed the infection for 10 months; however, when new peri-aortic abscesses developed, the patient agreed to revision surgery. The endograft was explanted and an autologous in situ venous reconstruction was performed. As a result of post-operative complications, the patient died 3 days later. CONCLUSION This study demonstrates that autologous venous reconstruction is technically feasible. An earlier decision on such radical surgery could potentially have improved the patient's chances of survival.
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Affiliation(s)
- C Terry
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - G Maleux
- Department of Interventional Radiology, University Hospitals Leuven, Leuven, Belgium
| | - I Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Delmotte K, Houthoofd S, Demaerel P, Lemmens R. Internal carotid artery dissection coincides with celiac artery dissection. Acta Neurol Belg 2017; 117:333-335. [PMID: 27495121 DOI: 10.1007/s13760-016-0681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Koen Delmotte
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Leuven, Belgium.
- VIB, Vesalius Research Center, Laboratory of Neurobiology, Leuven, Belgium.
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Abstract
Cannulation of the contralateral gate is a crucial step in endovascular aortic aneurysm repair (EVAR) to configure a modular stent-graft. Most commonly, the contralateral gate is cannulated retrogradely using a conventional catheter and hydrophilic guide wire; if this maneuver fails, a cross-over technique or additional access in the left brachial artery in association with a contralateral femoral snare catheter may be used. A cross-over technique using a microcatheter and a contralateral snare catheter might be a valuable alternative to cannulate the contralateral gate, especially in cases where there is a partly nondeployed contralateral stent-graft limb.
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Affiliation(s)
- Geert Maleux
- 1 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- 2 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- 2 Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Keunen B, Houthoofd S, Daenens K, Hendriks J, Fourneau I. A Case of Primary Aortoenteric Fistula: Review of Therapeutic Challenges. Ann Vasc Surg 2016; 33:230.e5-230.e13. [PMID: 26965800 DOI: 10.1016/j.avsg.2015.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/17/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUNDS Primary aortoenteric fistula (PAEF) is a lethal cause of gastrointestinal bleeding. They mainly originate from eroding abdominal aortic aneurysms into the intestinal wall. Other known causes involve malignancies, infection, corpora aliena, or radiation therapy. Traditional treatment consists of resection of the fistula and extra-anatomic reconstruction. In situ repair and endovascular stenting have offered new therapeutic options in managing this complex entity. CASE REPORT A 79-year-old woman presented with a PAEF. She was known with a 3.9-cm abdominal aortic aneurysm and polymyalgia rheumatica. The initial treatment consisted of endovascular stenting. Several months later, she presented with persistent inflammation of the aortic endoprosthesis. The prosthesis and inflammatory tissue were resected, and in situ reconstruction with autologous superficial femoral vein and omentoplasty was performed. Two years later, she remains well with no evidence for infection or bleeding. CONCLUSIONS Polymyalgia rheumatica might induce an AEF as in this patient no other provoking factors were retained. The different therapeutic options all have their advantages and disadvantages. In line with this case, we suggest an individualized approach for AEFs. In case of precarious hemodynamical state or life expectancy, endovascular treatment is indicated. Afterward, the possibility and/or necessity of open repair should be discussed. For stable patients with respectable life expectancy in situ repair with autologuous vein or rifampicin-soaked prosthesis (adjusted to comorbidities) might be most appropriate. Extra-anatomic reconstruction still remains a valuable alternative in older patients and in the presence of any other local factors hampering in situ reconstruction.
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Affiliation(s)
- Bram Keunen
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
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Maleux G, Van Camp L, Houthoofd S, Heye S, Fourneau I. Endurant endograft limb occlusion associated with a floating thrombus: a word of caution. J Vasc Interv Radiol 2015; 26:918-20. [PMID: 26003460 DOI: 10.1016/j.jvir.2015.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Geert Maleux
- Departments of RadiologyUniversity Hospitals Leuven, Herestraat 49, B-3000 Leuven; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Laurent Van Camp
- Departments of RadiologyUniversity Hospitals Leuven, Herestraat 49, B-3000 Leuven; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Departments of RadiologyUniversity Hospitals Leuven, Herestraat 49, B-3000 Leuven; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Sam Heye
- Vascular Surgery University Hospitals Leuven, Herestraat 49, B-3000 Leuven
| | - Inge Fourneau
- Vascular Surgery University Hospitals Leuven, Herestraat 49, B-3000 Leuven
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Katsargyris A, Oikonomou K, Spinelli D, Houthoofd S, Verhoeven ELG. Fenestrated and branched stent-grafting after previous open or endovascular aortic surgery. J Cardiovasc Surg (Torino) 2014; 55:95-103. [PMID: 24796902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Aim of the study was to review our experience with fenestrated and branched stent-grafts to treat juxtarenal (JAA) and thoracoabdominal (TAAA) aortic aneurysms after previous open or endovascular aortic surgery. METHODS A prospectively maintained database including all consecutive patients with JAA or TAAA treated with fenestrated/branched stent-grafts after previous open or endovascular aortic surgery within the period March 2002-November 2013 was analyzed. Evaluated outcomes included initial technical success, operative mortality and morbidity and late procedure-related events with regard to survival, target vessel patency, and re-intervention. RESULTS A total of 122 patients (110 male, 12 female; mean age mean age 70±9.5 years) were treated. Median time interval from previous aortic surgery to current fenestrated/branched stent-grafting was 80 months (range 3-261 months). Seventy-seven (63.1%) patients had previous open infrarenal aortic surgery, 33 (27%) had previous endovascular abdominal aortic aneurysm repair (EVAR), nine (7.4%) had previous open thoracic aortic surgery, and three (2.5%) had previous endovascular thoracic aortic repair (TEVAR). Indication for current treatment was a JAA in 65 (53.3%) patients and a TAAA in 57 (46.7%) patients. Technical success was achieved in 115 (94.3%) patients. Seven patients were considered as technical failure (open conversion; N.=1, target vessel loss; N.=6). Operative target vessel perfusion success rate with endovascular means was 98.5% (391/397). Intraoperative technical difficulties due to pre-existing stent-graft/surgical graft were encountered in 28 (23%) patients (access, N.=12; target vessel catheterisation, N.=16). Thirty-day operative mortality was 4.1% (5/122), with zero mortality in 65 JAA, and 8.8% (5/57) in TAAA, respectively. Cause of death was multiple organ failure (N.=3), acute gastrointestinal bleeding (N.=1), and subdural hematoma (N.=1). Major complications occurred in 20 (16.4%) patients. Median hospital stay was 7 days (range 3-50 days), and mean ICU stay 1.5±3.2 days. Mean follow-up was 22.5±21 months. All-cause late mortality was encountered in 23 patients, including one aneurysm-related mortality. Estimated survival was 91.2±3%, 83.3±4.2% and 81.1±4.6% at one, two and three years, respectively. During follow-up, eight target vessels occluded. Estimated target vessel patency was 97.2±1.1%, and 96.3±1.2% at one and three years, respectively. Reintervention during follow-up was required in 13 (10.6%) cases accounting for an estimated freedom from reintervention of 91.6±3.1%, and 82.1±5.4% at one and three years, respectively. CONCLUSION Fenestrated and branched stent-grafting represents a feasible option for the repair of JAA and TAAA after prior endovascular or open aortic surgery. Despite increased technical difficulties it is associated with high technical success rate and is advantageous in terms of mortality and morbidity compared to redo open aortic surgery.
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Affiliation(s)
- A Katsargyris
- Department of Vascular and Endovascular Surgery Klinikum Nürnberg, Nürnberg, Germany -
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Houthoofd S, Morrens M, Sabbe B, Schrijvers D, Vandendriessche F, Hulstijn W, de Bruijn ERA. Trait and state aspects of internal and external performance monitoring in schizophrenia. Int J Psychophysiol 2013; 87:42-51. [PMID: 23127478 DOI: 10.1016/j.ijpsycho.2012.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 10/25/2012] [Accepted: 10/27/2012] [Indexed: 11/16/2022]
Affiliation(s)
- S Houthoofd
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.
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Abstract
BACKGROUND Poor wound healing can occur after limb amputation. CASE REPORT We describe the case of a patient with a persistent fistula after below-knee amputation. The fistula is maintained due to an infected stent graft. After removal of the stent graft and adequate antibiotic treatment the wounds healed and extended amputation was avoided. CONCLUSION The diagnosis of stent graft infection is challenging and requires aggressive treatment to prevent further amputation.
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Affiliation(s)
- S. Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - O. Yazar
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - H. Topal
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - K. Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - I. Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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Elens M, Daenen G, Houthoofd S, Daenens K, Fourneau I. Arterioureteral fistula. An unusual cause of aortofemoral bypass infection. A case report. Acta Chir Belg 2012; 112:71-3. [PMID: 22442914 DOI: 10.1080/00015458.2012.11680799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report a case of arterioureteral fistula after aortobifemoral bypass surgery and prolonged bilateral double J stents due to ureteral stenosis. A 70-year-old woman presented with a non-tender mass in the left groin and a single episode of haematuria 2 months earlier. A Computed Tomography (CT) revealed a pseudoaneurysm of the left distal suture of the graft. Surgical repair was performed. Because of suspicion of infection the entire aortobifemoral graft was removed and replaced by an autologous venous aortofemoral bypass to the right groin and femorofemoral crossover bypass from the right to the left. During surgery an arterioureteral fistula could be visualized. The urologists performed a left nephroureterectomy of the afunctional left kidney. The further postoperative course was uneventful during the 10 months of follow up.
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Affiliation(s)
- M. Elens
- Department of Vascular Surgery, University Hospital Leuven, Belgium
| | - G. Daenen
- 2Department of Vascular Surgery, AZ Sint Elisabeth, Turnhout, Belgium
| | - S. Houthoofd
- Department of Vascular Surgery, University Hospital Leuven, Belgium
| | - K. Daenens
- Department of Vascular Surgery, University Hospital Leuven, Belgium
| | - I. Fourneau
- Department of Vascular Surgery, University Hospital Leuven, Belgium
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Yazar O, Budts W, Maleux G, Houthoofd S, Daenens K, Fourneau I. Thoracic Endovascular Aortic Repair for Treatment of Late Complications After Aortic Coarctation Repair. Ann Vasc Surg 2011; 25:1005-11. [DOI: 10.1016/j.avsg.2011.05.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 05/23/2011] [Accepted: 05/27/2011] [Indexed: 11/30/2022]
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Onsea K, Houthoofd S, Adriaenssens T. Ulnar and cerebellar embolization from an ulcerative subclavian artery lesion. Acta Cardiol 2010; 65:693-4. [PMID: 21302676 DOI: 10.1080/ac.65.6.2059867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kevin Onsea
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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Dubois M, Daenens K, Houthoofd S, Peetermans W, Fourneau I. Treatment of Mycotic Aneurysms with Involvement of the Abdominal Aorta: Single-centre Experience in 44 Consecutive Cases. Eur J Vasc Endovasc Surg 2010; 40:450-6. [DOI: 10.1016/j.ejvs.2010.07.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/24/2010] [Indexed: 02/06/2023]
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Volders D, Fourneau I, Daenens K, Houthoofd S, Maleux G, Nevelsteen A. Paraparesis after thoracic stent-graft relining for an unrecognized type III endoleak. Ann Vasc Surg 2010; 24:550.e5-9. [PMID: 20129755 DOI: 10.1016/j.avsg.2009.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 08/20/2009] [Accepted: 08/27/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND We examined the reasons for missing a type III endoleak on conventional imaging and the pathophysiology of paraparesis after relining this stent graft. METHODS AND RESULTS A 46-year-old man was treated with a thoracic stent graft for thoracic rupture of a chronic type B thoracoabdominal dissection with aneurysm formation. In a second intervention, retrograde revascularization of the visceral and renal arteries was performed in combination with insertion of an abdominal stent graft. After initial shrinkage of the aneurysmal sac, the thoracic aortic diameter started increasing again. Consecutive three-phase helical computed tomographic scans did not reveal any endoleak. Because of unbearable back pain, an open surgical exploration was performed. This showed a type III endoleak. Relining of the thoracic stent graft was performed, but paraparesis developed. CONCLUSION In patients with unexplained increase of the aneurysmal sac contrast-enhanced magnetic resonance imaging could help to illuminate the underlying endoleak. The collateral network concept can explain spinal cord injury by even minor hemodynamic changes.
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Affiliation(s)
- David Volders
- Department of Vascular Surgery, University Hospital Leuven, B-3000 Leuven, Belgium
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Fourneau I, Mariën I, Remy P, D'hont C, Sabbe T, Daenens K, Houthoofd S, Nevelsteen A. Conversion During Laparoscopic Aortobifemoral Bypass: A Failure? Eur J Vasc Endovasc Surg 2010; 39:239-45. [DOI: 10.1016/j.ejvs.2009.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 09/28/2009] [Indexed: 11/16/2022]
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Daenens K, Schepers S, Fourneau I, Houthoofd S, Nevelsteen A. Heparin-bonded ePTFE grafts compared with vein grafts in femoropopliteal and femorocrural bypasses: 1- and 2-year results. J Vasc Surg 2009; 49:1210-6. [PMID: 19394550 DOI: 10.1016/j.jvs.2008.12.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 11/18/2008] [Accepted: 12/04/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Many patients with peripheral arterial occlusive disease who require a lower-limb bypass have no available autologous saphenous vein (ASV) for the procedure and thus require a prosthetic graft. Expanded polytetrafluoroethylene (ePTFE) grafts are commonly used, but results with these prostheses have varied, especially when the distal anastomosis is below the knee. However, there is increasing evidence that ePTFE grafts to which heparin has been bound with use of covalent endpoint linkage provide better results. This nonrandomized study compared the performance of these grafts with that of ASV conduits in the largest clinical series of heparin-bonded ePTFE graft implantations reported so far. METHODS The records of 350 patients who underwent a lower-limb bypass procedure that used either a heparin-bonded ePTFE graft (n = 240) or an ASV graft (n = 110) were reviewed, and preoperative, operative, and follow-up data were recorded. Kaplan-Meier analyses were used to calculate primary patency and limb salvage rates in the two graft groups; results were compared by using log-rank testing. RESULTS The primary patency rates at 1 year for the heparin-bonded ePTFE grafts were 92% for above-knee femoropopliteal (AK FP) bypasses, 92% for below-knee femoropopliteal (BK FP) bypasses, and 79% for femorocrural (FC) applications. The corresponding 2-year rates were 83%, 83%, and 69%, respectively. In the ASV group, the 1-year primary patency rates for AK FP, BK FP, and FC bypasses were 91%, 72%, and 69%, respectively; the 2-year rates were 80%, 72%, and 64%, respectively. There were no significant differences in patency when AK FP, BK FP, or FC procedures were considered separately. Two-year limb salvage rates in the heparin-bonded ePTFE graft group were 92%, 98%, and 87%, respectively, for AK FP, BK FP, and FC bypasses; in the ASV group, the rates were 100%, 91%, and 96%, respectively. Two infections occurred in patients given a heparin-bonded ePTFE graft. CONCLUSION In this large retrospective study, heparin-bonded ePTFE grafts had 1- and 2-year primary patency results that were not significantly different from those for ASV grafts. Results in BK FP and FC applications were especially promising. Randomized studies comparing the use of heparin-bonded ePTFE and ASV grafts in the treatment of peripheral arterial disease are needed to substantiate our results.
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Affiliation(s)
- Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium
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Callaert J, Fourneau I, Daenens K, Houthoofd S, Maleux G, Nevelsteen A. Endovascular aneurysm repair or open surgery for treatment of abdominal aortic aneurysm with involvement of both common iliac arteries? Acta Chir Belg 2008; 108:586-9. [PMID: 19051472 DOI: 10.1080/00015458.2008.11680291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) involving the entire common iliac arteries requires proximal coil embolisation of both internal iliac arteries and extension of the stent graft into the external iliac arteries (type E according to the Eurostar classification). A potential complication of this treatment is pelvic ischemia. Therefore, this type of aneurysm is a relative contra-indication for EVAR. In this case-report we describe a hybrid procedure preserving antegrade circulation in one of the internal iliac arteries in a patient with a type E aneurysm who was unfit for open surgery.
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Affiliation(s)
- J. Callaert
- Department of vascular surgery, University Hospital Leuven, Leuven, Belgium
| | - I. Fourneau
- Department of vascular surgery, University Hospital Leuven, Leuven, Belgium
| | - K. Daenens
- Department of vascular surgery, University Hospital Leuven, Leuven, Belgium
| | - S. Houthoofd
- Department of vascular surgery, University Hospital Leuven, Leuven, Belgium
| | - G. Maleux
- Department of interventional radiology, University Hospital Leuven, Leuven, Belgium
| | - A. Nevelsteen
- Department of vascular surgery, University Hospital Leuven, Leuven, Belgium
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Fourneau I, Lerut P, Sabbe T, Houthoofd S, Daenens K, Nevelsteen A. The Learning Curve of Totally Laparoscopic Aortobifemoral Bypass for Occlusive Disease. How Many Cases and How Safe? Eur J Vasc Endovasc Surg 2008; 35:723-9. [DOI: 10.1016/j.ejvs.2008.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 01/04/2008] [Indexed: 11/17/2022]
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Fourneau I, Lerut P, Sabbe T, Houthoofd S, Daenens K, Nevelsteen A. The Learning Curve of Totally Laparoscopic Aortobifemoral Bypass for Occlusive Disease. How Many Cases and How Safe? J Vasc Surg 2008. [DOI: 10.1016/j.jvs.2008.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The authors wish to describe a combined open and endovascular approach to repair a complex thoracic aortic aneurysm. A 72-year-old man with chronic obstructive pulmonary disease, aortic valvular insufficiency and diffuse thoracic aortic aneurysm underwent aortic valve and ascending aorta replacement by a Bentall-procedure and replacement of arch aneurysm using the elephant trunk technique, performed in a first procedure. During the second procedure, endovascular stenting of the descending thoracic aorta was done. Only a few similar case reports have been presented. Endovascular repair after an elephant trunk procedure for complex thoracic aortic aneurysms is an elegant approach to deal with such mega aortas. Further research is necessary to compare open and endovascular repair and to determine long-term follow-up with regard to endoleaks and mortality.
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Affiliation(s)
- A M Wolthuis
- Department of Cardiovascular and Thoracic surgery, A.Z. Imelda Bonheiden, Belgium.
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