1
|
Ogino H, Isogai N, Kume N, Shibutani S, Yashiro H, Takahara M, Fujimura N. Evaluating the Effectiveness and Clinical Outcomes of Endovascular Aneurysm Repair-First Approach for Ruptured Abdominal Aortic Aneurysm in Japan. J Endovasc Ther 2024:15266028241248337. [PMID: 38659330 DOI: 10.1177/15266028241248337] [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: 04/26/2024]
Abstract
PURPOSE To verify the validity of an endovascular aneurysm repair (EVAR)-first strategy for treating patients with ruptured abdominal aortic aneurysm (rAAA) in Japan. MATERIALS AND METHODS This study was conducted on 2 groups of patients with rAAA who underwent surgical treatment at 3 hospitals in the Kanagawa Prefecture, Japan, between January 2007 and September 2016. The open surgical treatment group comprised patients with rAAA who underwent open surgical treatment before January 2012; their data were retrospectively collected from their medical records. The EVAR-first strategy group comprised patients with rAAA who underwent treatment based on the Shonan rAAA protocol (SRAP; the standard protocol-based EVAR-first strategy) in or after February 2012; their data were collected prospectively. The short- and long-term treatment outcomes of both groups were compared. In addition, a risk score-based sensitivity analysis (one-to-one matching) was conducted on both groups using a caliper with 0.2 standard deviations of the score. RESULTS Of the 163 patients with rAAA, the open surgical and EVAR-first strategy groups comprised 53 and 110 patients, respectively (EVAR: 91.8%, open repair: 8.2%). The 30-day postoperative mortality rate differed significantly, being 42% for the open surgery group and 25% for the EVAR-first strategy group (odds ratio: 0.44, 95% confidence interval: 0.20-0.97). The postoperative survival rates at 6 months, 1 year, and 3 years were 66%, 48%, and 58% for the EVAR-first group, respectively, and 51%, 66%, and 48% for the open surgery group, respectively (p=0.072). In a matched cohort analysis (n=50), the 30-day postoperative mortality rate was 22% for the EVAR-first group and 44% for the open surgery group (odds ratio: 0.35, 95% confidence interval: 0.14-0.90). The postoperative survival rates at 6 months, 1 year, and 3 years were 76%, 76%, and 63% for the EVAR-first group, respectively, and 48%, 45%, and 45% for the open surgery group, respectively (p=0.003). CONCLUSION The SRAP-based EVAR-first strategy for rAAA yielded significantly better treatment outcomes than the open surgical strategy. These findings suggest that EVAR should be considered the primary treatment option for rAAA, given its potential to reduce early mortality rates. CLINICAL IMPACT Multicenter retrospective analysis of prospectively collected registry data was done to compare treatment outcomes of two groups of ruptured abdominal aortic aneurysm patients open surgery and endovascular-aneurysm-repair (EVAR)-first strategy (Shonan ruptured abdominal aortic aneurysm protocol). EVAR-first group showed better outcomes: lower 30-day mortality (25% vs. 42%), higher survival rates at 6 months, 1 year, and 3 years. Take home Message: The study supports the use of the EVAR-first strategy with the Shonan Protocol for treating ruptured abdominal aortic aneurysms in Japan, showing improved outcomes, reduced 30-day postoperative mortality, and better long-term survival rates compared to the conventional approach.
Collapse
Affiliation(s)
- Hidemitsu Ogino
- Department of Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, Japan
| | - Naoko Isogai
- Department of Vascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Nao Kume
- Department of Vascular Surgery, Narita Tomisato Tokushukai Hospital, Chiba, Japan
| | - Shintaro Shibutani
- Department of Vascular Surgery, Kawasaki Tsurumi Vascular Surgery Clinic, Kawasaki, Japan
| | - Hideki Yashiro
- Department of Radiology, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| |
Collapse
|
2
|
Ali AA, Stana J, Bruno S, Joseph G, Eleshra A, Tsilimparis N. The "Bundle Wire" Technique: A Novel Approach to Cannulating Challenging Target Vessels Using Multiple Fine Atraumatic Guidewires That Together Serve as a Stiff Guidewire. J Endovasc Ther 2024:15266028241245345. [PMID: 38654600 DOI: 10.1177/15266028241245345] [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: 04/26/2024]
Abstract
PURPOSE To present a novel technique that enables safe and effective cannulation of target vessels with challenging anatomy during fenestrated/branched endovascular aortic repair (F/B-EVAR). TECHNIQUE Following deployment of the F/B-EVAR endograft, the target vessels (TVs) are cannulated. The bundle wire technique provides a solution to challenging TVs and uses multiple fine atraumatic guidewires that together serve as a stiff guidewire. The technique can be executed in 2 ways using: (1) one 0.018 inch and one 0.014 inch guidewire or (2) three 0.014 inch guidewires. We demonstrate the technique in a case of a complex abdominal aortic aneurysm treated using branched EVAR in which the left renal artery with severe ostial stenosis was catheterized using the bundle wire technique. CONCLUSIONS The bundle wire technique offers a technically feasible and economically viable solution for facilitating catheter and bridging stent delivery in anatomically challenging TVs during F/B-EVAR. It is a useful addition to the therapeutic armamentarium available to physicians for accessing demanding TVs.
Collapse
Affiliation(s)
- Ahmed A Ali
- Department of Vascular Surgery, Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
- Department of Vascular Surgery, Cardiovascular and Vascular Surgery Center, University Hospital, Mansoura University, Mansoura, Egypt
| | - Jan Stana
- Department of Vascular Surgery, Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Salvatore Bruno
- Department of Vascular Surgery, Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - George Joseph
- Department of Cardiology, Christian Medical College Hospital, Vellore, India
| | - Ahmed Eleshra
- Department of Vascular Surgery, Cardiovascular and Vascular Surgery Center, University Hospital, Mansoura University, Mansoura, Egypt
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Vascular and Endovascular Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| |
Collapse
|
3
|
Fujimura N, Ichihashi S, Shibata T, Matsumura H, Watanabe M, Morikage N, Kurimoto Y, Banno H, Uchiyama H, Obara H. Early Clinical Results From the Japanese Prospective Multicenter Study to Evaluate Zenith Alpha Abdominal Stent Graft for Abdominal Aortic Aneurysm (JUSTICE) Registry Demonstrate Acceptable Limb Patency at 12 Months. J Endovasc Ther 2024:15266028241248311. [PMID: 38654524 DOI: 10.1177/15266028241248311] [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: 04/26/2024]
Abstract
PURPOSE Recent reports of the Zenith Alpha abdominal endovascular graft (Zenith Alpha AAA, Cook, Inc., Bloomington, Indiana) have demonstrated an unexpectedly high incidence of limb graft occlusion (LGO). The purpose of this study was to prospectively evaluate the performance of the Zenith AAA in Japan, with a specific focus on LGO. MATERIALS AND METHODS All endovascular aneurysm repairs (EVARs) for abdominal aortic aneurysms performed using the Zenith Alpha AAA from July 2020 to October 2021 in 23 Japanese hospitals were prospectively evaluated. All computed tomographic images were analyzed in the core laboratory. Late complications were defined as any aneurysm-related events occurring >30 days after EVAR, including aneurysm sac enlargement of >5 mm and any reinterventions performed. Endoleaks without sac enlargement or reintervention were excluded as late complications. RESULTS During the study period, 147 EVARs were performed using the Zenith Alpha AAA. The mean patient age was 76.5±7.7 years, 84.4% of patients were male, and the mean aneurysm diameter was 52.4±9.2 mm. Instruction-for-use violations were observed in 76 patients (51.7%), primarily associated with a severely angulated proximal neck (>60°). There were six intraoperative complications and 62 additional intraoperative treatments reported, most of which involved preemptive coil embolization of the inferior mesenteric artery (37 cases). Technical success, defined as the absence of type 1 or 3 endoleaks on final angiography, was achieved in 99.3% of patients. At 12 months, there was only one case of type 1/3 endoleak (0.8%) and one aneurysm sac enlargement exceeding 5 mm (0.8%); however, a high incidence of type 2 endoleaks was observed in 35.2% of patients, and aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients. Nine late complications were observed, and the rate of freedom from late complications at 12 months was 93.5%, encompassing four LGOs and one limb graft stenosis (3.4%). CONCLUSIONS In contrast to recent reports, our Japanese multicenter prospective study demonstrated satisfactory early clinical results, including an acceptable LGO rate, for the low-profile Zenith Alpha AAA. Long-term follow-ups will be performed to confirm the persistence of these outcomes. CLINICAL IMPACT This study prospectively evaluated the performance of 147 Zenith Alpha AAAs used for endovascular aneurysm repair with core-lab adjudication focusing especially on limb graft occlusion (LGO). At 12 months, aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients, and there was only one type 1/3 endoleak, one aneurysm sac enlargement (>5 mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg." 5mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg.
Collapse
Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University, Hokkaido, Japan
| | - Hitoshi Matsumura
- Department of Cardiovascular Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University, Chiba, Japan
| | - Noriyasu Morikage
- Department of Vascular Surgery, Yamaguchi University, Yamaguchi, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
4
|
Zhang Y, Wang H, Bai L, Li X, Liu L, Wang L. Endovascular Repair and Prognosis of Patients with Brucella abortus Infection-Induced Aorto-Iliac Aneurysm. J Inflamm Res 2024; 17:2353-2363. [PMID: 38645876 PMCID: PMC11032661 DOI: 10.2147/jir.s450573] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
Objective To establish the endovascular repair and prognosis of patients with aorto-iliac aneurysm and Brucella abortus infection. Methods From September 2018 to September 2021, seven cases of Brucella abortus infection with aorto-iliac aneurysm were treated by the endovascular aneurysm repair (EVAR) procedure. Clinical and imaging data were collected to evaluate the therapeutic results, including body temperature, blood culture, imaging manifestations, stent patency and endoleak during the postoperative and follow-up periods. Results Except for one patient who died of acute hematemesis and hematochezia just after the admission, seven patients were treated successfully. The aneurysms were completely excluded, and all stent grafts were patent. Patients were followed up for 12-32 months, with an average follow-up of 18.5 ± 9.1 months. There were no cases of endoleak, infection recurrence, gluteal muscle ischemia or spinal cord ischemia during the follow-up period. Conclusion It is feasible to treat Brucella abortus-infected aneurysms with the EVAR procedure. The results were optimistic in the short and medium-term. The application of sensitive antibiotics before and after the operation is the cornerstone of endovascular therapy. However, the long-term results require further follow-up.
Collapse
Affiliation(s)
- Yujing Zhang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Haiqian Wang
- Department of Outpatient, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Lei Bai
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Xiaodong Li
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Li Liu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China
| | - Liang Wang
- Department of Interventional Therapy and Vascular Surgery, Dongguan People’s Hospital, Dongguan, 523059, People’s Republic of China
| |
Collapse
|
5
|
Ozawa H, Ohki T, Shukuzawa K, Kasa K, Yamada Y, Nakagawa H, Shirouzu M, Omori M, Fukushima S, Tachihara H. Mid-term outcomes of endovascular repair for abdominal aortic aneurysm using the cuff-first technique to prevent type II endoleaks. J Vasc Surg 2024:S0741-5214(24)00996-0. [PMID: 38631517 DOI: 10.1016/j.jvs.2024.04.034] [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: 02/03/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To evaluate the initial and mid-term outcomes of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) using the cuff-first technique (CFT) to prevent type II endoleak (T2EL). METHODS CFT involves deploying an aortic cuff inside the AAA to cover the ostium of the aortic side branch vessels before deploying the main body. We performed a retrospective review of all patients undergoing EVAR with CFT or side branch embolization (SBE) for AAAs at The Jikei University Hospital between 2016 and 2022. Primary endpoint was the rate of aneurysm sac shrinkage. Secondary endpoints were procedure time, radiation exposure, technical and clinical success rates, occurrence of T2EL, and freedom from reintervention or aneurysm-related death (ARD). RESULTS Out of 406 patients who underwent EVAR for AAAs, CFT was utilized in 56 (CFT group) and SBE in 35 (SBE group); all 91 patients were included in this study. There were no differences in patient demographics between groups but there were differences in patency rate of the inferior mesenteric artery (IMA) and absent intraluminal thrombus. The technical success rate per target vessel in the CFT and SBE group was 97.8% and 91.8%, and the clinical success rate was 91.0% and 100%, respectively. The procedure time was shorter for CFT than for SBE (median [IQR, interquartile range]; CFT: 10 [6-14] min vs. SBE: 25 [18.5-45] min; P < 0.05), and radiation exposure was lower for CFT than for SBE (median [IQR]; CFT: 1455 [840-2634] mGy vs. SBE: 2353 [1552-3586] mGy, P < 0.05). During the median follow-up of 25 (12.5-47) months, sac shrinkage occurred at similar rates in both groups (CFT: 37.5% vs. SBE: 40.0%; P = 0.812), and there were no differences in freedom from reintervention (CFT: 96.2% and 91.4% at 12 and 36 months vs. SBE: 100% and 89.5% at 12 and 36 months; log-rank, P = 0.761) and freedom from ARD (100% at 36 months in both groups; log-rank, P = 0.440). The odds ratio (OR) of CFT vs. SBE for sac regression was calculated by adjusting for IMA patency and absent intraluminal thrombus, resulting in no statistical significance (OR, 1.231, 95% confidence interval, 0.486-3.122). CONCLUSIONS CFT is feasible with a shorter procedure time and lower radiation exposure than SBE and comparable mid-term outcomes, including sac shrinkage rate, compared with SBE. We believe that CFT, if anatomically suitable, is an alternative to SBT for the prevention of T2EL during EVAR.
Collapse
Affiliation(s)
- Hirotsugu Ozawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Kasa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuta Yamada
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hikaru Nakagawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Miyo Shirouzu
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Makiko Omori
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Soichiro Fukushima
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromasa Tachihara
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Wolosker N, Portela FSO, Louzada ACS, Galastri FL, Affonso BB, Nasser F. Robot-assisted endovascular treatment of hepatic artery aneurysm: A case report. Vascular 2024:17085381241246322. [PMID: 38597580 DOI: 10.1177/17085381241246322] [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: 04/11/2024]
Abstract
OBJECTIVE Robot-assisted endovascular surgery has emerged as a new alternative to interventional procedures, with its application expanding to peripheral and visceral approaches. The objective of this paper is to describe a robot-assisted endovascular treatment in splanchnic arteries. METHODS A case report of an asymptomatic male patient with an incidental finding of a saccular aneurysm of the proper hepatic artery measuring 3.7 × 2.7 cm and distant 0.6 cm from the origin of the gastroduodenal artery. RESULTS Using a robot-assisted endovascular technique (CorPath GRX platform - Siemens), 2 guidewires were advanced in parallel: the first one was placed inside the aneurysm sac, while the second one was placed in the proper hepatic artery distal to the aneurysm; through the first guidewire, a balloon was advanced, positioned distally to the aneurysm, and through the second one, a microcatheter was advanced. Embolization of the aneurysm was performed with the use of coils and Onyx. Control exam performed 120 days after embolization revealed treated aneurysm and preserved distal arterial flow. CONCLUSION Using a robotic platform for navigation in splanchnic territory is safe and effective.
Collapse
Affiliation(s)
- Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
7
|
Boukobza M, Ilic-Habensus E, Arregle F, Habib G, Duval X, Laissy JP. Hepatic artery aneurysms in infective endocarditis: report of 10 cases and literature review. Ann Vasc Surg 2024:S0890-5096(24)00129-8. [PMID: 38574810 DOI: 10.1016/j.avsg.2024.01.013] [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: 10/16/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hepatic artery aneurysms (HAAs), albeit rare in infective endocarditis (IE), are associated with a life-threatening morbidity. METHODS Retrospective review of 10 HAA-IE-patients based on a total of 623 IE-patients managed in two institutions (2008-2020) vs 35 literature' cases. RESULTS In our patient population, HAAs (10 males, mean-age 48) were incidentally found during IE-workup. All were asymptomatic. IE involved mitral (n=6), aortic (n=3), or mitral-aortic valve (n=1). Predisposing factors for IE were: prosthetic valve (n= 6), previous IE (n=2), IV drug user (n=1). Streptococcus spp were predominant (n=4), then staphylococcus spp (n=2) and E. faecalis (n=2). All patients presented associated lesions: infectious aneurysms (n=5), emboli (n=9), abscesses (n=5) and spondylitis/spondylodiscitis (n=2). HAA patterns on abdominal CT-Angiography (CTA) were solitary (70%), mean diameter 11.7mm (range 2-30), intrahepatic location (100%) involving the right HA in 9/10 (90%) patients. In 2 patients HAAs were complicated (rectorragia and hemobilia in 1, cholestasis in the other). Six patients underwent endovascular hepatic embolization (2 with multiple HAAs). Three HAA-IEs <15mm resolved under antibiotherapy on abdominal CTA follow-up. All patients underwent cardiac surgery. Late outcome was favorable in all followed patients (5/10). Literature review showed the preponderance of Streptococcus spp., of right lobe and intrahepatic HAA localization. Complications revealed HAAs in patients under antibiotic therapy and/or after cardiac surgery in 17 literature' cases of delayed diagnosis. CONCLUSION Abdominal CTA was pivotal in the initial IE work-up. Small aneurysms (≤15mm) resolved under antibiotherapy. The usual treatment modality was HAA embolization and endovascular embolization prior to valve surgery was safe.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France.
| | - Emila Ilic-Habensus
- Clinical Investigation Center, Hopital Bichat - Claude-Bernard, 46 rue Henri Huchard, 75018, Paris, France Assistance Publique-Hôpitaux de Paris.
| | - Florent Arregle
- Cardiology Department, La Timone Hospital, APHM, 13005 Marseille, France.
| | - Gilbert Habib
- Cardiology Department, La Timone Hospital, 13005, Marseille, Assistance Publique Hôpitaux de Marseille, France; Aix Marseille University ; IRD (Institut de Recherche pour le Développement.
| | - Xavier Duval
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard, Hospital, Paris, France; INSERM Clinical Investigation Center 007, Paris, France, INSERM U738, Paris; Paris University, France.
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France ; INSERM U1148, Paris, France; Paris University, France.
| |
Collapse
|
8
|
Phuyal P, Shrestha S, Phuyal S, Dhakal B, Gautam A, Yogi N. Endovascular management of residual intracranial aneurysm after neurosurgical clipping: a case report. Ann Med Surg (Lond) 2024; 86:2262-2265. [PMID: 38576906 PMCID: PMC10990398 DOI: 10.1097/ms9.0000000000001885] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping in aneurysmal subarachnoid haemorrhage. Aneurysmal subarachnoid haemorrhage is a rare subtype of stroke which can be life-threatening. Case presentation The authors herein report a case of successful management by endovascular coiling of residual intracranial aneurysm post-surgical clipping in a 60-year-old male who was previously diagnosed as diffuse subarachnoid haemorrhage (SAH) Fisher grade 4. On examination, he had a Glasgow Coma Scale 14/15 with verbal confusion present and was hypertensive. Clinical discussion Aneurysmal subarachnoid haemorrhage is a rare and serious type of stroke and may result in dependency. Endovascular coiling can be used to treat residual intracranial aneurysms with prior neurosurgical clipping. It further helps in decreasing dependency and mortality. Conclusion Endovascular coiling is a good treatment option for patients who have undergone neurosurgical clipping as their prior surgical attempt in aneurysmal subarachnoid haemorrhage. An endovascular approach may further lead to a better prognosis.
Collapse
Affiliation(s)
- Prakash Phuyal
- Departments of Neuroimaging and Interventional Neuroradiology
| | | | - Subash Phuyal
- Departments of Neuroimaging and Interventional Neuroradiology
| | - Bishal Dhakal
- Bardibas Field Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Ashima Gautam
- Nepal Medical College and Teaching Hospital, Attarkhel
| | - Nikunj Yogi
- Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences
| |
Collapse
|
9
|
Tatsuishi W, Shibuya K, Konishi Y, Konno N, Oi A, Tamura K, Kato Y, Abe T. Impact of Accessory Renal Artery Embolization on Renal Deterioration Under Endovascular Aortic Repair. Vasc Endovascular Surg 2024; 58:308-315. [PMID: 37919942 DOI: 10.1177/15385744231213551] [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] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The optimal management strategy for patients with accessory renal arteries undergoing endovascular aortic repair is unclear. This study aimed to investigate the impact of accessory renal artery (aRA) embolization on postoperative renal deterioration and to identify the predictors of postoperative renal deterioration in patients who underwent endovascular aortic repair (EVAR). METHODS A retrospective single-centre observational study was conducted at our hospital. Of 331 consecutive patients who underwent endovascular aortic repair between April 2011 and February 2021, 29 patients with an aRA were included in this study. Spearman's rank correlation coefficients of decrease in estimated glomerular filtration rate (eGFR), renal volume reduction rate, infarcted renal volume, and quantity of contrast use for postoperative renal deterioration were analyzed. The correlation coefficients of the correlations between infarcted renal volume, renal volume reduction rate, and decrease in eGFR and the rate of aRA diameter were also analyzed. Multivariable nominal logistic regression analyses were conducted to evaluate the odds of postoperative renal deterioration. RESULTS The renal volume reduction rate and infarcted renal volume had a significant positive correlation with the decrease in eGFR. Body surface area and preoperative renal volume were significantly but negatively correlated with the decrease in eGFR. The infarcted renal volume, renal volume reduction rate, and decrease in eGFR were significantly and positively correlated with the aRA diameter. The odds ratio for decreased eGFR rate in preoperative renal volume was .96 (95% CI 0.930‒.996, P = .009). CONCLUSIONS EVAR with aRA embolization impacts postoperative renal deterioration in patients with preoperative low renal volume, and the diameter of the embolized aRA might be a predictor of postoperative renal deterioration.
Collapse
Affiliation(s)
- Wataru Tatsuishi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| | - Kei Shibuya
- Department of Radiology, Gunma University, Maebashi, Japan
| | - Yasunobu Konishi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| | - Naoki Konno
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| | - Atsushi Oi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| | - Kazuki Tamura
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| | - Yusuke Kato
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| | - Tomonobu Abe
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| |
Collapse
|
10
|
Rodríguez-Fernández C, Ruiz-Garcia P, Garcia-Sanchez MJ, Manrique-Zegarra M, Toledano-Illán C, Escartin J, Vences MA, Rubio LA, Luttich A, Pumar JM. Technical success, procedural safety, and efficacy of the Silk Vista Baby in the treatment of cerebral aneurysms over a mid-to-long-term follow-up. Front Neurol 2024; 15:1369443. [PMID: 38638309 PMCID: PMC11025534 DOI: 10.3389/fneur.2024.1369443] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Background Long-term follow-up of cerebral aneurysms treated with the Silk Vista Baby (SVB) flow diverter is lacking. This study aimed to assess the technical success, procedural safety, and efficacy of the SVB (Balt, Montmorency, France) for the treatment of intracranial aneurysms in small cerebral vessels over a mid-to long-term follow-up. Methods We retrospectively analyzed a prospectively maintained database of patients treated with the SVB between September 2018 and June 2021. Data regarding patient demographics, aneurysm characteristics, and technical procedures were also collected. Angiographic and clinical findings were recorded during the procedure and over a period of at least 12 months. Results Angiographic and clinical follow-up data were available for 50 patients/50 aneurysms. The procedural complication rate was 8%. At 12 months, the final results showed a technical success rate of 100%, the re rupture rate was 0%, neuromorbidity and mortality rates of 4 and 0%, respectively, and an almost complete occlusion rate of 94%. Conclusion Treatment of complex intracranial aneurysms with the SVB was safe and effective. Long-term results showed high rates of adequate and stable occlusions.
Collapse
Affiliation(s)
| | - Pedro Ruiz-Garcia
- Interventional Neuroradiology Department, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | | | - Martiel Manrique-Zegarra
- Interventional Neuroradiology Department, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Carlos Toledano-Illán
- Interventional Neuroradiology Department, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Jorge Escartin
- Interventional Neuroradiology Department, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Miguel Angel Vences
- Interventional Neuroradiology Department, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
- School of Medicine, Universidad César Vallejo, Piura, Peru
| | - Luis Angel Rubio
- Interventional Neuroradiology Department, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Alex Luttich
- Interventional Neuroradiology Department, Hospital Universitario Donostia, San Sebastian, Spain
| | - José Manuel Pumar
- Chair of Interventional Neuroradiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
11
|
Luo X, Guo Q, Wang J, Li Y, Zhao J, Huang B, Chen X. The impact of dyslipidemia on prognosis of patients after endovascular abdominal aortic aneurysm repair. Front Cardiovasc Med 2024; 11:1341663. [PMID: 38590698 PMCID: PMC10999528 DOI: 10.3389/fcvm.2024.1341663] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Dyslipidemia is common in patients with abdominal aortic aneurysm (AAA). However, there is insufficient research on the impact of dyslipidemia on the postoperative outcomes of patients with AAA after endovascular aortic aneurysm repair (EVAR). This study aimed to determine the impact of dyslipidemia on the prognosis of patients with AAA treated with EVAR. Method We retrospectively reviewed patients with AAA who underwent EVAR at our hospital between 2010 and 2020. The baseline characteristics and prognoses of patients in the dyslipidemia and non-dyslipidemia groups were analyzed. Results A total of 641 patients were included; the prevalence of dyslipidemia in patients with AAA was 42.3% (271/641), and the mean follow-up time was 63.37 ± 26.49 months. The prevalence of diabetes (10.0% vs. 15.1%, P = 0.050), peripheral arterial disease (17.3% vs. 25.8%, P = 0.018), and chronic kidney disease (3.0% vs. 6.3%, P = 0.043) was higher in the dyslipidemia group. The three-year all-cause mortality rate after EVAR was 9.98% (64/641), and there was no difference in the incidence of all-cause mortality (10.27% vs. 9.59%, P = 0.778) between the two groups. A total of 36 (5.62%) major adverse cardiovascular and cerebrovascular events (MACCEs) were observed within 3 years and were more common in patients with dyslipidemia (2.97% vs. 9.59%, P < 0.001). The incidence of stent-related complications in all patients was 19.97% (128/641), and there was no difference in the incidence of stent-related complications between the two groups (22.16% vs. 16.97%, P = 0.105); however, the incidence of type I endoleak in the dyslipidemia group was lower than that in the non-dyslipidemia group (9.19% vs. 4.06%, P = 0.012). Cox-regression analysis showed that high level of high-density lipoprotein cholesterol (HDL-C) was the protective factor (HR, 0.203, 95% CI, 0.067-0.616, P = 0.005) for MACCES, but it was the risk factor for type I endoleak (HR, 2.317, 95% CI, 1.202-4.466, P = 0.012). Conclusion Dyslipidemia did not affect the mortality of patients with AAA who underwent EVAR; however, it may increase the incidence of MACCEs. Dyslipidemia may decrease the incidence of type I endoleaks after EVAR; however, further studies are warranted. We should strengthen the postoperative management of patients with dyslipidemia, prevent the occurrence of MACCEs.
Collapse
Affiliation(s)
| | | | | | | | | | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | |
Collapse
|
12
|
Pennetta FF, De Santis F, Millarelli M, Diotallevi N, Chiappa R. Modified upside-down technique with Gore tapered iliac limbs for isolated iliac artery aneurysms. Vascular 2024:17085381241242859. [PMID: 38527213 DOI: 10.1177/17085381241242859] [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: 03/27/2024]
Abstract
PURPOSE To describe the off-label use of tapered iliac limbs for the treatment of isolated iliac aneurysms with proximal landing zone significantly larger than distal landing zone. TECHNIQUE Inversion of a Gore Excluder tapered leg (W. L. Gore & Associates Inc, Flagstaff, Arizona) with a modified upside-down technique is described. The endoprosthesis, with the olive at the tip of the releasing system previously cut, is inserted in a tip-to-tip fashion into a 15 Fr introducer sheath. The graft is released inside the introducer. An 18 Fr introducer sheath is advanced up to the proximal sealing zone. Following the removal of the 18 Fr dilator, the 15 Fr introducer with the pre-released graft is inserted co-axially into the 18 Fr introducer. A pre-cut 15 Fr dilator is brought up to the endograft and used as a pusher. A pull-back maneuver of the co-axial system, countertractioning with the dilator maintained in position, allows the delivery of the endograft. CONCLUSION This technique might offer a feasible option in case of endovascular exclusion of isolated iliac artery aneurysms with significant landing zone diameter mismatch. Extracorporeal inversion is time-saving and could be safer in terms of graft damage and infection.
Collapse
Affiliation(s)
| | - Francesco De Santis
- Vascular and Endovascular Surgery Unit, Sandro Pertini Hospital, Rome, Italy
| | | | - Nicolò Diotallevi
- Vascular and Endovascular Surgery Unit, Sandro Pertini Hospital, Rome, Italy
| | - Roberto Chiappa
- Vascular and Endovascular Surgery Unit, Sandro Pertini Hospital, Rome, Italy
| |
Collapse
|
13
|
Bisdas T, Zambas N, Zertalis M, Theodorides P, Iatrou N, Dimopoulos C, Charalambous N. Real-World Evaluation of the Off-the-Shelf Precannulated Inner-Branched Endograft for Pararenal Aortic Aneurysms. J Endovasc Ther 2024:15266028241241006. [PMID: 38528651 DOI: 10.1177/15266028241241006] [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: 03/27/2024]
Abstract
PURPOSE To analyze the early performance and efficacy of the first commercially available off-the-shelf precannulated multibranched endograft in the endovascular repair of pararenal abdominal aortic aneurysms (PAAAs). The device received European marketing approval in late 2020. MATERIALS AND METHODS Between January 2021 and June 2023, a retrospective analysis of prospectively collected data from all consecutive patients with pAAAs undergoing implantation of the E-nside precannulated inner-branched endograft was conducted in 2 centers. The primary outcome measure was technical success defined as the composite endpoint of successful (1) delivery of the 24F endograft, (2) use of the precannulation tubes, and (3) implantation of the bridging stent-grafts (BSGs) to the target vessels. Main secondary endpoints were mortality, target vessel instability (TVI), absence of type I or III endoleak, reintervention, spinal cord ischemia, and supra-celiac aortic coverage. RESULTS Twenty-one patients (20 men, mean age: 71 years) were included in this study with a mean follow-up of 14±7.7 months. Nine patients had a symptomatic aneurysm (43%). Technical success amounted to 95% (in one patient, an iliofemoral conduit was necessary to advance the device). One out of 112 BSGs (1%, right renal artery) occluded at 30 days, resulting in freedom from TVI and reintervention rate at 12 months of 95%. No type I or III endoleaks were identified during follow-up. One patient (5%) died at 13 months due to non-aneurysm-related death, and 1 patient (5%) developed spinal cord ischemia. No other major perioperative complications were observed. Mean supra-celiac aortic coverage reached 52±8%. CONCLUSIONS Given the imperative need for an off-the-shelf endograft tailored to address PAAAs, the E-nside stent-graft demonstrated encouraging outcomes in this study. Nevertheless, it is essential to emphasize that the extent of aortic coverage mandates the production of a truncated variant. CLINICAL IMPACT The endovascular repair of urgent pararenal aortic aneurysms remains still an unsolved problem in the endovascular era since there are no available off-the-shelf dedicated fenestrated or branched endografts. This paper confirms the safety and efficacy of the off-the-shelf precannulated inner branched endograft for this specific indication.
Collapse
Affiliation(s)
- Theodosios Bisdas
- Clinic of Vascular Surgery III, Athens Medical Group, Athens, Greece
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Neophytos Zambas
- Department of Vascular and Interventional Radiology, Aretaeio Hospital, Nicosia, Cyprus
| | - Marios Zertalis
- University of Nicosia Medical School, Nicosia, Cyprus
- Department of Vascular and Interventional Radiology, Aretaeio Hospital, Nicosia, Cyprus
| | | | - Nikolaos Iatrou
- Clinic of Vascular Surgery III, Athens Medical Group, Athens, Greece
| | | | - Nikolas Charalambous
- University of Nicosia Medical School, Nicosia, Cyprus
- Department of Vascular and Interventional Radiology, Aretaeio Hospital, Nicosia, Cyprus
| |
Collapse
|
14
|
Onohara T, Handa N, Kawasaki M, Kasashima F, Saito T, Nakamura T, Une D, Nakai M, Shiraya S, Maeda K, Imai K, Yamamoto T, Shimoe Y, Okamoto M, Kawazu Y. Long-Term Outcomes of Endovascular Aneurysm Repair in Patients Aged ≤70 Years. Ann Vasc Dis 2024; 17:25-33. [PMID: 38628930 PMCID: PMC11018108 DOI: 10.3400/avd.oa.23-00072] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/15/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives: The efficacy of endovascular aneurysm repair (EVAR) against abdominal aortic aneurysm (AAA) in younger patients remains unknown. Hence, the current study aimed to investigate whether the aneurysm-related mortality rate of EVAR is acceptable among patients aged ≤70 years. Methods: Among 644 patients, 148 underwent EVAR (EVAR group), and 496 received open surgical repair (OSR group). The cumulative incidence rates of aneurysm-related death, any intervention, and serious aneurysm-related events after AAA repair were evaluated using the cumulative incidence function in the presence of competing risks. Results: The EVAR group had higher prevalences of several comorbidities, and overall survival for the EVAR group was significantly inferior to that of the OSR group. The cumulative incidence rates of aneurysm-related death, any intervention, and serious aneurysm-related events at 5 years were 1.5%, 11.7%, and 6.4% in the EVAR group and 1.3%, 5.3%, and 5.9% in the OSR group, respectively. EVAR was not a significant prognostic factor of aneurysm-related mortality and serious aneurysm-related events. However, it was an independent poor prognostic factor of any intervention. Conclusion: EVAR was not a significant prognostic factor of aneurysm-related mortality and serious aneurysm-related events. Therefore, it demonstrated acceptable procedure-related long-term outcomes, at least in high-risk young patients.
Collapse
Affiliation(s)
- Toshihiro Onohara
- Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Nobuhiro Handa
- Department of Cardiovascular Surgery, Nagara Medical Center, Gifu, Gifu, Japan
| | - Masakazu Kawasaki
- Department of Cardiovascular Surgery, Hokkaido Medical Center, Sapporo, Hokkaido, Japan
| | - Fuminori Kasashima
- Department of Cardiovascular Surgery, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Tetsuya Saito
- Department of Cardiovascular Surgery, Osaka National Hospital, Osaka, Osaka, Japan
| | - Teruya Nakamura
- Department of Cardiovascular Surgery, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center, Okayama, Okayama, Japan
| | - Mikizo Nakai
- Department of Cardiovascular Surgery, Okayama Medical Center, Okayama, Okayama, Japan
| | - Suguru Shiraya
- Department of Cardiovascular Surgery, Hamada Medical Center, Hamada, Shimane, Japan
| | - Kazuki Maeda
- Department of Cardiovascular Surgery, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center, Kure, Hiroshima, Japan
| | - Tsuyoshi Yamamoto
- Department of Cardiovascular Surgery, Iwakuni Medical Center, Iwakuni, Yamaguchi, Japan
| | - Yasushi Shimoe
- Department of Cardiovascular Surgery, Shikoku Medical Center for Children and Adults, Zentsu¯ji, Kagawa, Japan
| | - Minoru Okamoto
- Department of Cardiovascular Surgery, Kumamoto Medical Center, Kumamoto, Kumamoto, Japan
| | - Yoshikazu Kawazu
- Department of Cardiovascular Surgery, Kagoshima Medical Center, Kagoshima, Kagoshima, Japan
| | - on behalf of National Hospital Organization Network Study Group in Japan for Abdominal Aortic Aneurysm
- Department of Vascular Surgery, Kyushu Medical Center, Fukuoka, Fukuoka, Japan
- Department of Cardiovascular Surgery, Nagara Medical Center, Gifu, Gifu, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center, Sapporo, Hokkaido, Japan
- Department of Cardiovascular Surgery, Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
- Department of Cardiovascular Surgery, Osaka National Hospital, Osaka, Osaka, Japan
- Department of Cardiovascular Surgery, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
- Department of Cardiovascular Surgery, Okayama Medical Center, Okayama, Okayama, Japan
- Department of Cardiovascular Surgery, Hamada Medical Center, Hamada, Shimane, Japan
- Department of Cardiovascular Surgery, Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan
- Department of Cardiovascular Surgery, Kure Medical Center, Kure, Hiroshima, Japan
- Department of Cardiovascular Surgery, Iwakuni Medical Center, Iwakuni, Yamaguchi, Japan
- Department of Cardiovascular Surgery, Shikoku Medical Center for Children and Adults, Zentsu¯ji, Kagawa, Japan
- Department of Cardiovascular Surgery, Kumamoto Medical Center, Kumamoto, Kumamoto, Japan
- Department of Cardiovascular Surgery, Kagoshima Medical Center, Kagoshima, Kagoshima, Japan
| |
Collapse
|
15
|
Zhu L, Guo W, Chen L, Zhang H, Xu B, Ding Z, Lu Q, Zhang L. Contrast-Free Endovascular Aneurysm Repair Combined With Fibrin Sealant Filling for Treating Abdominal Aortic Aneurysm: Technical Note. J Endovasc Ther 2024:15266028241237465. [PMID: 38528653 DOI: 10.1177/15266028241237465] [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: 03/27/2024]
Abstract
INTRODUCTION Endovascular aneurysm repair using iodinated contrast agents risks contrast-induced nephropathy, especially in high-risk patients. This technical note describes a contrast-free endovascular aneurysm repair (EVAR) protocol using preoperative imaging measurement and fibrin sealant (FS) filling. TECHNIQUE Preoperative imaging measurement and intraoperative guidewire manipulation facilitated anatomical identification without contrast. After endograft deployment, the aneurysm sac was filled with FS if endoleak was indicated by pressure fluctuations. RESULT Between 2017 and 2020, 6 high-risk patients underwent contrast-free EVAR with FS filling. Complete exclusion was achieved in all cases. Over follow-up, no endoleaks, deterioration in renal function, or other complications were observed. CONCLUSION Contrast-free EVAR with FS filling shows early feasibility as an alternative technique for contrast-induced nephropathy (CIN) high-risk patients, while larger studies with long-term monitoring are imperative to validate outcomes. CLINICAL IMPACT This study showcases a contrast-free EVAR technique with fibrin sealant filling for high-risk CIN patients. It offers a safer approach for those with renal challenges, reducing CIN risk. The technique's feasibility in a small cohort suggests its utility in treating AAA without iodinated contrast, crucial for patients with specific health risks. For clinicians, it introduces a method that decreases nephrotoxic risks, potentially changing practice for vulnerable patients.
Collapse
Affiliation(s)
- Longtu Zhu
- Department of Vascular Surgery, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Wenying Guo
- Department of Vascular Surgery, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Li Chen
- Department of Vascular Surgery, Department of General Surgery, Tai'an City Central Hospital, Shandong, China
| | - Hao Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Bing Xu
- Department of Radiology, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Zhichen Ding
- Department of Vascular Surgery, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| |
Collapse
|
16
|
Anthony L, Gillies M, Goh D. Trends in AAA Repair in Australia Over Twenty Years. Vasc Health Risk Manag 2024; 20:69-75. [PMID: 38435054 PMCID: PMC10909325 DOI: 10.2147/vhrm.s449375] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The advent of endovascular techniques has revolutionised the treatment of abdominal aortic aneurysms (AAA). Many countries have seen a transition from open AAA repair (OAR) to endovascular AAA repair (EVAR) over the past 25 years. The only study done in Australia that describes this change was done in the private sector. Majority of healthcare in Australia is delivered through the public, universal healthcare system. The aim of this study was to evaluate the trends in AAA repair in the Australian public sector over the past two decades. Methods The Australian Institute of Health and Welfare (AIHW) Procedures Data Cubes from the National Hospitals Data Collection was used to extract data pertaining to AAA repairs from 2000 to 2021. Population data from the Australian Bureau of Statistics was used to calculate incidence of each type of repair per 100,000 population. Results There were 65,529 AAA repairs performed in the Australian public sector from 2000 to 2021. EVARs accounted for 64.4% (42,205) and OARs accounted for 35.6% (23, 324) of them. EVAR surpassed OAR as the preferred method of AAA repair in 2006. This trend was observed in both males and females and across all age groups. Conclusion There was a consistent and steady transition from OAR to EVAR over the 21 year period with EVAR surpassing OAR as the preferred method of AAA repair relatively early in Australia compared to other countries. Further research that investigates medium- and long-term outcomes of newer stent grafts is needed to further ascertain the continued viability and effectiveness of this trend in AAA treatment.
Collapse
Affiliation(s)
- Lakmali Anthony
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
| | - Madeline Gillies
- Department of Surgery, Western Health, Footscray, Victoria, Australia
| | - David Goh
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
| |
Collapse
|
17
|
Lee J, Oh PC, Jang AY, Ahn CM, Choi D, Ko YG, Kang WC. Long-Term Outcomes of Endovascular Repair Within and Outside the Instructions for Use in Korean Patients With Abdominal Aortic Aneurysm. J Endovasc Ther 2024:15266028241232915. [PMID: 38414229 DOI: 10.1177/15266028241232915] [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: 02/29/2024]
Abstract
OBJECTIVE Endovascular aneurysm repair (EVAR) has been used worldwide to treat abdominal aortic aneurysms (AAAs). Outcomes after EVAR within and outside the instruction for use (IFU) remain controversial. We analyzed long-term outcomes of EVAR within-the-IFU compared with that outside-the-IFU and baseline clinical/anatomical characteristics that influence outcomes of EVAR. METHODS The study included 546 patients who underwent EVAR for infrarenal AAA from 1997 to 2021 at 2 Korean medical centers. The primary endpoint was graft-related adverse events (GRAEs), including type 1 or 3 endoleak, reintervention (included open conversion), aneurysm sac enlargement, aneurysm-related mortality (ARM), rupture, stent-graft migration, and stent thrombotic occlusion. RESULTS The patients who underwent EVAR outside the IFU were 287 (52.6%). A neck angle of >60° was most common outside the IFU criteria (n=146, 50.9%). This study revealed that patients outside the IFU had a higher rate of GRAEs compared with patients within the IFU (hazard ratio [HR]: 1.879; 95% confidence interval [CI]: 1.045-2.386). A neck angle of >60° was a significant risk factor for GRAEs (adjusted HR: 2.229; 95% CI: 1.418-3.503), type 1 or 3 endoleak (adjusted HR: 2.640; 95% CI: 1.343-5.189), and reintervention (adjusted HR: 1.891; 95% CI: 1.055-3.388). CONCLUSIONS Our study revealed EVAR with outside the IFU was associated with increased GRAEs, mainly attributed to endoleak and ARM, compared with EVAR with within the IFU. In addition, severe neck angulation was an independent risk factor for GRAEs, type 1 or 3 endoleak, and reintervention. CLINICAL IMPACT Our study revealed endovascular aneurysm repair (EVAR) with outside-the-instruction for use (IFU) was associated with increased graft-related adverse events (GRAEs) compared with EVAR with within-the-IFU. In the low-risk population, the incidence of GRAEs and Aneurysm related mortality were higher in the outside-the-IFU group rather than within-the-IFU group. In addition, severe neck angulation was an independent risk factor for GRAEs, type 1 or 3 endoleak and reintervention.
Collapse
Affiliation(s)
- Joonpyo Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| |
Collapse
|
18
|
Mahmood DN, Rocha R, Ouzounian M, Teng Tan K, Forbes SM, Chung JCY, Lindsay TF. Thoracoabdominal Aortic Aneurysm Repair Using Fenestrated and Branched Endovascular Grafts for High-Risk Patients: Evolving yet Safe. J Endovasc Ther 2024:15266028241229005. [PMID: 38339966 DOI: 10.1177/15266028241229005] [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: 02/12/2024]
Abstract
PURPOSE The purpose was to investigate outcomes of high-risk patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair using fenestrated or branched endovascular aneurysm repair (F/BEVAR) devices at a single center in Canada. MATERIALS AND METHODS A retrospective review of all patients undergoing endovascular TAAA repair with F/BEVAR from June 2007 to July 2020. Imaging and clinical endpoints of interest including death, reintervention, and target vessel patency were reported. RESULTS Ninety-five consecutive patients underwent endovascular TAAA repair using F/BEVAR stent grafts (63 males, median age 74 [interquartile range 70, 78] years). Repairs included 81 elective and 14 urgent/emergent cases (6 ruptures and 8 symptomatic). Graft deployment was 100% successful. Intraoperative target vessel revascularization was successful in 336/355 (94.6%) vessels with the celiac having the lowest success rate 72/82 (87.8%). In-hospital mortality was 9.5% (7.4% elective and 21.4% urgent/emergent, p=0.125) and permanent paraplegia was 4.2% (3.7% elective and 7.1% urgent/emergent, p=0.458). In-hospital complications included stroke in 5.3%, acute myocardial infarction in 8.4%, and bowel ischemia in 5.3%. No patients required permanent dialysis or tracheostomy during their hospital stay. However, 22 (23.2%) patients required additional unplanned procedures for various indications (branch occlusion, endoleaks, realignment) during their hospital stay. Patients were followed up for a mean of 3.6 ± 3.0 years. Clinical follow-up was 100%, with 80/86 (93%) having surveillance imaging. On follow-up imaging, 43 (50%) patients had at least 1 endoleak identified and 337/341 (98.8%) of the target vessels were found to be patent. At 5 years, cumulative probability of reintervention was 46.3% (95% confidence interval [CI], 36.1-56.4). Survival at 5 and 8 years was 50.1% (95% CI, 38.4-65.4) and 34.4% (95% CI, 22.5-52.8), respectively. Progression of aneurysmal disease leading to rupture on follow-up was confirmed in 1 patient at 10 years. CONCLUSION Endovascular TAAA repair provides a safe treatment option with a high technical success rate and low pulmonary and renal complications. Long-term survival is similar to previous literature; however, high rates of secondary reintervention reaffirm the need for ongoing patient follow-up and further technical improvements. CLINICAL IMPACT This study demonstrates that endovascular repair of TAAAs can be performed in a high-risk elderly population with acceptable rates of mortality, TALE and SCI, using evolving technology. The incidences of post-operative respiratory failure and renal dysfunction were lower in patients who underwent endovascular repair compared with open repair. Future technical and procedural refinements in addition to increasing surgical experience are expected to lead to further improvements in short- and long-term outcomes exceeding those of open repair.
Collapse
Affiliation(s)
- Daniyal N Mahmood
- Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rodolfo Rocha
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kong Teng Tan
- Division of Interventional Radiology, Toronto General Hospital, Toronto, ON, Canada
| | - Samantha M Forbes
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jennifer C-Y Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Thomas F Lindsay
- Division of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
19
|
Hill MA, Wooster M, Zeigler S. Palliative Repair of a Mycotic Aortic Arch Pseudoaneurysm With a Physician-Modified Endograft and In-Situ Laser Fenestration. J Endovasc Ther 2024; 31:132-135. [PMID: 35766455 DOI: 10.1177/15266028221107879] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE Open aortic arch repair is the gold standard in the treatment of diseases involving the ascending aorta and aortic arch. However, due to the invasive nature of open repair, high-risk patients with multiple comorbidities are often not suitable candidates for open surgical repair. While endovascular aortic repair is far less invasive, endovascular arch repair remains a difficult challenge due to the aortic arch diameter and angulation, origin of the supra-aortic arteries, and the lack of commercially available thoracic branched devices in the United States. CASE REPORT Here we describe palliation of a mycotic aortic arch pseudoaneurysm with a physician-modified endograft and in situ laser fenestration. Our technique allowed for rapid repair of the pseudoaneurysm with minimal physiologic disturbances and no perioperative complications in a high-risk surgical patient. CONCLUSION Physician-modified endografts are feasible and may be an effective treatment option for palliation of acute aortic arch lesions in high-risk surgical patients.
Collapse
Affiliation(s)
- Morgan A Hill
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Mathew Wooster
- Division of Vascular Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Sanford Zeigler
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
20
|
Kanemura T, Nakahara Y, Tateishi R, Haba F, Ono S. Mid-term outcomes of hypogastric artery embolization in endovascular aneurysm repair: a case series. J Surg Case Rep 2024; 2024:rjae029. [PMID: 38328452 PMCID: PMC10847400 DOI: 10.1093/jscr/rjae029] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Hypogastric artery embolization is performed during endovascular aneurysm repair (EVAR) involving the common iliac artery. Within this case series, we have observed elevated rates of sac expansion subsequent to this intervention. April 2009 to March 2021, 22 patients underwent EVAR with hypogastric artery embolization. We evaluated the mid-term outcomes for these patients. The mean follow-up period was 57 months. We achieved a 100% technical success rate without open conversion and no hospital deaths. The rates of freedom from aneurysm expansion at 1, 3, and 5 years were 90.5%, 59.1%, and 37.5%, respectively. The percentage of sac expansion exceeding 5 mm was 54.5% (12/22). Combined endovascular aortic aneurysm repair and embolization of the hypogastric artery might be associated with a high rate of remote sac expansion. Larger trials are needed to verify risks and benefits.
Collapse
Affiliation(s)
- Takeyuki Kanemura
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Yoshinori Nakahara
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Retsu Tateishi
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Fumiya Haba
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| | - Shunya Ono
- Department of Cardiovascular Surgery, IMS Katsushika Heart Center, 3-30-1 Horikiri, Katsushika Ward, Tokyo 124-0006, Japan
| |
Collapse
|
21
|
Katsarou M, Auyang PL, Chinnadurai P, Bismuth J. "Octafen": A Noninvestigational Alternative Endograft Configuration for the Treatment of Thoracoabdominal Aortic Aneurysms. J Endovasc Ther 2024; 31:19-25. [PMID: 35869618 DOI: 10.1177/15266028221113752] [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] [Indexed: 01/07/2024]
Abstract
PURPOSE To demonstrate the feasibility of Octafen technique, a novel endovascular configuration for the treatment of thoracoabdominal aortic aneurysms (TAAA). TECHNIQUE Two patients with complex TAAA and high surgical risk were treated with Octafen endograft configuration in a hybrid operating room with computed tomography (CT)-fluoroscopy image fusion guidance, using 3D-3D fusion techniques to facilitate procedural success. The procedure is a modification of the previously-described Octopus technique for endovascular repair of TAAA. The main advantage of this technique is the ability to use devices to repair a TAAA with the combination of off-the-shelf and noninvestigational custom-made devices. The devices used are readily available to most practicing vascular surgeons, which provides an alternative treatment in case of limited access to investigational devices, in time-sensitive cases, and in patients with limited functional capacity who cannot undergo open repair. In the modification described herein, we use a combination of standard bifurcated endovascular aneurysm repair (EVAR) devices (Excluder; W.L. Gore & Associates, Flagstaff, Arizona) in combination with a 2-vessel renal fenestrated device (Z-Fen; Cook Medical, Bloomington, Indiana). The article describes a step-by-step approach to this technique to elucidate pitfalls, benefits, and advantages. CONCLUSION The Octafen technique might offer an alternative option for thoracoabdominal aneurysm treatment circumventing the need for access to custom-made, investigational devices. CLINICAL IMPACT In this manuscript, we describe a technique for endovascular repair of thoraco-abdominal aortic aneurysms that involves the combination of off-the-shelf and non-investigational, custom-made devices. The 'Octafen' technique provides a treatment alternative in case of limited access to investigational devices and can be adjusted according to patient anatomy.
Collapse
Affiliation(s)
- Maria Katsarou
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Philip L Auyang
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ponraj Chinnadurai
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Advanced Therapies, Siemens Medical Solutions, Malvern, PA, USA
| | - Jean Bismuth
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
22
|
Lee SH, Melvin R, Kerr S, Barakova L, Wilson A, Renwick B. Novel conformable stent-graft repair of abdominal aortic aneurysms with hostile neck anatomy: A single-centre experience. Vascular 2024; 32:19-24. [PMID: 36052681 DOI: 10.1177/17085381221124990] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Abdominal aortic aneurysms (AAAs) demonstrating hostile neck anatomy (HNA) are associated with increased perioperative risk and mortality. A number of these patients are not suitable for standard endovascular aneurysm repair (EVAR) and are high risk for open surgery. We present our experience with the first implantations in Scotland of a novel conformable aortic stent-graft designed to overcome some of the challenges of HNAs. METHODS From May 2018 to March 2022, 24 consecutive patients with non-ruptured AAAs demonstrating HNAs (neck length < 15 mm, or angulation > 60°) were treated with GORE Excluder Conformable AAA endoprosthesis (CLEVAR) (CEXC Device, W.L. Gore and Associates, Flagstaff, AZ, USA) at a Scottish vascular centre. We assessed clinical outcomes and technical success of CLEVAR during deployment, primary admission and the post-operative period at 3- and 12-month clinical follow-up alongside CT angiography. RESULTS Twenty-four patients (20 males, mean age 75.6) were included. Primary technical success of proximal seal zones and CLEVAR deployment (no type 1/3 endoleaks, no conversion to open repair, AAA excluded and patient leaving theatre alive) was achieved in 100% of patients. All patients were alive and clinically stable at 3- and 12-month follow-up. There were five patients requiring re-intervention; at the 3-month follow-up, one patient (4.2%) developed a type 1b endoleak requiring graft limb extension, one patient developed a right common femoral artery dissection requiring open repair and one patient required a limb extension of the right iliac limb due to risk of developing a type 1b endoleak. At the 12-month follow-up, two patients required embolization of type 2 endoleaks and no patients demonstrated type 1 or type 3 endoleaks.Conclusions: In-hospital and post-operative 3- and 12-month clinical and angiographic outcomes demonstrate safety and efficacy with CLEVARs in treating unruptured AAAs with HNA. Further research involving larger heterogenous sample sizes is warranted to determine long-term clinical outcomes.
Collapse
Affiliation(s)
- Seong Hoon Lee
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Ross Melvin
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Stacey Kerr
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Lucie Barakova
- Institute of Applied Health Sciences, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - Alasdair Wilson
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Bryce Renwick
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| |
Collapse
|
23
|
Ogawa Y, Fujimura N, Yamaguchi M, Banno H, Furuyama T, Yamaoka T, Sumi M, Fukuda T, Morikage N, Sohgawa E, Onitsuka S, Nishimaki H, Ichihashi S. Outcomes of the Gore Excluder Iliac Branch Endoprosthesis for Japanese Patients With Aortoiliac Aneurysms: A Study Based on J-Preserve Registry. J Endovasc Ther 2024; 31:55-61. [PMID: 35815459 DOI: 10.1177/15266028221109477] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the clinical utility of the Gore Excluder iliac branch endoprosthesis (IBE) for Japanese patients with aortoiliac aneurysms. MATERIALS AND METHODS This was a multicenter retrospective cohort study (J-Preserve Registry). Patients undergoing endovascular aortic repair using the Gore Excluder IBE for aortoiliac aneurysms between August 2017 and June 2020 were enrolled. Data pertaining to the baseline and anatomical characteristics, technical details, and clinical outcomes were collected from each institution. The primary endpoints were technical success, IBE-related complications, and reinterventions. Secondary endpoints were mortality, aneurysm size change, and reintervention during follow-up. Technical success was defined as accurate deployment of the IBE without type Ib, Ic, or III endoleaks on the IBE sides on completion angiography. A change in aneurysm size of 5 mm or more was taken to be a significant change. RESULTS We included 141 patients with 151 IBE implantations. Sixty-five IBE implantations (43.0%) had at least one instruction for use violation. Twenty-two patients (15.6%) required internal iliac artery (IIA) embolization for external iliac artery extension on the contralateral side. Of 151 IBE implantations, 19 exhibited IIA branch landing zones due to IIA aneurysms. Mean maximum and proximal common iliac artery (CIA) diameters were 32.9±9.9 mm and 20.5±6.9 mm, respectively. The mean CIA length was 59.1±17.1 mm. The IIA landing diameter and length were 9.0±2.3 mm and 33.8±14.6 mm. The overall technical success rate was 96.7%. There were no significant differences in IBE-related complications (2.3% vs 5.3%, p=0.86) or IBE-related reinterventions (1.5% vs 5.3%, p=0.33) between the IIA trunk and IIA branch landing groups. The mean follow-up period was 635±341 days. The all-cause mortality rate was 5.0%. There were no aneurysm-related deaths or ruptures during the follow-up. Most patients (95.7%) had sac stability or shrinkage. CONCLUSION The Gore Excluder IBE was safe and effective for Japanese patients in the midterm. Extending the IIA device into the distal branches of the IIA was acceptable, which may permit extending indications for endovascular aortic aneurysm repair of aortoiliac aneurysms to more complex lesions. CLINICAL IMPACT This study suggests clinical benefits of the Gore Excluder IBE for Japanese patients, despite 43% of the IBE implantations having at least one IFU violation.
Collapse
Affiliation(s)
- Yukihisa Ogawa
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naoki Fujimura
- Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Masato Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Makoto Sumi
- Department of Vascular Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Noriyasu Morikage
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University, Ube, Japan
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Seiji Onitsuka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| |
Collapse
|
24
|
Giagtzidis I, Theologou M, Papoutsis I, Karkos C, Papazoglou K. Cleaning Up the Chimney: Early Renal Stent Graft Thrombosis Following Endovascular Treatment of a Juxtarenal Aortic Aneurysm With the Chimney Technique. Cureus 2024; 16:e54669. [PMID: 38523961 PMCID: PMC10960231 DOI: 10.7759/cureus.54669] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
The endovascular management of juxtarenal aortic aneurysms with the chimney technique (ch-EVAR) has gained popularity in recent years. It provides an alternative to open repair, allowing treatment of challenging anatomies with devices readily available in any vascular suite. The primary drawback persists as the occurrence of type-Ia endoleak from gutters and renal stent thrombosis. We present two cases of early renal stent graft thrombosis following chimney endovascular aneurysm repair. The first patient was an 80-year-old man who underwent single ch-EVAR and came back on the fifth post-op day with renal stent graft thrombosis. He was re-operated for recanalization and additional stenting of his chimney graft. The patient recovered well with no complications. The second case involved a 72-year-old man with a juxtarenal aneurysm, treated with ch-EVAR on both renal arteries. Unfortunately, on the 10th post-op day, he was referred to our department due to lumbar pain and acute renal failure due to chimney graft thrombosis bilaterally. The left renal chimney graft was recanalized by endovascular means. On the contrary, despite efforts of the endovascular and open approach, the right chimney graft and the right renal artery remained occluded. While ch-EVAR is a viable and off-the-shelf solution for urgent and complex juxtarenal aortic aneurysms, it should be performed with awareness of the potential for graft thrombosis and persistent endoleaks. Despite these complications, the chimney technique can still be a viable treatment option. A better understanding of the indications and advancements in the devices used can lead to better long-term results.
Collapse
Affiliation(s)
- Ioakeim Giagtzidis
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Marios Theologou
- 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioakeim Papoutsis
- Vascular Surgery, 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Christos Karkos
- Vascular Surgery, 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Papazoglou
- Vascular Surgery, 5th Surgical Department, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| |
Collapse
|
25
|
't Mannetje YW, Reijnen MMPJ, Zeebregts CJ. Upside-Down Gore Excluder as an Endoprosthesis for Aortoiliac Aneurysm Exclusion: A Retrospective Multicenter Study. J Endovasc Ther 2024:15266028231224257. [PMID: 38193446 DOI: 10.1177/15266028231224257] [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: 01/10/2024]
Abstract
OBJECTIVE The upside-down configuration of a Gore Excluder contralateral leg endoprosthesis has been used to overcome diameter differences in the endovascular treatment of aortoiliac aneurysms. Our goal was not to describe the technique but to study the applicability and safety. MATERIAL AND METHODS Patients were retrospectively enrolled. The indication and details of the procedure were at the discretion of the treating physicians. A case report form was completed including baseline characteristics, indication for treatment, procedural data, and outcomes during follow-up. RESULTS A total of 31 subjects were enrolled with a range of indications, including 3 patients treated in the emergency setting (9.7%). In 64.5% (n=20), it was a primary intervention for a common iliac aneurysm (n=10), internal iliac aneurysm (n=4), or abdominal aortic aneurysm (n=6). In 11 subjects (35.5%), treatment was performed after previous aortoiliac interventions, including anastomotic iliac artery aneurysm (n=5), type III endoleak (n=3), and endograft thrombus (n=3). Median follow-up was 13 months (range=1-142 months). During follow-up, 2 patients required an upside-down contralateral leg-related secondary intervention, one for an occlusion and another for a type Ia endoleak. There was no type Ib or III endoleak, and no migration, kinking/stenosis, or conversion to open repair was observed. The aneurysm-related mortality was 3.3% (n=1). CONCLUSION An upside-down contralateral leg is a valuable technique that can be used to achieve adequate aneurysm exclusion or resolve complications. It is associated with a limited number of complications. CLINICAL IMPACT This article studies the use of an upside-down iliac endograft. We describe a wide range of indications in which this previously published technique has been applied. In elective and acute settings and as primary and revision intervention an upside-down iliac endograft was performed successfully. Furthermore, follow-up data is presented showing the effectiveness of the technique. Knowledge of this procedure is a valuable addition to the skillset of every interventionalist.
Collapse
Affiliation(s)
| | - Michel M P J Reijnen
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
26
|
Van Gerwen A, Gallala S, Kerselaers L, Aerden D, Debing E. Stentgraft Limb Occlusion After Endovascular Aneurysm Repair: Incidence and Risk Factors. Vasc Endovascular Surg 2024; 58:34-41. [PMID: 37400356 DOI: 10.1177/15385744231186276] [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] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors. METHODS All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study. Demographic data, cardiovascular risk factors, aneurysm characteristics, arterial anatomy, repair strategy, systemic and stentgraft-related complications, and in-hospital and late mortality were collected. Routine follow-up included duplex examination and/or CT angiography at 3 months, 12 months and annually thereafter. Logistic regression analysis was performed to detect predictors for SLO. RESULTS A total of 221 patients (425 stentgraft limbs) were included; of whom 11 patients (5.0%) occluded. Median time to occlusion was 3.3 months and most of the patients presented ischemic signs. Two risk factors for SLO could be identified: symptomatic aneurysm (P .015, odds ratio 4.62, 95% confidence interval 1.35-15.86) and length of the infrarenal abdominal aortic aneurysm (AAA) (P .021, odds ratio 1.31, 95% confidence interval 1.04 - 1.64). CONCLUSION The incidence of SLO after EVAR is low, and most occlusions occur within the first year. Predictors for SLO are the symptomatic aneurysm and the length of the infrarenal AAA. Further research is necessary to pool all predictors and to assess the clinical impact of different follow-up strategies for high-vs low-risk patients.
Collapse
Affiliation(s)
- Anouk Van Gerwen
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Sarah Gallala
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Laura Kerselaers
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Dimitri Aerden
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Erik Debing
- Department of Vascular Surgery, Universitair Ziekenhuis Brussel, Brussel, Belgium
| |
Collapse
|
27
|
Martio AE, Kieling DM, Manzato LB, Vanzin JR. Overt nickel and cobalt hypersensitivity after pipeline embolization device placement: A case report. Brain Circ 2024; 10:85-88. [PMID: 38655437 PMCID: PMC11034441 DOI: 10.4103/bc.bc_85_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 04/26/2024] Open
Abstract
Nickel and cobalt are frequently found in metallic alloys used in the manufacture of aneurysm clips and endovascular prostheses, such as the pipeline embolization device (PED). Nickel hypersensitivity can affect up to 15% of the population, however, it is very rarely overt in patients who undergo endovascular stent placement. Here, we present the case of a 35-year-old woman who developed allergic symptoms after PED placement and was later confirmed to be allergic to both nickel and cobalt by patch testing. Fortunately, she responded well to pharmacologic treatment, rendering surgical intervention unnecessary. To the best of our knowledge, this is the first report of symptomatic nickel hypersensitivity, and the second report of symptomatic cobalt allergy caused by the PED. Despite its low prevalence, we believe that surgeons should actively inquire patients in the postoperative period about allergic symptoms, to facilitate early diagnosis and treatment.
Collapse
Affiliation(s)
- Artur Eduardo Martio
- Division of Interventional Neuroradiology, Passo Fundo Clinics Hospital, Passo Fundo, RS, Brazil
| | - Daniel Marchi Kieling
- Division of Interventional Neuroradiology, Passo Fundo Clinics Hospital, Passo Fundo, RS, Brazil
| | - Luciano Bambini Manzato
- Division of Interventional Neuroradiology, Passo Fundo Clinics Hospital, Passo Fundo, RS, Brazil
| | - José Ricardo Vanzin
- Division of Interventional Neuroradiology, Passo Fundo Clinics Hospital, Passo Fundo, RS, Brazil
| |
Collapse
|
28
|
Sena G, Montemurro R, Pezzo F, Gioffrè R, Gallelli G, Rubino P. Contralateral Snare Cannulation vs. Retrograde Gate Cannulation during Endovascular Aortic Repair in Difficult Iliac Artery Anatomy: A Single Center Experience. J Clin Med 2023; 13:175. [PMID: 38202182 PMCID: PMC10780168 DOI: 10.3390/jcm13010175] [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: 09/13/2023] [Revised: 12/01/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Endovascular aneurysm repair is well established as the gold standard in treating abdominal aortic aneurysms. Generally, endovascular repair is performed using a bi or trimodular stent graft, requiring placement of a contralateral iliac limb. Deployment of the contralateral iliac limb requires retrograde gate cannulation of the endograft main body contralateral limb. This step represents the crucial point of a standard endovascular repair procedure and can become challenging, especially in the case of high iliac tortuosity. This study compares the procedural times between the retrograde gate cannulation and the contralateral snare cannulation to demonstrate the possibility of directly performing the contralateral snare cannulation in the case of a complex iliac anatomy assessed by the iliac tortuosity index. METHODS One hundred and forty-eight patients with infrarenal abdominal aortic aneurysms who underwent endovascular aneurysm repair from 2017 to 2022 were analyzed retrospectively. Cannulation times between retrograde gate cannulation and contralateral snare cannulation were compared for each degree of iliac tortuosity. The degree of iliac tortuosity was assessed through the iliac tortuosity index. Cannulation times were detected from inserting the wire into the introducer to passing through the radio-opaque gate markers. RESULTS The cannulation times were 2.94 min for the retrograde gate cannulation group and 3.15 min for the contralateral snare cannulation group, respectively, with no statistically significant differences (p = 0.33). Overall cannulation times were 2.98 min. For the iliac tortuosity index grade 0, the cannulation times were 2.71 min for the retrograde gate cannulation group and 3.85 min for the contralateral snare cannulation group, respectively, with a significant difference in favor of the retrograde gate cannulation group (p < 0.0001). For the iliac tortuosity index grade 1, the cannulation times were 2.74 min for the retrograde gate cannulation group and 2.8 min for the contralateral snare cannulation group, respectively, with no statistically significant differences (p = 0.63). Regarding the iliac tortuosity index grades 2 and 3, the cannulation times were 3.01 and 4.93 min for the retrograde gate cannulation group and 2.71 and 3.28 min for the contralateral snare cannulation group, respectively. The first group's times were significantly higher than the second group's (p = 0.01 and p = 0.0001). CONCLUSIONS In patients with infrarenal abdominal aortic aneurysms undergoing endovascular aortic repair, the gate cannulation times were significantly shorter for the contralateral snare cannulation method than the retrograde gate cannulation method in the iliac tortuosity index grades 2 and 3. Therefore, performing the contralateral snare cannulation method would be appropriate.
Collapse
Affiliation(s)
- Giuseppe Sena
- Department of Vascular Surgery, “Pugliese-Ciaccio” Hospital, 88100 Catanzaro, Italy; (R.M.); (F.P.); (R.G.); (G.G.); (P.R.)
| | | | | | | | | | | |
Collapse
|
29
|
Mirgolbabaee H, van de Velde L, Geelkerken RH, Versluis M, Groot Jebbink E, Reijnen MMPJ. Ultrasound Particle Image Velocimetry to Investigate Potential Hemodynamic Causes of Limb Thrombosis After Endovascular Aneurysm Repair With the Anaconda Device. J Endovasc Ther 2023:15266028231219988. [PMID: 38149463 DOI: 10.1177/15266028231219988] [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: 12/28/2023]
Abstract
PURPOSE To identify potential hemodynamic predictors for limb thrombosis (LT) following endovascular aneurysm repair with the Anaconda endograft in a patient-specific phantom. MATERIALS AND METHODS A thin-walled flow phantom, based on a patient's aortic anatomy and treated with an Anaconda endograft, that presented with a left-sided LT was fabricated. Contrast-enhanced ultrasound particle image velocimetry was performed to quantify time-resolved velocity fields. Measurements were performed in the same phantom with and without the Anaconda endograft, to investigate the impact of the endograft on the local flow fields. Hemodynamic parameters, namely vector complexity (VC) and residence time (RT), were calculated for both iliac arteries. RESULTS In both limbs, the vector fields were mostly unidirectional during the peak systolic and end-systolic velocity phases before and after endograft placement. Local vortical structures and complex flow fields were observed at the diastolic and transitional flow phases. The average VC was higher (0.11) in the phantom with endograft, compared to the phantom without endograft (0.05). Notably, in both left and right iliac arteries, the anterior wall regions corresponded to a 2- and 4-fold increase in VC in the phantom with endograft, respectively. RT simulations showed values of 1.3 to 6 seconds in the phantom without endograft. A higher RT (up to 25 seconds) was observed in the phantom with endograft, in which the left iliac artery, with LT in follow-up, showed 2 fluid stasis regions. CONCLUSION This in vitro study shows that unfavorable hemodynamics were present mostly in the limb that thrombosed during follow-up, with the highest VC and longest RT. These parameters might be valuable in predicting the occurrence of LT in the future. CLINICAL IMPACT This in-vitro study aimed to identify potential hemodynamic predictors for limb thrombosis following EVAR using ultrasound particle image velocimetry (echoPIV) technique. It was shown that unfavorable hemodynamic norms were present mostly in the thrombosed limb. Owing to the in-vivo feasibility of the echoPIV, future efforts should focus on the evaluation of these hemodynamic norms in clinical trials. Thereafter, using echoPIV as a bedside technique in hospitals becomes more promising. Performing echoPIV in pre-op phase may provide valuable insights for surgeons to enhance treatment planning. EchoPIV is also applicable for follow-up sessions to evaluate treatment progress and avoid/predict complications.
Collapse
Affiliation(s)
- Hadi Mirgolbabaee
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Lennart van de Velde
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Robert H Geelkerken
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Section of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Erik Groot Jebbink
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel M P J Reijnen
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| |
Collapse
|
30
|
Gormley S, Bernau O, Xu W, Khashram M. Propensity score analysis demonstrates no long term survival benefit from contemporary endovascular aneurysm repair compared to open in Aotearoa New Zealand. ANZ J Surg 2023. [PMID: 38131414 DOI: 10.1111/ans.18815] [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: 04/13/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Current guidelines for AAA management are based on landmark trials comparing EVAR and open aneurysm repair (OAR) conducted more than 20 years ago. Important advancements have been made in peri-operative care but the impact of EVAR and OAR on long-term patient survival has not been well reported using contemporary data. The objective of this study was to compare the short and long-term outcomes of OAR and EVAR in the recent era. METHODS This retrospective observational study included all patients undergoing intact AAA repair in NZ from 1st of January 2011 until 31st of December 2019. Data was collected from national administrative and clinical vascular databases and matched using unique identifiers. Time-to-event survival analyses was conducted using cox proportional hazard models to adjust for confounders and propensity score matching were used. RESULTS Two thousand two hundred and ninety-seven patients had an intact AAA repair with a median (IQR) age of 75 (69-80) years; 494 (21.2%) patients were females and 1206 (53%) underwent EVAR. The 30-day mortality for OAR and EVAR was 4.8% and 1.2%. The median (IQR) follow up was 5.2 (2.3-9.2) years. After propensity matching for co-variates, the study cohort consisted of 835 patients in each matched group. Patients undergoing EVAR had a higher overall mortality (HR 1.48 (95% CI: 1.26-1.74) after adjusting for confounders compared to OAR. CONCLUSION Analysis of survival following EVAR and OAR in the current era demonstrates that patients that underwent EVAR had a lower 30-day mortality. However, in the long-term after adjusting for confounders OAR had a better overall survival.
Collapse
Affiliation(s)
- Sinead Gormley
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Oliver Bernau
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - William Xu
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Manar Khashram
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
31
|
Oberhuber A, Simonte G, Isernia G, Schäfers J. The Semibranch: A New Tool for Complex Aortic Pathologies. J Endovasc Ther 2023:15266028231219661. [PMID: 38140760 DOI: 10.1177/15266028231219661] [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: 12/24/2023]
Abstract
PURPOSE To describe the semibranch as new tool to treat patients with thoracoabdominal, para- and juxtarenal aortic pathologies. TECHNIQUE The technique is demonstrated in 2 patients with aortic pathologies. First, a 76-year-old woman with a type Ia endoleak after endovascular repair of abdominal aneurysm (EVAR). Due to the short mainbody of the EVAR and suprarenal extension of the pathology, a 4-branched device with integrated bifurcation was chosen. To realize a branched device in small diameters of the suprarenal aorta, 2 semibranches, for the superior mesenteric artery (SMA) and the celiac trunc (CT), were planned. The second patient, a 75-year-old man, had a juxtarenal aneurysm. Due to small diameters of the aorta, semibranches for the SMA and the CT were planned. In both cases, a total transfemoral approach was used with a steerable sheath. Placement, cannulation of the semibranch, forwarding of the bridging stentgraft, and sealing was uneventful. All 4 semibranches were successful in sealing the aneurysm. CONCLUSION The semibranch is another tool in the armamentarium of the endovascular interventionalist, which can expand the range of patients that can be treated. Especially patients with small aortic diameter or short distances between target vessels with the same offspring angle can profit from the semibranch design. CLINICAL IMPACT The semibranch is a new tool to treat thoracoabdominal as well para- and juxtarenal aortic pathologies. Due to its reduced length, packaging density can be higher and diameter of the stentgraft can be larger. It closes the gap in pathologies where fenestration are not suitable (kinked aortas) and there is not enough space for standard inner branches (small diameters).
Collapse
Affiliation(s)
- Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - Gioele Simonte
- Department of Vascular and Endovascular Surgery, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Giacomo Isernia
- Department of Vascular and Endovascular Surgery, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Johannes Schäfers
- Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| |
Collapse
|
32
|
Jónsson GG, Shehab M, Wanhainen A, Mani K, Kuzniar M, Lindström D. Off-the-Shelf Single-Fenestrated Endograft for Emergent Juxtarenal and Pararenal Abdominal Aortic Aneurysm. J Endovasc Ther 2023:15266028231215976. [PMID: 38049945 DOI: 10.1177/15266028231215976] [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: 12/06/2023]
Abstract
INTRODUCTION Endovascular solutions to emergent juxtarenal and pararenal abdominal aortic aneurysms (AAAs) are complicated. Endovascular aortic repair (EVAR) with in situ laser fenestration (ISLF) is promising but requires a period of visceral ischemia. With an off-the-shelf, single superior mesenteric artery (SMA)-fenestrated device mesenteric ischemia is avoided and renal ischemia decreased. The aim was to develop an optimized design of such an endograft suitable for >90% of juxtarenal and pararenal AAAs. METHODS Single-center analysis on 44 consecutive preoperative CTs for previously elective fenestrated EVARs for juxtarenal and pararenal aneurysms. Anatomical characteristics were analyzed to define: (1) shortest aortic coverage above SMA fenestration to achieve ≥4 cm seal; (2) feasibility of a scallop for the celiac artery; (3) shortest distance between the SMA and lowest renal, to facilitate renal ISLF in a straight endograft; (4) distance from the lowest renal to the aortic bifurcation, to allow an overlapping zone >40 mm with a bifurcated stent graft; (5) aortic diameter in the sealing zone, for optimal proximal stent graft diameter with 10% to 30% oversizing; (6) the final design was then tested on individual level. RESULTS (1) The stent graft needs to start 40 mm above the SMA fenestration to achieve a 4 cm sealing zone in >90% of cases. (2) A proximal sealing zone of 40 mm without a scallop covers 77% of celiac arteries. With an addition of a 20 mm deep, 20 mm wide scallop at 12:30, the stent graft still covers 27% of celiacs. This suggests that a scallop would not be practically feasible. (3) In >90% of cases, the lowest renal was <31 mm from the SMA, suggesting that the tapering should start 30 mm below the SMA. (4) The distance from the lowest renal to the aortic bifurcation ranged from 82 to 166 mm. This allows for a 20 mm tapering and 50 mm straight part in all cases. (5) The 5th and 95th percentile of the aortic diameter in the sealing zone was 22 and 31 mm, respectively. Thus, 2 different stent graft diameters (28 and 34 mm) would fit >90% of cases. (6) The final design was suitable in 91% cases. CONCLUSIONS Two sizes of a single-fenestrated aortic stent graft without scallop cover >90% of juxtarenal and pararenal anatomies. CLINICAL IMPACT Emergent juxta- and pararenal aortic aneurysms is a difficult clinical scenario that continuously challenges physicians. An endovascular option is in situ laser fenestrated endografts. One risk with these is the complete visceral ischemia occurring before the fenestrations are completed. An off-the-shelf single-fenestrated stent graft facilitates the treatment by removing the ischemia time for the SMA and reducing the ischemia time for the celiac and renal arteries thus decreasing the risk of visceral ischemia complications.
Collapse
Affiliation(s)
- Gísli Gunnar Jónsson
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Maysam Shehab
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anders Wanhainen
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
- Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Kevin Mani
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Marek Kuzniar
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - David Lindström
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| |
Collapse
|
33
|
Meekel JP, Tran BL, van Schaik TG, Donas KP, Taneva GT, Jongkind V, Yeung KK. What we have learned from in-vitro studies of the chimney endovascular technique for treatment of complex abdominal aortic aneurysms: A systematic review. Vascular 2023; 31:1051-1060. [PMID: 35578179 DOI: 10.1177/17085381221095294] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND A considerable number of patients with abdominal aortic aneurysms (AAA) is not eligible for standard endovascular repair. These complex cases require alternative surgical approaches including the readily available chimney graft endovascular aneurysm repair (Ch-EVAR) or sealing (Ch-EVAS). The optimal configuration for Ch-EVAR or Ch-EVAS is important for success but not yet known. OBJECTIVE The aim of the present study was to analyze current data of the outcomes of in-vitro chimney graft treatment in complex AAA. METHODS A systematic review following PRISMA guidelines was conducted including studies reporting on gutter size, main graft compression, and chimney graft compression in in-vitro configurations. RESULTS The search resulted in 285 articles. 11 studies considering 219 individual tests could be included. Gutter size was comparable between Ch-EVAR and Ch-EVAS configurations. In Ch-EVAR set-ups, the deployed BECG were Advanta V12, VIABAHN®, and BeGraft. One type of SECG was used: VIABAHN®. The four types of main grafts (MG) deployed were: Endurant™ I/II; EXCLUDER Conformable AAA Endoprosthesis and AAA Endoprosthesis, and AFX™ Endovascular AAA Delivery System. In the EVAS-configurations, the Nellix® EVAS system was deployed. In general, SECG presented smaller gutters with higher chimney graft compression. 30% main grafts oversizing seems to give the smallest gutters without high risk of infolding of MG. Oversizing, EndoAnchors, and secondary endobag filling (in Ch-EVAS) reduced gutter sizes. CG ballooning during the entire polymer injection in Ch-EVAS prevented CG compression. CONCLUSION In-vitro investigations provide insight in optimal Ch-EVAR and Ch-EVAS configurations for simulated complex AAA repair. The findings above might aid physicians in their planning to potential CG set-ups and can be used in future research to refine the most optimal configuration for chimney graft technique in complex AAA.
Collapse
Affiliation(s)
- Jorn P Meekel
- Department of Surgery, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Bich L Tran
- Department of Surgery, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Theodorus G van Schaik
- Department of Surgery, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Konstantinos P Donas
- Department of Vascular Surgery, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Gergana T Taneva
- Department of Vascular Surgery, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Vincent Jongkind
- Department of Surgery, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kak K Yeung
- Department of Surgery, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Kontopodis N, Galanakis N, Ioannou CV, Antoniou GA. Systematic Review and Meta-Analysis of the Effect of Anticoagulation on Outcomes After Endovascular Aneurysm Repair. J Endovasc Ther 2023:15266028231214761. [PMID: 38031419 DOI: 10.1177/15266028231214761] [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: 12/01/2023]
Abstract
PURPOSE Our objective was to investigate whether patients who receive anticoagulation therapy have different outcomes after endovascular aneurysm repair (EVAR) from those who do not. MATERIALS AND METHODS We conducted a systematic review of studies that compared outcomes of EVAR in patients who were on therapeutic anticoagulation vs those who were not. We developed and reported the review in accordance with the PRISMA guidelines with a registered protocol (CRD42022375894). The Ovid interface was used to search Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) up to November 2022. The quality of studies was assessed with the Newcastle-Ottawa Scale (NOS) (maximum score=9), and the evidence was appraised with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The hazard ratio (HR) and 95% confidence interval (CI) was the effect estimate in time-to-event meta-analyses, calculated using the inverse-variance statistical method and random-effects models. RESULTS Sixteen studies qualified for inclusion reporting a total of 35 739 individuals. Anticoagulated patients had a statistically significantly higher hazard of death (HR=1.93, 95% CI=1.03-3.63), endoleak (HR=2.13, 95% CI=1.55-2.93), reintervention (HR=1.79, 95% CI=1.27-2.52), and aneurysm sac expansion (HR=2.72, 95% CI=1.57-4.72) than patients not receiving anticoagulation therapy. The median score on the NOS was 7 (range=4-9). The certainty of evidence was very low for mortality and reintervention and low for endoleak and sac expansion. CONCLUSIONS Anticoagulation is a poor prognostic factor after standard EVAR and should be considered in decision-making, consent processes, and surveillance strategies. CLINICAL IMPACT The number of individuals who take anticoagulation treatment has been rapidly increasing over the recent years. We aimed to investigate the effect of such treatment on outcomes after endovascular aneurysm repair (EVAR). Anticoagulated patients were found to have increased mortality, endoleak, and reintervention rates after EVAR compared to their non-anticoagulated counterparts. Anticoagulation therapy has a prognostic role in EVAR and should be considered in decision making and EVAR surveillance. Anticoagulated patients need to be informed of the higher failure rates of EVAR, and intensified surveillance strategies may need to be implemented in this patient cohort.
Collapse
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - George A Antoniou
- Manchester Vascular Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
35
|
Piazza M, Squizzato F, James Bilato M, Grego F, Antonello M. Physician-Modified Single-Fenestrated EndoSuture Aneurysm Repair (FESAR) for Urgent Juxtarenal AAA Repair. J Endovasc Ther 2023:15266028231212131. [PMID: 37990854 DOI: 10.1177/15266028231212131] [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: 11/23/2023]
Abstract
PURPOSE To describe the endovascular treatment of a symptomatic juxtarenal abdominal aortic aneurysm (JAAA) using a combination of endoanchors (Heli-FX EndoAnchor, Medtronic, Minneapolis, Minnesota) and a physician-modified single-fenestrated endograft. TECHNIQUE An 85 year-old patient unfit for open aortic repair presented for a symptomatic JAAA, characterized by an infrarenal neck with 0.6 cm in length and 23 mm in diameter. A 28 mm-diameter Endurant aortic cuff (Medtronic, Minneapolis, Minnesota) was modified with a single fenestration for the left renal artery (LRA) and diameter-reducing tie, then re-sheathed and deployed. The LRA was cannulated with a 7F sheath and the constraining wire was withdrawn. Being the shortest neck length on the right side of the cuff, the endograft was anchored to the aortic wall on this side with 2 endoanchors. The LRA was stented and flared, then a distal physician-modified (without free-flow) bifurcated Endurant graft (Medtronic, Minneapolis, Minnesota) was overlapped with the proximal cuff and stabilized with 6 endoanchors. Correct positioning with complete aneurysm exclusion was confirmed with a 30 day and 9 month computed tomography angiograms. CONCLUSIONS In extremely selected cases, association of endoanchors and single-fenestrated physician-modified graft may be useful to treat complex urgent aortic aneurysm using readily available devices. CLINICAL IMPACT This technical note demonstrates the feasibility of a single-fenestrated physician-modified Endurant endograft deployed in combination with endosuture fixation (FESAR), to urgently treat a juxtarenal aortic aneurysm unfit for open repair and not suitable for standard endovascular repair nor off-the-shelf endografts.
Collapse
Affiliation(s)
- Michele Piazza
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco James Bilato
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Franco Grego
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Antonello
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
36
|
Özdemir-van Brunschot D, Zerellari R, Tevs M, Holzhey D, Botsios S. Factors Influencing Compliance to Follow-Up After Endovascular Aneurysm Repair. Vasc Endovascular Surg 2023; 57:878-883. [PMID: 37306151 DOI: 10.1177/15385744231183790] [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] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Regular follow-up after endovascular repair of aortic aneurysm is necessary to detect endoleak and/or migration of the stentgraft. However, absence or incomplete compliance to follow-up is common in this patient population. In this study we will analyse the frequency of non-compliance to post-EVAR follow-up and explore the underlying reasons. METHODS All patients undergoing EVAR for infrarenal aortic aneurysm between 1st January 2011 and 31st December 2020 were included in this retrospective study. Absence of compliance to FU was defined as not showing up at the out-patient clinic; incomplete FU was defined as a surveillance gap of >18 months. RESULTS AND CONCLUSION Non-compliance to follow-up was 35.9% (175 patients). In the multivariate analysis the patients who came with a ruptured aneurysm and patients who needed secondary therapy in the first 30 days more often did not comply with the FU protocol (P = .03 and P < .01). Other studies have confirmed the low attendance to follow-up after EVAR.
Collapse
Affiliation(s)
- Denise Özdemir-van Brunschot
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospitaland Catholic Hospital Group Düsseldorf, Düsseldorf, Germany
| | - Romina Zerellari
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospitaland Catholic Hospital Group Düsseldorf, Düsseldorf, Germany
| | - Maria Tevs
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospitaland Catholic Hospital Group Düsseldorf, Düsseldorf, Germany
| | - David Holzhey
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Spiridon Botsios
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospitaland Catholic Hospital Group Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
37
|
Hahl T, Karvonen R, Uurto I, Protto S, Suominen V. The Safety and Effectiveness of the Prostar XL Closure Device Compared to Open Groin Cutdown for Endovascular Aneurysm Repair. Vasc Endovascular Surg 2023; 57:848-855. [PMID: 37272299 PMCID: PMC10543140 DOI: 10.1177/15385744231180663] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study is to compare the outcomes of percutaneous femoral closure with the Prostar XL for endovascular aneurysm repair (EVAR) to those of open femoral cutdown, and to evaluate factors which may predict the failure of percutaneous closure. METHODS Patients undergoing endovascular aneurysm repair for an infrarenal abdominal aortic aneurysm between 2005 and 2013 were included. Patient characteristics, anatomic femoral artery measurements, and postoperative complications were recorded retrospectively. Operator experience was defined with a cut-off point of >30 Prostar XL closures performed. Comparisons were made per access site. RESULTS A total of 443 access sites were included, with percutaneous closure used in 257 cases (58.0%) and open cutdown in 186 cases (42.0%). The complication rate was 2.7% for the percutaneous and 4.3% for the open cutdown group (P = .482). No significant differences between groups were found with respect to 30-day mortality, wound infections, thrombosis, seromas, or bleeding complications. Fourteen failures (5.4%) of percutaneous closure occurred. The success rates were similar for experienced and unexperienced operators (94.2% vs 95.5%, P = .768). Renal insufficiency was more common in the failed than in the successful percutaneous closure group (64.3% vs 24.7%, P = .003). Common femoral artery calcification or diameter, BMI, sheath size, or operator experience did not predict failure. No further complications were seen in follow-up CT at 1-3 years postoperatively. CONCLUSION The use of the Prostar XL is safe compared to open cutdown. The success rate is 94.6%. Operator experience, sheath size, obesity, or femoral artery diameter or calcification do not appear to predict a failure of percutaneous closure. Complications seem to occur perioperatively, and late complications are rare.
Collapse
Affiliation(s)
- Tilda Hahl
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | | | - Ilkka Uurto
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
- Tampere University, Tampere, Finland
| | - Sara Protto
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | - Velipekka Suominen
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
- Tampere University, Tampere, Finland
| |
Collapse
|
38
|
Torrealba J, Grandi A, Nana P, Panuccio G, Rohlffs F, Kölbel T. Transfemoral Access to Implant Iliac Branch Devices After Previous Aortic Grafts. J Endovasc Ther 2023:15266028231208657. [PMID: 37902437 DOI: 10.1177/15266028231208657] [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: 10/31/2023]
Abstract
OBJECTIVE To report on the outcomes of patients undergoing an iliac branch device implantation after previous open or endovascular aorto-biliac repair, using exclusively femoral access for catheterization and delivery of the covering stent to the hypogastric artery. METHODS Single-center retrospective study in which all patients in whom an iliac branch device was implanted after previous open or endovascular aorto-biliac repair were identified. Patients in whom the hypogastric artery catheterization and delivery of the bridging cover stent were achieved via exclusive femoral access were included. Different techniques were used based on surgeon preference. Technical success and access-related complications, as well as iliac branch device endoleak or occlusions during follow-up, were evaluated. RESULTS From 2015 to 2021, 28 patients with a prior open or endovascular aorto-biliac repair underwent 34 iliac branch device implantations. Most (71%) had juxtarenal or thoracoabdominal aortic aneurysms, 82% had common iliac artery aneurysms, and 25% had hypogastric artery aneurysms. Bilateral iliac branch device implantations were performed in 21% of the patients, and in 26% of cases, landing in the superior gluteal artery was obtained. An "up-and-over" technique from the contralateral groin was used in 65% of the cases, and a steerable sheath in 35%. Technical success was 94%, with no complications related to access or technique to catheterize and deliver the stents in the hypogastric artery. The cohort had 20% of major complications, with 3 perioperative deaths. Kaplan-Meier estimated an iliac branch device freedom from occlusion and endoleak was 92% and 83% at 2 years. CONCLUSIONS The implantation of an iliac branch device over previous aortic or open endografts involving the aortic bifurcation is feasible and safe. We suggest using a femoral approach as the primary access of choice. CLINICAL IMPACT In this study we present 28 patients with previous aortoiliac grafts in which iliac branch devices were performed as a subsequent step.We demonstrated the feasibility of the technique despite the difficulty of crossing a neobifurcation, with a steep angle, without complications associated with the technique. Based on our experience, we recommend transfemoral access as the first option for bypassing the hypogastric artery stent, preserving upper extremity access and its possible complications.
Collapse
Affiliation(s)
- Jose Torrealba
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Alessandro Grandi
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Petroula Nana
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| |
Collapse
|
39
|
Nagao K, Yamashita S, Ebe R, Naruto N, Ito H, Nagura S, Doi T, Fukahara K, Yoshimura N. Intraoperative Heparin Resistance after Administration of Andexanet Alfa to Manage an Internal Iliac Artery Aneurysm Rupture: A Case Report. Ann Vasc Dis 2023; 16:273-276. [PMID: 38188977 PMCID: PMC10766740 DOI: 10.3400/avd.cr.23-00060] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 01/09/2024] Open
Abstract
Antithrombotic agents are increasingly prescribed to older adults; however, they are associated with bleeding-related complications. We describe a case of intraoperative heparin resistance after administration of andexanet alfa (AA). An 81-year-old man was diagnosed with a ruptured internal iliac artery aneurysm. The patient required emergency endovascular aneurysm repair and was treated with AA because he was receiving apixaban. Despite high-dose intraoperative heparin administration, his activated coagulation time was not prolonged. Our findings suggest that AA should be administered with caution in patients experiencing potentially fatal bleeding (requiring surgical intervention) who are also receiving direct oral anticoagulants.
Collapse
Affiliation(s)
- Kanetsugu Nagao
- First Department of Surgery, University of Toyama, Toyama, Toyama, Japan
| | | | - Rina Ebe
- First Department of Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Norihito Naruto
- Department of Radiology, University of Toyama, Toyama, Toyama, Japan
| | - Hisakatsu Ito
- Department of Anesthesia, University of Toyama, Toyama, Toyama, Japan
| | - Saori Nagura
- First Department of Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Toshio Doi
- First Department of Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Kazuaki Fukahara
- First Department of Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Naoki Yoshimura
- First Department of Surgery, University of Toyama, Toyama, Toyama, Japan
| |
Collapse
|
40
|
Perini P, Gargiulo M, Silingardi R, Bonardelli S, Bellosta R, Piffaretti G, Michelagnoli S, Ferrari M, Turicchia GU, Freyrie A, Fornasari A, Mariani E, Faggioli G, Spath P, Migliari M, Gennai S, Paro B, Baggi P, Attisani L, Pegorer M, Franchin M, Mauri F, Chisci E, Troisi N, Paciaroni E, Fanelli M. Twenty-Five Year Multicentre Experience of Explantation of Infected Abdominal Aortic Endografts. Angiology 2023:33197231206430. [PMID: 37820380 DOI: 10.1177/00033197231206430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/13/2023]
Abstract
We report a multicenter experience of open conversions (OC) for aortic endograft infections (AEI). We retrospectively analyzed all patients who underwent OC for AEI after endovascular aneurysm repair (EVAR), from 1997 to 2021 in 12 Italian centers. The endpoints were as follows: mortality (30-days, in-hospital), major postoperative complications. Follow-up data included: survival, aortic-related complications, infection persistence or reoccurrence. Fifty-eight patients (mean age: 73.8 ± 6.6 years) were included. Median time from EVAR to OC was 14 months (interquartile range 7-45). Thirty-five patients (60.3%) were symptomatic at presentation. Aortic reconstruction was anatomic in 32 patients (55.2%), extra-anatomic in 26 (44.8%). Thirty-day mortality was 31% (18/58). Six additional patients died after 30 days during the same hospitalization (in-hospital mortality: 41.4%). Most common post-operative complications included respiratory failure (38.6%) and renal insufficiency (35.1%). During 28.1 ± 4 months follow-up, 4 aneurysm-related deaths were recorded. Infection re-occurred in 29.4% of the patients. Estimated survival was 50% at 1 year, and 30% at 5 years, and was significantly lower for patients who underwent extra-anatomic reconstructions (37 vs 61% at 1 year, 16 vs 45% at 5 years; log-rank P = .021). OC for AEI is associated with high early mortality. The poor mid-term survival is influenced by aortic complications and infection re-occurrence.
Collapse
Affiliation(s)
- Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Parma, Parma, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Roberto Silingardi
- Vascular Surgery, Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Bonardelli
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy
| | - Stefano Michelagnoli
- Vascular and Endovascular Surgery, Department of Surgery, USL Toscana Centro, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Mauro Ferrari
- Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Fornasari
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Erica Mariani
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - GianLuca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Paolo Spath
- Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Mattia Migliari
- Vascular Surgery, Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Gennai
- Vascular Surgery, Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Paro
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Baggi
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Attisani
- Vascular Surgery, Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Matteo Pegorer
- Vascular Surgery, Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Franchin
- Vascular Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy
| | - Francesca Mauri
- Vascular Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy
| | - Emiliano Chisci
- Vascular and Endovascular Surgery, Department of Surgery, USL Toscana Centro, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Nicola Troisi
- Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Elisa Paciaroni
- Department of Vascular Surgery, Cesena Hospital, AUSL Romagna, Forlì-Cesena, Italy
| | - Mara Fanelli
- Department of Vascular Surgery, Cesena Hospital, AUSL Romagna, Forlì-Cesena, Italy
| |
Collapse
|
41
|
Zhou G, Ma H, Liu J, Sun X, Liu Y, Luan J, Li Y, Guo M. Quadruple fenestration aortic stent implantation combined with unilateral IBE and internal iliac artery stent implantation for complex abdominal aortic aneurysm: one case report. Front Cardiovasc Med 2023; 10:1276064. [PMID: 37881725 PMCID: PMC10595028 DOI: 10.3389/fcvm.2023.1276064] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
An abdominal aortic aneurysm is a frequently encountered clinical condition, which necessitates prompt and effective remediation to avoid rupture. Surgeons must meticulously select an appropriate method of repair and assess the long-term surgical prognosis when dealing with patients with complex abdominal aortic aneurysms. In this case report, a 74-year-old man was hospitalized due to acute abdominal pain. Upon further examination, it was discovered that he was suffering from a complex abdominal aortic aneurysm. The thoracoabdominal aorta CTA showed that the aneurysm involved both renal arteries, the part below the kidney was severely twisted, the neck of the aneurysm was short, and it was accompanied by bilateral common iliac and internal iliac aneurysms, and there were considerable thrombus attached to the vessel wall. In this case, our team used 3D technology to simulate the spatial structure of the aneurysm and comprehensively evaluate the patient's condition. Ultimately, we decided to perform a quadruple fenestration aortic stent implantation and endovascular repair of aortic aneurysm, combined with right IBE and internal iliac artery stent implantation, right internal iliac artery reconstruction, and left internal iliac artery aneurysm embolization on this patient. This is an innovative surgical method. The operation was successful and the patient recovered well after the operation.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yongxin Li
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingjin Guo
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| |
Collapse
|
42
|
Teng A, Sun A, Chen Z, Deng X, Fan Y. Sex different abdominal artery anatomy may induce different displacement force on stent-graft after endovascular aneurysm repair. Int J Numer Method Biomed Eng 2023; 39:e3739. [PMID: 37317060 DOI: 10.1002/cnm.3739] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
Women with abdominal aortic aneurysm (AAA) have a higher incidence of complications after Endovascular aneurysm repair (EVAR), most of which are related to the migration of stent-graft. The different force acting on the stent-graft after EVAR caused by different abdominal artery anatomy of male and female AAA patients may be the reason for the sex-different complications. This article aims to explore the possible biomechanical mechanisms of sex differences by making a comparison of displacement force acting on the stent graft of male and female AAA patients. To explore the effect of different vascular anatomy on stent-graft migration, the uniformed models were constructed according to the specific vascular anatomy parameters of AAA patients of different sex, which have been measured before. The computational fluid dynamics method was used to quantitate the pulsatile force acting on the stent-graft after EVAR in a cardiac cycle. Then the displacement force was calculated with the pressure and the wall shear stress, and the total and area-weighted average of displacement force acting on the stent-graft were compared respectively. In one cardiac cycle, the wall pressure for the male model is greater than that of the female model (2.7-4.4 vs. 2.2-3.4 N), and the wall shear force for the female model is slightly greater (0-0.0065 vs. 0-0.0055 N). The displacement force is mainly provided by the wall pressure, which is also greater in the male model. However, the area-averaged displacement force is greater for the female model than that for the male model (180-290 vs. 160-250 Pa). Because of the different vascular anatomies, the impact caused by the pulsating aortic blood flow on the AAA stent-graft of women after EVAR was greater than that of men. Women's vascular anatomy leads to greater area-averaged displacement force after stent-graft implantation, resulting in a greater risk of stent-graft migration, which might be one of the reasons why women had a higher incidence of complications after EVAR.
Collapse
Affiliation(s)
- Anna Teng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zengsheng Chen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| |
Collapse
|
43
|
Kouvelos G, Nana P, Brodis A, Spanos K, Tasoudis P, Katsargyris A, Verhoeven E. A Meta-Analysis of Mid-Term Outcomes of Endovascular Aneurysm Sealing. J Endovasc Ther 2023; 30:664-675. [PMID: 35674455 DOI: 10.1177/15266028221098706] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND-AIM Several studies have been published showing conflicting results on the outcome after endovascular aneurysm sealing (EVAS). The aim of the present study is to conduct a systematic review and meta-analysis of published evidence to assess the efficacy of EVAS in the management of patients with abdominal aortic aneurysm (AAA). METHODS An electronic search of the English medical literature, from 2010 to March 2021, was conducted using MEDLINE, EMBASE, and Cochrane databases to find studies relevant to outcome after EVAS. RESULTS The final analysis included 12 articles published between 2011 and 2021, including 1440 patients. In total, 79.3% of the included patients underwent aneurysm treatment according to the instructions for use. Technical success was 98.8%. Overall, 30-day mortality was 1.3%. Procedure-related complications were reported in 4% of the cohort. During median follow-up of 28.1 months (range 9-72 months), the pooled estimate of endoleak type I, migration and reinterventions was 16% (95% confidence interval [CI]=7-25), 16% (95% CI=9-23), and 19% (95% CI=11-28), respectively. In a sub-analysis, 7 studies (703 patients) reported outcome with a mean follow-up of more than 2 years (range 24-72 months). In these studies, the pooled estimate of endoleak type I, migration, and reinterventions was 25% (95% CI=13-38), 22% (95% CI=19-26), and 27% (95% CI=21-33), respectively. CONCLUSION Patients who have been treated with EVAS are in high risk for reintervention especially beyond 2 years following implantation. Close surveillance for patients treated with EVAS is mandatory.
Collapse
Affiliation(s)
- G Kouvelos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - P Nana
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - A Brodis
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - K Spanos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - P Tasoudis
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - A Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - E Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
| |
Collapse
|
44
|
Waldeck S, Overhoff D, Brockmann MA, Becker BV. Detection of Endoleaks Following Thoracic and Abdominal Aortic Endovascular Aortic Repair-: A Comparison of Standard and Dynamic 4D-Computed Tomography Angiography. J Endovasc Ther 2023; 30:739-745. [PMID: 35582987 DOI: 10.1177/15266028221095390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Endoleaks are a common complication after endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). The detection and correct classification of endoleaks is essential for the further treatment of affected patients. However, standard computed tomography angiography (CTA) provides no hemodynamic information on endoleaks, which can result in misclassification in complex cases. The aim of this study was to compare standard CTA (sCTA) with dynamic, dual-energy CTA (dCTA) for detection and classification of endoleaks following EVAR or TEVAR. MATERIALS AND METHODS This retrospective evaluation compared 69 sCTA diagnostic examinations performed on 50 different patients with 89 dCTA diagnostic examinations performed on 69 different patients. RESULTS In total, 15.9% of sCTA examinations and 49.4% of dCTA examinations led to the detection of endoleaks. With sCTA, 20.0% of patients were diagnosed with endoleaks, while with dCTA, 37.7% of patients were diagnosed with endoleaks. With sCTA, mainly Type 1 endoleaks were detected, whereas, with dCTA, the types of detected endoleaks were more evenly distributed. In comparison with the literature, the frequencies of endoleak types detected with dCTA better reflect the natural distribution than the frequencies detected with standard CTA. CONCLUSION Based on the retrospective comparative evaluation, dCTA could pose a valuable supplementary diagnostic tool resulting in a more accurate and realistic detection and classification of suspected endoleaks.
Collapse
Affiliation(s)
- Stephan Waldeck
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Overhoff
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc A Brockmann
- Institute of Neuroradiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benjamin V Becker
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
- Institute of Neuroradiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
45
|
Melloni A, Bertoglio L, Van den Eynde W, Agrusa CJ, Parlani G, Howard DPJ, Rio J, Fazzini S, Mansour W, Dias NV, Ronchey S, Branzan D. Outcomes of Percutaneous Access to the First Versus Third Segment of Axillary Artery During Aortic Procedures. J Endovasc Ther 2023:15266028231202456. [PMID: 37750487 DOI: 10.1177/15266028231202456] [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: 09/27/2023]
Abstract
PURPOSE This article aims at investigating the outcomes of percutaneous access via the first versus third axillary artery (AXA) segments with closure devices during aortic procedures. MATERIALS AND METHODS All patients receiving percutaneous AXA access closed with Perclose ProGlide device (Abbott, Santa Clara, California) from 2008 to 2021 were included in a retrospective multicenter registry (NCT: 04589962). Efficacy endpoint was the technically successful percutaneous procedure (no open conversion). Safety endpoints were stroke and access complications according to the Valve Academic Research Consortium-3 reporting standards. The first (AXA1) or third (AXA3) axillary puncture sites were compared. RESULTS A total of 412 percutaneous AXA accesses were included: 172 (42%) in AXA1 and 240 (58%) in AXA3. Left AXA was catheterized in 363 cases (76% of AXA1 vs 97% of AXA3, p<0.001) and 91% of fenestrated/branched endovascular repair (F/BEVAR) procedures were conducted from the left. A ≥12F internal diameter (ID) sheath was used in 49% of procedures. Open conversion rate was 1%, no major vascular complications occurred, and only one major non-vascular complication was recorded. Primary closure failure occurred in 18 AXA1 (11%) and 32 AXA3 accesses (13%), treated by covered (8.3%) or bare-metal (2.7%) stenting. Bailout stent patency was 100% at median follow-up of 12 months, with 6 of 6 stents still patent after >36 months of follow-up. Stroke rate was 4.4%. An introducer sheath >12F was independently associated with both access complications (p<0.001) and stroke (p=0.005), while a right-side access was associated with stroke only (p=0.034). Even after adjustment for covariates, AXA1 versus AXA3 showed an equal success rate (odds ratio [OR]=0.537, 95% confidence interval [CI]=0.011-1.22 for AXA3, p=0.104). The combination of AXA3 and a >10F introducer sheath provided worse outcomes compared with >10F sheaths through AXA1 (OR for success=0.367, 95% CI=0.176-0.767, p=0.008). This was not confirmed for >12F sheaths, associated with similar outcomes (p=0.31 AXA 1 vs AXA 3). CONCLUSION Major local complications with the percutaneous axillary approach and ≤12F sheaths are infrequent and solvable by complementary endovascular interventions. Stroke risk remains an issue. First and third AXA segments are both amenable for access with good results, but larger sheaths (12F) perform better in AXA1. CLINICAL IMPACT Percutaneous access with vascular closure devices at the first or third axillary artery (AXA) segments during aortic procedures is burdened by a negligible risk of open conversion. Local complications with the percutaneous axillary approach are infrequent and solvable by complementary endovascular interventions. First and third AXA segments are both amenable to access with excellent results, but larger sheaths (12F) perform better in the wider first AXA segment. In this setting, bailout stenting does not appear to be associated with mid-term stent occlusion.
Collapse
Affiliation(s)
- Andrea Melloni
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Wouter Van den Eynde
- Department of Vascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Christopher J Agrusa
- Division of Vascular Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Gianbattista Parlani
- Vascular and Endovascular Surgery Unit, S. Maria Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Dominic P J Howard
- Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Javier Rio
- Servicio de Angiología y Cirugía Vascular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Stefano Fazzini
- Vascular Surgery Unit, Biomedicine and Prevention Department, University of Rome Tor Vergata, Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini," Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Nuno V Dias
- Department of Thoracic Surgery and Vascular Diseases, Vascular Centre, Skåne University Hospital, Malmö, Sweden
| | - Sonia Ronchey
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Daniela Branzan
- Department of Vascular Surgery, University Hospital Leipzig, and Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
46
|
Ferreira M, Mannarino M, Cunha R, Ferreira D, Capotorto LF. Urgent Juxtarenal Aortic Aneurysm Repair With Modified Off-the-shelf Endograft to Preserve Intercostal Arteries and Branch Incorporation by Transfemoral Access. J Endovasc Ther 2023:15266028231199042. [PMID: 37731319 DOI: 10.1177/15266028231199042] [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: 09/22/2023]
Abstract
PURPOSE To demonstrate the feasibility of the modification to preserve intercostal arteries of the t-Branch Endograft (Cook Medical, Bloomington, IN) in an urgent setting, associated with a less invasive approach for branch incorporation from percutaneous femoral access with steerable sheaths. TECHNIQUE A 73-year-old female patient presented at our institution with intense abdominal pain. Angiotomography showed a 50-mm juxtarenal aortic aneurysm, with no signs of rupture. Urgent endovascular repair was indicated due to abdominal symptom with an off-the-shelf multi-branched endograft. To limit descending thoracic aortic coverage, we performed t-Branch modification to preserve intercostal arteries and minimize the risk of spinal cord injury, associated with a percutaneous transfemoral approach and branch incorporation with steerable sheaths to avoid the risks associated with a superior axillary or brachial access. Control angiotomography showed adequate aneurysm sac exclusion with patency of all four visceral vessels. CONCLUSION t-Branch-modified endograft to limit aortic coverage is an alternative option in urgent cases to diminish the risk of spinal cord injury, and association of steerable sheaths with branch incorporation is leading complex aortic repairs to an even less invasive procedure. CLINICAL IMPACT This paper highlights the possibility of performing complex endovascular aortic repair in an urgent setting with modification of an off-the-shelf multi branched endograft limiting intercostal arteries coverage, thereby diminishing the risk of spinal cord ischemia. This technical innovation provides an alternative for clinicians when treating large, rapidly expanding, or symptomatic juxtarenal, pararenal, paravisceral or type 4 thoracoabdominal aortic aneurysms that could not wait for a custom-made device and do not need extensive thoracic aortic coverage that an off-the-shelf device provides. In summary, expand the possibilities of an endovascular repair of complex aortic aneurysms.
Collapse
Affiliation(s)
- Marcelo Ferreira
- Department of Vascular and Endovascular Surgery, SITE Endovascular, Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Matheus Mannarino
- Department of Vascular and Endovascular Surgery, SITE Endovascular, Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Rodrigo Cunha
- Department of Vascular and Endovascular Surgery, SITE Endovascular, Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Diego Ferreira
- Department of Vascular and Endovascular Surgery, SITE Endovascular, Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Luis Fernando Capotorto
- Department of Vascular and Endovascular Surgery, SITE Endovascular, Casa de Saúde São José, Rio de Janeiro, Brazil
| |
Collapse
|
47
|
Chowdary PB, Maheshwari G, Haynes M, Amaechi I, Dickson-Lowe R. Intraperitoneal Haemorrhage Secondary to Rupture of Right Colic Artery Pseudoaneurysm: A Case Report and Literature Review. Cureus 2023; 15:e44634. [PMID: 37799213 PMCID: PMC10548298 DOI: 10.7759/cureus.44634] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
This article presents the case of a 58-year-old woman who presented feeling unwell with pain in the right upper abdomen for three days. She had a history of splenic infarcts, was on lifelong warfarin and had recently returned from a trip to Gambia. She was admitted to the hospital under suspicion of sepsis of unknown origin, and a CT scan later revealed haemoperitoneum along with a pseudoaneurysm of the right colic artery. After initially responding to resuscitation, the patient deteriorated haemodynamically, and a decision was made to perform a laparotomy, revealing a ruptured right colic artery pseudoaneurysm. In this article, the authors highlight the challenges of managing a complex unwell patient with a ruptured right colic artery pseudoaneurysm, emphasising the importance of a multi-disciplinary team approach and shared decision-making and reviewing the available literature.
Collapse
Affiliation(s)
| | - Gaurav Maheshwari
- General and Colorectal Surgery, Medway NHS Foundation Trust, Gillingham, GBR
| | - Maria Haynes
- Pathology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, GBR
| | - Iheoma Amaechi
- Interventional Radiology, Medway NHS Foundation Trust, Gillingham, GBR
| | | |
Collapse
|
48
|
Chen GX, Wan JH, Chen CW, Huang B. Hybrid surgery management challenges of a Behcet's disease patient with recurrence of aortic aneurysms: a case report. Front Cardiovasc Med 2023; 10:1097129. [PMID: 37719979 PMCID: PMC10502721 DOI: 10.3389/fcvm.2023.1097129] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/28/2023] [Indexed: 09/19/2023] Open
Abstract
Background Behcet's disease is a vasculitis of unknown origin that can involve multiple organs or tissues. Aneurysm or pseudoaneurysm, also one of the complications of Behcet's disease, is usually accompanied by a poor prognosis. Surgery is usually accompanied by a high risk of complications, such as the recurrence of anastomotic pseudoaneurysms and blockage of the target vessel. Using hybrid surgery, we successfully treated a complex and recurrent abdominal aortic pseudoaneurysm in a patient with BD. Methods We report a 32-year-old female diagnosed with Behcet's disease with recurrent thoracoabdominal aortic aneurysm. Adequate immunotherapy was given during the perioperative period. The splanchnic artery branches were reconstructed, and the aneurysm was sequestered with endovascular repair. The patient recovered uneventfully and was discharged from the hospital 8 days after hybrid surgery. At the 60-month follow-up, no aneurysm was observed, the stent had no displacement or internal leakage, and the reconstructed blood vessels were unobstructed. Conclusion Hybrid surgery could be a feasible and effective strategy for BD aneurysms. Adequate preoperative and postoperative immunotherapy with arterial anastomosis away from the diseased artery may be the key to success.
Collapse
Affiliation(s)
- Guo Xin Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Hong Wan
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Chu Wen Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
49
|
Vázquez Pérez R, Álvarez Marcos F, Tello Díaz C, Bellmunt Montoya S, Fernández-Samos Gutiérrez R, Gil Sala D. Psoas muscle analysis as a surrogate marker of sarcopenia and frailty: A multicenter analysis of predictive capacities over short- and long-term outcomes after abdominal aortic aneurysm repair. Vascular 2023:17085381231193453. [PMID: 37526918 DOI: 10.1177/17085381231193453] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Several predictive models exist for estimating the postoperative risks of abdominal aortic aneurysm (AAA) repair, although no particular tool has seen widespread use. We present the results of a multicenter, historic cohort study comparing the predictive capacity of the psoas muscle area (PMA), radiodensity (PMD), and lean muscle area (LMA) as surrogate markers of sarcopenia, over short- and long-term outcomes after AAA repair, compared to the mFI-5 and American Society of Anesthesiologists (ASA) scales. METHODS Retrospective review was conducted of all consecutive AAA elective repair cases (open or endovascular) in three tertiary-care centers from 2014 to 2019. Cross-sectional PMA, PMD, and LMA at the mid-body of the L3 vertebra were measured by two independent operators in the preoperative computed tomography. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff values. Bivariate analysis, logistic regression, and Cox's proportional hazards models were built to examine the relationship between baseline variables and postoperative mortality, long-term mortality, and complications. RESULTS 596 patients were included (mean age 72.7 ± 8 years, 95.1% male, 66.9% EVAR). Perioperative mortality was 2.3% (EVAR 1.2% vs open repair 4.6%, p = .015), and no independent predictors could be identified in the multivariate analysis. Conversely, an age over 74 years old (OR 1.84 95%CI 1.25-2.70), previous heart diseases (OR 1.62 95%CI 1.13-2.32), diabetes mellitus (OR 1.61 95%CI 1.13-2.32), and a PMD value over 66 HU (OR 0.58 95%CI 0.39-0.84) acted as independent predictors of long-term mortality in the Cox's proportional hazards model. Heart diseases (congestive heart failure or coronary artery disease), serum creatinine levels over 1.05 mg/dL, and an aneurysm diameter over 60 mm were independent predictors of major complications. CONCLUSION Surrogate markers of sarcopenia had a poor predictive profile for postoperative mortality after AAA repair in our sample. However, PMD stood out as an independent predictor of long-term mortality. This finding can guide future research and should be confirmed in larger datasets.
Collapse
Affiliation(s)
- Rocío Vázquez Pérez
- Angiology and Vascular Surgery Department, Hospital Universitario de Canarias, La Laguna, Spain
| | - Francisco Álvarez Marcos
- Angiology and Vascular Surgery Department, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Cristina Tello Díaz
- Angiology and Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sergi Bellmunt Montoya
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Daniel Gil Sala
- Angiology and Vascular Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| |
Collapse
|
50
|
Rahman SU, Prasad K, Akram MS, Adoni N, Mehta S. A Treatment Dilemma: Bentall vs Transcatheter Paravalvular Leak Closure with Aortic Aneurysm Repair in a High Surgical Risk Patient. Cureus 2023; 15:e43765. [PMID: 37600434 PMCID: PMC10439814 DOI: 10.7759/cureus.43765] [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] [Accepted: 08/19/2023] [Indexed: 08/22/2023] Open
Abstract
This case presentation involves an 80-year-old male with a history of surgically repaired patent ductus arteriosus and surgical aortic valve replacement due to infective endocarditis, who presented with progressive heart failure symptoms and was found to have a severe aortic paravalvular leak (PVL) and ascending thoracic aortic aneurysm. Due to complex surgical anatomy and multiple chronic comorbidities, he was considered a poor candidate for traditional valve replacement surgery including the Bentall procedure. Instead, a multidisciplinary team opted for transcatheter paravalvular leak closure (TPLC) with an Amplatzer plug followed by planned endovascular aortic aneurysm repair. The patient showed significant improvement in symptoms and reduction in aneurysm size post-procedure leading to avoidance of the open-heart surgery. This case highlights the effectiveness of the percutaneous approach in high-risk surgical patients with PVL and complex anatomical considerations.
Collapse
Affiliation(s)
- Saad Ur Rahman
- Internal Medicine, Carle Illinois College of Medicine, Urbana, USA
- Internal Medicine, Carle Health, Urbana, USA
| | | | | | - Naveed Adoni
- Interventional Cardiology, Carle Foundation Hospital, Urbana, USA
| | - Sanjay Mehta
- Cardiology, Carle Foundation Hospital, Urbana, USA
| |
Collapse
|