Extravascular Migration of a Stentgraft Into the Bladder: A Rare Complication After Endovascular Treatment of an Arterio-Ureteral Fistula

Endovascular repair has gained acceptance for the treatment of arterio-ureteral fistula (AUF). However, data on associated postoperative complications are relatively scarce. We report the case of a 59-year-old woman with an external iliac artery (EIA)-ureteral fistula treated by endovascular stentgraft placement. Hematuria resolved after the procedure; however, occlusion of the left EIA and migration of the stentgraft into the bladder occurred 3 months postoperatively. Endovascular repair is a safe and effective method for the treatment of AUF, but it needs to be carefully followed. Extravascular migration of a stentgraft is a rare but possible complication.

[Results of elective endovascular repair of infrarenal aortic and common iliac artery aneurysms]

Bevezetés: Napjainkban az infrarenalis aorta aneurysmák miatt végzett beavatkozások háromnegyede endovascularisan történik, melynél a nyitott műtéthez képest alacsonyabb perioperatív morbiditással és mortalitással, rövidebb kórházi tartózkodással, kevesebb korai szövődménnyel, de több hosszú távú komplikációval számolhatunk. Célkitűzés: A Pécsi Tudományegyetem Érsebészeti Klinikáján 2010 és 2020 között infrarenalis aorta és/vagy arteria iliaca communis aneurysma miatt végzett elektív sztentgraftbeültetések eredményeit vizsgáltuk. Módszer: Retrospektív analízisünkben a betegek demográfiai adatai, társbetegségei, a halálozás, a hospitalizációs idő és a posztoperatív intenzív osztályos megfigyelés időtartama mellett vizsgáltuk az intraoperatív, korai és késői szövődményeket, illetve a közöttük fennálló összefüggéseket. Eredmények: 274 eset került beválogatásra. Intraoperatív szövődményt 42 alkalommal (15,33%) észleltünk, 7 esetben (2,56%) endoleaket. A korai időszakban 9 (3,28%), a posztoperatív első évben 14 betegünk hunyt el (5,11%). A korai szövődmények között 3 endoleaket (1,09%) és 1 aneurysmazsák-rupturát (0,36%) detektáltunk. A sztentgraftspecifikus szövődmények közül a leggyakoribbak az endoleak voltak (n = 68, 24,82%). A vizsgálati periódus során az intenzív osztályra helyezett betegek száma és a hospitalizációs idő is szignifikánsan csökkent. Diabetes mellitus mellett szignifikánsan ritkábbak voltak a korai szövődmények, dohányzás mellett közel kétszeres, hyperlipidaemia mellett viszont kétharmadnyi volt a sztentgraftspecifikus szövődmények esélye. Következtetés: A vizsgálati periódusban klinikánkon infrarenalis elektív sztentgraftbeültetéseknél rövidült a hospitalizációs idő, egyre kevesebb beteg került intenzív osztályos posztoperatív megfigyelésre, míg kapcsolatot találtunk a dohányzás, a diabetes és a hyperlipidaemia jelenléte, valamint a szövődmények megjelenési esélye között. Fontos kiemelni azonban, hogy az endovascularis eszközök rapid fejlődése és az alacsony esetszám miatt a speciális szövődmények hatékony követési és kezelési stratégiájának meghatározása sokszor individuális döntést igényel. Orv Hetil. 2023; 164(50): 1993–2000.

[The Cannulation of the Arteriovenous Fistula in the Presence of a Stent: Precautions, Risks, and Possibilities]

A proper management and tailored interventions represented two fundamental steps to ensure a long-term use of the arteriovenous fistula (AVF). AVF failure can be attributed to various factors, with stenosis being the most common cause. Different techniques are employed for treating complications, but percutaneous endovascular procedures are the most widely used. In addition to angioplasty (PTA), the possibility of utilizing stents, particularly stent grafts (SG), has further improved outcomes. However, the insertion of these devices involves commitment to a segment of the vessel, which may vary in length, making the indication necessitate a careful evaluation. The positioning of a stent graft indeed limits the space for needle insertion, and on the other hand, the cannulation of the device is considered off-label according to technical specification. This work addresses the issue of puncturing these devices. Alongside a rapid overview, we describe a clinical case of continuous cannulation of a multiply stented AVF, for over 9 years, which opens up the discussion about the possibility of long-term cannulation through proper planning.

U-bent Viabahn stent graft in the main left pulmonary artery in a hemodialysis patient after asymptomatic migration: Percutaneous removal and technical considerations

BACKGROUND

Stent grafts (SG) have gained the highest level of evidence for superior management over angioplasty of arteriovenous graft (AVG) venous outflow stenosis, which increases their use in hemodialysis patients. Migration to the heart and lungs is the most feared complication of SG of the venous system.

METHOD

We present a previously unreported case of asymptomatic migration of a 10-cm-long Viabahn lodged in a U-shaped configuration in the main left pulmonary artery after AVG intervention in a 50 year old male hemodialysis patient.

RESULTS

Through a single femoral access percutaneous retrieval of migrated SG was accomplished. Technique of coaxial buddy snaring technique is described.

CONCLUSION

Our technique may expand the endovascular likelihood of successful stent removal.

Complex Aortic Interventions Can Be Safely Introduced to the Clinical Practice by Physicians Skilled in Basic Endovascular Techniques

Our purpose was to evaluate the risk associated with the learning curve of starting a complex aortic programme in an Eastern European country. A retrospective study was conducted involving the initial 20 patients (16 males, mean age: 65 ± 11 years) undergoing fenestrated/branched endovascular aortic repair in a single centre. Demographic, anatomical, procedural, and postoperative variables were collected. Our elective patient cohort consisted of 9 pararenal aneurysms (45%) and 11 thoracoabdominal aortic aneurysms (55%), with the latter including 4 chronic dissection cases (20%). A total of 71 branch vessels were incorporated (3.5 ± 0.9 per patient). The per vessel technical success rate was 100%. In-hospital mortality was 5% (1/20). At an average follow-up of 14 ± 22 months, the primary clinical success rate was 45% (9/20) and the secondary clinical success was achieved in 75% of cases (15/20). All-cause mortality at 14 months was 20% (4/20; aortic related: 1/20, 5%). Four bridging stent occlusions were found (5.6%). Mortality and reintervention rates were comparable to the initial results of high-volume centres, while the complexity of our cases and the per vessel technical success rate was comparable to the values reported as late experience. The morbidity of the learning curve could be decreased if operators are skilled in basic endovascular procedures.

A Very Rare Cause of Thrombotic Peripheral Occlusion

A 45-year-old healthy woman presented with claudication of the right leg. The resting ankle-brachial index (ABI) was reduced to 0.6, and a duplex scan revealed an occlusion of the right popliteal artery. Angiography presented a patent superficial femoral artery that ends above the knee joint. Laterally, there was delayed retrograde contrast filling of the popliteal artery. After exploring the internal iliac artery, we crossed a thrombotic occlusion of a persisting sciatic artery (PSA). Local thrombolysis with recombinant tissue plasminogen activator (1 mg/h) was initiated. The Angiography 18 hours later showed a reduction of thrombotic material and relevant stenosis in the proximal part of the vessel. Residual thrombus and the stenosis were covered by two stentgrafts (Gore Viabahn Endoprosthesis) that were stabilized by an interwoven stent (Supera). Final angiography displayed a patent sciatic artery and a three-vessel run off. Postinterventional ABI was normalized to 1.0. The magnetic resonance imaging 6 days after the intervention demonstrated a patent PSA again and a normal blood flow on the left leg. A PSA should be included in the differential diagnosis of lower limb ischemia or suspected aneurysm formation. We demonstrated the feasibility of an interventional approach with an excellent outcome in this case.

Ruptured infected popliteal artery aneurysm treated with endovascular therapy: A case report

An 86-year-old woman was admitted for a ruptured popliteal artery aneurysm (rPAA, 26 × 28 mm). Due to the patient’s age and comorbidities, emergency endovascular repair was performed. After the failed antegrade guidewire crossing, a retrograde approach from the anterior tibial artery and snaring was performed for lesion crossing, and stentgraft (5 × 50 mm) was deployed from antegrade fashion. At the 14-month follow-up, computed tomography angiogram demonstrated stentgraft patency and reduced aneurysmal size. Although open surgery remains the first-line treatment for infected rPAA, our approach adds to the evidence and can be applied to emergency cases or high-risk surgical patients.

Balloon Fragment Technique Used to Close Distal Coronary Vessel Perforation

AIMS

Coronary artery perforation is a rare but potentially serious complication of percutaneous coronary intervention (PCI). Clinical manifestation and prognosis of patients depend on the severity of the complication, the occurrence of tamponade, and the methods of treatment. A special type of perforation is caused by damage to the distal segment of the coronary vessel by guidewire. This type of perforation is mostly connected with subacute clinical presentation. The treatment can be difficult, especially when prolonged balloon inflation is not efficient. The aim of the article is to present a balloon fragment technique as a treatment method for distal vessel perforation.

METHODS

The method of treating distal perforation, which we presented at EuroPCR 2019, involves embolization of a perforated vessel with a cut part of balloon catheter. Six patients are included in this registry; only 1 truncated proximal balloon fragment was enough to effectively embolize the perforated vessel in 4 patients, while 2 balloons were required in 1 patient and 3 balloons were required in 1 patient.

CONCLUSION

Compared with other methods, this technique is an easy, cheap, and effective treatment for distal vessel perforation. The described method is available in every catheterization laboratory and does not require expensive equipment or exceptional operator experience.

Aorto-caval fistula - case report

Aorto-caval fistula can be associated with abdominal aortic aneurysm. The fistula can manifest with nonspecific symptoms. The rupture of abdominal aortic aneurysm is one of the leading symptoms. The symptoms and the necessity of treatment are related to these acute conditions. This article describes the case of a 78 years old man with a huge abdominal aortic aneurysm and aorto-caval fistula that was presented with a sudden onset of abdominal pain, dyspnoea, hypotension and cardiac insufficiency with an acute cor pulmonale. Urgent surgery was performed - aneurysm resection with transaortic suture of the fistula and aortic replacement using a Dacron graft. Resuscitation and defibrillation were needed during the surgery due to fibrillation cardiac arrest, which were successful. The post-operative period was complicated with a persisting consciousness disorder of the patient and persisting myocardial ischaemia, resulting in the patients death 3 weeks after the surgery. The aim of this report is to point out the severity of this condition, the various treatment options of this uncommon disease with an uncertain prognosis, and also the importance of a multidisciplinary approach, essential in the entire treatment process as well as in the primary diagnosis.

Impact of hybrid thoracoabdominal aortic repair on visceral and spinal cord perfusion: The new and improved SPIDER-graft

OBJECTIVES

SPIDER-graft for thoracoabdominal aortic aneurysm repair avoiding thoracotomy and extracorporeal circulation was modified, enabling reimplantation of lumbar arteries to prevent spinal cord ischemia and compared with open aortic repair (control) in a pig model.

METHODS

Graft implantation was performed in 7 pigs per group (75-85 kg). For SPIDER-graft (groups I and II), the infra-diaphragmatic aorta was exposed through retroperitoneal access. The right iliac branch was first temporarily anastomosed end-to-side to the distal aorta maintaining periprocedural retrograde visceral perfusion. SPIDER-graft was deployed in the descending thoracic aorta via the celiac artery ostium. The celiac, superior mesenteric, and renal arteries were successively connected to the corresponding side branches of the graft. In group II, the lumbar arteries were reimplanted into the former access branch. For control, complete thoracoabdominal exposure of the aorta was required. After crossclamping, proximal anastomosis was performed, and the celiac artery, superior mesenteric artery, renal arteries, and iliac arteries were reattached. Technical feasibility, ischemic times, blood flow, and visceral and spinal cord perfusion in the related organs were evaluated before implantation and 3 and 6 hours after implantation using transit-time flow measurement and fluorescent microspheres.

RESULTS

Technical success was achieved in all animals in all groups. Total aortic clamping time and selective ischemic times of related organs were significantly longer during open aortic repair compared with groups I and II (P < .0001). Fluorescent microspheres confirmed best spinal cord perfusion in group II.

CONCLUSIONS

SPIDER-graft reduced ischemic time, avoided extracorporeal circulation and thoracotomy, and improved spinal cord perfusion during thoracoabdominal aortic aneurysm repair in a pig model.

[Open and endovascular repair of iliac artery aneurysms]

INTRODUCTION AND AIM

Iliac artery aneurysms make up 2% of all aneurysms. There are only a few data available on the results of surgical treatment, therefore the optimal treatment is unclear. Our objective was the retrospective analysis of the perioperative morbidity and mortality of patients who underwent iliac artery surgery as well as the comparison of elective open surgery and endovascular iliac aneurysm repair (EVIAR).

METHOD

Retrospective analysis of patients who underwent surgery for iliac artery aneurysm between 1 January 2005 and 31 December 2014.

RESULTS

During the 10-year period, 62 patients with a mean age of 68.9 years underwent elective surgery for iliac artery aneurysm (54 males, 87.1%). In 10 cases acute surgery was performed due to aneurysm ruptures (13.9%), 3 patients died within the perioperative period (30%). Regarding anatomical localisation, aneurysm developed mostly on the common iliac artery (80.6%). As an elective surgery, 35 patients (56.5%) underwent open surgery, 25 (40.3%) underwent EVIAR and other endovascular interventions were performed in 2 cases (3.2%). Postoperative complications (1 patient [4.0%] vs. 17 patients [48.5%]; p<0.001) and intensive care treatment (29 patients [82.8%] vs. 2 patients [8.0%]; p<0.001) were significantly rarer after EVIAR than after open surgery. Furthermore, EVIAR resulted in considerably shorter postoperative hospital stays (4.7 ± 2.3 days vs. 11.8 ± 12.2 days; p = 0.006) and significantly less blood transfusion demand (1 patient [4.0%] vs. 26 patients [74.2%]; p<0.001). There were no significant differences regarding long-term survival rates between EVIAR and open surgery (81.4% vs. 71.4%; p = 0.95).

CONCLUSION

In case of the surgical treatment of iliac artery aneurysms, owing to the lower complication rates and shorter postoperative length of stay, EVIAR is primarily recommended. Orv Hetil. 2018; 159(13): 520-525.

[Thoracic aortic stentgraft implantations in Hungary from 2012 to 2016]

Thoracic aortic endograft implantation has become a widespread procedure in recent years, yet no report is available about Hungarian outcomes. Examination of our results is crucial to define further treatment strategies. Analysis of perioperative data from Hungarian thoracic endograft implantations based on the experience of 5 years is presented. Our retrospective, multicentric study analysed voluntarily reported data from all Hungarian institutions where thoracic endograft implantations are performed. Information was collected from every procedure performed in 5 years. Between 2012 and 2016, 131 thoracic stent graft implantations were performed in Hungary (67.18% male, mean age 62.80 years). 25.19% of the procedures were acute. 13.74% of the patients were diabetic. Indications for the procedure were aneurysm (64.89%), dissection (17.56%), aortic trauma (6.87%) and other conditions (10.69%). 73.91% of the dissection cases were acute. 16.47% of repaired aneurysms were ruptured. Additional preoperative revascularization (debranching) was performed in 26.72% of the cases. Postoperative stroke occured in 4.58%, temporary hemodialysis was needed in 1.53%, bowel ischaemia was present in 2.29% and reoperation within 30 days was needed in 5.34% of all cases. Thirty-day mortality of the procedure was 9.92%, 5-year long-term mortality reached 16.03%. Endovascular repair of the thoracic aorta is an effective procedure and our national data comfirmed its advantages compared to open thoracic surgery. Further use of the procedure in Hungary depends on the centralised care in vascular surgery and financial matters. Multidisciplinary cooperation and proper logistics are needed to provide patients with optimal treatment. Orv Hetil. 2018; 159(2): 53-57.

Post-traumatic acute thoracic aortic injury (TAI)-a single center experience

Background

We assess the effectiveness and our experience in emergency thoracic endovascular aortic repair (TEVAR) in patients with post-traumatic acute thoracic aortic injury (TAI) and associated multiorgan trauma. TAI is a life-threatening condition. It usually results from a sudden deceleration caused by vehicle accident, a fall or some other misfortune. Techniques of endovascular aortic repair have become promising methods to treat emergent TAI.

Methods

Since 2007, 114 patients with thoracic aorta pathologies have been treated by TEVAR. Our study involved 15 (incl. 14 men) of them (13%) who underwent stent graft implantation for post-traumatic either aortic rupture or pseudoaneurysm. The procedural access was limited to small skin incision in one groin and percutaneous puncture of the contralateral femoral artery. We evaluated technical success, early and long-term mortality, complication rate of procedure and throughout clinical and instrumental follow-up.

Results

Technical success rate was 100%. All patients survived the endovascular interventions. No additional procedures or conversions to open surgery were necessary. After the operation, none of the patients had symptoms of stroke or spinal cord ischemia (SCI). No serious stent-graft-related adverse events such as endoleak, infection or migration were noted during follow-up period that ranged from 6 to 108 months.

Conclusions

In our department, techniques of TEVAR with stentgraft implantation have become methods of choice in treatment of traumatic TAIs since they have enabled to minimize operational risk, particularly in unstable multitrauma patients in severe clinical status. TEVAR for TAI performed in emergency settings provide favorable long-term results.

[Endovascular treatment of blunt thoracic aortic injuries]

INTRODUCTION

A new era has begun in the last two decades with the advent of endovascular methods in the therapy of blunt thoracic aorta injuries. Our experiences with the endovascular interventions of blunt aortic trauma in the Cardiovascular Center of Semmelweis University are summarised here.

METHODS

We included those patients who underwent endovascular intervention due to blunt aortic trauma in a university hospital between 1998 and 2014. The statistical analysis was performed with the use of Excel.

RESULTS

41 patients were selected from our database. There were 34 males, the average age was 47 years (±17 years). Among the 41 patients 15 underwent an acute procedure (12 ruptures) and 26 patients received delayed treatment (in 4 cases due to growing of the pseudoaneurysm). There was only one early postoperative death. Late mortality was 22.5% and 7.5% was related to the aortic injury.

CONCLUSION

Our late mortality and complication rates were similar to other studies, which reinforces international experiences. In the cases when delayed treatment is feasible, the patient can be stabilized and the CTA images can be analyzed for precise stentgraft planning. The treatment of blunt thoracic aorta injured patients should take place in specialized centers capable of such endovascular interventions.

The Impact of Stent Graft Material on the Inflammatory Response After EVAR

BACKGROUND

Patients undergoing endovascular aneurysm repair (EVAR) due to abdominal aortic aneurysm often develop an inflammatory response, postimplantation syndrome (PIS) where fever and leukocytosis are common. Previous studies suggest that type of stent graft material (polyester or polytetrafluoroethylene [PTFE]) plays a role.

OBJECTIVES

To investigate the effect of stent graft material on the inflammatory response and length of hospital stay in patients undergoing standard elective EVAR.

METHODS

Sixty-nine elective EVAR patients were included in this observational study. To avoid comparing patients with a different graft location and stent graft burden, 12 cases were excluded as well as cases with complication or simultaneous open surgical procedures, leaving 45 patients (32 with polyester and 13 with PTFE graft) for final analysis. Tympanic temperature, C-reactive protein (CRP), white blood cell (WBC), and procalcitonin (PCT) were measured on days -1 and +1 and +3. Duration of in-hospital stay and frequency of PIS were recorded.

RESULTS

The PIS was diagnosed in 9 (28.1%) of the 32 polyester cases and in 1 (7.7%) of the 13 cases in the PTFE group (P = .24). Median (interquartile range) in-hospital stay was 5 (5-6) days in the polyester group and 4 (4-5) days in the PTFE group (P = .009). On day +3, in the polyester group, mean CRP was 154 (95% confidence interval: 127-182) mg/L, WBC 9.5 (8.4-10.5) ×10(9)/L, and PCT 0.17 (0.12-0.21) ng/mL. In the PTFE group, mean CRP was 70 (32-109) mg/L (P = .001), WBC 8.8 (6.4-11.1) ×10(9)/L (P = .37), and PCT 0.09 (0.06-0.13) ng/mL (P = .009) on day +3.

CONCLUSION

Standard EVAR with polyester stent grafts appears to result in a trend toward a more pronounced inflammatory reaction than similar EVAR using PTFE and is associated with a longer in-hospital stay.

[Early and late mortality and morbidity after elective repair of infrarenal aortic aneurysm]

INTRODUCTION

The open repair (OR) of infrarenal aortic aneurysm (AAA) has low mortality in tertiary care centres, however, endovascular repair (ER) could be more beneficial for some cases. The aim of our study was to compare the mortality and morbidity of the different AAA repair techniques.

MATERIAL AND METHODS

In a single centre retrospective study we evaluated the postoperative complications, the early and late mortality of patients underwent open or endovascular AAA repair.

RESULTS

Total of 431 patients underwent OR and 59 had ER. Early mortality was below 2% in both groups (statistically non-significant [NS] difference). Postoperative complications were found in 14.4% in the OR group and 11.9% in the ER group (NS). The intraoperative blood loss and use of blood products were higher, the operation time was significantly longer in the OR group (p < 0.001). The average follow-up time was 37 ± 22 months. Long term mortality and the prevalence of stroke and acute myocardial infarction were similar in both groups. 16% of the patients in the OR group developed incisional hernia. Patients after ER needed further vascular intervention more frequently than patients in the OR group (16.2% vs. 6.2%; p = 0.0327).

CONCLUSION

The early and late mortality was similar after open and endovascular AAA repair. Postoperative complications did not show significant difference between the two groups. We found significant difference in the use of blood products, the prevalence of incisional hernias and the number of reinterventions. According to our results, stent graft implantation is mainly recommended in high risk patients and open aortic repair still has a role in the low-moderate operative risk group.

Acute endovascular repair of iatrogenic right internal carotid arterial laceration

Carotid arterial bleeding is a feared and possible life-threatening complication of transsphenoidal surgery. We present a case of a meningioma that during resection had a serious complication with laceration of the internal carotid artery (ICA). These patients rarely undergo endovascular treatment, with indications mainly due to the development of pseudoaneurysms or penetrating trauma. However, endovascular treatment with covered stents of carotid arterial bleedings is a feasible alternative due to technical advances and smaller sized stentgrafts that expand treatment options.

Innovative application of available stent grafts in Japan in aortic aneurysm treatment-significance of innovative debranching and chimney method and coil embolization procedure

OBJECTIVE

We here describe our experience with innovative uses of these devices.

PATIENTS AND METHODS

We reviewed treatment outcomes of 310 endovascular abdominal aortic repair (EVAR) and 83 thoracic endovascular aortic repair (TEVAR) cases performed between August 2007 and February 2012. We separately assessed results in elderly and high-risk patients who had a novel procedure. This group included 94 patients who underwent EVAR with IIA embolization, 10 patients who had EVAR and a renal artery chimney procedure for a short aortic neck, 20 patients who had two de-branching TEVAR or Chimney method for thoracic aortic aneurysms (TAA) and 3 patients who had debranching TEVAR for thoracic abdominal aortic aneurysms (TAAA).

RESULTS

Of the 393 patients given stent grafts (SGs), 3 (0.8%) died in the hospital, including 1 patient with pneumonia who underwent EVAR and IIA embolization and 1 patient with a cerebral infarction who had TEVAR. Four patients (4.3%) who were treated with EVAR with internal iliac artery (IIA) embolization presented with residual buttock claudication 6 months postoperatively, and 3 patients (3.2%) had onset of ischemic enteritis; however, in all 7 patients, the condition resolved without additional intervention. In the 10 patients who had EVAR and a renal artery chimney method, the landing zone (LZ) was ≤10 mm, but neither endoleak nor renal artery occlusion was observed perioperatively or during midterm follow-up. Of the 20 patients who had a 2-debranching TEVAR, including 9 in whom the chimney method was used with the LZ in zone 0, 1 (5%) had a residual endoleak. In 3 patients with TAAA, we used SGs to cover 4 abdominal branches and bypassed the visceral artery; the outcomes were good, with all patients being ambulatory at hospital discharge.

CONCLUSION

Among innovative SGs treatments, the debranching procedure and the chimney method using catheterization and the coil-embolization technique provided good outcomes, as used in addition to surgical procedures. Aortic aneurysm treatment will become increasingly noninvasive with the continuing development of more innovative ways to use the SGs currently available in Japan. (English Translation of Jpn J Vasc Surg 2012; 21: 165-173).

Open surgery for abdominal aortic aneurysm in the era of endovascular repair: comparison with long term results of endovascular repair using zenith stentgraft

OBJECTIVE

Our study focuses on the long term result of open surgery and endovascular abdominal aortic aneurysm repair (EVAR) using the Zenith stentgraft.

PATIENTS AND METHODS

A total of 237 patients underwent elective abdominal aortic aneurysm (AAA) repair between April 1999 and December 2006. Nineteen patients underwent EVAR, whereas 218 patients underwent open surgery. The mean follow-up time for EVAR group was 73.8 ± 49 months (range; 25-150 months), and 69.7 ± 46 months (range; 1-156 months) for open surgery group.

RESULTS

One open surgery patient (1/218, 0.46%) died of aspiration pneumonia, whereas all the EVAR patients survived the operation. Remote complications requiring reintervention occurred in 8 patients (8/174, 4.6%) in open surgery group. Six EVAR patients (6/19, 31.6%) developed late aneurysm expansion, among whom four patients (4/19, 21.1%) required reinterventions after 3 or more years postoperatively. The need for reintervention persisted even at 11 years after initial EVAR. There was no significant intergroup difference in late mortality.

CONCLUSIONS

There was no statistically significant intergroup difference in early and long term mortality. Complications requiring reinterventions, however, were more frequent in EVAR than in open surgery, especially in the late period. Long term follow-up is mandatory for comparison of the clinical results between open surgery and EVAR.

Hybrid repair combined with open surgery and endografting for lesions in right aortic arch: report of three cases

Three cases with lesions in the right aortic arch (RAA) are presented. For two patients, whose RAA contained a retroesophageal segment, the primary treatment was total arch replacement (TAR) for acute type A dissection or severe arch angulation with thoracic endovascular aneurysm repair (TEVAR) as second-stage surgery. The third patient, who had RAA with mirror image branching, underwent supra-aortic bypass followed by TEVAR. There was no operative mortality, but the condition of two patients who underwent TAR was complicated by bilateral recurrent nerve palsy, which can be critical. The combination of TEVAR and supra-aortic bypass might thus be preferable for patients with RAA.

Two-stage Surgery for Endovascular Repair and Laparoscopic Colectomy for a Patient with Abdominal Aortic Aneurysm and Concomitant Colon Cancer: Report of a Case

Surgical management of abdominal aortic aneurysm (AAA) with concomitant malignancy remains controversial. Commercial availability of a stentgraft may change the treatment strategy for such patients. We present a case of AAA with concomitant colon cancer, in which two-stage surgery consisting of EVAR and subsequent laparoscopic colectomy was performed with an interval of six days. The patient's postoperative course was uneventful. For high-risk patients, application of endovascular AAA repair and laparoscopic surgery may decrease the risk of surgical morbidity and mortality.