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Nauta FJH, Conti M, Kamman AV, van Bogerijen GHW, Tolenaar JL, Auricchio F, Figueroa CA, van Herwaarden JA, Moll FL, Trimarchi S. Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection. J Endovasc Ther 2015; 22:918-33. [DOI: 10.1177/1526602815608848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.
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Buck DB, Curran T, McCallum JC, Darling J, Mamtani R, van Herwaarden JA, Moll FL, Schermerhorn ML. Management and outcomes of isolated renal artery aneurysms in the endovascular era. J Vasc Surg 2015; 63:77-81. [PMID: 26386509 DOI: 10.1016/j.jvs.2015.07.094] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/26/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Isolated renal artery aneurysms are rare, and controversy remains about indications for surgical repair. Little is known about the impact of endovascular therapy on selection of patients and outcomes of renal artery aneurysms. METHODS We identified all patients undergoing open or endovascular repair of isolated renal artery aneurysms in the Nationwide Inpatient Sample from 1988 to 2011 for epidemiologic analysis. Elective cases were selected from the period 2000 to 2011 to create comparable cohorts for outcome comparison. We identified all patients with a primary diagnosis of renal artery aneurysms undergoing open surgery (reconstruction or nephrectomy) or endovascular repair (coil or stent). Patients with concomitant aortic aneurysms or dissections were excluded. We evaluated patient characteristics, management, and in-hospital outcomes for open and endovascular repair, and we examined changes in management and outcomes over time. RESULTS We identified 6234 renal artery aneurysm repairs between 1988 and 2011. Total repairs increased after the introduction of endovascular repair (8.4 in 1988 to 13.8 in 2011 per 10 million U.S. population; P = .03). Endovascular repair increased from 0 in 1988 to 6.4 in 2011 per 10 million U.S. population (P < .0001). However, there was no concomitant decrease in open surgery (5.5 in 1988 to 7.4 in 2011 per 10 million U.S. population; P = .28). From 2000 to 2011, there were 1627 open and 1082 endovascular elective repairs. Patients undergoing endovascular repair were more likely to have a history of coronary artery disease (18% vs 11%; P < .001), prior myocardial infarction (5.2% vs 1.8%; P < .001), and renal failure (7.7% vs 3.3%; P < .001). In-hospital mortality was 1.8% for endovascular repair, 0.9% for open reconstruction (P = .037), and 5.4% for nephrectomy (P < .001 compared with all revascularization). Complication rates were 12.4% for open repair vs 10.5% for endovascular repair (P = .134), including more cardiac (2.2% vs 0.6%; P = .001) and peripheral vascular complications (0.6% vs 0.0%; P = .014) with open repair. Open repair had a longer length of stay (6.0 vs 4.6 days; P < .001). After adjustment for other predictors of mortality, including age (odds ratio [OR], 1.05 per decade; 95% confidence interval [CI], 1.0-1.1; P = .001), heart failure (OR, 7.0; 95% CI, 3.1-16.0; P < .001), and dysrhythmia (OR, 5.9; 95% CI, 2.0-16.8; P = .005), endovascular repair was still not protective (OR, 1.6; 95% CI, 0.8-3.2; P = .145). CONCLUSIONS More renal artery aneurysms are being treated with the advent of endovascular techniques, without a reduction in operative mortality or a reduction in open surgery. Indications for repair of renal artery aneurysms should be re-evaluated.
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de Jonge JC, Zandvoort HJA, Vonken EJPA, Moll FL, van Herwaarden JA. Through-Plane Movement at Multiple Aortic Levels on Dynamic Computed Tomography Angiography Is Limited in Patients With an Abdominal Aortic Aneurysm. J Endovasc Ther 2015; 22:765-9. [PMID: 26276554 DOI: 10.1177/1526602815601402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze the movement of the aorta in the craniocaudal direction (through-plane movement) during the cardiac cycle at several levels to determine any potential impact on endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS For this study, 30 patients (median age 73.0 years; 27 men) with an infrarenal AAA were randomly selected from a prospectively maintained EVAR database. All patients had undergone preoperative electrocardiogram-gated computed tomography angiography consisting of 8 phases. After semiautomatic segmentation, a 3-dimensional location probe was placed in the center of the aorta (center point) on the orthogonal slices at 12 different levels along the aorta and iliac arteries for all 8 phases. Movement of the center point during the cardiac cycle was analyzed for each level. Values are given as the median and interquartile range (IQR). RESULTS The median through-plane movement of all levels was 3.0 mm (IQR 2.8-3.2) and appeared to be lower in the region of the celiac and renal arteries: 2.6 mm (IQR 1.7-3.1) at 3 cm proximal to the most distal renal artery and 2.4 mm (IQR 1.9-2.9) at 1 cm distal to the most distal renal artery, respectively. The thoracic part of the aorta showed the largest through-plane motion: 4.1 mm (IQR 2.7-4.6). CONCLUSION This study quantifies aortic through-plane motion in the craniocaudal direction. Since through-plane movement appears to be limited, findings of previous studies investigating pulsatile in-plane distension seem to be representative for aortic distension.
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Kamman AV, Jonker FHW, Nauta FJH, Trimarchi S, Moll FL, van Herwaarden JA. A review of follow-up outcomes after elective endovascular repair of degenerative thoracic aortic aneurysms. Vascular 2015; 24:208-16. [DOI: 10.1177/1708538115588648] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Long-term outcomes of elective thoracic endovascular aortic repair (TEVAR) for degenerative thoracic aortic aneurysms (TAA) are not well defined. A review of the literature on the follow-up outcomes of elective TEVAR for degenerative TAA resulted in 22 relevant articles. Two- and five-year freedom from aneurysm-related death varied between 93.0% and 100.0%, and 82.4% to 92.7%, respectively. Two-year and five-year all-cause survival ranged between 68.0% and 97.2% and 47.0% to 78.0%, respectively. Follow-up ranged between 17.3 and 66.0 months. Most common endograft-related complication was endoleak, with reported rate between 1.4% and 14.8% during six months up to five years of follow-up. Endovascular reinterventions were reported in 0.0–32.3%, secondary open surgery was needed in 0.0% to 4.7% during follow-up. Aneurysm-related survival rates after elective TEVAR for degenerative TAA are acceptable. However, reported incidences of endograft-related complications vary considerably in the literature, but the majority can be managed with conservative treatment or additional endovascular procedures.
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Hurks R, Ultee KHJ, Buck DB, DaSilva GS, Soden PA, van Herwaarden JA, Verhagen HJM, Schermerhorn ML. The impact of endovascular repair on specialties performing abdominal aortic aneurysm repair. J Vasc Surg 2015; 62:562-568.e3. [PMID: 25953013 DOI: 10.1016/j.jvs.2015.03.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) repair has been performed by various surgical specialties for many years. Endovascular aneurysm repair (EVAR) may be a disruptive technology, having an impact on which specialties care for patients with AAA. Therefore, we examined the proportion of AAA repairs performed by various specialties over time in the United States and evaluated the impact of the introduction of EVAR. METHODS The Nationwide Inpatient Sample (2001-2009) was queried for intact and ruptured AAA and for open repair and EVAR. Specific procedures were used to identify vascular surgeons (VSs), cardiac surgeons (CSs), and general surgeons (GSs) as well as interventional cardiologists and interventional radiologists for states that reported unique treating physician identifiers. Annual procedure volumes were subsequently calculated for each specialty. RESULTS We identified 108,587 EVARs and 85,080 open AAA repairs (3011 EVARs and 12,811 open repairs for ruptured AAA). VSs performed an increasing proportion of AAA repairs during the study period (52% in 2001 to 66% in 2009; P < .001). GSs and CSs performed fewer repairs during the same period (25% to 17% [P < .001] and 19% to 13% [P < .001], respectively). EVAR was increasingly used for intact (33% to 78% of annual cases; P < .001) as well as ruptured AAA repair (5% to 28%; P < .001). The proportion of intact open repairs performed by VSs increased from 52% to 65% (P < .001), whereas for EVAR, the proportion went from 60% to 67% (P < .001). The proportion performed by VSs increased for ruptured open repairs from 37% to 53% (P < .001) and for ruptured EVARs from 28% to 73% (P < .001). Compared with treatment by VSs, treatment by a CS (0.55 [0.53-0.56]) and GS (0.66 [0.64-0.68]) was associated with a decreased likelihood of undergoing endovascular rather than open AAA repair. CONCLUSIONS VSs are performing an increasing majority of AAA repairs, in large part driven by the increased utilization of EVAR for both intact and ruptured AAA repair. However, GSs and CSs still perform AAA repair. Further studies should examine the implications of these national trends on the outcome of AAA repair.
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Buck DB, Bensley RP, Darling J, Curran T, McCallum JC, Moll FL, van Herwaarden JA, Schermerhorn ML. The effect of endovascular treatment on isolated iliac artery aneurysm treatment and mortality. J Vasc Surg 2015; 62:331-5. [PMID: 25943454 DOI: 10.1016/j.jvs.2015.03.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/11/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Isolated iliac artery aneurysms are rare, but potentially fatal. The effect of recent trends in the use of endovascular iliac aneurysm repair (EVIR) on isolated iliac artery aneurysm-associated mortality is unknown. METHODS We identified all patients with a primary diagnosis of iliac artery aneurysm in the National Inpatient Sample from 1988 to 2011. We examined trends in management (open vs EVIR, elective and urgent) and overall isolated iliac artery aneurysm-related deaths (with or without repair). We compared in-hospital mortality and complications for the subgroup of patients undergoing elective open and EVIR from 2000 to 2011. RESULTS We identified 33,161 patients undergoing isolated iliac artery aneurysm repair from 1988 to 2011, of which there were 9016 EVIR and 4933 open elective repairs from 2000 to 2011. Total repairs increased after the introduction of EVIR, from 28 to 71 per 10 million United States (U.S.) population (P < .001). EVIR surpassed open repair in 2003. Total isolated iliac artery aneurysm-related deaths, due to rupture or elective repair, decreased after the introduction of EVIR from 4.4 to 2.3 per 10 million U.S. population (P < .001). However, urgent admissions did not decrease during this time period (15 to 15 procedures per 10 million U.S. population; P = .30). Among elective repairs after 2000, EVIR patients were older (72.4 vs 69.4 years; P = .002) and were more likely to have a history of prior myocardial infarction (14.0% vs 11.3%; P < .001) and renal failure (7.2% vs 3.6%; P < .001). Open repair had significantly higher rate of in-hospital mortality (1.8% vs 0.5%; P < .001) and complications (17.9% vs 6.7%; P < .001) and a longer length of stay (6.7 vs 2.3 days; P < .001). CONCLUSIONS Treatment of isolated iliac artery aneurysms has increased since the introduction of EVIR and is associated with lower perioperative mortality, despite a higher burden of comorbid illness. Decreasing iliac artery aneurysm-attributable in-hospital deaths are likely related primarily to lower elective mortality with EVIR rather than rupture prevention.
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Timmers TK, van Herwaarden JA, de Borst GJ, Moll FL, Leenen LPH. Long-term survival and quality of life after open abdominal aortic aneurysm repair. World J Surg 2015; 37:2957-64. [PMID: 24132818 DOI: 10.1007/s00268-013-2206-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Open repair of abdominal aortic aneurysm (AAA) generally involves postsurgery admission to the intensive care unit (ICU). Few studies have evaluated the impact of surgery for either ruptured or nonruptured AAA (with postoperative ICU treatment) on long-term survival and quality of life. The primary aim of this study was to quantify long-term survival and health-related quality of life (HrQpL) of a cohort of patients undergoing open AAA repair after hospital discharge. METHODS Consecutive patients undergoing open elective or acute AAA reconstruction with postoperative admission to the ICU and discharged alive from the hospital during 2009 were identified. Primary outcome measures were 1-year and long-term mortality. The secondary outcome was the HrQoL using the EuroQol-6D (EQ-6D) questionnaire at the end of the follow-up period. RESULTS A total of 263 patients were treated and postoperatively discharged alive: 56 had a ruptured AAA (rAAA), 35 a symptomatic AAA, and 172 an asymptomatic AAA. The 1-year mortality after open AAA repair was 8 %. Overall, 39 % of patients died within 10 postoperative years (mean 6.0 ± 2.8 years). Long-term survival of patients with a ruptured or symptomatic aneurysm was similar to that of patients undergoing elective aneurysm repair. Long-term HrQoL of the total study population was worse than that of an age-matched general Dutch population on the EQ-us (range 0-1, difference 0.12). This decrease in HrQoL was mainly seen in mobility, self-care, usual activities, and cognition. CONCLUSIONS Ten years after open AAA repair, the overall survival rate was 59 %. Long-term survival and HrQoL were similar for patients with a repaired ruptured or symptomatic aneurysm and those who underwent elective aneurysm repair. There were also no differences in patients with infrarenal versus juxtarenal/suprarenal aneurysms. Surviving patients had a lower HrQoL than the age-matched general Dutch population, especially regarding mobility, self-care, usual activities, and cognition.
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Teraa M, van Herwaarden JA, Trimarchi S, Moll FL. Morphologic characteristics for treatment guidance in uncomplicated acute type B aortic dissection. Circulation 2015; 130:1723-5. [PMID: 25366834 DOI: 10.1161/circulationaha.114.010362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nelissen BGL, van Herwaarden JA, Moll FL, van Diest PJ, Pasterkamp G. SlideToolkit: an assistive toolset for the histological quantification of whole slide images. PLoS One 2014; 9:e110289. [PMID: 25372389 PMCID: PMC4220929 DOI: 10.1371/journal.pone.0110289] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022] Open
Abstract
The demand for accurate and reproducible phenotyping of a disease trait increases with the rising number of biobanks and genome wide association studies. Detailed analysis of histology is a powerful way of phenotyping human tissues. Nonetheless, purely visual assessment of histological slides is time-consuming and liable to sampling variation and optical illusions and thereby observer variation, and external validation may be cumbersome. Therefore, within our own biobank, computerized quantification of digitized histological slides is often preferred as a more precise and reproducible, and sometimes more sensitive approach. Relatively few free toolkits are, however, available for fully digitized microscopic slides, usually known as whole slides images. In order to comply with this need, we developed the slideToolkit as a fast method to handle large quantities of low contrast whole slides images using advanced cell detecting algorithms. The slideToolkit has been developed for modern personal computers and high-performance clusters (HPCs) and is available as an open-source project on github.com. We here illustrate the power of slideToolkit by a repeated measurement of 303 digital slides containing CD3 stained (DAB) abdominal aortic aneurysm tissue from a tissue biobank. Our workflow consists of four consecutive steps. In the first step (acquisition), whole slide images are collected and converted to TIFF files. In the second step (preparation), files are organized. The third step (tiles), creates multiple manageable tiles to count. In the fourth step (analysis), tissue is analyzed and results are stored in a data set. Using this method, two consecutive measurements of 303 slides showed an intraclass correlation of 0.99. In conclusion, slideToolkit provides a free, powerful and versatile collection of tools for automated feature analysis of whole slide images to create reproducible and meaningful phenotypic data sets.
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de Ruiter QMB, Moll FL, van Herwaarden JA. Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair. J Vasc Surg 2014; 61:256-64. [PMID: 25441011 DOI: 10.1016/j.jvs.2014.08.069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study reviewed the current developments in manual tracking and robotic navigation technologies for application in endovascular aortic aneurysm repair (EVAR). METHODS EMBASE and MEDLINE databases were searched for studies reporting manual tracking or robotic navigation systems that are able to manipulate endovascular surgical tools during abdominal or thoracic aortic aneurysm repair. Reports were grouped by the navigation systems and categorized into phantom, animal, and clinical studies. First, the general characteristics of each system were compared. Second, target registration error and deployment error were used to compare the accuracy of the tracking systems. Third, all systems were reviewed for fluoroscopy time (FT), radiation dose, and contrast volumes, if reported, in rigid and nonrigid studies. Fourth, vascular cannulation performance of the systems was compared, studying cannulation time, Imperial College Complex Cannulation Scoring Tool score, and the number of wall hits and catheter movements within rigid studies. RESULTS Of 721 articles and references found, 18 studies of four different navigation systems were included: the Aurora (Northern Digital, Waterloo, Ontario, Canada) tracking system, the StealthStation (Medtronic Inc, Minneapolis, Minn) tracking system, an ultrasound localization tracking system, and the Sensei (Hansen Medical, Mountain View, Calif) steerable remote-controlled robotic navigation system. The mean tracking accuracy averaged 1 mm for the three manual tracking systems measured in a rigid environment. An increase of target registration error reaching >3 mm was reported when measured in a nonrigid experimental environment or due to external distortion factors. Except within small-animal studies or case studies, no evidence was found on reduction of clinical outcome parameters, such as FT, radiation dose, and contrast volumes, within clinical EVAR. A comparison of vascular cannulation performance in rigid studies revealed that the Sensei robotic system might have an advantage during advanced cannulation compared with standard cannulation within complex cannulations tasks. CONCLUSIONS This review summarizes the current studies on manual tracking and robotic navigation systems for application in EVAR. The main focus of these systems is improving aortic vessel cannulation, required in complex EVAR, in which the robotic system with the improved steerability is favored over manual tracking systems or conventional cannulation. All reviewed tracking systems still require X-ray for anatomic imaging, stent graft deployment, and device registration. Although the current reviewed endovascular navigation systems have shown their potential in phantom and animal studies, clinical trials are too limited to conclude that these systems can improve EVAR outcomes or that they can systematically reduce FTs, radiation doses, and contrast volumes during (complex) EVAR.
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Kranendonk MEG, Visseren FLJ, van Herwaarden JA, Nolte-'t Hoen ENM, de Jager W, Wauben MHM, Kalkhoven E. Effect of extracellular vesicles of human adipose tissue on insulin signaling in liver and muscle cells. Obesity (Silver Spring) 2014; 22:2216-23. [PMID: 25045057 DOI: 10.1002/oby.20847] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Insulin resistance (IR) is a key mechanism in obesity-induced cardiovascular disease. To unravel mechanisms whereby human adipose tissue (AT) contributes to systemic IR, the effect of human AT-extracellular vesicles (EVs) on insulin signaling in liver and muscle cells was determined. METHODS EVs released from human subcutaneous (SAT) and omental AT (OAT)-explants ex vivo were used for stimulation of hepatocytes and myotubes in vitro. Subsequently, insulin-induced Akt phosphorylation and expression of gluconeogenic genes (G6P, PEPCK) was determined. AT-EV adipokine levels were measured by multiplex immunoassay, and AT-EVs were quantified by high-resolution flow cytometry. RESULTS In hepatocytes, AT-EVs from the majority of patients inhibited insulin-induced Akt phosphorylation, while EVs from some patients stimulated insulin-induced Akt phosphorylation. In myotubes AT-EVs exerted an ambiguous effect on insulin signaling. Hepatic Akt phosphorylation related negatively to G6P-expression by both SAT-EVs (r = -0.60, P = 0.01) and OAT-EVs (r = -0.74, P = 0.001). MCP-1, IL-6, and MIF concentrations were higher in OAT-EVs compared to SAT-EVs and differently related to lower Akt phosphorylation in hepatocytes. Finally, the number of OAT-EVs correlated positively with liver enzymes indicative for liver dysfunction. CONCLUSIONS Human AT-EVs can stimulate or inhibit insulin signaling in hepatocytes- possibly depending on their adipokine content- and may thereby contribute to systemic IR.
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de Jong PA, Hellings WE, Takx RAP, Išgum I, van Herwaarden JA, Mali WPTM. Computed tomography of aortic wall calcifications in aortic dissection patients. PLoS One 2014; 9:e102036. [PMID: 25003993 PMCID: PMC4087005 DOI: 10.1371/journal.pone.0102036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/15/2014] [Indexed: 01/30/2023] Open
Abstract
Objectives To investigate the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications in a consecutive series of patients with aortic dissection who underwent contrast-enhanced CT. Methods The study population compromised of 69 consecutive subjects aged 60 years and older with a contrast-enhanced CT scan demonstrating an aortic dissection. All CT scans were evaluated for the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications by two experienced observers. Between observer reliability was evaluated by using Cohen’s Kappa. Differences between groups were tested using unpaired T test and Chi-square test. Results Presumed media calcifications were observed in 22 (32%) patients of 60 years and older and were found more frequently in chronic aortic dissection (N = 12/23, 52%) than in acute aortic dissection (N = 10/46, 22%). Conclusion As the intima has been torn away by the aortic dissection it is highly likely that CT scans can visualize the calcifications in the tunica media of the aorta.
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van Bogerijen GHW, van Herwaarden JA, Conti M, Auricchio F, Rampoldi V, Trimarchi S, Moll FL. Importance of dynamic aortic evaluation in planning TEVAR. Ann Cardiothorac Surg 2014; 3:300-6. [PMID: 24967170 DOI: 10.3978/j.issn.2225-319x.2014.04.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/27/2014] [Indexed: 11/14/2022]
Abstract
Dynamic aortic evaluation in planning thoracic endovascular aortic repair (TEVAR) is important to provide optimal stent graft sizing. Static imaging protocols do not consider normal aortic dynamics and may lead to stent graft to aorta mismatch, causing stent graft related complications, such as type I endoleak and stent graft migration. Dynamic imaging can assist in accurate stent graft selection and sizing preoperatively, and evaluate stent graft performance during follow-up. To create new imaging technologies, integration of knowledge between diverse scientific fields is essential (i.e., engineering, informatics and medicine). Different dynamic imaging modalities, such as electrocardiographic-gated computed tomography angiography (ECG-gated CTA) and four-dimensional phase-contrast MRI (4D PC-MRI), are progressively investigated and implemented into clinical practice as important instruments in preoperative planning for TEVAR. In time, further application of dynamic imaging tools for preoperative screening and follow-up after TEVAR might lead to better outcomes for patients. The advances in dynamic imaging for evaluation of the thoracic aorta using new imaging modalities and their future perspectives are addressed in this manuscript.
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Buck DB, Curran T, McCallum JC, Darling JD, van Herwaarden JA, Moll FL, Schermerhorn ML. PS142. Isolated Iliac Artery Aneurysms: The Impact of Endovascular Repair. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Buck DB, Curran T, McCallum JC, Darling JD, van Herwaarden JA, Moll FL, Schermerhorn ML. PS86. Isolated Renal Artery Aneurysms: Management and Outcomes in the Endovascular Era. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zandvoort HJ, Gonçalves FB, Verhagen HJ, Werson DA, Moll FL, de Vries JPP, van Herwaarden JA. Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft. J Vasc Surg 2014; 59:1195-202. [DOI: 10.1016/j.jvs.2013.12.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/09/2013] [Accepted: 12/15/2013] [Indexed: 11/29/2022]
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Kranendonk MEG, Visseren FLJ, van Balkom BWM, Nolte-'t Hoen ENM, van Herwaarden JA, de Jager W, Schipper HS, Brenkman AB, Verhaar MC, Wauben MHM, Kalkhoven E. Human adipocyte extracellular vesicles in reciprocal signaling between adipocytes and macrophages. Obesity (Silver Spring) 2014; 22:1296-308. [PMID: 24339422 DOI: 10.1002/oby.20679] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 12/03/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Extracellular vesicles (EVs) released by human adipocytes or adipose tissue (AT)-explants play a role in the paracrine interaction between adipocytes and macrophages, a key mechanism in AT inflammation, leading to metabolic complications like insulin resistance (IR) were determined. METHODS EVs released from in vitro differentiated adipocytes and AT-explants ex vivo were characterized by electron microscopy, Western blot, multiplex adipokine-profiling, and quantified by flow cytometry. Primary monocytes were stimulated with EVs from adipocytes, subcutaneous (SCAT) or omental-derived AT (OAT), and phenotyped. Macrophage supernatant was subsequently used to assess the effect on insulin signaling in adipocytes. RESULTS Adipocyte and AT-derived EVs differentiated monocytes into macrophages characteristic of human adipose tissue macrophages (ATM), defined by release of both pro- and anti-inflammatory cytokines. The adiponectin-positive subset of AT-derived EVs, presumably representing adipocyte-derived EVs, induced a more pronounced ATM-phenotype than the adiponectin-negative AT-EVs. This effect was more evident for OAT-EVs versus SCAT-EVs. Furthermore, supernatant of macrophages pre-stimulated with AT-EVs interfered with insulin signaling in human adipocytes. Finally, the number of OAT-derived EVs correlated positively with patients HOMA-IR. CONCLUSIONS A possible role for human AT-EVs in a reciprocal pro-inflammatory loop between adipocytes and macrophages, with the potential to aggravate local and systemic IR was demonstrated.
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Zandvoort HJ, Moll FL, Domanian A, van Keulen JW, Vonken EJP, van Herwaarden JA. Preoperative Infra- and Suprarenal Aortic Pulsatile Distension is Comparable between Relatively Young and Older Patients with an Abdominal Aortic Aneurysm. Ann Vasc Surg 2014; 28:845-9. [DOI: 10.1016/j.avsg.2013.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/02/2013] [Accepted: 07/18/2013] [Indexed: 01/21/2023]
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van Bogerijen GH, Tolenaar JL, Rampoldi V, Moll FL, van Herwaarden JA, Jonker FH, Eagle KA, Trimarchi S. Predictors of aortic growth in uncomplicated type B aortic dissection. J Vasc Surg 2014; 59:1134-43. [DOI: 10.1016/j.jvs.2014.01.042] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/10/2014] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
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120
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Abstract
Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR.
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121
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Tolenaar JL, van Herwaarden JA, Verhagen H, Moll FL, Muhs BE, Trimarchi S. Importance of entry tears in Type B aortic dissection prognosis. Ann Cardiothorac Surg 2013; 2:631-2. [PMID: 24109572 DOI: 10.3978/j.issn.2225-319x.2013.09.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/06/2013] [Indexed: 11/14/2022]
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122
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Prince JF, Smits MLJ, van Herwaarden JA, Arntz MJ, Vonken EJPA, van den Bosch MAAJ, de Borst GJ. Endovascular treatment of internal iliac artery stenosis in patients with buttock claudication. PLoS One 2013; 8:e73331. [PMID: 23951349 PMCID: PMC3738523 DOI: 10.1371/journal.pone.0073331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/23/2013] [Indexed: 11/19/2022] Open
Abstract
Aim To assess the technical feasibility and clinical outcome of percutaneous transluminal angioplasty (PTA) with and without stent placement for treatment of buttock claudication caused by internal iliac artery (IIA) stenosis. Methods Between September 2001 and July 2011, thirty-four patients with buttock claudication underwent endovascular treatment. After angiographic lesion evaluation PTA with or without stent placement was performed. Technical success was recorded. Clinical outcome post-treatment was assessed at three months post-intervention and was classified as: 1) complete relief of symptoms, 2) partial relief, or 3) no relief of symptoms. Complications during follow-up were recorded. Results Forty-four lesions in 34 symptomatic patients were treated with PTA. Eight lesions were treated with additional stent placement. Technical success was achieved in 40/44 lesions (91%). Three procedure-related minor complications occurred, i.e. asymptomatic conservatively treated intimal dissections. After a median of 2.9 months, patients experienced no relief of symptoms in 7/34 cases (21%), partial relief in 14/34 cases (41%), and complete relief in 13/34 cases (38%). Six patients required a reintervention during follow-up. Conclusion Endovascular treatment of IIA stenosis has a high technical success rate and a low complication rate. Complete or partial relief of symptoms is achieved in the majority (79%) of patients.
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123
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van Bogerijen GH, Tolenaar JL, Conti M, Auricchio F, Secchi F, Sardanelli F, Moll FL, van Herwaarden JA, Rampoldi V, Trimarchi S. Contemporary Role of Computational Analysis in Endovascular Treatment for Thoracic Aortic Disease. AORTA (STAMFORD, CONN.) 2013; 1:171-181. [PMID: 26798690 PMCID: PMC4682739 DOI: 10.12945/j.aorta.2013.13-003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/12/2013] [Indexed: 06/05/2023]
Abstract
In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure. Different techniques of medical imaging, like computed tomography or magnetic resonance imaging, can be used to evaluate dynamics in the thoracic aorta. Such information can also be combined with dedicated patient-specific computer-based simulations, to provide a further insight into the biomechanical aspects. In clinical practice, computational analysis might show the development of aortic disease, such as the aortic wall segments which experience higher stress in places where rupture and dissection may occur. In aortic dissections, the intimal tear is usually located at the level of the sino-tubular junction and/or at the origin of the left subclavian artery. Besides, computational models may potentially be used preoperatively to predict stent graft behavior, virtually testing the optimal stent graft sizing, deployment, and conformability, in order to provide the best endovascular treatment. The present study reviews the current literature regarding the use of computational tools for TEVAR biomechanics, highlighting their potential clinical applications.
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124
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Tolenaar JL, van Keulen JW, Trimarchi S, Jonker FH, van Herwaarden JA, Verhagen HJ, Moll FL, Muhs BE. Number of Entry Tears Is Associated With Aortic Growth in Type B Dissections. Ann Thorac Surg 2013; 96:39-42. [DOI: 10.1016/j.athoracsur.2013.03.087] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 11/28/2022]
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125
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Tolenaar JL, Zandvoort HJA, Moll FL, van Herwaarden JA. Technical considerations and results of chimney grafts for the treatment of juxtarenal aneursyms. J Vasc Surg 2013; 58:607-15. [PMID: 23684412 DOI: 10.1016/j.jvs.2013.02.238] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To present our initial experience and technical considerations for the use of chimney grafts in the treatment of patients that require endovascular aneurysm repair with aortic branch preservation. METHODS All patients treated with a chimney procedure between October 2009 and June 2011 were included in our analyses. Chimney procedures were only performed in patients that were unsuitable for open repair and without opportunity to use fenestrated grafts (because of unsuitable anatomy or emergency operation). Open brachial or axillary access was used to deploy covered chimney grafts in the target vessels, and subsequently, a stent graft was deployed via femoral cut-down access. RESULTS Thirteen patients (12 males; mean age, 77.2 ± 6.2 years; mean maximal diameter, 71.4 ± 10.2 mm) underwent a chimney procedure with the preservation of 22 aortic side branches. Primary technical success was 92.3% due to occlusion of one renal artery within 24 hours. Thirty-day mortality was 0%. Infrarenal mean neck length was 2.6 mm ± 3.2 mm (range, 0-8 mm) and could be extended to 27.3 mm ± 9.9 mm (range, 18-53 mm) by the use of chimney grafts. During follow-up (median, 10.8 months; interquartile range, 7.4-19.4), one patient died from complications from mesenteric ischemia based on a stenosis of the celiac trunk attributable to the bare stent of the stent graft, and one patient died from aneurysm rupture. Other complications included late occlusion of one renal artery and a type II endoleak, which was unsuccessfully treated with coil embolization and required laparotomy. If we disregard the ruptured patient who had an enormous increase of aneurysm diameter, mean aortic aneurysm diameter reduced from 70.7 ± 10.3 mm (range, 54-89 mm) to 66.7 ± 13.9 mm (range, 48-96 mm) during follow-up (P = .13). In three patients, the aneurysm diameter decreased by more than 5 mm and in two patients, the diameter increased by more than 5 mm. The aneurysm diameter remained stable in the other eight patients. CONCLUSIONS Until off-the-shelf fenestrated or branched stent grafts become available, the chimney procedure offers a minimally invasive treatment option in patients requiring aneurysm exclusion with side branch revascularization. Although long-term follow-up has to be awaited, the initial results show that chimney grafts can help to decrease or stabilize the aneurysm diameter in most patients, but aneurysm rupture was not prevented in all patients.
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126
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Bastos Gonçalves FM, Zandvoort HJ, van Herwaarden JA, Moll FL, Werson D, de Vries JPM, Verhagen HJ. Mid-Term Results and Morphological Neck Changes After EVAR in Patients With Severe Proximal Neck Angulation. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.02.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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127
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Trimarchi S, Tolenaar JL, Jonker FH, Murray B, Tsai TT, Eagle KA, Rampoldi V, Verhagen HJ, van Herwaarden JA, Moll FL, Muhs BE, Elefteriades JA. Importance of false lumen thrombosis in type B aortic dissection prognosis. J Thorac Cardiovasc Surg 2013; 145:S208-12. [DOI: 10.1016/j.jtcvs.2012.11.048] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/07/2012] [Accepted: 11/20/2012] [Indexed: 11/17/2022]
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128
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Cornelissen SA, Verhagen HJ, van Herwaarden JA, Vonken EJP, Moll FL, Bartels LW. Lack of thrombus organization in nonshrinking aneurysms years after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 56:938-42. [DOI: 10.1016/j.jvs.2012.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/27/2012] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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129
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van Zeggeren L, van Herwaarden JA, Verhagen HJ, Werson DA, Zandvoort HJ, Goncalves FB, Moll FL, de Vries JPP. SS13. Obstruction of the Endurant Endograft Post-EVAR: Incidence and Treatment Results. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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130
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Koole D, Hurks R, Schoneveld A, Vink A, Golledge J, Moran CS, de Kleijn DP, van Herwaarden JA, de Vries JP, Laman JD, Huizinga R, Pasterkamp G, Moll FL. Osteoprotegerin Is Associated With Aneurysm Diameter and Proteolysis in Abdominal Aortic Aneurysm Disease. Arterioscler Thromb Vasc Biol 2012; 32:1497-504. [DOI: 10.1161/atvbaha.111.243592] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective—
Serum osteoprotegerin (OPG) concentrations have previously been associated with growth of abdominal aortic aneurysms (AAAs). In vitro experiments showed that OPG promotes matrix metalloprotease (MMP) release from monocytes and vascular smooth muscle cells. We hypothesized that OPG expression is increased in human AAAs and is associated with proteolysis.
Methods and Results—
AAA biopsies were collected from 329 patients. We assessed the concentrations of OPG, cathepsins A, B, and S as well as the activity of MMP-2 and MMP-9. The AAA wall infiltration by macrophages, lymphocytes, and plasma cells was estimated by immunohistochemistry. The concentration of OPG correlated positively with aortic diameter (<55 mm: 16.1 [5.8–28.7], 55–70 mm: 21.9 [10.2–36.0], >70 mm: 24.0 [13.5–52.9] ng OPG/mg total amount of protein,
P
=0.020), cathepsin A (
r
=0.221,
P
=0.005), B (
r
=0.384,
P
<0.001), and S (
r
=0.467, P<0.001), MMP-2 (
r
=0.180,
P
<0.001), MMP-9 (
r
=0.178, P<0.001), and the number of lymphocytes (
P
<0.001) and plasma cells (
P
=0.001). OPG immunostaining was predominantly demonstrated in plasma cells.
Conclusion—
The concentration of aortic wall OPG is positively associated with established markers of AAA severity and pathogenesis. OPG appeared to be associated with lymphocytes and plasma cells. These human data support previous experimental data suggesting a role for OPG in AAA pathogenesis.
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Tolenaar JL, van Keulen JW, Trimarchi S, Muhs BE, Moll FL, van Herwaarden JA. The chimney graft, a systematic review. Ann Vasc Surg 2012; 26:1030-8. [PMID: 22498342 DOI: 10.1016/j.avsg.2011.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/30/2011] [Accepted: 11/30/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Approximately 20% to 30% of the patients are considered not eligible for standard endovascular aneurysm repair because of aortic neck morphology. Most of these patients have an aortic neck situated in the vicinity of the aortic side branches, requiring extensive open surgery. The introduction of fenestrated and branched stent grafts has made endovascular branch preservation possible, but these procedures are time-consuming and expensive. The chimney procedure offers a readily available endovascular alternative for the treatment in patients with acute aneurysms and challenging anatomy. We conducted a systematic review to evaluate the short- and long-term results of the chimney procedure. METHODS A comprehensive literature search for studies describing the chimney procedure was performed using MEDLINE and Excerpta Medica Database. All articles were critically appraised and included, based on relevance, validity, and outcome measures. Patient characteristics, details of the surgical intervention, and short- and long-term outcomes were studied. RESULTS A total of 75 patients were included who underwent a chimney procedure for the preservation of a total of 96 branches. Used operating techniques differed considerably between all studies, with an overall technical success rate of 98.9%. Three perioperative deaths were reported, of which one patient died from intervention-related complication. The follow-up duration ranged from 2 days to 54 months. Late complications included three deaths, none of which was device or aneurysm related. Three chimney grafts occluded during follow-up, of which two required reintervention. CONCLUSION The chimney procedure appears as an acceptable alternative for patients in an emergency setting, although data regarding long-term follow-up are not yet available.
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132
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Koole D, Moll FL, Buth J, Hobo R, Zandvoort H, Pasterkamp G, van Herwaarden JA. The influence of smoking on endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 55:1581-6. [PMID: 22325665 DOI: 10.1016/j.jvs.2011.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The main purpose of this study was to evaluate the influence of smoking on perioperative outcomes of endovascular aneurysm repair (EVAR), aneurysm sac behavior, abdominal aortic aneurysm (AAA) neck growth after EVAR, and its effect on stent graft migration during follow-up. METHODS Baseline characteristics and follow-up data were collected prospectively by patient record forms. Follow-up visits were scheduled at 1, 3, 6, 12, 18, and 24 months, and annually thereafter and included a clinical examination and imaging studies. Patients were stratified in three groups according to their smoking status as nonsmokers, former smokers, and smokers. RESULTS This study analyzed the data for 4176 nonsmokers, 2406 former smokers, and 2056 smokers who were enrolled prospectively in the European Collaborators on Stent-Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) database. Compared with nonsmokers, smokers required more percutaneous transluminal angioplasty and stent placements during EVAR (P < .001), and stent graft migration occurred more often (hazard ratio, 1.45; 95% confidence interval, 1.03-2.05; P = .033). Nonsmokers had more late type II endoleaks than former smokers and smokers (58.5%, 55.9%, and 35.5%, respectively; P < .001). Smoking had no effect on aneurysm sac behavior or AAA neck growth after EVAR. CONCLUSIONS Smokers need more percutaneous transluminal angioplasty procedures and stents during EVAR. They have fewer late type II endoleaks during follow-up; however, smokers should be closely monitored because they have an increased risk of stent graft migration.
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133
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Zandvoort HJA, Moll FL, van Herwaarden JA. Re: "pragmatic minimum reporting standards for endovascular abdominal aortic aneurysm repair". J Endovasc Ther 2011; 18:819; author reply 819-20. [PMID: 22149232 DOI: 10.1583/11-3676.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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134
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Ten Bosch JA, Waasdorp EJ, de Vries JPP, Moll FL, Teijink JA, van Herwaarden JA. The durability of endovascular repair of para-anastomotic aneurysms after previous open aortic reconstruction. J Vasc Surg 2011; 54:1571-8. [PMID: 21944919 DOI: 10.1016/j.jvs.2011.04.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/17/2011] [Accepted: 04/19/2011] [Indexed: 10/17/2022]
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135
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Koole D, Moll FL, Buth J, Hobo R, Zandvoort HJ, Bots ML, Pasterkamp G, van Herwaarden JA. Annual rupture risk of abdominal aortic aneurysm enlargement without detectable endoleak after endovascular abdominal aortic repair. J Vasc Surg 2011; 54:1614-22. [DOI: 10.1016/j.jvs.2011.06.095] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/27/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
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136
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Bastos Gonçalves FM, van Herwaarden JA, van Keulen JW, Poldermans D, Moll FL, de Vries JPM, Verhagen HJ. PS36. Severe Proximal Aneurysm Neck Angulation: Mid-Term Results and Morphological Changes after EVAR Using Latest Stent Graft Technology. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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137
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Orimoto Y, van Keulen JW, Waasdorp EJ, Moll FL, van Herwaarden JA. Treatment of a recurrent false aneurysm of the femoral artery by stent--graft placement from the brachial artery. Ann Vasc Surg 2011; 25:841.e1-4. [PMID: 21620657 DOI: 10.1016/j.avsg.2011.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 01/21/2011] [Accepted: 01/24/2011] [Indexed: 11/28/2022]
Abstract
An anastomotic false aneurysm is a well known complication after femoral artery surgery. Open surgical repair is the treatment of choice for anastomotic femoral aneurysms, but this can be challenging, unsuccessful, or even impossible. Endovascular repair is an alternative in these cases, but the delivery of a stent--graft in the femoral artery can be difficult. We report the case of a patient with a recurrent left femoral artery anastomotic false aneurysm, treated twice by open exclusion, and finally excluded successfully by a stent--graft that was inserted through the left brachial artery.
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van Keulen JW, Moll FL, Vonken EJP, Tolenaar JL, Muhs BE, van Herwaarden JA. Pulsatility in the iliac artery is significant at several levels: implications for EVAR. J Endovasc Ther 2011; 18:199-204. [PMID: 21521060 DOI: 10.1583/10-3322.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the pulsatility of the iliac arteries and compare their distension at several levels that might influence preoperative stent-graft sizing and the long-term durability of stent-graft sealing and fixation. METHODS Preoperative dynamic computed tomographic angiography (CTA) scans of 30 patients (24 men; median age 75 years, range 60-85) with an abdominal aortic aneurysm and patent iliac arteries were included. The CTAs consisted of 8 images per heartbeat. Bilateral diameter and area changes per heartbeat were measured semi-automatically in the common iliac artery (CIA) at 3 levels: (A) 0.5 cm after the aortic bifurcation, (B) in the middle of the CIA, and (C) 0.5 cm proximal to the iliac bifurcation. Pulsatility was defined as the largest difference in area and average diameter change over 180 axes per heartbeat. Pulsatility at the 3 levels was compared, and the intraobserver variability of the method was calculated according to Bland and Altman. RESULTS The mean area increases in the CIAs at levels A, B, and C were 12.5% (16.3 mm²), 11.2% (13.6 mm²), and 9.6% (12.6 mm²), respectively, and the mean iliac diameter increases were 9.2% (1.1 mm), 8.5% (1.0 mm), and 8.1% (1.0 mm). The iliac distension was statistically significant at all levels. The iliac distension at level A was statistically significantly larger than the distension at level C. The intraobserver variability was 13.3 mm² for area and 0.6 mm for diameter measurements. CONCLUSION The pulsatility in the iliac arteries is statistically significant at several levels relevant to endovascular aneurysm repair. The distension of the iliac artery possibly decreases more distally, which might encourage the extension of stent-grafts to the internal iliac artery.
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139
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Tolenaar JL, van Keulen JW, Vonken EJ, van Herwaarden JA, Moll FL, de Borst GJ. Fenestration of an Iatrogenic Aortic Dissection After Endovascular Aneurysm Repair. J Endovasc Ther 2011; 18:256-60. [DOI: 10.1583/10-3330.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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140
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Verhoeven BA, Waasdorp EJ, Gorrepati ML, van Herwaarden JA, Vos JA, Wille J, Moll FL, Zarins CK, de Vries JPP. Long-term results of Talent endografts for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2011; 53:293-8. [DOI: 10.1016/j.jvs.2010.08.078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 08/25/2010] [Accepted: 08/26/2010] [Indexed: 10/18/2022]
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141
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Huisman M, van den Bosch MAAJ, Mooiweer E, Molenaar IQ, van Herwaarden JA. Endovascular treatment of a patient with an aneurysm of the proper hepatic artery and a duodenal fistula. J Vasc Surg 2011; 53:814-7. [PMID: 21211935 DOI: 10.1016/j.jvs.2010.10.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 10/14/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
Aneurysms of the proper hepatic artery comprise a rare but potentially dangerous entity for which treatment is performed both surgically and endovascularly. Covered stents are generally used for endovascular treatment of such aneurysms. When the aneurysm is contaminated due to an enteric fistula, however, use of a covered stent is considered inappropriate. This case report describes the endovascular repair of a proper hepatic artery aneurysm using overlapping bare metal stents after the patient was surgically treated for duodenal hemorrhage.
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142
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Gonçalves FB, van Herwaarden JA, Verhagen HJM. Insights on the prevention of endograft collapse after thoracic endovascular aortic repair. J Endovasc Ther 2010; 17:735-7. [PMID: 21142481 DOI: 10.1583/10-3130c1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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143
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Tolenaar JL, van Keulen JW, Leijdekkers VJ, Vonken EJ, Moll FL, van Herwaarden JA. A ruptured aneurysm after stent graft puncture during computed tomography-guided thrombin injection. J Vasc Surg 2010; 52:1045-7. [DOI: 10.1016/j.jvs.2010.04.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/29/2010] [Accepted: 03/29/2010] [Indexed: 11/28/2022]
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144
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van Keulen JW, Moll FL, Arts J, Vonken EJP, van Herwaarden JA. Aortic Neck Angulations Decrease During and After Endovascular Aneurysm Repair. J Endovasc Ther 2010; 17:594-8. [DOI: 10.1583/10-3131mr.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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145
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van Keulen JW, van Prehn J, Moll FL, van Herwaarden JA. Recurrent stent-graft disintegration caused by cardiac-induced aortoiliac movements. J Endovasc Ther 2010; 17:354-5. [PMID: 20557175 DOI: 10.1583/10-3058.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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146
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Ten Bosch JA, Waasdorp EJ, Teijink JA, de Vries JPM, Moll FL, van Herwaarden JA. RR8. Long-term Results of Endovascular Repair of Paraanastomotic Aneurysms After Previous Conventional Aortic Prosthetic Reconstruction. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.02.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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147
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Verhoeven B, Waasdorp E, van Herwaarden JA, van de Mortel R, Moll F, Zarins C, de Vries JP. PS20. Long-term Results of Talent Endografts for Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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148
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van Lammeren GW, Fioole B, Waasdorp EJ, Moll FL, van Herwaarden JA, de Vries JPPM. Long-term Follow-up of Secondary Interventions After Endovascular Aneurysm Repair With the AneuRx Endoprosthesis: A Single-Center Experience. J Endovasc Ther 2010; 17:408-15. [DOI: 10.1583/10-3086.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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149
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van Keulen JW, de Vries JPP, Dekker H, Gonçalves FB, Moll FL, Verhagen HJ, van Herwaarden JA. PS38. One-Year Results of a New Endograft for AAA Treatment: Real-life Experience with the Endurant Stentgraft System. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.02.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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150
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van Keulen JW, Moll FL, Tolenaar JL, Verhagen HJ, van Herwaarden JA. Validation of a new standardized method to measure proximal aneurysm neck angulation. J Vasc Surg 2010; 51:821-8. [DOI: 10.1016/j.jvs.2009.10.114] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 10/20/2009] [Accepted: 10/21/2009] [Indexed: 10/19/2022]
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