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Mesnard T, Sulzer T, Kanamori LR, Babocs D, Vacirca A, Baghbani-Oskouei A, Savadi S, Tenorio ER, Mirza A, Saqib N, Mendes B, Macedo T, Verhagen HJM, Huang Y, Oderich GS. Aneurysm Sac Shrinkage at 1 Year after Fenestrated-Branched Endovascular Aortic Repair of Complex Aortic Aneurysms Offers Mid-Term Survival Advantage. J Vasc Surg 2024:S0741-5214(24)01233-3. [PMID: 38825213 DOI: 10.1016/j.jvs.2024.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES To investigate the impact of 1-year changes in aneurysm sac diameter on patient survival after fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal (CAAA) or thoracoabdominal aortic aneurysms (TAAA). METHODS We reviewed the clinical data of patients enrolled in a prospective non-randomized study investigating FB-EVAR (2013-2022). Patients with sequential follow up computed tomography (CT) scans at baseline and 6 to 18 months after FB-EVAR were included in the analysis. Aneurysm sac diameter change was defined as the difference in maximum aortic diameter (MAD) from baseline measurements obtained in centerline of flow. Patients were classified as those with sac shrinkage (≥5mm) or failure to regress (<5mm or expansion) according to sac diameter change. Primary endpoint was all-cause mortality. Secondary endpoints were aortic-related mortality (ARM), aortic aneurysm rupture (AAR) and aorta-related secondary intervention. RESULTS There were 549 patients treated by FB-EVAR. Of these, 463 patients (71% male, mean 74±8 years-old) with sequential CT imaging were investigated. Aneurysm extent was TAAA in 328 (71%) patients and CAAA in 135 (29%). Sac shrinkage occurred in 270 (58%) patients and failure to regress in 193 (42%) patients, including 19 (4%) patients with sac expansion at 1-year. Patients from both groups had similar cardiovascular risk factors, except for younger age among patients with sac shrinkage (73±8 vs. 75±8 years-old; P<.001). Median follow-up was 38 months (interquartile range, 18-51 months). Five-year survival estimate was 69%±4.1% for sac shrinkage and 46%±6.2% for failure to regress group. Survival estimates adjusted for confounders (age, chronic pulmonary obstructive disease, chronic kidney disease, congestive heart failure, and aneurysm extent) revealed a higher hazard of late mortality in patients with failure to regress (adjusted hazard ratio, 1.72; 95% confidence interval, 1.18-2.52; P=.005). Five-year cumulative incidences of ARM (1.1% vs. 3.1%, P=.30), AAR (0.6% vs. 2.6%, P=.20) and aorta-related secondary intervention (17±2.8% vs. 19±3.8%) were both comparable between the groups. CONCLUSIONS Aneurysm sac shrinkage at 1 year is frequent after FB-EVAR and is associated with improved patient survival, while sac enlargement affects only a minority of patients. The low incidences of ARM and AAR indicate that failure to regress may serve as a surrogate marker for non-aortic-related death.
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Affiliation(s)
- T Mesnard
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - T Sulzer
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - L Ruiter Kanamori
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - D Babocs
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - A Vacirca
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - A Baghbani-Oskouei
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - S Savadi
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - Emanuel R Tenorio
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - Aleem Mirza
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - Naveed Saqib
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - B Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - T Macedo
- Department of Diagnostic and Interventional Radiology at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ying Huang
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX
| | - Gustavo S Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, Houston, TX.
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Wang S, Jia H, Xi Y, Yuan P, Wu M, Ren L, Guo W, Xiong J. Risk Factors Associated with Poor Prognosis in Patients with Stanford Type B Aortic Dissection after Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2023:S0890-5096(23)00108-5. [PMID: 36870563 DOI: 10.1016/j.avsg.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The aim of the study was to analyze the clinical characteristics of patients with Stanford type B aortic dissection (TBAD) and risk factors for poor prognosis after thoracic endovascular aortic repair (TEVAR). METHODS Clinical records for patients with TBAD presenting to a medical center between March 1, 2012 and July 31, 2020 were reviewed. Clinical data including demographics, comorbidities, and postoperative complications were obtained from electronic medical records. Comparative analysis and subgroup analysis were performed. A logistic regression model was used to analyze prognostic factors in patients with TBAD after TEVAR. RESULTS TEVAR was performed on all 170 patients with TBAD, and poor prognosis was identified in 28.2% (48/170) of cases. Patients with a poor prognosis were younger (38.5 [32.0, 53.8] years vs. 55.0 [48.0, 62.0] years, P < 0.001), had higher systolic blood pressure (SBP) (138.5 [127.8, 152.8] mm Hg vs. 132.0 [120.8, 145.3] mm Hg, P = 0.013) and more complicated aortic dissection patients (19 [60.4] vs. 71 [41.8], P = 0.029) than those without a poor prognosis. According to the results of binary logic regression analysis, the possibility of a poor prognosis after TEVAR decreased with each 10 years increase in age (odds ratio: 0.464, 95% confidence interval: 0.327-0.658, P < 0.001). CONCLUSIONS There is an association between younger age and a poor prognosis after TEVAR in patients with TBAD, with the condition that those with poor prognoses have higher SBP and more complicated cases. In younger patients, postoperative follow-up should be more frequent, and complications should be managed in time.
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Affiliation(s)
- Shuangjing Wang
- Department of Vascular and Endovascular Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Heyue Jia
- Department of Emergency Surgery, The People's Hospital of Peking University, Beijing, PR China
| | - Yifu Xi
- Department of Vascular and Endovascular Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Pengfei Yuan
- Department of Vascular and Endovascular Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Mingwei Wu
- Department of Vascular and Endovascular Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Luxia Ren
- Department of Vascular and Endovascular Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China.
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China.
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Jones M, Faris P, Moore R. Mortality and risk factors for ruptured abdominal aortic Aneurysm after Repair Endovascular (rARE). J Vasc Surg Cases Innov Tech 2023. [DOI: 10.1016/j.jvscit.2023.101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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A nomogram risk assessment model to predict the possibility of type II endoleak-related re-intervention after endovascular aneurysm repair (EVAR). Sci Rep 2023; 13:14. [PMID: 36593362 PMCID: PMC9807575 DOI: 10.1038/s41598-022-27356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to develop and validate a novel nomogram risk assessment model to predict the possibility of type II endoleak (T2EL)-related re-intervention. The data of 455 patients with abdominal aortic aneurysms who underwent elective endovascular aneurysm repair (EVAR) procedures between January 2018 and December 2021 at our single center were retrospectively reviewed. Following the implementation of exclusion criteria, 283 patients were finally included and divided into T2EL-related re-intervention (n = 42) and non-T2EL (n = 241) groups. The overall T2EL-related re-intervention rate for 283 patients was 14.8% (42/283). Using multivariate analysis, significant risk factors for re-intervention included age (OR, 1.172; 95% CI, 1.051-1.307; P = 0.004), smoking (OR, 13.418; 95% CI, 2.362-76.215; P = 0.003), diameter of inferior mesenteric artery (IMA) (OR, 21.380; 95% CI, 3.060-149.390; P = 0.002), and number of patent lumbar arteries (OR, 9.736; 95% CI, 3.175-29.857; P < 0.001). The discrimination ability of this risk-predictive model was reasonable (concordance index [C-index] = 0.921; 95% CI, 0.878-0.964). The Hosmer-Lemeshow goodness of fit test was performed on the model, and the chi-square value was 3.210 (P = 0.920), presenting an excellent agreement between the model-predicted and observed values. The receiver operating characteristic (ROC) curve identified that the risk thresholds of re-intervention were a diameter of > 2.77 mm for the diameter of the inferior mesenteric artery and a proportion of < 45.5% for thrombus volume in the aneurysm sac. This novel nomogram risk assessment model for predicting the possibility of patients' T2EL-related re-interventions after EVAR should be helpful in discriminating high-risk patients. Two novel risk thresholds may imply a higher possibility of T2EL-related re-intervention after EVAR.
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Stern JR, Lee JT. Factors Associated with Sac Regression after F/BEVAR for Complex Abdominal and Thoracoabdominal Aneurysms. Semin Vasc Surg 2022; 35:306-311. [DOI: 10.1053/j.semvascsurg.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
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Esposito D, Fargion AT, Dorigo W, Melani A, Capone A, DI Domenico R, Villani F, Speziali S, Pratesi C. Stability of the aneurysmatic sac post-EVAR could no longer be a reliable criterion of healing. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:155-159. [PMID: 34825794 DOI: 10.23736/s0021-9509.21.12014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Evaluation of the impact of aneurysm sac behavior in terms of either stability or shrinkage after endovascular aneurysm repair (EVAR) on long-term clinical outcomes. METHODS A retrospective study was conducted on 1483 consecutive patients who underwent EVAR from 1999 to 2021 at our institution. 1037 patients met inclusion criteria (1037/1483, 69.9%): abdominal aortic or aorto-iliac aneurysm, elective surgery, follow-up (FU) ≥12 months. Patients who had sac stability (330/1037, 31.8%) and patients who demonstrated sac shrinkage (542/1037, 52.2%) at FU were compared; patients who presented sac increase at FU were excluded (165/1037, 16%). PRIMARY ENDPOINTS rupture rates, need for surgical conversion, and long-term aneurysm-related mortality. Secondary endpoints: all type endoleak rates and long-term reintervention rates. RESULTS Mean FU was 61.2 months (IQ 26-85.7 months). In terms of comorbidities, the group of patients with stable sac showed greater association with polidistrectual atherosclerotic manifestations. Estimated 12-year survival was 42.9% in the stable sac group and 65% in the shrinked group (P<0.001), although there were no significant differences in terms of freedom from aneurysm-related death (97.3% vs. 95.4% estimated at 12 years, P=0.493). Patients with sac stability had higher rates of rupture (2.1% vs. 0.6%, P=0.035) and surgical conversion (2.1% vs. 0.6%, P=0.035). The stable sac group had significantly higher rates of all type endoleak during FU (45.8% vs. 24%, P<0.001). Estimated 12-year freedom from reintervention rates were 56.2% and 83.9% respectively (P<0.001). CONCLUSIONS After more than 20 years of EVAR experience it is probably time to reconsider the procedure clinical success parameters as a patient with a stable sac cannot be considered healed.
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Affiliation(s)
- Davide Esposito
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy -
| | - Aaron T Fargion
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Walter Dorigo
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Alberto Melani
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Amedeo Capone
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Rossella DI Domenico
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Flavio Villani
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Sara Speziali
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Carlo Pratesi
- Department of Excellence in Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
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Kano M, Nishibe T, Dardik A, Iwahashi T, Ogino H. Association of High-Sensitivity C-Reactive Protein With Aneurysm Sac Shrinkage in Patients Undergoing Endovascular Abdominal Aneurysm Repair. J Endovasc Ther 2021; 29:866-873. [PMID: 34969319 DOI: 10.1177/15266028211067738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The factors associated with aneurysm sac shrinkage after endovascular aneurysm repair (EVAR) are not well established. As inflammation is implicated in aneurysm pathophysiology, we hypothesized that high-sensitivity C-reactive protein (hsCRP) was associated with aneurysm sac shrinkage after EVAR and compared the preoperative level of hsCRP between patients with and without postoperative aneurysm sac shrinkage after EVAR. METHODS From November 2013 to April 2019, 143 patients undergoing EVAR using Gore C3 Excluder (W. L. Gore & Associates, Inc, Flagstaff, Arizona) at our university hospital were included in this study. Aneurysm sac size was compared between that on baseline preoperative computed tomography (CT) and that on postoperative CT scans. A change in aneurysm sac size ≥5 mm was considered to be significant, whether due to enlargement or shrinkage. RESULTS Aneurysm sac size showed a significant decrease from 50.6 ± 9.8 mm to 47.1 ± 10.3 mm at 1 year. At 1 year postoperatively, aneurysm sac shrinkage (≥5 mm) was observed in 48 patients (34%), a stable aneurysm sac was noted in 93 patients (65%), and aneurysm sac enlargement was noted in 2 patients (1.4%). The mean preoperative hsCRP was 0.33 ± 0.54 mg/dL. Univariable analysis showed that preoperative hsCRP (p=0.029) and the presence of a renal cyst (p=0.002) were associated with aneurysm sac shrinkage. Multivariable analysis showed that preoperative hsCRP [>0.19mg/dL] (odds ratio [OR] = 0.22; 95% confidence interval [CI] = 0.05-0.96; p=0.042), and the presence of a renal cyst (OR = 0.31; 95% CI = 0.15-0.67; p=0.002) were independent risk factors for aneurysm sac shrinkage after EVAR. CONCLUSIONS The level of preoperative hsCRP was independently associated with aneurysm sac shrinkage after EVAR in patients with abdominal aortic aneurysms. These data suggest that the high level of hsCRP can be a negative predictor for aneurysm sac shrinkage after EVAR.
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Affiliation(s)
- Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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Fabre D, Mougin J, Mitilian D, Cochennec F, Garcia Alonso C, Becquemin JP, Desgranges P, Allaire E, Hamdi S, Brenot P, Bourkaib R, Haulon S. Prospective, Randomised Two Centre Trial of Endovascular Repair of Abdominal Aortic Aneurysm With or Without Sac Embolisation. Eur J Vasc Endovasc Surg 2020; 61:201-209. [PMID: 33342658 DOI: 10.1016/j.ejvs.2020.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The benefit of aneurysm sac coil embolisation (ASCE) during endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) remains unclear. This prospective randomised two centre study (SCOPE 1: Sac COil embolisation for Prevention of Endoleak) compared the outcomes of standard EVAR in patients with AAA at high risk of type II endoleak (EL with EVAR with ASCE during the period 2014-2019. METHODS Patients at high risk of type II EL were randomised to standard EVAR (group A) or EVAR with coil ASCE (group B). The primary endpoint was the rate of all types of EL during follow up. Secondary endpoints included freedom from type II EL related re-interventions, and aneurysm sac diameter and volume variation at two year follow up. Adverse events included type II EL and re-interventions. CTA and Duplex ultrasound scans were scheduled at 30 days, six months, one year, and two years after surgery. RESULTS Ninety-four patients were enrolled, 47 in each group. There were no intra-operative complications. At M1, 16/47 early type II EL occurred (34%) in group A vs. 2/47 (4.3%) in group B (p < .001). At M6, 15/36 type II EL (41.7%) occurred in group A vs. 2/39 (4.26%) in group B (p < .001). At M12, 15/37 type II El (40.5%) occurred in group A vs. 5/35 (14.3%) in group B (p = .018). At 24 months, 8/32 type 2 El (25%) occurred in group A vs. 3/29 (6.5%) in group B (p = .19). Kaplan-Meier curves of survival free from EL and re-interventions were significantly in favour of group B (p < .001). Aneurysm sac volume decreased significantly in group B compared with group A at M6 (p = .081), at M12 (p = .004), and M24 (p = .001). CONCLUSION For selected patients at risk of EL, ASCE seems effective in preventing EL at one, six, and at 12 months. However, the difference was not statistically significant at 24 months. ASCE decreases the re-intervention rate two years after EVAR. A significantly faster aneurysm volume shrinkage was observed at one and two years following surgery. (SCOPE 1 trial: NCT01878240).
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Affiliation(s)
- Dominique Fabre
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France.
| | - Justine Mougin
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Delphine Mitilian
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | | | - Carlos Garcia Alonso
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | | | | | - Eric Allaire
- Henri Mondor Hospital, University Paris XII, Creteil, France
| | - Sarah Hamdi
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Philippe Brenot
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Riyad Bourkaib
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Stephan Haulon
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
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Hou K, Zhu T, Zhang W, Zeng M, Guo D, Fu W, Si Y. Dynamic Volumetric Computed Tomography Angiography Is a Preferred Method for Unclassified Endoleaks by Conventional Computed Tomography Angiography After Endovascular Aortic Repair. J Am Heart Assoc 2020; 8:e012011. [PMID: 30957675 PMCID: PMC6507202 DOI: 10.1161/jaha.119.012011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The aim of this study was to assess the feasibility and safety of dynamic volumetric computed tomography angiography (DV‐CTA) for endoleaks detected but not classified by conventional CTA in patients after endovascular aortic repair. Methods and Results From January 2016 to October 2017, 24 patients with endoleaks with aneurysm sac enlargement detected but not classified by conventional CTA were randomly assigned to the conventional CTA group and the DV‐CTA group for further evaluation. The amount of contrast agent, radiation dosage, and changes in creatinine during the operation were compared between the 2 groups. Reintervention was performed according to the endoleak classification followed by the 6‐ and 12‐month follow‐up. The accuracy of classifying endoleaks by DV‐CTA was comparable to that by digital subtraction angiography. Additionally, the total amount of contrast agent and the radiation dosage in the DV‐CTA group during the operation were diminished by 14.0% (P=0.007) and 12.1% (P=0.004), respectively, compared with those in the conventional CTA group. No contrast‐induced nephropathy was observed. All endoleaks were treated instantly after identification. No endoleaks were found in any of the patients during follow‐up. Conclusions DV‐CTA could replace digital subtraction angiography as an alternative method for the classification of endoleaks that cannot be differentiated by conventional CTA. Additionally, the amount of contrast agent and the total radiation dosage were substantially reduced, which improved safety among operators and patients.
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Affiliation(s)
- Kai Hou
- 1 Department of Radiology Shanghai Institute of Medical Imaging Zhongshan Hospital Fudan University Shanghai China
| | - Ting Zhu
- 2 Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Wei Zhang
- 3 Department of Biostatistics School of Public Health Fudan University Shanghai China
| | - Mengsu Zeng
- 1 Department of Radiology Shanghai Institute of Medical Imaging Zhongshan Hospital Fudan University Shanghai China
| | - Daqiao Guo
- 2 Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Weiguo Fu
- 2 Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Yi Si
- 2 Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
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Antoniou GA, Alfahad A, Antoniou SA, Torella F. Prognostic Significance of Aneurysm Sac Shrinkage After Endovascular Aneurysm Repair. J Endovasc Ther 2020; 27:857-868. [DOI: 10.1177/1526602820937432] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: To investigate whether patients who develop aneurysm sac shrinkage following endovascular aneurysm repair (EVAR) have better outcomes than patients with a stable or increased aneurysm sac. Materials and Methods: The Healthcare Databases Advanced Search interface developed by the National Institute for Health and Care Excellence was used to interrogate MEDLINE and EMBASE. Thesaurus headings were adapted accordingly. Case-control studies were identified comparing outcomes in patients demonstrating aneurysm sac shrinkage after EVAR with those of patients with a stable or expanded aneurysm sac. Pooled estimates of dichotomous outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Meta-analysis of time-to-event data was conducted using the inverse-variance method; the results are reported as a summary hazard ratio (HR) and 95% CI. Summary outcome estimates were calculated using random-effects models. Results: Eight studies were included in quantitative synthesis reporting a total of 17,096 patients (8518 patients with sac shrinkage and 8578 patients without sac shrinkage). The pooled incidence of sac shrinkage at 12 months was 48% (95% CI 40% to 56%). Patients with aneurysm sac shrinkage had a significantly lower hazard of death (HR 0.73, 95% CI 0.60 to 0.87), secondary interventions (HR 0.42, 95% CI 0.29 to 0.62), and late complications (HR 0.37, 95% CI 0.24 to 0.56) than patients with a stable or increased aneurysm sac. Furthermore, their odds of rupture were significantly lower than those in patients without shrinkage (OR 0.09, 95% CI 0.02 to 0.36). Conclusion: Sac regression is correlated to improved survival and a reduced rate of secondary interventions and EVAR-related complications. The prognostic significance of sac regression should be considered in surveillance strategies. Intensified surveillance should be applied in patients who fail to achieve sac regression following EVAR.
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Affiliation(s)
- George A. Antoniou
- Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, UK
| | - Aws Alfahad
- Department of Radiology, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK
| | - Stavros A. Antoniou
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Francesco Torella
- Liverpool Vascular & Endovascular Service, Liverpool, UK
- School of Physical Sciences, University of Liverpool, UK
- Liverpool Cardiovascular Service, Liverpool, UK
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O'Donnell TF, Deery SE, Boitano LT, Siracuse JJ, Schermerhorn ML, Scali ST, Schanzer A, Lancaster RT, Patel VI. Aneurysm sac failure to regress after endovascular aneurysm repair is associated with lower long-term survival. J Vasc Surg 2019; 69:414-422. [DOI: 10.1016/j.jvs.2018.04.050] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
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A systematic review of surveillance after endovascular aortic repair. J Vasc Surg 2018; 67:320-331.e37. [DOI: 10.1016/j.jvs.2017.04.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/23/2017] [Indexed: 11/17/2022]
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Berg P, Stroetges RA, Miller LE, Schoefferle J. A Propensity Score–Matched Analysis of Inflammatory Response With Endovascular Aneurysm Sealing vs Endovascular Aneurysm Repair. J Endovasc Ther 2017; 24:670-674. [DOI: 10.1177/1526602817722019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the risk of postimplantation syndrome associated with endovascular aneurysm sealing (EVAS) and endovascular aneurysm repair (EVAR) in patients treated for abdominal aortic aneurysm (AAA). Methods: From December 2013 to May 2015, 41 AAA patients treated with EVAS (mean age 72±9 years; 38 men) and 63 with EVAR (mean age 74±10 years; 55 men) at a single center were retrospectively reviewed. To control for treatment selection bias, propensity score matching was used to compare outcomes by treatment mode. Main outcomes were postimplantation syndrome (defined as temperature >38°C and leukocyte count >12,000/µL), inflammatory response markers [platelets and high-sensitivity C-reactive protein (hs-CRP)], and clinical complications through 30 days. Results: In 39 matched patients per group, the incidences of postimplantation syndrome (p=0.07), mean body temperature (p=0.05), mean leukocyte count (p=0.003), and mean hs-CRP (p<0.001) were proportionally lower with EVAS vs EVAR. Serious adverse events (0% vs 12.8%, p=0.05) and endoleaks (0% vs 10.3%, p=0.13) through 30 days were less frequent with EVAS, but the group differences were not significantly different. The choice of endovascular graft material influenced postoperative and 30-day clinical outcomes, with greater overall risk observed with polyester stent-grafts. Conclusion: Endovascular aneurysm sealing is associated with a blunted systematic inflammatory response compared with EVAR. Polyester stent-grafts induce the greatest periprocedural inflammatory response.
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Affiliation(s)
- Patrick Berg
- Department of Vascular & Endovascular Surgery, Katholisches Karl-Leisner-Klinikum, Marienhospital Kevelaer, Kevelaer, Nordrhein-Westfalen, Germany
| | - Roland A. Stroetges
- Department of Vascular & Endovascular Surgery, Katholisches Karl-Leisner-Klinikum, Marienhospital Kevelaer, Kevelaer, Nordrhein-Westfalen, Germany
| | | | - Jochen Schoefferle
- Medical Controlling, Katholisches Karl-Leisner-Klinikum, Marienhospital Kevelaer, Kevelaer, Germany
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Kuziez MS, Sanchez LA, Zayed MA. Abdominal Aortic Aneurysm Type II Endoleaks. JOURNAL OF CARDIOVASCULAR DISEASES & DIAGNOSIS 2016; 4. [PMID: 27857945 PMCID: PMC5110147 DOI: 10.4172/2329-9517.1000255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Type II endoleaks occur commonly following endovascular aneurysm repair (EVAR). Although they remain enigmatic, multiples studies have evaluated preoperative risk factors and strategies for prevention of type II endoleaks. Prophylactic treatment of type II endoleaks can include embolization of accessory arteries, as well as complete aneurysmal sac occlusion. Regular post-operative surveillance and screening for type II endoleaks with triple-phase CTA is the standard of care. Aneurysm size and growth rate are factors that predict whether a persistence type II endoleak is hemodynamically significant, and whether it requires treatment with percutaneous trans-lumbar or trans-arterial embolization techniques. Less commonly, type II endoleaks can be repaired using laparoscopic or open surgical ligation of feeder arterial branches. Emerging methods using endovascular aneurysm sac sealing technology may continue to alter the incidence and long-term management strategies of type II endoleaks. Here we review the latest strategies in the treatment of Type II endoleaks following EVAR.
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Affiliation(s)
- Mohamed S Kuziez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Luis A Sanchez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri, USA
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