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Kiernan A, Elsherif M, Fahey B, Canning C, Moloney T, Kavanagh E, O'Callaghan A, O'Neill S, Madhavan P, Martin Z. Rescue of Failed Aortic Repair with Fenestrated Endovascular Device. Ann Vasc Surg 2021; 82:265-275. [PMID: 34902472 DOI: 10.1016/j.avsg.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The incidence of failed endovascular (EVAR) and open repair (OR) is increasing. Redo aortic repair is required in 10% of patients. Extension of the proximal sealing zone above the visceral arteries to adequate, healthier thoracic aorta using a fenestrated graft (FEVAR) can rescue a failing repair. A custom-made device can treat proximal type 1A endoleaks or proximal dilatation post endovascular or open repair, respectively. The aim of this investigation was to present a single-centre experience with FEVAR for patients with a failing aortic repair. METHODS A prospectively maintained database of FEVAR patients treated with a Zenithࣨ Fenestrated endovascular (ZFEN) device (Cook Medical LLC, Bloomington, Indiana, USA) was interrogated for individuals who had the device implanted as a rescue therapy after prior endovascular (EVAR) or open repair (OR). Statistical analysis was performed with SPSS v 25 software. RESULTS Between January 1, 2011 and March 31, 2019, 17 ZFEN devices were implanted. Ten patients had a type 1A endoleak from a prior EVAR and seven patients had proximal disease progression after prior OR. There were 12 males and 5 females, median age of 75 (interquartile range, IQR 7). 76.4% (n=13) of patients had an American Society of Anaesthesiologists (ASA) grade of 3. Primary technical success was 70.5% (n=12). Of the remainder, four cases (24%) had a type III endoleak at completion angiogram; of which, two patients (12%) required re-intervention within 30 days. One further case (6%) had primary assisted technical success as stenting of a flow limiting dissection flap in an iliac vessel was required. Peri-operative rate of deployment related complications and systemic complications were 5.8% (n=1) and 35% (n=6), respectively. Median length of hospital stay was 11 days (IQR 11). There was no mortality within the study follow up. Overall thirty-day re-intervention rate was 23.5%. Overall survival was 92% at one year. CONCLUSION FEVAR is a safe but technically challenging option for rescue of failing aortic repairs. These are a high risk group of patients and this is reflected in the high post-operative morbidity rate. Technical success was high and 30-day mortality was low.
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Affiliation(s)
- Aoife Kiernan
- St James's Vascular Institute, St James's Hospital, Dublin 8, Ireland
| | - Mohamed Elsherif
- St James's Vascular Institute, St James's Hospital, Dublin 8, Ireland
| | - Brian Fahey
- St James's Vascular Institute, St James's Hospital, Dublin 8, Ireland
| | - Caitríona Canning
- St James's Vascular Institute, St James's Hospital, Dublin 8, Ireland
| | - Tony Moloney
- Department of Vascular Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Eamon Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | | | - Sean O'Neill
- St James's Vascular Institute, St James's Hospital, Dublin 8, Ireland
| | - Prakash Madhavan
- St James's Vascular Institute, St James's Hospital, Dublin 8, Ireland
| | - Zenia Martin
- St James's Vascular Institute, St James's Hospital, Dublin 8, Ireland
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Marcaccio CL, Zettervall SL, Wu WW, Schermerhorn ML, Wyers MC. Endovascular Snare Facilitates Difficult Transfemoral Target Vessel Cannulation During Fenestrated and Branched Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2021; 77:338-342. [PMID: 34464731 DOI: 10.1016/j.avsg.2021.05.030] [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: 10/21/2020] [Revised: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 10/20/2022]
Abstract
We developed a novel technique using an endovascular snare system to stabilize target vessel cannulation via transfemoral access during fenestrated and branched endovascular aortic aneurysm repair (FBEVAR) in patients with challenging target vessel anatomy. This technique uses a snare, an outer sheath, and an inner delivery sheath to facilitate target vessel cannulation and stenting during FBEVAR. With the outer sheath positioned in the lower end of the partially deployed aortic graft and the delivery sheath within, a large snare is advanced through the outer sheath and over the outside of the delivery sheath until it reaches the curved portion of the delivery sheath at the level of the target vessel. The snare is then tightened to provide stability and maintain proper curvature and alignment of the delivery sheath while the target vessel is selected and stented. Following successful passage, the snare is loosened and removed from the body via the outer sheath. This snare technique is a simple, effective, and inexpensive tool that can be used for difficult target vessel cannulation during FBEVAR.
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Affiliation(s)
- Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sara L Zettervall
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Winona W Wu
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mark C Wyers
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Karaolanis GI, Antonopoulos CN, Scali S, Koutsias SG, Kotelis D, Donas KP. Systematic review with pooled data analysis reveals the need for a standardized reporting protocol including the visceral vessels during fenestrated endovascular aortic repair (FEVAR). Vascular 2021; 30:405-417. [PMID: 34074168 DOI: 10.1177/17085381211019148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To collect and analyse the available evidence in the outcomes of patients treated with fenestrated endovascular aortic repair (f-EVAR) technique focusing specifically on visceral vessel outcomes. METHODS The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the studies reporting the f-EVAR technique for the management of degenerative pararenal and/or type IV thoracoabdominal aortic aneurysms (TAAA) were considered eligible for inclusion in the study. The main study outcomes (technical success, type I endoleaks, fracture or occlusion of the bridging stents, overall aneurysm-related mortality, and the reintervention rate) were subsequently expressed as proportions and 95% confidence intervals. RESULTS Fourteen studies with a total of 1804 patients were included in a pooled analysis. The technical success of the procedure was 95.97% (95%CI = 92.35-98.60). Intraoperatively, the pooled proportion of reported type I endoleak was 7.6% (95%CI = 2.52-14.60) while during a median follow-up of 41 months (range 11-96) follow-up period the pooled rate of fracture and occlusion of the bridging stents was 2.79% (95%CI = 0.00-8.52) and 4.46% (95%CI = 1.93-7.77), respectively. The overall aneurysm-related mortality was detected to be 0.63% (95%CI = 0.04-1.63), and the pooled estimate for re-intervention rate was 15.69%. CONCLUSIONS Fenestrated endovascular repair for p-AAA is an effective and safe treatment. Target vessel complications and endoleaks remain the two most important concerns for fenestrated endovascular procedures, contributing to most of the secondary interventions. The lack of computed tomography angiography follow-up evaluation does not allow us to draw robust conclusions about the complication rates for the superior mesenteric artery during f-EVAR. Due to the potential implications of SMA complications on aneurysm-related mortality, standardized reporting of short- and long-term target visceral vessel outcomes is required.
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Affiliation(s)
- Georgios I Karaolanis
- Vascular Unit, Department of Surgery, University of Ioannina, and of School of Medicine, Ioannina, Greece
| | - Constantine N Antonopoulos
- Cardiothoracic and Vascular Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Salvatore Scali
- Division of Vascular Surgery, University of Florida, Gainesville, FL, USA
| | - Stylianos G Koutsias
- Vascular Unit, Department of Surgery, University of Ioannina, and of School of Medicine, Ioannina, Greece
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Konstantinos P Donas
- Department of Vascular and Endovascular Surgery, Research Vascular Centre, Asclepios Clinic Langen, University of Frankfurt, Germany
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Harmon TS, Ghannam A, Meyer TE, Concepcion C, Pirris J, Matteo J. Covered or Not, Here I Come: Stanford Type B Aortic Dissection Repair With a Covered and Uncovered Stent Hybrid Technique. Cureus 2020; 12:e11729. [PMID: 33391956 PMCID: PMC7772157 DOI: 10.7759/cureus.11729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The complications resulting from aortic dissections are often devastating. Historically, when a Stanford B aortic dissection extended into the visceral abdominal aorta, only surgical management was considered to limit visceral organ malperfusion. Complications of surgical management for Stanford B aortic dissections are as high as 50%. The inherently high complication and mortality rate for any acute aortic dissection, in addition to the complication rates resulting from surgical management, have demonstrated poor outcomes. This is especially true when aortic dissections involve the visceral segment, where thoracic endovascular aortic repair (TEVAR) becomes limited or contraindicated. In the last two decades, various approaches for TEVAR have improved in both endograft design and interventional technique. The current literature demonstrates improved outcomes for patients that receive TEVAR for Stanford B aortic dissections, including those that involve the visceral segment. Despite favorable prognostic advancement in TEVAR, the proven management complexity of Stanford B aortic dissections continue to reflect the pitfalls of the endovascular devices that are currently available. We describe a covered and uncovered stent hybrid technique in patients with complicated Stanford B aortic dissections involving the visceral segment, considering these deficiencies. Hundred percent technical success was demonstrated in the short and mid-term surveillance periods.
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Affiliation(s)
- Taylor S Harmon
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Alexander Ghannam
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Travis E Meyer
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - John Pirris
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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Končar IB, Jovanović AL, Dučič SM. The role of fEVAR, chEVAR and open repair in treatment of juxtarenal aneurysms: a systematic review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:24-36. [PMID: 32079378 DOI: 10.23736/s0021-9509.19.11187-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Open repair (OR), fenestrated endovascular aneurysm repair (fEVAR) and endovascular exclusion using parallel graft (chEVAR) are complementary procedures used for treatment of juxtarenal abdominal aortic aneurysm (jrAAA). The aim of our study was to assess available literature and analyze dispersion of OR, fEVAR and chEVAR procedures among reported papers related to treatment of jrAAA. EVIDENCE ACQUISITION The PubMed database was systematically searched using predefined strategy and key words related to treatment of jrAAA on September 28th, 2019. Studies were assessed for eligibility using the inclusion and exclusion criteria with at least five patients treated with at least one of the procedures while systematic reviews, meta-analysis, reviews, comments, editorials and letters were excluded as well as studies without clear classification of the location of the aneurysm, studies not specifying the number of patients treated with each of the techniques or not discriminated between aortic pathologies (juxtarenal, paravisceral and thoracoabdominal), hybrid procedures, endoanchors or with branched stent-graft. EVIDENCE SYNTHESIS Overall, 1533 papers were identified while papers that met inclusion criteria were either representing experience of single institution (87 papers) or from multicenter studies (6 papers), national or international registries (18 papers). In the period between January 1977 and December 2017, treatment of 5664 patients with jrAAA was reported in 87 papers as a single institution report. Out of them 2531 (45%) were treated with OR, 2592 (46%) with fEVAR and 541 (9%) with chEVAR. Out of 29 institutions reporting OR, there were 11 (37.9%) with more than 100 treated patients while 21 (41.1%) out of 51 institutions that reported more than 50 jrAAA treated with fEVAR. Only four institutions reported results of all three treatment modalities. CONCLUSIONS Based on the results reported in the literature, regardless of its complexity and costs, fEVAR for jrAAA has been accepted in substantial number of hospitals worldwide, while number of reported procedures is reaching OR.
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Affiliation(s)
- Igor B Končar
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia - .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
| | - Aleksa L Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan M Dučič
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia
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Liang NL, Mohapatra A, Avgerinos ED, Katsargyris A. Acute Kidney Injury after Complex Endovascular Aneurysm Repair. Curr Pharm Des 2020; 25:4686-4694. [DOI: 10.2174/1381612825666191129095829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022]
Abstract
Background:
Complex endovascular repair of abdominal aortic aneurysm carries higher perioperative
morbidity than standard infrarenal endovascular repair.
Objective:
This study reviews the incidence and associated factors of acute kidney injury in complex aortic endovascular
repair of juxtarenal, pararenal, and thoracoabdominal aortic aneurysms.
Methods:
A literature review was performed for all studies on the endovascular repair of juxtarenal, pararenal,
and thoracoabdominal aneurysms that evaluated rates of acute kidney injury as an outcome. Outcomes were further
analyzed by the level of anatomic complexity and method of repair.
Results:
52 studies met inclusion criteria, with a total of 5454 individuals undergoing repair from 2004 to 2017.
The overall rate of acute kidney injury ranged widely from 0 to 41%, with a rate of hemodialysis from 0 to 19%
(temporary) and 0 to 14% (permanent). Increasing anatomic complexity was associated with higher rates of acute
kidney injury. Mode of endovascular repair, learning curve effect, and preoperative chronic renal insufficiency
did not demonstrate any associations with the outcome.
Conclusion:
Published rates of acute kidney injury in complex aortic aneurysm repair vary widely with few definitively
associated factors other than increasing anatomic complexity and operative time. Further study is
needed for the identification of predictors related to postoperative acute kidney injury.
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Affiliation(s)
- Nathan L. Liang
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, Penn, United States
| | - Abhisekh Mohapatra
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, Penn, United States
| | - Efthymios D. Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, Penn, United States
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Nuremberg, Germany
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7
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Lee JH, Choi JH, Kim EJ. The Influence of Unfavorable Aortoiliac Anatomy on Short-Term Outcomes after Endovascular Aortic Repair. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:180-186. [PMID: 29854662 PMCID: PMC5973214 DOI: 10.5090/kjtcs.2018.51.3.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
Abstract
Background Endovascular aortic repair (EVAR) is widely performed to treat infrarenal abdominal aortic aneurysms (AAAs), and related techniques and devices continue to be developed. Although continuous attempts have been made to perform EVAR in patients with unfavorable aortic anatomy, the outcomes are still controversial. This study examined the short-term outcomes of EVAR for the treatment of infrarenal AAAs in patients with a ‘hostile’ neck and unfavorable iliac anatomy. Methods Thirty-eight patients who underwent EVAR from January 2012 to December 2017 were enrolled in this study. A hostile neck was defined based on neck length, angulation, the presence of an associated thrombus, or a conical shape. Unfavorable iliac anatomy was considered to be present in patients with a short common iliac artery (<15 mm) or the presence of aneurysmal changes. Results No perioperative mortality was recorded. No significant differences were found depending on the presence of a hostile neck, but aneurysmal sac shrinkage was significantly less common in the group with unfavorable iliac anatomy (p=0.04). A multivariate analysis performed to analyze the risk factors for aneurysmal progression revealed only unfavorable iliac anatomy to be a risk factor (p=0.02). Conclusion Patients with unfavorable aortic anatomy showed relatively satisfactory short-term outcomes after EVAR. No difference in the surgical outcomes was observed in patients with a hostile neck. However, unfavorable iliac anatomy was found to inhibit the shrinkage of the aneurysmal sac.
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Affiliation(s)
- Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital
| | - Jin-Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital
| | - Eung-Joong Kim
- Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital
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Francois CJ, Skulborstad EP, Majdalany BS, Chandra A, Collins JD, Farsad K, Gerhard-Herman MD, Gornik HL, Kendi AT, Khaja MS, Lee MH, Sutphin PD, Kapoor BS, Kalva SP. ACR Appropriateness Criteria ® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018; 15:S2-S12. [DOI: 10.1016/j.jacr.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/17/2022]
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Ciani O, Epstein D, Rothery C, Taylor RS, Sculpher M. Decision uncertainty and value of further research: a case-study in fenestrated endovascular aneurysm repair for complex abdominal aortic aneurysms. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:15. [PMID: 29686541 PMCID: PMC5902886 DOI: 10.1186/s12962-018-0098-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 04/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background Fenestrated endovascular aneurysm repair (fEVAR) is a new approach for complex abdominal aortic aneurysms, limited to a few specialist centers, with limited evidence base. We developed a cost-effectiveness decision model of fEVAR compared to open surgical repair (OSR) to investigate the likely direction of costs and benefits and inform further research projects on this technology. Methods A systematic review with meta-analysis and a four-state Markov model were used to estimate the cost-effectiveness of fEVAR versus OSR. We used a recent coverage with evidence development framework to characterize the main sources of uncertainty and inform decisions about the type of further research that would be most worthwhile and feasible. Results Seven observational comparative studies were identified, of which four presented odds ratios adjusted for confounders. The odds ratios for operative mortality varied widely between studies. Assuming a central estimate of the odds ratio of 0.54 (95% CI 0.05–6.24), the decision model estimated that the incremental cost per quality adjusted life year (QALY) was £74,580/QALY with a probability of 9 and 16% of being cost-effective at standard cost-effectiveness thresholds of £20,000/QALY and £30,000/QALY, respectively. The Expected Value of Perfect Information over 10 years at a threshold of £20,000/QALY was £11.2 million. Operative mortality contributed to most of the uncertainty in the decision model. Conclusions In the case of “maturing technologies”, decision modelling indicates the likely direction of costs and benefits and guides the development of further research projects. In our analysis of fEVAR versus OSR, decision uncertainty, particularly around operative mortality, might be effectively resolved by a short-term RCT, or possibly a well-conducted comparative observational study. Decision makers may consider that a conditional coverage decision is warranted with assessments required to make this type of recommendation depending on local priorities and circumstances. Electronic supplementary material The online version of this article (10.1186/s12962-018-0098-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oriana Ciani
- 1Evidence Synthesis and Modeling for Health Improvement, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU UK.,2Center for Research on Health and Social Care Management, SDA Bocconi University, via Roentgen 1, 20136 Milan, Italy
| | - David Epstein
- 3Centre for Health Economics, University of York, Heslington, Alcuin 'A' Block, York, YO10 5DD UK.,4Department of Applied Economics, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain
| | - Claire Rothery
- 3Centre for Health Economics, University of York, Heslington, Alcuin 'A' Block, York, YO10 5DD UK
| | - Rod S Taylor
- 1Evidence Synthesis and Modeling for Health Improvement, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU UK
| | - Mark Sculpher
- 3Centre for Health Economics, University of York, Heslington, Alcuin 'A' Block, York, YO10 5DD UK
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Endovaskuläre Aortentherapie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-017-0163-0] [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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Aiello F, Durgin J, Daniel V, Messina L, Doucet D, Simons J, Jenkins J, Schanzer A. Surgeon leadership in the coding, billing, and contractual negotiations for fenestrated endovascular aortic aneurysm repair increases medical center contribution margin and physician reimbursement. J Vasc Surg 2017; 66:997-1006. [DOI: 10.1016/j.jvs.2017.01.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
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de Souza LR, Oderich GS, Farber MA, Haulon S, Banga PV, Pereira AH, Gloviczki P, Textor SC, Jia F. Editor's Choice - Comparison of Renal Outcomes in Patients Treated by Zenith ® Fenestrated and Zenith ® Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal Trials. Eur J Vasc Endovasc Surg 2017; 53:648-655. [PMID: 28285957 DOI: 10.1016/j.ejvs.2017.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/03/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE/BACKGROUND Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined. METHODS Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR. Sixty-seven patients were treated by FEVAR and 134 matched controls treated by EVAR. Mean follow-up was 30 ± 20 months. Outcomes included acute kidney injury (AKI) defined by RIFLE and changes in serum creatinine (sCr), eGFR, and chronic kidney disease (CKD) staging up to 5 years. RESULTS AKI at 1 month was similar between groups, with > 25% decline in eGFR observed in 5% of FEVAR and 9% of EVAR patients (p = .39). There were no significant differences in > 25% decline in eGFR at 2 years (FEVAR 20% vs. EVAR 20%; p > .99) or 5 years (FEVAR 27% vs. EVAR 50%; p = .50). Progression to stage IV-V CKD was similar at 2 years (FEVAR 2% vs. EVAR 3%; p > .99) and 5 years (FEVAR 7% vs. EVAR 8%; p > .99), with similar sCr and eGFR up to 5 years. During follow-up, there were more renal artery stenosis/occlusions (15/67 [22%] vs. 3/134 [2%]; p < .001) and renal related re-interventions (12/67 [18%] vs. 4/134 [3%]; p < .001) in patients treated by FEVAR. Rate of progression to renal failure requiring dialysis was low and identical in both groups (1.5% vs. 1.5%; p > .99). CONCLUSION Aortic repair with FEVAR and EVAR was associated with similar rates of renal function deterioration in patients with preserved pre-operative renal function. Renal related re-interventions were higher following FEVAR, although net changes in renal function were similar in both groups.
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Affiliation(s)
- L R de Souza
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA; Surgery PhD Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - G S Oderich
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
| | - M A Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - S Haulon
- Aortic Center, CHRU Lille, France
| | - P V Banga
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA; Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - A H Pereira
- Surgery PhD Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - P Gloviczki
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - S C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - F Jia
- Cook Research Incorporated, West Lafayette, IN, USA
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Rylski B, Czerny M, Südkamp M, Russe M, Siep M, Beyersdorf F. Fenestrated and Branched Aortic Grafts. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:816-22. [PMID: 26667980 DOI: 10.3238/arztebl.2015.0816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Abdominal and thoracic aortic aneurysms are diagnosed in 40 and 10 to 15 out of 100 000 persons per year, respectively. Fenestrated (fEVAR) and branched (bEVAR) stent grafts have been developed for abdominal juxtarenal and thoracoabdominal aneurysms. We discuss the patency and complication rates of fEVAR and bEVAR procedures and compare them with the outcome of open surgery. METHODS This review is based on pertinent publications from 2011 to 2014 that were retrieved by a selective literature search. The clinical outcomes of case series involving a total of more than 1500 patients are presented. The discussion takes account of recommendations contained in the literature and the authors' own experience. RESULTS Open surgery and aortic stent grafting have not been compared in any randomized trial to date. We identified 7 clinical series that included a total of 1270 fEVAR patients and 5 with a total of 408 bEVAR patients. The perioperative mortality after fEVAR procedures was 0-4%. Spinal cord ischemia arose in 1% of cases. The stent patency rate in visceral vessels ranged from 93 to 98%. bEVAR procedures were associated with both higher mortality (4-7%) and more common spinal cord ischemia (4-13%). 5-8% of all patients needed dialysis perioperatively, and the stent patency rate in visceral vessels was 94-97%. Preoperative renal insufficiency was a risk factor for peri-interventional death. Impaired renal function after fEVAR/bEVAR procedures was mainly associated with intermittent lower limb ischemia. CONCLUSION The results of fEVAR/bEVAR procedures in the last 5 years are similar to those of open surgery. The high postoperative rate of spinal cord ischemia remains a serious problem in the endovascular treatment of thoracoabdominal aortic aneurysms. The decision to implant a stent graft by an endovascular approach or to treat surgically should be made on a case-to-case basis in an interdisciplinary vascular conference.
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Affiliation(s)
- Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Center for Diagnostic and Therapeutic Radiology, Medical Center-University of Freiburg
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Tanious A, Lee JT, Shames M. Snorkel endovascular abdominal aortic aneurysm repair versus fenestrated endovascular aneurysm repair: is it a competition? Semin Vasc Surg 2016; 29:68-73. [PMID: 27823593 DOI: 10.1053/j.semvascsurg.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The endovascular treatment of juxtarenal abdominal aortic aneurysm (AAA) can be performed by either a standard endovascular stent graft with additional snorkle grafts to aorta branches (snorkel endovascular aneurysm repair) or implantation of a fenestrated stent graft (fenestrated endovascular aneurysm repair). While many vascular surgeons consider snorkel endovascular aneurysm repair and fenestrated endovascular aneurysm repair to be competing techniques or alternate strategies, published procedural outcomes suggest more complementary roles. In this clinical review, the advantages and disadvantages of these two approaches are debated, as much can be learned from both strategies. Because the indications and circumstances for juxtarenal AAA repair vary based on patient-specific comorbidities and anatomy, it is recommended that vascular surgeons have access to, and experience with, both treatment strategies. Based on published outcomes, patient outcomes, stent-graft patency, and re-intervention rates are generally similar and acceptable compared with open AAA repair. We conclude that there is a time and a place for both snorkel endovascular aneurysm repair and fenestrated endovascular aneurysm repair for the endovascular management of juxtarenal and pararenal AAA anatomy.
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Affiliation(s)
- Adam Tanious
- Division of Vascular and Endovascular Surgery of University of South Florida College of Medicine, Tampa, FL
| | - Jason T Lee
- Divisions of Vascular and Endovascular Surgery of Stanford University, Palo Alto, CA
| | - Murray Shames
- Division of Vascular and Endovascular Surgery of University of South Florida College of Medicine, Tampa, FL.
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Open abdominal aortic aneurysm repair is still necessary in an era of advanced endovascular repair. J Vasc Surg 2016; 64:333-337. [PMID: 27183852 DOI: 10.1016/j.jvs.2016.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/04/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Recent advances in endovascular aneurysm repair have overcome substantial anatomic barriers associated with short and challenging necks. With greater range to treat more difficult anatomy from an endovascular approach, one would assume the need of open surgical repair (OSR) would be diminished. The purpose of our study was to determine the need for OSR for abdominal aortic aneurysms, in a tertiary academic setting, with a moderate volume (10-15 cases/year) of fenestrated endografting being performed. METHODS An Institutional Review Board approved retrospective review was performed of all patients who underwent elective aortic aneurysm repair between January 2010 and July 2014. Computed tomography scans for patients who underwent OSR were reviewed and anatomic characteristics obtained. Instructions for use of (IFU) a commercially available fenestrated device (Cook Medical, Bloomington, Ind) were used to determine if open repair patients had anatomy amenable to advanced endovascular repair. RESULTS During the study interval, 415 patients underwent abdominal aortic aneurysm repair. Of those patients who underwent elective aneurysm repair, 105 patients had OSR. The study subsequently excluded 11 patients because they underwent secondary interventions after a failed endovascular repair and thus were not further evaluated. Also excluded were 18 patients who had OSR for an emergency intervention. The remaining 76 patients (35 female, 41 male; average age, 72 ± 8 years) had OSR and were outside the IFU of the fenestrated endovascular aneurysm repair (FEVAR) device. The average diameter of the abdominal aorta was 5.9 cm. Indications for OSR were an aneurysm neck <4 mm (71%), inclusion of at least 1 visceral vessel (69.7%), unilateral iliac artery aneurysms (15.5%), bilateral iliac artery aneurysms (14.3%), iliac artery tortuosity >40° of angulation (37.6%), extensive aortic thrombus (23.2%), and aortic neck angulation >45° (11.8%). Rejected patients had an average of 1.7 ± 0.8 anatomic constraints (range 1-4) that prevented use of the FEVAR device. CONCLUSIONS With evidence to support the strict adherence to IFU protocols of the FEVAR device in patients, our institution's practice has been to continue to perform open abdominal aortic aneurysm repair for patients with anatomy outside device protocols. Although it was thought that the decreased requirement of aortic neck required to deploy an endograft would lead to an increased patient population amenable to endovascular repair, there is still a clinically significant need for open aortic surgery.
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van Lammeren GW, Ünlü Ç, Verschoor S, van Dongen EP, Wille J, van de Pavoordt ED, de Vries-Werson DA, De Vries JPP. Results of open pararenal abdominal aortic aneurysm repair: single centre series and pooled analysis of literature. Vascular 2016; 25:234-241. [PMID: 27565511 DOI: 10.1177/1708538116665268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Endovascular treatment of pararenal abdominal aortic aneurysm has gained terrain over the past decade, despite the substantial need for reinterventions during follow-up. However, open repair is still a well-established treatment option. With the current study we report the results of a consecutive series of elective primary open pararenal abdominal aortic aneurysm repair in a tertiary vascular referral centre, combined with an overview of current literature and pooled data analysis of perioperative mortality of open and endovascular pararenal abdominal aortic aneurysm repair. Methods A retrospective analysis of a prospective database of all elective open pararenal abdominal aortic aneurysm repairs in the St. Antonius Hospital between 2005 and 2014 was performed. Primary endpoint was 30-day mortality. Secondary endpoints were 30-day morbidity, new onset dialysis, reintervention free survival, and overall survival during follow-up. Results Between 2005 and 2014, 214 consecutive patients underwent elective open pararenal abdominal aortic aneurysm repair. Mean age was 69.8 (±7.1) years, 82.7% (177/214) were men, and mean abdominal aortic aneurysm diameter was 62 (±11) mm. Thirty-day mortality was 3.4%. Thirty-day morbidity was 27.1%, which predominantly consisted of pneumonia (18.7% (40/214)), cardiac events (3.3% (7/214)), and new onset dialysis (2.8% (6/214)). Estimated five-year overall survival rate was 74.2%. 0.9% (2/214) of patients required abdominal aortic aneurysm-related reintervention, and an additional 2.3% (5/214) required surgical repair of an incisional hernia. Pooled analysis of literature revealed a 30-day mortality of 3.0% for open pararenal repair and 1.9% for fenestrated endovascular repair. Conclusion Open pararenal abdominal aortic aneurysm repair in the era of increasing endovascular options results in acceptable perioperative morbidity and mortality rates. Mid-term reintervention rate is low compared to fenestrated endovascular aneurysm repair. Expertise with open repair still remains essential for treatment of pararenal abdominal aortic aneurysms in the near future, especially for those patients that are declined for endovascular treatment.
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Affiliation(s)
- Guus W van Lammeren
- 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Çağdaş Ünlü
- 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Sjoerd Verschoor
- 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Eric P van Dongen
- 2 Department of Anaesthesiology, Intensive Care and Pain Therapy, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Jan Wille
- 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | | | | | - Jean-Paul Pm De Vries
- 1 Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
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Henry M, Benjelloun A, Henry I. The Multilayer Flow Modulator stent for the treatment for arterial aneurysms: Concept, Indications and Contraindications. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jicc.2015.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Georgiadis GS, van Herwaarden JA, Antoniou GA, Giannoukas AD, Lazarides MK, Moll FL. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm. Vasc Med 2016; 21:223-38. [DOI: 10.1177/1358863x16631841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).
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Affiliation(s)
- George S Georgiadis
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Miltos K Lazarides
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
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Hu Z, Li Y, Peng R, Liu J, Zhang T, Guo W. Experience With Fenestrated Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms at a Single Center. Medicine (Baltimore) 2016; 95:e2683. [PMID: 26962769 PMCID: PMC4998850 DOI: 10.1097/md.0000000000002683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED To present the early and mid-term results of fenestrated endovascular aneurysm repair (FEVAR) using the Zenith fenestrated device for juxtarenal abdominal aortic aneurysms (JAAAs) at our center in China. DESIGN Retrospective study.The study included 15 male patients with JAAAs, who underwent FEVAR using the Zenith fenestrated device at our center between February 2011 and June 2015.All custom-made Zenith fenestrated devices were designed according to computed tomography angiography (CTA) images obtained preoperatively. The patients with renal insufficiency underwent duplex ultrasonography, while the patients with normal renal function underwent 3 CT data acquisitions including nonenhanced CT, arterial phase, and venous phase. These examinations and blood examinations were completed at 3, 6, and 12 months after discharge, and annually thereafter.The mean age of the patients was 73.13 ± 9.06 years (range, 57-86 years), and the median follow-up period was 30 months (8-52 months). Small fenestrations were used in 27 renal arteries, scallops were used in 7 superior mesenteric arteries (SMAs) and 2 renal arteries, and large fenestrations were used in 2 SMAs. Conversion to an open procedure was not required in any of the patients, and the technical success rate was 100%. The mean length of hospital stay was 11.33 ± 2.02 days (7-15 days). No patient died within the 1st 30 days after the operation. One patient had a type Ia endoleak, which disappeared at 6 months after the operation, 1 patient had a type Ib endoleak, which was detected at 17 months after the operation, and 2 patients had type II endoleaks. One patient died at 17 months and another patient died at 30 months after the operation. Therefore, the all-cause mortality rate was 13.33% (2/15). The target vessel patency rate was 100% without occlusion.The early and mid-term results of FEVAR using the Zenith fenestrated device were good, demonstrating that this procedure is effective for the treatment of JAAAs.
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Affiliation(s)
- Zhongzhou Hu
- From the Medical Center Tsinghua University (ZH); Department of Vascular Surgery, General Hospital of People's Liberation Army (YL, JL, WG); State Key Laboratory of Microbial Technology, School of Life Science, Shandong University, Jinan 250100, China (RP); and Department of Vascular Surgery, Peking University People's Hospital, Beijing, China (TZ)
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Li Y, Hu Z, Bai C, Liu J, Zhang T, Ge Y, Luan S, Guo W. Fenestrated and Chimney Technique for Juxtarenal Aortic Aneurysm: A Systematic Review and Pooled Data Analysis. Sci Rep 2016; 6:20497. [PMID: 26869488 PMCID: PMC4751537 DOI: 10.1038/srep20497] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/05/2016] [Indexed: 12/02/2022] Open
Abstract
Juxtarenal aortic aneurysms (JAA) account for approximately 15% of abdominal aortic aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) and chimney endovascular aneurysm repair (CH-EVAR) are both effective methods to treat JAAs, but the comparative effectiveness of these treatment modalities is unclear. We searched the PubMed, Medline, Embase, and Cochrane databases to identify English language articles published between January 2005 and September 2013 on management of JAA with fenestrated and chimney techniques to conduct a systematic review to compare outcomes of patients with juxtarenal aortic aneurysm (JAA) treated with the two techniques. We compared nine F-EVAR cohort studies including 542 JAA patients and 8 CH-EVAR cohorts with 158 JAA patients regarding techniques success rates, 30-day mortality, late mortality, endoleak events and secondary intervention rates. The results of this systematic review indicate that both fenestrated and chimney techniques are attractive options for JAAs treatment with encouraging early and mid-term outcomes.
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Affiliation(s)
- Yue Li
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Zhongzhou Hu
- Medical Center Tsinghua University, Beijing, China
| | - Chujie Bai
- Department of Orthopaedic Oncology, Peking University Caner Hospital, Beijing, China
| | - Jie Liu
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Yangyang Ge
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Shaoliang Luan
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Wei Guo
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
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Osman E, Tan KT, Tse L, Jaskolka J, Roche-Nagle G, Oreopoulos G, Rubin B, Lindsay T. The in-hospital costs of treating high-risk patients with fenestrated and branched endografts. J Vasc Surg 2015; 62:1457-64. [DOI: 10.1016/j.jvs.2015.07.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/07/2015] [Indexed: 01/22/2023]
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Part Two: Against the Motion. Fenestrated EVAR Procedures are not Better than Snorkels, Chimneys, or Periscopes in the Treatment of Most Thoracoabdominal and Juxtarenal Aneurysms. Eur J Vasc Endovasc Surg 2015; 50:557-61. [PMID: 26602953 DOI: 10.1016/j.ejvs.2015.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hertault A, Haulon S, Lee JT. Debate: Whether branched/fenestrated endovascular aneurysm repair procedures are better than snorkels, chimneys, or periscopes in the treatment of most thoracoabdominal and juxtarenal aneurysms. J Vasc Surg 2015; 62:1357-65. [DOI: 10.1016/j.jvs.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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A Systematic Review of Fenestrated Endovascular Repair for Juxtarenal and Short-Neck Aortic Aneurysm: Evidence So Far. Ann Vasc Surg 2015; 29:1680-8. [DOI: 10.1016/j.avsg.2015.06.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/15/2015] [Accepted: 06/04/2015] [Indexed: 11/21/2022]
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Graves HL, Jackson BM. The Current State of Fenestrated and Branched Devices for Abdominal Aortic Aneurysm Repair. Semin Intervent Radiol 2015; 32:304-10. [PMID: 26327749 DOI: 10.1055/s-0035-1558707] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) provides an attractive alternative to traditional open techniques. Endovascular repair is frequently limited by aortic aneurysm neck angulation, the absence of an adequate infrarenal neck, and the need for internal iliac preservation. Several devices have been created to incorporate visceral artery segments as well as preserve the internal iliac artery, thus broadening the patient population suited for endovascular repair. This article will provide a review of the current literature regarding fenestrated devices, branch devices, off-the-shelf devices, and physician-modified devices. It will also highlight the iliac branch stent grafts currently on trial for internal iliac artery preservation. Data thus far have suggested that these devices will be both a safe and effective option for anatomically challenging abdominal aortic aneurysms.
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Affiliation(s)
- Holly L Graves
- Division of Vascular Surgery and Endovascular Therapy, Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin M Jackson
- Division of Vascular Surgery and Endovascular Therapy, Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Armstrong N, Burgers L, Deshpande S, Al M, Riemsma R, Vallabhaneni SR, Holt P, Severens J, Kleijnen J. The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: a systematic review and cost-effectiveness analysis. Health Technol Assess 2015; 18:1-66. [PMID: 25522080 DOI: 10.3310/hta18700] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with large abdominal aortic aneurysms (AAAs) are usually offered reparative treatment given the high mortality risk. There is uncertainty about how to treat juxtarenal AAAs (JRAAAs) or thoracoabdominal aortic aneurysms (TAAAs). Endovascular repair of an abdominal aortic aneurysm (EVAR) is often seen as safer and easier than open surgical repair (OSR). However, endovascular treatment of JRAAAs or TAAAs requires specially manufactured stent grafts, with openings to allow blood to reach branches of the aorta. Commissioners are receiving increasing requests for fenestrated EVAR (fEVAR) and branched EVAR (bEVAR), but it is unclear whether or not the extra cost of fEVAR or bEVAR is justified by advantages for patients. OBJECTIVE(S) To assess the clinical effectiveness, safety and cost-effectiveness of fEVAR and bEVAR in comparison with conventional treatment (i.e. no surgery) or OSR for two populations: JRAAAs and TAAAs. DATA SOURCES Resources were searched from inception to October 2013, including MEDLINE (OvidSP), EMBASE (OvidSP) and the Cochrane Central Register of Controlled Trials (Wiley) and, additionally, for cost-effectiveness, NHS Economic Evaluation Database (NHS EED; Wiley) and EconLit (EBSCOhost). Conference abstracts were also searched. REVIEW METHODS Studies were included based on an intervention of either fEVAR or bEVAR and a comparator of either OSR or no surgery. For clinical effectiveness, observational studies were excluded only if they were not comparative, i.e. explicitly selected on the basis of prognosis. RESULTS For clinical effectiveness, searches retrieved 5253 records before deduplication. Owing to overlap between the databases, 1985 duplicate records were removed. Of the remaining 3268 records, based on titles and abstracts, 3244 records were excluded, leaving 24 publications to be ordered. All 24 studies were excluded as none of them satisfied the inclusion criteria. Sixteen studies were excluded on study design, six on intervention and two on comparator. Five out of 16 studies excluded on study design reported a comparison. However, all of the studies acknowledged that they had groups that were not comparable at baseline given that they had selectively assigned younger, fitter patients to OSR. Therefore, these studies were considered 'non-comparative'. For cost-effectiveness, searches identified 104 references before deduplication. Owing to overlap between the databases, 34 duplicate records were removed. Of the remaining 70 records, seven were included for the full assessment based on initial screening. After a full-text review, no studies were included. Because of the lack of clinical effectiveness evidence and difficulty in estimating costs given the rapidly changing and variable technology, a cost-effectiveness analysis (CEA) was not performed. Instead a detailed description of modelling methods was provided. CONCLUSIONS Despite a thorough search, no studies could be found that met the inclusion criteria. All studies that compared either fEVAR or bEVAR with either OSR or no surgery explicitly selected patients based on prognosis, i.e. essentially the populations for each comparator were not the same. Despite not being able to conduct a CEA, we have provided detailed methods for the conduct if data becomes available. FUTURE WORK We recommend at least one clinical trial to provide an unbiased estimate of effect for fEVAR/bEVAR compared with OSR or no surgery. This trial should also collect data for a CEA. STUDY REGISTRATION This study is registered as PROSPERO CRD42013006051. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Laura Burgers
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Maiwenn Al
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - S R Vallabhaneni
- Regional Vascular Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Peter Holt
- St George's Vascular Institute, London, UK
| | - Johan Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Sveinsson M, Sobocinski J, Resch T, Sonesson B, Dias N, Haulon S, Kristmundsson T. Early versus late experience in fenestrated endovascular repair for abdominal aortic aneurysm. J Vasc Surg 2015; 61:895-901. [DOI: 10.1016/j.jvs.2014.11.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022]
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Twelve-year results of fenestrated endografts for juxtarenal and group IV thoracoabdominal aneurysms. J Vasc Surg 2015; 61:355-64. [DOI: 10.1016/j.jvs.2014.09.068] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022]
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Suominen V, Pimenoff G, Salenius J. Fenestrated and chimney endografts for juxtarenal aneurysms: early and midterm results. Scand J Surg 2015; 102:182-8. [PMID: 23963033 DOI: 10.1177/1457496913490464] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess the early and short-term outcome of fenestrated and chimney grafting for juxtarenal aortic aneurysms. MATERIAL AND METHODS A prospective vascular registry of 28 patients who had undergone elective primary endovascular repair for abdominal aortic aneurysm between December 2007 and August 2011 with infrarenal neck anatomy unacceptable for conventional endovascular repair. Fenestrated endografts were designed based on reconstructed computed tomography (CT) data by the authors. Off-the-shelf grafts and stents were used for chimney cases. Patients were followed up until 31 May 2012. RESULTS A total of 21 (75%) patients were treated with fenestrated endografts, while 7 (25%) received chimney grafts. The mean aneurysm diameter was 65 mm (standard deviation = 7 mm) and the median neck length 2.5 mm (range: 0-10 mm). Altogether, 63 (mean = 2.3/patient) visceral arteries were incorporated (42 renal, 21 superior mesenteric arteries). The overall primary technical success rate was 93% (one type I and one type III endoleak). The mean follow-up was 22 months (standard deviation: 14 months). The primary type III endoleak resolved spontaneously with thrombosis of the target vessel, while the patient with primary type I endoleak died of acute myocardial infarction 3 weeks after the procedure. Two late endoleaks developed: one type II endoleak without aneurysm sac growth remains under surveillance, while in another patient, multiple attempts to treat type I endoleak proved unsuccessful and the patient later died of gastrointestinal bleeding. A total of 4 (14%) patients so far required additional procedures. Two patients died within 30 days of the device implantation and another six during the follow-up. No rupture occurred. The cumulative survival for patients with fenestrated endografts was 85% at 1 year and for those treated with chimney technique 57%. CONCLUSIONS The treatment of juxtarenal aortic aneurysms seems to be feasible by exploiting various endovascular techniques. Even with a low volume of cases, good immediate and short-term results can be achieved, especially with fenestrated endografts.
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Affiliation(s)
- V Suominen
- Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland
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Fenestrated endovascular repair of abdominal aortic aneurysms is associated with increased morbidity but comparable mortality with infrarenal endovascular aneurysm repair. J Vasc Surg 2014; 61:604-10. [PMID: 25499706 DOI: 10.1016/j.jvs.2014.10.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/16/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE A recent prospective study found that fenestrated endovascular abdominal aortic aneurysm (AAA) repair (FEVAR) was safe and effective in appropriately selected patients at experienced centers. As this new technology is disseminated to the community, it will be important to understand how this technology compares with standard endovascular AAA repair (EVAR). The goal of this study was to compare the outcomes of FEVAR vs EVAR of AAAs. METHODS The American College of Surgeons-National Surgical Quality Improvement Program database from 2005 to 2012 was queried for AAAs (International Classification of Diseases, Ninth Revision code 441.4). Patients were stratified according to procedure (FEVAR vs EVAR). A bivariate analysis was done to assess preoperative and intraoperative risk factors for postoperative outcomes. Thirty-day postoperative mortality and complication rates were described for each procedure type. Multivariable logistic regression was performed to assess the association between the type of procedure and the risk of postoperative complications. RESULTS A total of 458 patients underwent FEVAR and 19,060 patients underwent EVAR for AAA. Patients undergoing FEVAR were older (P = .02) and less likely to have a bleeding disorder (P = .046). Otherwise, the incidence of comorbidities in both groups was similar. FEVAR was associated with increased median operative time (156 vs 137 minutes; P < .001), and average postoperative length of stay (3.3 vs 2.8 days; P = .03). There was a statistically significant increase in overall complications (23.6% vs 14.3%; P < .001) and postoperative transfusions (15.3% vs 6.1%, P < .001) and trends toward increased cardiac complications (2.2% vs 1.3%; P = .09) and the need for dialysis (1.5% vs 0.8%; P = .08) in the FEVAR group. Mortality (2.4% vs 1.5%; P = .12) was not statistically different. On multivariable analysis, FEVAR remained independently associated with the need for postoperative transfusions when operative time was <75th percentile (adjusted odds ratio, 1.72; 95% confidence interval, 1.09-2.72; P = .02) as well as when operative time was >75th percentile for respective procedures (adjusted odds ratio, 5.33; 95% confidence interval, 3.55-8.00; P < .001). CONCLUSIONS Patients undergoing FEVAR are more likely than patients undergoing EVAR to receive blood transfusions postoperatively and are more likely to sustain postoperative complications. Although mortality was similar, trends toward increased cardiac and renal complications may suggest the need for judicious dissemination of this new technology. Future research with larger number of FEVAR cases will be necessary to determine if these associations remain.
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Belczak SQ, Lanziotti L, Botelho Y, Aun R, Silva ESD, Puech-Leão P, Luccia ND. Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review. Clinics (Sao Paulo) 2014; 69:641-6. [PMID: 25318097 PMCID: PMC4192422 DOI: 10.6061/clinics/2014(09)11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022] Open
Abstract
This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked (<15 mm) juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, using "juxtarenal abdominal aortic aneurysm" and "treatment" as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality), except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck <15 mm.
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Affiliation(s)
- Sergio Quilici Belczak
- Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Lanziotti
- Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Yuri Botelho
- Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Aun
- Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Erasmo Simão da Silva
- Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Puech-Leão
- Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nelson de Luccia
- Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Vemuri C, Oderich GS, Lee JT, Farber MA, Fajardo A, Woo EY, Cayne N, Sanchez LA. Postapproval outcomes of juxtarenal aortic aneurysms treated with the Zenith fenestrated endovascular graft. J Vasc Surg 2014; 60:295-300. [DOI: 10.1016/j.jvs.2014.01.071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/30/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
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Canning C, Martin Z, Colgan MP, Abdulrahim O, McCafferty M, Fitzpatrick J, Haider SN, Madhavan P, O'Neill S. Fenestrated endovascular repair of complex aortic aneurysms. Ir J Med Sci 2014; 184:249-55. [PMID: 24599499 DOI: 10.1007/s11845-014-1095-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 02/18/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fenestrated endovascular aneurysm repair (FEVAR) provides an endovascular solution for patients with large abdominal aortic aneurysms and challenging neck anatomy in addition to repair of endoleaks and pseudoaneurysms. This article reports the midterm outcomes of FEVAR from a single-tertiary referral centre in Ireland. METHODS From 2006 to 2012, nine consecutive asymptomatic patients with neck anatomy unfavourable for standard EVAR underwent endovascular repair with a customised fenestrated Zenith stent graft. An additional three patients had fenestrated grafts for repair of pseudoaneurysms (n = 2) following open AAA repair and a type I endoleak (n = 1). All patients were prospectively enrolled in a computerised database. Outcomes including mortality, morbidity, renal function, target vessel patency, endoleak and reintervention were analysed. FINDINGS The mean age and aneurysm size in the primary repair group were 74 years (65-84 years) and 6 cm (5-8.3 cm), respectively, and in the secondary repair group, the mean age was 66 years (61-75 years). No procedures required open conversion, and no visceral arteries were lost. On completion angiography, two patients in group 1 had a type I endoleak and one had a type III endoleak. There were no endoleaks in the secondary repair group. Follow-up ranged from 30 days to 6 years. There was one death within 30 days (8 %) and two deaths at 3 years from non-aneurysm-related causes. Six patients required secondary interventions. Three patients had a transient post-operative creatinine rise of >30 %. CONCLUSION Our study supports FEVAR as a feasible and effective therapy in the management of patients with complex aortic aneurysms.
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Affiliation(s)
- C Canning
- St James's Hospital, Dublin, Ireland,
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Navarro TP, Bernardes RDC, Procopio RJ, Leite JO, Dardik A. Treatment of Hostile Proximal Necks During Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:28-36. [PMID: 26798712 DOI: 10.12945/j.aorta.2014.13-030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/06/2014] [Indexed: 11/18/2022]
Abstract
Endovascular aneurysm repair (EVAR) is a therapy that continues to evolve rapidly as advances in technology are incorporated into new generations of devices and surgical practice. Although EVAR has emerged as a safe and effective treatment for patients with favorable anatomy, treatment of patients with unfavorable anatomy remains controversial and is still an off-label indication for endovascular treatment with some current stent-grafts. The proximal neck of the aneurysm remains the most hostile anatomic barrier to successful endovascular repair with long-term durability. Open surgery for unfavorable necks is still considered the gold standard treatment in contemporary practice, despite the increased mortality and morbidity attributed to suprarenal cross-clamping, particularly in high-risk patients. Evolving technology may overcome the obstacles preventing endovascular treatment of unfavorable proximal neck anatomy; current approaches include purely endovascular as well as hybrid approaches, and generally include strategies that either extend the length of the short neck, move the proximal neck more proximally, or keep the short neck intact. These approaches include the use of debranching techniques, banding, chimneys, fenestrated and branched devices, filling the sac with endobags, endoanchors, and other novel devices. These newer-generation devices appear to have promising short- and midterm results. However, lack of good evidence of efficacy with long-term results for these newer approaches still precludes wide dissemination of endovascular solutions for the hostile proximal neck.
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Affiliation(s)
- Tulio Pinho Navarro
- Federal University of Minas Gerais, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo de Castro Bernardes
- Madre Teresa Hospital Aortic Center, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil; and
| | - Ricardo Jayme Procopio
- Federal University of Minas Gerais, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Jose Oyama Leite
- Federal University of Minas Gerais, Panamerican Circulation Institute, Belo Horizonte, Minas Gerais, Brazil
| | - Alan Dardik
- Yale University School of Medicine, New Haven, Connecticut
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Nessvi S, Gottsäter A, Acosta S. Comparable mid-term survival in patients undergoing elective fenestrated endovascular aneurysm repair and endovascular aneurysm repair for abdominal aortic aneurysm. SAGE Open Med 2014; 2:2050312113519986. [PMID: 26770700 PMCID: PMC4607194 DOI: 10.1177/2050312113519986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/04/2013] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate mid-term survival in patients undergoing elective fenestrated
endovascular aneurysm repair and standard endovascular aneurysm repair for
abdominal aortic aneurysm. Methods: Consecutive patients treated from 2007 to 2011 with elective fenestrated
endovascular aneurysm repair (n = 81) and endovascular aneurysm repair (n =
201) were evaluated concerning age, cardiovascular medication,
comorbidities, and mid-term mortality. Results: Patients in the elective fenestrated endovascular aneurysm repair group were
younger than the endovascular aneurysm repair group (p = 0.006). In
comparison with the endovascular aneurysm repair group, a lower proportion
of patients in the elective fenestrated endovascular aneurysm repair group
had diabetes (p = 0.013) and anemia (p = 0.003), and a higher proportion had
arterial hypertension (p = 0.009). When entering age, endovascular aneurysm
repair or fenestrated endovascular aneurysm repair operation, diabetes,
anemia, and hypertension in a Cox regression model, only age (hazard ratio:
1.07; 95% confidence interval: 1.03–1.11; p < 0.001) was a
risk factor for mid-term mortality. Conclusion: Careful patient selection and medical optimization resulted in comparable
mid-term survival in patients undergoing elective fenestrated endovascular
aneurysm repair and endovascular aneurysm repair.
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Affiliation(s)
- Sofia Nessvi
- Vascular Center Malmö-Lund, Skåne
University Hospital, Malmö, Sweden
| | - Anders Gottsäter
- Vascular Center Malmö-Lund, Skåne
University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Vascular Center Malmö-Lund, Skåne
University Hospital, Malmö, Sweden
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Fenestrated Endovascular Repair for Pararenal Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2013; 27:1190-200. [DOI: 10.1016/j.avsg.2013.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
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Kitagawa A, Greenberg RK, Eagleton MJ, Mastracci TM. Zenith p-branch standard fenestrated endovascular graft for juxtarenal abdominal aortic aneurysms. J Vasc Surg 2013; 58:291-300. [DOI: 10.1016/j.jvs.2012.12.087] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 12/27/2012] [Accepted: 12/27/2012] [Indexed: 10/26/2022]
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Perot C, Sobocinski J, Maurel B, Millet G, Guillou M, d’Elia P, Amiot S, Wattez H, Bohnert A, Azzaoui R, Haulon S. Comparison of Short- and Mid-Term Follow-Up Between Standard and Fenestrated Endografts. Ann Vasc Surg 2013; 27:562-70. [DOI: 10.1016/j.avsg.2011.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/14/2011] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
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Spiliopoulos S, Mani K, Sabharwal T, Krokidis M, Gkoutzios P. First application of the ‘lasso technique’ on an endograft with suprarenal fixation stent. Vascular 2013; 21:177-81. [PMID: 23508386 DOI: 10.1177/1708538113478733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report the use of the ‘lasso technique’ for the preservation of bilateral renal artery patency, following the intraoperative proximal migration of an aortic endograft with suprarenal bare metal fixation and anchoring barbs, due to device delivery failure.During an emergency endovascular repair of a ruptured mycotic abdominal aortic aneurysm using the Zenith Flex device, the main body of the graft migrated proximally to cover both renal arteries. Attempts to pull down the graft using balloons were not effective.Finally, the ‘lasso technique’ using a guidewire over the aortic bifurcation was employed and successfully adjusted the graft below the level of the renal arteries. No procedure-related complications were noted. The endovascular repair was used as a bridging procedure and two months following the primary endovascular procedure, open surgical repair of the infected aneurysm with excision of the stent graft was performed. The patient is alive after eight months follow-up.
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Affiliation(s)
- Stavros Spiliopoulos
- Department of Interventional Radiology, Guy's and St Thomas’ NHS Foundation Trust, King's Health Partners, London SE1 7EH, UK.
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Saratzis AN, Goodyear S, Sur H, Saedon M, Imray C, Mahmood A. Acute Kidney Injury After Endovascular Repair of Abdominal Aortic Aneurysm. J Endovasc Ther 2013; 20:315-30. [DOI: 10.1583/12-4104mr2.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Endovascular Repair of Complex Aortic Pathology. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Donas KP, Torsello G, Bisdas T, Osada N, Schönefeld E, Pitoulias GA. Early outcomes for fenestrated and chimney endografts in the treatment of pararenal aortic pathologies are not significantly different: a systematic review with pooled data analysis. J Endovasc Ther 2013; 19:723-8. [PMID: 23210868 DOI: 10.1583/jevt-12-3952mr.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare short-term outcomes between fenestrated and chimney endografts for pararenal aortic pathologies. METHODS An English-language literature search up to January 2012 found 129 articles evaluating the immediate outcomes of endovascular repair of degenerative juxta-/suprarenal aortic aneurysms, type I endoleaks, and para-anastomotic aneurysms using the chimney technique or fenestrated endografts. Data concerning thoracoabdominal aortic aneurysms, ruptured aneurysms, and reports with <5 cases were excluded (n=84). An additional 28 articles were excluded for insufficient data, leaving 17 articles for review: 5 dealing with chimney grafts in 123 patients with pararenal aortic pathologies and 12 presenting data on 660 [corrected] patients undergoing fenestrated stent-grafting. The composite endpoints were 30-day mortality, deterioration of renal function, new postoperative dialysis dependence, and endoleak rate. RESULTS Cumulative 30-day procedure-related mortality was 0.58% (95% CI 0.0% to 2.93%) for the chimney group (n=3) and 1.17% (95% CI 0.26% to 2.09%, p=0.645) for the f-EVAR group (n=9). In the f-EVAR group, 86 (9.67%; 95% CI 4.77% to 14.57%) patients suffered from postoperative renal impairment vs. 16 (12.43%) patients in the chimney group (95% CI 2.39% to 22.48%, p=0.628). In the chimney group, 4 (0.57%; 95% CI 0.0% to 2.94%) patients required persistent postoperative dialysis in contrast to the 1.33% (95% CI 0.29% to 2.37%, p=0.567) rate (n=9) in patients undergoing f-EVAR. There were also no significant differences recorded in the endoleak rate: 1.93% (95% CI 0.0% to 4.82%) of the chimney patients had a persistent type Ia endoleak vs. 2.06% (95% CI 0.69% to 3.43%) for the f-EVAR group (p=0.939). For type II endoleaks, the rates were 2.16% (95% CI 0.0% to 10.77%) for the chimney group vs. 6.88% (95% CI 1.92% to 11.83%) for the f-EVAR group (p=0.352). No patient in the chimney group had a type III endoleak, and the rate was low in the f-EVAR group (0.32%, 95% CI 0.0% to 0.91%, p=0.079). CONCLUSION No statistically significant differences were found between the two endovascular approaches for pararenal aortic pathologies in terms of 30-day mortality, renal impairment, or endoleak. These findings support the assumption that chimney grafts may be a reliable alternative in the treatment of pararenal aortic pathologies.
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Affiliation(s)
- Konstantinos P Donas
- Department of Vascular Surgery, St. Franziskus Hospital and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
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Tsilimparis N, Perez S, Dayama A, Ricotta JJ. Endovascular Repair With Fenestrated-Branched Stent Grafts Improves 30-Day Outcomes for Complex Aortic Aneurysms Compared With Open Repair. Ann Vasc Surg 2013; 27:267-73. [PMID: 23403330 DOI: 10.1016/j.avsg.2012.05.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/17/2012] [Accepted: 05/17/2012] [Indexed: 10/27/2022]
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Postoperative Renal Function After Juxtarenal Aortic Aneurysm Repair With Simple Cross-Clamping. Ann Vasc Surg 2013; 27:291-8. [DOI: 10.1016/j.avsg.2012.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/15/2012] [Accepted: 04/29/2012] [Indexed: 11/20/2022]
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Katsargyris A, Oikonomou K, Klonaris C, Töpel I, Verhoeven EL. Comparison of Outcomes With Open, Fenestrated, and Chimney Graft Repair of Juxtarenal Aneurysms: Are We Ready for a Paradigm Shift? J Endovasc Ther 2013; 20:159-69. [PMID: 23581756 DOI: 10.1583/1545-1550-20.2.159] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Canavati R, How TV, Brennan JA, Vallabhaneni SR, Fisher RK, McWilliams RG. Fractured superior mesenteric artery stents after fenestrated endovascular aneurysm repair. J Vasc Surg 2013; 57:511-4. [DOI: 10.1016/j.jvs.2012.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 08/06/2012] [Accepted: 08/08/2012] [Indexed: 11/27/2022]
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Farber MA, Vallabhaneni R. Moving Into the Paravisceral Aorta Using Fenestrated and Branched Endografts. Semin Vasc Surg 2012. [DOI: 10.1053/j.semvascsurg.2012.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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50
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Gohel MS, Clark M, Kashef E, Gibbs RGJ. Salvage antegrade visceral revascularization and antegrade aortic stenting for type I and III endoleaks after fenestrated juxtarenal aneurysm repair. J Vasc Surg 2012; 56:1731-3. [PMID: 23089303 DOI: 10.1016/j.jvs.2012.06.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 06/06/2012] [Accepted: 06/06/2012] [Indexed: 10/27/2022]
Abstract
A 73-year-old man developed type I and III endoleaks from a fractured right renal stent with downward migration of a fenestrated endograft, 6 years after endovascular repair of a juxtarenal aneurysm. Endovascular treatment attempts were unsuccessful. He underwent aortic debranching and antegrade visceral artery revascularization via a left thoracolaparotomy incision and an extraperitoneal approach to the visceral aorta. An antegrade aortic stent covered the endoleak, with technical and clinical success at 9 months. Failure of complex endografts presents particular problems, potentially not amenable to totally endovascular repair. Continued surveillance is mandated as late, asymptomatic sac expansion can occur.
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