1
|
Tay S, Zaghloul MS, Shafqat M, Yang C, Desai KA, De Silva G, Sanchez LA, Zayed MA. Totally percutaneous endovascular repair for ruptured abdominal aortic aneurysms. Front Surg 2022; 9:1040929. [PMID: 36338637 PMCID: PMC9634472 DOI: 10.3389/fsurg.2022.1040929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose The PEVAR Trial demonstrated that compared to open femoral exposure, elective percutaneous endovascular AAA repair (ePEVAR) is associated with decreased perioperative morbidity and access site complications. We hypothesized that PEVAR for ruptured AAA (rPEVAR) may also improve perioperative morbidity compared to open femoral exposure (rEVAR). There are currently no reports that evaluate the utility and outcomes of rPEVAR. Materials and methods From 2015 to 2021, all patients who underwent an endovascular repair of a ruptured AAA at a single institution were included in the study and grouped into rPEVAR and rEVAR. Demographics, procedural details (successful preclose technique, conversion to femoral cutdown), postoperative variables (blood transfusion, ICU and hospital length of stay) and short-term outcomes (30-day major adverse events (30-day MAE) and 30-day femoral access-site complications (30-day FAAC)) were collected and compared with 50 historical ePEVAR patients from the PEVAR Trial. Statistical significance was determined using χ 2 or Fisher's exact test for categorical variables, and Mann-Whitney U-test for continuous variables. Results 35 patients were identified (21 rPEVAR; 14 rEVAR), 86% were male with a mean age of 72 ± 9 years. All patients underwent emergent endovascular aortic repair with 100% technical success. Seventeen patients (49%) presented with evidence of hemorrhagic shock and 22 patients (63%) had blood transfusion. 30-day MAE occurred in 12 patients (34%) (7 rPEVAR; 5 rEVAR). There was no difference in demographic, perioperative outcomes and 30-day MAE rate between rPEVAR and rEVAR patients. Compared to ePEVAR patient (from PEVAR trial), rPEVAR patients had higher rate of 30-day MAE (34% vs. 6%; p < 0.006) but no difference in 30-day FAAC (19% vs. 12%; p = 0.54). The success rate of the preclose technique was higher in ePEVAR compared to rPEVAR (96% vs. 76%; p = 0.02), but the rate of conversion to femoral cutdown was similar between the two groups (10% vs. 4%; p = 0.57). Conclusion Emergent rPEVAR appears to have similar outcomes when compared to rEVAR. Although patients undergoing rPEVAR have higher 30-day major adverse events rate compared to ePEVAR, the method of percutaneous femoral cannulation does not appear to increase the overall procedural or 30-day femoral artery access-site complications.
Collapse
Affiliation(s)
- Shirli Tay
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Mohamed S. Zaghloul
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Mehreen Shafqat
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Chao Yang
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kshitij A. Desai
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Gayan De Silva
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Luis A. Sanchez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Mohamed A. Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
- Division of Molecular Cell Biology, Washington University School of Medicine, St. Louis, MO, United States
- McKelvey School of Engineering, Department of Biomedical Engineering, Washington Univesrity, St. Louis, MO, United States
- Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, MO, United States
| |
Collapse
|
2
|
Verbist J, Peeters P, Bosiers M, Deferm H, Haenen L, Vermaercke M, Vercaeren P. Endoleaks after Endoluminal Repair of Abdominal Aortic Aneurysms : Diagnosis and Treatment. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - M. Bosiers
- St.-Blasius Hospital, Dendermonde, Belgium
| | | | | | | | | |
Collapse
|
3
|
Baderkhan H, Wanhainen A, Haller O, Björck M, Mani K. Editor's Choice - Detection of Late Complications After Endovascular Abdominal Aortic Aneurysm Repair and Implications for Follow up Based on Retrospective Assessment of a Two Centre Cohort. Eur J Vasc Endovasc Surg 2020; 60:171-179. [PMID: 32209282 DOI: 10.1016/j.ejvs.2020.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 01/10/2020] [Accepted: 02/25/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Endovascular aortic aneurysm repair (EVAR) is associated with the risk of late complications and mandates follow up. This retrospective study assessed post-EVAR complications in a two centre cohort. The study evaluated the rate of complications presenting with symptoms vs. those detected by imaging follow up. Additionally, the agreement between DUS and CTA in detecting complications was assessed in patients with both. METHODS All EVAR patients from 1998 to 2012 in two centres were included. Complications were classified based on whether they were symptomatic or detected by imaging, as well as based on imaging detection modality (DUS or CTA). For patients who had undergone DUS and CTA within three months of each other, the kappa coefficient of agreement was assessed. RESULTS Four hundred and fifty-four patients treated by EVAR were identified. The median follow up time was 5.2 (IQR 2.8-7.6) years. One hundred and eighteen patients (26%) developed 176 complications. One hundred and six (60.2%) of the complications were asymptomatic, and 70 (39.8%) were symptomatic. Two hundred and fifty-three patients had imaging with both modalities within three months of each other; the kappa coefficient for agreement between CTA and DUS for detecting clinically significant complications was 0.91. Regarding CTA as the standard modality, DUS had a sensitivity of 88.8% (95% CI 77.3-95.8%) and a specificity of 99.4% (95% CI 97.1-99.9%). Three of the complications missed by DUS were related to loss of proximal and distal seal, all occurring in patients with short sealing length on first post-operative CT scan. CONCLUSION Approximately a quarter of the patients developed complications, the majority of which were asymptomatic, underlining the importance of adequate surveillance. There was good agreement between CTA and DUS in detecting complications. Clinically significant complications related to inadequate seal were missed by DUS, suggesting that CTA still plays an important role in EVAR surveillance.
Collapse
Affiliation(s)
- Hassan Baderkhan
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Olov Haller
- Department of Radiology, Gävle Hospital, Gävle, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| |
Collapse
|
4
|
Akbulut M, Aksoy E, Kara İ, Cekmecelioglu D, Koksal C. Quality of Life After Open Surgical versus Endovascular Repair of Abdominal Aortic Aneurysms. Braz J Cardiovasc Surg 2019; 33:265-270. [PMID: 30043919 PMCID: PMC6089137 DOI: 10.21470/1678-9741-2017-0236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/23/2018] [Indexed: 11/15/2022] Open
Abstract
Objective This study aims to compare open surgical and endovascular aneurysm repair
(EVAR) of abdominal aortic aneurysms in terms of their effects on quality of
life, using Short Form-36 (SF-36). Methods A total of 133 consecutive patients who underwent EVAR or open surgical
repair for infra-renal abdominal aorta aneurysm between January 2009 and
June 2014 were included in the study. Twenty-six (19.5%) patients died
during follow-up and were excluded from the analysis. Overall, 107 patients,
39 (36.4%) in the open repair group, and 68 (63.6%) in the EVAR group,
completed all follow-up visits and study assessments. Quality of life
assessments using SF-36 were performed before surgery and at post-operative
months 1, 6, and 12. Results The mean duration of follow-up was 29.55±19.95 months. At one month,
both physical and mental domains of the quality of life assessments favored
EVAR, while the two surgical approaches did not differ significantly at or
after six months postoperatively. Conclusion Despite anatomical advantages and acceptable mid-phase mortality in patients
with high- or medium-risk for open surgery, EVAR did not exhibit a quality
of life superiority over open surgery in terms of physical function and
patient comfort at or after postoperative six months.
Collapse
Affiliation(s)
- Mustafa Akbulut
- Department of Cardiovascular Surgery, Kartal Koşuyolu Research and Training Hospital, Kartal, Istanbul, Turkey
| | - Eray Aksoy
- Department of Cardiovascular Surgery, Kartal Koşuyolu Research and Training Hospital, Kartal, Istanbul, Turkey
| | - İbrahim Kara
- Department of Cardiovascular Surgery, Sakarya University Medical Faculty, Sakarya, Turkey
| | - Davut Cekmecelioglu
- Department of Cardiovascular Surgery, Kartal Koşuyolu Research and Training Hospital, Kartal, Istanbul, Turkey
| | - Cengiz Koksal
- Department of Cardiovascular Surgery, Bezmialem Vakıf University Medical Faculty, Istanbul, Turkey
| |
Collapse
|
5
|
Mohapatra A, Robinson D, Malak O, Madigan MC, Avgerinos ED, Chaer RA, Singh MJ, Makaroun MS. Increasing use of open conversion for late complications after endovascular aortic aneurysm repair. J Vasc Surg 2018; 69:1766-1775. [PMID: 30583895 DOI: 10.1016/j.jvs.2018.09.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/29/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Open procedures are often required for late complications after endovascular aneurysm repair (EVAR). Our aim was to describe the indications for open interventions and their postoperative outcomes and to specifically examine our experience with limited conversions in which problem endoleaks are targeted without endograft explantation. METHODS We reviewed patients from 2002 to 2017 who underwent any surgical abdominal aortic operation after a previous EVAR. Baseline characteristics, preoperative imaging, procedural details, and postoperative outcomes were reviewed. The primary end point was 30-day mortality. RESULTS There were 102 patients who underwent open conversion 3.8 ± 3.1 years after EVAR. The numbers increased significantly in recent years, with 18 cases performed in 2016; 48.5% of patients had undergone 1.9 ± 1.0 prior endovascular interventions. The indication for surgical conversion was an endoleak in 85 patients and infection in 15. One patient had a limb occlusion and another a proximal aneurysm. The 30-day mortality was 6.2% in 65 patients treated electively for endoleak but higher in 20 ruptures (40.0%) and 15 infections (40.0%). In a multivariate logistic regression model, independent predictors of 30-day mortality were rupture (odds ratio [OR], 6.70; 95% confidence interval [CI], 1.75-25.60; P = .005), endograft infection (OR, 8.48; 95% CI, 1.99-36.20; P = .004), and use of a supraceliac clamp (OR, 4.80; 95% CI, 1.47-15.66; P = .009). Transient acute kidney injury (12.8%) and prolonged intubation (11.8%) were the most common postoperative complications. In 65 patients treated for endoleak without rupture, 37 underwent endograft explantation, whereas 28 had a graft-preserving intervention (branch vessel ligation for type II endoleak in 26, external banding of the aneurysm neck for type IA endoleak in 8). Mortality was 8.1% when the endograft was explanted and 3.6% when it was not (P = .63). During 3.0 ± 3.5 years of follow-up, there was one reintervention after endograft explantation (for rupture secondary to type IB endoleak) and two reinterventions after graft preservation (for a new type IA endoleak and a new type II endoleak). Survival was 87.4% at 1 year and 70.9% at 5 years. CONCLUSIONS Open conversion is playing an increasing role in the management of late EVAR complications. Endoleaks treated electively by open conversion are reasonably safe and show good midterm durability, even with graft-preserving interventions that avoid endograft explantation.
Collapse
Affiliation(s)
- Abhisekh Mohapatra
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Darve Robinson
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Othman Malak
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael C Madigan
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Efthimios D Avgerinos
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Rabih A Chaer
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael J Singh
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michel S Makaroun
- Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| |
Collapse
|
6
|
Belvroy VM, Houben IB, Trimarchi S, Patel HJ, Moll FL, Van Herwaarden JA. Identifying and addressing the limitations of EVAR technology. Expert Rev Med Devices 2018; 15:541-554. [PMID: 30058398 DOI: 10.1080/17434440.2018.1505496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Endovascular aortic repair (EVAR) has improved over the last two decades. Approximately 80% of the patients presenting with an abdominal aortic aneurysm (AAA) is nowadays primarily treated with EVAR. AREAS COVERED In this review, the differences between endovascular and open repair, the clinical characteristics needed for EVAR, the role of clinical imaging and the developments in EVAR technology will be discussed. Early mortality is lower in EVAR as compared to open repair, whereas this benefit is lost after 3 years postoperatively. EVAR comes with a high reintervention rate, with endoleak being the most important predictive factor for reintervention. Expanding technical possibilities have allowed surgeons to choose from a palate of endovascular approaches in aneurysm patients with challenging anatomies. EXPERT COMMENTARY Although EVAR has taken a giant leap forward in development, the new developments have seemed to surpass the long-term limitations with older devices. It is important to start focusing on the current limitations of EVAR, in particular the durability of devices in the human variable anatomic and dynamic environment.
Collapse
Affiliation(s)
- Viony M Belvroy
- a Department of Vascular Surgery II , Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan , Milan , Italy
| | - Ignas B Houben
- b Department of Cardiovascular Surgery , Frankel Cardiovascular Center, University of Michigan Health Center , Ann Arbor , Michigan , USA
| | - Santi Trimarchi
- a Department of Vascular Surgery II , Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan , Milan , Italy
| | - Himanshu J Patel
- b Department of Cardiovascular Surgery , Frankel Cardiovascular Center, University of Michigan Health Center , Ann Arbor , Michigan , USA
| | - Frans L Moll
- c Department of Vascular Surgery , University Medical Center Utrecht , Utrecht , the Netherlands
| | - Joost A Van Herwaarden
- c Department of Vascular Surgery , University Medical Center Utrecht , Utrecht , the Netherlands
| |
Collapse
|
7
|
Karaolanis G, Kostakis ID, Moris D, Palla VV, Moulakakis KG. Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review. Int J Angiol 2018; 27:13-22. [PMID: 29483761 DOI: 10.1055/s-0037-1620241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of the present study is to review the available data on suture-mediated closure devices (SMCDs) and fascia suture technique (FST), which are alternatives for minimizing the invasiveness of percutaneous endovascular aortic aneurysm repair (p-EVAR) and reduce the complications related to groin dissections. Methods The Medline, ClinicalTrials.gov, and Cochrane library - Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for publications regarding SMCD and FST between January 1999 and December 2016. Results We review 37 original articles, 30 referring to SMCDs (Prostar XL and Proglide), which included 3,992 patients, and 6 articles referring to FST, which include 426 patients. The two techniques are compared only in one article (100 patients). The two types of SMCDs were Prostar and Proglide. In most studies on SMCDs, the reported technical success rates were between 89 and 100%, but the complication rates varied greatly between 0 and 25%. Concerning FST, the technical success rates were also high, ranging between 87 and 99%. However, intraoperative complication rates ranged between 1.2 and 13%, whereas postoperative complication rates varied from 0.9 to 6.2% for the short-term and from 1.9 to 13.6% for the long-term. Conclusions SMCDs and FST seem to be effective and simple methods for closing common femoral artery (CFA) punctures after p-EVAR. FST can reduce the access closure time and the procedural costs with a quite short learning curve, whereas it can work as a bailout procedure for failed SMCDs suture. The few failures of the SMCDs and FST that may occur due to bleeding or occlusion can easily be managed.
Collapse
Affiliation(s)
- Georgios Karaolanis
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Demetrios Moris
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Viktoria-Varvara Palla
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| |
Collapse
|
8
|
Clinical outcomes for endovascular repair of abdominal aortic aneurysm with the Seal stent graft. J Vasc Surg 2016; 64:1270-1277. [PMID: 27161287 DOI: 10.1016/j.jvs.2016.02.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/06/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Since 2007, the availability of the Seal (S & G Biotech Inc, Seong-nam, Gyeonggi-do, Korea) stent graft for endovascular aneurysm repair (EVAR) has improved short-term outcomes in Korea. However, midterm outcome data are lacking. This retrospective study evaluated the midterm outcomes of 126 patients who underwent EVAR using the Seal stent graft between 2007 and 2010. METHODS Data regarding use of the Seal stent graft for EVAR were collected from 16 Korean centers, and were analyzed retrospectively using Kaplan-Meier and Cox univariate and multivariate analyses. RESULTS The mean patient age was 71 ± 8 years (median, 70; range, 49-87 years). Patients who were treated using a bifurcated graft (113; 90%) were generally symptomatic (56; 44%, which included 13 ruptured abdominal aortic aneurysms [10%]) and male (105; 83%). The primary technical success rate was 99%. Four patients (3%) died within 30 days, 5 patients (4%) died after 30 days, and 12 patients (9%) were lost to follow-up. The survival rates were 97% ± 2% (1 month), 97% ± 2% (3 months), 96% ± 2% (6 months), 96% ± 2% (1 year), 94% ± 3% (3 years), and 81% ± 10% (5 years). During a mean follow-up of 55 ± 22 months (median, 40; range, 0.03-91.2 months), 18 reinterventions were performed for 16 patients (13%). The freedom from reintervention rates were 96% ± 2% (1 month), 96% ± 2% (3 months), 94% ± 2% (6 months), 89% ± 3% (1 year), 84% ± 4% (3 years), and 57% ± 17% (5 years). The mean aneurysm diameter significantly decreased from 69.6 to 46.6 mm during the follow-up (P < .0001). A proximal neck of less than 15 mm, different simultaneous endoleaks, and insufficient bilateral coverage of the iliac aneurysm were associated with significantly higher rates of increased or unchanged aneurysm diameters (all P < .0001). Significantly higher rates of clinical failure were observed in patients who were less than 70 years old (P = .04), had a neck length of less than 15 mm (P = .02), and had a neck diameter of greater than 28 mm (P = .02). CONCLUSIONS Most Seal stent grafts were implanted successfully (even in cases with a physical status of grade IV or higher or a ruptured abdominal aortic aneurysm), had an appropriate reintervention rate, and were stable during the midterm follow-up. However, there was a high rate of type I endoleak, which may be related to the early device model that we used. Therefore, long-term radiologic follow-up is recommended for the early detection of stent graft migration or endoleaks.
Collapse
|
9
|
Nowicka M, Kowalczyk A, Rusak G, Ratajczak P, Sobociński B. Evaluation the Aortic Aneurysm Remodeling After a Successful Stentgraft Implantation. Pol J Radiol 2016; 81:486-490. [PMID: 27800038 PMCID: PMC5066507 DOI: 10.12659/pjr.900116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 11/09/2022] Open
Abstract
Background Routine imaging follow-up after endovascular treatment of abdominal aortic aneurysms (EVAR) is mainly aimed at detection of endoleaks. The aim of the study was to assess changes in the size of the abdominal aortic aneurysm sack using CT angiography (CTA) after successful treatment using endovascular stent graft implantation. Material/Methods A retrospective analysis of CTA results included 102 patients aged 54–88, who had no postoperative complications. Patients underwent CTA before EVAR and after the treatment (mean time between studies, 7.6 months). The largest cross-sectional area of the aneurysm sac was measured using a curved multiplanar reconstruction. A change of the aneurysm cross-sectional over 10% was considered significant. Results The average cross-sectional area decreased after EVAR by 3% and this change was not statistically significant. Regression of the cross-sectional area was observed in 18.6% of patients, progression was in 23.5%, and no change was seen in 57.8%. Cross-sectional areas before and after EVAR were significantly correlated (r=0.75, p<0.0001). There was no correlation between the cross-sectional area change after EVAR and patients’ age or the time between the treatment and the follow-up CTA. Cross-sectional area before the treatment predicted changes in the aneurysm size after EVAR (p=0.0045). Conclusions Remodeling of abdominal aortic aneurysms after EVAR is not uniform. The change of aneurysm size depends on the initial aneurysm size but not on the time from EVAR. The size of the aneurysm after EVAR should not be considered as a measure of the treatment efficacy.
Collapse
Affiliation(s)
- Monika Nowicka
- Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Agnieszka Kowalczyk
- Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Grażyna Rusak
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Przemysław Ratajczak
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Bartosz Sobociński
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| |
Collapse
|
10
|
Abularrage CJ, Sheridan MJ, Mukherjee D. Endovascular versus “Fast-Track” Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2016; 39:229-36. [PMID: 15920651 DOI: 10.1177/153857440503900303] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies have shown that endovascular abdominal aortic aneurysm repair (EVAR) has decreased costs, as well as decreased intensive care unit and total hospital length of stays when compared to abdominal aortic aneurysm (AAA) repair using a retroperitoneal exposure. The authors hypothesized that the fast-track AAA repair, which combines a retroperitoneal exposure with a patient care pathway that includes a gastric promotility agent and patient-controlled analgesia, would have no differences when compared to EVAR. Records of 58 patients who underwent AAA repair between April 14, 2000, and July 12, 2002, were reviewed retrospectively. Demographic information, length of stay, intraoperative and postoperative complications, mortality, and costs were evaluated. Fifty-eight AAA repairs were performed with the EVAR (n=28) and fast-track (n=30) techniques. The EVAR group was slightly older (72 vs 68 years, p=0.04), had slightly smaller average aneurysm size (5.5 ±0.13 vs 6.1 ±0.17 cm, p=0.008), and had more patients designated American Society of Anesthesia class 4 (p<0.0001). Both groups were predominantly male. Otherwise there were no statistically significant differences in risk factors. Patients who underwent fast-track repair tended to have a longer operation (216 ±7.4 vs 158 ±6.8 minutes, p<0.0001), with a greater volume of blood (1.8 ±0.29 vs 0.32 ±0.24 units, p=0.0005), colloid (565 ±89 vs 32 ±22 cc, p<0.0001), and crystalloid transfusions (4,625 ±252 vs 2,627 ±170 cc, p<0.0001). There were no statistically significant differences in the number of intraoperative or postoperative complications between the 2 groups. EVAR patients resumed a regular diet earlier (0.21 ±0.08 vs 1.8 ±0.11 days, p<0.0001). Intensive care unit stay was shorter for EVAR (0.50 ±0.10 vs 0.87 ±0.10 days, p=0.01), but floor (2.1 ±0.23 vs 2.6 ±0.21 days, p=0.17), and total hospital lengths of stay (2.8 ±0.32 vs 3.4 ±0.18 days, p=0.07) were similar between the 2 groups. Total hospital cost was lower in the fast-track ($10,205 ±$736 vs $20,640 ±$1,206, p<0.0001) leading to greater overall hospital earnings ($6,141 ±$1,280 vs $107 ±$1,940, p=0.01). Fast-track AAA repair is a viable alternative for the treatment of abdominal aortic aneurysms. Compared to endovascular repair, the fast-track method had increased transfusions of blood and intravenous fluids and increased operating room times, but equivalent lengths of floor and total hospital stay and increased total hospital earnings.
Collapse
|
11
|
Park B, Mavanur A, Drezner AD, Gallagher J, Menzoian JO. Clinical Impact of Chronic Renal Insufficiency on Endovascular Aneurysm Repair. Vasc Endovascular Surg 2016; 40:437-45. [PMID: 17202089 DOI: 10.1177/1538574406294071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endovascular aneurysm repair of abdominal aortic aneurysms has become a viable alternative to open repair. A significant proportion of this patient population has chronic renal insufficiency. The surgical outcomes associated with endovascular repair in 342 patients, with and without chronic renal insufficiency, are reported. Perioperative mortality, length of admission, length of intensive care unit admission, and rates of acute renal failure, congestive heart failure, myocardial infarction, conversion to open surgery, progression to hemodialysis, and incidence of endoleaks were retrospectively reviewed and analyzed. Endovascular repair demonstrated higher rates of acute renal failure, longer length of stay, and longer intensive care unit admissions in patients with chronic renal insufficiency. Patients with severe renal dysfunction demonstrated markedly elevated mortality and morbidity. These results indicate that chronic renal insufficiency is not an absolute contraindication to endovascular repair in patients with moderate renal dysfunction, but patients with severe renal dysfunction perform poorly after aortic reconstruction.
Collapse
Affiliation(s)
- Brian Park
- Division of Vascular Surgery, Hartford Hospital, Hartford, Connecticut 06102-5037, USA
| | | | | | | | | |
Collapse
|
12
|
Elkouri S, Martelli E, Gloviczki P, McKusick MA, Panneton JM, Andrews JC, Noel AA, Bower TC, Sullivan TM, Rowland C, Hoskin TL, Cherry KJ. Most Patients with Abdominal Aortic Aneurysm Are Not Suitable for Endovascular Repair Using Currently Approved Bifurcated Stent-Grafts. Vasc Endovascular Surg 2016; 38:401-12. [PMID: 15490036 DOI: 10.1177/153857440403800502] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution. Three hundred and twenty patients had an AAA with a diameter of =5.0 cm, measured on computed tomography (CT). The records of 301 patients, 254 men, 47 women, with a mean age of 74 years were available for review, and these patients constituted the study cohort. Criteria used for MS included a proximal neck length =15 mm; neck diameter between 18 and 26 mm; neck angulation =60°; common or external iliac artery (CIA or EIA) diameters of 7–16 mm and 8–13 mm, respectively, for AneuRx (Medtronic Ave, Santa Rosa, CA) and Ancure (Guidant Cardiac and Vascular Division, Menlo Park, CA) bifurcated grafts. AAAs were suitable for AneuRx device in 14% of patients (43 of 301; 95% CI = 11–19%) and for Ancure in 5% (16 of 301; 95% CI = 3.1–9%). The main reason for exclusion was an inadequate proximal aortic neck (73%). The neck was too short in 49.5%, too wide in 64% and badly angulated in 12% of the patients. Iliac artery morphology precluded EVAR with AneuRx and Ancure devices in 52% and 80%. Both CIAs were too wide for EVAR in 43% and 77%, respectively. When iliac artery diameter =20 mm was accepted, iliac suitability for AneuRx increased from 49% to 70% and overall suitability increased from 14% to 20%. When more permissive criteria were used for MS (neck length =10 mm, neck diameter =30 mm, CIA =20), 39% of patients became candidates for EVAR. More than three fourths of the patients with an AAA =5.0 cm in size, seen in a tertiary referral center, are morphologically not suitable for EVAR using 2 currently approved bifurcated endografts. The main reasons for exclusion are a short or wide proximal aortic neck. Considerable changes in size of the devices and in proximal attachment techniques have to occur before most AAAs will be suitable for EVAR.
Collapse
|
13
|
Rowlands TE, Homer-Vanniasinkam S. Paradoxical Neutrophil Elastase Release in Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2016; 41:48-54. [PMID: 17277243 DOI: 10.1177/1538574406294070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular repair of abdominal aortic aneurysm potentially avoids problems associated with prolonged aortic cross-clamping that occurs with open repair, but it appears to have its own biologic consequences, which may relate to neutrophil elastase release. Blood samples of consecutive patients undergoing open or endovascular abdominal aneurysm repair were analyzed for neutrophil elastase/α1-antitrypsin complex and free elastase. Free elastase rose from baseline and fell quickly in open repair patients, returning to baseline by 144 hours. In the endovascular repair group, it continued to increase for up to 144 hours. Bound elastase increased to 24 hours, returning to baseline in endovascular repair patients by 72 hours, but remaining elevated in open repair patients at 144 hours. Open repair patients showed raised elastase/α1-antitrypsin complex and initial raised free elastase levels. High free elastase levels in endovascular repair patients may reflect less bound elastase and may paradoxically lead to a prolonged inflammatory postoperative response.
Collapse
Affiliation(s)
- Timothy E Rowlands
- Vascular Surgical Unit, The General Infirmary at Leeds, Great George Street, Leeds, United Kingdom.
| | | |
Collapse
|
14
|
Endovascular repair of abdominal aortic aneurysms. Best Pract Res Clin Anaesthesiol 2016; 30:331-40. [PMID: 27650343 DOI: 10.1016/j.bpa.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/10/2016] [Indexed: 12/17/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms is an important technique in the vascular surgeon's armamentarium, which has created a seismic shift in the management of aortic pathology over the past two decades. In comparison to traditional open repair, the endovascular approach is associated with significantly improved perioperative morbidity and mortality. The early survival benefit of endovascular abdominal aortic aneurysm repair is sustained up to 3 years postoperatively, but longer-term life expectancy remains poor regardless of operative modality. Nonetheless, most abdominal aortic aneurysms are now repaired using endovascular stent grafts. The technology is not perfect as several postoperative complications, namely endoleak, stent-graft migration, and graft limb thrombosis, can develop and therefore lifelong imaging surveillance is required. In addition, a postoperative inflammatory response has been documented after endovascular repair of aortic aneurysms; the clinical significance of this finding has yet to be determined. Subsequently, the safety and applicability of endovascular stent grafts are likely to improve and expand with the introduction of newer-generation devices and with the simplification of fenestrated systems.
Collapse
|
15
|
Walker SR, Macierewicz J, MacSweeney ST, Gregson RHS, Whitaker SC, Wenham PW, Hopkinson BR. Mortality Rates following Endovascular Repair of Abdominal Aortic Aneurysms. J Endovasc Ther 2016. [DOI: 10.1177/152660289900600304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To present the perioperative and late mortality following endovascular repair (EVR) of abdominal aortic aneurysms (AAAs). Methods: Data were collected prospectively on 221 patients undergoing AAA EVR over a 4-year period (median 5-month follow-up). Patients were classified preoperatively as high risk with at least 1 of these features: serum creatinine > 150 μmol/L, ischemic heart disease or poor left ventricular function, respiratory function < 50% of predicted normal, ruptured or symptomatic AAA, contraindication to or failed open repair, and age > 80 years. Results: One hundred forty (63.3%) patients were classified as high risk, the most common criterion being cardiac disease (n = 96, 68.6%). There were 25 (11.3%) deaths in the 30-day perioperative period, 22 (15.7%) in the high-risk group compared to 3 (3.7%) in the acceptable-risk group (p = 0.02). The most common causes of perioperative death were multisystem organ failure and myocardial infarction. A further 21 (9.5%) late deaths occurred, 16 (11.4%) in the high-risk group and 5 (6.2%) in the acceptable-risk group (p > 0.1). Conclusions: The mortality of patients at acceptable risk undergoing EVR compares with the best published series for conventional open AAA repair. The perioperative and late mortality in the high-risk patients are substantially higher.
Collapse
Affiliation(s)
- Stuart R. Walker
- Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Jan Macierewicz
- Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Shane T. MacSweeney
- Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Simon C. Whitaker
- Department of Radiology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Peter W. Wenham
- Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Brian R. Hopkinson
- Department of Vascular and Endovascular Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| |
Collapse
|
16
|
Parodi JC, Ferreira LM, Fornari MC, Berardi VE, Diez RA. Neutrophil Respiratory Burst Activity and Pro- and Anti-inflammatory Cytokines in AAA Surgery: Conventional versus Endoluminal Treatment. J Endovasc Ther 2016; 8:114-24. [PMID: 11357969 DOI: 10.1177/152660280100800203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the inflammatory impact of endovascular and conventional surgery of abdominal aortic aneurysm (AAA) as assessed by the activation of neutrophils and serum levels of pro- and anti-inflammatory cytokines. Methods: Twenty-four patients undergoing AAA exclusion were treated with either endovascular (n = 14) or conventional (n=10) techniques. Clinical and hematological data, respiratory burst of neutrophils, and the expression of adhesion and activation molecules (CD18, CD11b, CD69, and HLA-DR) were analyzed by flow cytometry. The enzyme-linked immunosorbent assay technique was used to measure proinflammatory cytokine interleukin (IL)–8 and anti-inflammatory cytokines IL-1 receptor antagonist (IL-1RA) and transforming growth factor β1 (TGF-β1). Results: All patients, most of whom had normal cytokine values before surgery, were successfully treated. No significant changes were found in surface antigens. Basal respiratory burst was quite heterogeneous; in all cases respiratory burst activity decreased after surgery and remained low throughout the observation period. Despite marked interpatient differences, IL-1RA and IL-8 increased after surgery, whereas TGF-β1 decreased, although the variation achieved statistical significance only in the conventional group. Elevated IL-1RA returned to normal within 48 hours in the endoluminal group, whereas the level remained high in the conventional group in the last sample. Conclusions: Despite heterogeneity before surgery, the respiratory burst decreased for most of the patients regardless of the approach, and both techniques increased IL-1RA. Although both procedures seemed to decrease TGF-β1, the difference was significant only with the conventional approach. IL-1RA levels fell toward basal values quicker in the endograft patients, suggesting that the endoluminal approach was less aggressive.
Collapse
Affiliation(s)
- J C Parodi
- Instituto Cardiovascular de Buenos Aires, Facultad de Medicina (UBA), Argentina
| | | | | | | | | |
Collapse
|
17
|
Ruppert V, Erz K, Bürklein D, Treitl M, Steckmeier B, Stelter W, Umscheid T. Double Tube Stent-Grafts for Infrarenal Aortic Aneurysm: A New Concept. J Endovasc Ther 2016; 14:144-9. [PMID: 17484529 DOI: 10.1177/152660280701400205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To present the concept of double tube stent-grafts and examine the indications for and results achieved with these devices. Methods: From January 1, 2000, to December 31, 2005, 759 patients who underwent endovascular repair of infrarenal aortic aneurysms at 2 centers. Of these, 45 (5.9%) patients received a double tube stent-graft; complete operative and follow-up data were available for retrospective analysis in 41 patients (33 men; mean age 73.1±8.9 years). Diameters measured before stent-graft implantation and at follow-up (12, 24, 36, and 48 months) with clinical examination, 2-phase computed tomographic angiography, duplex sonography, and biplanar abdominal radiography were tested for significant changes using ANOVA with the Bonferroni-Dunn correction. Late outcomes (clinical success and endoleak) were analyzed by the Kaplan-Meier method. Results: The postoperative complication rate was 12.2%, with 2.4% systemic complications (1 patient with angina pectoris); the early mortality rate was 0%. Mean follow-up was 21.9±12.8 months (range 12–61) for the 41 patients. Four (9.8%) patients died during follow-up of cardiac causes (n=2), lung cancer (n=1), and bowel ischemia (n=1). Four (9.8%) endoleaks were observed during follow-up: 1 distal type I, 2 type II, and 1 type III. Maximum aneurysm diameters shrank from 52.0±9.5 mm preoperatively to 44.0±10.8 mm (p<0.0001) postoperatively at the latest available follow-up. Conclusion: Our study supports the use of this double tube technique for repair of appropriate saccular infrarenal aortic aneurysms. The double tube stent-graft method appears safe in terms of endoleaks and migration, so we recommend that it be considered an option of endovascular aortic aneurysm therapy.
Collapse
Affiliation(s)
- Volker Ruppert
- Department of Surgery, Hospital of Ludwig Maximilian University Munich-Campus Innenstadt, Germany.
| | | | | | | | | | | | | |
Collapse
|
18
|
Görich J, Rilinger N, Söldner J, Krämer S, Orend KH, Schütz A, Sokiranski R, Bartel M, Sunder-Plassmann L, Scharrer-Pamler R. Endovascular Repair of Aortic Aneurysms: Treatment of Complications. J Endovasc Ther 2016. [DOI: 10.1177/152660289900600205] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate the use of interventional procedures for treating complications following endovascular repair of aortic aneurysms. Methods: Fifty-five patients (49 men; mean age 67.5 years) underwent endoluminal stent-graft repair of traumatic (n = 4) or arteriosclerotic (n = 51) aortic aneurysms in the thoracic (n = 3) or infrarenal (n = 52) aorta. Follow-up of therapeutic success included periodic clinical examination, angiography, and spiral computed tomography. Results: Discounting the 25 (45%) cases of postimplantation syndrome that did not require treatment, there were 22 complications observed in 20 (36%) patients over a mean 10-month follow-up (range 1 to 27). There were 2 transrenal endograft maldeployments, 1 case of twisted graft limbs, 2 access site problems (1 patient), 12 endoleaks (11 patients), 1 late graft limb thrombosis, 1 symptomatic internal iliac artery occlusion, 2 myocardial infarctions, and 1 transient psychosis. Seven (13%) patients did not undergo specific therapy, while 4 (7%) required operation (2 crossover bypass grafts, 1 suture revision, and 1 graft replacement). Among 9 (16%) patients treated with interventional techniques, 7 underwent percutaneous coil embolization for 8 endoleaks (7 successfully resolved). One late stent-graft disconnection required an additional stent-graft, and 1 of the 2 malpositioned endografts was repositioned. All patients remain alive with no increase in the diameter of the aneurysm in any patient. Conclusions: Technical problems resulting from the endovascular repair of aortic aneurysms often respond to interventional treatment.
Collapse
Affiliation(s)
| | | | - Joachim Söldner
- Department of Diagnostic and Interventional Radiology, University of Jena, Jena, Germany
| | | | - Karl-Heinz Orend
- Department of Thoracic and Vascular Surgery, University of Ulm, Ulm
| | | | | | - Martin Bartel
- Department of Vascular Surgery, University of Jena, Jena, Germany
| | | | | |
Collapse
|
19
|
Yamada M, Takahashi H, Tauchi Y, Satoh H, Matsuda H. Open Surgical Repair Can Be One Option for the Treatment of Persistent Type II Endoleak after EVAR. Ann Vasc Dis 2015; 8:210-4. [PMID: 26421069 DOI: 10.3400/avd.oa.14-00133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/07/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSES Endovascular abdominal aortic aneurysm repair (EVAR) is an increasingly used method of repairing abdominal aortic aneurysm (AAA). However, the treatment of persistent type II endoleak is still a controversial issue. Five cases are reported here in which we performed open surgical repair of growing aneurysm due to persistent type II endoleak. METHOD Totally 128 EVAR cases were retrospectively reviewed, which were operated in our hospital from April 2008 to October 2013. These cases were followed by periodical contrast-enhanced computed tomography (CT) after EVAR. When persistent type II endoleak caused aneurysm sac growth, we performed surgical repair method for the first line treatment. In the operation, we incised the aneurysm sac by abdominal small median incision approach and sutured lumber arteries from inside of aneurysm sac and tied inferior mesenteric artery (IMA) in addition to aneurysmorrhaphy. Contrast-enhanced CT scanning was performed in a week after open repair for the confirmation of complete treatment. RESULTS Five of 128 cases (3.9%) were needed to be surgically repaired because of aneurysm sac growth (>5 mm), including two ruptured AAA cases. All patients recovered uneventfully. Contrast-enhanced CT scanning performed a week after these operations showed no endoleak and intact stent grafts and reduction of the aneurysm size. CONCLUSION We believe open surgical repair method of persistent type II endoleak with aneurysm expansion is secure method, and can be one of the preferable options for this life threatening complication after EVAR.
Collapse
Affiliation(s)
- Mitsutomo Yamada
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Hideki Takahashi
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Yuya Tauchi
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Hisashi Satoh
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Hikaru Matsuda
- The Division of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| |
Collapse
|
20
|
Kim WC, Jeon YS, Hong KC, Kim JY, Cho SG, Park JY. Internal iliac artery embolization during an endovascular aneurysm repair with detachable interlock microcoils. Korean J Radiol 2014; 15:613-21. [PMID: 25246822 PMCID: PMC4170162 DOI: 10.3348/kjr.2014.15.5.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 06/09/2014] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR). Materials and Methods A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed. Results Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed. Conclusion Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.
Collapse
Affiliation(s)
- Woo Chul Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Kee Chun Hong
- Department of Vascular Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Jang Yong Kim
- Department of Vascular and Endovascular Surgery, The Catholic University of Korea School of Medicine, Seoul 137-701, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| | - Jae Young Park
- Department of Vascular Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, Korea
| |
Collapse
|
21
|
Petronelli S, Zurlo MT, Giambersio S, Danieli L, Occhipinti M. A single-centre experience of 200 consecutive unselected patients in percutaneous EVAR. Radiol Med 2014; 119:835-41. [PMID: 24700151 DOI: 10.1007/s11547-014-0399-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 11/22/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE This study evaluated the feasibility and safety of percutaneous endovascular aneurysm repair (P-EVAR) in an "unselected" population of patients using Prostar XL closure device, comparing our results with the literature data reported for open EVAR (O-EVAR) and P-EVAR in selected populations. MATERIALS AND METHODS We prospectively enrolled 200 patients with abdominal aortic aneurysms to be treated with the P-EVAR procedure, without any selection criteria. Four hundred percutaneous femoral accesses using the Prostar XL closure device were performed. The early follow-up protocol consisted of a Doppler ultrasound (US) examination. Later evaluations were performed with US and computed tomography. RESULTS Technical success was achieved in all percutaneous accesses (100 %). Ten early complications related to access site were recorded (10/400; 2.5 %): four pseudoaneurysms and six cases of lower limb ischaemia. Five of ten complications occurred in patients presenting calcification of the common femoral arteries, whereas 4/10 were in patients with "complex" groin anatomy. Eight of ten complications occurred at the access site of the main body of the prosthesis using a sheath size >20 Fr. CONCLUSIONS Percutaneous endovascular aneurysm repair in "unselected" patients is safe and efficient, with a very low risk of access-related complications, comparable to P-EVAR in selected populations and to the best O-EVAR series.
Collapse
Affiliation(s)
- Sergio Petronelli
- Unità Operativa Semplice dipartimentale di Radiologia Interventistica, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, BA, Italy,
| | | | | | | | | |
Collapse
|
22
|
Badea R, Chiorean L, Chira O, Caraiani C. Associated gastroduodenal artery aneurysm aortic aneurysm: the diagnostic contribution of contrast-enhanced ultrasound in correlation with computed tomography angiography. J Med Ultrason (2001) 2013; 41:217-21. [PMID: 27277776 DOI: 10.1007/s10396-013-0507-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022]
Abstract
Splanchnic aneurysms are rare conditions, with localization at the level of the gastroduodenal artery being encountered in only 1.5 % of the cases. Due to the high mortality risk, early detection and optimal treatment are required. We stress the importance of ultrasonography as a primary method of detection as well as the role of contrast-enhanced ultrasound in characterization of visceral aneurysms. Due to its noninvasive nature, the examination could be used for follow-up after therapeutic procedures or in cases were a curative intervention is not possible.
Collapse
Affiliation(s)
- Radu Badea
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Liliana Chiorean
- Department of Radiology and Computed Tomography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Str. Croitorilor 19-21, 400 162, Cluj-Napoca, Romania.
| | - Olimpia Chira
- Department of Gastroenterology, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Str. Croitorilor 19-21, 400 162, Cluj-Napoca, Romania
| |
Collapse
|
23
|
Dayama A, Tsilimparis N, Kasirajan K, Reeves JG. Late Gore Excluder endoprosthesis fabric tear leading to abdominal aortic aneurysm rupture 5 years after initial implant. J Vasc Surg 2013; 57:221-4. [DOI: 10.1016/j.jvs.2012.06.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 10/27/2022]
|
24
|
Casey K, Hernandez-Boussard T, Mell MW, Lee JT. Differences in readmissions after open repair versus endovascular aneurysm repair. J Vasc Surg 2012; 57:89-95. [PMID: 23164606 DOI: 10.1016/j.jvs.2012.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Reintervention rates after repair of abdominal aortic aneurysm (AAA) are higher for endovascular repair (EVAR) than for open repair, mostly due to treatment for endoleaks, whereas open surgical operations for bowel obstruction and abdominal hernias are higher after open repair. However, readmission rates after EVAR or open repair for nonoperative conditions and complications that do not require an intervention are not well documented. We sought to determine reasons for all-cause readmissions within the first year after open repair and EVAR. METHODS Patients who underwent elective AAA repair in California during a 6-year period were identified from the Health Care and Utilization Project State Inpatient Database. All patients who had a readmission in California ≤1 year of their index procedure were included for evaluation. Readmission rates and primary and secondary diagnoses associated with each readmission were analyzed and recorded. RESULTS From 2003 to 2008, there were 15,736 operations for elective AAA repair, comprising 9356 EVARs (60%) and 6380 open repairs (40%). At 1 year postoperatively, the readmission rate was 52.1% after open repair and 55.4% after EVAR (P=.0003). The three most common principle diagnoses associated with readmission after any type of AAA repair were failure to thrive, cardiac issues, and infection. When stratified by repair type, patients who underwent open repair were more likely to be readmitted with primary diagnoses associated with failure to thrive, cardiac complications, and infection compared with EVAR (all P<.001). Those who underwent EVAR were more likely, however, to be readmitted with primary diagnoses of device-related complications (P=.05), cardiac complications, and infection. CONCLUSIONS Total readmission rates within 1 year after elective AAA repair are greater after EVAR than after open repair. Reasons for readmission vary between the two cohorts but are related to the magnitude of open surgery after open repair, device issues after EVAR, and the usual cardiac and infectious complications after either intervention. Systems-based analysis of these causes of readmission can potentially improve patient expectations and care after elective aneurysm repair.
Collapse
Affiliation(s)
- Kevin Casey
- Division of Vascular Surgery, Naval Medical Center San Diego, San Diego, Calif
| | | | | | | |
Collapse
|
25
|
Open Surgical and Endovascular Conduits for Difficult Access During Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2012; 26:1022-9. [DOI: 10.1016/j.avsg.2012.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 12/20/2022]
|
26
|
Sarmiento JM, Wisniewski PJ, Do NT, Slezak JM, Tayyarah M, Aka PK, Vo TD, Hsu JH. The Kaiser Permanente Experience With Ultrasound-Guided Percutaneous Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2012; 26:906-12. [DOI: 10.1016/j.avsg.2011.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 09/18/2011] [Accepted: 09/26/2011] [Indexed: 12/17/2022]
|
27
|
Khan JA, Mazari FA, Abdul Rahman M, Mockford K, Chetter IC, McCollum PT. Patients' Perspective of Functional Outcome After Elective Abdominal Aortic Aneurysm Repair: A Questionnaire Survey. Ann Vasc Surg 2011; 25:878-86. [DOI: 10.1016/j.avsg.2011.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/17/2011] [Accepted: 05/24/2011] [Indexed: 10/17/2022]
|
28
|
Cuypers P, Buth J, Harris PL, Gevers E, Lahey R. Reprinted article "Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry". Eur J Vasc Endovasc Surg 2011; 42 Suppl 1:S63-71. [PMID: 21855026 DOI: 10.1016/j.ejvs.2011.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/1999] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The outcomes for patients after endovascular treatment of abdominal aortic aneurysm (AAA) are determined primarily by the endpoints of death and endoleaks, the latter representing continued risk of rupture. The data of a multicentre registry were analysed with regard to the early outcome of stent-graft procedures for AAA and the complications associated with this treatment. In addition, the results during follow-up were analysed by determining mortality and endoleak development as separate endpoints and as a combined endpoint defined as endoleak-free survival. SETTING 38 European institutions of Vascular Surgery collaborating in a multicentre registry project. PATIENTS AND METHODS 899 patients with AAA underwent between May 1994 and March 1998 elective endovascular repair (818 men and 81 women; mean age 69 years). 80 (8.9%) of the patients had medical conditions that excluded them from open repair. 818 (91%) of patients had a bifurcated device, 63 (7%) had a straight tube graft, and only 18 (2%) had an aorto-uni-iliac device. Clinical examination and contrast-enhanced computed tomography was performed at fixed follow-up intervals to assess increase or decrease of the maximum transverse diameter (MTD). Endoleaks observed at follow-up were discriminated into persistent endoleak and temporary endoleak. The latter is defined as single time observed endoleaks or with two or more negative imaging studies between observed endoleaks. Life-table analyses were used to calculate the rates of freedom-from-endoleak (no endoleak at any time), freedom-from-persistent endoleak (no persistent endoleak), patient survival, and persistent-endoleak-free-survival. RESULTS The median follow-up of this patient series was 6.2 months. The ratio between observed and expected follow-up data was 82% for the overall follow-up period. However, at 18 months of follow-up this rate was only 45%. The number of patients followed during this period was sufficient to allow statistically meaningful assessment. The MTD in patients with temporary endoleaks demonstrated a significant decrease at 6 to 12 months compared to preoperative values (mean 57 and 53 respectively, p = 0.004). In patients with persistent endoleaks there was no change between the preoperative and 6-month MTD (mean 57 and 60 mm respectively). At 6 and 18 months freedom-from-endoleak was 83% and 74% and freedom-from-persistent endoleak was 93% and 90%, respectively. The 18-month cumulative patient survival was 88% and the main outcome measure, the persistent endoleak-free-survival was 79%. CONCLUSIONS The MTD decreases in patients with temporary endoleak, but not in patients with persistent endoleak. Therefore, the use of the rate of freedom-from-persistent endoleak, reflecting absence of persisting endoleaks to estimate the prognosis with regard to the AAA, is justified. Determining persistent endoleak-free survival appears a rational approach to provide a realistic outlook for patients with stent-grafted AAA. The observed 18-month endoleak-free survival reflects a satisfactory mid-term result.
Collapse
Affiliation(s)
- Ph Cuypers
- EUROSTAR Data Registry Centre, Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | | | | |
Collapse
|
29
|
Georgiadis GS, Antoniou GA, Papaioakim M, Georgakarakos E, Trellopoulos G, Papanas N, Lazarides MK. A Meta-Analysis of Outcome After Percutaneous Endovascular Aortic Aneurysm Repair Using Different Size Sheaths or Endograft Delivery Systems. J Endovasc Ther 2011; 18:445-59. [DOI: 10.1583/11-342.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
30
|
Malkawi A, Hinchliffe R, Holt P, Loftus I, Thompson M. Percutaneous Access for Endovascular Aneurysm Repair: A Systematic Review. Eur J Vasc Endovasc Surg 2010; 39:676-82. [DOI: 10.1016/j.ejvs.2010.02.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/01/2010] [Indexed: 12/17/2022]
|
31
|
Goodney PP, Tavris D, Lucas FL, Gross T, Fisher ES, Finlayson SRG. Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2010; 51:1340-1347.e1. [PMID: 20385469 DOI: 10.1016/j.jvs.2010.01.054] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 01/01/2010] [Accepted: 01/16/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Several reports suggest unexpectedly high rates of late abdominal aortic aneurysm (AAA) rupture occur after endovascular AAA repair (EVAR). However, a population-based study examining causes of late death after EVAR vs open surgical repair has not been performed. METHODS We performed a retrospective cohort study of patients undergoing infrarenal AAA repair using information from the Medicare inpatient hospital discharge records (MedPAR files), physician claim files (Part B files, 20% sample), and Medicare Denominator Files for the years 2001 to 2004. Using the Social Security Death Index, we identified all "late" deaths, defined as deaths occurring >30 days and after hospital discharge. We used the National Death Index to identify cause of death information; in particular, those deaths that were likely caused by late rupture. We compared causes of late death and survival between EVAR and open repair using Wilcoxon log-rank and rank-sum tests. RESULTS Between 2001 and 2004, 13,971 patients underwent AAA repair (6119 EVAR, 7852 open repair). After a mean follow-up of 1.6 years in the EVAR cohort and 1.9 years in the open cohort, mortality rates were similar across repair type (15.4% EVAR, 15.9% open repair), with an adjusted odds ratio for death after open repair of 0.98 (95% confidence interval, 0.90-1.07). Of the 2194 documented deaths, 523 occurred before discharge or <or=30 days, and 1671 occurred >30 days and after hospital discharge. Cause of death information for the 1671 late deaths was available from the National Death Index for 1515 (91%). The 15 most common codes for causes of late death were dominated by cardiac disease (atherosclerotic heart disease, acute myocardial infarction) and pulmonary disease (lung cancer, respiratory failure). Causes of late death with specific mention of aneurysm were identified in 37 patients (2.4% of all deaths), but this event was not more common in EVAR or open repair (15 [0.3%] in the EVAR group, 22 [0.3%], in the open repair group; P = .71). CONCLUSIONS Late deaths from aneurysm rupture after EVAR or open repair appear to be relatively infrequent and similarly distributed across procedure type. Our results emphasize that the effectiveness of EVAR is comparable to open AAA repair in preventing aneurysm-related death.
Collapse
Affiliation(s)
- Philip P Goodney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03765, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Jahnke T, Schäfer JP, Charalambous N, Trentmann J, Siggelkow M, Hümme TH, Bolte H, Demirbas E, Heller M, Müller-Hülsbeck S. Total Percutaneous Endovascular Aneurysm Repair with the Dual 6-F Perclose-AT Preclosing Technique: A Case-control Study. J Vasc Interv Radiol 2009; 20:1292-8. [DOI: 10.1016/j.jvir.2009.06.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 06/12/2009] [Accepted: 06/29/2009] [Indexed: 12/17/2022] Open
|
33
|
Egorova N, Giacovelli JK, Gelijns A, Greco G, Moskowitz A, McKinsey J, Kent KC. Defining high-risk patients for endovascular aneurysm repair. J Vasc Surg 2009; 50:1271-9.e1. [PMID: 19782526 DOI: 10.1016/j.jvs.2009.06.061] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 06/30/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Endovascular aneurysm repair (EVAR) is commonly used as a minimally invasive technique for repairing infrarenal aortic aneurysms. There have been recent concerns that a subset of high-risk patients experience unfavorable outcomes with this intervention. To determine whether such a high-risk cohort exists and to identify the characteristics of these patients, we analyzed the outcomes of Medicare patients treated with EVAR from 2000-2006. METHODS We identified 66,943 patients who underwent EVAR from Inpatient Medicare database. The overall 30-day mortality was 1.6%. A risk model for perioperative mortality was developed by randomly selecting 44,630 patients; the other one third of the dataset was used to validate the model. The model was deemed reliable (Hosmer-Lemeshow statistics were P = .25 for the development, P = .24 for the validation model) and accurate (c = 0.735 and c = 0.731 for the development and the validation model, respectively). RESULTS In our scoring system, where scores ranged between 1 and 7, the following were identified as significant baseline factors that predict mortality: renal failure with dialysis (score = 7); renal failure without dialysis (score = 3); clinically significant lower extremity ischemia (score = 5); patient age >or=85 years (score = 3), 75-84 years (score = 2), 70-74 years (score = 1); heart failure (score = 3); chronic liver disease (score = 3); female gender (score = 2); neurological disorders (score = 2); chronic pulmonary disease (score = 2); surgeon experience in EVAR <3 procedures (score = 1); and hospital annual volume in EVAR <7 procedures (score = 1). The majority of Medicare patients who were treated (96.6%, n = 64,651) had a score of 9 or less, which correlated with a mortality <5%. Only 3.4% of patients had a mortality >or=5% and 0.8% of patients (n = 509) had a score of 13 or higher, which correlated with a mortality >10%. CONCLUSION We conclude that there is a high-risk cohort of patients that should not be treated with EVAR because of prohibitively high mortality; however, this cohort is small. Our scoring system, which is based on patient and institutional factors, provides criteria that can be easily used by clinicians to quantify perioperative risk for EVAR candidates.
Collapse
Affiliation(s)
- Natalia Egorova
- Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Predictors of Survival Following Open and Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2009; 23:153-8. [DOI: 10.1016/j.avsg.2008.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 07/23/2008] [Accepted: 07/23/2008] [Indexed: 11/19/2022]
|
35
|
McDonnell CO, Haider SN, Colgan MP, Shanik GD, Moore DJ, Madhavan P. Endovascular management of thoracic aortic pathology. Surgeon 2009; 7:24-30. [PMID: 19241982 DOI: 10.1016/s1479-666x(09)80063-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endovascular technology has revolutionised the management of abdominal aortic aneurysmal disease but the less frequent occurrence of pathology in the thoracic aorta has meant that evidence demonstrating the primacy of endovascular treatment strategies in this portion of the vessel is less convincing. Herein we summarise the best available evidence to date. METHODS A comprehensive search of the surgical and radiological literature using the search term 'endovascular thoracic aorta' was conducted. FINDINGS AND CONCLUSIONS The vast majority of patients treated by thoracic aortic stent grafting have had their treatment outside the context of a randomised trial. While it would seem that endovascular repair is the treatment of choice for the thoracic aorta, the present evidence is based on single centre case series and is anecdotal at best.
Collapse
Affiliation(s)
- C O McDonnell
- Department ofVascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | | | | | | | | |
Collapse
|
36
|
Hopkins R, Bowen J, Campbell K, Blackhouse G, De Rose G, Novick T, O'Reilly D, Goeree R, Tarride JE. Effects of study design and trends for EVAR versus OSR. Vasc Health Risk Manag 2009; 4:1011-22. [PMID: 19183749 PMCID: PMC2605334 DOI: 10.2147/vhrm.s3810] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To investigate if study design factors such as randomization, multi-center versus single center evidence, institutional surgical volume, and patient selection affect the outcomes for endovascular repair (EVAR) versus open surgical repair (OSR). Finally, we investigate trends over time in EVAR versus OSR outcomes. Methods: Search strategies for comparative studies were performed individually for: OVID’s MEDLINE, EMBASE, CINAHL, HAPI, and Evidence Based Medicine (EBM) Reviews (including Cochrane DSR, ACP Journal Club, DARE and CCTR), limited to 1990 and November 2006. Results: Identified literature: 84 comparative studies pertaining to 57,645 patients. These include 4 randomized controlled trials (RCTs), plus 2 RCTs with long-term follow-up. The other 78 comparative studies were nonrandomized with 75 reporting perioperative outcomes, of which 16 were multi-center, and 59 single-center studies. Of the single-center studies 31 were low-volume and 28 were high-volume centers. In addition, 5 studies had all patients anatomically eligible for EVAR, and 8 studies included high-risk patients only. Finally, 25 long term observational studies reported outcomes up to 3 years. Outcomes: Lower perioperative mortality and rates of complications for EVAR versus OSR varied across study designs and patient populations. EVAR adverse outcomes have decreased in recent times. Conclusion: EVAR highlights the problem of performing meta-analysis when the experience evolves over time.
Collapse
Affiliation(s)
- Robert Hopkins
- Program for the Assessment of Technology in Health (PATH) Research Institute, Department of Clinical Epidemiology and Biostatistics, London Health Sciences Center, London, Ontario, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Clinical Significance of Endoleak Detected on Follow-Up CT After Endovascular Repair of Abdominal Aortic Aneurysm. AJR Am J Roentgenol 2008; 191:808-13. [DOI: 10.2214/ajr.07.3668] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
38
|
Islam T, Hines G, Katz DS, Purtil W, Castiller F. Life-Threatening Upper Gastrointestinal Bleeding Secondary to Aortoenteric Fistula. CLINICAL MEDICINE. CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2008. [DOI: 10.4137/ccrpm.s376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a patient with gastrointestinal bleeding secondary to an aortoduodenal fistula. The patient had undergone an open surgical repair of an abdominal aortic aneurysm five years prior to admission.
Collapse
Affiliation(s)
- Tasbirul Islam
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - George Hines
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - Douglas S. Katz
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - William Purtil
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| | - Francis Castiller
- Pulmonary and Critical Care Medicine, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery, Winthrop-University Hospital, Mineola, NY, U.S.A
- State University of New York at Stony Brook, Stony Brook, NY, U.S.A
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, U.S.A
- Department of Vascular Surgery Winthrop-University Hospital, Mineola, NY, U.S.A
| |
Collapse
|
39
|
Lovegrove RE, Javid M, Magee TR, Galland RB. A meta-analysis of 21 178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 2008; 95:677-84. [DOI: 10.1002/bjs.6240] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results.
Methods
A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate.
Results
Forty-two studies comprising 21 178 patients (10 855 open; 10 323 endovascular) were included. In the elective setting (20 715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD − 36 h; P < 0·001) and a shorter total postoperative stay (WMD − 5·4 days; P < 0·001). Cardiac (OR 1·76; P = 0·002) and respiratory (OR 4·01; P < 0·001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0·46; P < 0·001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0·39; P < 0·001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD − 100·4 h; P = 0·005) and a significantly lower 30-day mortality (OR 0·45; P = 0·005).
Conclusions
The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality.
Collapse
Affiliation(s)
- R E Lovegrove
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - M Javid
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - T R Magee
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - R B Galland
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| |
Collapse
|
40
|
Park B, Mavanur A, Drezner AD. Chronic obstructive pulmonary disease is not an independent marker for adverse outcomes in endograft repair of abdominal aortic aneurysms. Ann Vasc Surg 2008; 22:341-5. [PMID: 18430545 DOI: 10.1016/j.avsg.2008.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 11/01/2007] [Accepted: 01/03/2008] [Indexed: 11/19/2022]
Abstract
A significant proportion of patients undergoing endograft repair of abdominal aortic aneurysms (AAAs) suffer from chronic obstructive pulmonary disease (COPD). We report here our experience and analysis of 342 consecutive AAA endograft repairs in patients with and without COPD (137, or 39%, of patients with COPD and 55, or 16%, with moderate to severe COPD). Patient outcomes such as perioperative mortality, length of admission, intensive care unit admission, congestive heart failure, myocardial infarction, conversion to open surgery, duration of surgery, postoperative endoleaks, and combined respiratory complications were analyzed; differences were not statistically significant compared to patients without COPD (p > 0.05). Endograft repair of AAA demonstrated equivalent outcomes in patients with and without COPD.
Collapse
Affiliation(s)
- Brian Park
- Division of Vascular Surgery, Hartford Hospital, Hartford, CT 06102-5037, USA
| | | | | |
Collapse
|
41
|
The fate of infrarenal abdominal aortic aneurysms after stent grafting: influence of thrombosis at side branch ostia. J Comput Assist Tomogr 2008; 32:93-8. [PMID: 18303295 DOI: 10.1097/rct.0b013e31805ce1e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of postoperative thrombosis of the side branch ostia on the shrinkage of endoluminally treated abdominal aortic aneurysms with patent side branch vessels. MATERIALS AND METHODS Thirty-three patients were followed up with serial computed tomography (CT). Special attention was paid to presence or absence of retrograde enhancement of the side branch ostia after the covering of the patent side branch vessels by the stent graft and aneurysm diameter change on postoperative CT. Preoperative CT was also reviewed to assess the number of patent side branch vessels, degree of aneurysm wall calcification, and thickness of the mural thrombus. The patients with type 2 endoleak were excluded from this evaluation. The patients were divided into 2 groups, the nonthrombosed and thrombosed groups, based on presence or absence of retrograde enhancement of the side branch ostia as depicted on all postoperative CT. RESULTS Type 1 endoleak was not seen in all patients. Preoperative diameter of the aneurysm was 4.75 +/- 0.18 cm in the thrombosed group (n = 12) and 4.98 +/- 0.35 cm in the nonthrombosed group (n = 8). There were no significant differences in follow-up periods, preoperative diameter of the aneurysm, number of patent side branch vessels, degrees of aneurysm wall calcification, and thickness of the mural thrombus between the 2 groups. The mean diameter of the aneurysm in the nonthrombosed group did not change at 3 and 6 months then first decreased at 12 months after the stent grafting. However, in the thrombosed group, the mean diameter of the aneurysm had decreased at 3 months after stent grafting. Thereafter, the aneurysms continuously shrank. CONCLUSIONS Postoperative thrombosis of the side branch ostia may predict favorable shrinkage of endoluminally treated aneurysms.
Collapse
|
42
|
Walsh SR, Tang TY, Boyle JR. Renal Consequences of Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2008; 15:73-82. [PMID: 18254679 DOI: 10.1583/07-2299.1] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
43
|
Ruppert V, Leurs LJ, Hobo R, Buth J, Rieger J, Umscheid T. Tube Stent-Grafts for Infrarenal Aortic Aneurysm: A Matched-Paired Analysis Based on EUROSTAR Data. Cardiovasc Intervent Radiol 2007; 30:611-8. [PMID: 17573551 DOI: 10.1007/s00270-007-9066-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 04/03/2007] [Accepted: 04/06/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Tube stent-grafts for treatment of infrarenal aortic aneurysms (AAAs) are a nearly forgotten concept. For focal aortic pathologies tube stent-grafts may be a treatment option. We have performed a retrospective matched-paired analysis of the EUROSTAR registry regarding the outcome of tube vs. bifurcated stent-grafts for AAA. Tapered aortomonoiliac stent-grafts were not the objective of this study. MATERIALS AND METHODS From July 1997 to June 2006, 7581 patients who underwent an endovascular AAA repair were entered in the EUROSTAR registry by 164 centers. One hundred fifty-three patients were treated with tube stent-grafts. For each of these 153 patients we selected one patient from a bifurcated stent-graft group (BGG-original, 7428 patients) matched according to gender, ASA, age, AAA diameter, and type of anesthesia. Differences in preoperative details between the two study groups were analyzed using chi-square test for discrete variables and Wilcoxon rank-sum test for continuous variables. Multivariate logistic regression analysis was performed on early complications. Midterm outcomes (>30 days) were analyzed by Kaplan-Meier and multivariate Cox proportional hazard model. RESULTS The duration of the procedure was shorter in the tube stent-graft group (TGG; 102.3 +/- 52.2) than in BGG (128.3 +/- 55.0; p = 0.0002). Type II endoleak was less frequent in TGG (4.0%; mean follow-up, 23.12 +/- 23.9 months) than in BGG (14.3%; mean follow-up, 20.77 +/- 20.0 months; p = 0.0394). Type I endoleaks and migration were distributed equally, without significant differences between the groups. Combined 30-day and late mortality was higher for TGG (p = 0.0346) and was obviously not aneurysm related. CONCLUSIONS We conclude that after selection of patients, tube stent-grafts for infrarenal aortic repair can be performed with great safety regarding endoleaks and migration. The combined higher 30-day mortality and non-aneurysm-related mortality during follow-up were mainly caused by cardiac failures in our sample.
Collapse
Affiliation(s)
- Volker Ruppert
- Department of Vascular and Endovascular Surgery, Klinikum Ingolstadt, Krumenauerstrasse 25, D-85049, Ingolstadt, Germany.
| | | | | | | | | | | |
Collapse
|
44
|
van Herwaarden JA, van de Pavoordt EDWM, Waasdorp EJ, Albert Vos J, Overtoom TT, Kelder JC, Moll FL, de Vries JPPM. Long-Term Single-Center Results with Aneurx Endografts for Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2007; 14:307-17. [PMID: 17723008 DOI: 10.1583/06-1993.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the long-term single-center results with the AneuRx stent-graft in endovascular abdominal aortic aneurysm (AAA) repair (EVAR). METHODS Between December 1996 and August 2003, 212 patients (197 men; mean age 71.3+/-7.0 years) were treated with the AneuRx stent-graft for an infrarenal AAA. Postoperatively, patients were enrolled in a fixed surveillance protocol, and data were prospectively captured into a database. RESULTS Graft deployment was successful in 98.6% (209/212). Thirty-day mortality was 2.4%. Median hospital stay was 4.3+/-5.5 days. Median follow-up was 52.0 months (range 1-109); only 1 patient was lost to follow-up. At 9 years, patient survival was 56% and freedom from secondary interventions was 48%. In 68% of cases, these reinterventions were needed for a fixation-related complication, and most of these complications (75%) encompassed the area of the proximal aneurysm neck. Primary clinical success was 37% at 9 years. After secondary interventions, the assisted primary clinical success improved to 73% at 9 years. Freedom from aneurysm-related death was 97% at 1 year and 90% at 9 years. CONCLUSION As an alternative to open repair, EVAR with the AneuRx device has low perioperative mortality. Reinterventions are mostly due to fixation-related complications. While the overall mortality risk in this population was 5% per year, annual aneurysm-related death was only 1%. The focus should be on surveillance and reducing the rate of long-term complications, which might be possible with improved proximal stent-graft fixation.
Collapse
|
45
|
Peterson BG, Matsumura JS, Brewster DC, Makaroun MS. Five-year report of a multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysms. J Vasc Surg 2007; 45:885-90. [PMID: 17398057 DOI: 10.1016/j.jvs.2007.01.044] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 01/08/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Compare long-term results of endovascular treatment and standard open repair of abdominal aortic aneurysms in a multicenter, concurrent-controlled trial. METHODS 334 subjects were treated with standard open repair (control, n = 99) or the original EXCLUDER Bifurcated Endoprosthesis (test, n = 235). Five-year clinical evaluations and corelab radiographic results are analyzed. RESULTS Overall and aneurysm-related survival are similar. There have been ten open conversions, most frequently for enlarging sacs without endoleak. Two patients died after conversion. Including reinterventions and complications of reinterventions as adverse events, there is significant, persistent long-term reduction in major adverse events. At 5 years, corelab reported 0% limb narrowing, 0% trunk migration, 0% component (contralateral leg, aortic extender, and iliac extender) migration, 0% fracture, endoleak in 3% (2 type II/68), and aneurysm growth (>5 mm compared to baseline) in 38% (30/78) of the test group. There are no aneurysm ruptures in either test or control group. CONCLUSIONS After 5 years follow-up, endovascular repair is a safer and effective treatment compared with open surgical repair for abdominal aortic aneurysms. Major adverse events are less frequent with the endograft despite the need for late reinterventions. Aneurysm expansion is observed in nearly two-fifths of patients but is not associated with endoleak or aneurysm rupture. Multicenter clinical trials are evaluating a newer version of this device designed to avoid this high rate of sac expansion.
Collapse
|
46
|
Jonk YC, Kane RL, Lederle FA, MacDonald R, Cutting AH, Wilt TJ. Cost-effectiveness of abdominal aortic aneurysm repair: A systematic review. Int J Technol Assess Health Care 2007; 23:205-15. [PMID: 17493306 DOI: 10.1017/s0266462307070316] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options.Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded.Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival.Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.
Collapse
Affiliation(s)
- Yvonne C Jonk
- University of Minnesota, Minneapolis VA Center for Chronic Disease Outcomes Research, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Ruppert V, Erz K, Bürklein D, Treitl M, Steckmeier B, Stelter W, Umscheid T. Double Tube Stent-Grafts for Infrarenal Aortic Aneurysm: A New Concept. J Endovasc Ther 2007. [DOI: 10.1583/1545-1550(2007)14[144:dtsfia]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
48
|
Norwood MGA, Lloyd GM, Bown MJ, Fishwick G, London NJ, Sayers RD. Endovascular abdominal aortic aneurysm repair. Postgrad Med J 2007; 83:21-7. [PMID: 17267674 PMCID: PMC2599974 DOI: 10.1136/pgmj.2006.051177] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The operative mortality following conventional abdominal aortic aneurysm (AAA) repair has not fallen significantly over the past two decades. Since its inception in 1991, endovascular aneurysm repair (EVAR) has provided an alternative to open AAA repair and perhaps an opportunity to improve operative mortality. Two recent large randomised trials have demonstrated the short and medium term benefit of EVAR over open AAA repair, although data on the long term efficacy of the technique are still lacking. This review aimed at providing an overview of EVAR and a discussion of the potential benefits and current limitations of the technique.
Collapse
Affiliation(s)
- M G A Norwood
- Department of Vascular Surgery, The Leicester Royal Infirmary, Leicester, UK.
| | | | | | | | | | | |
Collapse
|
49
|
Franks SC, Sutton AJ, Bown MJ, Sayers RD. Systematic Review and Meta-analysis of 12 Years of Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2007; 33:154-71. [PMID: 17166748 DOI: 10.1016/j.ejvs.2006.10.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 10/03/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endovascular repair (ER) of abdominal aortic aneurysm (AAA) is a new technique, and reported rates of endoleak, conversion to open repair, rupture and mortality vary widely. The aim of this study was to estimate these rates from the published data, and examine how this has changed as more patients have undergone ER. METHODS A systematic review and meta-analysis of publications identified through searches of the electronic databases EMBASE and Medline. All publications quoting endoleak, conversion to open repair, rupture and mortality rates for a series of patients undergoing ER were included. RESULTS 163 studies pertaining to 28,862 patients undergoing ER were identified as relevant for the review and meta-analysis. The pooled estimate for operative mortality was 3.3% (95% confidence interval 2.9 to 3.6%). The pooled estimate for type 1 endoleaks was 10.5% (95% confidence interval 9.0 to 12.1%), with an annual rate of 8.4% (95% confidence interval 5.7% to 12.2%). The pooled estimate of type 2,3 and 4 endoleaks was 13.7% (95% confidence interval 12.3 to 15.3%), with an annual rate of 10.2% (95% confidence interval 7.4% to 14.1%). The pooled estimate for primary conversion to open repair was 3.8% (95% confidence interval 3.2 to 4.4%), and for secondary conversion to open repair 3.4% (95% confidence interval 2.8 to 4.2%). The pooled estimate for post-operative rupture was 1.3% (95% confidence interval 1.1 to 1.7%), with an annual rupture rate of 0.6% (95% confidence interval 0.5% to 0.8%). Multivariate meta-regression analysis showed that rates of operative mortality, post-operative rupture and total number of endoleaks all fell significantly (p<0.05) over time. CONCLUSIONS This study demonstrates a low mortality and a gradual reduction in vascular morbidity and mortality associated with endovascular repair since it was first introduced.
Collapse
Affiliation(s)
- S C Franks
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | | | | | | |
Collapse
|
50
|
Hiromatsu S, Egawa N, Hosokawa Y, Ishihara K, Yokokura H, Tanaka A, Aoyagi S. A Shorter Skin Incision Technique for the Repair of Infrarenal Abdominal Aortic Aneurysms. Surg Today 2007; 37:97-102. [PMID: 17243025 DOI: 10.1007/s00595-006-3353-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 07/25/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated the effectiveness of a shorter skin incision technique for the treatment of infrarenal abdominal aortic aneurysms (AAA). The aim of the present study was to evaluate whether or not the difference in the length of the skin incision contributed to an early recovery after the operation. METHODS Between October 2001 and December 2004, we performed 105 elective repairs for AAA. The patients were divided into three groups according to the length of the skin incision as follows: group A, less than 15 cm, group B, from 15 cm to less than 20 cm, and group C, 20 cm or more. RESULTS There was no significant difference in the intraoperative course among the three groups. The duration of paralytic ileus was shorter in group A than in group C (2.0 +/- 0.9 days versus 3.2 +/- 2.3 days; P = 0.0428). Although the periods before removal of nasogastric suction and before starting a solid diet were slightly shorter in group A than in groups B and C, there were no statistically significant differences. CONCLUSION We define minimally invasive vascular surgery as surgery performed with a small abdominal skin incision that does not expose the intestine to air while providing a good operative field that does not place any undue stress on the surgeon.
Collapse
Affiliation(s)
- Shinichi Hiromatsu
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | | | | | | | | | | | | |
Collapse
|