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Tohmasi S, Fujitani RM, Duong WQ, Donayre CE, Kuo IJ, Chau AH, Kabutey NK. Intentional Bilateral Renal Artery Coverage During Ruptured Endovascular Paraanastomotic Pseudoaneurysm Repair. Ann Vasc Surg 2021; 79:440.e1-440.e6. [PMID: 34653639 DOI: 10.1016/j.avsg.2021.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/01/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
The development of a paraanastomotic pseudoaneurysm is a serious complication after open prosthetic reconstruction of the aorta for occlusive or aneurysmal disease. Open repair of these lesions has previously been associated with high rates of morbidity and mortality. Endovascular repair may provide suitable treatment for proximal paraanastomotic aortic bypass graft pseudoaneurysms in patients who are poor candidates for open surgery. Bilateral renal artery coverage may be necessary to achieve adequate fixation and seal during life-threatening emergency cases of pseudoaneurysm rupture. Due to the infrequency of reported cases, the consequences of bilateral renal artery occlusion during these complex procedures are poorly understood. We present a case of a proximal paraanastomotic aortobifemoral bypass pseudoaneurysm rupture that was managed using endovascular repair with intentional coverage of both renal arteries. We also review the contemporary literature on endovascular management of paraanastomotic aneurysms and discuss the role of bilateral renal artery coverage in treating select patients with complex ruptured aortic pathology.
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Affiliation(s)
- Steven Tohmasi
- Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Orange, CA
| | - Roy M Fujitani
- Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Orange, CA
| | - William Q Duong
- Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Orange, CA
| | - Carlos E Donayre
- Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Orange, CA
| | - Isabella J Kuo
- Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Orange, CA
| | - Anthony H Chau
- Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Orange, CA
| | - Nii-Kabu Kabutey
- Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Orange, CA.
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2
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Hirai K, Skripochnik E, Terrana LM, Loh S. Endovascular Solution to Endoleak Phenomenon After Open Repair of Abdominal Aortic Aneurysm. Vasc Endovascular Surg 2020; 54:633-637. [PMID: 32648523 DOI: 10.1177/1538574420939365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular aneurysm repair (EVAR) has quickly outpaced open treatment of infrarenal abdominal aortic aneurysm (AAA) and iliac artery aneurysms, relegating most open AAA repair for either young patients with long life expectancy or patients with extreme anatomic constraints. Typically, open repair involves opening the aneurysm sac with suture ligation of back-bleeding vessels. However, in situations where an aortobifemoral repair is performed, proximal and distal ligation can be performed leaving behind a "remnant" aorta and iliac arteries. Usually, major palpable vessels are ligated and small lumbars spontaneously thrombose. However, failure of this to occur can lead to a rare situation in which there is persistent filling of a remnant aorta and aneurysm sac leading to a situation similar to a type II endoleak after EVAR. Typically, this leak has been repaired by open ligation. We present a technique for endovascular coiling and thrombin injection to correct a "type II endoleak" from a back-bleeding lumbar artery after open aortoiliac and femoral aneurysm repair.
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Affiliation(s)
- Kelsi Hirai
- Department of Surgery, State University of New York, 480303Stony Brook, NY, USA
| | - Edvard Skripochnik
- Department of Vascular Surgery, State University of New York, 480303Stony Brook, NY, USA
| | - Lisa Marie Terrana
- Department of Vascular Surgery, Veterans Affairs Medical Center, Northport, NY, USA
| | - Shang Loh
- Department of Vascular Surgery, State University of New York, 480303Stony Brook, NY, USA
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Spanos K, Kölbel T, Kouvelos G, Tsilimparis N, Debus SE, Giannoukas AD. Endovascular treatment of para-anastomotic aneurysms after open abdominal aortic surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:159-170. [PMID: 29430886 DOI: 10.23736/s0021-9509.18.10145-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The repair of long-term complications of open abdominal aortic repair such as para-anastomotic aneurysm (PAA) and pseudoaneurysm (PSA) is very challenging. The aim of this study was to assess the outcomes of endovascular repair of PAA/PSA after previous open aortic surgery for aneurismal or occlusive disease. EVIDENCE ACQUISITION A systematic review was undertaken; a search was performed (PRISMA) in MEDLINE, CENTRAL, Cochrane databases and key references of all studies of endovascular treatment of PAA/PSA after open aortic surgery. EVIDENCE SYNTHESIS Eighteen studies included totally 433 patients (86.3% males) with mean age of 71±2.5 years were identified. Most of the patients were asymptomatic (76%) and diagnosed with PAA (60.5%), while 81.6% had history of open aortic reconstruction for aneurismal disease. The mean diameter of para-anastomotic aneurysms was 59.7 mm (from 23 mm to 110 mm) and the mean duration until their diagnosis was 10±2 years. Standard bifurcated (23.7%), fenestrated (23.4%) and aorto-uni-iliac stent-grafts (16.3%) were mostly used. The technical success rate was 97.8% (391/400) with 1.4% (6/433) 30 day-mortality rate and mean hospital stay of 6±3 days. The mean 1- and 2- year survival rate was 87.8% and 78.8%, respectively. The follow-up ranged from 9 to 43 months, with presenting complications such as endoleak type I (24/378; 6.3%), type II (15/354; 4.3%), type III (3/378;0.8%), migration (4/378; 1%) and limb occlusion (5/310;1.6%). Additionally, 5.7% (19/332) of the patients underwent open conversion, while the total re-intervention rate was 11.4% (39/340; time of reintervention ranged from 7 to 30 months). In cases in which a stent was used for splanchnic vessels (renal artery: 188, superior mesenteric artery: 98, celiac artery: 64), the primary patency rate was 97.4% (341/350). CONCLUSIONS Endovascular treatment of PAAs and PSAs after previous open aortic surgery is a feasible and efficient option with high technical success rate, low 30-day mortality and good mid-term outcomes.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany -
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - George Kouvelos
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - Sebastian E Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece
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Tasselli S, Perini P, Paini E, Milan L, Bonvini S. Use of a Thoracic Endograft in an Acute Abdominal Aortic Setting: Case Report and Literature Review. Vasc Endovascular Surg 2017; 51:493-497. [PMID: 28743219 DOI: 10.1177/1538574417718446] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE We report the case of a thoracic endograft used to achieve exclusion of a ruptured proximal paranastomotic abdominal aortic aneurysm (PAAA) as a consequence of aortic ballooning. CASE REPORT A type I proximal endoleak was evidenced following endovascular repair of a PAAA with an aortic cuff. The leak was treated with ballooning, which caused distal aortic rupture. A thoracic endograft was deployed inside the cuff, achieving complete exclusion. At 1 year, there are no signs of migration or endoleak with complete PAAA thrombosis, according to computed tomographic angiography. CONCLUSION In hostile proximal abdominal aortic neck, challenging anatomies, or urgent cases, the structural adaptability of thoracic endografts could provide safe and successful abdominal aortic endovascular exclusion.
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Affiliation(s)
| | - Paolo Perini
- 2 Department of Vascular Surgery, University Hospital, Parma, Italy
| | - Elisa Paini
- 1 Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
| | - Luca Milan
- 1 Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
| | - Stefano Bonvini
- 1 Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
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Bez LG, Botelho FE, Maciel JCA, Cardinelli DM. Endovascular repair of abdominal aortic para-anastomotic pseudoaneurysm. J Vasc Bras 2013. [DOI: 10.1590/s1677-54492013000200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Para-anastomotic aneurysms are either true aneurysms or pseudoaneurysms. The latter tend to be asymptomatic until rupture. Para-anastomotic aneurysms should be approached surgically, despite the high morbidity and mortality associated with their treatment. This report describes the case of a 68-year-old woman who presented with a para-anastomotic pseudoaneurysm secondary to infrarenal aortic aneurysmectomy. We chose to use an endovascular approach, and results were good. Endovascular techniques are increasingly becoming the method of choice in the treatment of anastomotic pseudoaneurysms.
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Affiliation(s)
- Leonardo Ghizoni Bez
- Hospital do Instituto de Previdencia dos Servidores do Estado de Minas Gerais, Brazil; Hospital Felicio Rocho, Brazil
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Mossdorf A, Ulmer T, Kalverkamp S, Neumann U, Heidenhain C. Transposition of the hepatic artery as a salvage procedure for an aortic pseudoaneurysm after liver transplantation. Liver Transpl 2013; 19:105-7. [PMID: 23152169 DOI: 10.1002/lt.23568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/13/2012] [Indexed: 01/12/2023]
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Nayeemuddin M, Pherwani AD, Asquith JR. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms. Clin Radiol 2012; 67:802-14. [PMID: 22341185 DOI: 10.1016/j.crad.2011.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 12/12/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
Abstract
Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.
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Affiliation(s)
- M Nayeemuddin
- Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent, UK
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Ten Bosch JA, Waasdorp EJ, de Vries JPP, Moll FL, Teijink JA, van Herwaarden JA. The durability of endovascular repair of para-anastomotic aneurysms after previous open aortic reconstruction. J Vasc Surg 2011; 54:1571-8. [PMID: 21944919 DOI: 10.1016/j.jvs.2011.04.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/17/2011] [Accepted: 04/19/2011] [Indexed: 10/17/2022]
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Cerná M, Köcher M, Utíkal P, Koutná J, Drác P, Bachleda P, Burval S, Kozák J, Thomas RP. Endovascular treatment of abdominal aortic paraanastomotic pseudoaneurysms after surgical reconstruction. Eur J Radiol 2009; 71:333-7. [PMID: 18450399 DOI: 10.1016/j.ejrad.2008.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/26/2008] [Accepted: 03/20/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Marie Cerná
- Department of Radiology, University Hospital, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
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Heidenhain C, Werk M, Gebauer B, Gerlach U, Puhl G, Neuhaus P, Heise M. Endovascular treatment of supra-celiac aortic pseudoaneurysms following liver transplantation. Clin Transplant 2009; 24:188-91. [DOI: 10.1111/j.1399-0012.2009.01046.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heidenhain C, Gerlach U, Gebauer B, Pratschke J, Neuhaus P, Puhl G. Endovascular treatment of supratruncal aortic hemorrhage following liver transplantation as a bridging procedure for hepatic retransplantation. Liver Transpl 2009; 15:347-9. [PMID: 19243000 DOI: 10.1002/lt.21592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Christoph Heidenhain
- General, Visceral, and Transplantation Surgery, Charite-University Medicine Berlin, Berlin, Germany.
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Mofidi R, Flett M, Milne A, Chakraverty S. Endovascular repair of an anastomotic leak following open repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol 2007; 30:1013-5. [PMID: 17533537 DOI: 10.1007/s00270-007-9076-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 12/19/2006] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
Abstract
This report describes the case of an early postoperative anastomotic leak following elective open repair of an infrarenal abdominal aortic aneurysm which was successfully treated by endovascular stent-grafting. A 71-year-old man underwent open tube graft repair of abdominal aortic aneurysm. Twelve days later he presented with a contained leak from the distal anastomosis, which was confirmed on CT scan. This was successfully treated with a bifurcated aortic stent-graft. This case illustrates the usefulness of the endovascular approach for resolving this rare surgical complication of open repair of abdominal aortic aneurysm and the challenges associated with the deployment of such a device within an aortic tube graft.
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Affiliation(s)
- R Mofidi
- Department of Vascular Surgery and Radiology, Ninewells Hospital, Dundee DD1 9SY, UK.
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Di Tommaso L, Monaco M, Piscione F, Sarno G, Iannelli G. Endovascular Stent Grafts as a Safe Secondary Option for Paraanastomotic Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2007; 33:91-3. [PMID: 16798027 DOI: 10.1016/j.ejvs.2006.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 05/08/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our experience of endovascular repair of para-anastomotic aortic aneurysm. METHODS AND RESULTS From March 2001 to December 2004 we identified 6 patients with a para-anastomotic aortic aneurysms following previous open repair of abdominal aortic aneurysm. All patients were treated with endovascular surgery under epidural anaesthesia. There were no major complications, surgical conversions or deaths. Four patients received a bifurcated aortic stent-graft, and two an aorto-uniliac stent-graft followed by a femoro-femoral bypass. At follow-up (mean 26.1+/-10.2 months) there were no deaths, endoleaks or graft migrations observed. CONCLUSION Endovascular surgery, avoiding general anesthesia and re-laparotomy, is the ideal technique for treatment of this complication resulting from failed primary conventional AAA repair.
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Affiliation(s)
- L Di Tommaso
- Department of Cardiac Surgery, University Federico II of Naples, Italy.
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