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Sachsamanis G, Delgado JP, Oikonomou K, Schierling W, Pfister K, Zuelke C, Betz T. Wound healing and hernia after abdominal aortic aneurysm repair - Onlay self-gripping polyester mesh reinforcement compared with small bite sutured closure. Clin Hemorheol Microcirc 2024:CH232008. [PMID: 38277284 DOI: 10.3233/ch-232008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Prophylactic mesh implantation following open surgical repair of abdominal aortic aneurysm is a debatable subject. OBJECTIVE To assess the efficacy of a self-gripping polyester mesh used in on-lay technique to prevent incisional hernia after open abdominal aortic aneurysm repair. METHODS We retrospectively reviewed the records of 495 patients who underwent aortic surgery between May 2017 and May 2021. Patients included in the study underwent open surgical repair for infrarenal abdominal aortic aneurysm (AAA) with closure of the abdominal wall with either small bite suture technique or prophylactic mesh reinforcement. Primary endpoint of the study was the occurrence of incisional hernia during a two-year follow-up period. Secondary endpoints were mesh-related complications. RESULTS Mesh implantation with the on-lay technique was successful in all cases. No patient in the mesh group developed an incisional hernia during the 24-month follow-up period. Two patients in the non-mesh group developed a symptomatic incisional hernia during the follow-up period at 6 months. Three cases of post-operative access site complications were observed in the mesh group. CONCLUSIONS Application of a self-gripping polyester mesh using the on-lay technique demonstrates acceptable early-durability after open surgical repair of abdominal aortic aneurysms. However, it appears to be associated with a number of post-operative access site complications.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Julio Perez Delgado
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Carl Zuelke
- Department of Visceral Surgery, Rotthalmünster Hospital, Rotthalmünster, Germany
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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Shafique H, Quaye K, Cox MW, Long CA, Williams ZF. Endovascular Management of Aortic Stump Blowout by Parallel Grafting and Coil Embolization of Visceral Aorta. Vasc Endovascular Surg 2024:15385744231225890. [PMID: 38166566 DOI: 10.1177/15385744231225890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Aortic graft and endograft infections remain a significant source of morbidity and mortality after abdominal aortic aneurysm repair. With graft excision and extra-anatomic bypass, an infrarenal aortic stump remains which can have suture line dehiscence and catastrophic stump blowout. Treatment of this is extremely challenging, especially for severely co-morbid patients who cannot undergo major surgery, or in patients with a hostile abdomen. We present a case study of a 74-year-old male found to have an aortoenteric fistula (AEF). This case broadens operative options for this type of patient population by demonstrating an endovascular technique for addressing aortic stump blowout by parallel grafting and coil embolization of the visceral aorta.
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Affiliation(s)
| | - Kofi Quaye
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mitchell W Cox
- Division of Vascular and Endovascular Therapy, Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Elsayed N, Gaffey AC, Abou-Zamzam A, Malas MB. Renin-Angiotensin-Aldosterone System Inhibitors Are Associated With Favorable Outcomes Compared to Beta Blockers in Reducing Mortality Following Abdominal Aneurysm Repair. J Am Heart Assoc 2023:e029761. [PMID: 37449564 PMCID: PMC10382116 DOI: 10.1161/jaha.122.029761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/23/2023] [Indexed: 07/18/2023]
Abstract
Background The best medical therapy to control hypertension following abdominal aortic aneurysm repair is yet to be determined. We therefore examined whether treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs) versus beta blockers influenced postoperative and 1-year clinical end points following abdominal aortic aneurysm repair in a Medicare-linked database. Methods and Results All patients with hypertension undergoing endovascular aneurysm repair and open aneurysm repair in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database between 2003 and 2018 were included. Patients were divided into 2 groups based on their preoperative and discharge medications, either RAASIs or beta blockers. Our cohort included 8789 patients, of whom 3523 (40.1%) were on RAASIs, and 5266 (59.9%) were on beta blockers. After propensity score matching, there were 3053 matched pairs of patients in each group. After matching, RAASI use was associated with lower risk of postoperative mortality (odds ratio [OR], 0.3 [95% CI, 0.1-0.6]), myocardial infarction (OR, 0.1 [95% CI, 0.03-0.6]), and nonhome discharge (OR, 0.6 [95% CI, 0.5-0.7]). Before propensity score matching, RAASI use was associated with lower 1-year mortality (hazard ratio [HR], 0.4 [95% CI, 0.4-0.5]) and lower risk of aneurysmal rupture (HR, 0.7 [95% CI, 0.5-0.9]). These results persisted after propensity score matching for mortality (HR, 0.4 [95% CI, 0.4-0.5]) and aneurysmal rupture (HR, 0.7 [95% CI, 0.5-0.9]). Conclusions In this large contemporary retrospective cohort study, RAASI use was associated with favorable postoperative outcomes compared with beta blockers. It was also associated with lower mortality and aneurysmal rupture at 1 year of follow-up.
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Affiliation(s)
- Nadin Elsayed
- Division of Vascular and Endovascular Surgery, Department of Surgery University of California San Diego La Jolla CA USA
| | - Ann C Gaffey
- Division of Vascular and Endovascular Surgery, Department of Surgery University of California San Diego La Jolla CA USA
| | - Ahmed Abou-Zamzam
- Department of Surgery, Division of Vascular Surgery Loma Linda University Medical Center Loma Linda CA USA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery University of California San Diego La Jolla CA USA
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Bruijn LE, Louhichi J, Veger HTC, Wever JJ, van Dijk LC, van Overhagen H, Hamming JF, Statius van Eps RGS. Identifying Patients at High Risk for Post-EVAR Aneurysm Sac Growth. J Endovasc Ther 2023:15266028231158302. [PMID: 36927207 DOI: 10.1177/15266028231158302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE Post-EVAR (endovascular aneurysm repair) aneurysm sac growth can be seen as therapy failure as it is a risk factor for post-EVAR aneurysm rupture. This study sought to identify preoperative patient predictors for developing post-EVAR aneurysm sac growth. MATERIAL AND METHODS A systematic review was conducted to select potential predictive preoperative factors for post-EVAR sac growth (including a total of 34.886 patients), which were evaluated by a retrospective single-center analysis of patients undergoing EVAR between 2009 and 2019 (N=247) with pre-EVAR computed tomography scans and at least 1 year follow-up. The primary study outcome was post-EVAR abdominal aortic aneurysm (AAA) sac enlargement (≥5 mm diameter increase). Multivariate Cox regression and Kaplan-Meier survival curves were constructed. RESULTS Potential correlative factors for post-EVAR sac growth included in the cohort analysis were age, sex, anticoagulants, antiplatelets, renal insufficiency, anemia, low thrombocyte count, pulmonary comorbidities, aneurysm diameter, neck diameter, neck angle, neck length, configuration of intraluminal thrombus, common iliac artery diameter, the number of patent lumbar arteries, and a patent inferior mesenteric artery. Multivariate analysis showed that infrarenal neck angulation (hazard ratio, 1.014; confidence interval (CI), 1.001-1.026; p=0.034) and the number of patent lumbar arteries (hazard ratio, 1.340; CI, 1.131-1.588; p<0.001) were associated with post-EVAR growth. Difference in estimated freedom from post-EVAR sac growth for patients with ≥4 patent lumbar arteries versus <4 patent lumbar arteries became clear after 2 years: 88.5% versus 100%, respectively (p<0.001). Of note, 31% of the patients (n=51) with ≥4 patent lumbar arteries (n=167) developed post-EVAR sac growth. In our cohort, the median maximum AAA diameter was 57 mm (interquartile range [IQR] = 54-62) and the median postoperative follow-up time was 54 months (IQR = 34-79). In all, 23% (n=57) of the patients suffered from post-EVAR growth. The median time for post-EVAR growth was 37 months (IQR = 24-63). In 46 of the 57 post-EVAR growth cases (81%), an endoleak was observed; 2.4% (n=6) of the patients suffered from post-EVAR rupture. The total mortality in the cohort was 24% (n=60); 4% (n=10) was AAA related. CONCLUSIONS This study showed that having 4 or more patent lumbar arteries is an important predictive factor for postoperative sac growth in patients undergoing EVAR. CLINICAL IMPACT This study strongly suggests that having 4 or more patent lumbar arteries should be included in preoperative counseling for EVAR, in conjunction to the instructions for use (IFU).
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Affiliation(s)
- Laura E Bruijn
- Division of Vascular Surgery, Department of Surgery, Haga Teaching Hospital, The Hague, The Netherlands.,Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jihene Louhichi
- Division of Vascular Surgery, Department of Surgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - Hugo T C Veger
- Division of Vascular Surgery, Department of Surgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jan J Wever
- Division of Vascular Surgery, Department of Surgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - Lukas C van Dijk
- Division of Interventional Radiology, Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Hendrik van Overhagen
- Division of Interventional Radiology, Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Jaap F Hamming
- Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Bellamkonda KS, Scali ST, D'Oria M, Columbo JA, Stableford J, Goodney PP, Powell RJ, Suckow BD, Jacobs BN, Cooper M, Upchurch G, Stone DH. The Contemporary Impact of Body Mass Index on Open Aortic Aneurysm Repair. J Vasc Surg 2023:S0741-5214(23)00081-2. [PMID: 36682598 DOI: 10.1016/j.jvs.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention (CDC) has deemed obesity a national epidemic and contributor to other leading causes of death including heart disease, stroke, and diabetes. Accordingly, the role of body mass index (BMI) and its impact on surgical outcomes has been a focus of persistent investigation. The purpose of this study was to quantify the effect of BMI on open abdominal aortic aneurysm repair (oAAA) outcomes in contemporary practice. METHODS All elective oAAAs in the VQI (2010-2021) were identified. End-points included 30-day death, in-hospital complications and 1-year mortality. Patients were stratified into four BMI cohorts (BMI<18.5, 18.5≤BMI<25, 25≤BMI<30, BMI≥30). Spline interpolation was used to explore a potential non-linear association between BMI and perioperative mortality. Mixed-effects Cox regression was used to assess the association between BMI and 1-year survival. RESULTS 9,479 patients underwent oAAA over the study interval (median age-70, 74%-male, BMI 27±6). Lower BMI patients(<18.5) compared to higher BMI(>30) patients were more likely to be women (53% vs. 32%;p<.0001), current smokers(65% vs. 50%;p<.0001), and have COPD(58% vs. 37%;p<.0001). In contrast, an increased BMI was associated with a greater prevalence of diabetes and CAD (DM-26% vs. 6%;p<.0001; CAD-27% vs. 20%;p=.01). There was no difference in cross-clamp position or visceral/renal bypass between groups, though low BMI patients necessitated more frequent infrainguinal bypass(5% vs. 2%;p=.0002). 30-day mortality and in-hospital complications were greater among low BMI patients(30-day mortality:12% vs. 4%;p<.0001;complications-47% vs. 37%;p<.0001). Interestingly, low BMI conferred a nearly 2-fold increase in observed pulmonary complications(18% vs. 11%;p<.0001). Surgical site infections were twice as common among the lowest and highest BMI groups(4% vs. 2%;p<.0001). 1-year mortality was greatest among low BMI patients(23% vs. 9%;p<.0001). Adjusted spline-fit analysis demonstrated increased mortality among patients with BMI<21 or >34(BMI<18.5-HR 2.1, 95%CI 1.6-2.8;p<.0001; BMI>34-HR 1.3, 95%CI 1.1-1.6;p=.009). CONCLUSION Both low (<18.5) and high (>34) BMI were associated with increased oAAA mortality in current practice. Despite the perception that obesity confers substantial surgical risk during oAAA, diminished BMI was associated with a 3-fold increase in 30-day and 1-year mortality. It appears that BMI extremes are distinct proxies for differential clinical phenotypes and should inform risk stratification for oAAA repair.
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Affiliation(s)
- Kirthi S Bellamkonda
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Florida
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Jesse A Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jennifer Stableford
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Richard J Powell
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Benjamin N Jacobs
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Florida
| | - Michol Cooper
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Florida
| | - Gilbert Upchurch
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Florida
| | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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6
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Bailey DM, Rose GA, O'Donovan D, Locker D, Appadurai IR, Davies RG, Whiston RJ, Bashir M, Lewis MH, Williams IM. Retroperitoneal Compared to Transperitoneal Approach for Open Abdominal Aortic Aneurysm Repair Is Associated with Reduced Systemic Inflammation and Postoperative Morbidity. Aorta (Stamford) 2022; 10:225-234. [PMID: 36539114 PMCID: PMC9767756 DOI: 10.1055/s-0042-1749173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the United Kingdom, the most common surgical approach for repair of open abdominal aortic aneurysms (AAAs) is transperitoneal (TP). However, retroperitoneal (RP) approach is favored in those with more complex vascular anatomy often requiring a cross-clamp on the aorta superior to the renal arteries. This study compared these approaches in patients matched on all major demographic, comorbid, anatomic, and physiological variables. METHODS Fifty-seven patients (TP: n = 24; RP: n = 33) unsuitable for endovascular aneurysm repair underwent preoperative cardiopulmonary exercise testing prior to open AAA repair. The surgical approach undertaken was dictated by individual surgeon preference. Postoperative mortality, complications, and length of hospital stay (LoS) were recorded. Patients were further stratified according to infrarenal (IR) or suprarenal/supraceliac (SR/SC) surgical clamping. Systemic inflammation (C-reactive protein) and renal function (serum creatinine and estimated glomerular filtration rate) were recorded. RESULTS Twenty-three (96%) of TP patients only required an IR clamp compared with 12 (36%) in the RP group. Postoperative systemic inflammation was lower in RP patients (p = 0.002 vs. TP) and fewer reported pulmonary/gastrointestinal complications whereas renal impairment was more marked in those receiving SR/SC clamps (p < 0.001 vs. IR clamp). RP patients were defined by lower LoS (p = 0.001), while mid-/long-term mortality was low/comparable with TP, resulting in considerable cost savings. CONCLUSION Despite the demands of more complicated vascular anatomy, the clinical and economic benefits highlighted by these findings justify the more routine adoption of the RP approach for complex AAA repair.
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Affiliation(s)
- Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Address for correspondence Damian Miles Bailey, PhD Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South WalesAlfred Russel Wallace Building, CF37 4ATUnited Kingdom
| | - George A. Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Daniel O'Donovan
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Dafydd Locker
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Ian R. Appadurai
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Richard G. Davies
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Richard J. Whiston
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Michael H. Lewis
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Ian M. Williams
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom,Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom
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Benedetto F, Spinelli D, La Corte F, Pipitò N, Passari G, De Caridi G. Role of Contrast-Enhanced Ultrasound in the Follow-Up after Endovascular Abdominal Aortic Aneurysm Repair. Diagnostics (Basel) 2022; 12:diagnostics12123173. [PMID: 36553180 PMCID: PMC9777802 DOI: 10.3390/diagnostics12123173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/16/2022] Open
Abstract
Background: The aim of this study was to assess whether contrast-enhanced ultrasound (CEUS) shows a false negative rate close to zero and therefore is suitable as the main non-invasive follow-up strategy for long-term monitoring after endovascular aortic repair (EVAR). Methods: We included all consecutive patients who underwent CEUS as follow-up after EVAR at our center between January 2017 and December 2021.The follow-up protocol consisted of Duplex ultrasound (DUS) with CEUS at 1, 3, 6 months postoperatively and every 6 months thereafter. Results: A total of 125 patients underwent 228 CEUS. The aneurysm sac showed shrinkage in 80 (64%) patients, stability in 32 (25.6%), and enlargement in 13 (10.4%). A total of 29 (23.2%) patients showed type 2 endoleak, 6 (4.8%) patients showed type 1 endoleak and 3 (2.4%) patients showed type 3 endoleak. Thirteen patients underwent one or more reinterventions. The sensitivity of CEUS vs. DUS was 100% vs. 75% (p > 0.0001). In classifying type 2 endoleak, CEUS compared to DUS showed a sensitivity of 93.2% vs. 59.4% and a specificity of 99.3% vs. 99.3%. CEUS showed a higher sensitivity compared to DUS in the detection of type 2 endoleak. CEUS permits the identification of a subset of patients requiring a stricter follow-up protocol.
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8
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Gray DE, Samaan C, Oikonomou K, Gruber-Rouh T, Schmitz-Rixen T, Derwich W. Age and Oversizing Influence Iliac Dilatation after EVAR. J Clin Med 2022; 11:jcm11237113. [PMID: 36498686 PMCID: PMC9738790 DOI: 10.3390/jcm11237113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/16/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022] Open
Abstract
In the past two decades, endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) has become the first line treatment for infrarenal AAA repair in many countries. While short-term results are good, concerns have been raised about long-term durability. Changes in aortoiliac anatomy, especially at the landing zones, could play a role in EVAR failure over time. The current study aimed to determine certain morphological changes in the distal iliac landing zone after EVAR implantation, as well aspossible risk factors associated with iliac sealing failure. In a retrospective analysis of a tertiary single-centre registry, including patients treated with EVAR between January 2008 and July 2018, clinical follow-up data were assessed, and computer tomography (CT) imaging was evaluated regarding morphological changes in the iliac anatomy during follow-up. For clinical analysis all patients with a minimum follow-up of one year were included; for morphological analysis of iliac anatomy all patients with available CT follow-up of a minimum of one year and a minimum of two CT scans were included. Overall, 127 out of 241 treated patients (92.1% male) were included in the clinical follow-up. Complete CT imaging of 99 iliac arteries in 55 patients was available for morphological analysis. Median postoperative follow-up (FU) for these patients was 33 months (IQR 31; min−max: 12−124). Incidence of type 1b endoleak was 3% but iliac limb detachment from the vessel wall was seen in 18.2% of the target vessels. There was a significant difference in oversizing in iliac limbs with detachment (median 13.9%, IQR 23.1) vs. without detachment (median 23.1%, IQR 19.1) (p = 0.034). Iliac arteries at the landing zone showed a significant diameter increase independent of an endoleak presence (overall cohort median diameter increase at one year 23.1 mm; at two years 0 mm; at three years 4.9 mm). Iliac arteries with detachment (median 14.4%; IQR 23.9) showed a significantly higher diameter increase at the landing zone after four years compared to arteries without detachment (median 5.3%; IQR 9) (p = 0.042). Oversizing correlated positively with an iliac diameter increase at the landing zone over time (3 m: p= 0.001; one year: p < 0.001; two years: p < 0.001; three years: p = 0.006). Older patients showed a significantly lower diameter increase at the distal landing zone over time than younger patients in the first two years after EVAR (p < 0.001/r = −0.606 after two years). In the current study, iliac limb oversizing was associated with increased dilatation of the distal landing zone during a three-year follow-up, while iliac limb detachment was observed less often. An older age was inversely associated to the iliac diameter increase. Future studies should clarify the association between stent graft oversizing, age, and changes in the iliac anatomy in order to identify parameters that affect EVAR durability.
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Affiliation(s)
- Daphne Elisabeth Gray
- Department of Vascular and Endovascular Surgery, Goethe University Hospital Frankfurt, 60590 Frankfurt, Germany
- Correspondence:
| | - Carla Samaan
- Department of Vascular and Endovascular Surgery, Goethe University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, Goethe University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Radiology, Goethe University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, Goethe University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, Goethe University Hospital Frankfurt, 60590 Frankfurt, Germany
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Ahmad A, Aiman W, Ali MA, Shehade A, Suleiman A. Incidental Finding of an Asymptomatic Aortic Dissection in a Patient With Catheterization Failure. Cureus 2022; 14:e20984. [PMID: 35154960 PMCID: PMC8817675 DOI: 10.7759/cureus.20984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 02/05/2023] Open
Abstract
Aortic dissection (AD) is an injury to the innermost layer of the aorta, leading to the formation of a false lumen. AD usually presents with tearing chest pain radiating to the back and is a medical emergency. Other common symptoms include abdominal pain, diaphoresis, loss of consciousness, shortness of breath, stroke-like symptoms, or leg pain. Here, we present a rare case of an incidental finding of asymptomatic AD on computed tomography angiography performed after cardiac catheterization failure. The patient had a history of aortic aneurysm, hypertension, and heart failure. Appropriate imaging should be performed to rule out the possibility of AD in patients with risk factors and cardiac catheterization failure.
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Affiliation(s)
- Asrar Ahmad
- Cardiology, Saint Michael's Medical Center, Newark, USA
| | - Wajeeha Aiman
- Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Muhammad Ashar Ali
- Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Abbas Shehade
- Cardiology, Saint Michael's Medical Center, Newark, USA
| | - Addi Suleiman
- Cardiology, Saint Michael's Medical Center, Newark, USA
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10
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Bartosh FL, Sivushchina SV, Dudin DS, Bazylev VV. [Possibilities of duplex scanning in assessment of endoleaks after abdominal aorta endoprosthetic repair]. Angiol Sosud Khir 2021; 27:28-32. [PMID: 34528586 DOI: 10.33529/angio2021304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Endovascular abdominal aortic aneurysm repair is an operation of choice in rendering hi-tech care for patients with aneurysms of the infrarenal aortic portion. The most frequently performed reoperations account for cases related to removing endoleaks. The article deals with assessing the presence of various types of endoleaks depending on the time elapsed after abdominal aortic aneurysm repair by means of duplex scanning and multislice computed tomography. Duplex scanning proved highly informative in detecting various types of endoleaks, being comparable with the findings of multislice computed tomography (p=0.917). The presence or absence of aneurysmal cavity coloration in the mode of Doppler colour mapping makes it possible to dynamically follow up the process of thrombogenesis. For timely diagnosis of complications after endoprosthetic repair of abdominal aortic aneurysms, the use of ultrasound duplex scanning is considered to be an informative and safe technique, possessing potential possibility of detecting endoleaks and, in our opinion, may be included into the protocol of follow-up of patients in the early postoperative period.
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Affiliation(s)
- F L Bartosh
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - S V Sivushchina
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - D S Dudin
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - V V Bazylev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
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Abugov SA, Polyakov RS, Puretsky MV, Mardanyan GV, Pirkova AA, Kraynikov DA, Vartanyan EL, Charchyan ER. [Endovascular treatment of common iliac artery aneurisms]. Khirurgiia (Mosk) 2021:52-58. [PMID: 34032789 DOI: 10.17116/hirurgia202106252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To demonstrate endovascular management of common iliac artery aneurysms with iliac branch devices and to discuss some technical aspects of these interventions including bilateral procedures. MATERIAL AND METHODS Endovascular abdominal aortic aneurysm repair with concomitant implantation of iliac branch devices was performed in 9 patients at the Petrovsky National Research Center of Surgery for the period from January 2019 to December 2020. Mean age of patients was 64.8± years (min 52; max 72 years). Preoperative planning and morphometric analysis were based on CT data with a slice thickness of 1 mm. Angiographic reconstruction was made using Osirix 3D software (OsiriX Foundation, Geneva, Switzerland). Abdominal aortic aneurysm was combined with common iliac artery aneurysm in 7 patients (77.7%). Three (33.3%) patients had isolated common iliac artery aneurysm without significant abdominal aorta enlargement (Reber type I). Bilateral common iliac artery aneurysms were detected in 1 (11.1%) patient. All patients had iliac artery aneurysms over 4 cm. Iliac branch device implantation was accompanied by endovascular abdominal aneurysm repair in all patients. RESULTS Technical success rate was 100%. Six-month results were followed-up in 5 patients (55.5%), annual outcomes - in 2 patients (22.2%). Control examination consisted of a telephone interview, ultrasound of abdominal aorta, pelvic and lower limb arteries and computed tomography. All patients had no endoleaks, stent-graft thrombosis, as well as signs of ischemia of pelvic organs and lower extremities. Incidence of iliac artery aneurysm combined with abdominal aortic aneurysms is about 20%. Until recently, treatment of these patients was performed exclusively with covering of internal iliac artery. Improvement of technologies and development of iliac branch devices made it possible to preserve blood flow in internal iliac artery after endovascular management. This approach allowed avoiding of ischemic complications associated with embolization of internal iliac arteries.
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Affiliation(s)
- S A Abugov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - R S Polyakov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - M V Puretsky
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - G V Mardanyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A A Pirkova
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - D A Kraynikov
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - E L Vartanyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - E R Charchyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
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12
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Ferrel B, Patel S, Castillo A, Gryn O, Franko J, Chew D. The Effect of Abdominal Aortic Aneurysm Size on Endoleak, Secondary Intervention and Overall Survival Following Endovascular Aortic Aneurysm Repair. Vasc Endovascular Surg 2021; 55:467-474. [PMID: 33722111 DOI: 10.1177/15385744211000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the effect of abdominal aortic aneurysm (AAA) size on endoleak development and secondary intervention after endovascular repair (EVAR), as well as to examine the effect on overall survival and cause of mortality. METHODS Retrospective analysis was performed on all non-ruptured AAA treated by elective EVAR using FDA-approved endografts in our facility from July 2004 to December 2017. Patients were grouped into 3 cohorts based on preoperative aneurysm size: Group I (<5.5 cm), Group II (5.5-6.4 cm), and Group III (≥ 6.5 cm). Occurrences of endoleak, secondary intervention and overall survival underwent univariate and multivariate analysis. Cause of death data on deceased patients was similarly examined. RESULTS A total of 517 patients were analyzed. There was no difference between size groups in the rate of endoleak (Group I 48/277, 17.3%; Group II 33/160, 20.6%; Group III 18/80, 22.5%; p = 0.46) or time until endoleak development. Univariate analysis showed no difference in the rate of secondary intervention (Group I 36/277, 13.0%; Group II 24/160, 15.0%; Group III 18/80, 22.5%; p = 0.11), time until intervention or number of interventions performed. Multivariate analysis showed an association with shorter time to secondary intervention for both Group III aneurysms (HR 2.03, 95% CI 1.11-3.73; p = 0.02) and female patients (HR 1.79, 95% CI 1.02-3.13; p = 0.04). There was no difference in overall survival, aneurysm-related mortality or overall cause of mortality. CONCLUSION AAA diameter prior to EVAR was not associated with any differences in rates of endoleak or secondary intervention, and was not associated with poorer overall survival or greater aneurysm-related mortality. Patients with suitable anatomy for EVAR can be considered for this intervention without concern for increased complications or poorer outcomes related to large aneurysm diameter alone.
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Affiliation(s)
| | - Shiv Patel
- 22606MercyOne Medical Center, Des Moines, IA, USA
| | | | | | - Jan Franko
- 22606MercyOne Medical Center, Des Moines, IA, USA
| | - David Chew
- 22606MercyOne Medical Center, Des Moines, IA, USA
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13
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Zhang MH, Du X, Guo W, Liu XP, Jia X, Wu Y. Effect of Remote Ischemic Preconditioning on Complications After Elective Abdominal Aortic Aneurysm Repair: A Meta-Analysis With Randomized Control Trials. Vasc Endovascular Surg 2019; 53:387-394. [PMID: 30991903 DOI: 10.1177/1538574419840878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This meta-analysis was to evaluate the effect of remote ischemic preconditioning (RIP) on complications after abdominal aortic aneurysm repair. METHODS A literature search was conducted in Google scholar, PubMed, Embase, and Web of Science databases up to February 2019. The pooled risk difference (RD) as well as their 95% confidence interval (CI) were calculated by RevMan 5.3 software. RESULTS A total of 249 patients receiving abdominal aortic aneurysm repair with RIP and 248 receiving abdominal aortic aneurysm repair without RIP in 7 included studies were reanalyzed in this meta-analysis. The results showed that RIP cannot significantly reduce the postoperative mortality (RD = -0.01, 95% CI: -0.07 to 0.06, P = .87), myocardial infarction (RD = -0.01, 95% CI, -0.09 to 0.07, P = .79), and renal impairment (RD = 0.06, 95% CI: -0.41 to 0.30, P = .89) and renal failure (RD = 0.04, 95% CI: -0.03 to 0.10, P = .30). Moreover, the pooled estimate indicated that the RIP significantly increased the risk of arrhythmia after abdominal aortic aneurysm repair surgery (RD = 0.08, 95% CI: 0.01 to -0.16, P = .03). Nevertheless, sensitivity analyses indicated unreliable results for risk of arrhythmia. CONCLUSION There is no evidence that RIP reduces mortality after abdominal aortic aneurysm repair. Moreover, the current evidence is not robust enough to prove the effect of RIP on kidney- and cardiac-related complications.
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Affiliation(s)
- Min-Hong Zhang
- 1 Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China
| | - Xin Du
- 1 Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China
| | - Wei Guo
- 1 Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China
| | - Xiao-Ping Liu
- 1 Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China
| | - Xin Jia
- 1 Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China
| | - Ye Wu
- 1 Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China
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14
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Balceniuk MD, Trakimas LE, Aghaie C, Mix D, Rasheed K, Ellis J, Glocker R, Doyle A, Stoner MC. Aspirin use is associated with decreased radiologically-determined thrombus sac volume in abdominal aortic aneurysms. Vascular 2018; 26:440-444. [PMID: 29473449 DOI: 10.1177/1708538118762214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Formation and renewal of intramural thrombus is associated with inflammation, and contributes to the complexity of aneurysm repair. Current cardiovascular pharmacotherapy includes several inflammatory modulators such as aspirin, statins, clopidogrel, and angiotensin-converting enzyme inhibitors. The purpose of our study was to investigate the effect of these inflammatory modulators on radiographically-determined thrombus sac volume. Methods Pre-operative computed tomography scans were reviewed in patients who underwent elective infrarenal aortic aneurysm repair. Thrombus sac volume was obtained using a Hounsfield unit restricted region growth algorithm. Co-morbid conditions such as diabetes mellitus and post-operative complications were evaluated compared to thrombus sac volume. Receiver-operator characteristic curves were generated for thrombus sac volume and patients on the various cardiovascular pharmacotherapies. Results A total of 266 patients (mean age = 72.6 ± 0.6 years; mean thrombus sac volume = 58.7 (34.4-89.0) cm3) were identified. Acetylsalicylic acid use was associated with a decreased thrombus sac volume ≤50 cm3 (AUC = 0.616, p = 0.013) whereas statins ( p = 0.26), angiotensin-converting enzyme inhibitors ( p = 0.46), and clopidogrel ( p = 0.62) had no correlation to thrombus sac volume. Diabetes mellitus was not associated with thrombus sac volume ( p = 0.31). Conclusion Acetylsalicylic acid use is associated with decreased thrombus sac volume in a patient population undergoing elective abdominal aortic aneurysms repair. The effect of acetylsalicylic acid over other anti-inflammatory and anti-platelet agents is possibly attributable to its distinct mechanism of cyclooxygenase-1 inhibition. Diabetes mellitus, a known correlate of aneurysm incidence, is not associated with thrombus burden. The potential to alter aneurysm thrombus volume, thereby affecting aneurysm morphology, may yield a more favorable aneurysmal repair.
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Affiliation(s)
- Mark D Balceniuk
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Lauren E Trakimas
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Claudia Aghaie
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Doran Mix
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Khurram Rasheed
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Jennifer Ellis
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Roan Glocker
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Adam Doyle
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
| | - Michael C Stoner
- University of Rochester, Strong Memorial Hospital, Rochester, NY, USA
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15
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Ota K, Tatsumi Y, Matsui M, Yokoya Y, Tsuchimoto Y, Yano K, Yoshida M, Tsuchida T, Fukumoto H, Kojima Y, Takeuchi T, Higashino T, Higuchi K. Case of massive hematemesis by secondary aortic duodenal fistula 8 years after abdominal aortic aneurysm repair. Geriatr Gerontol Int 2017; 17:1234-1235. [PMID: 28849626 DOI: 10.1111/ggi.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/18/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Kazuhiro Ota
- Department of Gastroenterology and Hepatology, Shiroyama Hospital, Habikino, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshihiro Tatsumi
- Department of Gastroenterology and Hepatology, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Masahiro Matsui
- Department of Gastroenterology and Hepatology, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yuta Yokoya
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yusuke Tsuchimoto
- Department of Gastroenterology and Hepatology, Shiroyama Hospital, Habikino, Osaka, Japan.,Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kentaro Yano
- Department of Cardiovascular Surgery, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Masataka Yoshida
- Department of Cardiovascular Surgery, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Takao Tsuchida
- Department of Cardiovascular Surgery, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Hitoshi Fukumoto
- Department of Cardiovascular Surgery, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Yuichi Kojima
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Toshihisa Takeuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takeshi Higashino
- Department of Gastroenterology and Hepatology, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
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Zhang X, Sun Y, Chen Z, Jing Y, Xu M. Management of Endovascular Aortic Aneurysm Complications via Retrograde Catheterization Through the Distal Stent-Graft Landing Zone. Vasc Endovascular Surg 2017; 51:390-393. [PMID: 28548006 DOI: 10.1177/1538574417710414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A retrograde technique through the gap between the distal stent landing zone and the iliac artery wall has been applied to treat type II endoleak after endovascular aortic aneurysm repair (EVAR). In this study, we tried to investigate its efficacy in the management of type III endoleak and intraoperative accidental events. METHODS We reported 2 complications of EVAR that were difficult to treat with conventional methods. One patient had a sustained type III endoleak after EVAR, and the right renal artery was accidentally sealed by a graft stent in the other patient during the operation. RESULTS Both complications were managed by the retrograde technique from the distal stent landing zone. In the first case, the endoleak was easily embolized by the retrograde catheterization technique, and in the second case, a stent was implanted in the right renal artery using the retrograde technique to restore blood flow. CONCLUSION In some EVAR cases, the technique of retrograde catheterization through the distal stent-graft landing zone is feasible, safe, and easy to perform.
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Affiliation(s)
- Xicheng Zhang
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuan Sun
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhaolei Chen
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuanhu Jing
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Miao Xu
- 1 Department of Vascular Surgery, The Clinical Medical College of Yangzhou University, Yangzhou, China
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17
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Kuhelj D, Avsenik J, Nuredini D. Access From Above-Bailout Solution for Intraoperative Distal Migration of Abdominal Aortic Stent Graft. Vasc Endovascular Surg 2017; 51:338-341. [PMID: 28535733 DOI: 10.1177/1538574417708132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of the ruptured abdominal aortic aneurysms today is treated endovascularly. In cases with short aneurysm neck, chimney technique can be used to extend landing zone in emergency setting. Additionally, the repositioning ability of C3 delivery system (Gore & Associates) allows better positioning in cases with challenging anatomy. In our experience, proximal reposition of partially deployed device can be problematic in some patients. We present a case of endovascular repair of ruptured abdominal aortic aneurysm using chimney technique where proximal reposition was achieved by snaring the aortic device via axillary access.
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Affiliation(s)
- Dimitrij Kuhelj
- 1 Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Avsenik
- 1 Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dašmir Nuredini
- 1 Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
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18
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Mouton R, Pollock J, Soar J, Mitchell DC, Rogers CA. Remote ischaemic preconditioning versus sham procedure for abdominal aortic aneurysm repair: an external feasibility randomized controlled trial. Trials 2015; 16:377. [PMID: 26303818 PMCID: PMC4549128 DOI: 10.1186/s13063-015-0899-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 08/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite advances in perioperative care, elective abdominal aorta aneurysm (AAA) repair carries significant morbidity and mortality. Remote ischaemic preconditioning (RIC) is a physiological phenomenon whereby a brief episode of ischaemia-reperfusion protects against a subsequent longer ischaemic insult. Trials in cardiovascular surgery have shown that RIC can protect patients' organs during surgery. The aim of this study was to investigate whether RIC could be successfully introduced in elective AAA repair and to obtain the information needed to design a multi-centre RCT. METHODS Consecutive patients presenting for elective AAA repair, using an endovascular (EVAR) or open procedure, in a single large city hospital in the UK were assessed for trial eligibility. Patients who consented to participate were randomized to receive RIC (three cycles of 5 min ischaemia followed by 5 min reperfusion in the upper arm immediately before surgery) or a sham procedure. Patients were followed up for 6 months. We assessed eligibility and consent rates, the logistics of RIC implementation, randomization, blinding, data capture, patient and staff opinion, and variability and frequency of clinical outcome measures. RESULTS Between January 2010 and December 2012, 98 patients were referred for AAA repair, 93 were screened, 85 (91%) were eligible, 70 were approached for participation and 69 consented to participate; 34 were randomized to RIC and 35 to the sham procedure. There was a greater than expected variation in the complexity of EVAR that impacted the outcomes. Acute kidney injury occurred in 28 (AKIN 1: 23%; AKIN 2: 15% and AKIN 3: 3%) and 7 (10%) had a perioperative myocardial infarction. Blinding was successful, and interviews with participants and staff indicated that the procedure was acceptable. There were no adverse events secondary to the intervention in the 6 months following the intervention. CONCLUSIONS This study provided essential information for the planning and design of a multi-centre RCT to assess effectiveness of RIC for improving clinical outcomes in elective AAA repair. Patient consent was high, and the RIC intervention was carried out with minimal disruption to clinical care. The allocation scheme for a definite trial should take into account both the surgical procedure and its complexity to avoid confounding the effect of the RIC, as was observed in this study. TRIAL REGISTRATION Current Controlled Trials ISRCTN19332276 (date of registration: 16 March 2012). The trial protocol is available from the corresponding author.
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Affiliation(s)
- Ronelle Mouton
- Department Anaesthesia, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Jon Pollock
- Faculty of Health & Life Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.
| | - Jasmeet Soar
- Department Anaesthesia, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - David C Mitchell
- Department Vascular Surgery, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
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Umeda Y, Imaizumi M, Mori Y, Takiya H. Severe limb ischemia related to previous abdominal aortic aneurysm repair induced by acute aortic dissection. Ann Vasc Dis 2011; 4:37-9. [PMID: 23555425 DOI: 10.3400/avd.cr.10.00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 12/08/2010] [Indexed: 11/13/2022] Open
Abstract
We described the first case of limb ischemia induced by acute aortic dissection in the patient with previous abdominal aortic aneurysm (AAA) repair. A 56-year-old male was referred for severe limb ischemia. He underwent AAA repair one month before the referral. Computed tomography (CT) scan revealed Stanford type B aortic dissection extended to the proximal anastomosis site of the AAA repair. The false lumen made the complete interruption of antegrade blood flow at the proximal anastomosis site of the AAA repair.
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Affiliation(s)
- Yukio Umeda
- Department of Cardiovascular Surgery, Gifu Prefectural General Medical Center, Gifu, Gifu, Japan
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