Results of reinterventions for failed endovascular aortic repair: a single-center experience

AIM

The aim of this paper was to review technical success and clinical outcome of reinterventions to treat complications after endovascular abdominal aortic aneurysm (AAA) repair (EVAR) in a tertiary vascular center.

METHODS

The study enrolled 107 patients treated for post-EVAR complications between January 2005 and March 2014. Details of reinterventions, technical success, and midterm clinical outcome were analyzed for reinterventions. Radiologic follow-up after reinterventions was performed by computed tomography scans and duplex ultrasonography.

RESULTS

Indications for reinterventions in the 107 patients were predominantly endoleaks type Ia, Ib, II, and III (55.1%). Endograft obstructions were observed in 39 patients (36.4%). The initial technical success rate for the 107 reinterventions was 93.5% (N.=100). Median follow-up postreintervention was 20 months (range, 1-107 months). During follow-up, 34 of 107 patients (31.8%) needed at least one renewed reintervention. Kaplan-Meier analysis of overall survival after the primary reinterventions was 85% at 1 year, and 78% at 3 years of follow-up. AAA/EVAR-associated mortality was 4% at 3 years. Kaplan-Meier survival estimation of freedom of recurrence was 88% at 1 year post-reintervention and 78% at 3 years. Renewed reintervention-free survival dropped to 78% at 1 year and 58% at 3 years.

CONCLUSION

In this series of patients, the technical success rate of reinterventions to treat post-EVAR complications was high. During a median follow-up of 20 months, AAA-associated mortality is low, but the need for renewed (endovascular) reinterventions is substantial.

CT angiography to evaluate hemodynamic changes in popliteal artery aneurysms during flexion and extension of the knee joint

AIM

The aim of this study was to find out which characteristics of an asymptomatic popliteal artery aneurysm (PAA) will increase the risk for acute thrombosis.

METHODS

This was a single-center prospective study of consecutive patients with asymptomatic PAAs presenting from January 2010 to April 2012. Computed tomography angiography was used to perform measurements of the PAA during 0º extension and 90º flexion of the knee. After semi-automated segmentation of the popliteal artery (PA) lumen, a center lumen line (CLL) was automatically constructed.

RESULTS

The study included 16 asymptomatic PAAs. Median lumen area of the PA was directly proximal and distal of the PAA 57 mm2 (IQR, 44-87 mm2) and 46 mm2 (IQR, 32-66 mm2) in extension vs. 51 mm2 (IQR, 38-73 mm2) and 38 mm2 (IQR, 30-62 mm2) during 90º flexion, respectively (P=0.007) and (P=0.03). The median of the greatest decrease in lumen area after flexion and extension of the knee was 36 mm (IQR, 28-48 mm) in PAAs≥30 mm compared with 11 mm (IQR, 4-18 mm) in PAAs<30 mm (P<0.05). The proximal angulation was a median 48° in extension (IQR, 27-61º) and 75° during flexion (IQR, 46-99º; P=0.02). Distal angulation was a median of 31° (IQR, 21-42º) after extension vs. 62° (IQR, 33-81º) during flexion (P=0.03).

CONCLUSION

Knee bending in patients with PAAs will lead to a reduction in the lumen area of the PAA and a change in the degree of angulation of the PAA. A significant decrease in lumen area was seen in PAAs≥30 mm compared with PAAs<30 mm after flexion of the knee.

First- and second-generation drug-eluting balloons for femoro-popliteal arterial obstructions: update of technique and results

The use of drug-eluting balloons for treatment of long-segment femoropopliteal artery obstructions has become widespread in recent years. The possibility to deliver a drug into the arterial wall with sustained antiproliferative effects, without leaving behind metal scaffolding, seems very promising. The current generation of drug-eluting balloons differs in the formulation of the drug (usually paclitaxel), technique of coating, and the elution excipients. Results of published randomized trials are reviewed in this report. A new innovative coating technique has been introduced recently. The PRIMUS® coronary drug-eluting balloon and the Legflow® peripheral drug-eluting balloon consist of paclitaxel nanoparticles that are embedded underneath the surface of the balloon as well as inside a new shellolic acid drug-release matrix. Risk for dislodgement of the paclitaxel particles is minimized in the newest generation of drug-eluting balloons. Short-term in vitro and in vivo results of this stable, coated balloon are promising, and large randomized trials have been started recently to gather more long-term and robust clinical data.