Maximum Diameter Measurements of Aortic Aneurysms on Axial CT Images After Endovascular Aneurysm Repair: Sufficient for Follow-up?

Objective Descending thoracic endovascular aneurysm repair (D-TEVAR) is often performed by vascular surgeons. At many institutions, cardiothoracic surgery support is required for an elective TEVAR to take place. Oftentimes, this means a dedicated cardiopulmonary bypass team must be available. This study aims to investigate that TEVAR is a safe procedure that does not require such a resource-intensive “back-up plan.” Methods This is a retrospective analysis of data collected from March 2014 to January 2018 of 18 patients who underwent TEVAR at a tertiary care facility with a level I trauma center. There were 11 males and 7 females with an average age of 68.8 years old (range 19–97; SD ± 19.52). The average body mass index (BMI) was 24.7 kg/m2 (range 16.8–35; SD ±4.67). Nine were never smokers, four were former smokers, and five were currently smoking at the time of the procedure. The most common presenting symptom prior to intervention was chest pain ( n = 10), followed by cough/dyspnea ( n = 5), back pain ( n = 3), and trauma ( n = 2). Results The average maximum diameter of the thoracic aortic aneurysms (TAA) treated with TEVAR was 5.49 cm ( n = 7; range 4.3–6.7; SD ± 0.855). Six patients had Stanford Type B aortic dissections. Two patients with TAAs had concomitant, rapidly expanding aortic ulcers. Two patients had traumatic pseudoaneurysms, one of which ruptured prior to TEVAR. One patient had an expanding 1.9 × 1.8 cm saccular pseudoaneurysm of the aortic arch. The mean follow-up time was 69.2 weeks ( n = 17; range 3–166; SD ± 62.67), and one patient did not follow up following their initial TEVAR procedure. Of the 18 patients who received TEVAR, there were no major complications. Two patients experienced a type II endoleak. No patients required conversion to an open procedure, nor did any patients necessitate intervention by cardiothoracic surgery or cardiopulmonary bypass support. Conclusion These data suggest that cardiothoracic surgery support is not required for descending thoracic endovascular aneurysm repair (D-TEVAR). Further research is warranted on the risk factors associated with open conversion during these procedures.

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Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211016423 ◽

2021 ◽

pp. 152660282110164

Author(s):

Claire van der Riet ◽

Richte C. L. Schuurmann ◽

Eric L. G. Verhoeven ◽

Clark J. Zeebregts ◽

Ignace F. J. Tielliu ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Stent Fracture ◽

Covered Stents ◽

Significant Stenosis ◽

Primary Endpoints ◽

Visceral Arteries ◽

Aneurysm Repair ◽

Type 3

Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent. Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up. Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years. Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.

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Comparing polymer-filled versus self-expanding endografts in Chinese patients

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318810108 ◽

2018 ◽

Vol 26 (9) ◽

pp. 667-676

Author(s):

Yuk Law ◽

Yiu Che Chan ◽

Stephen Wing-Keung Cheng

Keyword(s):

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

The Self ◽

Chinese Patients ◽

Type Ii ◽

Mortality And Morbidity ◽

Type Ia ◽

One Year ◽

Aneurysm Repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

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Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs

Journal of Endovascular Therapy ◽

10.1177/1526602816675622 ◽

2016 ◽

Vol 24 (1) ◽

pp. 115-120 ◽

Cited By ~ 23

Author(s):

Marwan Youssef ◽

Sebastian Zerwes ◽

Rudolf Jakob ◽

Oroa Salem ◽

Fritz Dünschede ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Multiple Organ ◽

Aortic Aneurysms ◽

Technical Success ◽

Graft Thrombosis ◽

Type Ia ◽

Aneurysm Repair ◽

Chimney Graft ◽

Bifurcated Graft

Purpose: To assess the technical success and clinical outcome of reinterventions using the Nellix Endovascular Aneurysm Sealing (EVAS) System to treat complications after endovascular aneurysm repair (EVAR). Methods: Fifteen consecutive patients (mean age 79 years; 14 men) with prior EVAR were treated with EVAS between March 2014 and December 2015 at 2 institutions. The failed prior EVARs included 13 bifurcated endografts, 1 bifurcated graft plus fenestrated cuff, and 1 tube endograft. Endoleaks were the predominant indications: type Ia in 10 and type III in 5 (3 type IIIa and 2 type IIIb). All patients presented with progressive aortic aneurysms (median 7.85-cm diameter; range 6.5–11). Eight patients were treated on an urgent or emergency basis (6 symptomatic aneurysms and 2 contained ruptures). All patients underwent Nellix relining of the failed stent-graft; 10 had chimney (Ch) procedures in combination with EVAS (chEVAS) because the proximal landing zones were inadequate. Results: Technical success was 100%. All endoleaks were successfully sealed, and no additional intervention was required. No further endoleak after EVAS or chEVAS was recorded. Endobag protrusion occurred in 1 case without sequelae. One elderly patient with ruptured aneurysm died from multiple organ failure 2 months postoperatively. One renal artery guidewire injury led to nephrectomy because of active bleeding. No reinterventions, aneurysm-related mortalities, graft thrombosis, endoleaks, or chimney graft occlusions were observed during a median follow-up of 8 months (range 3–24). Conclusion: The present preliminary experience demonstrates that the use of EVAS/chEVAS is feasible for treatment of failed EVAR. This technique may be used as bailout or an alternative treatment when other established methods are infeasible or not available.

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Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz125 ◽

2019 ◽

Vol 56 (5) ◽

pp. 993-1000 ◽

Cited By ~ 5

Author(s):

Enrico Gallitto ◽

Gianluca Faggioli ◽

Rodolfo Pini ◽

Chiara Mascoli ◽

Stefano Ancetti ◽

...

Keyword(s):

Spinal Cord ◽

Hospital Mortality ◽

Endovascular Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

The Mean ◽

Aneurysm Repair

Abstract OBJECTIVES Our objective was to report the outcomes of fenestrated/branched endovascular aneurysm repair of thoraco-abdominal aortic aneurysms (TAAAs) with endografts. METHODS Between January 2010 and April 2018, patients with TAAAs, considered at high surgical risk for open surgery and treated by Cook-Zenith fenestrated/branched endovascular aneurysm repair, were prospectively enrolled and retrospectively analysed. The early end points were 30-day/hospital mortality rate, spinal cord ischaemia and 30-day cardiopulmonary and nephrological morbidity. Follow-up end points were survival, patency of target visceral vessels and freedom from reinterventions. RESULTS Eighty-eight patients (male: 77%; mean age: 73 ± 7 years; American Society of Anesthesiologists 3/4: 58/42%) were enrolled. Using Crawford’s classification, 43 (49%) were types I–III and 45 (51%) were type IV TAAAs. The mean aneurysm diameter was 65 ± 15 mm. Custom-made and off-the-shelf endografts were used in 60 (68%) and 28 (32%) cases, respectively. Five (6%) patients had a contained ruptured TAAA. The procedure was performed in multiple steps in 42 (48%) cases. There was 1 (1%) intraoperative death. Five (6%) patients suffered spinal cord ischaemia with permanent paraplegia in 3 (3%) cases. Postoperative cardiac and pulmonary complications occurred in 7 (8%) and 12 (14%) patients, respectively. Worsening of renal function (≥30% of baseline level) was detected in 11 (13%) cases, and 2 (2%) patients required haemodialysis. The 30-day and hospital mortality rates were 5% and 8%, respectively. The mean follow-up was 36 ± 22 months. Survival at 12, 24 and 36 months was 89%, 75% and 70%, respectively. The patency of target visceral vessels at 12, 24 and 36 months was 92%, 92% and 92%, respectively. Freedom from reinterventions at 12, 24 and 36 months was 85%, 85% and 83%, respectively. CONCLUSIONS The endovascular repair of TAAAs with fenestrated/branched endovascular aneurysm repair is feasible and effective with acceptable technical/clinical outcomes at early/midterm follow-up.

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Endovascular abdominal aortic aneurysm repair in patients with Marfan syndrome

Vascular ◽

10.1177/1708538119858045 ◽

2019 ◽

Vol 28 (1) ◽

pp. 48-52

Author(s):

Allan Marc Conway ◽

Khalil Qato ◽

Gautam Anand ◽

Laurie Mondry ◽

Gary Giangola ◽

...

Keyword(s):

Marfan Syndrome ◽

Open Repair ◽

Aortic Surgery ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Type I ◽

Femoral Access ◽

Abdominal Aortic ◽

Aneurysm Repair

Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed.

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Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants

Vascular ◽

10.1177/1708538120923417 ◽

2020 ◽

Vol 28 (5) ◽

pp. 568-576

Author(s):

Georgios Karaolanis ◽

Constantine N Antonopoulos ◽

Stylianos Koutsias ◽

George A Antoniou ◽

Efthymios Beropoulis ◽

...

Keyword(s):

Therapeutic Option ◽

Meta Analysis ◽

Endovascular Aneurysm Repair ◽

Pooled Analysis ◽

Aortic Aneurysms ◽

Technical Success ◽

Hostile Neck ◽

Type Ia ◽

Aneurysm Repair

Objective Endovascular aneurysm repair has gained field over open surgery for the treatment of abdominal aortic aneurysm. However, type Ia endoleak represents a common complication especially in hostile neck anatomy that is recently faced using endoanchors. We conducted a systematic review and meta-analysis to collect and analyse all the available comparative evidence on the outcomes of the endosuture aneurysm repair in patients with or without hostile neck in standard endovascular aneurysm repair. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the prospective and retrospective studies reporting primary use of the Heli-FX EndoAnchor implants were considered eligible for inclusion in this study. The main study outcomes (technical success of endoanchor implantation, incidence of type Ia endoleak, aortic stent graft migration and the percentage of patients who presented regression or expansion of aneurysm sac throughout the follow-up) were subsequently expressed as proportions and 95% confidence intervals. Results Eight studies with a total of 968 patients were included in a pooled analysis. The technical success of the primary endoanchor fixation was 97.12% (95%CI: 92.98–99.67). During a mean six months follow-up period, a pooled rate of 6.23% (95%CI: 0.83–15.25) of the patients developed a persistent type Ia endoleak despite the primary implantation. Migration of the main graft was reported in five studies, in which a 0.26% (95%CI = 0.00–1.54) of the patients required an additional proximal aortic cuff. Regression of the aneurysm sac was observed at 68.82% (95%CI: 51.02–84.21). An expansion of the aneurysm sac was found in 1.93% (95%CI: 0.91–3.24) of the participants. The overall survival rate was 93.43% (95%CI: 89.97–96.29) at a mean six months follow-up period. Conclusions Endosuture aneurysm repair with the Heli-FX EndoAnchor implants seems to be technically feasible and safe either for prevention or for repair of intraoperative type Ia endoleak. Despite the primary implants of endoanchors, few cases of persistent type Ia endoleak and migration are still conspicuous. Long-term follow up is needed to determinate the role of this therapeutic option in the treatment of aortic aneurysms.

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Endovascular Aneurysm Repair versus Open Repair in Patients with Abdominal Aortic Aneurysm

10.1093/med/9780199384075.003.0003 ◽

2017 ◽

Author(s):

F. Ben Pearce ◽

Tze-Woei Tan ◽

Wayne W. Zhang

Keyword(s):

Endovascular Repair ◽

Open Repair ◽

Perioperative Complications ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Study Intervention ◽

Complications And Mortality

This chapter provides a summary of the landmark EVAR Trial 1, which compared endovascular repair of abdominal aortic aneurysms (AAA) with open repair in patients judged to be fit for both open and endovascular repair. Although endovascular AAA (EVAR) repair was associated with lower perioperative complications and mortality than open surgical repair, after 4 years of follow-up the outcomes of the two approaches were similar. Follow-up at 15 years found EVAR had inferior late survival, necessitating lifelong surveillance of EVAR and reintervention if necessary. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

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Contrast-Enhanced Ultrasound: A Superior Method for Surveillance and Follow-up to Detect and Classify Endoleaks Following EVAR

Journal for Vascular Ultrasound ◽

10.1177/1544316720942683 ◽

2020 ◽

Vol 44 (4) ◽

pp. 185-191

Author(s):

Muhammad Hasan ◽

Brian J. Schiro ◽

James F. Benenati

Keyword(s):

Endovascular Aneurysm Repair ◽

Standard Of Care ◽

Aortic Aneurysms ◽

Contrast Enhanced Ultrasound ◽

Iodinated Contrast ◽

Abdominal Aortic ◽

Contrast Enhanced ◽

Excellent Method ◽

Aneurysm Repair

Endovascular aneurysm repair (EVAR) has become the standard of care for many patients with abdominal aortic aneurysms. Because of the delayed complications associated with EVAR, namely the development of endoleaks, yearly surveillance of the endograft and aneurysm sac is required. Surveillance has traditionally been carried out with 3-phase computed tomography angiography of the abdomen and pelvis with the use of intravenous iodinated contrast. This incurs cumulative doses of radiation over the remainder of the patient’s life and exposes these patients to repeated administrations of potentially nephrotoxic contrast agents. Contrast-enhanced ultrasound (CEUS) has emerged as an excellent method of evaluating and categorizing endoleaks without the use of radiation or nephrotoxic agents. This educational article centers around CEUS and its use in EVAR follow-up.

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The use of thoracic stent grafts for endovascular repair of abdominal aortic aneurysms

Vascular ◽

10.1177/1708538117733909 ◽

2017 ◽

Vol 26 (3) ◽

pp. 278-284 ◽

Cited By ~ 1

Author(s):

VP Bastiaenen ◽

MGJ Snoeijs ◽

JGAM Blomjous ◽

J Bosma ◽

VJ Leijdekkers ◽

...

Keyword(s):

Endovascular Repair ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Type I ◽

Stent Grafts ◽

Aortic Neck ◽

Abdominal Aortic ◽

Median Diameter ◽

Aneurysm Repair

Objectives Stent grafts for endovascular repair of infrarenal aneurysms are commercially available for aortic necks up to 32 mm in diameter. The aim of this study was to evaluate the feasibility of endovascular repair with large thoracic stent grafts in the infrarenal position to obtain adequate proximal seal in wider necks. Methods All patients who underwent endovascular aneurysm repair using thoracic stent grafts with diameters greater than 36 mm between 2012 and 2016 were included. Follow-up consisted of CT angiography after six weeks and annual duplex thereafter. Results Eleven patients with wide infrarenal aortic necks received endovascular repair with thoracic stent grafts. The median diameter of the aneurysms was 60 mm (range 52–78 mm) and the median aortic neck diameter was 37 mm (range 28–43 mm). Thoracic stent grafts were oversized by a median of 14% (range 2–43%). On completion angiography, one type I and two type II endoleaks were observed but did not require reintervention. One patient experienced graft migration with aneurysm sac expansion and needed conversion to open repair. Median follow-up time was 14 months (range 2–53 months), during which three patients died, including one aneurysm-related death. Conclusions Endovascular repair using thoracic stent grafts for patients with wide aortic necks is feasible. In these patients, the technique may be a reasonable alternative to complex endovascular repair with fenestrated, branched, or chimney grafts. However, more experience and longer follow-up are required to determine its position within the endovascular armamentarium.

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