Follow-Up of Aneurysm Neck Diameter after Endovascular Repair of Abdominal Aortic Aneurysms

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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Anatomical Suitability of Ruptured Abdominal Aortic Aneurysms for Endovascular Repair

Journal of Endovascular Therapy ◽

10.1177/152660280301000309 ◽

2003 ◽

Vol 10 (3) ◽

pp. 453-457 ◽

Cited By ~ 29

Author(s):

Daniel F.G. Rose ◽

Ian R. Davidson ◽

Robert J. Hinchliffe ◽

Simon C. Whitaker ◽

Roger H. Gregson ◽

...

Keyword(s):

Endovascular Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Computed Tomographic Angiography ◽

Aortic Aneurysms ◽

University Hospital ◽

Aneurysm Neck ◽

Computed Tomographic ◽

Abdominal Aortic ◽

Ruptured Abdominal Aortic Aneurysms

Purpose: To assess the anatomical suitability of ruptured abdominal aortic aneurysms (AAA) for emergency endovascular repair. Methods: All cases (46 patients [35 men; mean age 74 years, range 54–85]) in which computed tomographic angiography (CTA) confirmed AAA rupture over a 5-year period at our university hospital were reviewed for anatomical suitability for endovascular repair. Measurements were made by a radiologist experienced in anatomical assessment of CT criteria for elective endovascular aneurysm repair (EVAR). Results: The mean aneurysm neck length was 18 mm (range 0–59); 17 were conical, 13 straight, 4 barrel, and 6 reverse conical. Six cases had no proximal neck. Overall, 37 (80%) patients were unsuitable for EVAR according to our criteria. Nearly half the patients (22, 48%) had ≥2 adverse features. Unsuitable neck morphology (35, 76%) was the primary reason for exclusion, but CIA aneurysm (10, 22%) and EIA tortuosity (7, 15%) were secondary adverse features. Conclusions: With current stent-graft design, the majority of ruptured abdominal aortic aneurysms are anatomically unsuitable for endovascular repair.

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Midterm Follow-up of a Single-center Experience of Endovascular Repair of Abdominal Aortic Aneurysms with Use of the Talent Stent-Graft

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.0000222661.64390.3e ◽

2006 ◽

Vol 17 (6) ◽

pp. 973-977 ◽

Cited By ~ 18

Author(s):

Dare Mutiyu Seriki ◽

Raymond J. Ashleigh ◽

J.S. Butterfield ◽

Andrew England ◽

Charles N. McCollum ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Single Center ◽

Single Center Experience ◽

Abdominal Aortic

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A Comparative Study of Ultrasound and Computed Tomography Scan for the follow-up of Abdominal Aortic Aneurysms after Endovascular Repair

Journal for Vascular Ultrasound ◽

10.1177/154431670603000204 ◽

2006 ◽

Vol 30 (2) ◽

pp. 81-85 ◽

Cited By ~ 3

Author(s):

Ruta Nerlekar ◽

Ranjana Warrier ◽

Rex de Ryke ◽

Robert Miller ◽

Peter M. Hewitt ◽

...

Keyword(s):

Computed Tomography ◽

Comparative Study ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Computed Tomography Scan ◽

Abdominal Aortic ◽

Tomography Scan

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Acute Abdominal Aortic Aneurysms: Cost Analysis of Endovascular Repair and Open Surgery in Hemodynamically Stable Patients with 1-year Follow-up

Radiology ◽

10.1148/radiol.2403051005 ◽

2006 ◽

Vol 240 (3) ◽

pp. 681-689 ◽

Cited By ~ 16

Author(s):

Jacob J. Visser ◽

Marc R. H. M. van Sambeek ◽

M. G. Myriam Hunink ◽

W. Ken Redekop ◽

Lukas C. van Dijk ◽

...

Keyword(s):

Cost Analysis ◽

Endovascular Repair ◽

Open Surgery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic

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Midterm Follow-up of Inflammatory Abdominal Aortic Aneurysms Following Endovascular Repair

Annals of Vascular Surgery ◽

10.1007/s10016-004-5414-3 ◽

2005 ◽

Vol 19 (5) ◽

pp. 636-640 ◽

Cited By ~ 10

Author(s):

Rumi Faizer ◽

Guy DeRose ◽

Thomas L. Forbes ◽

Kenneth A. Harris ◽

Steven F. Millward ◽

...

Keyword(s):

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic

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Stent-Graft Migration after Endovascular Repair of Abdominal Aortic Aneurysm

Journal of Endovascular Therapy ◽

10.1177/152660280200900605 ◽

2002 ◽

Vol 9 (6) ◽

pp. 743-747 ◽

Cited By ~ 14

Author(s):

Stavros Kalliafas ◽

Jean-Noel Albertini ◽

Jan Macierewicz ◽

Syed W. Yusuf ◽

Simon C. Whitaker ◽

...

Keyword(s):

Endovascular Repair ◽

Aortic Aneurysms ◽

Stent Group ◽

Abdominal Aortic ◽

Computed Tomography Scans ◽

Stent Fixation ◽

Time To Onset ◽

Graft Migration ◽

Neck Diameter

Purpose: To report the incidence of graft migration in patients after endovascular repair of abdominal aortic aneurysms (AAA) and assess the significance of neck diameter changes in patients with and without suprarenal stent implantation. Methods: The medical records and imaging studies of 176 consecutive patients (175 men; median age 71 years, range 48–88) who had endovascular AAA repair with the Nottingham aortomonoiliac system were reviewed. The following parameters were recorded: preoperative neck diameter and length, presence of intraoperative and late graft migrations, time to onset of late migration, length of late migration, and neck diameter changes in patients with documented late graft migration. The patients were divided into 2 groups based on the placement of an endograft with or without suprarenal bare stent fixation. Median follow-up was 15 months (range 1–48). Results: There were 15 (8.5%) graft migrations (6 intraoperative and 9 late). Of those, 14 (10.9%) were in the 128-patient infrarenal fixation group and 1 (2.1%) in the 48-patient suprarenal stent group. Median neck diameters on preoperative and postoperative computed tomography scans in patients with late migration were 22.2 mm and 23.0 mm, respectively (p>0.05). The median time to graft migration was 14 months after the original operation (range 6–36). Conclusions: Distal device migration occurred frequently with the Nottingham system. Late graft migration was not associated with neck enlargement. Endografts with a suprarenal stent may have a decreased incidence of graft migration.

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Endovascular treatment of proximal para-anastomotic aneurysms after previous surgical repair of infrarenal aortic aneurysms by the chimney technique

Vascular ◽

10.1177/1708538118805304 ◽

2018 ◽

Vol 27 (1) ◽

pp. 3-7

Author(s):

Georgios I Karaolanis ◽

Marco Damiano Pipitone ◽

Giovanni Torsello ◽

Martin Austermann ◽

Konstantinos P Donas

Keyword(s):

Endovascular Repair ◽

Open Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Short Neck ◽

Aortic Repair ◽

Aortic Neck ◽

Abdominal Aortic

Objectives To evaluate the use of chimney grafts in the treatment of para-anastomotic aneurysms after previous abdominal aortic aneurysms open repair with short neck. Methods A retrospective analysis of prospectively collected data of consecutive patients who underwent endovascular repair for proximal aortic para-anastomotic aneurysms following previous open repair for infrarenal abdominal aortic aneurysms was performed. All included patients had a short infrarenal aortic neck (<10 mm) excluding standard endovascular aortic repair. Five patients were symptomatic at the admission needed urgent treatment. Results Twelve patients with para-anastomotic aneurysms underwent placement of chimney grafts. The median time between the original operations to redo endovascular procedure was 11 years (interquartile range, 9.5 years). The mean infrarenal length was 4.3 mm (1–9 mm). A total of 28 chimneys grafts were deployed for the 12 patients. The technical success rate was 91.7%. At a median radiologic follow-up of 16 months (2.0–29.4, 95% confidence interval), one patient died, while two late endoleaks and two reinterventions at one and three years for type Ia endoleak were performed by proximal extension and triple chimney graft placement. Conclusion The results of the present study show that ch-endovascular aortic repair is a safe technique for patients who suffered from proximal para-anastomotic aneurysms and having short neck unsuitable for standard endovascular repair. Longer follow up warranted to evaluate the durability of ch-endovascular aortic repair for this specific indication.

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