Challenging Treatment of Multiple Late Complications After Endovascular Aneurysm Repair

Purpose: To investigate whether patients who develop aneurysm sac shrinkage following endovascular aneurysm repair (EVAR) have better outcomes than patients with a stable or increased aneurysm sac. Materials and Methods: The Healthcare Databases Advanced Search interface developed by the National Institute for Health and Care Excellence was used to interrogate MEDLINE and EMBASE. Thesaurus headings were adapted accordingly. Case-control studies were identified comparing outcomes in patients demonstrating aneurysm sac shrinkage after EVAR with those of patients with a stable or expanded aneurysm sac. Pooled estimates of dichotomous outcome data were calculated using the odds ratio (OR) and 95% confidence interval (CI). Meta-analysis of time-to-event data was conducted using the inverse-variance method; the results are reported as a summary hazard ratio (HR) and 95% CI. Summary outcome estimates were calculated using random-effects models. Results: Eight studies were included in quantitative synthesis reporting a total of 17,096 patients (8518 patients with sac shrinkage and 8578 patients without sac shrinkage). The pooled incidence of sac shrinkage at 12 months was 48% (95% CI 40% to 56%). Patients with aneurysm sac shrinkage had a significantly lower hazard of death (HR 0.73, 95% CI 0.60 to 0.87), secondary interventions (HR 0.42, 95% CI 0.29 to 0.62), and late complications (HR 0.37, 95% CI 0.24 to 0.56) than patients with a stable or increased aneurysm sac. Furthermore, their odds of rupture were significantly lower than those in patients without shrinkage (OR 0.09, 95% CI 0.02 to 0.36). Conclusion: Sac regression is correlated to improved survival and a reduced rate of secondary interventions and EVAR-related complications. The prognostic significance of sac regression should be considered in surveillance strategies. Intensified surveillance should be applied in patients who fail to achieve sac regression following EVAR.

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Midterm Single-Center Results of Endovascular Aneurysm Repair With Additional EndoAnchors

Journal of Endovascular Therapy ◽

10.1177/1526602818816099 ◽

2018 ◽

Vol 26 (1) ◽

pp. 90-100 ◽

Cited By ~ 4

Author(s):

Seline R. Goudeketting ◽

Jan Wille ◽

Daniel A. F. van den Heuvel ◽

Jan-Albert Vos ◽

Jean-Paul P. M. de Vries

Keyword(s):

Endovascular Aneurysm Repair ◽

Late Complications ◽

Graft Occlusion ◽

Entire Cohort ◽

Aortic Neck ◽

Hostile Neck ◽

Type Ia ◽

New Type ◽

Aneurysm Repair

Purpose: To review midterm clinical outcomes of EndoAnchor placement during or after endovascular aneurysm repair (EVAR) or chimney EVAR (ch-EVAR). Materials and Methods: A retrospective analysis was conducted of 51 consecutive patients [median age 75 years; 38 men] who underwent EVAR/ch-EVAR with EndoAnchor placement between June 2010 and December 2016 to prevent seal failures (31, 61%) or to treat type Ia endoleak and/or migration (20, 39%). Median aortic neck diameter was 27.7 mm and median neck length was 9.0 mm. Thirty-three (65%) had a conical neck; 48 (94%) had at least 1 hostile neck characteristic. Thirty-two (63%) patients had severe comorbidities (ASA score ⩾III). Eight patients had a single ch-EVAR procedure. Baseline patient characteristics, anatomic variables, procedure details, early and late complications, reinterventions, and aneurysm-related and all-cause mortality rates were recorded. Follow-up imaging was performed with computed tomography angiography (CTA) or duplex ultrasonography. Results: Median procedure time was 100 minutes; a median of 6 EndoAnchors were implanted. There were 10 (10%) residual type Ia endoleaks at the end of the procedure; 9 had resolved by the first postoperative CTA. One residual and 2 new type Ia endoleaks were identified at the first postoperative imaging. Median follow-up for the entire cohort was 24.0 months, during which 3 new type Ia endoleaks were identified. Five of the 6 type Ia endoleaks were treated, 1 resolved spontaneously. There was 1 endograft limb occlusion without clinical consequences, 1 chimney graft occlusion without possibilities for a reintervention, 1 rupture after type IV endoleak (a Nellix device was successfully deployed within the main device), and 1 complete graft explantation for infection. There was no new-onset hemodialysis. Kaplan-Meier estimates of freedom from type Ia endoleak, proximal neck–related reinterventions, and aneurysm-related mortality at 2 years were 87.3%, 92.2%, and 94.0%, respectively. Conclusion: EndoAnchors are helpful in the endovascular treatment of unfavorable proximal aortic necks, with fair midterm results.

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Risk factors of early and late complications in patients undergoing endovascular aneurysm repair

European Journal of Vascular and Endovascular Surgery ◽

10.1053/ejvs.2002.1821 ◽

2003 ◽

Vol 25 (2) ◽

pp. 118-124 ◽

Cited By ~ 27

Author(s):

S. Haulon ◽

P. Devos ◽

S. Willoteaux ◽

C. Mounier-Vehier ◽

A. Sokoloff ◽

...

Keyword(s):

Risk Factors ◽

Endovascular Aneurysm Repair ◽

Late Complications ◽

Aneurysm Repair

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Bridging thoracic endovascular aneurysm repair for a late rupture following aortic coarctation angioplasty

Cardiology in the Young ◽

10.1017/s1047951115001699 ◽

2015 ◽

Vol 26 (5) ◽

pp. 957-960

Author(s):

Nelson F. G. Oliveira ◽

João A. Castro ◽

José D. Martins ◽

Anita Quintas ◽

Sérgio Laranjo ◽

...

Keyword(s):

Case Report ◽

Aortic Coarctation ◽

Endovascular Aneurysm Repair ◽

Late Complications ◽

Descending Aorta ◽

Endovascular Interventions ◽

Definitive Repair ◽

Life Threatening ◽

Thoracic Endovascular Aneurysm Repair ◽

Aneurysm Repair

AbstractIntroductionThoracic endovascular aneurysm repair has been employed to treat late complications after aortic coarctation correction. However, its use in children has seldomly been reported.Case reportWe present the case of a 15-year-old child who presented with a ruptured aneurysm of the descending aorta complicated later by an aortic-oesophageal fistula following aortic coarctation stenting that was managed with multiple bridging endovascular interventions until a definitive repair was performed.ConclusionThoracic endovascular aneurysm repair may be used successfully as a bridging intervention to a definitive repair in children with life-threatening aortic complications following aortic coarctation repair.

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Bowel ischaemia after endovascular aneurysm repair

VASA ◽

10.1024/0301-1526/a000698 ◽

2018 ◽

Vol 47 (4) ◽

pp. 273-277

Author(s):

Christopher Lowe ◽

Oussama El Bakbachi ◽

Damian Kelleher ◽

Imran Asghar ◽

Francesco Torella ◽

...

Keyword(s):

Case Reports ◽

Endovascular Aneurysm Repair ◽

Artery Occlusion ◽

Bibliographic Databases ◽

Bowel Ischaemia ◽

Prophylactic Measures ◽

Increased Risk ◽

Prisma Statement ◽

Meta Analyses ◽

Aneurysm Repair

Abstract. The aim of this review was to investigate presentation, aetiology, management, and outcomes of bowel ischaemia following EVAR. We present a case report and searched electronic bibliographic databases to identify published reports of bowel ischaemia following elective infra-renal EVAR not involving hypogastric artery coverage or iliac branch devices. We conducted our review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. In total, five cohort studies and three case reports were included. These studies detailed some 6,184 infra-renal elective EVARs, without procedure-related occlusion of the hypogastric arteries, performed between 1996 and 2014. Bowel ischaemia in this setting is uncommon with an incidence ranging from 0.5 to 2.8 % and includes a spectrum of severity from mucosal to transmural ischaemia. Due to varying reporting standards, an overall proportion of patients requiring bowel resection could not be ascertained. In the larger series, mortality ranged from 35 to 80 %. Atheroembolization, hypotension, and inferior mesenteric artery occlusion were reported as potential causative factors. Elderly patients and those undergoing prolonged procedures appear at higher risk. Bowel ischaemia is a rare but potentially devastating complication following elective infra-renal EVAR and can occur in the setting of patent mesenteric vessels and hypogastric arteries. Mortality ranges from 35 to 80 %. Further research is required to identify risk factors and establish prophylactic measures in patients that have an increased risk of developing bowel ischaemia after standard infra-renal EVAR.

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Laser-assisted transprosthesial coil embolization combined with thrombin injection for treatment of an endoleak type II after endovascular aneurysm repair

VASA ◽

10.1024/0301-1526/a000648 ◽

2018 ◽

Vol 47 (1) ◽

pp. 63-67 ◽

Cited By ~ 1

Author(s):

Tanja Boehme ◽

Aljoscha Rastan ◽

Elias Noory ◽

Peter-Christian Fluegel ◽

Thomas Zeller

Keyword(s):

Coil Embolization ◽

Endovascular Aneurysm Repair ◽

Type Ii ◽

Thrombin Injection ◽

Endoleak Type Ii ◽

Aneurysm Repair

Abstract. The treatment of endoleaks type II had to be adapted to the anatomy of each individual patient. The laser-assisted perforation of the prosthesis can be an easier method to reach the aneurysm sac directly than using transarterial or translumbar approaches.

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