Oversizing of Aortic Stent Grafts for Abdominal Aneurysm Repair: A Systematic Review of the Benefits and Risks

Purpose Proximal type 1A endoleaks on completion intra-operative angiography are not infrequently seen following endovascular abdominal aneurysm repair (EVAR). The natural course of these leaks is not well established. We sought to determine the rate of spontaneous resolution and a conservative treatment approach to these endoleaks. Methods All cases involving endovascular repairs of infra-renal abdominal aortic aneurysms resulting in proximal type 1A endoleak on final intra-operative completion angiography were retrospectively reviewed from 1 April 2010 and 30 March 2015. Demographic, pre and post-procedural imaging, and clinical outcomes were reviewed. Summarizing descriptive statistics are reported. Results Of the 337 patients who underwent an EVAR, 24 patients (7.1%) had a proximal type 1A endoleak on final intra-operative angiography. Twenty-two of 24 patients (92%) with proximal type 1A endoleaks had spontaneous resolution on follow-up imaging without any intervention, while two (8%) patients had a persistent endoleak. One of these patients required intervention. The median follow-up for patients with resolved endoleaks was 2.5 years vs. 4 and 6 years, respectively, for patients that did not resolve spontaneously. Conclusion A conservative approach may be used in the management of patients with proximal type 1A endoleaks on completion angiography once maximum proximal seal was achieved intra-operatively as the vast majority of these leaks spontaneously seal.

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Endovascular Aneurysm Repair with bifurcated stent-grafts in patients with narrow versus regular aortic bifurcation. Systematic review and metanalysis of comparative studies.

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.11.022 ◽

2020 ◽

Author(s):

Nikolaos Galanakis ◽

Nikolaos Kontopodis ◽

Stavros Charalambous ◽

Stefanos Palioudakis ◽

Ioannis Kakisis ◽

...

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Endovascular Aneurysm Repair ◽

Aortic Bifurcation ◽

Stent Grafts ◽

Aneurysm Repair

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De-novo peri-aortic inflammation after endovascular abdominal aneurysm repair

Italian Journal of Vascular and Endovascular Surgery ◽

10.23736/s1824-4777.19.01424-4 ◽

2019 ◽

Vol 26 (3) ◽

Author(s):

Enrico Gallitto ◽

Rodolfo Pini ◽

Chiara Mascoli ◽

Antonino Logiacco ◽

Martina Goretti ◽

...

Keyword(s):

De Novo ◽

Abdominal Aneurysm ◽

Aneurysm Repair

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The Clinical Utility and Assessment of Renal Biomarkers in Acute Kidney Injury After Abdominal Endovascular Aneurysm Repair. A Systematic Review

Current Pharmaceutical Design ◽

10.2174/1381612825666191209122804 ◽

2020 ◽

Vol 25 (44) ◽

pp. 4695-4701 ◽

Cited By ~ 1

Author(s):

Georgios Karaolanis ◽

Zachary F. Williams ◽

Chris Bakoyiannis ◽

Dimitrios Hadjis ◽

Mitchell W. Cox ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Systematic Reviews ◽

Clinical Utility ◽

Binding Protein ◽

Endovascular Aneurysm Repair ◽

Kidney Injury ◽

Aortic Aneurysms ◽

Renal Biomarkers ◽

Aneurysm Repair

: The widespread adoption of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) is due to the obvious advantages of the procedure compared to the traditional open repair. However, these advantages have to be weighed against the increased risk of renal dysfunction with EVAR. The evaluation of the perioperative renal function after EVAR has been hampered by the lack of sensitive and specific biochemical markers of acute kidney injury (AKI). The purpose of this study was to summarize all novel renal biomarkers and to evaluate their clinical utility for the assessment of the kidney function after EVAR. A systematic review of the current literature, as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, was performed to identify relevant studies with novel renal biomarkers and EVAR. Pubmed and Scopus databases were systemically searched. Studies reporting on thoracic endovascular aortic repair (TEVAR), case reports, case series, letters to the editor, and systematic reviews were excluded. Neutrophil-Gelatinase-Associated Lipocalin, Cystatin C, Liver-type fatty-acid-binding protein were the most common among the eligible studies while Interleukin-18, Retinol binding protein, N-acetyle-b-D-glucosaminidase and microalbumin have a sparse appearance in the literature. These biomarkers have been assessed in plasma as well as urine samples with each sample material having its own advantages and drawbacks. Which of these biomarkers has the most potential for assessing postoperative renal failure after EVAR, remains to be proved. The few studies presented in the literature show the potential clinical utility of these biomarkers, but larger studies with longer follow-up are required to determine the precise relationship between these biomarkers and postoperative acute kidney injury.

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Systematic Review and Meta-analysis of 12 Years of Endovascular Abdominal Aortic Aneurysm Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2006.12.030 ◽

2007 ◽

Vol 45 (2) ◽

pp. 438

Author(s):

S.C. Franks ◽

A.J. Sutton ◽

M.J. Bown ◽

R.D. Sayers

Keyword(s):

Systematic Review ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Meta Analysis ◽

Abdominal Aortic Aneurysm Repair ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

Journal of Endovascular Therapy ◽

10.1177/15266028211059447 ◽

2021 ◽

pp. 152660282110594

Author(s):

Mauricio Gonzalez-Urquijo ◽

Diana Paola Padilla-Armendariz ◽

David Eugenio Hinojosa-Gonzalez ◽

Gerardo Lozano-Balderas ◽

Eduardo Flores-Villalba ◽

...

Keyword(s):

Systematic Review ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Operative Time ◽

Endovascular Aneurysm Repair ◽

Horseshoe Kidney ◽

Complication Rates ◽

Abdominal Aortic ◽

Endovascular Approach ◽

Aneurysm Repair

Purpose: A systematic review of all patients that have been reported in the literature with abdominal aortic aneurysm (AAA) concomitant with horseshoe kidney (HSK) treated electively by endovascular aneurysm repair (EVAR) is presented. A new grouping system for describing HSK vasculature is implemented. Materials and Methods: We searched for published manuscripts using the Medical Subject Headings terms “abdominal aortic aneurysm,” “AAA,” “EVAR,” “endovascular aneurysm repair,” and “horseshoe kidney” in PubMed, Google Scholar, Scopus, and National Center for Biotechnology Information databases. Inclusion criteria include all published material of patients with AAA with HSK treated electively by an endovascular approach. We excluded patients who were treated by a hybrid or open repair or patients with ruptured AAA. Statistical analysis was carried out using SPSS Statistics version 25 (IBM Corp, Armonk, New York) software. Results: A total of 50 patients from 30 studies were included for analysis. Males made up 88% (n=44) of the population. The median age for this cohort was 70 years (range: 47–86 years). Median aneurysmal diameter was 6.0 cm (range: 4.0–10.3 cm). The median operative time for endovascular repair was 84 minutes (range: 40–332 minutes). The most common graft used was Zenith, used in 40% (n=20) of the cases, followed by Endurant in 14% (n=7). The overall complication rate was 14% (n=7). The median follow-up was 19 months (range: 1–108 months). While comorbidities did not appear to impact outcomes significantly, median operative times for smokers were higher than those in nonsmokers, 84 versus 118 minutes, respectively (p=0.048). Univariate linear regression modeling of aneurysmal size with age, operative time, and length of stay revealed a significant coefficient association between aneurysmal size and operative times. After adjusting for comorbidities and aneurysmal size, prior history of chronic kidney disease significantly increased odds for renal infarction. Conclusion: This review presents the most complete data set possible of patients with concomitant HSK and AAA treated by an endovascular approach. Furthermore, the A + B + C classification for grouping the HSK vasculature is implemented. This systematic review suggests EVAR to be an excellent option with low complication rates for the treatment of AAA in patients with HSK.

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Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602818811915 ◽

2018 ◽

Vol 26 (1) ◽

pp. 72-75

Author(s):

Fabien Lareyre ◽

Claude Mialhe ◽

Carine Dommerc ◽

Juliette Raffort

Keyword(s):

Stent Graft ◽

Mesenteric Artery ◽

Endovascular Aneurysm Repair ◽

Stent Grafts ◽

Aortic Thrombosis ◽

Aortic Stent Graft ◽

Aneurysm Repair ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

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