Distal Seal Dynamics and Clinical Consequences After Endovascular Aneurysm Repair

ObjectivesType 3 endoleaks (T3ELs) represent a lack of aneurysm protection from systemic pressure. Previous studies have found a ~2% incidence of T3EL after standard infrarenal endovascular aneurysm repair (EVAR); however, no prior studies with new-generation devices have been able to determine an association between T3EL and clinical outcomes. Here we examine T3EL within the Society for Vascular Surgery Vascular Quality Initiative (VQI) to define rates of occurrence, rates and modes of reintervention, and clinical consequences of these endoleaks.Design and settingParticipants receiving infrarenal EVAR in the VQI from January 2003 to September 2018 were analyzed in a retrospective cohort study.ParticipantsOf 42 246 entries in the EVAR procedural registry, 41 604 had complete procedural information and were included in analysis. Of these, 36 082 had long-term follow-up, and 26 422 had follow-up (9–21 months per VQI reporting standards) with complete endoleak data recorded.InterventionsAll patients included in this study underwent an infrarenal EVAR.ResultsWithin the VQI database, the rate of T3EL in infrarenal EVAR during index hospitalization was 0.37% (n=157/41 604), of which 85% were due to midgraft separation and 15% were due to fabric disruptions. Out of the 157 index hospitalization T3ELs, 4.5% (n=7) received procedural reintervention during that hospitalization, which accounted for 1% of all index hospitalization reinterventions. During the 21-month follow-up, the rate of incident T3EL was 0.7% (n=205/26 422), which accounted for 5% of all endoleaks seen during follow-up. Reinterventions for incident T3EL at follow-up were done in 30 patients (rate 0.1%), which accounted for 9% of endoleak reinterventions and 3.3% of all reinterventions. The presence of incident T3EL found during follow-up was associated with a significant decrease in 5-year survival (74% vs 80%, respectively; p=0.041) in Kaplan-Meier analysis.ConclusionT3ELs rates at placement and follow-up remain low; however, the majority reported in long-term follow-up are incident and these incident endoleaks are associated with decreased survival in EVAR.

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Predictors of Diffuse Renal Microembolization Following Endovascular Repair of Abdominal Aortic Aneurysms

Vascular ◽

10.2310/6670.2007.00006 ◽

2007 ◽

Vol 15 (1) ◽

pp. 18-23 ◽

Cited By ~ 17

Author(s):

Tamer N. Boules ◽

Stephen F. Stanziale ◽

Admir Chomic ◽

Faith Selzer ◽

Mitchell E. Tublin ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Radiographic Finding ◽

Renal Perfusion ◽

Aortic Aneurysms ◽

Computed Tomographic ◽

Significant Difference ◽

Incidence Risk ◽

Clinical Consequences ◽

Perfusion Defects ◽

Aneurysm Repair

We evaluated the incidence, risk factors, and clinical consequences of renal microembolic events following endovascular aneurysm repair using suprarenal or infrarenal fixation. Pre- and postoperative (1 month) computed tomographic angiograms were reviewed for new renal perfusion defects. Suprarenal aortic and infrarenal neck thrombus load was classified by circumference involved and thrombus thickness. Serum creatinine was measured preoperatively, on the first postoperative day, and 1 month postoperatively. Among 136 patients, 8 (5.9%) had bilateral microembolic cortical defects. Patients with moderate or severe suprarenal thrombus were more likely to have renal microemboli than those with no or mild suprarenal thrombus (17% vs 0%; p < .001). Similarly, patients with moderate or severe infrarenal neck thrombus were more likely to have renal microemboli than those with no or mild infrarenal thrombus (9.6% vs 1.5%; p = .08). Severe infrarenal thrombus was independently predictive of microembolization (odds ratio 15.0; 95% confidence interval 1.6–142; p = .018). There was no statistically significant difference in the incidence of renal microembolization when comparing suprarenal and infrarenal fixation (8.2% vs 4.0%; p = .47). Changes in creatinine from baseline were not different in those with or without renal microemboli. Renal microembolization is an uncommon but distinct radiographic finding that is more associated with significant neck thrombus than fixation level.

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Risk Factors, Dynamics, and Clinical Consequences of Aortic Neck Dilatation after Standard Endovascular Aneurysm Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.06.013 ◽

2021 ◽

Vol 74 (2) ◽

pp. 679

Author(s):

N.F.G. Oliveira ◽

J. Oliveira-Pinto ◽

Marie J. van Rijn ◽

S. Baart ◽

S.T. Raa ◽

...

Keyword(s):

Risk Factors ◽

Endovascular Aneurysm Repair ◽

Aortic Neck ◽

Clinical Consequences ◽

Aneurysm 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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