FT07. Follow-up Results of Arterial Reconstructions With Cryopreserved Arterial Allografts: Infected Abdominal Aortic Aneurysm and Aortic Prosthesis Infection

Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

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Endovascular Abdominal Aortic Aneurysm Repair in Patients with Challenging Anatomy: Utility of the Hybrid Endograft

Vascular ◽

10.1258/rsmvasc.12.2.106 ◽

2004 ◽

Vol 12 (2) ◽

pp. 106-113 ◽

Cited By ~ 1

Author(s):

William D. Jordan ◽

Thomas C. Naslund ◽

Mark A. Adelman ◽

Gene Simoni ◽

Douglas J. Wirthlin

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Radiographic Evaluation ◽

Covered Stents ◽

Aneurysm Size ◽

Abdominal Aortic ◽

Aneurysm Repair

Commercially available aortic stent grafts differ in construction and clinical advantage such that creating hybrid endografts by combining components from different manufacturers is sometimes useful. We describe a multicenter experience using hybrid endografts to treat patients with challenging anatomy. Hospital records and office charts were reviewed from four institutions. Hybrid endografts were defined as those with two types of covered stents in continuity to treat an abdominal aortic aneurysm (AAA). Indications for hybrid grafts were defined by type of endoleak and whether an endoleak was expected or unexpected as determined by the preoperative radiographic evaluation. Endpoints include intraoperative endoleaks, late endoleaks, change in aneurysm size, and rupture. Hybrid endografts were used to treat AAA (endovascular aneurysm repair [EVAR]) in 90 patients, representing 7.9% of the total multicenter experience. In 7 patients (7.8%), a hybrid graft construction as a secondary procedure successfully corrected a type 1 endoleak. In the remaining 83 patients (92.2%), hybrid grafts were created at the time of original EVAR to treat expected challenging anatomy or unexpected endoleaks. Hybrid endografts corrected 88 (97.8%) type 1 endoleaks, but 2 patients (2.2%) persisted with a proximal type 1 leak requiring conversion. During follow-up of 1 to 24 months, computed tomography and ultrasound surveillance, available for 73 patients (81.1%), detected one unresolved distal type 1 (1.1%) and seven type 2 (7.8%) endoleaks. Aneurysm size decreased at least 0.5 cm in 23 of 50 patients (46.0%) at 6 months and in 19 of 31 patients (61.3%) at 12 months. Aneurysm size increased at least 0.5 cm in 4 of 50 patients (8.0%) at 6 months and in 1 of 31 patients (3.2%) at 12 months. There were no ruptures. Hybrid endografts have favorable early and intermediate results in the treatment of AAA. Long-term follow-up will be needed to confirm the absence of significant adverse biomaterial interaction and the effect on AAA exclusion. We advocate the use of hybrid endografts as endovascular therapy for patients whose anatomy may be unsuitable for a single endograft type.

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Transcatheter, Endovascular Repair of Abdominal Aortic Aneurysm: Feasibility, Noninvasive Diagnosis, Problems, and Follow-Up

Echocardiography ◽

10.1111/j.1540-8175.1999.tb00116.x ◽

1999 ◽

Vol 16 (6) ◽

pp. 617-623

Author(s):

ITZHAK KRONZON ◽

MATHEW VARKEY ◽

PAUL A. TUNICK ◽

THOMAS RILES ◽

ROBERT ROSEN

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Noninvasive Diagnosis ◽

Abdominal Aortic

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Abstract 032: Associations between Middle-age Risk Factors and Future Risk of Abdominal Aortic Aneurysm: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.127.suppl_12.a032 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Weihong Tang ◽

Alvaro Alonso ◽

Pamela L Lutsey ◽

Frank A Lederle ◽

Lu Yao ◽

...

Keyword(s):

Risk Factors ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Middle Age ◽

Disease Risk ◽

Atherosclerotic Disease ◽

Cross Sectional ◽

Abdominal Aortic ◽

Aric Study

Introduction: Abdominal aortic aneurysm (AAA) is an important manifestation of vascular disease in older age and rupture of an AAA is a life threatening condition. Traditional atherosclerotic disease risk factors, particularly male sex, smoking and hypertension, are known to contribute to the etiology of AAA. However, epidemiologic studies of AAA have often been cross-sectional, and few have employed a prospective cohort design, especially with long follow-up. The objective of this study was to prospectively assess the association between atherosclerotic disease risk factors and hospitalized AAA in 15,722 participants (68% whites) of the ARIC study, a large, community-based cohort. Methods: Risk factors were measured at baseline at 45-64 year of age. Clinical AAAs were ascertained through hospital discharge diagnoses or death certificates. Over 15 years of follow-up, a total of 265 AAAs (85.3% whites) were identified, including repair procedures, AAA rupture or dissection, and incidental detection. Multivariable Cox proportional hazard models were used to estimate the association of risk factors with the risk of future AAA. Results: Consistent with the literature from prospective studies, we identified age, male gender, white race, smoking, height, total and HDL cholesterols, triglycerides, white blood cell count, and hypertension as risk factors for AAA (Table). In addition, LDL-C, fibrinogen, and peripheral artery disease that were previously reported only in cross-sectional case-control studies were also strongly associated with AAA (Table). Body mass index, diabetes, and alcohol consumption were not associated with AAA occurrence. Conclusions: Several lifestyle and clinical variables measured in middle-age were strong risk factors for future AAA during a long follow-up.

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Change in Abdominal Aortic Aneurysm Sac Diameter After Endovascular Repair: A Single-Center Experience From Taiwan

Journal of Endovascular Therapy ◽

10.1177/15266028211068755 ◽

2022 ◽

pp. 152660282110687

Author(s):

Hsien-Wei Tseng ◽

Po-Ya Chang ◽

Chin-Hao Chang ◽

I-Hui Wu ◽

Ron-Bin Hsu ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Adverse Events ◽

Survival Rates ◽

Incidence Rates ◽

Single Center Experience ◽

Maximal Diameter ◽

Abdominal Aortic ◽

Diameter Change

Purpose: The purpose of this study was to investigate the change in the diameter of infrarenal abdominal aortic aneurysm (AAA) sacs after endovascular aortic repair (EVAR) in Taiwanese patients and to depict its association with clinical outcomes. Materials and Methods: This retrospective cohort study was conducted on patients who underwent EVAR for infrarenal AAA between January 2011 and December 2016. All preoperative and follow-up computed tomography (CT) images were reviewed. Postoperative CT angiography was arranged after 1 month and annually thereafter. The maximal diameter on the axial plane and the maximal diameter perpendicular to the centerline on the coronal and sagittal planes were measured. The study examined post-EVAR sac diameter change over time and compared the differences in adverse events (AEs) among groups. Results: The survey included a total of 191 patients with a median follow-up duration of 2.5 (interquartile range: 1.1–2.9) years. Overall survival rates at 1, 2, and 5 years were 92%, 81%, and 76%, respectively. According to their last CT scans, the patients were categorized into 3 groups as follows: shrinkage, stationary, and enlargement, which comprised 58 (30.4%), 118 (61.8%), and 15 (7.9%) patients, respectively. Pre-EVAR characteristics and sac diameters were similar among the groups. Sac shrinkage was exclusively observed in the first 2 years, whereas sac enlargement developed at all follow-up periods. Patients with sac enlargement had higher incidence rates of endoleaks, complications, and reintervention than the other groups. Conclusion: Based on our observations, post-EVAR sac shrinkage only occurs in the first 2 years; however, post-EVAR sacs may enlarge at any point and even after 5 years. In our study, patients with sac enlargement had higher rates of adverse events and reintervention.

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Long-Term Follow-Up of Men Invited to Participate in a Population-Based Abdominal Aortic Aneurysm Screening Program

Angiology ◽

10.1177/0003319720921741 ◽

2020 ◽

Vol 71 (7) ◽

pp. 641-649

Author(s):

Rebecka Hultgren ◽

K. Miriam Elfström ◽

Daniel Öhman ◽

Anneli Linné

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Screening Program ◽

Dropout Rate ◽

Rupture Rate ◽

Aortic Repair ◽

Abdominal Aortic ◽

Long Term Follow Up

A screening program for abdominal aortic aneurysm (AAA), inviting 65-year-old men, was started in Stockholm in 2010 (2.3 million inhabitants). The aim was to present a long-term follow-up of men participating in screening, as well as AAA repair and ruptures among nonparticipants. Demographics were collected for men with screening detected with AAA 2010 to 2016 (n = 672) and a control group with normal aortas at screening (controls, n = 237). Medical charts and regional Swedvasc (Swedish Vascular registry) data were analyzed for aortic repair for men born 1945 to 1951. Ultrasound maximum aortic diameter (AD) as well as Aortic Size Index (ASI) was recorded. Participation was 78% and prevalence of AAA was 1.2% (n = 672). Aortic repair rates correlated with high ASI and AD. During the study period, 22% of the AAA patients were treated with the elective repair; 35 men in surveillance died (5.2%), non-AAA-related causes (82.9%) dominated, followed by unknown causes among 4 (11.4%), and 2 (5.7%) possibly AAA-related deaths. Abdominal aortic aneurysm rupture rate was higher among nonparticipants (0.096% vs 0.0036%, P < .001). The low dropout rate confirms acceptability of follow-up after screening. The efficacy is shown by the much higher rupture rate among the nonparticipating men.

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