Effect of vertebral compression fractures on aortic neck angulation after endovascular aneurysm repair

Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through end of follow-up (duration, 11–18 mo), all patients had patent endografts without type Ia endoleak (our primary endpoint), visceral stent-graft thrombosis, or renal complications. One patient who received 4 chimney grafts had a postprocedural type II endoleak, which was treated with embolization. We found it feasible to use EndoAnchors with the chimney-graft technique to prevent type Ia endoleaks in the treatment of juxtarenal AAAs. Further studies are needed to validate this adjunctive technique and to determine its durability.

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Determination of Endograft Apposition, Position, and Expansion in the Aortic Neck Predicts Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/1526602818764616 ◽

2018 ◽

Vol 25 (3) ◽

pp. 366-375 ◽

Cited By ~ 13

Author(s):

Richte C. L. Schuurmann ◽

Kim van Noort ◽

Simon P. Overeem ◽

Ruben van Veen ◽

Kenneth Ouriel ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Renal Arteries ◽

Added Value ◽

Control Group ◽

Main Body ◽

Aortic Neck ◽

Type Ia ◽

And Migration ◽

Aneurysm Repair

Purpose: To describe the added value of determining changes in position and apposition on computed tomography angiography (CTA) after endovascular aneurysm repair (EVAR) to detect early caudal displacement of the device and to prevent type Ia endoleak. Methods: Four groups of elective EVAR patients were selected from a dataset purposely enriched with type Ia endoleak and migration (>10 mm) cases. The groups included cases of late type Ia endoleak (n=36), migration (n=9), a type II endoleak (n=16), and controls without post-EVAR complications (n=37). Apposition of the endograft fabric with the aortic neck, shortest distance between the fabric and the renal arteries, expansion of the main body (or dilatation of the aorta in the infrarenal sealing zone), and tilt of the endograft toward the aortic axis were determined on the first postoperative and the last available CTA scan without type Ia endoleak or migration. Differences in these endograft dimensions were compared between the first vs last scan and among the 4 groups. Results: No significant differences in endograft configurations were observed among the groups on the first postoperative CTA scan. On the last CTA scan before a complication arose, the position of the fabric relative to the renal arteries, expansion of the main body, and apposition of the fabric with the aortic neck were significantly different between the type Ia endoleak (median follow-up 15 months) and migration groups (median follow-up 23 months) compared with the control group (median follow-up 19 months). Most endograft dimensions had changed significantly compared with the first postoperative CTA scan for all groups. Apposition had increased in the control group but had decreased significantly in the type Ia endoleak and migration groups. Conclusion: Progressive changes in dimensions of the endograft within the infrarenal neck could be detected on regular CTA scans before the complication became urgent in many patients.

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Predictors of Infrarenal Aortic Neck Diameter Changes After Endovascular Aneurysm Repair (EVAR)

Journal of Vascular Surgery ◽

10.1016/j.jvs.2013.02.161 ◽

2013 ◽

Vol 57 (5) ◽

pp. 39S

Author(s):

Lorena Gonzalez ◽

Neal R. Barshes ◽

Richard L. Lu ◽

Kathryn Dougherty ◽

Zvonimir Krajcer ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Aortic Neck ◽

Aneurysm Repair ◽

Neck Diameter

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Patient-Specific Simulation of Devices-Tissues Interactions for Endovascular Aneurysm Repair

ASME 2013 Conference on Frontiers in Medical Devices: Applications of Computer Modeling and Simulation ◽

10.1115/fmd2013-16070 ◽

2013 ◽

Author(s):

A. Duménil ◽

J. Gindre ◽

A. Kaladji ◽

P. Haigron ◽

D. Perrin ◽

...

Keyword(s):

Stent Graft ◽

Eligible Patient ◽

Endovascular Aneurysm Repair ◽

Length Of Hospital Stay ◽

Patient Specific ◽

Predictive Tool ◽

Complex Anatomy ◽

Aortic Neck ◽

Fenestrated Stent Graft ◽

Aneurysm Repair

The endovascular treatment of abdominal aortic aneurysm (EVAR) consists of inserting a delivery system through intravascular pathway and deploying one or several stent-grafts at the aneurysm site in order to exclude it. This procedure has proven to have a high success rate for eligible patient population and benefits in terms of reduced blood loss, intraoperative morbidity and length of hospital stay. As the selection criteria for EVAR extend progressively due to enhancements in the devices and delivery systems, clinicians are confronted with cases becoming increasingly difficult and demanding procedures with steep learning curve (aortic dissection, branched and fenestrated stent-graft, and complex anatomy with high tortuosity or short aortic neck). In this context patient-specific Finite Element Modeling (FEM) could provide a predictive tool to support endovascular device assessment and selection as well as intervention planning. Given the lack of dedicated solutions, the aim of this study was to assess the feasibility of simulating the main steps of EVAR procedure, from guidewire insertion to stent-graft deployment.

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Endovascular aneurysm repair in patients with a wide proximal aortic neck: a systematic review and meta-analysis of comparative studies

The Journal of Cardiovascular Surgery ◽

10.23736/s0021-9509.19.10869-5 ◽

2019 ◽

Vol 60 (2) ◽

Author(s):

George N. Kouvelos ◽

George Antoniou ◽

Konstantinos Spanos ◽

Athanasios Giannoukas ◽

Miltiadis Matsagkas

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Meta Analysis ◽

Endovascular Aneurysm Repair ◽

Aortic Neck ◽

Aneurysm Repair

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Prognostic significance of large diameter proximal aortic neck in endovascular aneurysm repair

VASA ◽

10.1024/0301-1526/a000844 ◽

2020 ◽

Vol 49 (3) ◽

pp. 215-224

Author(s):

George A. Antoniou ◽

Aws Alfahad ◽

Stavros A. Antoniou ◽

Hassan Badri

Keyword(s):

Meta Analysis ◽

Large Diameter ◽

Prognostic Significance ◽

Endovascular Aneurysm Repair ◽

Small Diameter ◽

Aneurysm Rupture ◽

Random Effects Models ◽

Late Failure ◽

Aortic Neck ◽

Aneurysm Repair

Summary. Background: Adverse morphological features of the proximal aortic neck have been identified as culprits for late failure after endovascular aneurysm repair (EVAR). Our objective was to investigate the prognostic role of wide proximal aortic neck in EVAR. Methods: We conducted a review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies comparing outcomes of EVAR in patients with large versus small proximal aortic neck. A meta-analysis of time-to-event data was performed with the inverse-variance method and the results were reported as summary hazard ratio (HR) and 95 % CI. We applied random-effects models of meta-analysis. Results: We identified 9 observational studies reporting on a total of 7,682 patients (1,961 with large diameter and 5,721 with small diameter neck). The hazard of death (HR 1.57, 95 % CI 1.23–2.01; P = 0.0003), aneurysm-related reintervention (HR 2.06, 95 % CI 1.23–3.45; P = 0.006), type Ia endoleak (HR 6.69, 95 % CI 4.39–10.20; P < 0.001), sac expansion (HR 10.07, 95 % CI 1.80–56.53; P = 0.009), aneurysm rupture (HR 2.96, 95 % CI 2.00–4.38; P < 0.0001), and neck-related adverse events (HR 10.33, 95 % CI 4.95–21.56; P < 0.0001) was higher in patients with large diameter proximal aortic neck than in those with small neck. Conclusions: Patients with a large proximal aortic neck were found to have poorer outcomes than those with small neck. This finding has implications in decision making when selecting methods for aneurysm treatment and in EVAR surveillance for aneurysm-related complications in this cohort of patients.

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Use of Chimney Technique Does Not Improve the Outcome of Endovascular Aneurysm Repair in Patients With a Hyperangulated and Short Proximal Aortic Neck

Journal of Endovascular Therapy ◽

10.1177/15266028211050315 ◽

2021 ◽

pp. 152660282110503

Author(s):

Denise Michelle Daniëlle Özdemir-van Brunschot ◽

Giovanni Battista Torsello ◽

Giulia Bernardini ◽

Sarah Litterscheid ◽

Giovanni Federico Torsello ◽

...

Keyword(s):

New Technologies ◽

Clinical Success ◽

Endovascular Aneurysm Repair ◽

Short Neck ◽

Chimney Technique ◽

Aortic Neck ◽

Significant Difference ◽

Group A ◽

Group B ◽

Aneurysm Repair

Purpose: We hypothesized that extending the proximal landing zone with the chimney technique could be beneficial in patients with a hyperangulated proximal aortic neck, defined as more > 60 degrees. Material and Methods: We retrospectively analyzed the outcome of prospectively collected data of patients treated by endovascular aneurysm repair (EVAR) for infrarenal aortic aneurysm with a hyperangulated proximal aortic neck. In all, 104 out of 130 patients were treated without (Group A) and 24 with the chimney endovascular aortic repair (ChEVAR, Group B). Primary outcome was technical and clinical success according to the reporting standards of the Society of Vascular Surgery. Results: The use of the chimney technique was associated with a significantly longer operation duration (167 vs. 93 min, p < .001), longer fluoroscopy time (44 vs.30 min, p = < .001), and larger amount of contrast medium used (149 vs. 127 ml, p = .03) but did not significantly improve technical (79.2% vs. 87.7%) and clinical success (54.2% vs. 68.9%). Aneurysm-related mortality was higher in group B (8.3% vs. = 0%, p < .001). Type IA endoleak was high in both groups at completion angiography (11.3% in Group A vs. 12.5% in Group B) and at follow-up (10.4% in Group A vs. 4.5% in Group B) without significant difference between the groups. Conclusions: Our data did not show a benefit of the primary use of the chimney technique in patients with a hyperangulated and short neck, although more studies are required to support this conclusion. Other strategies or new technologies are required for improving EVAR results in aneurysm patients with severe angulated proximal and short neck.

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