Mid-term Outcomes following Emergency Endovascular Aortic Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms

Objective Endovascular aneurysm repair for ruptured abdominal aortic aneurysm is being increasingly applied as the intervention of choice. The purpose of this study was to determine whether survival and reintervention rates after ruptured abdominal aortic aneurysm vary between endograft devices. Methods This cohort study identified all ruptured abdominal aortic aneurysms performed at The Ottawa Hospital from January 1999 to May 2015. Data collected included patient demographics, stability index at presentation, adherence to device instructions for use, endoleaks, reinterventions, and mortality. Kruskal–Wallis test was used to compare outcomes between groups. Mortality outcomes were assessed using Kaplan–Meier survival analysis, and multivariate Cox regression modeling. Results One thousand sixty endovascular aneurysm repairs were performed using nine unique devices. Ninety-six ruptured abdominal aortic aneurysms were performed using three devices: Cook Zenith ( n = 46), Medtronic Endurant ( n = 33), and Medtronic Talent ( n = 17). The percent of patients presented in unstable or extremis condition was 30.2, which did not differ between devices. Overall 30-day mortality was 18.8%, and was not statistically different between devices ( p = 0.16), although Medtronic Talent had markedly higher mortality (35.3%) than Cook Zenith (15.2%) and Medtronic Endurant (15.2%). AUI configuration was associated with increased 30-day mortality (33.3% vs. 12.1%, p = 0.02). Long-term mortality and graft-related reintervention rates at 30 days and 5 years were similar between devices. Instructions for use adherence was similar across devices, but differed between the ruptured abdominal aortic aneurysm and elective endovascular aneurysm repair cohorts (47.7% vs. 79.0%, p < 0.01). Notably, two patients who received Medtronic Talent grafts underwent open conversion >30 days post-endovascular aneurysm repair ( p = 0.01). Type 1 endoleak rates differed significantly across devices (Cook Zenith 0.0%, Medtronic Endurant 18.2%, Medtronic Talent 17.6%, p = 0.01). Conclusion Although we identified device-related differences in endoleak rates, there were no significant differences in reintervention rates or mortality outcomes. Favorable outcomes of Cook Zenith and Medtronic Endurant over Medtronic Talent reflect advances in endograft technology and improvements in operator experience over time. Results support selection of endograft by operator preference for ruptured abdominal aortic aneurysm.

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The Potential of AFX Iliac Extension in Abdominal Aortic Aneurysms with High Iliac Tortuosity

International Journal of Angiology ◽

10.1055/s-0041-1729736 ◽

2021 ◽

Author(s):

Yuta Kikuchi ◽

Norifumi Ohtani ◽

Hiroyuki Kamiya

Keyword(s):

Aortic Aneurysm ◽

Circulatory System ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Silicon Tube ◽

Underwater Camera ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Abstract Background Recently, endovascular aortic aneurysm repair (EVAR) is the most common surgery for abdominal aortic aneurysm (AAA). However, iliac limb complications of EVAR often cause problems in patients with high iliac tortuosity. There is no difference of rate of iliac limb complication among EVAR devices, such as Excluder, Endurant, and Zenith in high iliac tortuosity. But there has been not reported about AFX. Objectives We studied AFX iliac extension as it is the only stent graft with an endoskeletal framework. This study aimed to evaluate the AFX iliac extension patency in a case in vitro and to use it in seven cases of AAA with high iliac tortuosity. Methods The silicon tube inserted in the AFX iliac extension was flexed at 30, 60, 90, and 120 degrees, and the lumen of the iliac extension was monitored using an underwater camera in the circulatory system. During the experiment, the Iwaki Bellows Pump (IWAKI CO., LTD., Tokyo, Japan) produced a pulsating flow. We used this in seven patients with AAA high iliac tortuosity cases between November 2018 and May 2019. Results If the silicon tube inserted in the AFX iliac extension was flexed at 60 and 120 degrees, the stent protruded into the lumen. However, the graft was dilated at all degrees. All seven patients with AFX iliac extension had no complications and a patent iliac artery. Conclusion The AFX iliac extension can reduce iliac limb complications in cases of high iliac tortuosity.

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Long-term outcomes and factors influencing late survival following elective abdominal aortic aneurysm repair: A 24-year experience

Vascular ◽

10.1177/1708538115586682 ◽

2015 ◽

Vol 24 (2) ◽

pp. 115-125 ◽

Cited By ~ 12

Author(s):

Manar Khashram ◽

Julie S Jenkins ◽

Jason Jenkins ◽

Allan J Kruger ◽

Nicholas S Boyne ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Background Abdominal aortic aneurysms can be either treated by an open abdominal aortic aneurysm repair or an endovascular repair. Comparing clinical predictors of outcomes and those which influence survival rates in the long term is important in determining the choice of treatment offered and the decision-making process with patients. Aims To determine the influence of pre-existing clinical predictors and perioperative determinants on late survival of elective open abdominal aortic aneurysm repair and endovascular repair at a tertiary hospital. Methods Consecutive patients undergoing elective abdominal aortic aneurysm repair from 1990 to 2013 were included. Data were collected from a prospectively acquired database and death data were gathered from the Queensland state death registry. Pre-existing risks and perioperative factors were assessed independently. Kaplan–Meier and Cox regression modeling were performed. Results During the study period, 1340 abdominal aortic aneurysms were repaired electively, of which 982 were open abdominal aortic aneurysm repair. The average age was 72.4 years old and 81.7% were males. The cumulative percentage survival rates for open abdominal aortic aneurysms repair at 5, 10, 15 and 20 years were 79, 49, 31 and 22, respectively. The corresponding 5-, 10- and 15-year survival rates for endovascular repair were not significantly different at 75, 49 and 33%, respectively (P = 0.75). Predictors of reduced survival were advanced age, American Society of Anaesthesiology scores, chronic obstructive pulmonary disease, renal impairment, bifurcated grafts, peripheral vascular disease and congestive heart failure. Conclusions Open repair offers a good long-term treatment option for patients with an abdominal aortic aneurysm and in our experience there is no significant difference in late survival between open abdominal aortic aneurysms repair and endovascular repair. Consideration of the factors identified in this study that predict reduced long-term survival for open abdominal aortic aneurysms repair and endovascular repair should be considered when deciding repair of abdominal aortic aneurysm.

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742 Conventional Surgery vs Endovascular Abdominal Aortic Aneurysm Repair in the Management of Mycotic Abdominal Aortic Aneurysms

British Journal of Surgery ◽

10.1093/bjs/znab134.572 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Premnath ◽

V Zaver ◽

G Kuhan ◽

T Rowlands ◽

J Quarmby ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Conventional Surgery ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Abstract Introduction This study aimed to look into the short and long-term outcomes in Mycotic Abdominal Aortic Aneurysms (MAAA) managed by Conventional Surgery (CS) and Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Method Data of 17 patients who underwent CS or EVAR for MAAA from 2001 to 2017 in a single centre were collected. Complications and mortality at 3 years post-procedure were also analysed. Results Mean age was 66 (54 - 82 years), 15 (88.2%) were males. Mean aortic anterior-posterior diameter was 5.8cm (2.1 – 9.0 cm). 10 patients (58.8%) presented with rupture. 6 (35%) patients demonstrated positive cultures. 4 patients (23.5%) underwent CS and 13 (76.5) had EVAR of which 4 were surgeon modified EVARs. 5 (29%) patients developed complication within 30 days. 4 patients (23.5%) developed graft infection in long term. Total mortality was 5 (29.4%) of which one patient died within 30 days and two within 3 years of procedure. Long-term mortality was found to be significantly higher in patients treated with CS compared to EVAR (p-value 0.022). Conclusions CS for MAAA has a high mortality rate compared to EVAR. EVAR might be a simple and good alternative for this critical condition in centres with adequate expertise.

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Fenestrated and Branched Endografts

10.2310/vasc.3021 ◽

2018 ◽

Author(s):

Mirza Shadman Baig ◽

Carlos H. Timaran

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Individual Variability ◽

Aortic Aneurysms ◽

Endovascular Graft ◽

Endovascular Aortic Aneurysm Repair ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Multiple clinical trials have established the safety and efficacy of endovascular aortic aneurysm repair, which has resulted in a major paradigm shift from open to endovascular repair for the treatment of most aortic aneurysms. However, juxtarenal aneurysms (JRAAs) and more complex aneurysms involving the visceral aorta pose a significant challenge to the goals of fixation and seal using standard infrarenal devices. The need for branch vessel preservation and the individual variability of their origins from the aorta add significant complexity to the design, manufacturing, and implantation of endovascular grafts. To address these limitations, fenestrated and branched endografts have been developed that allow fixation and seal above the renal or visceral vessels but maintain perfusion to these branches by aligning fenestrations in the endograft fabric to the origins of these vessels or, in the case of thoracoabdominal aneurysms, providing branches. This review discusses fenestrated and branched endografts, as well as their complications and outcomes. Figures show definitions and examples of complex abdominal aortic aneurysm (AAA), features of the Zenith Fenestrated AAA Endovascular Graft, and features of the Cook Zenith P-branch device, an off-the-shelf fenestrated device under investigation for endovascular repair of JRAA. Tables list Zenith Fenestrated AAA Endovascular Graft indications for use and device components, graft and vessel-sized diameters for fenestrated devices, accessories for fenestrated endovascular repair, and results of reports dealing with fenestrated and branched endografts for juxtarenal and suprarenal AAA. This review contains 12 highly rendered figures, 5 tables, and 53 references. Key words: abdominal aortic aneurysm, branched endograft, complex abdominal aortic aneurysm, endovascular aortic aneurysm repair, fenestrated endograft, juxtarenal aneurysms, suprarenal abdominal aortic aneurysm

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The Fate of the Superior Mesenteric Artery in Fenestrated Endovascular Repair of Complex Abdominal Aortic Aneurysms

Vascular and Endovascular Review ◽

10.15420/ver.2019.1.1 ◽

2019 ◽

Vol 2 (1) ◽

pp. 38-39

Author(s):

Yongcheng Xu ◽

Yukun Li

Keyword(s):

Aortic Aneurysm ◽

Superior Mesenteric Artery ◽

Endovascular Repair ◽

Mesenteric Artery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Clinical Complications ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Issues related to the superior mesenteric artery (SMA) in fenestrated endovascular aortic aneurysm repair (f-EVAR), such as misalignment of the endograft and bridging devices-associated complications, are rarely reported. Moreover, the absence of autopsies in the majority of patients who died in the published series makes a possible correlation with occlusion of the SMA unknown. Current studies that reported on f-EVAR were reviewed accordingly, aiming to improve our understanding of the natural course of the SMA in fenestrated technology and to explore the associated clinical complications.

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