Bowel ischaemia after endovascular aneurysm repair

VASA ◽  
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.

Challenges in Treating Chlamydia trachomatis, Including Rectal Infections: Is It Time to Go Back to Doxycycline?

2021 ◽  
pp. 106002802110299
Author(s):  
S. Lena Kang-Birken
Keyword(s):  
Chlamydia Trachomatis ◽  
Treatment Failure ◽  
English Language ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Controlled Trial ◽  
Absolute Difference ◽  
Cochrane Library ◽  
Increased Risk ◽  
Meta Analyses

Objective: To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis. Data Sources: A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials. Study Selection and Data Extraction: English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered. Data Synthesis: Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site. Relevance to Patient Care and Clinical Practice: A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice. Conclusions: Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.

Polymer leak with the Ovation Abdominal Stent Graft System: Early recognition and treatment

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 159-164
Author(s):  
Navyash Gupta ◽  
Karen L Hynes ◽  
Omeed Mahrouyan ◽  
Charles S Briggs ◽  
Ali Azzizadeh
Keyword(s):  
Anaphylactic Reaction ◽  
Stent Graft ◽  
Early Recognition ◽  
Case Reports ◽  
Endovascular Aneurysm Repair ◽  
Systemic Exposure ◽  
Cure Rate ◽  
Root Cause ◽  
Incidence Risk ◽  
Aneurysm Repair

Objective Endovascular aneurysm repair can be performed using multiple commercially available stent graft systems, each with their own unique design features and potential complications. This study evaluated the incidence, risk factors and outcomes of patients who developed an anaphylactic reaction following systemic exposure to the polymer used with the Ovation Abdominal Stent Graft System (Endologix Inc., Irvine, CA). Methods We reviewed all reports related to polymer leak with the device received by the manufacturer (formerly known as TriVascular, Santa Rosa, CA). Patients who developed an anaphylactic or hypersensitivity reaction were evaluated for root cause. The manufacturer was contacted to assemble all available data and outcomes related to the case reports. Results Between November 2009 and August 2016, polymer leak was reported in 26 patients (mean age, 77, range 61–100 years) from approximately 10,000 device implants (reported incidence, 0.26%). Symptoms occurred in 24 patients, with hypotension being the primary symptom. Treatment was in accordance for an anaphylactic reaction. There were no deaths, and the aneurysm sac remained unexcluded in three patients at the end of the case. Of these, one patient underwent successful endovascular re-intervention, one was converted to open surgical repair and one patient continued to be monitored. Factors that appear to contribute to the risk of polymer leak include initial manufacturing process for the device, excessive graft manipulation, early ballooning prior to complete polymer cure and lower body temperature, which can slow the polymer cure rate. Conclusion Although polymer leak and anaphylaxis appear to be an infrequent event associated with use of the Ovation graft, awareness of this complication and prompt recognition can allow for timely treatment. Returning the patient to hemodynamic stability can allow for completion of the procedure and successful exclusion of the aneurysm sac.

The effect of Endovascular Aneurysm Repair on Renal Function in Patients Treated for Abdominal Aortic Aneurysm

2020 ◽  
Vol 25 (44) ◽  
pp. 4675-4685 ◽  
Author(s):  
Petroula Nana ◽  
George Kouvelos ◽  
Alexandros Brotis ◽  
Konstantinos Spanos ◽  
Athanasios Giannoukas ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Abdominal Aortic Aneurysm ◽  
Chronic Renal Failure ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic ◽  
Increased Risk ◽  
Aneurysm Repair

Aim: The effect of endovascular aneurysm repair in patients treated for abdominal aortic aneurysm has not been clearly defined. The objective of the present article was to provide a contemporary literature review and perform an analysis to determine the effect of EVAR on renal function in the early post-operative period and during follow-up. Methods: A systematic review of the literature was undertaken to identify all studies reporting the effect of EVAR on renal function. Outcome data were pooled and combined overall effect sizes were calculated using fixed or random-effects models. Results: Thirty-two studies reporting on 24846 patients were included. Acute renal failure after EVAR occurred with an estimated frequency of 9% (95%CI: 5-16%; I2=97%). Median follow-up period was 19.5 months (range 1-60 months). The estimated frequency of chronic renal failure during follow-up was 7% (95%CI: 3-17%; I2=98%). Hemodialysis was required in 2% (1-3%; I2=97%) of the cases. Conclusion: High-level evidence demonstrating the effect of EVAR on the incidence of acute and chronic renal failure is lacking. Based on the current available data, nearly 10% of patients undergoing EVAR for AAA have an increased risk for renal dysfunction after the procedure. Whether this deterioration may lead to a worse outcome has not been adequately proved.

scholarly journals RS13. Standard Endovascular Aneurysm Repair in Patients With Wide Proximal Aneurysm Necks Is Associated With Increased Risk of Adverse Events

2016 ◽  
Vol 63 (6) ◽  
pp. 146S
Author(s):  
Nelson Gomes Oliveira ◽  
Frederico Bastos Gonçalves ◽  
Quirina de Ruiter ◽  
Richte Schuurman ◽  
Frans Moll ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endovascular Aneurysm Repair ◽  
Increased Risk ◽  
Aneurysm Repair

scholarly journals Ten-year single-centre experience with type II endoleaks: Intervention versus observation

2017 ◽  
Vol 22 (4) ◽  
pp. 316-323 ◽  
Author(s):  
Ikram-Ul Haq ◽  
Arun Kelay ◽  
Meryl Davis ◽  
Jocelyn Brookes ◽  
Tara M Mastracci ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Time Frame ◽  
Type Ii ◽  
Risk Of Mortality ◽  
Surveillance Imaging ◽  
Increased Risk ◽  
Significant Difference ◽  
Aneurysm Growth ◽  
Aneurysm Repair

Our objective was to determine the relative merits of intervention or observation of type II endoleaks (T2Ls). A retrospective analysis was performed on 386 infra-renal endovascular aneurysm repair (IR-EVAR) patients from 2006 to 2015. Annual surveillance imaging of patients undergoing EVAR at our centre were analysed, and all endoleaks were subjected to a multidisciplinary team meeting for consideration and treatment. In the 10-year time frame, 386 patients (79.5±8.7 years) underwent an IR-EVAR. Eighty-one patients (21.0%) developed a T2L and intervention was undertaken in 28 (34.6%): 17 (60.7%) were treated via a transarterial approach (TA) and 11 (39.3%) using the translumbar approach (TL). Fifty-three patients (65.4%) with T2Ls were managed conservatively. Patients who received T2L treatment had a greater proportion of recurrent T2Ls than patients who were conservatively managed ( p=0.032). T2Ls associated with aneurysmal growth were more resistant to treatment than those where there was no change or a decrease in aneurysm size during follow-up (0.033). There was no significant difference in the TA and TL approach with respect to endoleak repair success ( p=0.525). Treatment of a T2L did not confer a survival advantage compared to conservative management ( p=0.449) nor did the choice of either the TA or TL approach ( p=0.148). Our study suggests the development of a T2L associated with aneurysm growth may represent an aggressive phenotype that is resistant to treatment. However, this did not lead to an increased risk of mortality over follow-up. Neither a transarterial nor a translumbar approach to treating a T2L conferred superiority.

scholarly journals Standard endovascular aneurysm repair in patients with wide infrarenal aneurysm necks is associated with increased risk of adverse events

2017 ◽  
Vol 65 (6) ◽  
pp. 1608-1616 ◽  
Author(s):  
Nelson F.G. Oliveira ◽  
Frederico M. Bastos Gonçalves ◽  
Marie Josee Van Rijn ◽  
Quirina de Ruiter ◽  
Sanne Hoeks ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endovascular Aneurysm Repair ◽  
Increased Risk ◽  
Aneurysm Repair
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