Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies

AbstractThe technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.

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Stents for the Treatment of Aortic Aneurysms

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615578 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 171-175 ◽

Cited By ~ 1

Author(s):

D. Ebert ◽

M. Langer ◽

P. Uhrmeister

Keyword(s):

Endovascular Treatment ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Imaging Modalities ◽

Exclusion Criteria ◽

Multicenter Studies ◽

Abdominal Aortic ◽

First Results

SummaryThe endovascular treatment of abdominal aortic aneurysms has generated a great deal of interest since the early 1990s, and many different devices are currently available. The procedure of endovascular repair has been evaluated in many institutions and the different devices are compared. The first results were encouraging, but complications like endoleak, dislocation or thrombosis of the graft occurred. By the available devices the stent application is only promising, if the known exclusion criteria are strictly respected. Therefore a careful preinterventional assessment of the patient by different imaging modalities is necessary. As the available results up to now are preliminary and the durability of the devices has to be controlled, multicenter studies are required to improve the devices and observe their long- term success in the exclusion of abdominal aortic aneurysms.

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Comparison of Long-term Outcomes Following Endovascular Repair of Abdominal Aortic Aneurysms Based on Size Threshold

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.10.048 ◽

2012 ◽

Vol 56 (6) ◽

pp. 1826-1827

Author(s):

Charles J. Keith ◽

Marc A. Passman ◽

Michael J. Gaffud ◽

Zdenek Novak ◽

Marjan U. Mujib ◽

...

Keyword(s):

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Outcomes ◽

Abdominal Aortic ◽

Size Threshold

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Influence of Type 2 Endoleaks on Long-Term Outcomes after Endovascular Repair for Abdominal Aortic Aneurysms: A National Hospital Organization Network Study for Abdominal Aortic Aneurysms in Japan

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.09.014 ◽

2020 ◽

Vol 64 ◽

pp. 116-123 ◽

Cited By ~ 2

Author(s):

Masayuki Sakaki ◽

Nobuhiro Handa ◽

Toshihiro Onohara ◽

Minoru Okamoto ◽

Tsuyoshi Yamamoto ◽

...

Keyword(s):

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Hospital Organization ◽

Long Term Outcomes ◽

National Hospital ◽

Abdominal Aortic ◽

National Hospital Organization

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Long-Term Outcomes of Immediate Repair Compared with Surveillance of Small Abdominal Aortic Aneurysms

New England Journal of Medicine ◽

10.1056/nejmoa013527 ◽

2002 ◽

Vol 346 (19) ◽

pp. 1445-1452 ◽

Cited By ~ 412

Keyword(s):

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Outcomes ◽

Abdominal Aortic

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Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario

Journal of Vascular Surgery ◽

10.1016/j.jvs.2009.10.101 ◽

2010 ◽

Vol 51 (3) ◽

pp. 577-583.e3 ◽

Cited By ~ 21

Author(s):

Prasad Jetty ◽

Paul Hebert ◽

Carl van Walraven

Keyword(s):

Resource Utilization ◽

Open Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Outcomes ◽

Abdominal Aortic

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PC046 Long-Term Outcomes After Repair of Symptomatic Abdominal Aortic Aneurysms

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.03.287 ◽

2017 ◽

Vol 65 (6) ◽

pp. 151S-152S

Author(s):

Karen Trang ◽

Venita Chandra ◽

Whitt Virgin-Dodwney ◽

E. John. Harris ◽

Jason T. Lee ◽

...

Keyword(s):

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Outcomes ◽

Abdominal Aortic

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Comparison of the Short and Long-Term Outcomes of Endovascular Repair and Open Surgical Repair in the Treatment of Unruptured Abdominal Aortic Aneurysms: Meta-Analysis and Systematic Review

Cureus ◽

10.7759/cureus.9683 ◽

2020 ◽

Author(s):

Othman AlOthman ◽

Suleiman Bobat

Keyword(s):

Systematic Review ◽

Surgical Repair ◽

Meta Analysis ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Outcomes ◽

Open Surgical Repair ◽

Abdominal Aortic ◽

Short And Long Term

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Mortality after endovascular treatment of infrarenal abdominal aortic aneurysms – the newer the better?

VASA ◽

10.1024/0301-1526/a000685 ◽

2018 ◽

Vol 47 (3) ◽

pp. 187-196 ◽

Cited By ~ 2

Author(s):

Aspasia Tzani ◽

Ilias P. Doulamis ◽

Ioannis Katsaros ◽

Eirini Martinou ◽

Dimitrios Schizas ◽

...

Keyword(s):

Mortality Rate ◽

Endovascular Treatment ◽

Abdominal Aortic Aneurysms ◽

Mortality Rates ◽

Aortic Aneurysms ◽

Late Mortality ◽

Ruptured Aneurysms ◽

Abdominal Aortic ◽

Perioperative Bleeding

Abstract. Although endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) presents a delicate alternative treatment for abdominal aortic aneurysms (AAA) with lower perioperative mortality, its long-term efficacy remains a matter of concern. The purpose of this study was to evaluate the currently reported mortality evidence after EVAR and to examine the possible effect of aneurysm status and the study period on mortality rates. The PubMed and Cochrane bibliographical databases were thoroughly searched for studies reporting on more than 1 000 patients with non-ruptured or ruptured infrarenal AAA, treated with EVAR from August 1991 to September 2016. A total of 10 910 titles/abstracts were retrieved and 121 studies were deemed relevant. Twenty-six studies met the inclusion criteria and reported on 354 500 patients with a mean age of 74.6 years. Almost all of the studies referred to elective EVAR and the mean aneurysm size was 5.58 cm. The most common early complication for elective EVAR was perioperative bleeding (1.9 %), whereas hospital-acquired pneumonia was a major concern in urgent EVAR (28.5 %). Conversion rate to open surgery was 1.2 %. The 30-day all-cause mortality rate was 4.84 % (1.7 % for non- ruptured aneurysms, 33.8 % for ruptured aneurysms).The overall all-cause late mortality in a mean follow-up period of 23.8 months was 19.1 %. The aneurysm-related late mortality rate was 3.4 %. With respect to the time period of patient enrollment, studies reporting on patients recruited before 2006 were found to face more secondary complications and higher late mortality rates than patients enrolled after 2005.The endovascular treatment of large and anatomically suitable infrarenal AAA in selected patients remains a safe alternative to open repair. Our findings demonstrate that newer studies show better long-term outcomes than the older ones, proposing a possible improvement of EVAR techniques and perioperative care and providing encouraging evidence for a wider application of EVAR.

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