Left ventricular global longitudinal peak strain deterioration in patients undergoing endovascular repair of abdominal aortic aneurysms: the effect of arterial stiffness

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Marketou ◽  
G Papadopoulos ◽  
N Kontopodis ◽  
A Patrianakos ◽  
H Nakou ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Open Repair ◽  
Systolic Function ◽  
Left Ventricular ◽  
Aortic Aneurysms ◽  
Peak Strain ◽  
Aortic Reconstruction ◽  
Abdominal Aortic ◽  
Cardiac Systolic Function

Abstract Purpose Invasive abdominal aortic aneurysm (AAA) replacement with an endograft interposes between the normal arterial tree which may acutely reduce overall systemic compliance and increase the input impedance. We evaluated the impact of aortic reconstruction, using currently available grafts and endografts, on pulse wave velocity (pwv) and its effect on early cardiac systolic function indices in these patients. Methods A total of 73 men, mean age 70±8 years, were evaluated. Of these, 61 underwent endovascular repair (EVAR) and 12 open repair (OS). All patients underwent an assessment with a standard conventional transthoracic and a two-dimensional speckle tracking echocardiography at baseline, at 1 and 6 months after the intervention. Carotid - femoral (c-f) artery waveforms were measured and pwv was determined in all participants on each follow up visit. Results No significant changes in blood pressure were observed during the study period. Notably, our findings revealed a significant reduction in global longitudinal peak strain (GLPS) during the 6 months follow-up (from −19.7±−5.9% at baseline to −17.1±−5.9% at 6 months, p=0.03). C-r pwv showed a significant increase 6 months after the procedure (from 10.7±−2.9 m/sec at baseline to 13.9±3.3 m/sec at 6 months, p<0.001). A significant time effect was found on cf-pwv, which showed an increase at 1 month and remained thereafter (p=0.007). Additionally, a deterioration in GLS values was revealed, with a significant increase at 1 month that persisted 5 months later (p<0.001). No significant group effect was observed between EVAR and open repair (p=0.98) and there was no significant interaction (p=0.96). Notably, the difference of global longitudinal strain (ΔGLS) between baseline and 6 months significantly correlated with the corresponding changes in cf-pwv (r=0.494, p<0.0001). Conclusions AAA repair not only leads to an increase in aortic stiffness, as measured by the increase in pwv, but also reduces cardiac systolic function. Our findings highlight the need a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology. Funding Acknowledgement Type of funding source: None

Endovascular Aneurysm Repair versus Open Repair in Patients with Abdominal Aortic Aneurysm

2017 ◽  
Author(s):  
F. Ben Pearce ◽  
Tze-Woei Tan ◽  
Wayne W. Zhang
Keyword(s):  
Endovascular Repair ◽  
Open Repair ◽  
Perioperative Complications ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Study Intervention ◽  
Complications And Mortality

This chapter provides a summary of the landmark EVAR Trial 1, which compared endovascular repair of abdominal aortic aneurysms (AAA) with open repair in patients judged to be fit for both open and endovascular repair. Although endovascular AAA (EVAR) repair was associated with lower perioperative complications and mortality than open surgical repair, after 4 years of follow-up the outcomes of the two approaches were similar. Follow-up at 15 years found EVAR had inferior late survival, necessitating lifelong surveillance of EVAR and reintervention if necessary. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Endovascular treatment of proximal para-anastomotic aneurysms after previous surgical repair of infrarenal aortic aneurysms by the chimney technique

Vascular ◽  
2018 ◽  
Vol 27 (1) ◽  
pp. 3-7
Author(s):  
Georgios I Karaolanis ◽  
Marco Damiano Pipitone ◽  
Giovanni Torsello ◽  
Martin Austermann ◽  
Konstantinos P Donas
Keyword(s):  
Endovascular Repair ◽  
Open Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Short Neck ◽  
Aortic Repair ◽  
Aortic Neck ◽  
Abdominal Aortic

Objectives To evaluate the use of chimney grafts in the treatment of para-anastomotic aneurysms after previous abdominal aortic aneurysms open repair with short neck. Methods A retrospective analysis of prospectively collected data of consecutive patients who underwent endovascular repair for proximal aortic para-anastomotic aneurysms following previous open repair for infrarenal abdominal aortic aneurysms was performed. All included patients had a short infrarenal aortic neck (<10 mm) excluding standard endovascular aortic repair. Five patients were symptomatic at the admission needed urgent treatment. Results Twelve patients with para-anastomotic aneurysms underwent placement of chimney grafts. The median time between the original operations to redo endovascular procedure was 11 years (interquartile range, 9.5 years). The mean infrarenal length was 4.3 mm (1–9 mm). A total of 28 chimneys grafts were deployed for the 12 patients. The technical success rate was 91.7%. At a median radiologic follow-up of 16 months (2.0–29.4, 95% confidence interval), one patient died, while two late endoleaks and two reinterventions at one and three years for type Ia endoleak were performed by proximal extension and triple chimney graft placement. Conclusion The results of the present study show that ch-endovascular aortic repair is a safe technique for patients who suffered from proximal para-anastomotic aneurysms and having short neck unsuitable for standard endovascular repair. Longer follow up warranted to evaluate the durability of ch-endovascular aortic repair for this specific indication.

Real-world cost analysis of endovascular repair versus open repair in patients with nonruptured abdominal aortic aneurysms

2020 ◽  
Vol 71 (2) ◽  
pp. 432-443.e4 ◽  
Author(s):  
Akshay Kumar Gupta ◽  
Husain N. Alshaikh ◽  
Hanaa Dakour-Aridi ◽  
Ryan W. King ◽  
Thomas E. Brothers ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Endovascular Repair ◽  
Real World ◽  
Open Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic

scholarly journals Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†

2019 ◽  
Vol 56 (5) ◽  
pp. 993-1000 ◽  
Author(s):  
Enrico Gallitto ◽  
Gianluca Faggioli ◽  
Rodolfo Pini ◽  
Chiara Mascoli ◽  
Stefano Ancetti ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Hospital Mortality ◽  
Endovascular Repair ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
The Mean ◽  
Aneurysm Repair

Abstract OBJECTIVES Our objective was to report the outcomes of fenestrated/branched endovascular aneurysm repair of thoraco-abdominal aortic aneurysms (TAAAs) with endografts. METHODS Between January 2010 and April 2018, patients with TAAAs, considered at high surgical risk for open surgery and treated by Cook-Zenith fenestrated/branched endovascular aneurysm repair, were prospectively enrolled and retrospectively analysed. The early end points were 30-day/hospital mortality rate, spinal cord ischaemia and 30-day cardiopulmonary and nephrological morbidity. Follow-up end points were survival, patency of target visceral vessels and freedom from reinterventions. RESULTS Eighty-eight patients (male: 77%; mean age: 73 ± 7 years; American Society of Anesthesiologists 3/4: 58/42%) were enrolled. Using Crawford’s classification, 43 (49%) were types I–III and 45 (51%) were type IV TAAAs. The mean aneurysm diameter was 65 ± 15 mm. Custom-made and off-the-shelf endografts were used in 60 (68%) and 28 (32%) cases, respectively. Five (6%) patients had a contained ruptured TAAA. The procedure was performed in multiple steps in 42 (48%) cases. There was 1 (1%) intraoperative death. Five (6%) patients suffered spinal cord ischaemia with permanent paraplegia in 3 (3%) cases. Postoperative cardiac and pulmonary complications occurred in 7 (8%) and 12 (14%) patients, respectively. Worsening of renal function (≥30% of baseline level) was detected in 11 (13%) cases, and 2 (2%) patients required haemodialysis. The 30-day and hospital mortality rates were 5% and 8%, respectively. The mean follow-up was 36 ± 22 months. Survival at 12, 24 and 36 months was 89%, 75% and 70%, respectively. The patency of target visceral vessels at 12, 24 and 36 months was 92%, 92% and 92%, respectively. Freedom from reinterventions at 12, 24 and 36 months was 85%, 85% and 83%, respectively. CONCLUSIONS The endovascular repair of TAAAs with fenestrated/branched endovascular aneurysm repair is feasible and effective with acceptable technical/clinical outcomes at early/midterm follow-up.

Endovascular abdominal aortic aneurysm repair in patients with Marfan syndrome

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 48-52
Author(s):  
Allan Marc Conway ◽  
Khalil Qato ◽  
Gautam Anand ◽  
Laurie Mondry ◽  
Gary Giangola ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Open Repair ◽  
Aortic Surgery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Femoral Access ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed.

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