Iatrogenic Diffusion-Weighted Imaging Lesions

Stroke ◽  
2021 ◽  
Author(s):  
Mayank Goyal ◽  
Aravind Ganesh ◽  
Michael Tymianski ◽  
Michael D. Hill ◽  
Johanna Maria Ospel
Keyword(s):  
Mr Imaging ◽  
Endovascular Procedures ◽  
Infarct Volume ◽  
Endovascular Aneurysm Repair ◽  
Clinical Impact ◽  
Relative Paucity ◽  
Diffusion Weighted ◽  
Aneurysm Repair ◽  
Clinical Deficits ◽  
Worse Prognosis

Infarct volume in acute ischemic stroke is closely linked with clinical outcome, with larger infarct volumes being associated with a worse prognosis. Small iatrogenic infarcts, which can occur as a result of surgical or endovascular procedures, are often only seen on diffusion-weighted MR imaging. They often do not lead to any overtly appreciable clinical deficits, hence the term covert or silent infarcts. There is relative paucity of data on the clinical impact of periprocedural hyperintense diffusion-weighted MR imaging lesions, partly because they commonly remain undiagnosed. Clearly, a better understanding of iatrogenic periprocedural diffusion-weighted MR imaging lesions and their clinical significance is needed. In this article, we describe the current limitations of our understanding of the significance of iatrogenic diffusion-weighted MR imaging lesions using exemplary data from the ENACT trial (Safety and Efficacy of NA-1 in Patients With Iatrogenic Stroke After Endovascular Aneurysm Repair) and outline a framework for how to investigate their clinical impact.

Analysis of Midterm Outcomes of Endovascular Aneurysm Repair in Octogenarians From the ENGAGE Registry

2020 ◽  
Vol 27 (5) ◽  
pp. 836-844 ◽  
Author(s):  
Bibombe P. Mwipatayi ◽  
Olufemi A. Oshin ◽  
Joseph Faraj ◽  
Ramon L. Varcoe ◽  
Jackie Wong ◽  
...  
Keyword(s):  
Endovascular Procedures ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Endovascular Aneurysm Repair ◽  
Patient Characteristics ◽  
Risk Scores ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Aneurysm Repair ◽  
Related Mortality

Purpose: To assess periprocedural results and secondary endovascular procedure outcomes over 5 years in patients aged ≥80 vs <80 years undergoing endovascular aneurysm repair (EVAR). Materials and Methods: Data from the Endurant Stent Graft Natural Selection Global post-market registry (ENGAGE) were used for the analyses. A total of 1263 consecutive patients were enrolled in the prospective, observational, single-arm registry and divided into 2 groups according to age: ≥80 years (290, 22.9%) and <80 years (973, 77.1%). Baseline patient characteristics, risk scores according to the Society for Vascular Surgery (SVS) reporting standards, American Society of Anesthesiologists (ASA) classification, quality of life assessments [EuroQol 5 (EQ5D) index], and treatment outcomes, including all-cause mortality, aneurysm-related mortality, major adverse events, secondary endovascular procedures, and endoleaks were compared between groups. Results: Octogenarians were classified into the highest category of the SVS risk stratification system; however, this did not result in a significant difference in the 30-day mortality [1.4% (4/290) vs 1.2% (12/973) for controls; p=0.85] or major adverse event rates [5.2% (15/290) vs 3.6% (35/973), p=0.23]. Multivariable analysis confirmed that age ≥80 years, pulmonary disease, large aneurysm diameter, and renal insufficiency were significantly associated with all-cause mortality, whereas diameter was the only parameter associated with increased aneurysm-related mortality. The differences in freedom from secondary endovascular procedures over 5 years between octogenarians and controls did not reach statistical significance (88.5% vs 83.2%, p=0.07). Conclusion: EVAR can be performed in individuals aged ≥80 years with no statistically significant difference in midterm aneurysm-related deaths compared with younger patients. The findings in this elderly patient cohort show that EVAR can be safely performed with acceptable morbidity rates in octogenarians.

Clinical Impact of Chronic Renal Insufficiency on Endovascular Aneurysm Repair

2007 ◽  
Vol 40 (6) ◽  
pp. 437-445 ◽  
Author(s):  
Brian Park ◽  
Arun Mavanur ◽  
A. David Drezner ◽  
James Gallagher ◽  
James O. Menzoian
Keyword(s):  
Renal Insufficiency ◽  
Chronic Renal Insufficiency ◽  
Endovascular Aneurysm Repair ◽  
Clinical Impact ◽  
Aneurysm Repair

Clinical impact of transrenal fixation during endovascular aneurysm repair on renal function

2007 ◽  
Vol 205 (3) ◽  
pp. S111-S112
Author(s):  
Zachary Arthurs ◽  
Vance Sohn ◽  
Jason Perry ◽  
Matthew Eckert ◽  
Charles Andersen ◽  
...  
Keyword(s):  
Renal Function ◽  
Endovascular Aneurysm Repair ◽  
Clinical Impact ◽  
Aneurysm Repair

scholarly journals SS25. Prevalence, Risk Factors, and Clinical Impact of Intraprosthetic Thrombus Deposits After Endovascular Aneurysm Repair

2019 ◽  
Vol 69 (6) ◽  
pp. e201-e202
Author(s):  
Claudio Bianchini Massoni ◽  
Alessandro Ucci ◽  
Paolo Perini ◽  
Matteo Azzarone ◽  
Erica Mariani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endovascular Aneurysm Repair ◽  
Clinical Impact ◽  
Aneurysm Repair

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.

Laser-assisted transprosthesial coil embolization combined with thrombin injection for treatment of an endoleak type II after endovascular aneurysm repair

VASA ◽  
2018 ◽  
Vol 47 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Tanja Boehme ◽  
Aljoscha Rastan ◽  
Elias Noory ◽  
Peter-Christian Fluegel ◽  
Thomas Zeller
Keyword(s):  
Coil Embolization ◽  
Endovascular Aneurysm Repair ◽  
Type Ii ◽  
Thrombin Injection ◽  
Endoleak Type Ii ◽  
Aneurysm Repair

Abstract. The treatment of endoleaks type II had to be adapted to the anatomy of each individual patient. The laser-assisted perforation of the prosthesis can be an easier method to reach the aneurysm sac directly than using transarterial or translumbar approaches.

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