80-kVp CT angiography for endovascular aneurysm repair follow-up with halved contrast medium dose and preserved diagnostic quality

2015 ◽  
Vol 57 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Leena Lehti ◽  
Ulf Nyman ◽  
Marcus Söderberg ◽  
Katarina Björses ◽  
Anders Gottsäter ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Ct Angiography ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Quality ◽  
Aneurysm Repair ◽  
Medium Dose

Tailored CT angiography in follow-up after endovascular aneurysm repair (EVAR): combined dose reduction techniques

2018 ◽  
Vol 59 (11) ◽  
pp. 1316-1325 ◽  
Author(s):  
Georg Böning ◽  
Roman A Rotzinger ◽  
Johannes F Kahn ◽  
Patrick Freyhardt ◽  
Diane M Renz ◽  
...  
Keyword(s):  
Image Quality ◽  
Dose Reduction ◽  
Iterative Reconstruction ◽  
Signal To Noise Ratio ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Confidence ◽  
Diagnostic Quality ◽  
Noise Ratio ◽  
Aneurysm Repair

Background Endovascular aneurysm repair (EVAR) requires lifelong surveillance by computed tomography angiography (CTA). This is attended by a substantial accumulation of radiation exposure. Iterative reconstruction (IR) has been introduced to approach dose reduction. Purpose To evaluate adaptive statistical iterative reconstruction (ASIR) at different levels of tube voltage concerning image quality and dose reduction potential in follow-up post EVAR. Material and Methods One hundred CTAs in 67 patients with EVAR were examined using five protocols: protocol A (n = 40) as biphasic standard using filtered back projection (FBP) at 120 kV; protocols B (n = 40), C (n = 10), and D1 (n = 5) biphasic using ASIR at 120, 100, and 80 kV, respectively; and protocol D2 (n = 5) with a monophasic splitbolus ASIR protocol at 80 kV. Image quality was assessed quantitatively and qualitatively. Applied doses were determined. Results Applied doses in ASIR protocols were significantly lower than FBP standard (up to 75%). Compared to protocol A, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) (e.g. arterial CNR intra-/extra-stent lumen: A = 35.4 ± 13.5, B = 34.2 ± 10.0, C = 29.6 ± 6.8, D1 = 32.1 ± 6.3, D2 = 40.8 ± 23.1) in protocol B were equal and in protocols C and D equal to partially inferior, however not decisive for diagnostic quality. Subjective image quality ratings in all protocols were good to excellent without impairments of diagnostic confidence (A–D2: 5), with high inter-rater agreement (60–100%). Conclusion ASIR contributes to significant dose reduction without decisive impairments of image quality and diagnostic confidence. We recommend an adapted follow-up introducing ASIR and combined low-kV in the long-term surveillance after EVAR.

Role of low dose CT angiography in the follow-up after endovascular aneurysm repair of abdominal aorta

2014 ◽  
Vol 56 (12) ◽  
pp. 1471-1478 ◽  
Author(s):  
Monica Macchi ◽  
Chiara Floridi ◽  
Sabina Strocchi ◽  
Federico Fontana ◽  
Monica Mangini ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Abdominal Aorta ◽  
Low Dose ◽  
Endovascular Aneurysm Repair ◽  
Low Dose Ct ◽  
Aneurysm Repair

Image-guided translumbar type II endoleak repair: A novel approach

2020 ◽  
Vol 4 ◽  
pp. 9
Author(s):  
Salman Mirza ◽  
Shahnawaz Ansari
Keyword(s):  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Endovascular Aneurysm Repair ◽  
Type Ii ◽  
Type Ii Endoleak ◽  
Image Guided ◽  
Novel Approach ◽  
Abdominal Aortic ◽  
Aneurysm Repair

We present a case of a 72-year-old male with an abdominal aortic aneurysm status post-endovascular aneurysm repair (EVAR). Follow-up imaging demonstrated an enlarging type II endoleak and attempts at transarterial coil embolization of the inferior mesenteric artery were unsuccessful. The patient underwent image-guided percutaneous translumbar type II endoleak repair using XperGuide (Philips, Andover, MA USA).

Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis—The PERU registry

Vascular ◽  
2021 ◽  
pp. 170853812199259
Author(s):  
Andrés Reyes Valdivia ◽  
Arindam Chaudhuri ◽  
Ross Milner ◽  
Giovanni Pratesi ◽  
Michel MPJ Reijnen ◽  
...  
Keyword(s):  
Real World ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Ultrasound ◽  
Interquartile Range ◽  
Technical Success ◽  
Number Of Patients ◽  
Hostile Neck ◽  
Aneurysm Repair ◽  
Related Mortality

Objectives We aim to describe real-world outcomes from multicenter data about the efficacy of adjunct Heli-FX EndoAnchor usage in preventing or repairing failures during infrarenal endovascular aneurysm repair (EVAR), so-called EndoSutured-aneurysm-repair (ESAR). Methods The current study has been assigned an identifier (NCT04100499) at the US National Library of Medicine ( https://ClinicalTrials.gov ). It is an observational retrospective study of prospectively collected data from seven vascular surgery departments between June 2010 and December 2019. Patients included in the ANCHOR registry were excluded from this analysis. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each center’s practice. Follow-up imaging was scheduled according to each center’s protocol, which necessarily included either abdominal ultrasound or radiography or computed tomographic scan imaging. The main outcomes analyzed were technical success, freedom from type Ia endoleaks (IaEL), all-cause and aneurysm-related mortality, and sac variation and trends evaluated for those with at least six months imaging follow-up. Results Two hundred and seventy-five patients underwent ESAR in participating centers during the study period. After exclusions, 221 patients (184 males, 37 females, mean age 75 ± 8.3 years) were finally included for analysis. Median follow-up for the cohort was 27 (interquartile range 12–48) months. A median 6 (interquartile range 3) EndoAnchors were deployed at ESAR, 175 (79%) procedures were primary and 46 (21%) revision cases, 40 associated with type IaEL. Technical success at operation (initial), 30-day, and overall success were 89, 95.5, and 96.8%, respectively; the 30-day success was higher due to those with subsequent spontaneous proximal endoleak seal. At two years, freedom from type IaEL was 94% for the whole series; 96% and 86% for the primary and revision groups, respectively; whereas freedom from all-cause mortality, aneurysm-related mortality, and reintervention was 89%, 98%, and 87%, respectively. Sac evolution pre-ESAR was 66 ± 15.1 vs. post ESAR 61 ± 17.5 (p < 0.001) and for 180 patients with at least six-month follow-up, 92.2% of them being in a stable (51%) or regression (41%) situation. Conclusions This real-world registry demonstrates that adjunct EndoAnchor usage at EVAR achieves high rates of freedom from type IaEL at mid-term including in a high number of patients with hostile neck anatomy, with positive trends in sac-size evolution. Further data with longer follow-up may help to establish EndoAnchor usage as a routine adjunct to EVAR, especially in hostile necks.

Experience With Unfavorable Iliac Access When Performing Fenestrated/Branched Endovascular Aneurysm Repair

2021 ◽  
pp. 152660282199112
Author(s):  
Adrien Hertault ◽  
Aurélia Bianchini ◽  
Guillaume Daniel ◽  
Teresa Martin-Gonzalez ◽  
Birgit Sweet ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Endovascular Repair ◽  
Clinical Success ◽  
Multiorgan Failure ◽  
Endovascular Aneurysm Repair ◽  
Small Diameter ◽  
Early Postoperative Period ◽  
Single Center Experience ◽  
Aneurysm Repair

Purpose: To review a single-center experience with fenestrated and branched endovascular aneurysm repair (f/bEVAR) in patients with challenging iliac anatomies. Materials and Methods: A retrospective review of the department’s database identified 398 consecutive patients who underwent complex endovascular repair f/bEVAR between January 2010 and June 2018; of these, 67 had challenging accesses. The strategies implemented to overcome access issues were reviewed, using a dedicated scoring system to evaluate the access (integrating diameter, tortuosity, calcification, and previous open or endovascular repair). Results: In this subgroup of patients, the most common graft design was a 4-vessel fenestrated endograft (27, 40.3%). Hostile access was due to small diameter (<7 mm) in 25 patients (37.3%) and/or concentric calcifications in 19 patients (26.9%). Mean iliac diameter was 5.5±2.6 mm on the right side and 6.0±2.5 mm on the left side. Previous open or endovascular aortoiliac repair had been performed in 15 patients (22.4%), and 20 patients (29.9%) had a stent previously implanted in at least 1 iliac artery, resulting in the inability to perform standard fenestrated repair with access from both sides. Five patients (7.5%) had a single patent iliac access. Eight distinctive strategies were identified to overcome these access issues, including the use of preloaded renal catheters in the endograft delivery system, angioplasty, graft modification (branches instead of fenestrations or 4 preloaded fenestrations), a conduit via a retroperitoneal approach, iliac artery recanalization, and/or the multiple puncture technique. Technical success was achieved in 62 cases (92.5%). Four patients had access complications and 1 died in the early postoperative period of multiorgan failure. Median follow-up was 24.6 months (IQR 7.2, 41.3). Clinical success at the end of follow-up was achieved in 57 patients (85.1%). During follow-up, 14 patients died, including 4 from an aorta-related cause. Conclusion: Dedicated strategies can be implemented to overcome hostile iliac access in patients with complex aneurysms when f/bEVAR is required. Typically, these maneuvers are associated with favorable outcomes.

scholarly journals Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair

2021 ◽  
pp. 152660282110164
Author(s):  
Claire van der Riet ◽  
Richte C. L. Schuurmann ◽  
Eric L. G. Verhoeven ◽  
Clark J. Zeebregts ◽  
Ignace F. J. Tielliu ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Fracture ◽  
Covered Stents ◽  
Significant Stenosis ◽  
Primary Endpoints ◽  
Visceral Arteries ◽  
Aneurysm Repair ◽  
Type 3

Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent. Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up. Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years. Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.

Comparing polymer-filled versus self-expanding endografts in Chinese patients

2018 ◽  
Vol 26 (9) ◽  
pp. 667-676
Author(s):  
Yuk Law ◽  
Yiu Che Chan ◽  
Stephen Wing-Keung Cheng
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
The Self ◽  
Chinese Patients ◽  
Type Ii ◽  
Mortality And Morbidity ◽  
Type Ia ◽  
One Year ◽  
Aneurysm Repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

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