Distribution of Sac Pressure in an Experimental Aneurysm Model after Endovascular Repair: The Effect of Endoleak Types I and II

2003 ◽  
Vol 10 (3) ◽  
pp. 516-523 ◽  
Author(s):  
Eleftherios S. Xenos ◽  
Scott L. Stevens ◽  
Michael B. Freeman ◽  
John P. Pacanowski ◽  
David C. Cassada ◽  
...  
Keyword(s):  
Type I ◽  
Type Ii ◽  
Experimental Aneurysm ◽  
Pump System ◽  
Type Ii Endoleak ◽  
Proximal Neck ◽  
Aneurysm Wall ◽  
Type I Endoleak ◽  
Aneurysm Model ◽  
P Distribution

Purpose: To study in an experimental aneurysm model the differential distribution of strain/pressure (S/P) on the aneurysm wall before and after endograft exclusion and in the presence of individual type I and type II endoleaks. Methods: Two tapered elliptical Gore-Tex patches were sutured to an anterior and posterior longitudinal arteriotomy of an 8-mm Gore-Tex tube graft, thus creating a fusiform aneurysm. Two S/P transducers were placed at the proximal sac adjacent to the proximal neck, 2 at the site of the widest sac diameter, and 2 at the sac adjacent to the distal neck. The aneurysm, which was connected to a pulsatile pump system, was excluded using a 10-mm endograft. Type I and type II endoleaks were created and tested individually. S/P measurements were obtained at systemic systolic pressures (BP) of 80, 110, and 150 mmHg. Thrombosis of the sac contents was induced by injection of thrombin and calcium in the sac. Angiography was used to verify presence or absence of flow in the sac. Results: Aneurysm exclusion resulted in significant S/P reductions at all 3 BP levels versus prior to exclusion (p<0.05). Thrombus in the sac did not alter S/P in the excluded sac (p>0.05 for all 3 BP levels). In the presence of a proximal type I endoleak, S/P distribution was not uniform, and S/P at the proximal neck was close to S/P prior to exclusion (p>0.05 no graft versus type I endoleak for all 3 BP levels). This was also true in the presence of thrombus. With a type II endoleak, S/P was more evenly distributed and was not significantly elevated compared to the pressure without an endoleak (p>0.05, graft versus type II endoleak for all 3 BP levels). Thrombus had no effect on intrasac S/P with a type II endoleak. Intrasac S/P was significantly higher in the presence of a type I endoleak compared to a type II endoleak when BP=150 mmHg (p=0.008). Conclusions: Endovascular exclusion of an aneurysm results in uniform S/P reduction in the aneurysm sac. Type I endoleak, but not type II endoleak, results in significantly higher S/P in an area of the sac adjacent to the proximal neck. Thrombus does not result in significantly different S/P distribution in the aneurysm sac.

Modeling Endoleaks and Collateral Reperfusion following Endovascular AAA Exclusion

2003 ◽  
Vol 10 (3) ◽  
pp. 424-432 ◽  
Author(s):  
Chuh K. Chong ◽  
Thien V. How ◽  
Geoffrey L. Gilling-Smith ◽  
Peter L. Harris
Keyword(s):  
Stent Graft ◽  
Aortic Pressure ◽  
Type I ◽  
Type Ii ◽  
Pump System ◽  
Type Ii Endoleak ◽  
Type I Endoleak ◽  
The Impact ◽  
Mean Aortic Pressure

Purpose: To investigate the effect on intrasac pressure of stent-graft deployment within a life-size silicone rubber model of an abdominal aortic aneurysm (AAA) maintained under physiological conditions of pressure and flow. Methods: A commercial bifurcated device with the polyester fabric preclotted with gelatin was deployed in the AAA model. A pump system generated physiological flow. Mean and pulse aortic and intrasac pressures were measured simultaneously using pressure transducers. To simulate a type I endoleak, plastic tubing was placed between the aortic wall and the stent-graft at the proximal anchoring site. Type II endoleak was simulated by means of side branches with set inflow and outflow pressures and perfusion rates. Type IV endoleak was replicated by removal of gelatin from the graft fabric. Results: With no endoleak, the coated graft reduced the mean and pulse sac pressures to negligible values. When a type I endoleak was present, mean sac pressure reached a value similar to mean aortic pressure. When net flow through the sac due to a type II endoleak was present, mean sac pressure was a function of the inlet pressure, while pulse pressure in the sac was dependent on both inlet and outlet pressures. As perfusion rates increased, both mean and pulse sac pressures decreased. When there was no outflow, mean sac pressure was similar to mean aortic pressure. In the presence of both type I and type II endoleaks, mean sac pressure reached mean aortic pressure when the net perfusion rate was low. Conclusions: In vitro studies are useful in gaining an understanding of the impact of different types of endoleaks, in isolation and in combination, on intrasac pressure after aortic stent-graft deployment.

Noninvasive Diagnosis of Incomplete Endovascular Aneurysm Repair: D-Dimer Assay to Detect Type I Endoleaks and Nonshrinking Aneurysms

2002 ◽  
Vol 9 (1) ◽  
pp. 90-97 ◽  
Author(s):  
Francesco Serino ◽  
Damiano Abeni ◽  
Elisabetta Galvagni ◽  
Savino G. Sardella ◽  
Alberto Scuro ◽  
...  
Keyword(s):  
Thrombotic Event ◽  
Endovascular Aneurysm Repair ◽  
Test Group ◽  
Type I ◽  
Type Ii ◽  
Type Ii Endoleak ◽  
Blood Samples ◽  
Type I Endoleak ◽  
D Values ◽  
D Dimer

Purpose: To test the hypothesis that D-dimer (D-D), a cross-linked fibrin degradation product of an ongoing thrombotic event, could be a marker for incomplete aneurysm exclusion after endovascular abdominal aortic aneurysm (AAA) repair. Methods: In a multicenter study, 83 venous blood samples were collected from 74 AAA endograft patients and controls. Twenty subjects who were >6 months postimplantation and had evidence of an endoleak and/or an unmodified or increasing AAA sac diameter formed the test group. Controls were 10 nondiseased subjects >65 years old, 18 AAA surgical candidates, and 26 postoperative endograft patients with no endoleak and a shrinking aneurysm. Blood samples were analyzed for D-D through a latex turbidimetric immunoassay. The endograft patients were stratified into 5 clinical groups for analysis: no endoleak and decreasing sac diameter, no endoleak and increasing/unchanged sac diameter, type II endoleak and decreasing sac diameter, type II endoleak and increasing/unchanged sac diameter, and type I endoleak. Results: Individual D-D values were highly variable, but differences among clinical groups were statistically significant (p < 0.0001). D-D values did not vary significantly between patients with stable, untreated AAAs and age-matched controls (238 ± 180 ng/mL versus 421 ± 400 ng/mL, p > 0.05). Median D-D values increased at 4 days postoperatively (963 ng/mL versus 382 ng/mL, p > 0.05) and did not vary thereafter if there was no endoleak and the aneurysm sac decreased. D-D mean values were higher in patients with type I endoleak (1931 ± 924 ng/mL, p < 0.005) and those with unchanged/increasing sac diameters (1272 ± 728 ng/mL) than in cases with decreasing diameters (median 638 ± 238 ng/mL) despite the presence of endoleak (p < 0.0005). Conclusions: Elevated D-D may prove to be a useful marker for fixation problems after endovascular AAA repair and may help rule out type I endoleak, thus excluding patients from unnecessary invasive tests.

Sac Embolization and Side Branch Embolization for Preventing Type II Endoleaks After Endovascular Aneurysm Repair: A Meta-analysis

2019 ◽  
Vol 27 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Qiyi Li ◽  
Peiyong Hou
Keyword(s):  
Randomized Trials ◽  
Meta Analysis ◽  
Endovascular Aneurysm Repair ◽  
Side Branch ◽  
Type I ◽  
Type Ii ◽  
Related Complication ◽  
Type Ii Endoleak ◽  
Random Effects Models ◽  
Aneurysm Repair

Purpose:To investigate the efficacy and safety of preoperative side branch embolization or intraoperative sac embolization for preventing type II endoleaks after endovascular aneurysm repair (EVAR). Materials and Methods: A systematic literature search of MEDLINE and EMBASE was performed to identify studies that evaluated the outcomes of sac embolization vs no embolization or side branch embolization vs no embolization in patients who received EVAR. Among the 904 studies screened, 17 studies with 2084 participants were included in this review. Outcome measures included the type II endoleak rate, the reintervention rate for type II endoleaks, the incidence of types I/III endoleaks, and the rate of complications. Fixed (no heterogeneity) or random effects models were constructed for each outcome; the results are presented as the odds ratio (OR) with 95% confidence interval (CI). Results: The sac embolization group had significantly lower type II endoleak (OR 0.21, 95% CI 0.13 to 0.34, p<0.001) and reintervention (OR 0.15, 95% CI 0.07 to 0.33, p<0.001) rates than the no embolization group. No significant differences between the 2 groups were found for the type I/III endoleak rate (OR 0.57, 95% CI 0.23 to 1.37, p=0.21) or complication rate (OR 1.22, 95% CI 0.32 to 4.70, p=0.77). Compared with no embolization, side branch embolization was also associated with a decrease in type II endoleak (OR 0.35, 95% CI 0.21 to 0.60, p<0.001) and reinterventions (OR 0.10, 95% CI 0.04 to 0.27, p<0.001). One severe procedure-related complication (fatal colon ischemia) was reported in the side branch embolization group. Conclusion: Sac embolization and side branch embolization are safe and effective in preventing type II endoleaks. Further randomized trials are needed to directly compare the clinical outcomes of these procedures.

PD84 Hostile Anatomic Neck Of Abdominal Aortic Aneurysm Patients And EndoAnchor Cost Analysis

2018 ◽  
Vol 34 (S1) ◽  
pp. 157-158
Author(s):  
Hyun-Sook Choi ◽  
Sang-Soo Lee
Keyword(s):  
Cost Analysis ◽  
Population Size ◽  
Open Repair ◽  
Type I ◽  
Proximal Neck ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Hostile Neck ◽  
Type I Endoleak ◽  
Neck Anatomy

Introduction:Failure at the proximal neck for endovascular aortic repair (EVAR) in abdominal aortic aneurysm (AAA) is more common in the presence of unfavorable proximal neck anatomy. In patients with hostile neck, EndoAnchors provide proximal fixation and reduces potential type I endoleak or endograft migration. However, the population size for AAA patients with hostile anatomic neck among Korean is unknown and cost-analysis with regard to EndoAnchors has not been established.Methods:To figure out the population size of AAA patients with hostile neck anatomy, retrospective medical chart review was conducted from four major medical centers. Hostile proximal aortic neck was defined as any or all of neck length 28 mm, infrarenal neck angulation >60°, ≥50 percent of circumferential thrombus, ≥50 percent of calcified neck, and conical neck. Cost-analysis on EndoAnchor use for treatment purpose was conducted based on Korean National Health Insurance Claims dataset (HIRA-NIS 2015).Results:Two-hundred and ten patients’ anatomic data treated with EVAR were included; 130 (61.9 percent) patients met the criteria for a hostile aortic neck and 32 (15.2 percent) patients had multiple hostile anatomy parameters. Endograft migration was reported in four (1.9 percent) patients and intra or post-op type I endoleak was reported in 21 (10.0 percent) patients. Based on 1-year claims data, 1,607 patients were treated with EVAR in 2015 and the annual average medical costs for open repair were USD 16,151. Given the patients with type I endoleak or endograft migration needs open repair if not treated with EndoAnchors, the estimated annual costs for patients treated with EndoAnchor were USD 2,234,321 and those for patients without EndoAnchor were USD 2,595,508, therefore USD 361,187 can be saved annually.Conclusions:The population size with hostile aortic neck in Korea was comparable with those in western countries. Economically, EndoAnchor is a cost-saving treatment for type I endoleak and migration after EVAR from Korean payer.

scholarly journals Endotension: twenty years of a controversial term

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Álvaro Torres-Blanco ◽  
Manuel Miralles-Hernández
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Experimental Studies ◽  
Low Flow ◽  
Type I ◽  
Type Ii ◽  
Flow Type ◽  
Aneurysm Wall ◽  
Attachment Sites

AbstractUse of the term endotension in the treatment of aortic aneurysm is currently controversial. Initially it was proposed to define the circumstance in which there is an enlargement of the aneurysm sac after endovascular repair without a demonstrable endoleak. The term was established with the aim of transmitting the possibility of causes other than pressure applying stress to the aneurysm wall. Twenty years have passed since the proposal of this terminology was published. The literature is reviewed with the purpose of providing an update on advances in the knowledge of the possible etiological mechanisms. The experimental studies call into question that causes other than pressure determine the increase of the aneurysm. On the basis of this review, the term `Sac Expansion Without Evident Leak´ (SEWEL) is proposed as a more accurate and precise denomination for what is aimed to be defined. Evidence suggests that the more likely mechanisms of persistent pressurization of the aneurysm sac are an unidentified endoleak (likely type I or low-flow Type II) or thrombus occluding wide and short channels that connects with the excluded aneurysm sac (at the attachment sites of the stent-graft or at the branch vessels orifices).

Matched-Pair Analysis of Conventional versus Endoluminal AAA Treatment Outcomes during the Initial Phase of an Aortic Endografting Program

2000 ◽  
Vol 7 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Tina U. Cohnert ◽  
Frank Oelert ◽  
Thorsten Wahlers ◽  
Bernhard Gohrbandt ◽  
Ajay Chavan ◽  
...  
Keyword(s):  
Perioperative Period ◽  
Matched Pair ◽  
Control Group ◽  
Type I ◽  
Type Ii ◽  
Stent Grafts ◽  
Infrarenal Aortic Aneurysm ◽  
Matched Pair Analysis ◽  
Type I Endoleak

Purpose: To investigate whether endovascular stent-grafts implanted during the early phase of an aortic endografting program have advantages over conventional surgical procedures for treatment of infrarenal aortic aneurysm (AAA). Methods: In the first months of an endografting program, 37 patients (36 men; mean age 67.9 ± 7.1 years, range 55 to 86) underwent AAA repair with endovascular implantation of a Vanguard (n = 17) or Talent (n = 20) bifurcated stent-graft. Data collected during the perioperative period and in follow-up were compared retrospectively to a matched group of 37 elective surgical patients. Results: All endograft implantations were completed. Two type I and 6 type II endoleaks (21.6%) were seen postoperatively. Five type II sealed without intervention; 1 type I endoleak was corrected with an additional stent, but 1 type I and 1 type II endoleaks persisted despite attempts with coil embolization. Two (5.4%) endograft patients died during the perioperative period; however, this was not significantly different (p = 0.15) from the control group. In the mean follow-up of 12 ± 6 months for both groups, 1 (2.7%) late conversion was necessary at 2 years for aneurysm expansion in an endograft patient with an unsealed type I endoleak. Conclusions: In our learning curve experience with aortic endografting, postoperative morbidity and mortality were higher in endograft patients compared to conventionally treated controls. Only in the endograft group was reoperation required during follow-up. Careful monitoring with periodic imaging studies is mandatory after endoluminal AAA treatment.

Homemade Fenestrated Stent-Grafts for Complete Endovascular Repair of Aortic Arch Dissections

2019 ◽  
Vol 26 (5) ◽  
pp. 645-651 ◽  
Author(s):  
Ludovic Canaud ◽  
Baris Ata Ozdemir ◽  
Lucien Chassin-Trubert ◽  
Julien Sfeir ◽  
Pierre Alric ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Covered Stent ◽  
Type I ◽  
Type Ii ◽  
Stent Grafts ◽  
Fenestrated Stent Graft ◽  
Type I Endoleak

Purpose: To evaluate outcomes of homemade fenestrated stent-grafts for complete endovascular aortic repair of aortic arch dissections. Materials and Methods: From July 2014 through September 2018, 35 patients (mean age 66±11 years; 25 men) underwent homemade fenestrated stent-graft repair of acute (n=16) or chronic (n=10) complicated type B aortic dissections (n=16) and dissecting aortic arch aneurysms subsequent to surgical treatment of acute type A dissections (n=9). Nineteen (54%) procedures were emergent. Results: Zone 2 single-fenestrated stent-grafts were used in 25 cases; the remaining 10 were double-fenestrated stent-grafts deployed in zone 0. Median time for stent-graft modification was 18 minutes (range 16–20). Technical success was achieved in all cases. An immediate distal type I endoleak was treated intraoperatively. Among the double-fenestrated stent-graft cases, the left subclavian artery fenestration could not be cannulated in 2 patients and revascularization was required. Partial coverage of the left common carotid artery necessitated placement of a covered stent in 3 cases. One (3%) patient had a stroke without permanent sequelae. Two type II endoleaks required additional covered stent placement at 5 and 7 days postoperatively, respectively. The 30-day mortality was 6% (2 patients with ruptured aortic arch aneurysm). During a mean follow-up of 17.6±13 months, there was no aortic rupture or retrograde dissection. One late type I endoleak was treated with additional proximal fenestrated stent-graft placement. One type II endoleak is currently under observation. One additional patient died (unrelated to the aorta); overall mortality was 9%. All supra-aortic trunks were patent. Conclusion: The use of homemade fenestrated stent-grafts for endovascular repair of aortic arch dissections is feasible and effective for total endovascular aortic arch repair. Durability concerns will need to be assessed in additional studies with long-term follow-up.

scholarly journals Occult type I or III endoleaks are a common cause of failure of type II endoleak treatment after endovascular aortic repair

2019 ◽  
Vol 69 (2) ◽  
pp. 432-439 ◽  
Author(s):  
Michael C. Madigan ◽  
Michael J. Singh ◽  
Rabih A. Chaer ◽  
Georges E. Al-Khoury ◽  
Michel S. Makaroun
Keyword(s):  
Endovascular Aortic Repair ◽  
Type I ◽  
Type Ii ◽  
Type Ii Endoleak ◽  
Common Cause ◽  
Aortic Repair ◽  
Cause Of Failure

Preoperative Embolization of Collateral Side Branches: A Valid Means to Reduce Type II Endoleaks after Endovascular AAA Repair

2003 ◽  
Vol 10 (2) ◽  
pp. 227-232 ◽  
Author(s):  
Robert Bonvini ◽  
Mario Alerci ◽  
Francesco Antonucci ◽  
Paolo Tutta ◽  
Rolf Wyttenbach ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Mesenteric Arteries ◽  
Preoperative Embolization ◽  
Type I ◽  
Type Ii ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Type Ii Endoleak

Purpose: To report the results of preprocedural embolization of collateral branches arising from abdominal aortic aneurysms (AAA) scheduled for endovascular repair. Methods: Twenty-three consecutive AAA patients (all men; mean age 73 years, range 56–82) had coil embolization of patent lumbar and inferior mesenteric arteries (IMA) in a staged procedure prior to endovascular repair. Embolization with microcoils was attempted in 37 of the 52 identified lumbar arteries and 14 of 15 inferior mesenteric arteries. Follow-up included biplanar abdominal radiography, spiral computed tomography, and duplex ultrasonography at 1, 30, 90, and 180 days after the stent-graft procedure and at 6-month intervals thereafter. Results: Successful embolization was obtained in 24 (65%) of lumbar arteries, while all 14 (100%) IMAs were occluded with coils. No complication was associated with embolotherapy. Over a mean 17-month follow-up of 22 patients (1 intraoperative death), there was only 1 (4.5%) type II endoleak from a patent lumbar artery, with no sac expansion after 2 years. There were 4 (18%) type I and 1 (4.5%) type III endoleaks. Conclusions: The embolization of side branches arising from an infrarenal aortic aneurysm before endovascular repair is feasible, with a high success rate; this maneuver may play a relevant role in reducing the rate of type II endoleak, improving long-term outcome.

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