A Systematic Review of Proximal Neck Dilatation After Endovascular Repair for Abdominal Aortic Aneurysm

2016 ◽  
Vol 24 (1) ◽  
pp. 59-67 ◽  
Author(s):  
George N. Kouvelos ◽  
Kyriakos Oikonomou ◽  
George A. Antoniou ◽  
Eric L. G. Verhoeven ◽  
Athanasios Katsargyris
Keyword(s):  
English Language ◽  
Endovascular Aneurysm Repair ◽  
Current Evidence ◽  
Considerable Proportion ◽  
Type I ◽  
Surveillance Strategy ◽  
Aortic Neck ◽  
Full Text Review ◽  
Type I Endoleak ◽  
Aneurysm Repair

Purpose: To provide an updated systematic literature review and summarize current evidence on proximal aortic neck dilatation (AND) after endovascular aneurysm repair (EVAR). Methods: A review of the English-language medical literature from 1991 to 2015 was conducted using MEDLINE and EMBASE to identify studies reporting AND after EVAR. Studies considered for inclusion and full-text review fulfilled the following criteria: (1) reported AND after EVAR, (2) included at least 5 patients, and (3) provided data on AND quantification. The search identified 26 articles published between 1998 and 2015 that encompassed 9721 patients (median age 71.8 years; 9439 men). Results: AND occurred in 24.6% of patients (95% CI 18.6% to 31.8%) over a period ranging from 15 months to 9 years after EVAR. No significant dilatation of the suprarenal part of the aorta was reported by most studies. The incidence of combined clinical events (endoleak type I, migration, reintervention during follow-up) was higher in the AND group (26%) when compared with 2% in the group without AND (OR 28.7, 95% CI 5.43 to 151.67, p<0.001). Conclusion: AND affects a considerable proportion of EVAR patients and was related to worse clinical outcome, as indicated by increased rates of type I endoleak, migration, and reinterventions. Future studies should focus on a better understanding of the pathophysiology, predictors, and risk factors of AND, which could identify patients who may warrant a different EVAR strategy and/or a closer post-EVAR surveillance strategy.

scholarly journals Type I Endoleak Post-Endovascular Aneurysm Repair, Successfully Treated With Excluder Cuff and Fixation Screws

2018 ◽  
Vol 11 (1) ◽  
pp. e5-e6 ◽  
Author(s):  
Omar A. Ayah ◽  
Jordan Klein ◽  
Muhammad Raza ◽  
Daniel J. McCormick
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Type I ◽  
Type I Endoleak ◽  
Aneurysm Repair

Initial Clinical Experience Using the Low-Profile Altura Endograft System With Double D-Shaped Proximal Stents for Endovascular Aneurysm Repair

2018 ◽  
Vol 25 (3) ◽  
pp. 379-386 ◽  
Author(s):  
Dainis Krievins ◽  
Albrecht Krämer ◽  
Janis Savlovskis ◽  
Georgij Oszkinis ◽  
E. Sebastian Debus ◽  
...  
Keyword(s):  
Clinical Investigation ◽  
Clinical Success ◽  
Endovascular Aneurysm Repair ◽  
Clinical Results ◽  
Type I ◽  
Midterm Outcome ◽  
Early Results ◽  
Low Profile ◽  
Type I Endoleak ◽  
Aneurysm Repair

Purpose: To report the initial clinical results of endovascular aneurysm repair (EVAR) using the low-profile (14-F) Altura Endograft System, which features a double “D-shaped” stent design with suprarenal fixation and modular iliac components that are deployed from distal to proximal. Methods: From 2011 to 2015, 90 patients (mean age 72.8±8.3 years; 79 men) with abdominal aortic aneurysm (AAA; mean diameter 53.8±5.7 mm) were treated at 10 clinical sites in 2 prospective, controlled clinical studies using the Altura endograft. Outcomes evaluated included mortality, major adverse events (MAEs: all-cause death, stroke, paraplegia, myocardial infarction, respiratory failure, bowel ischemia, and blood loss ≥1000 mL), and clinical success (freedom from procedure-related death, type I/III endoleak, migration, thrombosis, and reintervention). Results: Endografts were successfully implanted in 89 (99%) patients; the single failure was due to delivery system malfunction before insertion in the early-generation device. One (1%) patient died and 4 patients underwent reinterventions (1 type I endoleak, 2 iliac limb stenoses, and 1 endograft occlusion) within the first 30 days. During a median follow-up of 12.5 months (range 11.5–50.9), there were no aneurysm ruptures, surgical conversions, or AAA-related deaths. The cumulative MAE rates were 3% (3/89) at 6 months and 7% (6/89) at 1 year. Two patients underwent coil embolization of type II endoleaks at 6.5 months and 2.2 years, respectively. Clinical success was 94% (84/89) at 30 days, 98% (85/87) at 6 months, and 99% (82/83) at 1 year. Conclusion: Early results suggest that properly selected AAA patients can be safely treated using the Altura Endograft System with favorable midterm outcome. Thus, further clinical investigation is warranted to evaluate the role of this device in the treatment of AAA.

Type IIIb Endoleak After Endovascular Aneurysm Repair Using the Zenith Stent Graft

2019 ◽  
Vol 53 (6) ◽  
pp. 515-519
Author(s):  
Toshiya Nishibe ◽  
Toru Iwahashi ◽  
Kentaro Kamiya ◽  
Masaki Kano ◽  
Keita Maruno ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aneurysm Rupture ◽  
Type I ◽  
Stent Grafts ◽  
System Type ◽  
Type Iiib ◽  
Type I Endoleak ◽  
Aneurysm Repair

We present 3 cases of type IIIb endoleak after endovascular aneurysm repair (EVAR) using the Zenith stent graft system. Type III endoleak, like type I endoleak, is a high-pressure, high-risk leak that increases sac pressure up to or even above arterial pressure, and is associated with an increased frequency of open conversions or risk of aneurysm rupture. Type IIIb endoleak is rare but there is much concern that the incidence of type IIIb endoleak is likely to increase hereafter; the mechanism of type IIIb endoleak is deterioration of graft fabric in conjunction with stent sutures. Type IIIb endoleak is difficult to diagnose before rupture. The possibility of type IIIb endoleak should be highly suspected when the continued growth of an excluded aneurysm sac without direct radiologic evidence is observed during follow-up. Type IIIb endoleak can be repaired by relining of the stent graft with additional stent grafts.

The use of thoracic stent grafts for endovascular repair of abdominal aortic aneurysms

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 278-284 ◽  
Author(s):  
VP Bastiaenen ◽  
MGJ Snoeijs ◽  
JGAM Blomjous ◽  
J Bosma ◽  
VJ Leijdekkers ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Stent Grafts ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Median Diameter ◽  
Aneurysm Repair

Objectives Stent grafts for endovascular repair of infrarenal aneurysms are commercially available for aortic necks up to 32 mm in diameter. The aim of this study was to evaluate the feasibility of endovascular repair with large thoracic stent grafts in the infrarenal position to obtain adequate proximal seal in wider necks. Methods All patients who underwent endovascular aneurysm repair using thoracic stent grafts with diameters greater than 36 mm between 2012 and 2016 were included. Follow-up consisted of CT angiography after six weeks and annual duplex thereafter. Results Eleven patients with wide infrarenal aortic necks received endovascular repair with thoracic stent grafts. The median diameter of the aneurysms was 60 mm (range 52–78 mm) and the median aortic neck diameter was 37 mm (range 28–43 mm). Thoracic stent grafts were oversized by a median of 14% (range 2–43%). On completion angiography, one type I and two type II endoleaks were observed but did not require reintervention. One patient experienced graft migration with aneurysm sac expansion and needed conversion to open repair. Median follow-up time was 14 months (range 2–53 months), during which three patients died, including one aneurysm-related death. Conclusions Endovascular repair using thoracic stent grafts for patients with wide aortic necks is feasible. In these patients, the technique may be a reasonable alternative to complex endovascular repair with fenestrated, branched, or chimney grafts. However, more experience and longer follow-up are required to determine its position within the endovascular armamentarium.

scholarly journals Safety of EndoAnchors in real-world use: A report from the Manufacturer and User Facility Device Experience database

Vascular ◽  
2019 ◽  
Vol 27 (5) ◽  
pp. 495-499 ◽  
Author(s):  
Reza Masoomi ◽  
Emily Lancaster ◽  
Alexander Robinson ◽  
Ethan Hacker ◽  
Zvonimir Krajcer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Real World ◽  
Endovascular Aneurysm Repair ◽  
The United States ◽  
Type I ◽  
Fda Approval ◽  
User Facility ◽  
The Usa ◽  
Type I Endoleak ◽  
Aneurysm Repair

Objectives A hostile proximal neck anatomy is the most common cause of abdominal aorta endovascular aneurysm repair failure leading to a higher risk of device migration, proximal type I endoleak, and subsequent open surgical repair. Endostapling is a technique to attain better fixation of the endograft to the aortic wall, and the only available device in the USA is Aptus Heli-FX EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA). Preliminary data have shown efficacy and safety of its use, and the aim of this study is to assess device-related adverse events in real-world clinical use. Methods We quarried data from the publicly available Manufacturer and User Facility Device Experience database to identify Aptus Heli-FX EndoAnchor system-related adverse reports in endovascular aneurysm repair since FDA approval till August 31, 2017. An estimate of total devices implanted in the United States was quoted around 7,000 (Medtronic marketing internal data). Results Our query identified 229 separate reports, of which there were 85 adverse events (1.2% of the estimated EndoAnchor systems used). The most common adverse events were device dislodgement/fracture (65) and applicator malfunction (20). Conclusion In early post-FDA approval use in a real-world setting, the EndoAnchor system is associated with a low rate of adverse events. Device dislodgement and embolization remain the most common adverse events. With increasing use of these devices in more difficult anatomy, careful patient selection and careful attention to technique may help to reduce these events even further.

Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Yang Yaoguo ◽  
Chen Zhong ◽  
Kou Lei ◽  
Xiao Yaowen
Keyword(s):  
Aortic Aneurysm ◽  
Meta Analysis ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Type I Endoleak ◽  
Comprehensive Search ◽  
Aneurysm Repair ◽  
Related Mortality

Objective We reviewed data pertaining to fenestrated endograft technique and chimney stent repair of complex aortic aneurysm for comparative analysis of the outcomes. Methods A comprehensive search of relevant databases was conducted to identify articles in English, related to the treatment of complex aortic aneurysm with fenestrated endovascular aneurysm repair and chimney stent repair, published until January 2015. Results A total of 42 relevant studies and 2264 patients with aortic aneurysm undergoing fenestrated endovascular aneurysm repair and chimney stent repair were included in our review. A total of 4413 vessels were involved in these processes. The cumulative 30-day mortality was 2.4% and 3.2% ( p = 0.459). The follow-up aneurysm-related mortality was 1.4% and 3.2% ( p = 0.018), and target organ dysfunction was 5.0% and 4.0% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.27). A total of 156 vessels showed restenosis or occlusion after primary intervention (3.6% and 3.4% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively, p = 0.792). The cumulative type I endoleak was 2.0% (38/1884) after fenestrated endovascular aneurysm repair compared with 3.4% (13/380) after chimney stent repair ( p = 0.092), and the type II endoleak was 5.4% (102/1884) and 5.3% (20/380), respectively ( p = 0.905). Approximately, 1.1% and 1.6% increase in aneurysm was observed following fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.437). The re-intervention frequency was 205 and 19 cases after fenestrated endovascular aneurysm repair and chimney stent repair, respectively (11.7%, 5.6%, p = 0.001). Conclusions Fenestrated endovascular aneurysm repair and chimney stent repair are safe and effective in treating patients with complex aortic aneurysm. A higher aneurysm-related mortality was observed in chimney stent repair while fenestrated endovascular aneurysm repair was associated with a higher re-intervention rate.

Endograft platform does not influence aortic neck dilatation after infrarenal endovascular aneurysm repair with primary endostapling

Vascular ◽  
2020 ◽  
pp. 170853812095883
Author(s):  
Arindam Chaudhuri ◽  
Ayman Badawy
Keyword(s):  
Stainless Steel ◽  
Endovascular Aneurysm Repair ◽  
T Test ◽  
Type I ◽  
Aneurysm Neck ◽  
Aortic Neck ◽  
Aneurysm Repair ◽  
Neck Diameter ◽  
Paired T Test

Objectives Aortic endografts used for endovascular aneurysm repair (EVAR) are based on varying skeletal platforms such as stainless steel or nitinol stents, using radial force applied to seal at the aneurysm neck, and varying proximal fixation methods, applying either suprarenal or infrarenal fixation. This study assesses whether varying skeleton/fixation platforms affect neck-related outcomes after primary endostapling with Heli-FX EndoAnchors at EVAR. Methods Retrospective analysis of a prospective database of infrarenal EVAR undertaken at a single centre. Chimney-EVAR, secondary cases were excluded. Primary outcomes analysed included neck diameter evolution from pre-EVAR to latest imaging follow-up, including a comparison of stent platforms to see if there was any outcome difference between those using stainless steel or nitinol, as also freedom from type I endoleakage and migration. Secondary outcomes assessed included average number of EndoAnchors, and sac size patterns before and after EVAR. Results A total of 101 patients underwent endostapled infrarenal EVAR between September 2013 and March 2020. After exclusion of ineligible patients, 84 patients (76 male, 8 female, age 73.7 ± 7.8 years) were available for analysis. 57/27 endografts used suprarenal/infrarenal fixation, whilst 16/68 devices were based on stainless steel/nitinol platforms, respectively. Mean oversizing was higher for stainless steel/suprarenal fixation endografts ( p = 0.02). A total of 582 EndoAnchors were deployed, averaging 7 ± 2 per patient. Median neck diameter was 25 mm (IQR 22–31) with 22 necks having non-parallel morphology (conical, tapered or bubble). Median follow-up period was 28.5 (IQR 12–43) months. Neck evolution studies suggested aortic neck dilatation of 5 ± 4 mm ( p <0.001, paired T-test), independent of platforms employed ( p = NS, ANOVA). There was no endograft migration; one immediate post-EVAR endoleak settled by eight weeks. There was a mean 5.7 ± 8.2 mm sac size reduction ( p < 0.001, paired T-test). Conclusion Aortic neck dilatation occurs after EVAR with primary endostapling, but the process may be independent of stainless steel/nitinol platforms, possibly due to the attenuating effect of EndoAnchors. Adjunct aneurysm neck fixation by primary endostapling prevents migration regardless of whether suprarenal/infrarenal fixation is the primary fixative method. Device platform choice therefore may be left to the operator discretion if primary endostapling is applied at EVAR. Freedom from complications such as migration and endoleakage in the intermediate term suggests a higher level of ‘tolerance’ to aortic neck dilatation with primary endostapling. We would therefore suggest routine usage of EndoAnchors at EVAR when not otherwise contraindicated.

New morphological factor for predicting late proximal type I endoleak after endovascular aneurysm repair

2021 ◽  
Author(s):  
Hiroshi Banno ◽  
Masayuki Sugimoto ◽  
Tomohiro Sato ◽  
Shuta Ikeda ◽  
Yohei Kawai ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Type I ◽  
Type I Endoleak ◽  
Aneurysm Repair
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