scholarly journals Short- and Midterm Outcomes of Open Repair and Fenestrated Endografting of Pararenal Aortic Aneurysms in a Concurrent Propensity-Adjusted Comparison

2018 ◽  
Vol 26 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Beatrice Fiorucci ◽  
Francesco Speziale ◽  
Tilo Kölbel ◽  
Nikolaos Tsilimparis ◽  
Pasqualino Sirignano ◽  
...  
Keyword(s):  
Survival Rates ◽  
Endovascular Aneurysm Repair ◽  
High Volume ◽  
Artery Occlusion ◽  
Aortic Aneurysms ◽  
Visceral Artery ◽  
Cardiac Complications ◽  
Systemic Complications ◽  
Perioperative Morbidity ◽  
Vessel Patency

Purpose: To compare outcomes of patients treated for pararenal aortic aneurysms using fenestrated endovascular aneurysm repair (fEVAR) vs open surgical repair (OSR) in 3 high-volume centers. Materials and Methods: A multicenter retrospective analysis was conducted of 200 pararenal abdominal aortic aneurysm patients electively treated with OSR (n=108) or fEVAR (n=92) from 1998 to 2015 at 3 tertiary institutions. Endpoints were 30-day morbidity and mortality, late reinterventions, visceral artery occlusion, and mortality. Analysis was conducted on the entire population and on a propensity score–matched population constructed on age, gender, coronary artery disease (CAD), and chronic renal failure. Results: In the total cohort, fEVAR patients were significantly (p<0.001) older and had higher frequencies of CAD (p<0.001) and previous stroke (p=0.003). OSR patients had higher risk of perioperative morbidity (OR 2.5, 95% CI 1.09 to 5.71, p=0.033), specifically respiratory failure (OR 4.06, 95% CI 1.12 to 4.72, p=0.034). These findings were confirmed in the propensity-adjusted analysis, where cardiac complications were also higher after OSR (OR 12.8, 95% CI 0.07 to 0.21, p=0.02). No difference in perioperative mortality (2.2% in fEVAR vs 1.9% in OSR) was identified. Mean follow-up was 50 months (range 0–119). Four-year results showed higher survival (91.2% vs 69.3%, p=0.02) and freedom from reintervention (95.6% vs 77.8%, p=0.01) after OSR in the unmatched population, with a small but significant (p=0.021) difference in the risk of late visceral artery occlusion/stenosis after fEVAR. On propensity analysis, no differences in late survival were found between groups. Conclusion: fEVAR and OSR may afford similar early and midterm survival rates. Higher risks of perioperative systemic complications after OSR are counterbalanced by higher risks of late visceral vessel patency issues and need for reintervention after fEVAR. Both procedures are safe and effective in the long term in experienced centers, where patient evaluation should drive the treatment strategy.

Acute Kidney Injury after Complex Endovascular Aneurysm Repair

2020 ◽  
Vol 25 (44) ◽  
pp. 4686-4694 ◽  
Author(s):  
Nathan L. Liang ◽  
Abhisekh Mohapatra ◽  
Efthymios D. Avgerinos ◽  
Athanasios Katsargyris
Keyword(s):  
Acute Kidney Injury ◽  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Associated Factors ◽  
Endovascular Aneurysm Repair ◽  
Kidney Injury ◽  
Aortic Aneurysms ◽  
Perioperative Morbidity ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Background: Complex endovascular repair of abdominal aortic aneurysm carries higher perioperative morbidity than standard infrarenal endovascular repair. Objective: This study reviews the incidence and associated factors of acute kidney injury in complex aortic endovascular repair of juxtarenal, pararenal, and thoracoabdominal aortic aneurysms. Methods: A literature review was performed for all studies on the endovascular repair of juxtarenal, pararenal, and thoracoabdominal aneurysms that evaluated rates of acute kidney injury as an outcome. Outcomes were further analyzed by the level of anatomic complexity and method of repair. Results: 52 studies met inclusion criteria, with a total of 5454 individuals undergoing repair from 2004 to 2017. The overall rate of acute kidney injury ranged widely from 0 to 41%, with a rate of hemodialysis from 0 to 19% (temporary) and 0 to 14% (permanent). Increasing anatomic complexity was associated with higher rates of acute kidney injury. Mode of endovascular repair, learning curve effect, and preoperative chronic renal insufficiency did not demonstrate any associations with the outcome. Conclusion: Published rates of acute kidney injury in complex aortic aneurysm repair vary widely with few definitively associated factors other than increasing anatomic complexity and operative time. Further study is needed for the identification of predictors related to postoperative acute kidney injury.

Chimney Endovascular Aneurysm Repair Using Endurant Stent-Grafts With Bare Balloon-Expandable Stents for Patients With Juxtarenal Aortic Aneurysms

2019 ◽  
Vol 26 (3) ◽  
pp. 350-358 ◽  
Author(s):  
Noriyasu Morikage ◽  
Takahiro Mizoguchi ◽  
Yuriko Takeuchi ◽  
Takashi Nagase ◽  
Makoto Samura ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Covered Stents ◽  
Acute Renal Dysfunction ◽  
Systemic Complications ◽  
Proximal Neck ◽  
Type Ia ◽  
The Mean ◽  
Aneurysm Repair ◽  
Aneurysm Diameter

Purpose: To evaluate the advantages of chimney endovascular aneurysm repair (chEVAR) using an Endurant stent-graft with uncovered balloon-expandable stents (BES) for patients with juxtarenal aortic aneurysms. Materials and Methods: Twenty-two patients (mean age 78.5±9.0 years; 13 men) who underwent chEVAR using Endurant and uncovered BES between January 2014 and December 2017 were analyzed retrospectively. The maximum aneurysm diameter was 59.1±11.9 mm, and the proximal neck length was 5.2±2.9 mm. Of the 22 cases, 9 (40%) involved proximal neck angulation and 9 (40%) had a conical neck. Single and double chimneys were performed using BES in 19 and 3 cases, respectively. In 2 cases, an additional self-expanding covered stent was used inside the uncovered BES. Results: The technical success was 91% (20/22) as 2 (9%) cases showed minor type Ia endoleak. No postoperative systemic complications or acute renal dysfunction (Acute Kidney Injury Network classification stage 2 or higher) were observed. The mean radiologic observation period was 16.1±9.6 months, and no aneurysm expansion (>5 mm) was observed during this time. The mean maximum aneurysm diameter decreased to 52.9±10.2 mm (p<0.001 vs preoperative), with an individual mean sac regression of 6.2±5.9 mm. Overall primary chimney stent patency was 100%. One of the 2 cases of intraoperative type Ia endoleak resolved at the 6-month imaging, and no new type Ia endoleaks developed in any cases at follow-up. No additional treatment- or aneurysm-related events were observed. Conclusion: Short-term outcomes of chEVAR using Endurant with uncovered BES have been favorable when covered stents were unavailable, and it can be useful for high-risk patients with juxtarenal aortic aneurysms.

scholarly journals Graft Complexity–Related Outcomes of Fenestrated Endografting for Abdominal Aortic Aneurysms

2017 ◽  
Vol 24 (2) ◽  
pp. 230-236 ◽  
Author(s):  
Kyriakos Oikonomou ◽  
Piotr Kasprzak ◽  
Wilma Schierling ◽  
Reinhard Kopp ◽  
Karin Pfister
Keyword(s):  
Operative Mortality ◽  
Perioperative Complications ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Target Vessel ◽  
Technical Success ◽  
Midterm Results ◽  
Significant Difference ◽  
Vessel Patency

Purpose: To report the outcomes of fenestrated endovascular aneurysm repair (FEVAR) and compare early and midterm results in relation to stent-graft complexity. Methods: Between August 2006 and December 2014, 141 consecutive patients (mean age 72±7.6 years, range 50–89; 120 men) were treated electively with FEVAR for short-neck, juxtarenal, or suprarenal aortic aneurysms. Forty-five patients treated with stent-grafts featuring renal-only fenestrations were assigned to group A, while 96 patients receiving additional fenestrations for the superior mesenteric and/or celiac arteries were assigned to group B. Technical success, operative mortality and morbidity, target vessel patency, endoleak, reintervention, and survival were compared between the groups. Survival, target vessel stent patency, and reintervention during follow-up were estimated by Kaplan-Meier analysis; the estimates are presented with the 95% confidence interval (CI). Results: Technical success was achieved in 135 (95.7%) patients. Overall 30-day operative mortality was 3.5% (5/141). Perioperative complications occurred in 16 (12.1%) patients. Mean follow-up was 33±23 months. Overall estimated survival was 85.1% (95% CI 79.1% to 91.1%) at 1 year and 75.8% (95% CI 68.2% to 83.5%) at 3 years. Freedom from reintervention was 90.6% (95% CI 85.6% to 95.6%) at 1 year and 79.2% (95% CI 71% to 87.5%) at 3 years. There was no statistically significant difference between the groups in terms of perioperative mortality or morbidity, endoleak, survival, target vessel patency, or reintervention. Conclusion: The use of FEVAR for juxta- and suprarenal aneurysms is associated with low 30-day mortality/morbidity and high midterm efficacy. So far, perioperative and midterm results are not affected by the use of more complex fenestrated designs.

Abstract 41: Designation as “Unfit For Open Repair” is Associated with Poor Outcomes Following Endovascular Aneurysm Repair

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Randall R De Martino ◽  
Benjamin J Brooke ◽  
William P Robinson ◽  
Brian W Nolan ◽  
Jack L Cronenwett ◽  
...  
Keyword(s):  
New England ◽  
Open Repair ◽  
Endovascular Aneurysm Repair ◽  
Cox Proportional Hazards ◽  
Aortic Aneurysms ◽  
Cardiac Complications ◽  
Risk Of Rupture ◽  
Short And Long Term ◽  
Aneurysm Repair

Objective: Endovascular aneurysm repair (EVAR) is a minimally invasive method of repair for abdominal aortic aneurysms (AAA) with a lower perioperative morbidity and mortality compared to open repair (oAAA). In many cases, EVAR is offered to patients who otherwise are not candidates for oAAA. This study attempts to describe the short and long term outcomes of patients undergoing EVAR who are consideredunfit for oAAA with moderate sized aneurysms (<6..5cm diameter). Methods: We analyzed 1,653 elective EVARs within the Vascular Study Group of New England (2003-2011), a regional quality improvement collaborative across 21 hospitals and 87 surgeons in New England. Endpoints included in-hospitalmajor adverse events (MAEs) and one, three, and five-year mortality. Logistic regression was used to develop a prediction model for being deem unfit for open repair. Multivariate predictors of survival were determined using Cox Proportional Hazards. Results: Of 1,653 EVARs, 309 (18.7%) were performed in patients deemed unfit for open repair. These patients were more likely to be over 80 years of age, have advanced cardiac disease,COPD, and a larger aneurysms. Patients deemed unfit for open repair had andhigher rates of cardiac complications (7.8% vs 3.1%, p<0.01) and pulmonary complications (3.6 vs. 1.6, p<0..01). Patients unfit for open repair had poorer survival rates at 1 (93% vs.. 96%), 3 (73% vs. 89%) and 5 years (61% vs. 80%) compared to those appropriate for open repair (logrank p<0.01). The effect of "unfit for open" designation remained significant (HR 1.6, 96% CI 1.2-2.2, p<0.01), even when adjusted for patient characteristics and aneurysm size. Conclusions: Clinical provider assessment provides insight into both short and long-term efficacy of EVAR, even when adjusting for age and comorbidities. Patients in whom open repair is felt to be too "high-risk" may not benefit from EVAR unless their risk of rupture is very high.

scholarly journals Characterising the incidence and mode of visceral stent failure after fenestrated endovascular aneurysm repair (FEVAR)

2021 ◽  
Vol 10 ◽  
pp. 204800402110125
Author(s):  
Shaneel R Patel ◽  
Iain N Roy ◽  
Richard G McWilliams ◽  
John A Brennan ◽  
Srinivasa R Vallabhaneni ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
High Volume ◽  
Visceral Artery ◽  
Main Body ◽  
Covered Stents ◽  
Modes Of Failure ◽  
Type Iiia ◽  
Kaplan Meier ◽  
Aneurysm Repair ◽  
Stent Complications

Background In FEVAR, visceral stents provide continuity and maintain perfusion between the main body of the stent and the respective visceral artery. The aim of this study was to characterise the incidence and mode of visceral stent failure (type Ic endoleak, type IIIa endoleak, stenosis/kink, fracture, crush and occlusion) after FEVAR in a large cohort of patients at a high-volume centre. Methods A retrospective review of visceral stents placed during FEVAR over 15 years (February 2003-December 2018) was performed. Kaplan-Meier analyses of freedom from visceral stent-related complications were performed. The outcomes between graft configurations of varying complexity were compared, as were the outcomes of different stent types and different visceral vessels. Results Visceral stent complications occurred in 47/236 patients (19.9%) and 54/653 stents (8.3%). Median follow up was 3.7 years (IQR 1.7–5.3 years). There was no difference in visceral stent complication rate between renal, SMA and coeliac arteries. Visceral stent complications were more frequent in more complex grafts compared to less complex grafts. Visceral stent complications were more frequent in uncovered stents compared to covered stents. Visceral stent-related endoleaks (type Ic and type IIIa) occurred exclusively around renal artery stents. The most common modes of failure with SMA stents were kinking and fracture, whereas with coeliac artery stents it was external crush. Conclusion Visceral stent complications after FEVAR are common and merit continued and close long-term surveillance. The mode of visceral stent failure varies across the vessels in which the stents are located.

scholarly journals CT angiography for the assessment of EVAR complications: a pictorial review

2022 ◽  
Vol 13 (1) ◽  
Author(s):  
Cecilia Gozzo ◽  
Giovanni Caruana ◽  
Roberto Cannella ◽  
Arduino Farina ◽  
Dario Giambelluca ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Technique ◽  
Aortic Aneurysms ◽  
High Rate ◽  
Invasive Treatment ◽  
Systemic Complications ◽  
Pictorial Review ◽  
Risk Of Rupture ◽  
Long Term Follow Up

AbstractEndovascular aneurysm repair (EVAR) is a minimally invasive treatment proposed as an alternative to open repair in patients with abdominal aortic aneurysms. EVAR consists in a stent-graft placement within the aorta in order to exclude the aneurysm from arterial circulation and reduce the risk of rupture. Knowledge of the various types of devices is mandatory because some stents/grafts are more frequently associated with complications. CT angiography is the gold standard diagnostic technique for preprocedural planning and postprocedural surveillance. EVAR needs long-term follow-up due to the high rate of complications. Complications can be divided in endograft device-related and systemic complications. The purpose of this article is to review the CT imaging findings of EVAR complications and the key features for the diagnosis.

Parallel stent grafts for the treatment of complex aortic aneurysms: A single center study

Vascular ◽  
2018 ◽  
Vol 26 (5) ◽  
pp. 490-497 ◽  
Author(s):  
Daniel Silverberg ◽  
Uri Rimon ◽  
Daniel Raskin ◽  
Avner BarDayan ◽  
Moshe Halak
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Primary Patency ◽  
Aortic Aneurysms ◽  
Single Center ◽  
Technical Success ◽  
Perioperative Morbidity ◽  
Single Center Experience ◽  
Invasive Techniques ◽  
Aneurysm Repair

Background “Chimney” techniques with parallel grafts used in order to extend the landing zones in endovascular aneurysm repair (ch-EVAR) are increasingly being reported. Conflicting data has been reported regarding the success and durability of the repair. We report a single center experience using ch-EVAR in treating complex aortic pathologies. Methods We performed a retrospective review of all patients treated with ch-EVAR in our institution between 2013 and 2017. Data collected included patients demographics, indications for surgery, configuration of parallel grafts, technical success, and perioperative morbidity and mortality. Follow-up data included aortic sac size, reintervention rate, and overall mortality. Results Thirty-five patients underwent treatment of their aneurysms with parallel grafts. Sixty parallel grafts were placed. Mean age was 75 years (range 59–93) and 30 (85%) were male. Technical success was achieved in 32 (91%) patients. Mean follow up was 12 months. Sac size decreased in diameter or remained unchanged in 26 of the 30 (86.6%) patients. Four patients were found to have enlarging aneurysms due to gutter endoleaks. All were treated successfully with endovascular methods. The estimated primary patency was 95% at 12 months. Probability of freedom from intervention was 75% at 12 months. No late aneurysm related mortality occurred. Conclusion The use of ch-EVAR in treating complex aortic aneurysms is technically feasible and safe. Gutter endoleaks are encountered only in a minority of the cases, and can be treated with minimally invasive techniques. Longer term follow up is required to evaluate the patency of these parallel grafts and the durability of the aneurysm exclusion.

The great choke, Ovation® aortic body graft stenosis

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 359-362
Author(s):  
Ahmad Alsheekh ◽  
Afsha Aurshina ◽  
Jesse Chait ◽  
Anil Hingorani ◽  
Enrico Ascher
Keyword(s):  
Stent Graft ◽  
Survival Rates ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Graft Stenosis ◽  
Low Profile ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Recovery Times ◽  
Aneurysm Repair

Introduction Abdominal endovascular aneurysm repair is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms that results in reduced recovery times and early survival rates. Methods The TriVascular Ovation® Abdominal Stent Graft System is a low-profile endovascular device with active fixation used for endovascular aneurysm repair. The stent graft is designed to reline the diseased vasculature, providing an endovascular blood conduit for isolating the aneurysm from the high-pressure flow of blood, thereby reducing the risk of rupture. The stent graft is a modular configuration comprised of an aortic body section, iliac limbs, and iliac extensions as required. Results and Conclusion: We present a case of symptomatic aortic body graft stenosis in the unsupported segment below the O-rings, 26 months after the treatment of abdominal aortic aneurysm with Ovation® Abdominal Stent Graft System. The successful repair was performed by ballooning the stenotic area which resulted in complete resolution of the symptoms.

scholarly journals Fenestrated Endovascular Aneurysm Repair (FEVAR) for Juxtarenal Abdominal Aortic Aneurysms (AAAs): A Community Based Experience

2020 ◽  
Vol 3 ◽  
Author(s):  
Paul Bojrab ◽  
Douglas Gray ◽  
Kim Recht
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Artery Occlusion ◽  
Study Data ◽  
Aortic Aneurysms ◽  
Future Research ◽  
Fisher Exact Test ◽  
Complication Rates ◽  
Exact Test ◽  
Abdominal Aortic

Background and Hypothesis:  Rupture of abdominal aortic aneurysms (AAAs) comprise an estimated 4-5% of all sudden deaths. Half of all patients with ruptured AAAs never make it to the hospital. Of those who make it and receive emergent surgery, the mortality rate is still near 50%. Improved screening protocols and diagnostics tools have enhanced detection, monitoring, and if needed, repair of AAAs before rupture. Due to anatomical constraints, juxtarenal AAAs cannot be repaired using standard endovascular endograft repair (EVAR). A newer fenestrated EVAR (FEVAR) must be performed; however, it carries a higher risk for complications. This study will assess the complication rates and outcomes following FEVAR for juxtarenal AAAs at Parkview Heart Institute (PHI). We hypothesize that incidence of renal artery occlusion, limb occlusion, and endoleak will be consistent with those published in the literature and that the occurrence of these adverse effects has a significant effect on patient outcomes.  Methods:  The study is a retrospective review of the electronic medical records (EPIC) of PHI patients who underwent FEVAR for juxtarenal AAAs. Ruptured aneurysms and minors will be excluded. REDCap will be used for study data management. Patient demographics, medical history, hospital course, complication data, and follow-up visits will be analyzed. Analysis may include χ² test, Fisher exact test, Kaplan-Meier estimator, and two sample t-tests or the Mann–Whitney U tests.  Results:  This project resulted in a protocol and REDCap data collection tool for IRB submission. The researchers are seeking Parkview Health IRB approval in Fall 2020, with an anticipated study start date of Spring 2021.  Potential Impact:  This project will add to the current research on reintervention, complication, and morality rates for FEVAR for juxtarenal AAAs. Directions for future research include refining indications for FEVAR and evaluation of long-term outcomes compared to open repair.  

Sign in / Sign up

Export Citation Format

Share Document