Changing Aneurysmal Morphology after Endovascular Grafting: Relation to Leakage or Persistent Perfusion

Purpose: To relate changing abdominal aortic aneurysm (AAA) morphology after endovascular grafting to the presence of leakage, collateral perfusion, and other factors. Methods: Thirty-five patients who underwent successful AAA endovascular grafting were evaluated. Self-expanding Z-stents and Dacron grafts were applied in bifurcated and aortomonoiliac systems. Postoperative diameter changes were calculated from repeated spiral computed tomographic scans, angiograms, and ultrasonic phase-locked echo-tracking scans during a median 6-month follow-up (interquartile range [IQR] 3 to 12). Results: At 12 months, the diameters of completely excluded aneurysms had decreased 6 mm (IQR 2 to 11; p = 0.006). The proximal graft-anchoring stents had dilated 2 mm (IQR 0.5 to 3.3; p = 0.01). The aortic diameters immediately below the renal arteries but above the stents had not changed. Endoleakage and collateral perfusion (n = 13) were each associated with preserved aneurysm size and a 12 times higher risk of aneurysm dilation. After the leakage or the collateral perfusion had been treated, the aneurysm size decreased. Aneurysms with extensive intraluminal thrombi presented a reduced risk of leakage or perfusion. Conclusions: The diameters of endovascularly excluded AAAs decrease, except in cases of leakage or perfusion. Careful follow-up of patients with aortic endografts is necessary.

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Endovascular Abdominal Aortic Aneurysm Repair in Patients with Challenging Anatomy: Utility of the Hybrid Endograft

Vascular ◽

10.1258/rsmvasc.12.2.106 ◽

2004 ◽

Vol 12 (2) ◽

pp. 106-113 ◽

Cited By ~ 1

Author(s):

William D. Jordan ◽

Thomas C. Naslund ◽

Mark A. Adelman ◽

Gene Simoni ◽

Douglas J. Wirthlin

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Radiographic Evaluation ◽

Covered Stents ◽

Aneurysm Size ◽

Abdominal Aortic ◽

Aneurysm Repair

Commercially available aortic stent grafts differ in construction and clinical advantage such that creating hybrid endografts by combining components from different manufacturers is sometimes useful. We describe a multicenter experience using hybrid endografts to treat patients with challenging anatomy. Hospital records and office charts were reviewed from four institutions. Hybrid endografts were defined as those with two types of covered stents in continuity to treat an abdominal aortic aneurysm (AAA). Indications for hybrid grafts were defined by type of endoleak and whether an endoleak was expected or unexpected as determined by the preoperative radiographic evaluation. Endpoints include intraoperative endoleaks, late endoleaks, change in aneurysm size, and rupture. Hybrid endografts were used to treat AAA (endovascular aneurysm repair [EVAR]) in 90 patients, representing 7.9% of the total multicenter experience. In 7 patients (7.8%), a hybrid graft construction as a secondary procedure successfully corrected a type 1 endoleak. In the remaining 83 patients (92.2%), hybrid grafts were created at the time of original EVAR to treat expected challenging anatomy or unexpected endoleaks. Hybrid endografts corrected 88 (97.8%) type 1 endoleaks, but 2 patients (2.2%) persisted with a proximal type 1 leak requiring conversion. During follow-up of 1 to 24 months, computed tomography and ultrasound surveillance, available for 73 patients (81.1%), detected one unresolved distal type 1 (1.1%) and seven type 2 (7.8%) endoleaks. Aneurysm size decreased at least 0.5 cm in 23 of 50 patients (46.0%) at 6 months and in 19 of 31 patients (61.3%) at 12 months. Aneurysm size increased at least 0.5 cm in 4 of 50 patients (8.0%) at 6 months and in 1 of 31 patients (3.2%) at 12 months. There were no ruptures. Hybrid endografts have favorable early and intermediate results in the treatment of AAA. Long-term follow-up will be needed to confirm the absence of significant adverse biomaterial interaction and the effect on AAA exclusion. We advocate the use of hybrid endografts as endovascular therapy for patients whose anatomy may be unsuitable for a single endograft type.

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Ultrasound Imaging during Endovascular Abdominal Aortic Aneurysm Repair Using the Stentor Bifurcated Endograft

Journal of Endovascular Therapy ◽

10.1177/152660289700400306 ◽

1997 ◽

Vol 4 (3) ◽

pp. 272-278 ◽

Cited By ~ 3

Author(s):

Torgrim Lie ◽

Jan Lundbom ◽

Staal Hatlinghus ◽

Aage Grønningsaeter ◽

Steinar Ommedal ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Ultrasound Imaging ◽

Abdominal Aortic Aneurysm Repair ◽

Computed Tomographic ◽

Postoperative Control ◽

Abdominal Aortic ◽

2D Ultrasound ◽

Array Ultrasound

Purpose: To evaluate different ultrasound modalities during implantation and follow-up of endovascular grafts for abdominal aortic aneurysm (AAA) exclusion. Methods: Between February 1995 and May 1996, 18 patients (14 men; aged 49 to 80 years, mean 67) were treated with endovascular intervention for infrarenal AAA. Seventeen patients received Mialhe Stentor bifurcated grafts, while one patient was treated with a straight graft for pseudoaneurysm. During and after the implantation, 3.25- and 5-MHz annular array ultrasound probes were used for transabdominal visualization of the endograft. Intravascular ultrasound was applied in combination with angiography for postoperative control. Results: Intraprocedurally, transabdominal two-dimensional (2D) ultrasound successfully monitored guidewire passage from the groin into the main part of the bifurcated endograft for implantation of the second limb. All implantation procedures were technically successful, but four endoleaks were identified intraprocedurally by 2D ultrasound and angiography. One healed spontaneously, two were treated with endovascular techniques at 1 and 4 months, and the last leak was scheduled for repair when the patient died of probable myocardial infarction at 2 months. During follow-up, 2D ultrasound successfully visualized all the endografts; no endoleaks were found in up to 18 months of surveillance. Conclusions: Transabdominal ultrasound imaging could be valuable in bifurcated endograft deployment both for guiding guidewire insertion and for controlling wire position before the second graft limb is connected to the main graft. Provided that satisfactory visualization of the entire endograft can be obtained, ultrasound examination may possibly replace arteriography and computed tomographic scanning as a follow-up investigation.

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Endovascular Repair of Abdominal Aortic Aneurysm with the Ancure Endograft: CT Follow-up of Perigraft Flow and Aneurysm Size at 6 Months

Journal of Vascular and Interventional Radiology ◽

10.1016/s1051-0443(07)61374-8 ◽

2000 ◽

Vol 11 (4) ◽

pp. 429-435 ◽

Cited By ~ 25

Author(s):

Thomas J. Franco ◽

Albert B. Zajko ◽

Michael P. Federle ◽

Michel S. Makaroun

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Aneurysm Size ◽

Abdominal Aortic

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Routine use of polypropylene mesh for prophylaxis of abdominal compartment syndrome for patients after ruptured abdominal aortic aneurysm open repairing. Results of three years follow-up.

10.26226/morressier.59a6b34bd462b80290b558a4 ◽

2017 ◽

Author(s):

Oksana Popova

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Polypropylene Mesh ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Abdominal Compartment

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Isolated ascending aorta dilatation is associated with increased risk of abdominal aortic aneurysm

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01488-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Enrique Gallego-Colon ◽

Chaim Yosefy ◽

Evgenia Cherniavsky ◽

Azriel Osherov ◽

Vladimir Khalameizer ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Multiple Logistic Regression Analysis ◽

Ascending Aorta ◽

Predictive Tool ◽

Computed Tomographic ◽

Hemodynamic Compromise ◽

Abdominal Aortic ◽

Imaging Results ◽

Increased Risk

Abstract Background Abdominal aortic aneurysm (AAA) is an asymptomatic condition characterized by progressive dilatation of the aorta. The purpose of this study is to identify important 2D-TTE aortic indices associated with AAA as predictive tools for undiagnosed AAA. Methods In this retrospective study, we evaluated the size of the ascending aorta in patients without known valvular diseases or hemodynamic compromise as predictive tool for undiagnosed AAA. We studied the tubular ascending aorta of 170 patients by 2-dimensional transthoracic echocardiography (2D-TTE). Patients were further divided into two groups, 70 patients with AAA and 100 patients without AAA with normal imaging results. Results Dilatation of tubular ascending aorta was measured in patients with AAA compared to the group with absent AAA (37.5 ± 4.8 mm vs. 31.2 ± 3.6 mm, p < 0.001, respectively) and confirmed by computed tomographic (CT) (35.6 ± 5.1 mm vs. 30.8 ± 3.7 mm, p < 0.001, respectively). An increase in tubular ascending aorta size was associated with the presence of AAA by both 2D-TTE and CT (r = 0.40, p < 0.001 and r = 0.37, p < 0.001, respectively). The tubular ascending aorta (D diameter) size of ≥33 mm or ≥ 19 mm/m2 presented with 2–4 times more risk of AAA presence (OR 4.68, CI 2.18–10.25, p = 0.001 or OR 2.63, CI 1.21–5.62, p = 0.02, respectively). In addition, multiple logistic regression analysis identified tubular ascending aorta (OR 1.46, p < 0.001), age (OR 1.09, p = 0.013), gender (OR 0.12, p = 0.002), and LVESD (OR 1.24, p = 0.009) as independent risk factors of AAA presence. Conclusions An increased tubular ascending aortic diameter, measured by 2D-TTE, is associated with the presence of AAA. Routine 2D-TTE screening for silent AAA by means of ascending aorta analysis, may appear useful especially in older patients with a dilated tubular ascending aorta (≥33 mm).

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Association Between Aneurysm Shoulder Stress and Abdominal Aortic Aneurysm Expansion: A Longitudinal Follow-Up Study

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.02.039 ◽

2011 ◽

Vol 53 (4) ◽

pp. 1158

Author(s):

Z.-Y. Li ◽

U. Sadat ◽

J. U-King-Im

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Follow Up Study ◽

Abdominal Aortic

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Endovascular versus Open Repair of Abdominal Aortic Aneurysm in 15-Years’ Follow-Up of the UK Endovascular Aneurysm Repair Trial 1 (EVAR Trial 1): A Randomized Controlled Trial

50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know ◽

10.1201/9780429434020-11 ◽

2020 ◽

pp. 47-49

Author(s):

Juan Carlos Jimenez ◽

Samuel Eric Wilson

Keyword(s):

Randomized Controlled Trial ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Controlled Trial ◽

Endovascular Aneurysm Repair ◽

Randomized Controlled ◽

Abdominal Aortic ◽

The Uk ◽

Aneurysm Repair

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Endovascular repair of aortic aneurysm: Preliminary results

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0902010d ◽

2009 ◽

Vol 137 (1-2) ◽

pp. 10-17 ◽

Cited By ~ 1

Author(s):

Lazar Davidovic ◽

Momcilo Colic ◽

Igor Koncar ◽

Dejan Markovic ◽

Dusan Kostic ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Endovascular Stent ◽

Stent Grafts ◽

Graft Thrombosis ◽

Abdominal Aortic

Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

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