Morphometry and Classification in Abdominal Aortic Aneurysms: Patient Selection for Endovascular and Open Surgery

1997 ◽  
Vol 4 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Hardy Schumacher ◽  
Hans H. Eckstein ◽  
Friedrich Kallinowski ◽  
Jens Rainer Allenberg
Keyword(s):  
Patient Selection ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Type I ◽  
Infrarenal Aorta ◽  
Iliac Arteries ◽  
Proximal Neck ◽  
Aorta Aneurysm ◽  
Abdominal Aortic ◽  
Selection For

Purpose: To evaluate the anatomic morphology of abdominal aortic aneurysms (AAAs) and compose a classification system to facilitate patient selection for endovascular graft (EVG) repair. Methods: Data on 242 consecutive AAA patients evaluated on a nonemergent basis in a 3.5-year period to July 1996 were prospectively entered into a registry. Patients were examined using sequential intravenous spiral computed tomographic angiography and intraarterial digital subtraction angiography. The data collected and analyzed included: diameters of the supra- and infrarenal aorta, aneurysm, aortoiliac bifurcation, and iliac arteries; lengths of the proximal neck, distal cuff, and aneurysm; degrees of iliac artery tortuosity; and occlusion of the visceral, renal, or iliac arteries. Results: The 242 aneurysms could be easily grouped into three distinctive categories related to the extent of the aneurysmal disease. Type I AAAs (11.2%) had nondilated, thrombus-free infrarenal (15 mm) necks and distal (10 mm) cuffs appropriate for EVG anchoring. In type II and its subgroups (72.3%), a sufficient proximal neck was present, but the aneurysm extended into the iliac arteries; 56% of these were eligible for a bifurcated endograft. In type III (16.5%), a sufficient proximal neck was missing, independent of distal involvement. In all, 51.7% were good EVG candidates based on AAA morphology. Taking into consideration relevant concomitant vascular diseases, proximal iliac kinking, and iliac, renal, or visceral occlusive disease, only 30.2% of the population were potential candidates for an efficient and secure EVG repair using the devices currently available. Conclusions: In contrast to classical open repair, detailed preoperative measurements are recommended for EVG planning. The use of liberal EVG indications may lead to a higher incidence of complications, whereas restrictive morphology-based selection criteria may offer excellent results.

scholarly journals Targeting the Extracellular Matrix in Abdominal Aortic Aneurysms Using Molecular Imaging Insights

2021 ◽  
Vol 22 (5) ◽  
pp. 2685
Author(s):  
Lisa Adams ◽  
Julia Brangsch ◽  
Bernd Hamm ◽  
Marcus R. Makowski ◽  
Sarah Keller
Keyword(s):  
Extracellular Matrix ◽  
Molecular Imaging ◽  
Molecular Targets ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Type I ◽  
Target Tissue ◽  
Pharmacologic Treatment ◽  
Abdominal Aortic

This review outlines recent preclinical and clinical advances in molecular imaging of abdominal aortic aneurysms (AAA) with a focus on molecular magnetic resonance imaging (MRI) of the extracellular matrix (ECM). In addition, developments in pharmacologic treatment of AAA targeting the ECM will be discussed and results from animal studies will be contrasted with clinical trials. Abdominal aortic aneurysm (AAA) is an often fatal disease without non-invasive pharmacologic treatment options. The ECM, with collagen type I and elastin as major components, is the key structural component of the aortic wall and is recognized as a target tissue for both initiation and the progression of AAA. Molecular imaging allows in vivo measurement and characterization of biological processes at the cellular and molecular level and sets forth to visualize molecular abnormalities at an early stage of disease, facilitating novel diagnostic and therapeutic pathways. By providing surrogate criteria for the in vivo evaluation of the effects of pharmacological therapies, molecular imaging techniques targeting the ECM can facilitate pharmacological drug development. In addition, molecular targets can also be used in theranostic approaches that have the potential for timely diagnosis and concurrent medical therapy. Recent successes in preclinical studies suggest future opportunities for clinical translation. However, further clinical studies are needed to validate the most promising molecular targets for human application.

scholarly journals Regional variation exists in patient selection and treatment of abdominal aortic aneurysms

2016 ◽  
Vol 64 (4) ◽  
pp. 921-927.e1 ◽  
Author(s):  
Sara L. Zettervall ◽  
Dominique B. Buck ◽  
Peter A. Soden ◽  
Jack L. Cronenwett ◽  
Phillip P. Goodney ◽  
...  
Keyword(s):  
Patient Selection ◽  
Regional Variation ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic

Towards the Prediction and Minimization of Device Failure for Endolvascular Grafts in Abdominal Aortic Aneurysms

2007 ◽  
Author(s):  
Ron Layman ◽  
Samy Missoum ◽  
Jonathan Vande Geest
Keyword(s):  
United States ◽  
Abdominal Aortic Aneurysm ◽  
Critical Diameter ◽  
Abdominal Aortic Aneurysms ◽  
The United States ◽  
Aortic Aneurysms ◽  
Infrarenal Aorta ◽  
Device Failure ◽  
Clinical Challenge ◽  
Abdominal Aortic

The local dilation of the infrarenal aorta, termed an abdominal aortic aneurysm (AAA), occurs over several years and may eventually lead to rupture, an event currently ranked the 15th leading cause of death in the United States [1, 2]. AAA can often remain quiescent and asymptomatic, making the diagnosis and treatment of AAA patients a clinical challenge. For patients whose AAAs dilate to a critical diameter there are two standard treatments: open surgical resection and endovascular repair (EVAR). EVAR involves inserting an endovascular graft into the aneurysm to prevent pressurization of the AAA cavity.

Abdominal Aortic Aneurysms: Experience with the Ivancev-Malmö Endovascular System for Aortomonoiliac Stent-Grafts

1997 ◽  
Vol 4 (3) ◽  
pp. 242-251 ◽  
Author(s):  
Krassi Ivancev ◽  
Martin Malina ◽  
Bengt Lindblad ◽  
Timothy A.M. Chuter ◽  
Jan Brunkwall ◽  
...  
Keyword(s):  
Stent Graft ◽  
Clinical Results ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Iliac Arteries ◽  
Proximal Neck ◽  
Abdominal Aortic ◽  
Median Diameter ◽  
Proximal Extension ◽  
In The Beginning

Purpose: To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair. Methods: From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Ivancev-Malmö system. Results: Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients. Conclusions: Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.

scholarly journals Long Term Results After Endovascular Aorto-Iliac Repair in Patients with Abdominal Aortic Aneurysms and Ectatic Iliac Arteries

2019 ◽  
Vol 58 (6) ◽  
pp. e313
Author(s):  
Selena Pelliccia ◽  
Benedetta Peltristo ◽  
Gianbattista Parlani ◽  
Enrico Cieri ◽  
Eleonora Centonza ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Long Term Results ◽  
Iliac Arteries ◽  
Abdominal Aortic

Aortomonoiliac Endovascular Grafting: Difficult Solutions to Difficult Aneurysms

1997 ◽  
Vol 4 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Matthew M. Thompson ◽  
Robert D. Sayers ◽  
Ahktar Nasim ◽  
Jonathan R. Boyle ◽  
Guy Fishwick ◽  
...  
Keyword(s):  
Late Complication ◽  
Graft Infection ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Infrarenal Aorta ◽  
Iliac Arteries ◽  
Abdominal Aortic ◽  
Femoral Vessels ◽  
Aneurysm Repair

Purpose: To describe a refined technique for aortomonoiliac endograft exclusion of abdominal aortic aneurysms (AAAs). Methods: A tapered aortomonoiliac graft was prepared from an 8-mm thin-walled expanded polytetrafluoroethylene tube graft predilated proximally to 35 mm and tapered distally to 15 mm. The proximal graft was sutured to a 5-cm-long, predilated Palmaz stent, which was mounted on a 30-mm balloon and backloaded into a 21F packaging sheath. With the patient under general anesthesia and both common femoral arteries exposed, the endograft was anchored in the infrarenal aorta and subsequently passed into one iliac system, where it was anastomosed to the iliac or femoral vessels. The contralateral common iliac artery was occluded, and an extra-anatomic, femorofemoral, or iliofemoral bypass grafting was performed. Results: Twenty of the 25 AAAs treated to date with this technique have been successful, with aneurysm exclusion achieved in 18 (2 minor distal endoleaks are scheduled for endovascular repair). The technical failures were analyzed, resulting in enhancements to the technique. Complications included 2 early (< 30 days) deaths, 1 case of minor embolization, 1 transient renal failure, 1 pulmonary embolus, and 1 wound infection. The only late complication was a graft infection localized to the groin. Conclusions: Aortomonoiliac endovascular aneurysm repair is effective in patients with AAAs involving the iliac arteries. Short-term results are acceptable, but long-term efficacy must be addressed before this procedure is widely adopted. Technical changes made in response to early learning curve problems have led to a safer, more reliable procedure.

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