Ten-Year Follow-Up after Endovascular Repair of Traumatic Abdominal Aortic Rupture

Author(s):  
Stephen Nicholls ◽  
Riyad Karmy-Jones
Author(s):  
Stephen Nicholls ◽  
Riyad Karmy-Jones

Blunt abdominal aortic injury is often associated with bowel injury that precludes operative repair because of the risk of graft infection. Endovascular repair has been reported but with limited follow-up. We present a case of a 15-year-old boy who underwent endovascular repair of blunt abdominal aortic rupture and whom we were able to follow up over a decade. Our experience with this case and three others, as well as the experience reported in the literature, suggests that endovascular repair is a reasonable option in the setting of concomitant bowel injury. The risk of over sizing, collapse, and migration may be less than that described for thoracic aortic injuries because there is no need to deploy the endograft across an angle.


1999 ◽  
Vol 16 (6) ◽  
pp. 617-623
Author(s):  
ITZHAK KRONZON ◽  
MATHEW VARKEY ◽  
PAUL A. TUNICK ◽  
THOMAS RILES ◽  
ROBERT ROSEN

2019 ◽  
Vol 56 (5) ◽  
pp. 993-1000 ◽  
Author(s):  
Enrico Gallitto ◽  
Gianluca Faggioli ◽  
Rodolfo Pini ◽  
Chiara Mascoli ◽  
Stefano Ancetti ◽  
...  

Abstract OBJECTIVES Our objective was to report the outcomes of fenestrated/branched endovascular aneurysm repair of thoraco-abdominal aortic aneurysms (TAAAs) with endografts. METHODS Between January 2010 and April 2018, patients with TAAAs, considered at high surgical risk for open surgery and treated by Cook-Zenith fenestrated/branched endovascular aneurysm repair, were prospectively enrolled and retrospectively analysed. The early end points were 30-day/hospital mortality rate, spinal cord ischaemia and 30-day cardiopulmonary and nephrological morbidity. Follow-up end points were survival, patency of target visceral vessels and freedom from reinterventions. RESULTS Eighty-eight patients (male: 77%; mean age: 73 ± 7 years; American Society of Anesthesiologists 3/4: 58/42%) were enrolled. Using Crawford’s classification, 43 (49%) were types I–III and 45 (51%) were type IV TAAAs. The mean aneurysm diameter was 65 ± 15 mm. Custom-made and off-the-shelf endografts were used in 60 (68%) and 28 (32%) cases, respectively. Five (6%) patients had a contained ruptured TAAA. The procedure was performed in multiple steps in 42 (48%) cases. There was 1 (1%) intraoperative death. Five (6%) patients suffered spinal cord ischaemia with permanent paraplegia in 3 (3%) cases. Postoperative cardiac and pulmonary complications occurred in 7 (8%) and 12 (14%) patients, respectively. Worsening of renal function (≥30% of baseline level) was detected in 11 (13%) cases, and 2 (2%) patients required haemodialysis. The 30-day and hospital mortality rates were 5% and 8%, respectively. The mean follow-up was 36 ± 22 months. Survival at 12, 24 and 36 months was 89%, 75% and 70%, respectively. The patency of target visceral vessels at 12, 24 and 36 months was 92%, 92% and 92%, respectively. Freedom from reinterventions at 12, 24 and 36 months was 85%, 85% and 83%, respectively. CONCLUSIONS The endovascular repair of TAAAs with fenestrated/branched endovascular aneurysm repair is feasible and effective with acceptable technical/clinical outcomes at early/midterm follow-up.


2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Patrick T. Jasinski ◽  
Demetri Adrahtas ◽  
Spyridon Monastiriotis ◽  
Apostolos K. Tassiopoulos

Introduction. Seal zone failure after EVAR leads to type 1 endoleaks and increases the risk of delayed aortic rupture. Type 1b endoleaks, although rare, represent a true risk to the repair. Case Presentation. We report the case of a 65-year-old female who underwent emergent endovascular repair for a ruptured infrarenal abdominal aortic aneurysm and developed bilateral type 1b endoleaks following proximal migration of both endograft limbs. The right-side failure was diagnosed within 48 hours from the initial repair and the left side at the 1-year follow-up. Both sides were successfully treated with endovascular techniques. A review of the literature with an analysis of potential risk factors is also reported. Conclusion. For patients undergoing EVAR for ruptured AAA and with noncalcified iliac arteries, more aggressive oversizing of the iliac limbs is recommended to prevents distal seal zone failures.


Radiology ◽  
2006 ◽  
Vol 240 (3) ◽  
pp. 681-689 ◽  
Author(s):  
Jacob J. Visser ◽  
Marc R. H. M. van Sambeek ◽  
M. G. Myriam Hunink ◽  
W. Ken Redekop ◽  
Lukas C. van Dijk ◽  
...  

Author(s):  
Elena S. Di Martino ◽  
Michel S. Makaroun ◽  
David A. Vorp

The early benefits of an endovascular approach to abdominal aortic aneurysm (AAA) treatment has been reported by many authors [1,2]. One of the major advantages is that endovascular repair of AAA (EVAR) as opposed to traditional open surgery, is not a major abdominal surgery. EVAR has been shown to be associated with a death rate comparable to that of surgical repair [3]. In short term follow-up, EVAR is associated with fewer complications and a more rapid recovery [2]. On the contrary very limited data is available on long term follow-up of EVAR patients. Graft-related secondary interventions affect a consistent percentage of the treated cases. The EUROSTAR study [4] recently reported 13% of reintervention in 15.4 months. Our surgical unit reported 20.6% across 48 months in a recent review of 242 cases [3]. The frequence and type of reintervention, whose principal cause is endoleak or perigraft flow, requires careful consideration.


Author(s):  
F. Ben Pearce ◽  
Tze-Woei Tan ◽  
Wayne W. Zhang

This chapter provides a summary of the landmark EVAR Trial 1, which compared endovascular repair of abdominal aortic aneurysms (AAA) with open repair in patients judged to be fit for both open and endovascular repair. Although endovascular AAA (EVAR) repair was associated with lower perioperative complications and mortality than open surgical repair, after 4 years of follow-up the outcomes of the two approaches were similar. Follow-up at 15 years found EVAR had inferior late survival, necessitating lifelong surveillance of EVAR and reintervention if necessary. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.


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