Outcomes after endovascular repair of abdominal aortic aneurysm involving the renovisceral arteries: A multi-center follow-up study

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 397-404
Author(s):  
Otto Stackelberg ◽  
David Lindström ◽  
Kevin Mani ◽  
Göran Lundberg ◽  
Anneli Linné ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Graft Patency ◽  
Aortic Aneurysms ◽  
Swedish Population ◽  
Aneurysm Neck ◽  
Abdominal Aortic ◽  
Vessel Patency ◽  
Sealing Zone ◽  
One Year

Objectives To evaluate outcomes after endovascular treatment of abdominal aortic aneurysms (AAA) involving the renovisceral arteries and to compare outcomes after fenestrated/branched endovascular aortic repair (f/b-EVAR), chimney/periscope EVAR (ch-EVAR), and bailout ch-EVAR. Methods A retrospective multicenter study including all patients with AAA involving the renovisceral segment, treated with f/b-EVAR, ch-EVAR, or bailout ch-EVAR, between 1 January 2005 and 30 June 2015, in three Swedish vascular centers. Patient charts were reviewed for data. Renovisceral stent graft patency was assessed on follow-up CT. Mortality was cross-checked against the Swedish Population Registry. Bailout ch-EVAR was defined as a perioperative decision of renovisceral endografting, as the artery was accidentally covered, or as the aneurysm neck sealing zone was considered inadequate. Results Of the 99 identified patients (76 men; mean age 74 years (range 58–89 years)), 68 underwent f/b-EVAR, 18 ch-EVAR, and 13 bailout ch-EVAR. Follow-up lasted for a median of 3.2 years (Q1, Q3 (2.1, 4.7 years)). Elective surgery comprised 87.9% ( n = 87) of the cases. Six patients died within 30 days, and the 30-day mortality after elective surgery was 4.6% (95% CI, 1.3%–11.4%) overall, 1.6% after f/b-EVAR (95% CI, 0.0%–11.4%), 15.4% after ch-EVAR (95% CI, 1.9%–45.4%), and 10.0% (95% CI, 0.3%–44.5%) after bailout ch-EVAR. During follow-up, there were 16 secondary interventions, of which 75% ( n = 12) were performed within six months after the primary intervention. Compared with f/b-EVAR, ch-EVAR was associated with a higher degree of type 1 endoleaks (1.5% vs. 22.2%, P = 0.001) and re-interventions during follow-up (13.2% vs. 33.3%, P = 0.046). The overall assisted target vessel patency was 96.1% (95% CI, 91.7%–98.6%) at one year and 95.2% (95% CI, 89.2%–98.4%) at two years. Conclusions Results after EVAR involving endografting of renovisceral arteries from three centers in Sweden with medium volumes are consistent with results previously reported from centers with larger volumes.

Follow-Up of Aneurysm Neck Diameter after Endovascular Repair of Abdominal Aortic Aneurysms

2008 ◽  
Vol 22 (4) ◽  
pp. 559-563 ◽  
Author(s):  
Alberto Bravo Soberón ◽  
Milagros Martí de Garcia ◽  
Gonzalo Garzón Möll ◽  
Beatriz Rodríguez Vigil ◽  
María Allona Krauel ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Aneurysm Neck ◽  
Abdominal Aortic ◽  
Neck Diameter

Uncovered Chimney Stent Graft for Renal Arteries With the Nellix Endovascular Aneurysm Sealing Technique

2017 ◽  
Vol 52 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Luca Garriboli ◽  
Antonio Maria Jannello
Keyword(s):  
Aortic Aneurysms ◽  
Type I ◽  
Abdominal Aortic ◽  
Vessel Patency ◽  
Type I Endoleak ◽  
Procedural Costs ◽  
Endovascular Approach ◽  
Access Complications

Purpose: To describe the application of uncovered chimney stent grafts with the Nellix endovascular aneurysm sealing technique (ChEVAS) for juxtarenal abdominal aortic aneurysms (JAAAs). Case Report: Two patients with JAAA and multiple comorbidities were considered unfit for open surgery and were selected for an endovascular approach. Fenestrated and branched endografts were too expensive, and a chimney endovascular approach was considered inappropriate for the relatively high incidence of proximal type I endoleak and graft migration. ChEVAS was performed successfully with the novel addition of uncovered chimney stents to further reduce costs and possibly improve target vessel patency. JAAA exclusion and visceral vessel patency was confirmed at 18-month follow-up. Conclusion: ChEVAS with bare chimney stents is technically less complex, potentially reduces access complications and procedural costs, and may improve long-term patency compared to alternative techniques. Results at 18 months seem promising, but strict follow-up is necessary as the long-term durability is unknown.

Assessment of the criteria for elective surgery in screen-detected abdominal aortic aneurysms

2005 ◽  
Vol 12 (3) ◽  
pp. 150-154 ◽  
Author(s):  
R Alan P Scott ◽  
Lois G Kim ◽  
Hilary A Ashton ◽  
Keyword(s):  
Direct Evidence ◽  
Elective Surgery ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Rapid Expansion ◽  
Aortic Diameter ◽  
Abdominal Aortic ◽  
Screening Study ◽  
Accepted Practice

Objectives: Apart from aortic diameter, two other widely used criteria for considering surgery in screen-detected abdominal aortic aneurysms (AAAs) - annual aortic expansion ≥1.0 cm and presence of symptoms attributable to the AAA 0 are based on accepted practice and AAA expansion rates, rather than direct evidence. The Multi-centre Aneurysm Screening Study (MASS) enables assessment of their contribution to this risk reduction. Methods: MASS employs three criteria for referral for considering elective open surgery: maximum aortic diameter ≥5.5 cm, rapid aortic expansion (≥1.0 cm/year), and/or the presence of symptoms attributable to the AAA. Data from MASS are used to examine the value of these criteria in practice. Results: No patients were referred for symptoms alone. Of those referred for rapid expansion, 88% were returned to surveillance, compared with only 12% of those referred for diameter ≥5.5 cm at initial scan, and 34% of those referred for diameter ≥5.5 cm at a follow-up scan. Return to surveillance following referral for rapid expansion was strongly associated with aortic diameter (age-adjusted odds ratio for return 0.89 per mm, 95% confidence interval 0.79-1.00). Of those 5.0-5.4 cm at the time of referral for rapid expansion who were returned, 31% reached 5.5 cm during a median post-referral follow-up of 0.9 years. Among those referred for expansion, the rupture rate was only 8 per 1000 person-years of follow-up prior to reaching 5.5 cm. Conclusions: A single criterion for considering elective surgery is recommended in screen-detected AAA, based on a maximum aortic diameter of ≥5.5 cm. This criterion detects the majority of those at risk from rupture, and is simple to assess.

Dilatation of the Infrarenal Aneurysm Neck after Endovascular Exclusion of Abdominal Aortic Aneurysm

1998 ◽  
Vol 5 (3) ◽  
pp. 195-200 ◽  
Author(s):  
Björn Sonesson ◽  
Martin Malina ◽  
Krasnodar Ivancev ◽  
Mats Lindh ◽  
Bengt Lindblad ◽  
...  
Keyword(s):  
Aortic Aneurysms ◽  
Graft Material ◽  
Stent Grafts ◽  
Chi Square ◽  
Aneurysm Neck ◽  
Abdominal Aortic ◽  
Suprarenal Aorta ◽  
Custom Made ◽  
Diameter Change

Purpose: To determine the fate of the infrarenal aneurysm neck and suprarenal aorta after endovascular exclusion of abdominal aortic aneurysms (AAAs). Methods: Thirty-four patients underwent endovascular AAA repair between January 1994 and December 1995 using custom-made stent-grafts constructed from polyester graft material and modified self-expanding Gianturco Z-stents sutured to the graft orifices. Thirty-one patients were available for follow-up. Pre- and postimplantation diameters were measured using spiral computed tomography in the infrarenal aneurysm neck and the suprarenal aorta at the level of the superior mesenteric artery (SMA). Results: The mean follow-up time was 25 months. There was a significant increase of the diameter of the infrarenal aneurysm neck (+ 1.65 mm, p = 0.002), but not in the aorta at the level of the SMA (+ 0.52 mm, p = 0.100). There was no difference in the change in diameter in the infrarenal neck in the group with a stent adjacent to the level of measurement (n = 20) compared with the group without an adjacent stent (n = 11, p = 0.790). There was no correlation between preimplantation size of the infrarenal neck and its diameter change (r = 0.14, p = 0.488). There was no correlation (r = 0.10, p = 0.603) or association (chi-square test, p = 0.211) between aortic diameter change at the level of the SMA and the infrarenal neck. Conclusions: This investigation shows a significant dilatation of the infrarenal aneurysm neck, but not in the suprarenal aorta, after endovascular AAA repair with this device. The clinical significance of these findings is unclear. Whether such a dilatation in the infrarenal aneurysm neck may affect the long-term attachment of stent-grafts remains to be shown in the future.

Coronary endarterectomy in coronary artery disease: Factors affecting graft patency and survival

2021 ◽  
pp. 021849232110068
Author(s):  
Simon CY Chow ◽  
Jacky YK Ho ◽  
Micky WT Kwok ◽  
Takuya Fujikawa ◽  
Kevin Lim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Graft Patency ◽  
Complete Revascularization ◽  
Coronary Endarterectomy ◽  
Factors Affecting ◽  
Early Results ◽  
Cerebrovascular Events ◽  
Obtuse Marginal ◽  
One Year

Background Coronary endarterectomy aims to improve completeness of revascularization in patients with occluded coronary vessels. The benefits of coronary endarterectomy remain uncertain. The aim of this study was to evaluate short-term surgical outcomes and factors affecting graft patency post-coronary endarterectomy. Methods Between 2009 and 2019, 81 consecutive patients who had coronary endarterectomy done were evaluated for their perioperative and early results. A total of 36 patients with follow-up coronary studies were included in patency analysis. Mortality rates, major adverse cardiac and cerebrovascular events, and graft patency were outcomes of interest. Survival and risk factor analysis were performed with Kaplan–Meier and logistic regression analysis. Results The average age of the cohort was 61.9 ± 9.29 years. Complete revascularization rate was 95.4% post-coronary endarterectomy. The 30-day and 1-year mortality was 2.5 and 6.2%, respectively. One-year major adverse cardiac and cerebrovascular events rate was 11.1%. Periprocedural myocardial infarction rate was 7.4%. Three patients required repeat revascularization within a mean follow-up duration of 49.6 ± 36.5 months. Overall graft patency was 89.2% at 20.2 months and graft patency post-coronary endarterectomy was 85.4%. Arterial grafts showed 100% patency. Vein grafts to endarterectomized obtuse marginal branch had patency rates of 33.3%. Multiple endarterectomies were associated with worse one-year major adverse cardiac and cerebrovascular events (OR: 28.6 ± 1.16; P = 0.003). Conclusions Coronary endarterectomy facilitates completeness of revascularization and does not increase early mortality. Graft patency post-coronary endarterectomy on obtuse marginal artery was suboptimal. Judicious use of coronary endarterectomy should be practiced to balance the need of completeness of revascularization against the risk of myocardial infarction.

scholarly journals Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Jesse Manunga ◽  
Larissa I. Stanberry ◽  
Peter Alden ◽  
Jason Alexander ◽  
Nedaa Skeik ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Graft ◽  
Graft Patency ◽  
Hospital Length ◽  
Aortic Aneurysms ◽  
Hospital Length Of Stay ◽  
Type I ◽  
Technical Success ◽  
Vessel Patency ◽  
Major Adverse Events

Abstract Background Endovascular rescue of failed infrarenal repair (EVAR) has emerged as an attractive option to stent graft explantation. The procedure, however, is underutilized due to limited devices accessibility and the challenges associated with their implantation in this patient population. The purpose of this study was to report our outcomes and discuss our approach to rescuing previously failed infrarenal endovascular aneurysm repairs (EVAR) with fenestrated/branched endografts (f/b-EVAR). Methods A retrospective analysis of prospectively collected data of consecutive patients with failed EVAR rescued with f/b-EVAR at our institution from November 2013 to March 2019 was conducted. The study primary end point was technical success; defined as the implantation of the device with no type I a/b or type III endoleak or conversion to open repair. Secondary endpoints included major adverse events (MAEs), graft patency and reintervention rates. Results During this time, 202 patients with complex aortic aneurysms were treated with f/b-EVAR. Of these, 19 patients (Male: 17, mean age 79 ± 7 years) underwent repair for failed EVAR. The median time from failed repair to f/b-EVAR was 48 (30, 60) months. Treatment failure was attributed to stent graft migration in 9 (47.4%) patients, disease progression in 5 (26.3%), short initial neck in 3 (15.8%) and unable to be determined in 2 (10.5%). Three patients were treated urgently with surgeon modified stent graft. Technical success was achieved in 18 patients (95%), including two who had undergone emergent repair for rupture. Seventy-two targeted vessels (97.3%) were successfully incorporated. Sixteen (84.2%) patients required a thoracoabdominal repair to achieve a durable seal. Major adverse events (MAEs) occurred in 3 patients (15.7%) including paralysis and death in one (5.3%), compartment syndrome and temporary dialysis in another and laparotomy with snorkeling of one renal and bypass of the other in the third patient. Median (IQR) hospital length of stay was 3 (2, 4) days. Late reintervention, primary target vessel patency and primary assisted patency rates were 5.3%, 98.6% and 100%, respectively. Conclusion Implantation of f/b-EVAR in patients with failed previous EVAR is a challenging undertaking that can be performed safely with a high technical success and low reintervention rates.

Comparing polymer-filled versus self-expanding endografts in Chinese patients

2018 ◽  
Vol 26 (9) ◽  
pp. 667-676
Author(s):  
Yuk Law ◽  
Yiu Che Chan ◽  
Stephen Wing-Keung Cheng
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
The Self ◽  
Chinese Patients ◽  
Type Ii ◽  
Mortality And Morbidity ◽  
Type Ia ◽  
One Year ◽  
Aneurysm Repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

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