Abdominal aortic aneurysm neck dilatation and sac remodeling in fenestrated compared to standard endovascular aortic repair

Vascular ◽  
2021 ◽  
pp. 170853812110528
Author(s):  
Chong Li ◽  
Katherine Teter ◽  
Caron Rockman ◽  
Karan Garg ◽  
Neal Cayne ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Renal Artery ◽  
Aortic Rupture ◽  
Endovascular Aortic Repair ◽  
Aneurysm Neck ◽  
Aortic Repair ◽  
Aortic Neck ◽  
Abdominal Aortic

Objective Contemporary commercially available endovascular devices for the treatment of abdominal aortic aneurysm (AAA) include standard endovascular aortic repair (sEVAR) or fenestrated EVAR (fEVAR) endografts. However, aortic neck dilatation (AND) can occur in nearly 25% of patients following EVAR, resulting in loss of proximal seal with risk of aortic rupture. AND has not been well characterized in fEVAR, and direct comparisons studying AND between fEVAR and sEVAR have not been performed. This study aims to analyze AND in the infrarenal and suprarenal aortic segments, including seal zone, and quantify sac regression following fEVAR implantation compared to sEVAR. Method A retrospective review of prospectively collected data on 20 consecutive fEVAR patients (Cook Zenith® Fenestrated) and 20 sEVAR (Cook Zenith®) patients was performed. Demographic data, anatomic characteristics, procedural details, and clinical outcome were analyzed. Pre-operative, post-operative (1 month), and longest follow-up CT scan at an average of 29.3 months for fEVAR and 29.8 months for sEVAR were analyzed using a dedicated 3D workstation (iNtuition, TeraRecon Inc, Foster City, California). Abdominal aortic aneurysm neck diameter was measured in 5 mm increments, ranging from 20 mm above to 20 mm below the lowest renal artery. Sub-analysis comparing the fEVAR to the sEVAR group at 12 months and at greater than 30 months was performed. Standard statistical analysis was done. Results Demographic characteristics did not differ significantly between the two cohorts. The fEVAR group had a larger mean aortic diameter at the lowest renal artery, shorter infrarenal aortic neck length, increased prevalence of nonparallel neck shape, and longer AAA length. On follow-up imaging, the suprarenal aortic segment dilated significantly more at all locations in the fEVAR cohort, whereas the infrarenal aortic neck segment dilated significantly less compared to the sEVAR group. Compared to the sEVAR cohort, the fEVAR patients demonstrated significantly greater positive sac remodeling as evident by more sac diameter regression, and elongation of distance measured from the celiac axis to the most cephalad margin of the sac. Device migration, endoleak occurrence, re-intervention rate, and mortalities were similar in both groups. Conclusion Compared to sEVAR, patients undergoing fEVAR had greater extent of suprarenal AND, consistent with a more diseased native proximal aorta. However, the infrarenal neck, which is shorter and also more diseased in fEVAR patients, appears more stable in the post-operative period as compared to sEVAR. Moreover, the fEVAR cohort had significantly greater sac shrinkage and improved aortic remodeling. The suprarenal seal zone in fEVAR may result in a previously undescribed increased level of protection against infrarenal neck dilatation. We hypothesize that the resultant decreased endotension conferred by better seal zone may be responsible for a more dramatic sac shrinkage in fEVAR.

scholarly journals Postoperative Aortic Neck Dilation: Myth or Fact?

2018 ◽  
Vol 27 (02) ◽  
pp. 110-113 ◽  
Author(s):  
A.S. Ribner ◽  
A.K. Tassiopoulos
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Aortic Rupture ◽  
Common Site ◽  
Aneurysm Neck ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Type Ia ◽  
History Of ◽  
Migration Type

AbstractThe abdominal aorta is the most common site of an aortic aneurysm. The visceral and most proximal infrarenal segment (aneurysm neck) are usually spared and considered more resistant to aneurysmal degeneration. However, if an abdominal aortic aneurysm (AAA) is left untreated, the natural history of the aortic neck is progressive dilatation and shortening. This may have significant implications for patients undergoing endovascular repair of AAAs (EVAR) as endograft stability and integrity of the repair are dependent on an intact proximal seal zone. Compromised seal zones, caused by progressive diameter enlargement and foreshortening of the aortic neck, may lead to distal endograft migration, type Ia endoleak, aortic sac repressurization, and, ultimately, aortic rupture.

scholarly journals Endovascular Abdominal Aortic Aneurysm Repair – Patient Selection and Long-term Outcome Expectations – Current Challenges in 2013

2013 ◽  
Vol 8 (1) ◽  
pp. 57 ◽  
Author(s):  
Regula S von Allmen ◽  
Florian Dick ◽  
Thomas R Wyss ◽  
Roger M Greenhalgh ◽  
◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Open Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
The Uk

Endografts for repair of abdominal aortic aneurysm were first reported in the late 1980s and commercially available grafts were developed rapidly during the 1990s. This prompted a head-to-head comparison of the new, less invasive, endovascular technology with the existing gold standard of open repair. The first and largest randomised trial of open versus endovascular repair for large aneurysms started in the UK in 1999. Other trials comparing open and endovascular repair followed in the Netherlands, France and the US. Only the UK trial has reported long-term follow-up to 10 years. This has shown no statistically significant difference in long-term survival after open or endovascular repair. Aneurysm-related mortality curves converged at six years, which is described as endovascular aortic repair (EVAR) ‘catch up’ on open repair. It appears that this convergence is probably largely attributable to secondary sac rupture after endovascular repair, which is fatal in about two-thirds of cases. At this point, we have reached a crossroads and only longer-term follow-up data can provide the vital answer to the outcome of endovascular repair in the long run. This article gives a brief overview of the development and the current evidence of endovascular aortic repair and discusses the most important factors that are leading the way to the future of this technology.

scholarly journals Five-year results of endovascular aortic repair used according to instructions for use give a good general outcome for abdominal aortic aneurysm

2019 ◽  
Vol 7 ◽  
pp. 205031211985343
Author(s):  
Runa G Unsgård ◽  
Martin Altreuther ◽  
Conrad Lange ◽  
Tommy Hammer ◽  
Erney Mattsson
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Open Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
General Outcome ◽  
Secondary Procedures ◽  
Instructions For Use

Objectives: The primary aim of this study was to investigate the rate of sac enlargement and secondary procedures after 5 years when instructions for use are strictly applied with endovascular aortic repair. The secondary aim was to investigate if strict indications with endovascular aortic repair, rendering more open operations, would change the general outcome of patients with abdominal aortic aneurysm. Materials and methods: Patients having their abdominal aortic aneurysm procedure in a single institution between 01 January 2002 and 31 December 2006 were included. Indications for endovascular aortic repair were as follows: aortic neck: length 15 mm or more, diameter 32 mm or less and straight configuration; iliac arteries: length > 10 mm, 7.5–20 mm in diameter. Sac enlargement was defined as an increase in diameter of 5 mm or more. Results: A total of 123 patients were intended to be treated electively with endovascular aortic repair from 2002 to 2007 using Cook Zenith stent grafts. In the same period, 147 patients were treated with elective open repair. At 5 years, 7.3% (N = 9) of the elective intended-to-treat patients with endovascular aortic repair had a sac enlargement. Thirty-five percent of the patients were registered with endoleaks, 13% of the patients had secondary procedures, 12.2% of the patients had early and 6.5% late complications during the follow-up period. Aneurysm rupture was seen in 1.6% of the patients. During the 5-year follow-up period, 34 (27.6%) of the endovascular aortic repair patients died. Five-year mortality for open repair was 23.8%, and 12.2% of the open repair patients had secondary procedures. Conclusion: Endovascular aortic repair for abdominal aortic aneurysm in accordance with instructions for use gives a low long-term risk for increased diameter and low rate of secondary procedures. There was similar mortality after elective endovascular aortic repair and open repair for abdominal aortic aneurysm. Applying endovascular aortic repair according to instructions for use does not seem to change the general outcome of patients with abdominal aortic aneurysm but improves the outcome with the method.

scholarly journals Endovascular Aortic Repair (EVAR) Method in The Management of Abdominal Aortic Aneurysm

2020 ◽  
Vol 2 (1) ◽  
pp. 53-7
Author(s):  
Abed Nego Okthara Sebayang ◽  
Niko Azhari Hidayat
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Aortic Rupture ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Global Burden ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Aorta Abdominalis ◽  
Global Burden Disease

Aortic disease is a collection of diseases of the aorta, which includes aortic aneurysms; acute aortic infections consisting of aortic dissection, intramular hematoma, penetration of atherosclerotic ulcers (PAU) and traumatic injury to the aorta; pseudoaneurysm; aortic rupture; Marfan syndrome; and congenital abnormalities such as coarctation of the aorta. One of the aortic diseases that cause the death rate to increase according to the 2010 Global Burden Disease is aortic aneurysm. Abdominal aortic aneurysm (AAA) is a focal dilatation of the aortic segment. The diagnosis of AAA is done by history taking, physical examination and supporting examination. Management at AAA aims to prevent aortic wall rupture. An alternative procedure without open surgery is endovascular aortic repair (EVAR) using prostheses. It is expected that through the EVAR method, mortality and morbidity due to AAA can be reduced. Keywords: abdominal aortic aneursym, EVAR, prostheses     Penyakit aorta merupakan kumpulan penyakit pada aorta yang meliputi aneurisma aorta; sindrom aorta akut berupa diseksi aorta, hematoma intramular, penetrating atherosclerosis ulcer (PAU) dan cedera akibat trauma pada aorta; pseudoaneurysm; ruptur aorta; sindrom Marfan; serta penyakit kongenital seperti koarktasio aorta. Salah satu penyakit aorta yang menyebabkan angka kematian meningkat menurut Global Burden Disease 2010 adalah aneurisma aorta. Aneurisma aorta abdominalis (AAA) merupakan dilatasi fokal pada segmen aorta. Penegakan diagnosis AAA dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang. Penatalaksanaan pada AAA bertujuan untuk mencegah pecahnya dinding aorta. Prosedur alternatif tanpa pembedahan terbuka yang dijadikan pilihan adalah endovascular aortic repair (EVAR) menggunakan protesa. Diharapkan melalui metode EVAR angka mortalitas dan morbiditas akibat AAA dapat diturunkan. Kata kunci: aneurisma aorta abdominalis, EVAR, protesa

Follow-up of abdominal aortic aneurysm after endovascular aortic repair: Comparison of volumetric and diametric measurement

2012 ◽  
Vol 81 (6) ◽  
pp. 1187-1191 ◽  
Author(s):  
J.D. Hahne ◽  
C. Arndt ◽  
J. Herrmann ◽  
B. Schönnagel ◽  
G. Adam ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Abdominal Aortic

Long-Term Follow-Up of Men Invited to Participate in a Population-Based Abdominal Aortic Aneurysm Screening Program

Angiology ◽  
2020 ◽  
Vol 71 (7) ◽  
pp. 641-649
Author(s):  
Rebecka Hultgren ◽  
K. Miriam Elfström ◽  
Daniel Öhman ◽  
Anneli Linné
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Screening Program ◽  
Dropout Rate ◽  
Rupture Rate ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Long Term Follow Up

A screening program for abdominal aortic aneurysm (AAA), inviting 65-year-old men, was started in Stockholm in 2010 (2.3 million inhabitants). The aim was to present a long-term follow-up of men participating in screening, as well as AAA repair and ruptures among nonparticipants. Demographics were collected for men with screening detected with AAA 2010 to 2016 (n = 672) and a control group with normal aortas at screening (controls, n = 237). Medical charts and regional Swedvasc (Swedish Vascular registry) data were analyzed for aortic repair for men born 1945 to 1951. Ultrasound maximum aortic diameter (AD) as well as Aortic Size Index (ASI) was recorded. Participation was 78% and prevalence of AAA was 1.2% (n = 672). Aortic repair rates correlated with high ASI and AD. During the study period, 22% of the AAA patients were treated with the elective repair; 35 men in surveillance died (5.2%), non-AAA-related causes (82.9%) dominated, followed by unknown causes among 4 (11.4%), and 2 (5.7%) possibly AAA-related deaths. Abdominal aortic aneurysm rupture rate was higher among nonparticipants (0.096% vs 0.0036%, P < .001). The low dropout rate confirms acceptability of follow-up after screening. The efficacy is shown by the much higher rupture rate among the nonparticipating men.

Sign in / Sign up

Export Citation Format

Share Document