scholarly journals CT angiography for the assessment of EVAR complications: a pictorial review

2022 ◽  
Vol 13 (1) ◽  
Author(s):  
Cecilia Gozzo ◽  
Giovanni Caruana ◽  
Roberto Cannella ◽  
Arduino Farina ◽  
Dario Giambelluca ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Technique ◽  
Aortic Aneurysms ◽  
High Rate ◽  
Invasive Treatment ◽  
Systemic Complications ◽  
Pictorial Review ◽  
Risk Of Rupture ◽  
Long Term Follow Up

AbstractEndovascular aneurysm repair (EVAR) is a minimally invasive treatment proposed as an alternative to open repair in patients with abdominal aortic aneurysms. EVAR consists in a stent-graft placement within the aorta in order to exclude the aneurysm from arterial circulation and reduce the risk of rupture. Knowledge of the various types of devices is mandatory because some stents/grafts are more frequently associated with complications. CT angiography is the gold standard diagnostic technique for preprocedural planning and postprocedural surveillance. EVAR needs long-term follow-up due to the high rate of complications. Complications can be divided in endograft device-related and systemic complications. The purpose of this article is to review the CT imaging findings of EVAR complications and the key features for the diagnosis.

Abstract 13513: Serial CT Surveillance of Abdominal Aortic Aneurysm Diameter Demonstrates Predominantly Linear Growth (N-TA 3 CT)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sydney Olson ◽  
Marniker Wijesinha ◽  
Annalise Panthofer ◽  
William Blackwelder ◽  
Gilbert R Upchurch ◽  
...  
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Linear Growth ◽  
Growth Patterns ◽  
Aortic Aneurysms ◽  
Transverse Diameter ◽  
Invasive Treatment ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Serial Ct

Objective: Small abdominal aortic aneurysms (AAAs) have a low risk of rupture. Intervention is indicated when diameters exceed established thresholds. This study assessed the growth rates and patterns of AAAs over 2 years as documented on serial CT scans from the Non-Invasive Treatment of AAA Clinical Trial. Methods: 254 patients, 35 females with baseline AAA maximum transverse diameter (MTD) between 3.5-4.5 cm and 219 males with baseline MTD 3.5-5.0 cm, were included in this study. Linear regressions and segmental growth rates were used to model growth rates and patterns. Results: The yearly growth rates of AAA MTDs had a median of 0.17 cm/yr and mean of 0.19 cm/yr ± 0.14 (Figure 1). 10% of AAA displayed minimal to no growth (< 0.05 cm/yr), 62% low growth (0.05-0.25 cm/yr), 28% high growth (> 0.25 cm/yr). Baseline AAA diameter accounted for only 5.4% of growth rate variance (P<0.001, R 2 0.05). Most AAAs displayed linear growth (70%); large variations in interval growth rates occurred infrequently (3% staccato growth, 4% exponential growth); a minority of subjects’ growth patterns were not clearly classifiable (11% indeterminate-not growing, 12% indeterminate-growing) (Figure 2). No patients with baseline MTD < 4.25 cm exceeded sex-specific repair thresholds (males 0 / 92, [95% CI, 0.00-0.06]; females 0 / 25 [95% CI, 0.00-0.25]) in the course of follow-up for as long as two years. Conclusions: The majority of small AAAs exhibit linear growth; large intra-patient growth rate variations were infrequently observed over 2 years. AAA < 4.25 cm can be followed with a CT scan in 2 years with little chance of exceeding interventional MTD thresholds of 5.5 cm for men.

Treatment of scar endometriosis with elagolix

2020 ◽  
Vol 12 (1) ◽  
pp. 56-58
Author(s):  
Timothy A D’Amico ◽  
Lisa Bystry ◽  
Sean M Kandel
Keyword(s):  
Rare Complication ◽  
High Rate ◽  
Attractive Potential ◽  
Inflammatory Disorder ◽  
Invasive Treatment ◽  
Scar Endometriosis ◽  
Chronic Inflammatory Disorder ◽  
Non Invasive ◽  
Long Term Follow Up

Endometriosis is a chronic inflammatory disorder that affects approximately 5%–10% of women and is a major contributor to chronic pelvic pain. It can result in a significant impact on a woman’s quality of life with a high rate of reoccurrence throughout the woman’s reproductive years. Medical treatment is available but often surgical intervention is required. Scar endometriosis is a rare complication of this disease, mostly involving cesarean section scars. Our case demonstrates a possible new, non-invasive treatment for scar endometriosis with elagolix. The ability to avoid the potential morbidity of surgical scar revision makes this a very attractive potential option. Further studies with larger cohorts and long-term follow up are needed to confirm efficacy.

Endovascular repair for abdominal aortic aneurysms

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318288
Author(s):  
Samuel Debono ◽  
Jennifer Nash ◽  
Andrew L Tambyraja ◽  
David E Newby ◽  
Rachael O Forsythe
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Morbidity And Mortality ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Aneurysm Repair ◽  
Selection Of

Management of abdominal aortic aneurysms has been the subject of rigorous scientific scrutiny. Prevalence studies have directed the formation of screening programmes, and observational studies and randomised controlled trials have defined aneurysm growth and treatment thresholds. Pre-emptive intervention with traditional open surgical repair has been the bedrock of improving long-term outcome and survival in patients with abdominal aortic aneurysms but it is associated with a significant procedural morbidity and mortality. Endovascular aneurysm repair (EVAR) has substantially reduced these early complications and has been associated with promising results in both elective and emergency aneurysm repair. However, the technique has brought its own unique complications, endoleaks. An endoleak is the presence of blood flow within the aneurysm sac but outside the EVAR graft. Although in randomised control trials EVAR was associated with a reduced early mortality compared with open repair, its longer-term morbidity and mortality was higher because endoleak development is associated with a higher risk of rupture. These endoleak complications have necessitated the development of postoperative imaging surveillance and re-intervention. These contrasting benefits and risks inform the selection of the mode of repair and are heavily influenced by individual patient factors. An improved strategy to predict endoleak development could further help direct treatment choice for patients and improve both early and late outcomes. This article reviews current EVAR practice, recent updates in clinical practice guidelines and the potential future developments to facilitate the selection of mode of aneurysm repair.Trial registration number: ClinicalTrials.gov NCT04577716.

Chimney Endovascular Aneurysm Repair Using Endurant Stent-Grafts With Bare Balloon-Expandable Stents for Patients With Juxtarenal Aortic Aneurysms

2019 ◽  
Vol 26 (3) ◽  
pp. 350-358 ◽  
Author(s):  
Noriyasu Morikage ◽  
Takahiro Mizoguchi ◽  
Yuriko Takeuchi ◽  
Takashi Nagase ◽  
Makoto Samura ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Covered Stents ◽  
Acute Renal Dysfunction ◽  
Systemic Complications ◽  
Proximal Neck ◽  
Type Ia ◽  
The Mean ◽  
Aneurysm Repair ◽  
Aneurysm Diameter

Purpose: To evaluate the advantages of chimney endovascular aneurysm repair (chEVAR) using an Endurant stent-graft with uncovered balloon-expandable stents (BES) for patients with juxtarenal aortic aneurysms. Materials and Methods: Twenty-two patients (mean age 78.5±9.0 years; 13 men) who underwent chEVAR using Endurant and uncovered BES between January 2014 and December 2017 were analyzed retrospectively. The maximum aneurysm diameter was 59.1±11.9 mm, and the proximal neck length was 5.2±2.9 mm. Of the 22 cases, 9 (40%) involved proximal neck angulation and 9 (40%) had a conical neck. Single and double chimneys were performed using BES in 19 and 3 cases, respectively. In 2 cases, an additional self-expanding covered stent was used inside the uncovered BES. Results: The technical success was 91% (20/22) as 2 (9%) cases showed minor type Ia endoleak. No postoperative systemic complications or acute renal dysfunction (Acute Kidney Injury Network classification stage 2 or higher) were observed. The mean radiologic observation period was 16.1±9.6 months, and no aneurysm expansion (>5 mm) was observed during this time. The mean maximum aneurysm diameter decreased to 52.9±10.2 mm (p<0.001 vs preoperative), with an individual mean sac regression of 6.2±5.9 mm. Overall primary chimney stent patency was 100%. One of the 2 cases of intraoperative type Ia endoleak resolved at the 6-month imaging, and no new type Ia endoleaks developed in any cases at follow-up. No additional treatment- or aneurysm-related events were observed. Conclusion: Short-term outcomes of chEVAR using Endurant with uncovered BES have been favorable when covered stents were unavailable, and it can be useful for high-risk patients with juxtarenal aortic aneurysms.

Repair of Infrarenal Abdominal Aortic Aneurysms

2017 ◽  
Author(s):  
James Sampson ◽  
William D Jordan Jr
Keyword(s):  
Tobacco Use ◽  
Endovascular Aneurysm Repair ◽  
Careful Consideration ◽  
Aortic Aneurysms ◽  
Optimal Outcomes ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Aneurysm Detection ◽  
Aneurysm Repair

Aneurysms are localized arterial dilations with a propensity toward expansion and rupture. The abdominal aorta is the most common site of aneurysmal disease and shares risk factors with atherosclerosis, including advanced age, male sex, and tobacco use. Rupture is unpredictable, typically unheralded, and most often fatal. The risk of rupture is related to aneurysm size and continued tobacco use. There is no established medical treatment; therefore, prevention of aneurysm-related death relies on aneurysm detection through screening followed by intervention on appropriately selected and prepared individuals. Intervention is typically warranted when the aneurysm has reached a size of 5.5 cm. Treatment is possible through open surgical repair or through endovascular exclusion of the aneurysm. Optimal outcomes rely on careful consideration of the patient’s comorbid disease and life expectancy and the anatomic features of the aneurysm to determine the most appropriate timing and approach to repair. Continued surveillance after intervention is critical to optimizing long-term benefits of repair, especially for those treated through endovascular means. This review contains 33 figures, and 37 references. Key words: abdominal aortic aneurysm, aneurysm, endovascular, endovascular aneurysm repair, repair, rupture, screening

Abstract 41: Designation as “Unfit For Open Repair” is Associated with Poor Outcomes Following Endovascular Aneurysm Repair

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Randall R De Martino ◽  
Benjamin J Brooke ◽  
William P Robinson ◽  
Brian W Nolan ◽  
Jack L Cronenwett ◽  
...  
Keyword(s):  
New England ◽  
Open Repair ◽  
Endovascular Aneurysm Repair ◽  
Cox Proportional Hazards ◽  
Aortic Aneurysms ◽  
Cardiac Complications ◽  
Risk Of Rupture ◽  
Short And Long Term ◽  
Aneurysm Repair

Objective: Endovascular aneurysm repair (EVAR) is a minimally invasive method of repair for abdominal aortic aneurysms (AAA) with a lower perioperative morbidity and mortality compared to open repair (oAAA). In many cases, EVAR is offered to patients who otherwise are not candidates for oAAA. This study attempts to describe the short and long term outcomes of patients undergoing EVAR who are consideredunfit for oAAA with moderate sized aneurysms (<6..5cm diameter). Methods: We analyzed 1,653 elective EVARs within the Vascular Study Group of New England (2003-2011), a regional quality improvement collaborative across 21 hospitals and 87 surgeons in New England. Endpoints included in-hospitalmajor adverse events (MAEs) and one, three, and five-year mortality. Logistic regression was used to develop a prediction model for being deem unfit for open repair. Multivariate predictors of survival were determined using Cox Proportional Hazards. Results: Of 1,653 EVARs, 309 (18.7%) were performed in patients deemed unfit for open repair. These patients were more likely to be over 80 years of age, have advanced cardiac disease,COPD, and a larger aneurysms. Patients deemed unfit for open repair had andhigher rates of cardiac complications (7.8% vs 3.1%, p<0.01) and pulmonary complications (3.6 vs. 1.6, p<0..01). Patients unfit for open repair had poorer survival rates at 1 (93% vs.. 96%), 3 (73% vs. 89%) and 5 years (61% vs. 80%) compared to those appropriate for open repair (logrank p<0.01). The effect of "unfit for open" designation remained significant (HR 1.6, 96% CI 1.2-2.2, p<0.01), even when adjusted for patient characteristics and aneurysm size. Conclusions: Clinical provider assessment provides insight into both short and long-term efficacy of EVAR, even when adjusting for age and comorbidities. Patients in whom open repair is felt to be too "high-risk" may not benefit from EVAR unless their risk of rupture is very high.

scholarly journals Short- and Midterm Outcomes of Open Repair and Fenestrated Endografting of Pararenal Aortic Aneurysms in a Concurrent Propensity-Adjusted Comparison

2018 ◽  
Vol 26 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Beatrice Fiorucci ◽  
Francesco Speziale ◽  
Tilo Kölbel ◽  
Nikolaos Tsilimparis ◽  
Pasqualino Sirignano ◽  
...  
Keyword(s):  
Survival Rates ◽  
Endovascular Aneurysm Repair ◽  
High Volume ◽  
Artery Occlusion ◽  
Aortic Aneurysms ◽  
Visceral Artery ◽  
Cardiac Complications ◽  
Systemic Complications ◽  
Perioperative Morbidity ◽  
Vessel Patency

Purpose: To compare outcomes of patients treated for pararenal aortic aneurysms using fenestrated endovascular aneurysm repair (fEVAR) vs open surgical repair (OSR) in 3 high-volume centers. Materials and Methods: A multicenter retrospective analysis was conducted of 200 pararenal abdominal aortic aneurysm patients electively treated with OSR (n=108) or fEVAR (n=92) from 1998 to 2015 at 3 tertiary institutions. Endpoints were 30-day morbidity and mortality, late reinterventions, visceral artery occlusion, and mortality. Analysis was conducted on the entire population and on a propensity score–matched population constructed on age, gender, coronary artery disease (CAD), and chronic renal failure. Results: In the total cohort, fEVAR patients were significantly (p<0.001) older and had higher frequencies of CAD (p<0.001) and previous stroke (p=0.003). OSR patients had higher risk of perioperative morbidity (OR 2.5, 95% CI 1.09 to 5.71, p=0.033), specifically respiratory failure (OR 4.06, 95% CI 1.12 to 4.72, p=0.034). These findings were confirmed in the propensity-adjusted analysis, where cardiac complications were also higher after OSR (OR 12.8, 95% CI 0.07 to 0.21, p=0.02). No difference in perioperative mortality (2.2% in fEVAR vs 1.9% in OSR) was identified. Mean follow-up was 50 months (range 0–119). Four-year results showed higher survival (91.2% vs 69.3%, p=0.02) and freedom from reintervention (95.6% vs 77.8%, p=0.01) after OSR in the unmatched population, with a small but significant (p=0.021) difference in the risk of late visceral artery occlusion/stenosis after fEVAR. On propensity analysis, no differences in late survival were found between groups. Conclusion: fEVAR and OSR may afford similar early and midterm survival rates. Higher risks of perioperative systemic complications after OSR are counterbalanced by higher risks of late visceral vessel patency issues and need for reintervention after fEVAR. Both procedures are safe and effective in the long term in experienced centers, where patient evaluation should drive the treatment strategy.

scholarly journals Vascular Deformation Mapping of Abdominal Aortic Aneurysm

Tomography ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. 189-201
Author(s):  
Drew J. Braet ◽  
Jonathan Eliason ◽  
Yunus Ahmed ◽  
Pieter A. J. van Bakel ◽  
Jiayang Zhong ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Complex Disease ◽  
Endovascular Aneurysm Repair ◽  
Three Dimensional ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Abdominal Aortic ◽  
Risk Of Rupture ◽  
Imaging Surveillance

Abdominal aortic aneurysm (AAA) is a complex disease that requires regular imaging surveillance to monitor for aneurysm stability. Current imaging surveillance techniques use maximum diameter, often assessed by computed tomography angiography (CTA), to assess risk of rupture and determine candidacy for operative repair. However, maximum diameter measurements can be variable, do not reliably predict rupture risk and future AAA growth, and may be an oversimplification of complex AAA anatomy. Vascular deformation mapping (VDM) is a recently described technique that uses deformable image registration to quantify three-dimensional changes in aortic wall geometry, which has been previously used to quantify three-dimensional (3D) growth in thoracic aortic aneurysms, but the feasibility of the VDM technique for measuring 3D growth in AAA has not yet been studied. Seven patients with infra-renal AAAs were identified and VDM was used to identify three-dimensional maps of AAA growth. In the present study, we demonstrate that VDM is able to successfully identify and quantify 3D growth (and the lack thereof) in AAAs that is not apparent from maximum diameter. Furthermore, VDM can be used to quantify growth of the excluded aneurysm sac after endovascular aneurysm repair (EVAR). VDM may be a useful adjunct for surgical planning and appears to be a sensitive modality for detecting regional growth of AAAs.

scholarly journals Endovascular Aneurysm Repair Using Anaconda Repositionable Aortic Stent Graft Assisted Exclusively by Intravascular Ultrasound Imaging

2019 ◽  
Vol 2 (1) ◽  
pp. 32-37
Author(s):  
Gaetano La Barbera ◽  
Giuliana La Rosa ◽  
Fabrizio Valentino ◽  
Gabriele Ferro ◽  
Dario Parsaei ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Stent Graft ◽  
Clinical Success ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Technique ◽  
Primary Objective ◽  
Aortic Aneurysms ◽  
Aortic Stent Graft ◽  
Aneurysm Repair

Arteriography with contrast medium (CM) injection is normally employed to visualise the lowest renal artery during endovascular aneurysm repair (EVAR). Intravascular ultrasound (IVUS) has been proposed as an alternative, real-time imaging diagnostic technique to arteriography. In this study, we evaluated the feasibility of EVAR using Anaconda repositionable aortic stent graft (Vascutek) assisted by IVUS (Volcano Visions, Philips) during intraluminal navigation without CM. From January 2016 to December 2017, 25 patients with infrarenal abdominal aortic aneurysms, identified through anatomical inclusion criteria, underwent EVAR. All of the patients had an arteriogram at the end of the EVAR procedure to confirm aortic stent graft patency and to exclude type 1 endoleaks. The primary objective was the technical and clinical success of this CM-free aortic stent graft delivery procedure. At the end of the period, 150 target vessels were evaluated. IVUS versus angio-CT sensitivity and specificity rate were 97.3% and 100%, respectively. The primary technical success was obtained in 88% of the cases. Three patients (12%) needed CM injection to complete the procedure and there were no cases of type 1 endoleak. Primary clinical success was 100%. During follow-up at a mean of 20 months, none of the patients died or had complications. We conclude that a full EVAR procedure is feasible using only IVUS navigation and repositionable aortic stent graft without CM injection in anatomically selected cases.

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