scholarly journals Importance of Follow-up Imaging in the Detection of Delayed Type 2 Endoleaks Despite Complete Aneurysmal Sac Shrinkage

2019 ◽  
Vol 2 (1) ◽  
pp. 53-55
Author(s):  
Gergana T Taneva ◽  
Omid Shafe ◽  
Giovanni B Torsello ◽  
Arne Schwindt ◽  
Jamal Moosavi ◽  
...  
Keyword(s):  
Endovascular Aortic Repair ◽  
The Other ◽  
Small Subset ◽  
Delayed Onset ◽  
Aortic Repair ◽  
Type 2 Endoleak ◽  
New Onset

Type 2 endoleaks usually constitute a benign and self-limited phenomenon, which rarely leads to aneurysmal sac expansion. However, in a small subset of patients, a persistent type 2 endoleak might pressurise the aneurysmal sac causing expansion. The authors present two cases with delayed new-onset type 2 endoleak. One occurred after standard endovascular aortic repair and the other after chimney endovascular aortic repair, causing expansion of the aneurysmal sac after a period of complete aneurysmal sac shrinkage. Accordingly, there is a risk of sac re-expansion due to delayed onset endoleaks, independent of the technique, justifying the need for a continuous follow-up despite long-term aneurysmal sac shrinkage.

Outcomes of open and endovascular repair of inflammatory abdominal aortic aneurysms

Vascular ◽  
2017 ◽  
Vol 26 (2) ◽  
pp. 203-208 ◽  
Author(s):  
África Duque Santos ◽  
Andrés Reyes Valdivia ◽  
María Asunción Romero Lozano ◽  
Enrique Aracil Sanus ◽  
Julia Ocaña Guaita ◽  
...  
Keyword(s):  
Open Surgery ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Abdominal Aneurysm ◽  
Aortic Abdominal Aneurysm ◽  
Aortic Repair ◽  
Number Of Patients ◽  
Repair Group

Objective Reports on inflammatory aortic abdominal aneurysm treatment are scarce. Traditionally, open surgery has been validated as the gold standard of treatment; however, high technical skills are required. Endovascular aortic repair has been suggested as a less invasive treatment by some authors offering good results. The purpose of our study was to report our experience and outcomes in the treatment of inflammatory aortic abdominal aneurysm using both approaches. Material and methods A retrospective review and data collection of all patients treated for inflammatory aortic abdominal aneurysm between 2000 and 2015 was done in one academic center. Diagnosis of inflammatory aortic abdominal aneurysm was based on preoperative CT-scan imaging. Type of treatment, postoperative and long-term morbidity and mortality are described. Abdominal compressive symptoms (hydronephrosis) severity and relief after treatment are described. Results Thirty-four patients with intact inflammatory aortic abdominal aneurysm were included. Twenty-nine (85.3%) patients were treated by open means and the remaining five (14.7%) with endovascular aortic repair. Nearly 90% were considered high-risk patients. Median follow-up was 46 months (range 24–112). The two groups were comparable, except for the age and preoperative hydronephrosis. There was no statistical significance in blood transfusion requirements, intensive care hospitalization, 30-day and long-term mortality between the two groups. Preoperative hydronephrosis was diagnosed in four (13.8%) patients in the open surgery group and three (60%) patients in the endovascular aortic repair group. Improvement of hydronephrosis was recognized in three out of the four patients in the open repair group and two out of the three in the endovascular aortic repair group. Renal function remained stable in both groups during follow-up. Conclusions Open surgery remains a safe and valid option for the treatment of inflammatory aortic abdominal aneurysm. Although our study included a small number of patients with endovascular aortic repair treatment, results are promising. Further randomized controlled studies may be necessary to assess long-term effectiveness of endovascular aortic repair treatment in this disease.

A Case of Type-2 Endoleak from a Bronchial Artery after Endovascular Aortic Repair for Kommerell Diverticulum

2014 ◽  
Vol 28 (8) ◽  
pp. 1934.e3-1934.e6 ◽  
Author(s):  
Mau Amako ◽  
Hideichi Wada ◽  
Hitoshi Matsumura ◽  
Yuichi Morita ◽  
Masayuki Shimizu ◽  
...  
Keyword(s):  
Bronchial Artery ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Type 2 Endoleak ◽  
Kommerell Diverticulum

Preoperative proteinuria and clinical outcomes in type B aortic dissection after thoracic endovascular aortic repair

2019 ◽  
Vol 57 (5) ◽  
pp. 752-758
Author(s):  
Hongwei Yang ◽  
Jianwei Zhou ◽  
Keli Huang ◽  
Tao Yu ◽  
Zuhui Wang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Urine Dipstick ◽  
Aortic Repair

Abstract Background Proteinuria is a marker of poor outcomes in several diseases; however, few studies have been conducted to explore the prognostic value of proteinuria, assessed by urine dipstick test, for clinical outcomes in patients with type B acute aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Methods Consecutive patients with TBAD undergoing TEVAR were enrolled from January 2010 to July 2015. Proteinuria was defined as trace or higher, according to the results of urine dipstick testing. Associations among proteinuria and adverse events were evaluated. Results In total, 671 patients with a mean age of 44±15 years were included in the analysis. Proteinuria was detected in 281 patients (41.9%) before TEVAR. Multivariate logistic regression analysis showed that C-reactive protein and impaired renal function were independent predictors for proteinuria. During hospitalization, 21 patients died. In-hospital mortality was higher in patients with proteinuria (1.5% vs. 5.3%, p=0.005). After a median 3.4 years follow up, the post-TEVAR death rate was 10.4% (85 patients were lost to follow-up). The long-term cumulative mortality was significantly higher in patients with proteinuria (17.2% vs. 8.2%, log-rank=11.36, p=0.001). Multivariate Cox survival modeling indicated that proteinuria was significantly associated with long-term death, after adjustment for potential confounding risk factors (HR=1.92, p=0.012). Conclusions Pre-TEVAR proteinuria was identified as a prognostic marker in patients with TBAD and has potential for application as a convenient and simple risk assessment method before TEVAR.

scholarly journals Long‐Term Mortality Associated With Use of Carvedilol Versus Metoprolol in Heart Failure Patients With and Without Type 2 Diabetes: A Danish Nationwide Cohort Study

2021 ◽  
Vol 10 (18) ◽  
Author(s):  
Brian Schwartz ◽  
Colin Pierce ◽  
Christian Madelaire ◽  
Morten Schou ◽  
Søren Lund Kristensen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Mortality Benefit ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
Long Term Mortality ◽  
New Onset

Background Carvedilol may have favorable glycemic properties compared with metoprolol, but it is unknown if carvedilol has mortality benefit over metoprolol in patients with type 2 diabetes (T2D) and heart failure with reduced ejection fraction (HFrEF). Methods and Results Using Danish nationwide databases between 2010 and 2018, we followed patients with new‐onset HFrEF treated with either carvedilol or metoprolol for all‐cause mortality until the end of 2018. Follow‐up started 120 days after initial HFrEF diagnosis to allow initiation of guideline‐directed medical therapy. There were 39 260 patients on carvedilol or metoprolol at baseline (mean age 70.8 years, 35% women), of which 9355 (24%) had T2D. Carvedilol was used in 2989 (32%) patients with T2D and 10 411 (35%) of patients without T2D. Users of carvedilol had a lower prevalence of atrial fibrillation (20% versus 35%), but other characteristics appeared well‐balanced between the groups. Totally 11 306 (29%) were deceased by the end of follow‐up. We observed no mortality differences between carvedilol and metoprolol, multivariable‐adjusted hazard ratio (HR) 0.97 (0.90–1.05) in patients with T2D versus 1.00 (0.95–1.05) for those without T2D, P for difference =0.99. Rates of new‐onset T2D were lower in users of carvedilol versus metoprolol; age, sex, and calendar year adjusted HR 0.83 (0.75–0.91), P <0.0001. Conclusions In a contemporary clinical cohort of HFrEF patients with and without T2D, carvedilol was not associated with a reduction in long‐term mortality compared with metoprolol. However, carvedilol was associated with lowered risk of new‐onset T2D supporting the assertion that carvedilol has a more favorable metabolic profile than metoprolol.

scholarly journals Unibody Endograft Using AFX 2 for Less Invasive and Faster Endovascular Aortic Repair: Protocol for a Multicenter Nonrandomized Study

10.2196/16959 ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. e16959
Author(s):  
Roberto Silingardi ◽  
Pasqualino Sirignano ◽  
Francesco Andreoli ◽  
Wassim Mansour ◽  
Mattia Migliari ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Clinical Success ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Intraoperative Radiation ◽  
Nonrandomized Study ◽  
Aortic Repair ◽  
Number Of Patients

Background Since the introduction of endovascular aortic repair (EVAR) for treatment of abdominal aortic aneurysms (AAAs), progressive improvements in results have been achieved. However, conventional bifurcated stent grafts have been proven to have a nonnegligible risk of failure and secondary intervention, principally due to the lack of adequate proximal sealing. The unique AFX 2 Endovascular AAA System (Endologix, Irvine, CA) unibody device, which provides different sealing and fixation features compared with conventional devices, seems to overcome these limitations. Objective The aim of this study is to evaluate intraoperative, perioperative, and postoperative results in patients treated with the AFX 2 Endovascular AAA System endografts for elective AAA repair in a large cohort of consecutive patients. Methods All eligible EVAR patients will be included in this observational, multicenter, prospective, nonrandomized study. The number of patients to be enrolled is 500. Results The primary endpoint of the study is to evaluate the technical and clinical success of EVAR with unibody endografts in short- (90-day), mid- (1-year), and long-term (5-year) follow-up periods. The following secondary endpoints will also be addressed: operative time, intraoperative radiation exposure, contrast medium usage, AAA sac shrinkage at 12-month and 5-year follow-up, and any potential role of patients’ baseline characteristics and device configuration on primary endpoint. The actual start date of the investigation was November 2019. The final patient is expected to be treated by the end of December 2020, and the estimated study completion date is December 2025. Conclusions This study will provide verified real-world data on AAAs treated by AFX 2 endografts and followed for a long-term interval. International Registered Report Identifier (IRRID) PRR1-10.2196/16959

scholarly journals Occurrence of comorbidities in newly diagnosed type 2 diabetes patients and their impact after 11 years’ follow-up

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sophia Eilat-Tsanani ◽  
Avital Margalit ◽  
Liran Nevet Golan
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Newly Diagnosed ◽  
Risk Of Death ◽  
High Prevalence ◽  
Long Term Follow Up ◽  
New Onset

AbstractThe burden of type 2 diabetes is growing, not only through increased incidence, but also through its comorbidities. Concordant comorbidities for type 2 diabetes, such as cardiovascular diseases, are considered expected outcomes of the disease or disease complications, while discordant comorbidities are not considered to be directly related to type 2 diabetes and are less extensively addressed under diabetes management. Here we show that the combination of concordant and discordant comorbidities appears frequently in persons with diabetes (75%). Persons with combined comorbidities visited family physicians more than persons with discordant, concordant or no comorbidity (17.3 ± 10.2, 11.6 ± 6.5, 8.7 ± 6.8, 6.3 ± 6.6 visits/person/year respectively, p < 0.0001). The risk of death during the study period was highest in persons with combined comorbidities and discordant only comorbidities (HR = 33.4; 95% CI 12.5–89.2 and HR = 33.5; 95% CI 11.7–95.8), emphasizing the contribution of discordant comorbidities to the outcome. Our study is unique as a long-term follow-up of an 11-year cohort of 9725 persons with new-onset type 2 diabetes. The findings highlight the contribution of discordant comorbidity to the burden of the disease. The high prevalence of the combination of both concordant and discordant comorbidities, and their appearance before the onset of type 2 diabetes, indicates a continuum of morbidity.

scholarly journals Analysis of perioperative outcome and long-term survival rate of thoracic endovascular aortic repair in uncomplicated type B dissection: single-centre experience with 751 patients

2019 ◽  
Vol 56 (6) ◽  
pp. 1090-1096 ◽  
Author(s):  
Hui-Qiang Gao ◽  
Shang-Dong Xu ◽  
Chang-Wei Ren ◽  
Sheng Yang ◽  
Chao-Liang Liu ◽  
...  
Keyword(s):  
Survival Rates ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Term Survival ◽  
Long Term Survival ◽  
Aortic Repair ◽  
Type B Dissection

Abstract OBJECTIVES To study the perioperative outcomes and long-term survival rates in patients undergoing thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissection. METHODS A total of 751 patients with uncomplicated type B dissection who underwent TEVAR at our centre between May 2001 and December 2013 were retrospectively reviewed. The mean age of all patients (619 males and 132 females) was 52.8 ± 10.9 years. The follow-up period ranged from 1 to 170 months (median 70 months). RESULTS Five patients died during the perioperative period (mortality rate 0.7%). Four patients (0.5%) developed retrograde type A dissection. Two patients (0.3%) developed paraplegia and 1 patient developed incomplete paralysis (0.1%). There were no postoperative cerebral infarctions. The 5- and 10-year survival rates were 96.5% [95% confidence interval (CI) 95.0–98.0%] and 83.0% (95% CI 77.9–88.4%), respectively. The 5- and 10-year reintervention rates were 4.6% (95% CI 3.0–6.2%) and 7.9% (95% CI 5.3–10.5%), respectively. CONCLUSIONS Although the application of TEVAR for patients with uncomplicated dissection is still under debate, many patients who have undergone TEVAR have benefitted substantially from the treatment. Our data showed that TEVAR had low mortality and complication rates both in the short- and long-term follow-up periods. TEVAR may be considered as a first choice for patients with uncomplicated type B dissection.

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.

Quality of life after acute type b dissection in the era of thoracic endovascular aortic repair

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 219-228 ◽  
Author(s):  
Dick ◽  
Hirzel ◽  
Immer ◽  
Hinder ◽  
Dai-Do ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair ◽  
Type B Dissection

Background: Conservative management of acute type B aortic dissection is currently being challenged by primary thoracic endovascular aortic repair. Aim was to assess outcome and quality of life after these different approaches using an adjusted standard population as benchmark. Patients and methods: Observational study of a prospectively collected (January 2000 to December 2005) consecutive series of 87 patients with acute type B aortic dissection. Patients were 63 ± 13 years old and 68 were men (78.2 %). Seventy-two were managed conservatively (83 %) and 15 invasively (12 by endovascular aortic repair). Follow-up was 36 ± 19 months. Endpoints were early and late morbidity and mortality, and long-term quality of life as assessed by the Short Form health survey questionnaire. Results: Patient cohorts were similar regarding age, risk profile and local disease. In the conservative cohort, four patients died during early (5.6 %) and eight during long-term follow-up (cumulative four years survival rate 79 %). Thirty-two patients needed secondary surgical management (44 %), i.e. delayed aortic repair (n = 11), or interventions on adjacent aortic sections or major branches (n = 21). In the surgical cohort no patient died, and no repeated interventions were necessary after the peri-operative period. Long-term quality of life scores were 100 (69-115) in conservatively and 94 (75-124) in invasively managed patients. Normal scores range from 85 to 115. Conclusions: Primary endovascular management of uncomplicated acute type B dissection is safe and leads to excellent long-term results, whereas secondary interventions were required with high incidence after initial conservative management. Long-term quality of life, however, returned to normal with any successful treatment strategy.

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