Endovascular Repair of AAA Rupture 20 Months After Endoluminal Stent-Grafting

Objectives: The purpose of this paper is to report the different modalities for the treatment of isolated internal iliac artery aneurysms (IIIAA), as well as their outcomes. Methods: We performed a systematic review of the literature (database searched: PubMed, Web of Science, Scopus, Cochrane Library; last search: April 2020). We included articles reporting on the outcomes for IIIAA interventions comprising at least 5 patients. Studies were included when presenting extractable outcome data regarding intraoperative and/or early results. We performed meta-analyses of proportions for different outcomes, using random effects model. Results: Thirteen non-randomized studies were included (192 patients with 202 IIIAA). IIIAA were symptomatic in the 18.1% (95%CI 9.3-26.9; I2 54.46%, P = .019). Estimated mean IIIAA diameter was 46.28 mm (95%CI 39.72-52.85; I2 88.85%, P < .001). Open repair was performed in 21/202 cases. Endovascular treatments were: embolization (81/181), embolization and hypogastric artery coverage (79/181), hypogastric artery coverage by stent-grafting (15/181), stent-grafting in the hypogastric artery (6/181). Overall estimated technical success (TS) rate was 91.6% (95% CI 86.8-95.5; I2 45.82%, P = .031). TS rate was 94.5% for open surgery (95%CI 85.3-100; I2 0%, P = .907), and 89.7% for endovascular repair (95%CI 83.8-95.6; I2 55.43%, P = .006). Estimated overall 30-day mortality was 3.1% (95%CI 0.8-5.4; I2 0%, P = .969). Mortality rates after open surgery and endovascular repair were 8.2% (95%CI 3.4-19.8; I2 0%, P = .545) and 2.8% (95%CI 0.5-5.1; I2 0%, P = .994), respectively. Estimated mean follow-up was 32.63 months (95%CI 21.74-43.53; I2 94.45%, P < .001). During this timeframe, IIIAA exclusion was preserved in 92.8% of the patients (95%CI 89.3-96.2; I2 0%, P = .797). Buttock claudication occurred in 13.9% of the patients (95%CI 8.7-19.2; I2 0%, P = .622). Conclusions: IIIAA are frequently large, and symptomatic at presentation. Several treatments are proposed in literature, open and endovascular, both with good results. The endovascular treatment is the preferred method of treatment in literature, since it offers good short- to mid-term results and low early mortality. Buttock claudication after hypogastric artery exclusion is a common complication.

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Abstract 3051: Long Term Results Of Open Endovascular Repair For Aortic Dissections

Circulation ◽

10.1161/circ.116.suppl_16.ii_683-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kazuo Shimamura ◽

Toru Kuratani ◽

Goro Mastumiya ◽

Yoshiyuki Shirakawa ◽

Mugiho Takeuchi ◽

...

Keyword(s):

Aortic Arch ◽

Endovascular Repair ◽

Long Term Results ◽

Stent Grafting ◽

Grafting Technique ◽

Aortic Dissections ◽

Open Stent Grafting ◽

Open Stent ◽

Intimal Tear

Background . Complete resection of the intimal tear in aortic arch is one of the most complicated tasks in the treatment of aortic dissections. We introduced open stent grafting technique to complete this task with technical easiness. In this study we evaluated the long term efficacy of this procedure from our 12 years experience. Patients and Method. Form January 1994 to December 2004, 59 aortic dissections with intimal tear in aortic arch or proximal descending aorta were operated with open stent grafting technique (age 61.7yrs, 41 type A and 18 type B). Thirty three (55.9%) were in emergency status. All these cases were morphologically excluded from the indication of transluminal endovascular repair. Under deep hypothermic circulatory arrest with antegrade cerebral perfusion, the hybrid prosthesis was inserted into descending aorta through the transected proximal aortic arch in order to achieve intimal tear exclusion. Results. Complete exclusion of the aortic arch intimal tear was achieved in all cases. Operative mortality within 30 days was 3.4%. Major postoperative complications included 4(6.8%) cerebral infarctions, 2 (3.4%) paraplegia, 2 (3.4%) transient paraparesis. Median follow up was 71.2 months (maximum 153 months). One patient (1.7%) showed type I endoleak from the distal end. In 6 patients (10.2%) additional endovascular repair for other thoracic lesions were performed, and only one case with Marfan syndrome required open surgical repair for thoracoabdominal aorta because of expansion of the remaining thoracic dissection. CT scan showed shrinkage of the false channel in 78.6% of the patients. There were no rupture of the remaining dissected aorta and the freedom from aortic related death was 94.7%, 94.7%, and 88.8% at 1,5, and 8 years respectively. Conclusion. This study suggested that open stent grafting is a safe and effective technique with good long-term results. This procedure could be an alternative and standard method to repair aortic dissections with aortic arch intimal tear.

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Branch stent-grafting for endovascular repair of chronic aortic arch dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.10.184 ◽

2019 ◽

Cited By ~ 3

Author(s):

Lei Zhang ◽

Qingsheng Lu ◽

Hongqiao Zhu ◽

Zaiping Jing

Keyword(s):

Aortic Arch ◽

Endovascular Repair ◽

Stent Grafting

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Management of Uncomplicated Type B Aortic Dissection

Hearts ◽

10.3390/hearts1010004 ◽

2020 ◽

Vol 1 (1) ◽

pp. 14-24

Author(s):

Xun Yuan ◽

Rachel E. Clough ◽

Christoph A. Nienaber

Keyword(s):

Aortic Dissection ◽

Endovascular Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Term Survival ◽

Subacute Phase ◽

Stent Grafting ◽

Best Medical Treatment ◽

Type B Dissection ◽

Acute Dissection

Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management has been the mainstay of treatment for uncomplicated distal or type B aortic dissection, but endovascular intervention is now considered a potential treatment option for all type B dissection due to its success in complicated cases. Endovascular repair can be technically demanding in aortic dissection, and timing of the repair can have a significant influence on anatomical and clinical outcome. Observational reports of feasibility and reasonable safety are flanked by only two randomised trials; the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial demonstrated improved remodelling in acute dissection and the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) trial showed better long-term survival in patients treated endovascularly in the subacute phase. Meta-analyses and other large clinical studies have demonstrated mixed results. Due to some risks associated endovascular repair and the requirement of specialist aortic care (which is not always available), a pragmatic approach for current management could involve high intensity serial imaging in the acute phase of a type B aortic dissection, thereby identifying complicated cases for early intervention and selection of patients at high risk of disease progression for deferred endovascular management in the subacute phase within 90 days.

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Endovascular Repair of Ruptured Iliac Aneurysm With Ileocaval Fistula With Iliac Vein Disruption, Using Staged Aortic and iliocaval Stent-Grafting

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.09.049 ◽

2011 ◽

Vol 54 (5) ◽

pp. 1551

Author(s):

Mel J. Sharafuddin ◽

Parth B. Amin ◽

Rachael M. Nicholson ◽

Timothy F. Kresowik ◽

William J. Sharp

Keyword(s):

Endovascular Repair ◽

Iliac Vein ◽

Iliac Aneurysm ◽

Stent Grafting

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Endoluminal stent grafting in the descending aorta in a sheep model

Cardiovascular Surgery ◽

10.1016/0967-2109(95)93973-s ◽

1995 ◽

Vol 3 ◽

pp. 5-5

Author(s):

K OREND ◽

R PAMLAR ◽

B KIRCHDORFER ◽

J KICK ◽

J HAHN ◽

...

Keyword(s):

Sheep Model ◽

Descending Aorta ◽

Stent Grafting ◽

Endoluminal Stent

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Pseudoaneurysm of the Aortic Arch After Aortosubclavian Bypass Treated with Endoluminal Stent Grafting

Vascular and Endovascular Surgery ◽

10.1177/153857440303700511 ◽

2003 ◽

Vol 37 (5) ◽

pp. 375-379 ◽

Cited By ~ 4

Author(s):

Charles S. Thompson ◽

Julio A. Rodriguez ◽

Venkatesh G. Ramaiah ◽

Dawn Olsen ◽

Edward B. Diethrich

Keyword(s):

Aortic Arch ◽

Stent Grafting ◽

Endoluminal Stent

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Blunt Traumatic Injury to the Superficial Femoral Artery in a Morbidly Obese Female: Case Report Using Endovascular Covered Stent Repair

Vascular and Endovascular Surgery ◽

10.1177/1538574420954576 ◽

2020 ◽

pp. 153857442095457

Author(s):

Ahna H. Weeks ◽

April A. Grant ◽

Jason D. Sciarretta ◽

Jonathan Nguyen ◽

S. Rob Todd ◽

...

Keyword(s):

Femoral Artery ◽

Endovascular Repair ◽

Superficial Femoral Artery ◽

Traumatic Injury ◽

Covered Stent ◽

Morbidly Obese ◽

Trauma Patients ◽

Stent Grafting ◽

Obese Female ◽

Wide Range

Lower extremity vascular injuries following trauma are rare events that require prompt identification and management in order to prevent ischemia and limb loss. Endovascular approaches, rather than traditional open procedures, are increasingly used to treat a wide range of vascular disease. The use of endovascular repair for revascularization in the trauma setting is not routine but may provide an appealing alternative in select trauma patients and injuries. We present a case of successful endovascular repair with stent grafting of a superficial femoral artery intimal injury following a femur fracture in a 35-year-old morbidly obese female and review the current literature regarding the use of endovascular therapy in the trauma setting.

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