Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair

Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.

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Long-term outcomes and factors influencing late survival following elective abdominal aortic aneurysm repair: A 24-year experience

Vascular ◽

10.1177/1708538115586682 ◽

2015 ◽

Vol 24 (2) ◽

pp. 115-125 ◽

Cited By ~ 12

Author(s):

Manar Khashram ◽

Julie S Jenkins ◽

Jason Jenkins ◽

Allan J Kruger ◽

Nicholas S Boyne ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Background Abdominal aortic aneurysms can be either treated by an open abdominal aortic aneurysm repair or an endovascular repair. Comparing clinical predictors of outcomes and those which influence survival rates in the long term is important in determining the choice of treatment offered and the decision-making process with patients. Aims To determine the influence of pre-existing clinical predictors and perioperative determinants on late survival of elective open abdominal aortic aneurysm repair and endovascular repair at a tertiary hospital. Methods Consecutive patients undergoing elective abdominal aortic aneurysm repair from 1990 to 2013 were included. Data were collected from a prospectively acquired database and death data were gathered from the Queensland state death registry. Pre-existing risks and perioperative factors were assessed independently. Kaplan–Meier and Cox regression modeling were performed. Results During the study period, 1340 abdominal aortic aneurysms were repaired electively, of which 982 were open abdominal aortic aneurysm repair. The average age was 72.4 years old and 81.7% were males. The cumulative percentage survival rates for open abdominal aortic aneurysms repair at 5, 10, 15 and 20 years were 79, 49, 31 and 22, respectively. The corresponding 5-, 10- and 15-year survival rates for endovascular repair were not significantly different at 75, 49 and 33%, respectively (P = 0.75). Predictors of reduced survival were advanced age, American Society of Anaesthesiology scores, chronic obstructive pulmonary disease, renal impairment, bifurcated grafts, peripheral vascular disease and congestive heart failure. Conclusions Open repair offers a good long-term treatment option for patients with an abdominal aortic aneurysm and in our experience there is no significant difference in late survival between open abdominal aortic aneurysms repair and endovascular repair. Consideration of the factors identified in this study that predict reduced long-term survival for open abdominal aortic aneurysms repair and endovascular repair should be considered when deciding repair of abdominal aortic aneurysm.

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Unfavorable iliac artery anatomy causing access limitations during endovascular abdominal aortic aneurysm repair: application of the endoconduit technique

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.0021 ◽

2014 ◽

Vol 13 (4) ◽

pp. 318-324

Author(s):

Rodrigo Gibin Jaldin ◽

Marcone Lima Sobreira ◽

Regina Moura ◽

Matheus Bertanha ◽

Jamil Víctor de Oliveira Mariaúba ◽

...

Keyword(s):

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Arterial Access ◽

Abdominal Aortic ◽

First Choice ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) is already considered the first choice treatment for abdominal aortic aneurysms (AAA). Several different strategies have been used to address limitations to arterial access caused by unfavorable iliac artery anatomy. The aim of this report is to illustrate the advantages and limitations of each option and present the results of using the internal endoconduit technique and the difficulties involved.

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Quality of Life After Endovascular Abdominal Aortic Aneurysm Repair: Nellix Sac-Anchoring Endoprosthesis Versus Open Surgery

Medicina ◽

10.3390/medicina48060042 ◽

2012 ◽

Vol 48 (6) ◽

pp. 42

Author(s):

Kaspars Ķīsis ◽

Dainis Krieviņš ◽

Karina Naškoviča ◽

Mārcis Gediņš ◽

Natālija Ezīte ◽

...

Keyword(s):

Quality Of Life ◽

Open Surgery ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Life Evaluation ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

An increasing number of patients with abdominal aortic aneurysms are treated using endovascular rather than open surgical techniques. The Vascular Surgery Center, P. Stradins Clinical University Hospital, has the largest worldwide experience using a new type of endoprosthesis, which fills and anchors the device in the aneurysm sac. Within the framework of a clinical trial, the quality-of-life evaluation of patients treated using this type of device was carried out. Materials and Method. A cohort study was conducted from 2008 to 2011 comparing the quality of life (QOL) of patients after abdominal aortic aneurysm repair with either the new endovascular treatment method (EVAR) or open surgery (OS). Each group comprised 20 patients, and the quality-of life-evaluation was performed using the SF-36 questionnaire before operation, 1 month after operation, and 1 year after operation. Results. One month after operation, an improved QOL was documented in the EVAR group (47 [SD, 3] in the EVAR group vs. 38 [SD, 3] in the OS group, P<0.001). One year after operation, a significant improvement in QOL persisted although the difference between the groups diminished (48 [SD, 4] in the EVAR group vs. 42 [SD, 3] in the OS group, P<0.001). Conclusions. The patients with abdominal aortic aneurysms who underwent EVAR using the new sac-anchoring endoprosthesis have improved health-related quality of life compared to the patients undergoing open surgical repair. The improvement in quality of life remained slightly better in the EVAR group 1 year after operation.

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742 Conventional Surgery vs Endovascular Abdominal Aortic Aneurysm Repair in the Management of Mycotic Abdominal Aortic Aneurysms

British Journal of Surgery ◽

10.1093/bjs/znab134.572 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Premnath ◽

V Zaver ◽

G Kuhan ◽

T Rowlands ◽

J Quarmby ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Conventional Surgery ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Abstract Introduction This study aimed to look into the short and long-term outcomes in Mycotic Abdominal Aortic Aneurysms (MAAA) managed by Conventional Surgery (CS) and Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Method Data of 17 patients who underwent CS or EVAR for MAAA from 2001 to 2017 in a single centre were collected. Complications and mortality at 3 years post-procedure were also analysed. Results Mean age was 66 (54 - 82 years), 15 (88.2%) were males. Mean aortic anterior-posterior diameter was 5.8cm (2.1 – 9.0 cm). 10 patients (58.8%) presented with rupture. 6 (35%) patients demonstrated positive cultures. 4 patients (23.5%) underwent CS and 13 (76.5) had EVAR of which 4 were surgeon modified EVARs. 5 (29%) patients developed complication within 30 days. 4 patients (23.5%) developed graft infection in long term. Total mortality was 5 (29.4%) of which one patient died within 30 days and two within 3 years of procedure. Long-term mortality was found to be significantly higher in patients treated with CS compared to EVAR (p-value 0.022). Conclusions CS for MAAA has a high mortality rate compared to EVAR. EVAR might be a simple and good alternative for this critical condition in centres with adequate expertise.

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740 Transrenal Endovascular Abdominal Aortic Aneurysm Repair in Infrarenal Abdominal Aortic Aneurysms with Anatomically Challenging Neck outside the Indications for Use: A Novel Approach

British Journal of Surgery ◽

10.1093/bjs/znab134.571 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Premnath ◽

A Hostalery ◽

P Bungay ◽

T Rowlands ◽

J Quarmby ◽

...

Keyword(s):

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Aortic Aneurysms ◽

Short Term ◽

Post Procedure ◽

Novel Approach ◽

Abdominal Aortic ◽

Neck Anatomy ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Abstract Introduction Transrenal Endovascular Abdominal Aortic Aneurysm Repair (EVAR) is a novel approach for Infrarenal Abdominal Aortic Aneurysms (AAA) with unfavourable neck anatomy. This study aims to evaluate the long and short-term outcomes of Transrenal EVAR. Method Data of patients who underwent Transrenal EVAR in a single centre over 6 years were collected. Follow up on complications and mortality for 3 years post-procedure were analysed. Results A total of 36 patients were identified with a mean age of 77 years (61–89 years). Neck anatomy 32 (88.9%) cases had a proximal neck < 15mm. 21 (58.3%) had significant neck thrombus and 27(75%) had significant neck calcification. 11 (30.6 %) had an infra-renal neck angulation > 60 0 and 21 cases (58.3%) had an unfavourable shape. Outcome Post-procedure 30-day mortality was 5.6%. 4 developed renal dysfunction. The 3-year mortality was 33.3%, only 2 patients (5.6%) died of the aneurysm related complication. 7 (19.4%) patients developed endoleak. 5 patients (13.9 %) underwent reinterventions in 3 years. Conclusions In view of the acceptable short term and long-term outcomes, trans renal EVAR can be offered for patients with infrarenal AAA with technically challenging neck anatomy but unfit for open repair in centres with adequate expertise.

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The Fate of the Superior Mesenteric Artery in Fenestrated Endovascular Repair of Complex Abdominal Aortic Aneurysms

Vascular and Endovascular Review ◽

10.15420/ver.2019.1.1 ◽

2019 ◽

Vol 2 (1) ◽

pp. 38-39

Author(s):

Yongcheng Xu ◽

Yukun Li

Keyword(s):

Aortic Aneurysm ◽

Superior Mesenteric Artery ◽

Endovascular Repair ◽

Mesenteric Artery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Clinical Complications ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Issues related to the superior mesenteric artery (SMA) in fenestrated endovascular aortic aneurysm repair (f-EVAR), such as misalignment of the endograft and bridging devices-associated complications, are rarely reported. Moreover, the absence of autopsies in the majority of patients who died in the published series makes a possible correlation with occlusion of the SMA unknown. Current studies that reported on f-EVAR were reviewed accordingly, aiming to improve our understanding of the natural course of the SMA in fenestrated technology and to explore the associated clinical complications.

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Symptomatic Sac Enlargement and Rupture Due to Seroma After Open Abdominal Aortic Aneurysm Repair With Polytetrafluoroethylene Graft: Implications for Endovascular Repair and Endotension

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70141-6 ◽

2006 ◽

Vol 2006 ◽

pp. 169-170

Author(s):

W.A. Lee

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Efficacy and safety of doxycycline for the management of small abdominal aortic aneurysms- a meta analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.126 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

A Abdul Razzack ◽

D Rocha Castellanos ◽

A Lopez Mendez ◽

M Fernando Perez Paz ◽

S Pothuru ◽

...

Keyword(s):

Meta Analysis ◽

Abdominal Aortic Aneurysms ◽

Abdominal Aortic Aneurysm Repair ◽

Mean Difference ◽

Aortic Aneurysms ◽

Efficacy And Safety ◽

Funding Sources ◽

Abdominal Aortic ◽

Significant Difference ◽

Aneurysm Repair

Abstract Funding Acknowledgements Type of funding sources: None. Background- Patients with small Abdominal Aortic Aneurysms are managed with surveillance as there is currently insufficient evidence to recommend surgical aneurysm repair. Hence, there is a dire need and interest in pharmacotherapy like tetracycline antibiotics to reduce the need for aneurysm repair. Purpose- To determine the efficacy and safety of doxycycline in the management of small abdominal aortic aneurysms. Methods- Electronic databases (PubMed, Scopus, Embase, Cochrane) were searched until 25th November 2020.The primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to Abdominal aortic aneurysm repair in each group. Results- A total of three studies with 572 participants (Doxycycline = 290; Placebo = 282 ) were included in our analysis. Average follow up was a period of 18 months. For AAA expansion, the combined results demonstrated a statistically significant mean difference in expansion rates favoring the placebo groups over the intervention (WMD-0.75, 95%CI 0.12-1.38; p = 0.02;I2 = 0%) There was no statistically significant difference in the efficacy and safety of doxycycline as opposed to placebo groups for referral to AAA surgery (OR 1.01, 95%CI 0.61-1.69; p = 0.96, I2 = 0%) and all-cause mortality(OR 0.51; 95%CI 0.18-1.43; p = 0.20, I2 =0%) Conclusion- Amongst patients with small abdominal aortic aneurysms, doxycycline did not significantly reduce aneurysm growth. Abstract Figure. A) AAA expansion B)Surgery C)Mortality

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Visceral segment aortic thrombus is associated with proximal aortic degeneration after infrarenal abdominal aortic aneurysm repair

Vascular ◽

10.1177/17085381211021282 ◽

2021 ◽

pp. 170853812110212

Author(s):

Sean P Steenberge ◽

Daniel G Clair ◽

Matthew J Eagleton ◽

Francis J Caputo ◽

Christopher J Smolock ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Infrarenal Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Aortic Thrombus ◽

Aneurysm Development ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Objective To identify predictors of aortic aneurysm formation at or above an infrarenal abdominal aortic aneurysm repair. Methods A total of 881 infrarenal abdominal aortic aneurysm repairs were identified at a single institution from 2004 to 2008; 187 of the repairs were identified that had pre-operative and post-operative computed tomography imaging at least one year or greater to evaluate for aortic degeneration following repair. Aortic diameters at the celiac, superior mesenteric, and renal arteries were measured on all available computed tomographic scans. Aortic thrombus and calcification volumes in the visceral and infrarenal abdominal aortic segments were calculated. Multivariable modeling was used with log transformed variables to determine potential predictors of future aortic aneurysm development after infrarenal abdominal aortic aneurysm repair. Results Of the 187 patients in the cohort, 100 had an open abdominal aortic aneurysm repair while 87 were treated with endovascular repair. Proximal aortic aneurysms developed in 26% ( n = 49) of the cohort during an average of 72 ± 34.2 months of follow-up. After multivariable modeling, visceral segment aortic thrombus on pre-operative computed tomography imaging increased the risk of aortic aneurysm development above the infrarenal abdominal aortic aneurysm repair within both the open abdominal aortic aneurysm (hazard ratio 2.04, p = 0.033) and endovascular repair (hazard ratio 3.31, p = 0.004) cohorts. Endovascular repair was independently associated with a higher risk of future aortic aneurysm development after infrarenal abdominal aortic aneurysm repair when compared to open abdominal aortic aneurysm (hazard ratio 2.19, p = 0.025). Conclusions Visceral aortic thrombus present prior to abdominal aortic aneurysm repair and endovascular repair are both associated with an increased risk of future proximal aortic degeneration after infrarenal abdominal aortic aneurysm repair. These factors may predict patients at higher risk of developing proximal aortic aneurysms that may require complex aortic repairs.

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