Percutaneous Thoracic and Abdominal Aortic Aneurysm Repair: Techniques and Outcomes

Vascular ◽  
2006 ◽  
Vol 14 (5) ◽  
pp. 270-281 ◽  
Author(s):  
Melissa E. Hogg ◽  
Melina R. Kibbe
Keyword(s):  
Endovascular Repair ◽  
Common Femoral Artery ◽  
Abdominal Aortic Aneurysm Repair ◽  
Late Complications ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Aortic Pathology ◽  
History Of ◽  
Thoracic And Abdominal ◽  
Aneurysm Repair

Endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) has become a widely accepted treatment modality. The conventional approach of an EVAR involves bilateral groin incisions to expose the femoral arteries followed by introducer sheath placement, which is typically performed with the use of general or epidural anesthesia. As technology trends toward less invasive methods and sheath sizes become smaller, the use of a total percutaneous approach to endovascular repair of aortic pathology is becoming more common. In this review, we present a brief history of percutaneous closure devices for common femoral artery access, factors important in patient selection, the technique of performing a percutaneous EVAR procedure, early and late complications, and overall outcomes of percutaneous approaches for the endovascular treatment of aortic pathology.

Evaluation of the Effect of Endovascular Options on Infrarenal Abdominal Aortic Aneurysm Repair

2006 ◽  
Vol 72 (8) ◽  
pp. 700-706 ◽  
Author(s):  
Layne C. Sandridge ◽  
A.J. Baglioni ◽  
Gail L. Kongable ◽  
Nancy L. Harthun
Keyword(s):  
Endovascular Repair ◽  
Average Rate ◽  
The United States ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Veterans Administration ◽  
Abdominal Aortic ◽  
Elective Repair ◽  
Related Group ◽  
Aneurysm Repair

Endovascular devices designed to exclude flow to infrarenal abdominal aortic aneurysms (AAA) were approved by the Food and Drug Administration in the United States in 1999. This action allowed widespread use of this technology for AAA exclusion. The purpose of this report is to examine trends for use of these modalities, rates of rupture of AAA, and to compare results of open AAA repair with endovascular repair. Results were collected for all hospitals, except for Veterans Administration hospitals, by a state-wide repository. Data for the years 1996 through 1998 and 2001 through 2002 were evaluated, and data from 1999 through 2000 were excluded because no separate codes were available to distinguish between open and endovascular repair. The information gathered is based on the All Patient Refined Diagnostic Related Group (APR-DRG®; 3M, St. Paul, MN). An average of 718 open, elective AAA was performed between 1996 and 1998. This dropped to 503 open repairs from 2001 to 2002 ( P < 0.005). During that same interval, 308 endovascular elective AAA repairs were performed, therefore the total rate of elective repair increased by 100. The average rate of ruptured AAA repairs from 1996 to 1998 was 121 per year, and this dropped to 89 from 2001 to 2002 ( P < 0.005). The mortality of open AAA repair during the 1996 to 1998 and 2001 to 2002 intervals was unchanged (4.7%). Mortality from endovascular AAA repair between 2001 and 2002 was 1.9 per cent ( P = 0.003). Major morbidity was 14.5 per cent for open, elective AAA repair and 6.3 per cent for endovascular elective repair from 2001 to 2002 ( P < 0.001). These data suggest that the advent of endovascular AAA repair has contributed to a reduction in the rate of ruptured AAA repairs, an increase in total procedures performed, and a significant decrease in perioperative deaths and major complications when compared with open AAA repair.

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

Vascular ◽  
2015 ◽  
Vol 24 (2) ◽  
pp. 115-125 ◽  
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.

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

2014 ◽  
Vol 13 (4) ◽  
pp. 266-271
Author(s):  
Bruno Lorenção de Almeida ◽  
Antônio Massamitsu Kambara ◽  
Fabio Henrique Rossi ◽  
Marcelo Bueno de Oliveira Colli ◽  
Eduardo Silva Jordão de Oliveira ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Major Complication ◽  
Abdominal Aortic Aneurysms ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
And Control ◽  
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.

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

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

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

Vascular ◽  
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.

scholarly journals The Impact of Endovascular Repair of Abdominal Aortic Aneurysms on Vascular Surgery Training in Open Aneurysm Repair

2021 ◽  
Vol 74 (3) ◽  
pp. e158-e159
Author(s):  
Nadin Elsayed ◽  
Maryam A. Khan ◽  
Isaac Naazie ◽  
Jaideep Das Gupta ◽  
Randall De Martino ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Endovascular Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Surgery Training ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
The Impact

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

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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