Repair of Infrarenal Abdominal Aortic Aneurysms

Careful Consideration ◽

Aortic Aneurysms ◽

Optimal Outcomes ◽

Abdominal Aortic ◽

Risk Of Rupture ◽

Aneurysm Detection ◽

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

Long-term Durability of Open Repair of Juxtarenal Abdominal Aortic Aneurysms: A Performance Standard for Fenestrated and Branched Endovascular Aneurysm Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.07.007 ◽

2011 ◽

Vol 54 (4) ◽

pp. 1225

Author(s):

Shirling Tsai ◽

Mark F. Conrad ◽

Robert S. Crawford ◽

Virendra Patel ◽

Christopher J. Kwolek ◽

...

Keyword(s):

Open Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Performance Standard ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

A Performance

Delayed Paraplegia Following Infrarenal Abdominal Aortic Endograft Placement: Case Report and Literature Review

Vascular ◽

10.1258/rsmvasc.12.2.130 ◽

2004 ◽

Vol 12 (2) ◽

pp. 130-135 ◽

Cited By ~ 1

Author(s):

Daniel L. Fortes ◽

B. Zane Atkins ◽

Andy C. Chiou

Keyword(s):

Open Repair ◽

Spinal Cord Ischemia ◽

Abdominal Aortic Aneurysm Repair ◽

Careful Consideration ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair ◽

Made In

The treatment of abdominal aortic aneurysms (AAAs) has changed over the past 12 years, with increased numbers of endovascular procedures being performed. Early morbidity is decreased following endovascular abdominal aortic aneurysm repair (EVAR) compared with open repair, and long-term studies of EVAR have focused on freedom from death, rupture, and conversion to open repair. Other less commonly encountered complications of EVAR are rarely reported. For instance, spinal cord ischemia (SCI) is a devastating complication infrequently seen after open AAA repair. This report discusses a case of delayed paraplegia after EVAR and reviews the pertinent literature. The incidence of SCI after EVAR is similar to open repair, but the mechanisms may be different. Atheroembolization and occlusion of pelvic inflow appear to be the predominant etiologies for SCI after EVAR. Careful consideration of the potential for SCI should be made in elderly patients undergoing EVAR, particularly if difficult arterial anatomy is present.

Endovascular repair for abdominal aortic aneurysms

Heart ◽

10.1136/heartjnl-2020-318288 ◽

2021 ◽

pp. heartjnl-2020-318288

Author(s):

Samuel Debono ◽

Jennifer Nash ◽

Andrew L Tambyraja ◽

David E Newby ◽

Rachael O Forsythe

Keyword(s):

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.

Aortomonoiliac Endovascular Grafting: Difficult Solutions to Difficult Aneurysms

Journal of Endovascular Therapy ◽

10.1177/152660289700400209 ◽

1997 ◽

Vol 4 (2) ◽

pp. 174-181 ◽

Cited By ~ 9

Author(s):

Matthew M. Thompson ◽

Robert D. Sayers ◽

Ahktar Nasim ◽

Jonathan R. Boyle ◽

Guy Fishwick ◽

...

Keyword(s):

Late Complication ◽

Graft Infection ◽

Aortic Aneurysms ◽

Infrarenal Aorta ◽

Iliac Arteries ◽

Abdominal Aortic ◽

Femoral Vessels ◽

Purpose: To describe a refined technique for aortomonoiliac endograft exclusion of abdominal aortic aneurysms (AAAs). Methods: A tapered aortomonoiliac graft was prepared from an 8-mm thin-walled expanded polytetrafluoroethylene tube graft predilated proximally to 35 mm and tapered distally to 15 mm. The proximal graft was sutured to a 5-cm-long, predilated Palmaz stent, which was mounted on a 30-mm balloon and backloaded into a 21F packaging sheath. With the patient under general anesthesia and both common femoral arteries exposed, the endograft was anchored in the infrarenal aorta and subsequently passed into one iliac system, where it was anastomosed to the iliac or femoral vessels. The contralateral common iliac artery was occluded, and an extra-anatomic, femorofemoral, or iliofemoral bypass grafting was performed. Results: Twenty of the 25 AAAs treated to date with this technique have been successful, with aneurysm exclusion achieved in 18 (2 minor distal endoleaks are scheduled for endovascular repair). The technical failures were analyzed, resulting in enhancements to the technique. Complications included 2 early (< 30 days) deaths, 1 case of minor embolization, 1 transient renal failure, 1 pulmonary embolus, and 1 wound infection. The only late complication was a graft infection localized to the groin. Conclusions: Aortomonoiliac endovascular aneurysm repair is effective in patients with AAAs involving the iliac arteries. Short-term results are acceptable, but long-term efficacy must be addressed before this procedure is widely adopted. Technical changes made in response to early learning curve problems have led to a safer, more reliable procedure.

PS26. Long Term Quality of Life after Endovascular Aneurysm Repair, Compared to Open Repair in Patients with Abdominal Aortic Aneurysms

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.03.078 ◽

2011 ◽

Vol 53 (6) ◽

pp. 36S-37S

Author(s):

Niels J. Ravensbergen ◽

Mirjam H. Mastenbroek ◽

Michiel T. Voûte ◽

Sanne E. Hoeks ◽

Don Poldermans

Keyword(s):

Quality Of Life ◽

Open Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

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

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a41 ◽

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 ◽

Cox Proportional Hazards ◽

Aortic Aneurysms ◽

Cardiac Complications ◽

Risk Of Rupture ◽

Short And Long Term ◽

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.

Long-term Outcomes Following Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms

Journal of Endovascular Therapy ◽

10.1177/1526602820919901 ◽

2020 ◽

Vol 27 (3) ◽

pp. 428-435

Author(s):

Aurélien M. Guéroult ◽

Farhaan A. Khan ◽

Philip W. Stather ◽

Seamus C. Harrison ◽

Jonathan R. Boyle

Keyword(s):

Aortic Aneurysm ◽

Aortic Aneurysms ◽

Long Term Outcomes ◽

Kaplan Meier ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Vascular Center ◽

Observation Period

Purpose: To investigate the long-term outcomes of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) from a single center over an 11-year period. Materials and Methods: A retrospective analysis was conducted of 121 patients (median age 78 years; 100 men) with rAAA who underwent emergency EVAR at a single tertiary vascular center from January 2006 to December 2016. The study included only ruptures confirmed by evidence of hematoma on preoperative computed tomography; both iliac and aortic aneurysm ruptures were eligible. The primary outcome measures included mortality and reintervention rates. Kaplan-Meier estimates of survival and freedom from reintervention are reported with the 95% confidence interval (CI). Results: In-hospital and 30-day mortality rates for emergency EVAR were 16.5%; 90-day mortality was 24.0%. The mortality estimates were 27.3% (95% CI 20% to 36%) at 1 year and 61.7% (95% CI 51% to 72%) at 5 years. In the observation period to 2017, 63 reinterventions were performed on 37 patients (30.6%). Median time to the first reintervention was 3.2 years. Freedom from reintervention in surviving patients at 1 year was 86% (95% CI 72% to 94%) and 51% (95% CI 26% to 71%) at 5 years. Four patients (3.3%) had a secondary sac rupture over the study period. Conclusion: Emergency EVAR for ruptured AAA can be performed with acceptable short-term outcomes; however, long-term surveillance is necessary, and reintervention is common.

The TREO abdominal aortic stent-graft system

Future Cardiology ◽

10.2217/fca-2020-0158 ◽

2020 ◽

Author(s):

Laura Boitano ◽

Matthew J Eagleton

Keyword(s):

Stent Graft ◽

Primary Treatment ◽

Aortic Aneurysms ◽

Aortic Stent Graft ◽

Primary Treatment Modality ◽

Abdominal Aortic ◽

The Us ◽

Endovascular aneurysm repair has become a primary treatment modality for patients with abdominal aortic aneurysms due to its less invasive nature and improved peri-operative mortality rates compared with conventional open surgery. Long-term, endovascular aneurysm repair is hindered by the need for reintervention due to a variety of reasons. Device improvements are directed toward improving these long-term outcomes. The current manuscript highlights some of the details of the Terumo Aortic TREO abdominal aortic stent-graft, which was approved in 2020 for clinical use by the US FDA. A brief review of the available clinical outcomes from the US trial, as well as experience in the rest of the world, are provided demonstrating its excellent performance.