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Sample records for underwent endovascular repair

  1. Endovascular repair of blunt popliteal arterial injuries

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    Zhong, Shan; Zhang, Xiquan; Chen, Zhong; Zhu, Wei; Pan, Xiaolin [Dept. of nterventional Vascular, The 148th Hospital of Chinese People' s Liberation Army, Zibo (China); Dong, Peng; Sun, Yequan [Dept. of Medical Imaging, Weifang Medical University, Weifang (China); Qi, Deming [Dept. of Medical Imaging, Qilu Medical University, Zibo (China)

    2016-09-15

    To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.

  2. Total Endovascular Aortic Repair in a Patient with Marfan Syndrome.

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    Amako, Mau; Spear, Rafaëlle; Clough, Rachel E; Hertault, Adrien; Azzaoui, Richard; Martin-Gonzalez, Teresa; Sobocinski, Jonathan; Haulon, Stéphan

    2017-02-01

    The aim of this study is to describe a total endovascular aortic repair with branched and fenestrated endografts in a young patient with Marfan syndrome and a chronic aortic dissection. Open surgery is the gold standard to treat aortic dissections in patients with aortic disease and Marfan syndrome. In 2000, a 38-year-old man with Marfan syndrome underwent open ascending aorta repair for an acute type A aortic dissection. One year later, a redo sternotomy was performed for aortic valve replacement. In 2013, the patient presented with endocarditis and pulmonary infection, which necessitated tracheostomy and temporary dialysis. In 2014, the first stage of the endovascular repair was performed using an inner branched endograft to exclude a 77-mm distal arch and descending thoracic aortic aneurysm. In 2015, a 63-mm thoracoabdominal aortic aneurysm was excluded by implantation of a 4-fenestrated endograft. Follow-up after both endovascular repairs was uneventful. Total aortic endovascular repair was successfully performed to treat a patient with arch and thoraco-abdominal aortic aneurysm associated with chronic aortic dissection and Marfan syndrome. The postoperative images confirmed patency of the endograft and its branches, and complete exclusion of the aortic false lumen. Endovascular repair is a treatment option in patients with connective tissue disease who are not candidates for open surgery. Long-term follow-up is required to confirm these favorable early outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Aneurysm growth after late conversion of thoracic endovascular aortic repair

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    Hirofumi Kasahara

    2015-01-01

    Full Text Available A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

  4. Endovascular repair of para-anastomotic aortoiliac aneurysms.

    LENUS (Irish Health Repository)

    Tsang, Julian S

    2009-11-01

    The purpose of this study is to evaluate the use of endovascular stent grafts in the treatment of para-anastomotic aneurysms (PAAs) as an alternative to high-risk open surgical repair. We identified all patients with previous open aortic aneurysm repair who underwent infrarenal endovascular aneurysm repair (EVAR) at our institution from June 1998 to April 2007. Patient demographics, previous surgery, and operative complications were recorded. One hundred forty-eight patients underwent EVAR during the study period and 11 patients had previous aortic surgery. Of these 11 redo patients, the mean age was 62 years at initial surgery and 71 years at EVAR. All patients were male. Initial open repair was for rupture in five (45%) patients. The average time between initial and subsequent reintervention was 9 years. All patients were ASA Grade III or IV. Fifty-five percent of the PAAs involved the iliac arteries, 36% the abdominal aorta, and 9% were aortoiliac. Ten patients had endovascular stent-grafts inserted electively, and one patient presented with a contained leak. Aorto-uni-iliac stent-grafts were deployed in seven patients, and bifurcated stent-grafts in four patients. A 100% successful deployment rate was achieved. Perioperative mortality was not seen and one patient needed surgical reintervention to correct an endoleak. Endovascular repair of PAAs is safe and feasible. It is a suitable alternative and has probably now become the treatment of choice in the management of PAAs.

  5. Comparison between endovascular repair and open surgery for isolated iliac artery aneurysms.

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    Igari, Kimihiro; Kudo, Toshifumi; Toyofuku, Takahito; Jibiki, Masatoshi; Inoue, Yoshinori

    2015-03-01

    This study was performed to compare endovascular repair with conventional open repair of isolated iliac artery aneurysms (IAAs). We retrospectively reviewed the charts of all patients who underwent repair of isolated IAAs between January 2008 and June 2012. Patients with infected, mycotic and ruptured iliac aneurysms and those with concurrent infrarenal abdominal aortic aneurysms greater than 30 mm in diameter were excluded from this analysis. A total of 32 patients were treated with isolated IAAs. There were 20 open and 12 endovascular repairs. A comparison of the length of the operation (238 ± 84 min in the open group vs 176 ± 72 min in the endovascular group, P = 0.03) and intraoperative blood loss (1,735 ± 1,177 ml in the open group vs 503 ± 711 ml in the endovascular group, P = 0.01), revealed significant differences in favor of the endovascular procedure. Postoperative complications were less common in the endovascular group, although the difference did not reach statistical significance. The management of isolated IAAs with both endovascular and open repair can be accomplished with very low morbidity rates. Therefore, endovascular repair can be considered an alternative treatment for isolated IAAs.

  6. Salvage of bilateral renal artery occlusion after endovascular aneurysm repair with open splenorenal bypass

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    Samuel Jessula, MDCM

    2017-09-01

    Full Text Available We report renal salvage maneuvers after accidental bilateral renal artery coverage during endovascular aneurysm repair of an infrarenal abdominal aortic aneurysm. A 79-year-old man with an infrarenal abdominal aortic aneurysm was treated with endovascular aneurysm repair. Completion angiography demonstrated coverage of the renal arteries. Several revascularization techniques were attempted, including endograft repositioning and endovascular stenting through the femoral and brachial approach. The patient eventually underwent open splenorenal bypass with a Y Gore-Tex graft (W. L. Gore & Associates, Flagstaff, Ariz. After 3 months, computed tomography showed no evidence of endoleak and patent renal arteries. Renal function was well maintained, and the patient did not require dialysis.

  7. Incidence of systemic inflammatory response syndrome after endovascular aortic repair

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    De La Motte, L; Vogt, K; Jensen, Leif Panduro

    2011-01-01

    AIM: The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair. METHODS: All patients, undergoing elective primary endovascular repair of an asymptomatic infrarenal abdominal aortic aneurysm...

  8. Endovascular aortic repair: First twenty years

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    Končar Igor

    2012-01-01

    Full Text Available Endovascular aortic/aneurysm repair (EVAR was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives – engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method.

  9. Open versus endovascular aneurysm repair trial review.

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    Weinkauf, Craig; George, Elizabeth; Zhou, Wei

    2017-11-01

    The Open versus Endovascular Aneurysm Repair trial is the only randomized controlled trial that is funded by the federal government to evaluate the treatment outcomes of infrarenal abdominal aortic aneurysms. Since the initial publication, multiple post-hoc analyses have become available. This review summarizes these data, focusing on the primary outcome measures (ie, overall survival) and several key secondary outcomes including aneurysm-related death, age consideration, secondary procedures, and endoleaks. Cost-effectiveness of each treatment modality and the limitations of OVER trial also are discussed critically in this review. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Clinical impact of chronic renal insufficiency on endovascular aneurysm repair.

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    Park, Brian; Mavanur, Arun; Drezner, A David; Gallagher, James; Menzoian, James O

    Endovascular aneurysm repair of abdominal aortic aneurysms has become a viable alternative to open repair. A significant proportion of this patient population has chronic renal insufficiency. The surgical outcomes associated with endovascular repair in 342 patients, with and without chronic renal insufficiency, are reported. Perioperative mortality, length of admission, length of intensive care unit admission, and rates of acute renal failure, congestive heart failure, myocardial infarction, conversion to open surgery, progression to hemodialysis, and incidence of endoleaks were retrospectively reviewed and analyzed. Endovascular repair demonstrated higher rates of acute renal failure, longer length of stay, and longer intensive care unit admissions in patients with chronic renal insufficiency. Patients with severe renal dysfunction demonstrated markedly elevated mortality and morbidity. These results indicate that chronic renal insufficiency is not an absolute contraindication to endovascular repair in patients with moderate renal dysfunction, but patients with severe renal dysfunction perform poorly after aortic reconstruction.

  11. Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula.

    NARCIS (Netherlands)

    Koning, H.D. de; Sterkenburg, S.M. van; Pierie, M.; Reijnen, M.M.P.J.

    2008-01-01

    Infections of abdominal aortic endografts are rare. There are no reports on the association with spondylodiscitis. We report a case of a 74-year-old man who underwent endovascular aneurysm repair (EVAR) and subsequently femorofemoral bypass placement due to occlusion of the right limb of the

  12. Preoperative Evaluation and Endovascular Procedure of Intraoperative Aneurysm Rupture During Thoracic Endovascular Aortic Repair

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    Zha, Bin-Shan, E-mail: binszha2013@163.com; Zhu, Hua-Gang, E-mail: huagzhu@yeah.net; Ye, Yu-Sheng, E-mail: yeyusheng@aliyun.com; Li, Yong-Sheng, E-mail: 872868848@qq.com; Zhang, Zhi-Gong, E-mail: zzgedward@sina.com; Xie, Wen-Tao, E-mail: 345344347@qq.com [The First Affiliated Hospital of Anhui Medical University, Department of Vascular Surgery (China)

    2017-03-15

    Thoracic aortic aneurysms are now routinely repaired with endovascular repair if anatomically feasible because of advantages in safety and recovery. However, intraoperative aneurysm rupture is a severe complication which may have an adverse effect on the outcome of treatment. Comprehensive preoperative assessment and considerate treatment are keys to success of endovascular aneurysm repair, especially during unexpected circumstances. Few cases have reported on intraoperative aortic rupture, which were successfully managed by endovascular treatment. Here, we present a rare case of an intraoperative aneurysm rupture during endovascular repair of thoracic aortic aneurysm with narrow neck and angulated aorta arch (coarctation-associated aneurysm), which was successfully treated using double access route approach and iliac limbs of infrarenal devices.Level of EvidenceLevel 5.

  13. 3D printing guiding stent graft fenestration: A novel technique for fenestration in endovascular aneurysm repair.

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    Huang, Jianhua; Li, Gan; Wang, Wei; Wu, Keming; Le, Tianming

    2017-08-01

    Objective To describe a novel approach, 3D printing guiding stent graft fenestration, for fenestration during endovascular aneurysm repair for juxtarenal abdominal aortic aneurysm. Methods A 69-year-old male with juxtarenal abdominal aortic aneurysm underwent endovascular aneurysm repair with "off the label" fenestrated stent graft. To precisely locate the fenestration position, we reconstructed a 3D digital abdominal aortic aneurysm model and created a skin template covering this abdominal aortic aneurysm model. Then the skin template was physically printed and the position of the visceral vessel was hollowed out, thereby helping in locating the fenestration on stent graft. Results and conclusions With the help of this 3D printed skin template, we fenestrated the stent graft accurately and rebuilt the bilateral renal artery successfully. This is the first clinical case that used 3D printing guiding stent graft fenestration, which is a novel approach for precise fenestration on stent graft on the table during endovascular aneurysm repair.

  14. Fenestrated endovascular aortic aneurysm repair using physician-modified endovascular grafts versus company-manufactured devices.

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    Dossabhoy, Shernaz S; Simons, Jessica P; Flahive, Julie M; Aiello, Francesco A; Sheth, Parth; Arous, Edward J; Messina, Louis M; Schanzer, Andres

    2017-12-07

    Fenestrated endografts are customized, patient-specific endovascular devices with potential to reduce morbidity and mortality of complex aortic aneurysm repair. With approval from the U.S. Food and Drug Administration, our center began performing fenestrated endovascular aneurysm repair through a physician-sponsored investigational device exemption (IDE #G130210), using both physician-modified endografts (PMEGs) and company-manufactured devices (CMDs). Because these techniques are associated with specific advantages and disadvantages, we sought to investigate differences in outcomes between PMEG and CMD cases. A single-institution retrospective review of all fenestrated endovascular aneurysm repairs was performed. The cohort was analyzed by device type (PMEG or CMD) after matching of cases on the basis of (1) number of target vessels intended for treatment, (2) extent of aneurysm, (3) aneurysm diameter, (4) device configuration, and (5) date of operation. Outcomes of ruptures, common iliac artery aneurysms, and aortic arch aneurysms were excluded. Demographics, operative details, perioperative complications, length of stay, and reinterventions were compared. For patients with >1 year of follow-up time, survival, type I or type III endoleak rate, target artery patency, and reintervention rate were estimated using the Kaplan-Meier method. Between November 30, 2010, and July 30, 2016, 82 patients were identified and matched. The cohort included 41 PMEG and 41 CMD patients who underwent repair of 38 juxtarenal (PMEG, 17; CMD, 21; P = .38), 14 pararenal (PMEG, 6; CMD, 8; P = .56), and 30 thoracoabdominal type I to type IV (PMEG, 18; CMD, 12; P = .17) aneurysms. There were significant differences in presentation requiring urgent aneurysm repair (PMEG, 9; CMD, 0; P = .002), total fluoroscopy time (PMEG, 76 minutes; CMD, 61 minutes; P = .02), volume of contrast material used (PMEG, 88 mL; CMD, 70 mL; P = .02), in-operating room to out-of-operating room time

  15. Blunt traumatic aortic injury: initial experience with endovascular repair.

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    Azizzadeh, Ali; Keyhani, Kourosh; Miller, Charles C; Coogan, Sheila M; Safi, Hazim J; Estrera, Anthony L

    2009-06-01

    Endovascular treatment of traumatic aortic injury (TAI) is an alternative to open repair (OR) in patients with blunt trauma. We report our initial experience after integration of endovascular repair using thoracic devices. A retrospective review of a prospectively collected institutional trauma registry was performed. Between September 2005 and November 2008, 71 patients with TAI presented to our institution. Based on imaging, TAIs were classified into grade 1-4 in severity. These included: grade 1, intimal tear; grade 2, intramural hematoma; grade 3, aortic pseudoaneurysm; and grade 4, free rupture. Initial management included resuscitation, blood pressure control, and treatment of associated injuries. After stabilization, all patients were considered for thoracic endovascular aortic repair (TEVAR) using a thoracic device. If contraindicated, candidates underwent OR. Outcome measures were mortality, stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 39.8 years, with 50 males. The mean injury severity score (ISS) was 42.6. Nineteen (27%) patients with a mean ISS of 60 died shortly after arrival prior to any vascular intervention. Ten (14%) patients with grade 1 injuries were managed medically. The remaining 42 (59%) patients with grade 2 and 3 injuries underwent repair. Median interval between admission and repair was 4.3 days (range, 0-109 days). Fifteen (21%) patients with a mean ISS of 34.4 underwent OR with no mortality, stroke, or paraplegia. Twenty-seven (38%) patients with a mean ISS of 36.7 underwent TEVAR with no mortality or paraplegia. One TEVAR patient suffered a perioperative stroke. Twenty-two patients had a TAG (W.L. Gore & Associates, Flagstaff, Ariz) device. Four patients had a Talent Thoracic (Medtronic Vascular, Santa Rosa, Calif), and 1 patient had an Excluder (W.L. Gore) device. The left subclavian artery was covered in 13 (48%) patients. Patients who underwent TEVAR were older than those who had OR (47.8 vs 31

  16. Outcomes of fenestrated and branched endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms.

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    Schanzer, Andres; Simons, Jessica P; Flahive, Julie; Durgin, Jonathan; Aiello, Francesco A; Doucet, Danielle; Steppacher, Robert; Messina, Louis M

    2017-09-01

    More than 80% of infrarenal aortic aneurysms are treated by endovascular repair. However, adoption of fenestrated and branched endovascular repair for complex aortic aneurysms has been limited, despite high morbidity and mortality associated with open repair. There are few published reports of consecutive outcomes, inclusive of all fenestrated and branched endovascular repairs, starting from the inception of a complex aortic aneurysm program. Therefore, we examined a single center's consecutive experience of fenestrated and branched endovascular repair of complex aortic aneurysms. This is a single-center, prospective, observational cohort study evaluating 30-day and 1-year outcomes in all consecutive patients who underwent fenestrated and branched endovascular repair of complex aortic aneurysms (definition: requiring one or more fenestrations or branches). Data were collected prospectively through an Institutional Review Board-approved registry and a physician-sponsored investigational device exemption clinical trial (G130210). We performed 100 consecutive complex endovascular aortic aneurysm repairs (November 2010 to March 2016) using 58 (58%) commercially manufactured custom-made devices and 42 (42%) physician-modified devices to treat 4 (4%) common iliac, 42 (42%) juxtarenal, 18 (18%) pararenal, and 36 (36%) thoracoabdominal aneurysms (type I, n = 1; type II, n = 4; type III, n = 12; type IV, n = 18; arch, n = 1). The repairs included 309 fenestrations, branches, and scallops (average of 3.1 branch arteries/case). All patients had 30-day follow-up for 30-day event rates: three (3%) deaths; six (6%) target artery occlusions; five (5%) progressions to dialysis; eight (8%) access complications; one (1%) paraparesis; one (1%) bowel ischemia; and no instances of myocardial infarction, paralysis, or stroke. Of 10 type I or type III endoleaks, 8 resolved (7 with secondary intervention, 1 without intervention). Mean follow-up time was 563 days (interquartile range

  17. Fenestrated Stent-Grafts for Salvage of Prior Endovascular Abdominal Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Katsargyris, A.; Yazar, O.; Oikonomou, K.; Bekkema, F.; Tielliu, I.; Verhoeven, E. L. G.

    Objectives: To review our experience with fenestrated endovascular aneurysm repair (F-EVAR) to treat complications after previous standard infrarenal endovascular aneurysm repair (EVAR). Methods: A prospectively maintained database including all consecutive patients with juxtarenal abdominal aortic

  18. Endovascular versus open repair for blunt thoracic aortic injury: short-term results.

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    Kokotsakis, John; Kaskarelis, Ioannis; Misthos, Panagiotis; Athanasiou, Thanos; Kanakakis, Konstantinos; Athanasiou, Chariklia; Romana, Constantina; Skouteli, Elian; Lioulias, Achilles

    2007-12-01

    Endovascular stent grafting has been increasingly used as an alternative treatment modality. The aim of this study is to evaluate the immediate and short-term results of endovascular stent grafting repair after blunt thoracic aortic injury due to trauma. A review of a tertiary trauma center registry identified all patients who suffered blunt thoracic aortic injury from 2002 to 2006. All patients underwent either open repair with synthetic graft interposition or endovascular stent grafting (EVS) of the descending thoracic aorta. Type and severity of injury, concomitant injuries, clinical factors, and outcome were compared between groups. Univariate and multivariate analysis was performed. Endovascular stent grafting was performed in 22 patients, and 10 patients underwent open surgical repair. In the open group, the 30-day mortality rate was 10%, the paraplegia rate was 10%, and incidence of major complications was 30%, which were comparable with the incidences observed in the EVS group of 4.5%, 4.5%, and 13.6%, respectively. No statistically significant differences were demonstrated. Multivariate regression analysis identified associated thoracic injury as the main independent predictor of hospital length of stay (p = 0.03, 95% confidence interval: 0.53 to 18.85). In the EVS group, 1 patient died in the short-term follow-up period and 2 cases of endovascular leak required additional treatment. Although postoperative mortality and morbidity between open and endovascular repair were comparable, EVS can be considered a safe alternative treatment modality in the therapeutic algorithm of blunt thoracic aortic injury particularly for the higher risk multitrauma patients.

  19. Suprarenal fixation barbs can induce renal artery occlusion in endovascular aortic aneurysm repair.

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    Subedi, Shree K; Lee, Andy M; Landis, Gregg S

    2010-01-01

    Renal artery occlusion following endovascular abdominal aortic aneurysm repair with suprarenal fixation is uncommon. We report one patient who was found to develop renal artery occlusion and parenchymal infarction 6 months after repair using an endovascular graft with suprarenal fixation. Our patient underwent emergent endovascular repair of a symptomatic 6 cm abdominal aortic aneurysm. The covered portion of the endograft was inadvertently deployed well below the renal artery orifices. At the completion of the procedure both renal arteries were confirmed to be patent. One month postoperatively, a computed tomographic (CT) scan showed exclusion of the aortic sac and normal enhancement of both kidneys. At 6 months, the patient was found to have elevated serum creatinine levels despite having no clinical symptoms. CT scanning revealed a nonenhancing left kidney, and angiography demonstrated an occlusion of the left renal artery. A barb welded to the bare metal stent appeared to be impinging on the renal artery. We believe that renal artery occlusion after endovascular repair can occur due to repetitive injury to the renal artery orifice from barbs welded to the bare metal stent. To our knowledge, this is the first reported case of renal artery occlusion caused by repetitive injury from transrenal fixation systems. Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  20. Endovascular repair of abdominal aortic aneurysm.

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    Paravastu, Sharath Chandra Vikram; Jayarajasingam, Rubaraj; Cottam, Rachel; Palfreyman, Simon J; Michaels, Jonathan A; Thomas, Steven M

    2014-01-23

    An abnormal dilatation of the abdominal aorta is referred to as an abdominal aortic aneurysm (AAA). Due to the risk of rupture, surgical repair is offered electively to individuals with aneurysms greater than 5.5 cm in size. Traditionally, conventional open surgical repair (OSR) was considered the first choice approach. However, over the past two decades endovascular aneurysm repair (EVAR) has gained popularity as a treatment option. This article intends to review the role of EVAR in the management of elective AAA. To assess the effectiveness of EVAR versus conventional OSR in individuals with AAA considered fit for surgery, and EVAR versus best medical care in those considered unfit for surgery. This was determined by the effect on short, intermediate and long-term mortality, endograft related complications, re-intervention rates and major complications. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (January 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12). The TSC also searched trial databases for details of ongoing or unpublished studies. Prospective randomised controlled trials (RCTs) comparing EVAR with OSR in individuals with AAA considered fit for surgery. and comparing EVAR with best medical care in individuals considered unfit for surgery. We excluded studies with inadequate data or using an inadequate randomisation technique. Three reviewers independently evaluated trials for appropriateness for inclusion and extracted data using pro forma designed by the Cochrane PVD Group. We assessed the quality of trials using The Cochrane Collaboration's 'Risk of bias' tool. We entered collected data in to Review Manager (version 5.2.3) for analysis. Where direct comparisons could be made, we determined odds ratios (OR). We tested studies for heterogeneity and, when present, we used a random-effects model; otherwise we used a fixed-effect model. We tabulated

  1. Hybrid thoracic endovascular aortic repair: pushing the envelope.

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    Younes, Houssam K; Davies, Mark G; Bismuth, Jean; Naoum, Joseph J; Peden, Eric K; Reardon, Michael J; Lumsden, Alan B

    2010-01-01

    Thoracic endovascular aortic repair (TEVAR) can be limited by inadequate proximal and distal landing zones. Debranching or hybrid TEVAR has emerged as an important modality to expand landing zones and facilitate TEVAR. We report a single-center experience with hybrid TEVAR. We retrospectively reviewed all patients with thoracic aortic disease who received a TEVAR between February 2005 and October 2008. Forty-two patients underwent a hybrid procedure (mean age 68 +/- 13 years; 55% men). All patients were denied open surgery due to preoperative comorbidities or low physiologic reserve; 62% had a history of coronary artery disease, 67% had chronic obstructive pulmonary disease, 61% had undergone prior aortic surgery, and 90% had an American Society of Anesthesiology score of 4 and above. The average Society for Vascular Surgery comorbidity score was 12 +/- 2 with a range of 9 to 14. Fifty-five percent of cases were symptomatic on presentation and 83% were done emergently. Seventy-six percent underwent debranching of the aortic arch, 17% of the visceral vessels, and 7% required both. Primary technical success was achieved in all cases and of these, 43% were staged. The 30-day mortality was 5%. Myocardial infarction developed in 5%, respiratory failure in 31%, cerebrovascular accident (stroke or transient ischemic attack) in 19%, and spinal cord ischemia with ensuant paraplegia occurred in 5% of patients. Fifty-eight percent of patients were discharged home, 11% required rehabilitation, and 29% were transferred to a skilled nursing facility. There was a significant association between visceral vessel debranching and both spinal cord ischemia (P = .004) and gastrointestinal complications (P = .005). On the other hand, there was no difference between staged and non-staged hybrid procedures. Hybrid procedures can successfully extend the range of patients suitable for a subsequent TEVAR. These procedures are associated with higher complication rates than isolated infrarenal

  2. Endovascular repair of pseudoaneurysms after open surgery for aortic coarctation.

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    Kotelis, Drosos; Bischoff, Moritz S; Rengier, Fabian; Ruhparwar, Arjang; Gorenflo, Matthias; Böckler, Dittmar

    2016-01-01

    To analyse early and long-term results of thoracic endovascular aortic repair (TEVAR) in patients with pseudoaneurysms after open aortic coarctation (CoA) repair. A total of 11 patients of 418 patients who had been treated with TEVAR during the period from January 1998 to April 2015 (8 males; median age 53 years) were retrospectively analysed. Dacron patch aortoplasty was primarily performed in 9 patients and subclavian flap aortoplasty in 2 patients. Seven of the 11 patients had asymptomatic pseudoaneurysms (median diameter 56 mm, range 20-65 mm) diagnosed by routine screening. Symptomatic patients presented with haemoptysis, lower limb ischaemia, haemodynamic collapse and back pain and underwent emergency repair (4/11). Adjunctive procedures at the proximal landing zone were required in 7/11 patients. The median number of implanted endoprostheses per patient was 1 (range: 1-5). The median follow-up was 60 months (range 6-161 months). Technical success was achieved in 91% (10/11; 1 secondary elective open conversion). The 30-day mortality was 0%. The stroke rate was 18% (2 non-disabling strokes). In 2 patients (20%), stent-graft displacement during deployment was observed. The reintervention rate was 33% (Type Ib endoleak, left arm claudication, partial coverage of the left common carotid artery). Clinical success during follow-up was achieved in 10/11 patients. In 9/10 patients, aneurysm sac shrinkage was observed. The Type II endoleak rate was 10% (1/10; intercostal artery). The overall mortality rate was 9% (1 patient died of amyotrophic lateral sclerosis). Endovascular treatment of post-coarctation pseudoaneurysms is feasible in elective and emergency cases, yielding durable results in the long term. Due to anatomical specifics, implantation may be challenging and requires careful procedural planning. On-site cardiothoracic surgery backup is essential in case open conversion is required. © The Author 2015. Published by Oxford University Press on behalf of the

  3. MRI-based Assessment of Endovascular Abdominal Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Laan, M.J. van der

    2007-01-01

    Imaging techniques play a key role in the Endovascular Abdominal Aortic Aneurysm Repair (EVAR) follow-up. The most important parameters monitored after EVAR are the aneurysm size and the presence of endoleaks. Currently, computed tomographic angiography (CTA) is the most commonly used imaging

  4. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim

    2014-01-01

    We performed an analysis to assess the need for conducting additional randomized controlled trials (RCTs) comparing open and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Trial sequential analysis (TSA) is a statistical methodology that can calculate the required inform...

  5. Early endovascular aneurysm repair after percutaneous coronary interventions.

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    Pecoraro, Felice; Wilhelm, Markus; Kaufmann, Angela R; Bettex, Dominique; Maier, Willibald; Mayer, Dieter; Veith, Frank J; Lachat, Mario

    2015-05-01

    The objective of this study was to report long-term results of early endovascular aortic aneurysm repair after percutaneous coronary intervention (PCI). This was a retrospective analysis of all patients presenting with abdominal aortic aneurysm and coronary artery disease treated during the same hospitalization by endovascular aortic aneurysm repair performed soon after PCI. Primary outcomes were perioperative mortality, perioperative complications, survival after treatment, and freedom from reintervention. A total of 20 patients were included, and all completed both procedures. No deaths or abdominal aortic aneurysm ruptures occurred between the PCI and the aortic intervention. Perioperative mortality was 5% as one patient died of mesenteric ischemia after endovascular aneurysm repair. Major cardiovascular vascular complications occurred in four patients (20%) and included non-ST-segment elevation myocardial infarction (one) and access vessel complication (three). Mean follow-up was 94 (range, 1-164; standard deviation, 47) months. Estimated survival at 1 year, 2 years, 5 years, and 10 years was 90%, 90%, 90%, and 60%, respectively. A reoperation was required in six patients. Estimated freedom from reintervention at 1 year, 2 years, 5 years, and 10 years was 83%, 83%, 78%, and 72%, respectively. Our study indicates that early endovascular aneurysm repair performed within a week after PCI may be a reasonable approach in patients with large or symptomatic aneurysms. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  6. Predictors of Reintervention After Endovascular Repair of Isolated Iliac Artery Aneurysm

    International Nuclear Information System (INIS)

    Zayed, Hany A.; Attia, Rizwan; Modarai, Bijan; Clough, Rachel E.; Bell, Rachel E.; Carrell, Tom; Sabharwal, Tarun; Reidy, John; Taylor, Peter R.

    2011-01-01

    The objective of this study was to identify factors predicting the need for reintervention after endovascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneurysms was performed using computed tomography angiography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and analysis of patient survival and freedom from reintervention were performed using Kaplan–Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treated (all men; median age 75 years), and median follow-up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter >30 mm in the aorta or >24 mm in the common iliac artery or distal landing zone (DLZ) diameter >24 mm (P = 0.03, 0.03, and 0.0014, respectively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm-related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR.

  7. Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young; Lee, Do Yun; Lee, Kwang Hun [Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Won, Jong Yun [Gangnam Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Choi, Dong Hoon; Shim, Won Heum [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

  8. Outcomes of surgical versus endovascular repair of unruptured brain aneurysms in individuals aged ≥ 75 years.

    Science.gov (United States)

    Inamasu, Joji; Tanaka, Teppei; Sadato, Akiyo; Hayakawa, Motoharu; Adachi, Kazuhide; Hayashi, Takuro; Kato, Yoko; Hirose, Yuichi

    2014-10-01

    Therapeutic intervention to repair unruptured aneurysms (UA) has not been strongly recommended for the elderly, because of their limited life expectancy and low annual bleeding rate. However, physically and mentally healthy older adults with seemingly high risk of aneurysmal bleeding might benefit from having their UA repaired. A single-center retrospective study was carried out. Among 1078 patients admitted for treatment of UA between 2007 and 2011, the number of patients aged ≥ 75 years who underwent surgical and endovascular repair of UA was 30 and 31, respectively. The operative and mid-term outcomes were compared between the two groups. For evaluation of the operative outcomes, frequency and types of adverse events that occurred within 30 days of intervention (operative morbidity) were described. For assessment of the mid-term outcomes, activities of daily living (ADL) at 24 months after intervention were evaluated with the modified Rankin Scale (mRS). The operative morbidity rate was 6.7% in the open surgery group and 6.5% in the endovascular surgery group, and they did not differ significantly. The frequency of patients with mRS 0-2 at 24 months after intervention was 85.7% in the open surgery group and 82.8% in the endovascular surgery group, and they did not differ significantly. The adverse event rate of patients with middle cerebral artery aneurysms treated endovascularly was high (80%). The outcomes of individuals aged ≥ 75 years who underwent repair of UA were generally favorable in either treatment group, with more than 80% living an independent life at 24 months after intervention. © 2013 Japan Geriatrics Society.

  9. Endovascular repair of aortic disease: a venture capital perspective.

    Science.gov (United States)

    Buchanan, Lucas W; Stavropoulos, S William; Resnick, Joshua B; Solomon, Jeffrey

    2009-03-01

    Endovascular devices for the treatment of abdominal and thoracic aortic disease are poised to become the next $1 billion medical device market. A shift from open repair to endovascular repair, advances in technology, screening initiatives, and new indications are driving this growth. Although billion-dollar medical device markets are rare, this field is fraught with risk and uncertainty for startups and their venture capital investors. Technological hurdles, daunting clinical and regulatory timelines, market adoption issues, and entrenched competitors pose significant barriers to successful new venture creation. In fact, the number of aortic endografts that have failed to reach commercialization or have been pulled from the market exceeds the number of Food and Drug Administration-approved endografts in the United States. This article will shed some light on the venture capital mind-set and decision-making paradigm in the context of aortic disease.

  10. Incidence of systemic inflammatory response syndrome after endovascular aortic repair

    DEFF Research Database (Denmark)

    De La Motte, L; Vogt, K; Jensen, Leif Panduro

    2011-01-01

    AIM: The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair. METHODS: All patients, undergoing elective primary endovascular repair of an asymptomatic infrarenal abdominal aortic aneurysm...... during 2007, were retrospectively evaluated for SIRS within the first 5 postoperative days. The only exclusion-criteria were missing data. SIRS was assessed using the criteria defined by the American College of Chest Physicians and Society of Critical Care Medicine Consensus Conference Committee. RESULTS......: Sixty-six patients were included, 40 (60%) met the SIRS criteria within the first 5 postoperative days (95% of the 40 patients met the criteria within 3 days). We found no significant differences between the SIRS and the non-SIRS group in baseline characteristics or other data including volume...

  11. Flow and wall shear stress characterization following endovascular aneurysm repair and endovascular aneurysm sealing in an infrarenal aneurysm model

    NARCIS (Netherlands)

    Boersen, Johannes Thomas; Groot Jebbink, Erik; Versluis, Michel; Slump, Cornelis H.; Ku, David N.; de Vries, Jean-Paul P.M.; Reijnen, Michel M.P.J.

    2017-01-01

    Background Endovascular aneurysm repair (EVAR) with a modular endograft has become the preferred treatment for abdominal aortic aneurysms. A novel concept is endovascular aneurysm sealing (EVAS), consisting of dual endoframes surrounded by polymer-filled endobags. This dual-lumen configuration is

  12. Morphological risk factors of stroke during thoracic endovascular aortic repair.

    Science.gov (United States)

    Kotelis, Drosos; Bischoff, Moritz S; Jobst, Bertram; von Tengg-Kobligk, Hendrik; Hinz, Ulf; Geisbüsch, Philipp; Böckler, Dittmar

    2012-12-01

    This study aims to identify independent factors correlating to an increased risk of perioperative stroke during thoracic endovascular aortic repair (TEVAR). A prospective maintained TEVAR database, medical records, and imaging studies of 300 patients (205 men; median age of all, 66 years, range 21-89), who underwent TEVAR between March 1997 and February 2011, were reviewed. Preoperative CT data sets were reviewed by two experienced radiologists with focus on the atheroma burden in the aortic arch (grade I, normal, to grade V, ulcerated or pedunculated atheroma). Aortic arch geometry (arch types I-III) was documented. Further parameters included in the univariate analysis were age, gender, urgency of repair, duration of procedure, adenosine-induced cardiac arrest or rapid pacing, proximal landing zone, left subclavian artery (LSA) coverage, and number of stent grafts. Multivariate logistic regression analysis was performed to assess the independent correlations of potential risk factors. Atherosclerotic aneurysm was the most common pathology (44%). One hundred and fifty-four of our patients (51%) were treated under urgent or emergent conditions. Seventeen percent of all patients had significant arch atheroma (grade IV or V), and 43% had a steep type III aortic arch. The perioperative stroke was 4% (12 patients; median age, 73 years, range 31-78). Two strokes were lethal (0.7%). All strokes were classified as embolic based on imaging characteristics. In eight patients, strokes were located in the left cerebral hemisphere (seven of them in the anterior and one in the posterior circulation). Four stroke patients (one in the left posterior circulation) underwent LSA coverage without revascularization. Three stroke patients had severe arch atheroma grade V. Five patients suffering stroke were recognized to have a type III aortic arch. Strokes were equally distributed between zones 0-2 vs. 3-4 (n = 6 each, 5 vs. 3.3%). The highest incidence was found in zone 1 (11

  13. The incidence of contrast medium-induced nephropathy following endovascular aortic aneurysm repair: assessment of risk factors.

    Science.gov (United States)

    Guneyli, Serkan; Bozkaya, Halil; Cinar, Celal; Korkmaz, Mehmet; Duman, Soner; Acar, Turker; Akin, Yigit; Parildar, Mustafa; Oran, Ismail

    2015-05-01

    The aim of the study was to investigate the incidence of contrast medium-induced nephropathy (CIN) and risk factors for CIN following endovascular abdominal aortic aneurysm repair or thoracic endovascular aortic aneurysm repair. After exclusion criteria, 139 (121 males, 18 females) patients aged 20-86 (median 65.5) years who underwent endovascular aortic aneurysm repair between January 2002 and September 2013 were included in this retrospective study. CIN, with ≥25% increase in serum creatinine levels within 3 days after contrast medium administration, was compared to the patients' demographics, risk factors, type and complexity of the endovascular operation, parameters regarding to the contrast medium, preoperative estimated glomerular filtration rate (eGFR), and preoperative and early postoperative serum parameters. Statistical analyses were performed with Kolmogorov-Smirnov, χ (2) and Student's t tests. CIN, detected in 39 of 139 patients (28%), was correlated with preoperative eGFR <60 ml/min/1.73 m(2) (P = 0.04) and high preoperative and postoperative serum urea and creatinine levels. Postoperative serum urea levels (P < 0.001) were significant in multivariate analysis. In patients undergoing endovascular aortic aneurysm repair, CIN was correlated with preoperative and postoperative renal impairment, while it was not correlated with the contrast medium dose.

  14. Elective infrarenal abdominal aortic aneurysm repair--transperitoneal, retroperitoneal, endovascular?

    Science.gov (United States)

    Muehling, Bernd M; Orend, Karl Heinz; Sunder-Plassmann, Ludger

    2009-11-01

    We retrospectively analyzed the peri-operative outcome of 210 consecutive patients undergoing elective infrarenal abdominal aortic aneurysm (AAA) repair according to the surgical approach: transperitoneal (TP; 63 patients), retroperitoneal (RP; 81 patients) and endovascular (EV; 66 patients) repair. Concerning gender, AAA diameter and classification of the American Society of Anesthesiologists (ASA score) all groups were comparable; the median age in the EV group was significantly higher (78 years vs. 68 years and 67 years, respectively, P=0.001). Mortality rates were 0% for TP, 1.2% for RP and 3% for EV repair (n.s.). Morbidity rates did not significantly differ between the groups. In specialized centres mortality rates of elective infrarenal aneurysm repair are low - regardless of the surgical approach. In such centres the best treatment options for each patient as to the surgical approach as well as peri-operative management can be provided individually.

  15. Outcomes of endovascular aortic repair in the modern era

    DEFF Research Database (Denmark)

    Budtz-Lilly, Jacob; Wanhainen, Anders; Mani, Kevin

    2018-01-01

    Monitoring outcomes following endovascular aortic repair (EVAR) is critical. Although evidence from randomized controlled trials has solidified the role of EVAR, the analysis of outcomes and "real-world" data has uncovered limitations, improved the selection of appropriate patients, and underscored...... the importance of instructions for use. Subsequent studies demonstrated the learning curve of EVAR and gradual improvement of outcomes over time. Outcomes analyses will continue to play an important role, particularly as technological growth of endovascular therapy has enabled treatment of more complex aneurysm...... pathologies and patients. The important analyses are herein reviewed, following the development of EVAR in the treatment of intact abdominal aortic aneurysms (AAA) to ruptured AAAs, and finally to complex aneurysms, including thoracoabdominal aortic aneurysms and mycotic aneurysms. This includes an overview...

  16. Thoracic Endovascular Aortic Repair in a Patient with Mobile Aortic Thrombosis

    Directory of Open Access Journals (Sweden)

    Graham M. Lohrmann

    2014-01-01

    Full Text Available A 58-year-old female presented with acute arterial insufficiency to her left leg. Following cardiovascular evaluation using multimodality imaging, it was discovered that she had mobile thoracic thrombi overlying a normal descending thoracic aorta which had also caused a splenic infarction. This patient was treated with unfractionated heparin for three days and underwent subsequent thoracic endovascular aortic repair (TEVAR uneventfully with no subsequent complications at one-year followup. This case highlights the diagnostic and therapeutic challenges in treating patients with this uncommon challenging clinical scenario.

  17. An unique case of thoracic endovascular aortic repair (TEVAR) graft infection with Streptococcus viridans.

    Science.gov (United States)

    Zubaidah, N H; Azim, M I M; Osama, M H; Harunarashid, H; Das, S

    2012-01-01

    The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.

  18. Systemic inflammation, coagulopathy, and acute renal insufficiency following endovascular thoracoabdominal aortic aneurysm repair.

    Science.gov (United States)

    Chang, Catherine K; Chuter, Timothy A M; Niemann, Claus U; Shlipak, Michael G; Cohen, Mitchell J; Reilly, Linda M; Hiramoto, Jade S

    2009-05-01

    To characterize the inflammatory and coagulopathic response after endovascular thoracoabdominal aortic aneurysm (TAAA) repair and to evaluate the effect of the response on postoperative renal function. From July 2005 to June 2008, 42 patients underwent elective endovascular repair of a TAAA using custom designed multi-branched stent-grafts at a single academic institution. Four patients were excluded from the analysis. White blood cell count (WBC), platelet count, prothrombin time (PT), and creatinine were measured in all patients. In the last nine patients, interleukin-6 (IL-6), protein C, Factor V, d-dimers, cystatin C, and neutrophil gelatinase-associated lipocalin (NGAL) levels were also measured. Change in lab values were expressed as a percentage of baseline values. The 30-day mortality rate was 5% (2/38). All patients (n = 38) had a higher WBC (mean +/- SD: 139 +/- 80%, P acute renal insufficiency (>50% rise in creatinine). Patients with renal insufficiency had significantly larger changes in WBC (178 +/- 100% vs 121 +/- 64%, P = .04) and platelet count (64 +/- 17% vs 52 +/- 12%, P = .02) compared with those without renal insufficiency. All patients (n = 9) had significant increases in NGAL (182 +/- 115%, P = .008) after stent-graft insertion. Six of nine patients (67%) had increased cystatin C (35 +/- 43%, P = .04) after stent-graft insertion, with a greater rise in those with postoperative renal insufficiency (87 +/- 32% vs 8 +/- 13%, P = .02). IL-6 levels were markedly increased in all patients (n = 9) after repair (9840 +/- 6160%, P = .008). Protein C (35 +/- 10%, P = .008) and Factor V levels (28 +/- 20%, P = .008) were uniformly decreased, while d-dimers were elevated after repair in all patients (310 +/- 213%, P = .008). Leukocytosis and thrombocytopenia were uniform following endovascular TAAA repair, and the severity of the response correlated with post-operative renal dysfunction. Elevation of a sensitive marker of renal injury (NGAL) suggests that

  19. Sexual Dysfunction After Conventional and Endovascular AAA Repair: Results of the DREAM Trial.

    NARCIS (Netherlands)

    Prinssen, M.; Buskens, E.; Nolthenius, R.P.T.; Sterkenburg, S. van; Teijink, J.A.; Blankensteijn, J.D.

    2004-01-01

    Purpose: To assess sexual function in the first postoperative year after elective endovascular aneurysm repair (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA).Methods: In the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, 153 patients (141 men; mean age 71 years,

  20. Endovascular Treatment of Late Thoracic Aortic Aneurysms after Surgical Repair of Congenital Aortic Coarctation in Childhood

    Science.gov (United States)

    Juszkat, Robert; Perek, Bartlomiej; Zabicki, Bartosz; Trojnarska, Olga; Jemielity, Marek; Staniszewski, Ryszard; Smoczyk, Wiesław; Pukacki, Fryderyk

    2013-01-01

    Background In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs. Methods This study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. Results Follow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. Conclusions The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary. PMID:24386233

  1. Endovascular treatment of late thoracic aortic aneurysms after surgical repair of congenital aortic coarctation in childhood.

    Directory of Open Access Journals (Sweden)

    Robert Juszkat

    Full Text Available BACKGROUND: In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1 to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2 to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs and (3 to assess outcomes after intravascular treatment for TAAs. METHODS: This study involved 37 asymptomatic patients (26 female and 11 male who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. RESULTS: Follow-up studies revealed TAA in seven cases (19% (including six with the gothic type of the aortic arch and mild recoarctation in other six (16%. Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA, in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. CONCLUSIONS: The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary.

  2. High risk endovascular aneurysm repair: a case report.

    Science.gov (United States)

    De Silva, Samanthi

    2017-10-01

    Mr AB is a 66-year old gentleman who presented for elective endovascular aneurysm repair (EVAR) following a routine screening scan identifying a 5.5cm abdominal aortic aneurysm (AAA). He had a past history of chronic obstructive pulmonary disease (COPD) with FEV1/FVC ratio of 48% on pre-assessment. He was hypertensive with a history of ischaemic heart disease (IHD), which has remained asymptomatic following coronary artery bypass grafting (CABG) eight years prior to this presentation. Copyright the Association for Perioperative Practice.

  3. Comparison of Total Arch and Partial Arch Transposition During Hybrid Endovascular Repair for Aortic Arch Disease.

    Science.gov (United States)

    Kang, W C; Ko, Y-G; Oh, P C; Shin, E K; Park, C-H; Choi, D; Youn, Y N; Lee, D Y

    2016-08-01

    Total arch transposition (TAT) during hybrid endovascular repair for aortic arch disease is believed to allow a better landing zone, but also to be associated with higher peri-operative mortality than partial arch transposition (PAT). Information on this issue is limited. This study was a retrospective analysis. All 53 consecutive patients with aortic arch disease (41 males, mean age 65.0 years) who underwent hybrid endovascular repair with TAT (zone 0, n=20) or PAT (zone 1 or 2, n=33) from 2008 to 2014 were analyzed retrospectively. The peri-operative and late outcomes of these two groups were compared. Baseline characteristics, including EuroSCORE II results, were similar in the two groups. After procedures, peri-operative mortalities and stroke rates were similar in the two groups (5.0% vs. 9.1%, p=1.000, and 10.0% vs. 6.1%, p=.627). Interestingly, all four strokes occurred in patients with a type III aortic arch irrespective of transposition type. Primary success rates (80.0% vs. 69.7%, p=.527) and type I endoleak incidences (20.0% vs. 27.3%, p=.744) were not significantly different. During follow up (mean duration 36.9 months), overall survival (89.7% vs. 87.4% at 1 year and 89.7% vs. 79.3% at 3 years; p=.375) and re-intervention free survival rates (78.6% vs. 92.0% at 1 year; 72.0% vs. 62.2% at 3 years, p=.872) were similar in the two groups. Morbidity and mortality were high within the first year of hybrid endovascular therapy for aortic arch disease, implying that candidates for hybrid procedures need to be selected carefully. Hybrid endovascular repair with TAT was found to have peri-operative mortality, stroke, and long-term survival rates comparable with PAT, so hybrid endovascular repair may be considered, irrespective of type of arch reconstruction, when clinically indicated. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  4. Nursing cooperation in endovascular aneurysm repair treatment for aortic dissection

    International Nuclear Information System (INIS)

    Xing Li; Yuan Chanjuan; Chen Rumei; Xiao Zhanqiang; Qi Youfei

    2014-01-01

    Objective: To summarize the main points of nursing cooperation in endovascular aneurysm repair treatment for aortic dissection. Methods: Preoperative psychological care and the other preparations were carefully conducted. During the operation, the patient's body was correctly placed. Active cooperation with the performance of angiography and close observation during heparinization were carried out. The proper delivery of catheter and stent to the operator was carefully done. Close observation for the patient's vital signs, the renal function and the changes of limb blood supply were made. Results: Under close cooperation of' the operators, nurses, anesthesiologists and technicians, the surgery was successfully accomplished in 35 patients. The monitoring of vital signs during the entire performance of operation was well executed. No surgical instruments delivery error's or surgery failure due to unsuitable cooperation occurred. Conclusion: Perfect preoperative preparation, strict nursing cooperation and team cooperation are the key points to ensure a successful endovascular aneurysm repair for aortic dissection. (authors)

  5. Preoperative methylprednisolone enhances recovery after endovascular aortic repair

    DEFF Research Database (Denmark)

    de la Motte, Louise; Kehlet, Henrik; Vogt, Katja

    2014-01-01

    OBJECTIVE: To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR). BACKGROUND: The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators. Glucocortico......OBJECTIVE: To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR). BACKGROUND: The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators....../kg of methylprednisolone (MP) (n = 77) or placebo (n = 76) preoperatively. Primary outcome was a modified version of the systemic inflammatory response syndrome. Secondary outcome measures were the effect on inflammatory biomarkers, morbidity, and time to meet discharge criteria. RESULTS: Of 153 randomized patients, 150...... not modified. No differences in 30-day medical (23% vs 36%) (P = 0.1) or surgical (20% vs 21%) morbidity were found in the active group versus the placebo group. CONCLUSIONS: Preoperative MP attenuates the inflammatory response with a faster recovery after EVAR for abdominal aortic aneurysms. Further safety...

  6. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    Energy Technology Data Exchange (ETDEWEB)

    Silverberg, Daniel, E-mail: silverberg-d@msn.com; Yalon, Tal; Halak, Moshe [The Chaim Sheba Medical Center, The Department of Vascular Surgery (Israel)

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  7. Endovascular repair of inflammatory abdominal aortic aneurysm: serial changes of periaortic fibrosis demonstrated by CT.

    Science.gov (United States)

    Sueyoshi, Eijun; Sakamoto, Ichiro; Uetani, Masataka

    2009-07-01

    Inflammatory abdominal aortic aneurysm (IAAA) is characterized by inflammatory and/or fibrotic changes in the periaortic regions of the retroperitoneum. Surgical repair is usually selected for this disease. However, the perioperative mortality associated with open surgical repair of IAAs is three times higher than that with noninflammatory aortic aneurysms due to inflammation and periaortic fibrosis (PAF). Endovascular aneurysm repair of IAAs excludes the aneurysm and seems to reduce the size of the aneurysmal sac and the extent of PAF with acceptable peri-interventional and long-term morbidity. We describe the successful endovascular repair of an IAAA and the serial CT findings after repair.

  8. Outcome of renal stenting for renal artery coverage during endovascular aortic aneurysm repair.

    Science.gov (United States)

    Hiramoto, Jade S; Chang, Catherine K; Reilly, Linda M; Schneider, Darren B; Rapp, Joseph H; Chuter, Timothy A M

    2009-05-01

    This study was conducted to determine the outcome of adjunctive renal artery stenting for renal artery coverage at the time of endovascular abdominal aortic aneurysm repair (EVAR). Between August 2000 and August 2008, 29 patients underwent elective EVAR using bifurcated Zenith stent grafts (Cook, Indianapolis, Ind) and simultaneous renal artery stenting. Renal artery stenting during EVAR was performed with endograft "encroachment" on the renal artery ostium (n = 23) or placement of a renal stent parallel to the main body of the endograft ("snorkel," n = 8). Follow-up included routine contrast-enhanced computed tomography (CT), multiview abdominal radiographs, and serum creatinine measurement at 1, 6, and 12 months, and then yearly thereafter. Thirty-one renal arteries were stented successfully in 29 patients. The 18 patients with planned renal artery stent placement had a proximal neck length technique (6.9 +/- 3.1 mm) compared with those with planned endograft encroachment (9.9 +/- 2.6 mm). None of the patients with unplanned endograft encroachment had neck lengths 1 month postoperatively) or stent graft migrations. Adjunctive renal artery stenting during endovascular AAA repair using the "encroachment" and "snorkel" techniques is safe and effective. Short- and medium-term primary patency rates are excellent, but careful follow-up is needed to determine the durability of these techniques.

  9. Geometric Deformations of the Thoracic Aorta and Supra-Aortic Arch Branch Vessels Following Thoracic Endovascular Aortic Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Hirotsu, Kelsey; Zhu, David; Lee, Jason T; Dake, Michael D; Fleischmann, Dominik; Cheng, Christopher P

    2018-04-01

    To utilize 3-D modeling techniques to better characterize geometric deformations of the supra-aortic arch branch vessels and descending thoracic aorta after thoracic endovascular aortic repair. Eighteen patients underwent endovascular repair of either type B aortic dissection (n = 10) or thoracic aortic aneurysm (n = 8). Computed tomography angiography was obtained pre- and postprocedure, and 3-D geometric models of the aorta and supra-aortic branch vessels were constructed. Branch angle of the supra-aortic branch vessels and curvature metrics of the ascending aorta, aortic arch, and stented thoracic aortic lumen were calculated both at pre- and postintervention. The left common carotid artery branch angle was lower than the left subclavian artery angles preintervention ( P Supra-aortic branch vessel angulation remains relatively static when proximal landing zones are distal to the left common carotid artery.

  10. Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair

    NARCIS (Netherlands)

    F.M.V. Bastos Gonçalves (Frederico); H. Baderkhan (H.); H.J.M. Verhagen (Hence); A. Wanhainen (A.); E. Björck (Erik); R.J. Stolker (Robert); S.E. Hoeks (Sanne); A.R. Mani (Ali)

    2014-01-01

    textabstractBackground Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance. Methods Patients undergoing EVAR

  11. The influence of neck thrombus on clinical outcome and aneurysm morphology after endovascular aneurysm repair

    NARCIS (Netherlands)

    F.M.V. Bastos Gonçalves (Frederico); H.J.M. Verhagen (Hence); K. Chinsakchai (Khamin); J.W. van Keulen (Jasper); M.T. Voûte (Michiel); H.J.A. Zandvoort (Herman); F.L. Moll (Frans); J.A. van Herwaarden (Joost)

    2012-01-01

    textabstractObjective: This study investigated the influence of significant aneurysm neck thrombus in clinical and morphologic outcomes after endovascular aneurysm repair (EVAR). Methods: The patient population was derived from a prospective EVAR database from two university institutions in The

  12. Endovascular vs open repair for ruptured abdominal aortic aneurysm

    Science.gov (United States)

    Nedeau, April E.; Pomposelli, Frank B.; Hamdan, Allen D.; Wyers, Mark C.; Hsu, Richard; Sachs, Teviah; Siracuse, Jeffrey J.; Schermerhorn, Mark L.

    2014-01-01

    Objective Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has become first-line therapy at our institution and is performed under a standardized protocol. We compare perioperative mortality, midterm survival, and morbidity after EVAR and open surgical repair (OSR). Methods Records were retrospectively reviewed from May 2000 to September 2010 for repair of infrarenal rAAAs. Primary end points included perioperative mortality and midterm survival. Secondary end points included acute limb ischemia, length of stay, ventilator-dependent respiratory failure, myocardial infarction, renal failure, abdominal compartment syndrome, and secondary intervention. Statistical analysis was performed using the t-test,X2 test, the Fisher exact test, and logistic regression calculations. Midterm survival was assessed with Kaplan-Meier analysis and Cox proportional hazard models. Results Seventy-four infrarenal rAAAs were repaired, 19 by EVAR and 55 by OSR. Despite increased age and comorbidity in the EVAR patients, perioperative mortality was 15.7% for EVAR, which was significantly lower than the 49% for OSR (odds ratio, 0.19; 95% CI, 0.05-0.74; P = .008). Midterm survival also favored EVAR (hazard ratio, 0.40; 95% CI, 0.21-0.77; P = .028, adjusted for age and sex). Mean follow-up was 20 months, and 1-year survival was 60% for EVAR vs 45% for OSR. Mean length of stay for patients surviving >1 day was 10 days for EVAR and 21 days for OSR (P = .004). Ventilator-dependent respiratory failure was 5% in the EVAR group vs 42% for OSR (odds ratio, 0.08; 95% CI, 0.01-0.62; P = .001). Conclusions EVAR of rAAA has a superior perioperative survival advantage and decreased morbidity vs OSR. Although not statistically significant, overall survival favors EVAR. We recommend that EVAR be considered as the first-line treatment of rAAAs and practiced as the standard of care. PMID:22626871

  13. Off-the-shelf multibranched endograft for urgent endovascular repair of thoracoabdominal aortic aneurysms.

    Science.gov (United States)

    Gallitto, Enrico; Gargiulo, Mauro; Freyrie, Antonio; Pini, Rodolfo; Mascoli, Chiara; Ancetti, Stefano; Faggioli, Gianluca; Stella, Andrea

    2017-09-01

    The aim of this paper was to report early and midterm results of endovascular repair of urgent thoracoabdominal aortic aneurysms (TAAAs) by the off-the-shelf multibranched Zenith t-Branch endograft (Cook Medical, Bloomington, Ind). Between January 2014 and April 2016, all patients with urgent TAAAs (asymptomatic with diameter >8 cm, symptomatic, or ruptured TAAAs) and aortoiliac anatomic feasibility underwent endovascular repair by t-Branch and were prospectively enrolled. Clinical, morphologic, intraoperative, and postoperative data were recorded. Follow-up was performed by duplex ultrasound, contrast-enhanced duplex ultrasound, and computed tomography angiography. Early end points were technical success (absence of type I or type III endoleak, loss of target visceral vessels [TVVs], conversion to open repair, or 24-hour mortality), spinal cord ischemia, and 30-day mortality. Follow-up end points were survival, TVV patency, type I or type III endoleaks, and freedom from reintervention. Seventeen patients (male, 71%; age, 73 ± 6 years; American Society of Anesthesiologists class 3/4, 60%/40%) affected by type II (47%), III (29%), and IV (24%) TAAAs were enrolled. The indications for t-Branch were as follows: contained TAAA rupture, four (24%); symptomatic TAAA (pain or peripheral embolism), four (24%); and TAAA diameter ≥8 cm, nine (52%). The mean TAAA diameter was 80 ± 19 mm, with 63 TVVs. Fifteen patients (87%) needed adjunctive intraoperative procedures: 14 proximal thoracic endografts (thoracic endovascular aortic repair), 1 left carotid-subclavian bypass, 2 endovascular hypogastric branches, and 2 surgical iliac conduits. In four cases (24%), a significant malorientation (≥60 degrees) of the main body occurred during t-Branch deployment. Technical success was achieved in 14 cases (82%), with technical failures consisting of the loss of three renal arteries (TVV patency, 95%). Spinal cord ischemia occurred in one case (6%) with temporary

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

    Directory of Open Access Journals (Sweden)

    Bruno Lorenção de Almeida

    2014-12-01

    Full Text Available 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.

  15. Voiding patterns of adult patients who underwent hypospadias repair in childhood.

    Science.gov (United States)

    Jaber, Jawdat; Kocherov, Stanislav; Chertin, Leonid; Farkas, Amicur; Chertin, Boris

    2017-02-01

    This study aimed at evaluating the voiding patterns of adult patients who underwent hypospadias repair in childhood. Following IRB approval 103 (22.7%) of 449 adult patients who underwent hypospadias repair between 1978 and 1993 responded to the following questionnaires: International Prostate Symptom Score (I-PSS) and Short Form 12 questionnaire (SF-12). Uroflowmetry (UF) was performed for all patients. The patients were divided into three groups according to the primary meatus localization. Group I had 63 patients (61.5%) treated for glanular hypospadias, group II had 19 patients (18.4%) treated for distal hypospadias, and group III comprised the remaining 21 patients (20.4%) treated for proximal hypospadias. The mean ± SD I-PSS score for all patients who responded to the questionnaire was 2.3 ± 2.4, and UF was 21.1 ± 4.3 mL/s. The patients from groups I and III had fewer urinary symptoms compared with those of the group II: 1.3 ± 1.5, 5.5 ± 2.4, and 1.6 ± 1.4, respectively (p hypospadias repair in childhood had normal or mild voiding disturbance, with no effects on their physical or mental status. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  16. Endovascular Repair of Aortic Dissection in Marfan Syndrome: Current Status and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Rosario Parisi

    2015-07-01

    Full Text Available Over the last decades, improvement of medical and surgical therapy has increased life expectancy in Marfan patients. Consequently, the number of such patients requiring secondary interventions on the descending thoracic aorta due to new or residual dissections, and distal aneurysm formation has substantially enlarged. Surgical and endovascular procedures represent two valuable options of treatment, both associated with advantages and drawbacks. The aim of the present manuscript was to review endovascular outcomes in Marfan syndrome and to assess the potential role of Thoracic Endovascular Aortic Repair (TEVAR in this subset of patients.

  17. Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection.

    Science.gov (United States)

    Gao, Feng; Zeng, Qian; Lin, Fangming; Ge, Xiaohu

    2017-10-01

    To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5-17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stent-grafts. All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2-42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

  18. Extra-Thoracic Supra-aortic Bypass Surgery Is Safe in Thoracic Endovascular Aortic Repair and Arterial Occlusive Disease Treatment.

    Science.gov (United States)

    Gombert, Alexander; van Issum, Lea; Barbati, Mohammad E; Grommes, Jochen; Keszei, Andras; Kotelis, Drosos; Jalaie, Houman; Greiner, Andreas; Jacobs, Michael J; Kalder, Johannes

    2018-04-20

    The safety and feasibility of supra-aortic debranching as part of endovascular aortic surgery or as a treatment option for arterial occlusive disease (AOD) remains controversial. The aim of this study was to assess the clinical outcome of this surgery. This single centre, retrospective study included 107 patients (mean age 69.2 years, 38.4% women) who underwent supra-aortic bypass surgery (carotid-subclavian bypass, carotid-carotid bypass, and carotid-carotid-subclavian bypass) because of thoracic or thoraco-abdominal endovascular aortic repair (57%; 61/107) or as AOD treatment (42.9%; 46/107) between January 2006 and January 2015. Mortality, morbidity with a focus on neurological complications, and patency rate were assessed. Twenty-six of 107 (14.2%) of the debranching patients were treated under emergency conditions because of acute type B dissection or symptomatic aneurysm. Follow up, conducted by imaging interpretation and telephone interviews, continued till March 2017 (mean 42.1, 0-125, months). The in hospital mortality rate was 10.2% (11/107), all of these cases from the debranching group and related to emergency procedures (p supra-aortic bypass surgery involves low complication rates and high mid-term bypass patency rates. It is a safe and feasible treatment option in the form of debranching in combination with endovascular aortic aneurysm repair and in AOD. Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

  19. Individual-patient meta-analysis of three randomized trials comparing endovascular versus open repair for ruptured abdominal aortic aneurysm

    NARCIS (Netherlands)

    Sweeting, M. J.; Balm, R.; Desgranges, P.; Ulug, P.; Powell, J. T.; Koelemay, M. J. W.; Idu, M. M.; Kox, C.; Legemate, D. A.; Huisman, L. C.; Willems, M. C. M.; Reekers, J. A.; van Delden, O. M.; van Lienden, K. P.; Hoornweg, L. L.; Reimerink, J. J.; van Beek, S. C.; Vahl, A. C.; Leijdekkers, V. J.; Bosma, J.; Montauban van Swijndregt, A. D.; de Vries, C.; van der Hulst, V. P. M.; Peringa, J.; Blomjous, J. G. A. M.; Visser, M. J. T.; van der Heijden, F. H. W. M.; Wisselink, W.; Hoksbergen, A. W. J.; Blankensteijn, J. D.; Visser, M. T. J.; Coveliers, H. M. E.; Nederhoed, J. H.; van den Berg, F. G.; van der Meijs, B. B.; van den Oever, M. L. P.; Lely, R. J.; Meijerink, M. R.; Voorwinde, A.; Ultee, J. M.; van Nieuwenhuizen, R. C.; Dwars, B. J.; Nagy, T. O. M.; Tolenaar, P.; Wiersema, A. M.; Lawson, J. A.; van Aken, P. J.; Stigter, A. A.; van den Broek, T. A. A.; Vos, G. A.; Mulder, W.; Strating, R. P.; Nio, D.; Akkersdijk, G. J. M.; van der Elst, A.; van Exter, P.; Becquemin, J.-P.; Allaire, E.; Cochennec, F.; Marzelle, J.; Louis, N.; Schneider, J.; Majewski, M.; Castier, Y.; Leseche, G.; Francis, F.; Steinmetz, E.; Berne, J.-P.; Favier, C.; Haulon, S.; Koussa, M.; Azzaoui, R.; Piervito, D.; Alimi, Y.; Boufi, M.; Hartung, O.; Cerquetta, P.; Amabile, P.; Piquet, P.; Penard, J.; Demasi, M.; Alric, P.; Canaud, L.; Berthet, J.-P.; Julia, P.; Fabiani, J.-N.; Alsac, J. M.; Gouny, P.; Badra, A.; Braesco, J.; Favre, J.-P.; Albertini, J.-N.; Martinez, R.; Hassen-Khodja, R.; Batt, M.; Jean, E.; Sosa, M.; Declemy, S.; Destrieux-Garnier, L.; Lermusiaux, P.; Feugier, P.; Ashleigh, R.; Gomes, M.; Greenhalgh, R. M.; Grieve, R.; Hinchliffe, R.; Sweeting, M.; Thompson, M. M.; Thompson, S. G.; Cheshire, N. J.; Boyle, J. R.; Serracino-Inglott, F.; Smyth, J. V.; Hinchliffe, R. J.; Bell, R.; Wilson, N.; Bown, M.; Dennis, M.; Davis, M.; Howell, S.; Wyatt, M. G.; Valenti, D.; Bachoo, P.; Walker, P.; MacSweeney, S.; Davies, J. N.; Rittoo, D.; Parvin, S. D.; Yusuf, W.; Nice, C.; Chetter, I.; Howard, A.; Chong, P.; Bhat, R.; McLain, D.; Gordon, A.; Lane, I.; Hobbs, S.; Pillay, W.; Rowlands, T.; El-Tahir, A.; Asquith, J.; Cavanagh, S.; Dubois, L.; Forbes, T. L.

    2015-01-01

    The benefits of endovascular repair of ruptured abdominal aortic aneurysm remain controversial, without any strong evidence about advantages in specific subgroups. An individual-patient data meta-analysis of three recent randomized trials of endovascular versus open repair of abdominal aortic

  20. Sex differences in 30-day and 5-year outcomes after endovascular repair of abdominal aortic aneurysms in the EUROSTAR study

    DEFF Research Database (Denmark)

    Grootenboer, Nathalie; Hunink, M G Myriam; Hendriks, Johanna M

    2013-01-01

    The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair.......The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair....

  1. Clinical Aspects on Chimney Stent Graft Technique in Endovascular Repair of the Aorta.

    OpenAIRE

    BinJabr, Adel

    2015-01-01

    Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic...

  2. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair.

    Science.gov (United States)

    Li, Shoujun; Ma, Kai; Hu, Shengshou; Hua, Zhongdong; Yang, Keming; Yan, Jun; Chen, Qiuming

    2014-09-01

    The study objective was to report the outcomes of biventricular repair in patients with double outlet right ventricle. Patients with double outlet right ventricle who underwent biventricular repair at Fuwai Hospital from January 2005 to December 2012 were included. Patients were excluded if double outlet right ventricle was combined with atrioventricular septal defect, heterotaxy syndrome, atrioventricular discordance, or univentricular physiology. A total of 380 consecutive patients with a mean age of 1.9 ± 2.1 years (range, 1 month to 6 years) were included. Varied types of biventricular repair were customized individually. Follow-up was 90.4% complete, and the mean follow-up time was 3.4 ± 3.9 years. There were 17 (4.5%) early deaths and 7 (2.1%) late deaths. Preoperative pulmonary hypertension was the only risk factor for early mortality. Postoperative significant left ventricular outflow tract obstruction was present in 9 survivors. Patients with noncommitted ventricular septal defect had a longer crossclamp time, longer cardiopulmonary bypass time, and higher incidence of postdischarge left ventricular outflow tract obstruction. There were 4 reoperations, all of which were caused by subaortic left ventricular outflow tract obstruction. All of the pressure gradients were decreased to less than 20 mm Hg after the modified Konno procedure with an uneventful postoperative course. Optimal results of varied types of biventricular repair for double outlet right ventricle have been acquired. Although noncommitted ventricular septal defect is technically difficult, the outcomes of patients are favorable. Late-onset left ventricular outflow tract obstruction is the main reason for reoperation but can be successfully relieved by the modified Konno procedure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  3. Emergency endovascular repair of ruptured visceral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Tang Tjun

    2007-07-01

    Full Text Available Abstract Background Visceral artery aneurysms although rare, have very high mortality if they rupture. Case presentation An interesting case of a bleeding inferior pancreaticduodenal artery aneurysm is reported in a young patient who presented with hypovolemic shock while being treated in the hospital after undergoing total knee replacement. Endovascular embolization was successfully employed to treat this patient, with early hospital discharge. Conclusion Prompt diagnosis and endovascular management of ruptured visceral aneuryms can decrease the associated mortality and morbidity.

  4. Outcome of endovascular repair for intact and ruptured thoracic aortic aneurysms.

    Science.gov (United States)

    Hellgren, Tina; Wanhainen, Anders; Steuer, Johnny; Mani, Kevin

    2017-07-01

    The objective of this study was to assess long-term outcome after thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm (TAA). All patients who underwent TEVAR for TAA at Uppsala University Hospital from December 1999 to December 2014 were included. Characteristics of the patients and outcome data were collected from medical records, national population registry, and cause of death registry. Perioperative survival was analyzed with the χ 2 test, and 5-year survival was estimated with Kaplan-Meier analysis. Predictors of long-term survival were assessed with Cox regression. There were 77 patients included in the study, 49 with intact TAAs (iTAAs) and 28 with ruptured TAAs (rTAAs). Mean follow-up was 83.7 months for iTAA patients and 82.0 months for rTAA patients (P = .853). Mean age was 71.5 years for iTAA patients and 74.8 years for rTAA patients (P = .04). Survival after iTAA repair was 95.9% at 30 days, 91.8% at 90 days, and 62.5% at 5 years. After rTAA repair, survival was 71.4% at 30 days and decreased to 57.1% at 90 days (P < .01), with most deaths after 30 days being related to the aortic event. The 3-year survival rate after rTAA repair was 27.8%, and only one rTAA patient with 5 years of follow-up remained alive. Six aorta-related deaths occurred after 90 days (three iTAA patients, three rTAA patients); five were due to rupture of nontreated aortic segments. The 5-year reintervention rate was 13.2% for iTAA patients and 17.9% for rTAA patients (P = .682). All reinterventions occurred within 14 months of TEVAR. The age-adjusted hazard ratio for long-term mortality was 4.4 after rTAA repair compared with iTAA repair. TEVAR for iTAA was associated with low perioperative mortality and acceptable 5-year survival at 62.5%. Results were more pessimistic after rTAA repair, however, for which two-thirds of the patients were deceased at 3-year follow-up. Improved selection of patients is necessary to identify patients who are

  5. Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair.

    Science.gov (United States)

    Vallabhaneni, Raghuveer; Sorial, Ehab E; Jordan, William D; Minion, David J; Farber, Mark A

    2012-12-01

    Concurrent iliac occlusion and abdominal aortic aneurysm is rare. Traditionally, the endovascular approach to these patients has consisted of aortouniiliac devices combined with femoral-femoral bypass. With improved facility of endovascular techniques, standard bifurcated endografts represent an alternative option in these patients. This study examined outcomes of patients undergoing iliac recanalization and traditional bifurcated endovascular aneurysm repair in the face of access vessel occlusion. Outcomes of patients at three academic tertiary referral centers who underwent attempted iliac recanalization of chronic iliac occlusions and concurrent endovascular aneurysm repair of an infrarenal aortic aneurysm were retrospectively reviewed. Patients with acute iliac thrombosis and those with severely stenotic (but patent) iliac vessels were excluded. During a 6-year period, 15 occluded iliac arteries were treated in 14 patients (13 men). Mean age was 67.8 years (range, 52-80 years). Primary indication for intervention was disabling claudication in four patients, size of abdominal aortic aneurysm in nine, and symptomatic aneurysm in one. Seven patients presented with a unilateral common iliac artery (CIA) occlusion, four with a unilateral external iliac artery (EIA) occlusion, three with a unilateral combined CIA and EIA occlusion, and one with bilateral CIA occlusions. Stents had been placed previously in two of the occluded CIAs and in one of the occluded EIAs. Average length of the occluded segment was 7.5 cm (range, 2-17 cm). The occluded CIAs and EIAs had mean diameters of 8.6 and 5.7 mm, respectively. Successful recanalization was achieved in 14 of the 15 vessels (93.3%). One EIA ruptured during recanalization but was easily controlled with a covered stent. A re-entry device was used in two cases. Overall, 13 bifurcated devices were successfully implanted. Bilateral iliac occlusions in one patient were recanalized. One Talent (Medtronic, Santa Rosa, Calif

  6. Endovascular stent grafting of thoracic aortic aneurysms: technological advancements provide an alternative to traditional surgical repair.

    Science.gov (United States)

    Jones, Lauren E Beste

    2005-01-01

    The use of endovascular stent grafts is a leading technological advancement in the treatment of thoracic aortic aneurysms, and is being trialed in the United States as an alternative to medical management and traditional surgical repair. Aortic stent grafts, initially used only for abdominal aortic aneurysms, have been used for over 10 years in Europe and are currently under United States Food and Drug Administration investigation for the treatment of chronic and acute aortic aneurysms. Diseases of the thoracic aorta are often present in high-risk individuals, and, as a result, there is a high morbidity and mortality rate associated with both medical and surgical management of these patients. The development and refinement of endovascular approaches have the potential to decrease the need for traditional surgical repair, especially in high-risk populations such as the elderly and those with multiple comorbidities. Endovascular technology for thoracic repair has only been used in Europe for the last 10 years, with no long-term outcomes available; however, preliminary research demonstrates favorable early and midterm outcomes showing that endovascular stent graft placement to exclude the dilated, dissected, or ruptured aorta is both technically feasible and safe for patients. The article highlights the historical perspective of endovascular stent grafting as well as a description of patient selection, the operative procedure, benefits, risks, and unresolved issues pertaining to the procedure. A brief review of aneurysm and dissection pathophysiology and management is provided, as well as postoperative management for acute care nurses and recommendations for clinical practice.

  7. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

    International Nuclear Information System (INIS)

    Godfrey, Anthony D.; Morbi, Abigail H. M.; Nordon, Ian M.

    2015-01-01

    PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR

  8. Intraoperative Sac Pressure Measurement During Endovascular Abdominal Aortic Aneurysm Repair

    International Nuclear Information System (INIS)

    Ishibashi, Hiroyuki; Ishiguchi, Tsuneo; Ohta, Takashi; Sugimoto, Ikuo; Iwata, Hirohide; Yamada, Tetsuya; Tadakoshi, Masao; Hida, Noriyuki; Orimoto, Yuki; Kamei, Seiji

    2010-01-01

    PurposeIntraoperative sac pressure was measured during endovascular abdominal aortic aneurysm repair (EVAR) to evaluate the clinical significance of sac pressure measurement.MethodsA microcatheter was placed in an aneurysm sac from the contralateral femoral artery, and sac pressure was measured during EVAR procedures in 47 patients. Aortic blood pressure was measured as a control by a catheter from the left brachial artery.ResultsThe systolic sac pressure index (SPI) was 0.87 ± 0.10 after main-body deployment, 0.63 ± 0.12 after leg deployment (P < 0.01), and 0.56 ± 0.12 after completion of the procedure (P < 0.01). Pulse pressure was 55 ± 21 mmHg, 23 ± 15 mmHg (P < 0.01), and 16 ± 12 mmHg (P < 0.01), respectively. SPI showed no significant differences between the Zenith and Excluder stent grafts (0.56 ± 0.13 vs. 0.54 ± 0.10, NS). Type I endoleak was found in seven patients (15%), and the SPI decreased from 0.62 ± 0.10 to 0.55 ± 0.10 (P = 0.10) after fixing procedures. Type II endoleak was found in 12 patients (26%) by completion angiography. The SPI showed no difference between type II endoleak positive and negative (0.58 ± 0.12 vs. 0.55 ± 0.12, NS). There were no significant differences between the final SPI of abdominal aortic aneurysms in which the diameter decreased in the follow-up and that of abdominal aortic aneurysms in which the diameter did not change (0.53 ± 0.12 vs. 0.57 ± 0.12, NS).ConclusionsSac pressure measurement was useful for instant hemodynamic evaluation of the EVAR procedure, especially in type I endoleaks. However, on the basis of this small study, the SPI cannot be used to reliably predict sac growth or regression.

  9. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Godfrey, Anthony D., E-mail: deangodfrey@yahoo.co.uk; Morbi, Abigail H. M., E-mail: a.morbi@soton.ac.uk; Nordon, Ian M., E-mail: ian.nordon@uhs.nhs.uk [University Hospital Southampton NHS Foundation Trust, Unit of Cardiac Vascular and Thoracic Surgery - CV& T, Department of Vascular Surgery (United Kingdom)

    2015-10-15

    PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.

  10. Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms.

    Science.gov (United States)

    Silingardi, Roberto; Gennai, Stefano; Coppi, Giovanni; Chester, Johanna; Marcheselli, Luigi; Brunetti, Massimo

    2017-12-01

    The aim of this study was to assess clinical and contemporary costs associated with elective endovascular repair of intact descending thoracic aortic aneurysms (DTAA) into the mid-term follow-up. A retrospective review of a prospectively maintained clinical database including 29 consecutive patients from July 2005 to December 2009 treated with elective endovascular repair (TEVAR) or TEVAR and surgical infrarenal repair (hybrid) of intact DTAA was performed. Mean age was 74.5 years old (±7.1). Primary clinical endpoints include mortality and major morbidity. Additionally a comprehensive economic appraisal of individual in-hospital and follow-up costs was executed. Economic endpoints include in-hospital and follow-up costs and patient discharge status. Elective endovascular and open repairs' clinical and economical outcomes in contemporary literature were assessed for comparison according to PRISMA standards. Immediate mortality was 6.9% (1/24 TEVAR and 1/5 hybrid). Three respiratory complications were recorded (11%; 2 TEVAR, 1 hybrid). Renal and cardiac complication rates were 7.4% (1 TEVAR, 1 hybrid) and 3.7% (1 TEVAR) respectively. Routine discharge home was achieved for 85% of patients (95.7% TEVAR, 25% hybrid). Three endoleaks were treated throughout the follow-up (2 TEVAR, 1 hybrid; mean 30.4 mo, ±19.9) rendering an 11% (3/27) reintervention rate. Average immediate cost was €21,976.87 for elective endovascular repair and €33,783.21 for elective endovascular hybrid repair. Additional reintervention and routine follow-up costs augmented immediate costs by 12.4%. This study supports satisfying immediate clinical outcomes for TEVAR and TEVAR+surgical infrarenal procedures. Although limited by a small population size and difficulties in economic comparisons, this study presents the real world social and economic cost scenario for both elective TEVAR and TEVAR hybrid treatment of DTAA of both the in-hospital and at mid term follow-up periods.

  11. Procedure-related mortality of endovascular abdominal aortic aneurysm repair using revised reporting standards.

    NARCIS (Netherlands)

    Konig, G.G.; Vallabhneni, S.R.; Marrewijk, C.J. van; Leurs, L.J.; Laheij, R.J.F.; Buth, J.

    2007-01-01

    OBJECTIVE: The aim of this study was to evaluate the definition of Procedure-related mortality after endovascular aneurysm repair (EVAR) as defined by the Committee for Standardized Reporting Practices in Vascular Surgery. METHODS: Data on patients with an AAA were taken from the EUROSTAR database.

  12. Semiautomatic sizing software in emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysms

    NARCIS (Netherlands)

    Reimerink, Jorik J.; Marquering, Henk A.; Vahl, Anco; Wisselink, Willem; Schreve, Michiel A.; de Boo, Diederick W.; Reekers, Jim A.; Legemate, Dink A.; Balm, Ron

    2014-01-01

    In emergency endovascular repair (EVAR) of ruptured aneurysms of the aorta (rAAA), anatomical suitability must be determined. Semiautomatic three-dimensional assessment of the aortoiliac arteries has the potential to standardise measurements. This study assesses the fitness for purpose of such a

  13. MRI follow-up of abdominal aortic aneurysms after endovascular repair

    NARCIS (Netherlands)

    Cornelissen, S.A.P.

    2012-01-01

    Aneurysm size changes form the basis of the follow-up after endovascular abdominal aortic aneurysm repair, because aneurysm growth increases rupture risk. Aneurysm growth can be caused by endoleak (leakage of blood in the aneurysm sac). Therefore, accurate endoleak detection is important in growing

  14. Potential value of aneurysm sac volume measurements in addition to diameter measurements after endovascular aneurysm repair.

    NARCIS (Netherlands)

    Keulen, J.W. van; Prehn, J. van; Prokop, M.; Moll, F.L.; Herwaarden, J.A. van

    2009-01-01

    PURPOSE:To investigate the value of aneurysm sac volume measurement in addition to diameter measurements based on computed tomographic angiography (CTA) after endovascular aneurysm repair (EVAR). METHODS:Interrogation of a vascular database identified 56 patients (51 men; median age 77 years, range

  15. Emergency abdominal aortic aneurysm repair with a preferential endovascular strategy : Mortality and cost-effectiveness analysis

    NARCIS (Netherlands)

    Kapma, Marten R.; Groen, Henk; Oranen, Bjorn I.; van der Hilst, Christian S.; Tielliu, Ignace F.; Zeebregts, Clark J.; Prins, Ted R.; van den Dungen, Jan J.; Verhoeven, Eric L.

    2007-01-01

    Purpose: To assess mortality and treatment costs of a new management protocol with preferential use of emergency endovascular aneurysm repair (eEVAR) for acute abdominal aortic aneurysm (AAA). Methods: From September 2003 until February 2005, 49 consecutive patients (45 men; mean age 71 years) with

  16. From puncture to closure of the common femoral artery in endovascular aortic repair

    DEFF Research Database (Denmark)

    Lönn, Lars; Larzon, Thomas; Van Den Berg, Jos C

    2010-01-01

    of the arterial wall using percutaneous closure devices. We also aim to discuss three important approaches to expose and close the femoral arteries during endovascular aortic repair: The cut down approach, the true percutaneous technique, and the femoral fascial closure. Finally, factors important in the choice...

  17. Statin use is associated with reduced all-cause mortality after endovascular abdominal aortic aneurysm repair.

    NARCIS (Netherlands)

    Leurs, L.J.; Visser, P.; Laheij, R.J.F.; Buth, J.; Harris, P.L.; Blankensteijn, J.D.

    2006-01-01

    It has been shown that preoperative statin therapy reduces all-cause and cardiovascular mortality in patients undergoing major noncardiac vascular surgery. In this report, we investigated the influence of statin use on early and late outcome following endovascular abdominal aortic aneurysm repair

  18. Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial.

    Science.gov (United States)

    2017-11-14

    Objective  To assess the three year clinical outcomes and cost effectiveness of a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair for patients with suspected ruptured abdominal aortic aneurysm. Design  Randomised controlled trial. Setting  30 vascular centres (29 in UK, one in Canada), 2009-16. Participants  613 eligible patients (480 men) with a clinical diagnosis of ruptured aneurysm, of whom 502 underwent emergency repair for rupture. Interventions  316 patients were randomised to an endovascular strategy (275 with confirmed rupture) and 297 to open repair (261 with confirmed rupture). Main outcome measures  Mortality, with reinterventions after aneurysm repair, quality of life, and hospital costs to three years as secondary measures. Results  The maximum follow-up for mortality was 7.1 years, with two patients in each group lost to follow-up by three years. After similar mortality by 90 days, in the mid-term (three months to three years) there were fewer deaths in the endovascular than the open repair group (hazard ratio 0.57, 95% confidence interval 0.36 to 0.90), leading to lower mortality at three years (48% v 56%), but by seven years mortality was about 60% in each group (hazard ratio 0.92, 0.75 to 1.13). Results for the 502 patients with repaired ruptures were more pronounced: three year mortality was lower in the endovascular strategy group (42% v 54%; odds ratio 0.62, 0.43 to 0.88), but after seven years there was no clear difference between the groups (hazard ratio 0.86, 0.68 to 1.08). Reintervention rates up to three years were not significantly different between the randomised groups (hazard ratio 1.02, 0.79 to 1.32); the initial rapid rate of reinterventions was followed by a much slower mid-term reintervention rate in both groups. The early higher average quality of life in the endovascular strategy versus open repair group, coupled with the lower mortality at three years, led to a

  19. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Koike, Yuya, E-mail: r06118@hotmail.co.jp; Nishimura, Jun-ichi, E-mail: jun-ichi-n@nifty.com; Hase, Soichiro, E-mail: haseman@hotmail.co.jp; Yamasaki, Motoshige, E-mail: genyamasaki@gmail.com [Kawasaki Saiwai Hospital, Department of Interventional Radiology (Japan)

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  20. Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    International Nuclear Information System (INIS)

    Choke, Edward; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria; Loftus, Ian; McFarland, Robert; Loosemore, Thomas; Thompson, Matthew M.

    2006-01-01

    Purpose. The principal anatomic contraindication to endovascular aneurysm repair (EVR) is an unfavorable proximal aortic neck. With increasing experience, a greater proportion of patients with unfavorable neck anatomy are being offered EVR. This study aimed to evaluate outcomes in patients with challenging proximal aortic neck anatomy. Methods. Prospectively collected data from 147 consecutive patients who underwent EVR between December 1997 and April 2005 were supplemented with a retrospective review of medical records and radiological images. Unfavorable anatomic features were defined as neck diameter >28 mm, angulation >60 deg., circumferential thrombus >50%, and length 30 days) (p = 0.57), distal type I endoleak (p = 0.40), type III endoleak (p 0.51), secondary interventions (p = 1.0), aneurysm sac expansion (p = 0.44), or 30 day mortality (p = 0.70). The good neck group had a significantly increased incidence of type II endoleak (p = 0.023). By multivariate analysis, the incidence of intraoperative adjunctive procedures was significantly increased in the presence of severe angulation (p = 0.041, OR 3.08, 95% CI 1.05-9.04). Conclusion. Patients with severely hostile proximal aortic neck anatomy may be treated with EVR, although severely angulated necks require additional intraoperative procedures. Early outcomes are encouraging and suggest that indications for EVR may be expanded to include patients with hostile neck anatomy

  1. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    International Nuclear Information System (INIS)

    Koike, Yuya; Nishimura, Jun-ichi; Hase, Soichiro; Yamasaki, Motoshige

    2015-01-01

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients

  2. Internal Iliac Artery Embolization during an Endovascular Aneurysm Repair with Detachable Interlock Microcoils

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Woo ChuL; Jeon, Yong Sun; Hong, Kee Chun; Cho, Soon Gu; Park, Jae Young [Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of); Kim, Jang Yong [Dept. of Vascular and Endovascular Surgery, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR). A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed. Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed. Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.

  3. [Endovascular repair of iliocaval arteriovenous fistula complicating lumbar disc surgery].

    Science.gov (United States)

    Ben Jemaa, H; Maalej, A; Lazzez, K; Jemal, H; Karray, S; Ben Mahfoudh, K

    2016-05-01

    Vascular complications of lumbar disc surgery are rare. Few cases have been reported. Arteriovenous fistulas are the most common. They are due to anatomical relationships between the last lumbar vertebrae, the corresponding discs, and the iliac vessels; degenerative lesions of the intervertebral discs facilitate instrumental vessel perforation, and operative difficulty. Computed tomography is particularly accurate for making the diagnosis. Treatment strategies consist in surgery or endovascular management. Percutaneous endovascular treatment using a stent-graft is a reasonable option for treating arteriovenous fistula. We describe the case of a 50-year-old patient who developed an iliocaval arteriovenous fistula following lumbar disc hernia surgery. The lesion was excluded by a stent-graft. The postoperative period was uneventful. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Endovascular repair of the ascending aorta: when and how to implement the current technology.

    Science.gov (United States)

    Preventza, Ourania; Henry, Matthew J; Cheong, Benjamin Y C; Coselli, Joseph S

    2014-05-01

    The purpose of our study was to examine when and how to implement the current endoluminal stent graft technology to treat ascending aortic disease. During a 7-year period (March 2006 through July 2013), 7 consecutive patients (median age, 69 years; range, 61.5 to 80.5 years) with multiple comorbidities underwent endoluminal repair of the ascending aorta. Six had an ascending aortic pseudoaneurysm, and 1 had iatrogenic coarctation. The median number of prior sternotomies was 2 (range, 1 to 4). Technical success was achieved in all but 1 patient, with 1 death (14.3%) at 30 days. The endoluminal technology used included the Gore TAG (W.L. Gore and Associates, Flagstaff, AZ) thoracic graft (including the new C-TAG) in 6 patients, the Talent stent graft (Medtronic, Santa Rosa, CA) in 1, an Excluder cuff (W.L. Gore) in 2, and an Amplatzer occluder (AGA Medical Corp, Plymouth, MN) in 1. More than 1 stent was placed in 4 patients. Three patients required innominate artery stenting, and 1 required additional left common carotid artery stenting. One patient (14.3%) required intraoperative conversion to open surgical repair. Median follow-up was 14.4 months (interquartile [25th to 75th percentile] range, 5.5 to 22.6 months) with 66.6% overall survival. No aortic-related death was reported during the follow-up period. Stent grafting of the ascending aorta is feasible but limited and is reserved for high-risk individuals. Technical expertise is essential, and follow-up is mandatory. Technical points, tips, and challenges of the current endovascular technology to effectively treat the ascending aorta are described. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Endovascular repair of aortic isthmus coarctation with a self-expanding covered stent.

    Science.gov (United States)

    Oberhuber, Alexander; Muehling, Bernd M; Orend, Karl-Heinz; Schelzig, Hubert

    2012-05-01

    Coarctation is one of the most often seen congenital aortal defects. In the majority, diagnosis will be made in newborns. Endovascular repair is critical in children owing to their growth, but in adult patients, it is an interesting alternative. A 31-year-old man presenting with hypertension of upper extremities and pulseless lower extremities was admitted to our hospital. Systolic blood pressure was 190 mm Hg, although a triple antihypertensive medication was administered. Computed tomographic angiography showed a nearly total occlusion of the aortic isthmus. Coarctation was treated by an endovascular approach with a self-expanding covered stent-graft (Medtronic Talent; Medtronic World Medical, Sunrise, FL) after predilatation with a Reliant balloon (Medtronic World Medical, Sunrise, FL). After a follow-up of 40 months, the patient is normotensive and antihypertensive medication could be reduced. Lower extremities showed normal pulses and normal ankle-brachial index. Computed tomographic scans showed unchanged stent-graft position, with constant slight waist. Endovascular repair of atresia or coarctation of the thoracic aorta is a minimal invasive debatable option. Not only reduction of blood pressure but also reduction of left ventricular mass and prolongation of life expectancy can be achieved by endovascular treatment. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  6. Reporting standards for endovascular repair of saccular intracranial cerebral aneurysms.

    Science.gov (United States)

    Meyers, Philip M; Schumacher, H Christian; Higashida, Randall T; Derdeyn, Colin P; Nesbit, Gary M; Sacks, David; Wechsler, Lawrence R; Bederson, Joshua B; Lavine, Sean D; Rasmussen, Peter

    2010-12-01

    The goal of this article is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting on the radiological evaluation and endovascular treatment of intracranial, cerebral aneurysms. These criteria can be used to design clinical trials, to provide uniformity of definitions for appropriate selection and stratification of patients, and to allow analysis and meta-analysis of reported data. This article was written under the auspices of the Joint Writing Group of the Technology Assessment Committee, Society of Neurolnterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1991 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data about the assessment and endovascular treatment of cerebral aneurysms useful as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This article offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of cerebral aneurysms. Included in this guidance article are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications. The evaluation and treatment of brain aneurysms often involve multiple medical specialties. Recent reviews by the American Heart Association have surveyed the medical literature to develop guidelines for the clinical

  7. The current status of endovascular repair of thoracic aortic aneurysms (TEVAR).

    Science.gov (United States)

    El-Sayed, Hosam; Ramlawi, Basel

    2011-01-01

    Thoracic endovascular aortic repair (TEVAR) has been one of the most important advances in the management of thoracic aortic disease in the past two decades. The procedure was originally developed by Dake and colleagues in 1994 for the treatment of descending thoracic aortic aneurysm (DTAA), using the same principles as EVAR for the treatment of abdominal aortic aneurysm (AAA). The first device approved for this indication was the TAG device (W.L. Gore & Associated, Inc., Flagstaff, AZ) in 2005. Since then there has been a plethora of changes and new developments related to thoracic endovascular aortic repair. This article will summarize the major updates related to TEVAR, focusing on three main aspects: what is new in device technology and future prospects; the expanding indications of TEVAR for the treatment of other pathologies and the newly developed techniques involved; and a glimpse at the expected future direction in the field.

  8. Can an accessory renal artery be safely covered during endovascular aortic aneurysm repair?

    OpenAIRE

    Antoniou, George A.; Karkos, Christos D.; Antoniou, Stavros A.; Georgiadis, George S.

    2013-01-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether coverage of an accessory renal artery (ARA) in patients undergoing endovascular aortic aneurysm repair (EVAR) is associated with increased risk of renal impairment. Altogether, 106 papers were located using the reported searches, of which 5 represented the best evidence to answer the question. The authors, journal, date and country of publication, study type, patient group studied, rel...

  9. The influence of neck thrombus on clinical outcome and aneurysm morphology after endovascular aneurysm repair

    OpenAIRE

    Bastos Gonçalves, Frederico; Verhagen, Hence; Chinsakchai, Khamin; Keulen, Jasper; Voûte, Michiel; Zandvoort, Herman; Moll, Frans; Herwaarden, Joost

    2012-01-01

    textabstractObjective: This study investigated the influence of significant aneurysm neck thrombus in clinical and morphologic outcomes after endovascular aneurysm repair (EVAR). Methods: The patient population was derived from a prospective EVAR database from two university institutions in The Netherlands from 2004 to 2008. Patients with significant thrombus in the neck (>2 mm in thickness in at least >25% of circumference) were identified as the thrombus group and were compared with the rem...

  10. Volumetric analysis demonstrates that true and false lumen remodeling persists for 12 months after thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Ga-Young Suh, PhD

    2016-09-01

    Full Text Available A 62-year-old man underwent an elephant trunk procedure followed by thoracic endovascular aortic repair (TEVAR. Computed tomography angiography-based models were built to quantify volume of the whole aorta and true and false lumens preoperatively, before TEVAR, after TEVAR, and at follow-up at 3, 6, and 12 months. With TEVAR, descending aortic true lumen volume increased by 54%, then increased additionally by 60% during 12 months. The descending aortic false lumen volume regressed continuously for 12 months following TEVAR, with the most rapid rate from 6 to 12 months at 16 cm3/month. TEVAR immediately increased true lumen volume and continued to remodel the true and false lumens throughout the following 12 months.

  11. Results of a multicenter, prospective trial of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial).

    Science.gov (United States)

    Khoynezhad, Ali; Azizzadeh, Ali; Donayre, Carlos E; Matsumoto, Alan; Velazquez, Omaida; White, Rodney

    2013-04-01

    To evaluate the early outcomes of patients undergoing thoracic endovascular aortic repair for blunt thoracic aortic injuries. A prospective, nonrandomized, multicenter trial using the Medtronic Valiant Captivia stent graft was conducted at 20 sites in North America. Fifty patients with blunt thoracic aortic injuries were enrolled between April 2010 and January 2012 and will be followed for 5 years. The injuries were classified into categories (grades I-IV) based on severity: intimal tear, intramural hematoma, pseudoaneurysm, or rupture. The primary end point was 30-day all-cause mortality. Secondary end points were adverse events occurring within 30 days that were related to the procedure, device or aorta, and aortic-related mortality. Technical success was measured as successful device delivery and deployment. Seventy-six percent (38/50) of patients were male with mean age of 41 ± 17 years. Fifty-one Medtronic Valiant Captivia thoracic stent grafts and a single Talent thoracic stent graft were implanted within a median of 1.0 days following injury (mean, 1.8 ± 4.0 days). Seventy percent (35/50) of aortic injuries were grade III or higher, including one patient with free rupture. Mean injury severity score was 38 ± 14. Fifty-four percent of stent grafts were ≤26 mm (28/52). The left subclavian artery was completely covered in 40% of patients (20/50) and partially covered in 18% of patients (9/50). Four patients underwent subclavian artery revascularization: one at the time of the endograft procedure and three others after developing arm ischemia after the initial endograft procedure. Cerebral spinal fluid was drained in two patients. The median procedure time was 91 minutes, and median hospital stay was 12 days. There was 100% successful device delivery and deployment. Four (8%) patients died within 30 days. Nonfatal adverse events within 30 days that were related to the procedure, device, or aorta were experienced by 12% (6/50) of patients. No nonfatal

  12. Endovascular repair of early rupture of Dacron aortic graft--two case reports.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2005-01-01

    Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70-100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.

  13. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Roberto Moraes Bastos

    2011-01-01

    Full Text Available OBJECTIVE: The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS: Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS: Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION: The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.

  14. Endovascular Retrieval of Entrapped Elephant Trunk Graft During Complex Hybrid Aortic Arch Repair

    Energy Technology Data Exchange (ETDEWEB)

    Damodharan, Karthikeyan, E-mail: drdkarthik@hotmail.com [Singapore General Hospital, Department of Diagnostic Radiology (Singapore); Chao, Victor T. T., E-mail: victor.chao.t.t@singhealth.com.sg [National Heart Centre, Department of Cardiothoracic Surgery (Singapore); Tay, Kiang Hiong, E-mail: tay.kiang.hiong@singhealth.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore)

    2016-12-15

    Entrapment of the elephant trunk graft within the false lumen is a rare complication of surgical repair of an aortic dissection. This is normally retrieved by emergent open surgery. We describe a technique of endovascular retrieval of the dislodged graft, during hybrid aortic arch repair. The elephant trunk was cannulated through and through from a femoral access and the free end of the wire was snared and retrieved from a brachial access. The wire was externalised from both accesses and was used to reposition the graft into the true lumen using a body flossing technique.

  15. Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis.

    Science.gov (United States)

    Teixeira, Pedro Gr; Woo, Karen; Beck, Adam W; Scali, Salvatore T; Weaver, Fred A

    2017-12-01

    Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011-July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82-2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03-5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74-3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.

  16. An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement.

    Science.gov (United States)

    Png, Chien Yi M; Tadros, Rami O; Beckerman, William E; Han, Daniel K; Tardiff, Melissa L; Torres, Marielle R; Marin, Michael L; Faries, Peter L

    2017-09-01

    Follow-up computed tomography angiography (CTA) scans add considerable postimplantation costs to endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs). By building a risk model, we hope to identify patients at low risk for aneurysm sac enlargement to minimize unnecessary CTAs. 895 consecutive patients who underwent EVAR for AAA were reviewed, of which 556 met inclusion criteria. A Probit model was created for aneurysm sac enlargement, with preoperative aneurysm morphology, patient demographics, and operative details as variables. Our final model included 287 patients and had a sensitivity of 100%, a specificity of 68.9%, and an accuracy of 70.4%. Ninety-nine (35%) of patients were assigned to the high-risk group, whereas 188 (65%) of patients were assigned to the low-risk group. Notably, regarding anatomic variables, our model reported that age, pulmonary comorbidities, aortic neck diameter, iliac artery length, and aneurysms were independent predictors of post-EVAR sac enlargement. With the exception of age, all statistically significant variables were qualitatively supported by prior literature. With regards to secondary outcomes, the high-risk group had significantly higher proportions of AAA-related deaths (5.1% versus 1.1%, P = 0.037) and Type 1 endoleaks (9.1% versus 3.2%, P = 0.033). Our model is a decent predictor of patients at low risk for post AAA EVAR aneurysm sac enlargement and associated complications. With additional validation and refinement, it could be applied to practices to cut down on the overall need for postimplantation CTA. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. A preoperative risk score for transfusion in infrarenal endovascular aneurysm repair to avoid type and cross.

    Science.gov (United States)

    O'Donnell, Thomas F X; Shean, Katie E; Deery, Sarah E; Bodewes, Thomas C F; Wyers, Mark C; O'Brien, Kerry L; Matyal, Robina; Schermerhorn, Marc L

    2018-02-01

    Preoperative type and cross are often routinely ordered before elective endovascular aneurysm repair (EVAR), but the cost of this practice is high, and transfusion is rare. We therefore aimed to stratify patients by their risk of transfusion to identify a cohort in whom a type and screen would be sufficient. We queried the targeted vascular module of the National Surgical Quality Improvement Program (NSQIP) for all elective EVARs from 2011 to 2015. We included only infrarenal aneurysms and excluded ruptured aneurysms and patients transfused within 72 hours preoperatively. Two-thirds of the cases were randomly assigned to a model derivation cohort and one third to a validation cohort. We created and subsequently validated a risk model for transfusion within the first 24 hours of surgery (including intraoperatively), using logistic regression. Between 2011 and 2015, there were 4875 patients who underwent elective infrarenal EVAR, only 221 (4.5%) of whom received a transfusion within 24 hours of surgery. The frequency of transfusion during the study period declined monotonously from 6.5% in 2011 to 3.2% in 2015. The factors independently associated with transfusion were preoperative hematocrit risk prediction model based on these criteria produced a C statistic of 0.69 in the prediction cohort and 0.76 in the validation cohort and a Hosmer-Lemeshow goodness of fit of 0.62 and 0.14, respectively. A score of cross in 86% of patients. Of the 4203 patients (86%) with a hematocrit >36%, only 6 (0.1%) had a risk score of >3. Perioperative transfusion for EVAR is becoming increasingly uncommon and is predicted well by a transfusion risk score or simply a hematocrit of risk score would avoid unnecessary type and cross in the majority of patients, leading to significant savings in both time and cost. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  18. Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection

    Energy Technology Data Exchange (ETDEWEB)

    Chen, I-Ming [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China); Chen, Po-Lin; Huang, Chun-Yang [National Yang Ming University, Department of Medicine, School of Medicine (China); Weng, Shih-Hsien; Chen, Wei-Yuan; Shih, Chun-Che, E-mail: ccshih@vghtpe.gov.tw [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China)

    2017-05-15

    PurposeThe purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection.Materials and MethodsThe patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen.ResultsA total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively.ConclusionsIncreased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection.Level of EvidenceIII.

  19. Laparotomy during endovascular repair of ruptured abdominal aortic aneurysms increases mortality.

    Science.gov (United States)

    Adkar, Shaunak S; Turley, Ryan S; Benrashid, Ehsan; Cox, Mitchell W; Mureebe, Leila; Shortell, Cynthia K

    2017-02-01

    Subset analyses from small case series suggest patients requiring laparotomy during endovascular repair of ruptured abdominal aortic aneurysms (REVAR) have worse survival than those undergoing REVAR without laparotomy. Most concomitant laparotomies are performed for abdominal compartment syndrome. This study used data from the American College of Surgeons National Surgical Quality Improvement Program to determine whether the need for laparotomy during REVAR is associated with increased mortality. Data were obtained from the 2005 to 2013 National Surgical Quality Improvement Program participant user files based on Current Procedural Terminology (American Medical Association, Chicago, Ill) and International Classification of Diseases-9 Edition coding. Patient and procedure-related characteristics and 30-day postoperative outcomes were compared using Pearson χ 2 tests for categoric variables and Wilcoxon rank sum tests for continuous variables. A backward-stepwise multivariable logistic regression model was used to identify patient- and procedure-related factors associated with increased death after REVAR. We identified 1241 patients who underwent REVAR, and 91 (7.3%) required concomitant laparotomy. The 30-day mortality was 60% in the laparotomy group and 21% in the standard REVAR group (P < .001). The major complication rate was also higher in the laparotomy group (88% vs 63%; P < .001). Multivariable analysis showed laparotomy was strongly associated with 30-day mortality (odds ratio, 5.91; 95% confidence interval, 3.62-9.62; P < .001). Laparotomy during REVAR is a commonly used technique for the management of elevated intra-abdominal pressure and abdominal compartment syndrome development. The results of this study strongly confirm findings from smaller studies that the need for laparotomy during REVAR is associated with significantly worse 30-day survival. Copyright © 2016. Published by Elsevier Inc.

  20. Endovascular aneurysm repair patients who are lost to follow-up have worse outcomes.

    Science.gov (United States)

    Hicks, Caitlin W; Zarkowsky, Devin S; Bostock, Ian C; Stone, David H; Black, James H; Eldrup-Jorgensen, Jens; Goodney, Philip P; Malas, Mahmoud B

    2017-06-01

    Society for Vascular Surgery practice guidelines recommend 1- and 12-month follow-up with computed tomography imaging for the year after endovascular aneurysm repair (EVAR). We describe the incidence, risk factors, and outcomes of EVAR patients who are lost to follow-up (LTF). All patients undergoing elective EVAR in the Vascular Quality Initiative (VQI) data set (January 2003-December 2015) were stratified according to long-term follow-up method (in-person vs phone call vs LTF). Mortality was captured for all patients by linkage with the Social Security Death Index. Univariable statistics, Kaplan-Meier estimated survival curves, and Cox proportional hazard modeling were used to compare groups. Coarsened exact matching analysis was then performed to refine the association between LTF and risk of post-EVAR death. During the study period, 11,309 patients underwent elective EVAR (78% in-person follow-up, 11% phone call follow-up, 11% LTF). On univariable analysis, LTF patients had larger baseline aneurysms, higher American Society of Anesthesiologists scores, more comorbidities, and worse baseline functional status compared to patients with in-person or phone call follow-up (P ≤ .05). Procedural factors (contrast material volume, blood transfusions, postoperative vasopressor use) were higher in the LTF group, as was the incidence of postoperative complications (P ≤ .05). Accordingly, LTF patients had longer postoperative lengths of stay and were less frequently discharged to home (P importance of office-based postoperative follow-up to all EVAR patients, particularly those with poor baseline health and functional status and more complicated perioperative courses. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  1. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial

    Science.gov (United States)

    Braithwaite, Bruce; Cheshire, Nicholas J.; Greenhalgh, Roger M.; Grieve, Richard; Hassan, Tajek B.; Hinchliffe, Robert; Howell, Simon; Moore, Fionna; Nicholson, Anthony A.; Soong, Chee V.; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Heatley, Francine; Anjum, Aisha; Kalinowska, Gosia; Sweeting, Michael J.; Thompson, Simon G.; Gomes, Manuel; Grieve, Richard; Powell, Janet T.; Ashleigh, Ray; Gomes, Manuel; Greenhalgh, Roger M.; Grieve, Richard; Hinchliffe, Robert; Sweeting, Michael; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Roberts, Ian; Bell, Peter R. F.; Cheetham, Anne; Stephany, Jenny; Warlow, Charles; Lamont, Peter; Moss, Jonathan; Tijssen, Jan; Braithwaite, Bruce; Nicholson, Anthony A.; Thompson, Matthew; Ashleigh, Ray; Thompson, Luke; Cheshire, Nicholas J.; Boyle, Jonathan R.; Serracino-Inglott, Ferdinand; Thompson, Matt M.; Hinchliffe, Robert J.; Bell, Rachel; Wilson, Noel; Bown, Matt; Dennis, Martin; Davis, Meryl; Ashleigh, Ray; Howell, Simon; Wyatt, Michael G.; Valenti, Domenico; Bachoo, Paul; Walker, Paul; MacSweeney, Shane; Davies, Jonathan N.; Rittoo, Dynesh; Parvin, Simon D.; Yusuf, Waquar; Nice, Colin; Chetter, Ian; Howard, Adam; Chong, Patrick; Bhat, Raj; McLain, David; Gordon, Andrew; Lane, Ian; Hobbs, Simon; Pillay, Woolagasen; Rowlands, Timothy; El-Tahir, Amin; Asquith, John; Cavanagh, Steve; Dubois, Luc; Forbes, Thomas L.; Ashworth, Emily; Baker, Sara; Barakat, Hashem; Brady, Claire; Brown, Joanne; Bufton, Christine; Chance, Tina; Chrisopoulou, Angela; Cockell, Marie; Croucher, Andrea; Dabee, Leela; Dewhirst, Nikki; Evans, Jo; Gibson, Andy; Gorst, Siobhan; Gough, Moira; Graves, Lynne; Griffin, Michelle; Hatfield, Josie; Hogg, Florence; Howard, Susannah; Hughes, Cían; Metcalfe, David; Lapworth, Michelle; Massey, Ian; Novick, Teresa; Owen, Gareth; Parr, Noala; Pintar, David; Spencer, Sarah; Thomson, Claire; Thunder, Orla; Wallace, Tom; Ward, Sue; Wealleans, Vera; Wilson, Lesley; Woods, Janet; Zheng, Ting

    2015-01-01

    Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI −0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). Conclusion An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. Clinical trial registration ISRCTN 48334791. PMID:25855369

  2. Endovascular repair versus open surgery in patients in the treatment of the ruptured of aneurysms abdominal.

    Science.gov (United States)

    Novo Martínez, Gloria María; Ballesteros Pomar, Marta; Menéndez Sánchez, Elena; Santos Alcántara, Eliezer; Rodríguez Fernández, Inés; Zorita Calvo, Andrés Manuel

    2017-01-01

    Rupture of abdominal aortic aneurysm is still a difficult challenge for the vascular surgeon due to the high perioperative mortality. The aim of our study is to describe the characteristics of the population as well as to compare morbidity and mortality in patients undergoing open surgery or endovascular repair in our center. Database with 82 rAAA between January 2002-December 2014, studying two cohorts, open surgery and endovascular repair. Epidemiologic, clinical, surgical techniques, perioperative mortality and complications are analyzed. 82 rAAA cases were operated (men: 80, women: 2). Mean age 72±9.6 years. 76.8% (63 cases) was performed by open surgery. smokers 59, 7%, alcoholism 19.5%, DM 10.9%, AHT: 53.6%, dyslipidemia 30.5%. The most frequent clinical presentation was abdominal pain with lumbar irradiation: 50 cases (20.7% associating syncope). Overall hospital mortality was 58.5%. Hemodynamic shock prior to intervention was associated with increased mortality (p .05). The presence of iliac aneurysms was associated with increased mortality (p .05). Hospital stay was lower in the endovascular group (p=.3859). Hemodynamic shock and the presence of concomitant iliac aneurysms have a statistically significant association with perioperative mortality in both groups. We found clinically significant differences in mortality, complications and hospital stay when comparing both groups with better results for EVAR, without statistically significant differences. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Retrograde type A dissection following hybrid supra-aortic endovascular surgery in high-risk patients unfit for conventional open repair.

    Science.gov (United States)

    Yip, Hon C; Chan, Yiu C; Qing, Kai X; Cheng, Stephen W

    2018-04-01

    Hybrid procedures with combined open extra-anatomical supra-aortic bypasses and endovascular surgery are less invasive for patients with complex aortic arch pathology. The aim of this paper is to report patients who developed retrograde type A aortic dissection following initially successful hybrid endovascular treatment. Retrospective review of prospectively collected computerized departmental database. All patients with supra-aortic hybrid endovascular surgery and post-procedure retrograde type A dissection were identified. Patient demographics, comorbid conditions, perioperative parameters, procedural details and post-operative complications were collected. From May 2005 to July 2014, 163 patients underwent thoracic aortic endovascular procedures at our institution. From the 46 patients who had supra-aortic hybrid endovascular repair, six patients (6/46, 13% of all supra-aortic hybrid cases, 3 males) developed retrograde type A aortic dissection. All were elective cases, with 3 chronic dissecting aneurysms and 3 atherosclerotic aneurysms. All had one-stage hybrid procedures: 2 patients had carotid-carotid bypass grafts, one had carotid-carotid-left subclavian bypass graft, and 3 had bypass grafts from ascending aorta to innominate artery and left carotid artery. Five patients had Cook Zenith thoracic stent-grafts (Cook Medical, Bloomington, IN, USA), and one had Medtronic Valiant stent-grafts (Medtronic Vascular Inc, Santa Rosa, CA, USA). The retrograde type A dissection occurred with sudden symptoms at day 5, 6, 10, 20, 105 and 128, respectively. There were 3 immediate fatalities and 2 patients treated conservatively deemed unfit for reintervention (one died of pneumonia at 9 months, and one remained alive at 7 months post-complication). One patient underwent successful emergency open surgery and survived. Supra-aortic hybrid procedures in treating aortic arch pathology may be at risk of developing retrograde type A dissection. This post-operative complication

  4. Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms.

    Science.gov (United States)

    Mayer, Dieter; Rancic, Zoran; Pfammatter, Thomas; Hechelhammer, Lukas; Veith, Frank J; Donas, Konstantin; Lachat, Mario

    2010-01-01

    The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.

  5. Outcomes of thoracic endovascular repair for type B aortic dissection with multichanneled morphology.

    Science.gov (United States)

    Guo, Baolei; Hou, Kai; Guo, Daqiao; Xu, Xin; Shi, Zhenyu; Shan, Yan; Lv, Peng; Fu, Weiguo

    2017-10-01

    Clinical outcomes after thoracic endovascular aortic repair (TEVAR) for patients with multichanneled aortic dissection (MCAD) are poorly understood but seem substantially different from those for patients with double-channeled aortic dissection (AD). This study compared the anatomic and clinical factors for patients with MCAD who underwent TEVAR with or without full true lumen (TL) collapse. From January 2012 to March 2016, 54 of 644 consecutive type B AD patients (8.4%) who presented with MCAD were reviewed. Patients were classified as MCAD with full TL collapse and without full TL collapse according to computed tomography angiography findings. We analyzed potential variables including clinical characteristics, anatomic morphologic features, and procedural details. Multivariable analysis was performed to determine independent predictors of AD-related deaths. A total of four patients (7.4%) died preoperatively of aortic rupture, all of whom experienced full TL collapse. MCAD patients with full TL collapse showed significantly higher 30-day major adverse events than those without full TL collapse (36.8% vs 9.7%; P = .030). The mean follow-up duration was 25.6 ± 13.2 months (range, 3-53 months). The overall mortality for all MCAD patients was 16.7%, whereas the follow-up major adverse events rate was 40.0% after TEVAR. Significant differences were present between patients with full TL collapse and patients without full TL collapse in survival at 3 years (55.4% vs 94.7%; P = .002). Maximum diameter of affected aorta (hazard ratio, 1.176; 95% confidence interval, 1.015-1.362; P = .031) was identified as the only predictor of AD-related deaths. MCAD was identified in a small but not insignificant number of our patients presenting with type B AD. Urgent or elective TEVAR was indicated in all our patients with MCAD. In patients with MCAD, full TL collapse was associated with worse outcomes, and this finding may indicate the need for more urgent or emergent repair

  6. Thoracic Endovascular Repair of Complicated Penetrating Aortic Ulcer: An 11-Year Single-Center Experience.

    Science.gov (United States)

    Jánosi, Rolf Alexander; Gorla, Riccardo; Tsagakis, Konstantinos; Kahlert, Philipp; Horacek, Michael; Bruckschen, Florian; Dohle, Daniel-Sebastian; Jakob, Heinz; Schlosser, Thomas; Eggebrecht, Holger; Bossone, Eduardo; Erbel, Raimund

    2016-02-01

    To analyze an 11-year single-center experience of treating complicated penetrating aortic ulcer (PAU) using thoracic endovascular aortic repair (TEVAR). This study included 63 consecutive patients (mean age 69.1±11.5 years; 40 men) with complicated PAU (42 symptomatic, 22 with rupture) who underwent TEVAR between 2002 and 2013. The PAUs were located in the aortic arch (n=11), the descending thoracic aorta (n=43), and the thoracoabdominal aorta (n=9). TEVAR was performed within 14 days of diagnosis in 33 (52.3%) cases (19 ruptures treated immediately); the other 30 (47.6%) patients had an average interval between diagnosis and intervention of 40±39 days. Technical success was 98.4% (62/63). One patient had a type I endoleak after stent-graft repair of a PAU in the aortic arch without great vessel transposition; another procedure was required for carotid-subclavian bypass and proximal stent-graft extension. No patient experienced spinal cord ischemia after TEVAR. Five (7.9%) patients died in-hospital; 3 had severe cardiac complications, 1 died from complications of aortic rupture, and the other succumbed to septic shock. Mean follow-up was 45.6±47.2 months, during which 12 (19.0%) patients needed a secondary intervention because of late endoleaks (n=4, 6.3%) or new complications due to disease progression. Multivariate analysis indicated that a PAU depth >15 mm was an independent predictor of mortality (hazard ratio 6.92, p=0.03). In the biomarker analysis, symptomatic patients had significantly higher D-dimer and troponin levels compared to asymptomatic patients [559.5±460.7 vs 283.2±85.2 µg/L (p=0.016) and 0.22±0.61 vs 0.02±0.03 ng/mL (p=0.04), respectively]. Patients with PAU suffer from underlying severe atherosclerotic disease and have a significant number of cardiovascular comorbidities that lead to relevant mortality and morbidity after TEVAR. As a PAU diameter >15 mm represented high risk for disease progression, these patients may be candidates for

  7. Influence of distal entry tears in acute type B aortic dissection after thoracic endovascular aortic repair.

    Science.gov (United States)

    Zhu, Chenmou; Huang, Bin; Zhao, Jichun; Ma, Yukui; Yuan, Ding; Yang, Yi; Xiong, Fei; Wang, Tiehao

    2017-08-01

    This study evaluated the clinical influence of distal entry tears in acute type B aortic dissection (ATBAD) after thoracic endovascular aortic repair (TEVAR). From August 2009 to December 2014, the clinical outcomes of 130 patients who underwent TEVAR for ATBAD were retrospectively analyzed. According to whether distal entry tears existed after TEVAR, patients were divided into group A (n = 25, absence of distal entry tears) and group B (n = 105, presence of distal entry tears). We evaluated clinical outcomes, including mortality and morbidity in early and late follow-up, as well as aortic remolding. Late aortic events were defined as aortic dissection-related events occurring >30 days from the initial TEVAR procedures, which consisted of endoleak, retrograde type A aortic dissection, aortic enlargement, late rupture, repeat dissection, and stent-induced new entry tear. The study comprised 130 patients (114 men [87.7%] and 16 women [12.3%)] with a mean age of 53.71 years. The 30-day mortality was 3.1%, and early morbidity included type I endoleak, 3.1%, organ failure, 3.8%; stroke, 3.1%; spinal cord ischemia, 0%; and early rupture 1.5%. The overall survival rate by Kaplan-Meier analysis at 1, 3, and 5 years was 93.8%, 89.5%, and 79.2%, respectively. There were no significant differences in early morbidity and 30-day mortality and late survival between group A and group B. However, group A had a significantly lower rate of late aortic events than group B (P = .028 by log-rank test). Meanwhile, group A had better aortic remolding than group B in complete thrombosis of the thoracic aorta at 12 months postoperatively (100% vs 83.5%; P = .029). This study demonstrated that TEVAR for ATBAD had low perioperative morbidity and mortality and satisfactory midterm outcome. Distal entry tears increase the occurrence of late aortic events and inhibit aortic remolding but do not have a significantly negative effect on late survival. Repairing all entry tears to restore

  8. Anastomotic pseudoaneurysms after surgical reconstruction: Outcomes after endovascular repair of symptomatic versus asymptomatic patients

    International Nuclear Information System (INIS)

    Nolz, Richard; Gschwendtner, Manfred; Jülg, Gregor; Plank, Christina; Beitzke, Dietrich; Teufelsbauer, Harald; Wibmer, Andreas; Kretschmer, Georg; Lammer, Johannes

    2012-01-01

    Purpose: To compare perioperative and follow-up outcomes of symptomatic versus asymptomatic patients following endovascular repair of anastomotic pseudoaneurysms (APAs) of the abdominal aorta and iliac arteries. Methods: We retrospectively evaluated 17 patients (two women), with a mean age of 66.2 years (range 30–83 years). Endovascular treatment was performed in ten symptomatic, and seven asymptomatic patients electively. Data included technical success, perioperative (within 30 days) mortality and morbidity, as well as stent graft-related complications, reinterventions, and survival in follow-up. Results: Bifurcated (n = 13), aortomonoiliac (n = 3) endoprosthesis and one aortic cuff were implanted with a primary technical success rate of 100%. The overall in-hospital mortality and morbidity rate was 11.8% and 35.3%. The mean survival was 36.5 (range 0–111) months. There was a clear trend toward a lower overall survival within hospital and at one and three years for symptomatic patients compared to asymptomatic patients. (47.7 (CI: 0–138.8) versus 52.6 (CI: 28.5–76.8) months (p = 0.274)). During follow-up, late stent graft related complications were observed in six patients (35.3%) necessitating eight endovascular reinterventions. Additional three patients with primary fistulas between the APA and the intestine were treated by late surgical revision. Conclusion: Endovascular therapy of APAs represents a considerable alternative to open surgical repair. Short proximal anchoring zones still pose a risk for endoleaks and unintentional overstenting of side branches with commercially available devices, but this might be overcome by use of fenestrated and branched stent grafts in elective cases.

  9. Dual-energy CT for detection of endoleaks after endovascular abdominal aneurysm repair: usefulness of colored iodine overlay.

    Science.gov (United States)

    Ascenti, Giorgio; Mazziotti, Silvio; Lamberto, Salvatore; Bottari, Antonio; Caloggero, Simona; Racchiusa, Sergio; Mileto, Achille; Scribano, Emanuele

    2011-06-01

    The purpose of our study was to evaluate the value of dual-source dual-energy CT with colored iodine overlay for detection of endoleaks after endovascular abdominal aortic aneurysm repair. We also calculated the potential dose reduction by using a dual-energy CT single-phase protocol. From November 2007 to November 2009, 74 patients underwent CT angiography 2-7 days after endovascular repair during single-energy unenhanced and dual-energy venous phases. By using dual-energy software, the iodine overlay was superimposed on venous phase images with different percentages ranging between 0 (virtual unenhanced images) and 50-75% to show the iodine in an orange color. Two blinded readers evaluated the data for diagnosis of endoleaks during standard unenhanced and venous phase images (session 1, standard of reference) and virtual unenhanced and venous phase images with colored iodine overlay images (session 2). We compared the effective dose radiation of a single-energy biphasic protocol with that of a single-phase dual-energy protocol. The diagnostic accuracy of session 2 was calculated. The mean dual-energy effective dose was 7.27 mSv. By using a dual-energy single-phase protocol, we obtained a mean dose reduction of 28% with respect to a single-energy biphasic protocol. The diagnostic accuracy of session 2 was: 100% sensitivity, 100% specificity, 100% negative predictive value, and 100% positive predictive value. Statistically significant differences in the level of confidence for endoleak detection between the two sessions were found by reviewers for scores 3-5. Dual-energy CT with colored iodine overlay is a useful diagnostic tool in endoleak detection. The use of a dual-energy single-phase study protocol will lower radiation exposure to patients.

  10. Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.

    LENUS (Irish Health Repository)

    Manning, Brian J

    2012-02-01

    OBJECTIVES: Cumulative radiation dose, cost, and increased demand for computed tomography aortography (CTA) suggest that duplex ultrasonography (DU) may be an alternative to CTA-based surveillance. We compared CTA with DU during endovascular aneurysm repair (EVAR) follow-up. METHODS: Patients undergoing EVAR had clinical and radiological follow-up data entered in a prospectively maintained database. For the purpose of this study, the gold standard test for endoleak detection was CTA, and an endoleak detected on DU alone was assumed to be a false positive result. DU interpretation was performed independently of CTA and vice versa. RESULTS: One hundred thirty-two patients underwent EVAR, of whom 117 attended for follow-up ranging from six months to nine years (mean, 32 months). Adequate aneurysm sac visualisation on DU was not possible in 1.7% of patients, predominantly due to obesity. Twenty-eight endoleaks were detected in 28 patients during follow-up. Of these, 24 were initially identified on DU (four false negative DU examinations), and eight had at least one negative CTA with a positive DU prior to diagnosis. Twenty-three endoleaks were type II in nature and three of these patients had increased sac size. There was one type I and four type III endoleaks. Two of these (both type III) had an increased sac size. Of 12 patients with increased aneurysm size of 5 mm or more at follow-up, five had an endoleak visible on DU, yet negative CTA and a further five had endoleak visualisation on both DU and CTA. Of six endoleaks which underwent re-intervention, all were initially picked up on DU. One of these endoleaks was never demonstrated on CTA and a further two had at least one negative CTA prior to endoleak confirmation. Positive predictive value for DU was 45% and negative predictive value 94%. Specificity of DU for endoleak detection was 67% when compared with CTA, because of the large number of false positive DU results. Sensitivity for DU was 86%, with all

  11. Aortoenteric Fistula as a Complication of Open Reconstruction and Endovascular Repair of Abdominal Aorta

    Directory of Open Access Journals (Sweden)

    Marek Tagowski

    2014-01-01

    Full Text Available The paper intends to present a review of imaging characteristics of secondary aortoenteric fistula (AEF. Mechanical injury, infection, and adherence of a bowel segment to the aorta or aortic graft are major etiologic factors of AEF after open aortic repair. The pathogenesis of AEF formation after endovascular abdominal aortic repair is related to mechanical failure of the stent-graft, to stent graft infection, and to persistent pressurization of the aneurysmal sac. The major clinical manifestations of AEF comprise haematemesis, melaena, abdominal pain, sepsis, and fever. CT is the initial diagnostic modality of choice in a stable patient. However, the majority of reported CT appearances are not specific. In case of equivocal CT scans and clinical suspicion of AEF, scintigraphy, 67Ga citrate scans or 18F-FDG PET/CT is useful. Diagnostic accuracy of endoscopy in evaluation of AEF is low; nevertheless it allows to evaluate other than AEF etiologies of gastrointestinal bleeding. Without adequate therapy, AEF is lethal. Conventional surgical treatment is associated with high morbidity and mortality. The endovascular repair may be an option in hemodynamically unstable and high-risk surgical patients. We also illustrate an example of a secondary AEF with highly specific albeit rare radiologic picture from our institution.

  12. Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nathan Finnerty

    2014-01-01

    Full Text Available Endovascular aneurysm repair (EVAR is perhaps the most widely utilized surgical procedure for patients with large abdominal aortic aneurysms. This procedure is minimally invasive and reduces inpatient hospitalization requirements. The case involves a 72-year-old male who presented to the emergency department with right testicular ischemia two days following EVAR. Given the minimal inpatient hospitalization associated with this procedure, emergency physicians are likely to encounter associated complications. Ischemic and thromboembolic events following EVAR are extremely rare but require prompt vascular surgery intervention to minimize morbidity and mortality.

  13. JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

    International Nuclear Information System (INIS)

    Ricci, Carmelo; Ceccherini, Claudio; Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-01-01

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  14. Applicability and midterm results of branch cuff closure with vascular plug in branched endovascular repair for thoracoabdominal aortic aneurysms.

    Science.gov (United States)

    Hongku, Kiattisak; Resch, Timothy; Sonesson, Björn; Kristmundsson, Thorarinn; Dias, Nuno V

    2017-08-01

    This study assessed the applicability and outcomes of the closure of unused cuffs in branched endovascular aneurysm repair (b-EVAR) of thoracoabdominal aortic aneurysm. We reviewed b-EVAR procedures at a tertiary referral center to identify patients who underwent incomplete branching and needed closure of the unused branch cuffs. An electronic database and intraoperative and follow-up imaging studies were reviewed to assess technical applicability and outcomes. Between January 2007 and December 2015, 17 patients underwent incomplete branching during b-EVAR. The unused branch cuff in one patient occluded spontaneously after b-EVAR and was excluded from this analysis. The remaining 16 patients underwent 11 elective and five emergency repairs. Amplatzer Vascular Plugs (St. Jude Medical, Plymouth, Minn) were used to successfully close 17 branches: 8 targeting preoperatively occluded target vessels, 3 optional branches where fenestrations were used instead, 5 after failures of catheterization or stent bridging to target vessels, and 1 renal branch of an atrophic kidney. Four branch cuffs were extended with a peripheral covered stent before plug deployment. Sixteen branch cuffs were closed intraoperatively, and the remaining cuff was closed percutaneously at a later occasion. Perioperative death occurred in two patients. Median follow-up duration was 19 months (interquartile range, 11-30 months). There was no endoleak or reintervention related to the plugged cuffs. Two late deaths occurred not related to the aneurysm. Two patients required reinterventions for type III endoleaks with interval sac expansions caused by aortic stent graft component separation in tortuous thoracic segments not related to the occluded cuffs. Closure of the branch cuff of multibranched stent graft with Amplatzer Vascular Plug is feasible and effective. It was not associated with adverse aneurysm outcomes, and it is very useful especially when using an off-the-shelf device in the acute setting

  15. Flow and wall shear stress characterization after endovascular aneurysm repair and endovascular aneurysm sealing in an infrarenal aneurysm model.

    Science.gov (United States)

    Boersen, Johannes T; Groot Jebbink, Erik; Versluis, Michel; Slump, Cornelis H; Ku, David N; de Vries, Jean-Paul P M; Reijnen, Michel M P J

    2017-12-01

    Endovascular aneurysm repair (EVAR) with a modular endograft has become the preferred treatment for abdominal aortic aneurysms. A novel concept is endovascular aneurysm sealing (EVAS), consisting of dual endoframes surrounded by polymer-filled endobags. This dual-lumen configuration is different from a bifurcation with a tapered trajectory of the flow lumen into the two limbs and may induce unfavorable flow conditions. These include low and oscillatory wall shear stress (WSS), linked to atherosclerosis, and high shear rates that may result in thrombosis. An in vitro study was performed to assess the impact of EVAR and EVAS on flow patterns and WSS. Four abdominal aortic aneurysm phantoms were constructed, including three stented models, to study the influence of the flow divider on flow (Endurant [Medtronic, Minneapolis, Minn], AFX [Endologix, Irvine, Calif], and Nellix [Endologix]). Experimental models were tested under physiologic resting conditions, and flow was visualized with laser particle imaging velocimetry, quantified by shear rate, WSS, and oscillatory shear index (OSI) in the suprarenal aorta, renal artery (RA), and common iliac artery. WSS and OSI were comparable for all models in the suprarenal aorta. The RA flow profile in the EVAR models was comparable to the control, but a region of lower WSS was observed on the caudal wall compared with the control. The EVAS model showed a stronger jet flow with a higher shear rate in some regions compared with the other models. Small regions of low WSS and high OSI were found near the distal end of all stents in the common iliac artery compared with the control. Maximum shear rates in each region of interest were well below the pathologic threshold for acute thrombosis. The different stent designs do not influence suprarenal flow. Lower WSS is observed in the caudal wall of the RA after EVAR and a higher shear rate after EVAS. All stented models have a small region of low WSS and high OSI near the distal outflow

  16. Endovascular Aneurysm Repair: Is Imaging Surveillance Robust, and Does It Influence Long-term Mortality?

    Energy Technology Data Exchange (ETDEWEB)

    Waduud, Mohammed Abdul, E-mail: m.a.waduud@doctors.org.uk [Glasgow Royal Infirmary, Department of Surgery (United Kingdom); Choong, Wen Ling, E-mail: wenlingchoong@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Surgery (United Kingdom); Ritchie, Moira, E-mail: moirasim9@gmail.com; Williams, Claire, E-mail: c.williams.3@research.gla.ac.uk [University of Glasgow, Institute of Health and Wellbeing Glasgow (United Kingdom); Yadavali, Reddi, E-mail: reddi.yadavali@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Radiology (United Kingdom); Lim, Shueh, E-mail: s.lim.06@aberdeen.ac.uk [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Buchanan, Fraser, E-mail: f.buchanan.11@aberdeen.ac.uk [University of Aberdeen, The School of Medicine and Dentistry (United Kingdom); Bhat, Raj, E-mail: raj.bhat@nhs.net [Ninewells Hospital, NHS Tayside, Department of Radiology (United Kingdom); Ramanathan, Krishnappan, E-mail: k.ramanathan@dundee.ac.uk [University of Dundee, School of Medicine (United Kingdom); Ingram, Susan, E-mail: susan.ingram@luht.scot.nhs.uk; Cormack, Laura, E-mail: lgcormack@googlemail.com [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Moss, Jonathan G., E-mail: jon.moss@ggc.scot.nhs.uk [Gartnavel General Hospital, Department of Radiology (United Kingdom)

    2015-02-15

    PurposeEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.MethodsA retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.ResultsData were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).ConclusionOnly half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.

  17. Endovascular Aneurysm Repair: Is Imaging Surveillance Robust, and Does It Influence Long-term Mortality?

    International Nuclear Information System (INIS)

    Waduud, Mohammed Abdul; Choong, Wen Ling; Ritchie, Moira; Williams, Claire; Yadavali, Reddi; Lim, Shueh; Buchanan, Fraser; Bhat, Raj; Ramanathan, Krishnappan; Ingram, Susan; Cormack, Laura; Moss, Jonathan G.

    2015-01-01

    PurposeEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.MethodsA retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.ResultsData were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).ConclusionOnly half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance

  18. The impact of stent graft evolution on the results of endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Tadros, Rami O; Faries, Peter L; Ellozy, Sharif H; Lookstein, Robert A; Vouyouka, Ageliki G; Schrier, Rachel; Kim, Jamie; Marin, Michael L

    2014-06-01

    There have been four eras in the development of endovascular aneurysm repair (EVAR): physician-made grafts, early industry devices, intermediary commercial endografts, and modern stent grafts. This study analyzes differences in outcomes between these four groups and the impact of device evolution and increased physician experience. From 1992 to 2012, 1380 patients underwent elective EVAR. Fourteen different devices were used during this time. The four generations were defined as follows: era 1, all physician-made devices; era 2, June 1994 to June 2003; era 3, June 2003 to January 2008; and era 4, January 2008 to July 2012. Grafts used in each era were the following: era 1, physician made; era 2, early industry, such as EVT, Talent, AneuRx, Excluder, Quantum LP, Vanguard, Ancure, and Teramed; era 3, Talent, Endologix, Excluder, AAAdvantage, Zenith, and Aptus; and era 4, Zenith, Endurant, and Excluder. Mean age was 75.2 years, and 84.5% were men. Adjunctive procedures decreased from era 1 to era 2 (P < .001) but rose again in eras 3 and 4 (P < .001). Procedure times (P < .001), blood loss (P < .001), and length of stay (P < .001) have decreased in eras 2, 3, and 4 compared with era 1. Major perioperative complications (era 1, 23%; era 2, 5.9%; era 3, 4.9%; and era 4, 4.7%; P < .001), abdominal aortic aneurysm-related perioperative mortality (era 1, 4.3%; era 2, 0.2%; era 3, 0.06%; and era 4, 0.5%; P < .001), and all-cause perioperative mortality (era 1, 7.7%; era 2, 1.9%; era 3, 1.5%; and era 4, 0.47%; P < .001) have also decreased in eras 2, 3, and 4 compared with era 1. Type I and type III endoleaks (P < .001) and the need for reintervention (P < .001) have decreased. Freedom from aneurysm-related mortality has significantly improved. EVAR has evolved during the last 20 years, resulting in an improvement in efficiency, outcomes, and procedural success. The most significant advance is seen in the transition from era 1 to the later eras. Copyright © 2014 Society for

  19. Impact of iliac artery anatomy on the outcome of fenestrated and branched endovascular aortic repair.

    Science.gov (United States)

    Gallitto, Enrico; Gargiulo, Mauro; Faggioli, Gianluca; Pini, Rodolfo; Mascoli, Chiara; Freyrie, Antonio; Ancetti, Stefano; Stella, Andrea

    2017-12-01

    Fenestrated and branched endovascular aneurysm repair (FB-EVAR) is a valid option to treat juxtarenal and pararenal abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. Because successful deployment depends on complex maneuvers, hostile iliac artery anatomy (HIA) can prejudice the FB-EVAR outcome. The aim of the study was to evaluate the impact of HIA on FB-EVAR outcome. Between 2010 and 2015, all patients undergoing FB-EVAR were prospectively categorized according to iliac anatomy (friendly iliac artery anatomy [FIA] or HIA). HIA was defined as the presence of one of the following: severe (>90-degree) iliac angle, extensive (>50%) iliac circumferential calcification, hemodynamic iliac stenosis or obstruction, external iliac artery diameter <7 mm, or previous aortoiliac/femoral graft. Early end points were technical success (absence of type I or type III endoleak, target visceral vessel [TVV] loss, conversion to open repair), intraoperative adjunctive maneuvers (IAMs; iliac percutaneous transluminal angioplasty/stenting, surgical iliac conduit, intra-aortic graft rotations, several attempts of TVV cannulation), intraoperative technical problems (iliac rupture, significant endograft twisting, difficult TVV cannulations, TVV injuries, TVV loss), and 30-day mortality. Follow-up end points were survival, TVV patency, and freedom from reintervention. Ninety-four patients (male, 87%; age, 73 ± 6 years) with 59 (63%) juxtarenal and pararenal abdominal aortic aneurysms and 35 (37%) thoracoabdominal aortic aneurysms underwent FB-EVAR, for a total of 324 TVVs; 60 (64%) patients had HIA and 34 (36%) had FIA. Patients with HIA and FIA had similar preoperative clinical characteristics, except for coronary artery disease, peripheral artery occlusive disease, and American Society of Anesthesiologists class 4 (47% vs 24% [P = .03], 12% vs 0% [P = .04], and 28% vs 9% [P = .03], respectively). Technical success was 96% (HIA, 97%; FIA, 95%; P = .6). In HIA

  20. Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance

    DEFF Research Database (Denmark)

    Truijers, M; Resch, T; Van Den Berg, J C

    2009-01-01

    Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal...... echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance. Today most interventionists and surgeons will rely on CT or MR to assess aortic morphology, evaluate access artery...... and dual-source CT could reduce radiation dose and obviate the need for nephrotoxic contrast. Up-to-date knowledge of non-invasive vascular imaging and image processing is crucial for EVAR planning and is essential for the development of follow-up programs involving reduced risk of harmful side effects....

  1. A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2007-12-01

    To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.

  2. Select early type IA endoleaks after endovascular aneurysm repair will resolve without secondary intervention.

    Science.gov (United States)

    O'Donnell, Thomas F X; Corey, Michael R; Deery, Sarah E; Tsougranis, Gregory; Maruthi, Rohit; Clouse, W Darrin; Cambria, Richard P; Conrad, Mark F

    2018-01-01

    Although it is traditionally considered ominous, the natural history of early proximal attachment site endoleaks (IA) after endovascular aneurysm repair (EVAR) is not well known. Our aim was to identify risk factors for persistent type IA endoleaks and to determine their effect on long-term outcomes after EVAR. All patients who underwent infrarenal EVAR at a single institution between 1998 and 2015 were identified. Preoperative axial imaging and intraoperative arteriograms were reviewed, and those patients with a type IA endoleak were further studied. Aneurysm features were characterized by two reviewers and were studied for predictors of persistent endoleaks at the conclusion of the case. Patient records and the Social Security Death Index were used to record 1-year and overall survival. We identified 1484 EVARs, 122 (8%) of which were complicated by a type IA endoleak on arteriography after graft deployment, with a median follow-up of 4 years. The majority of patients underwent additional ballooning of the proximal site (52 [43%]) or placement of an aortic cuff (47 [39%]); 30 patients (25%) received a Palmaz stent, and four patients were treated with coils or anchors. At case end, only 43 (35%) of the type IA endoleaks remained; at 1 month, only 16 endoleaks persisted (13%), and only six persisted at 1 year (6%). In multivariable analysis, the only independent predictor of persistence of type IA endoleak at the conclusion of the case was the presence of extensive neck calcifications (odds ratio [OR], 9.9; 95% confidence interval [CI], 1.4-67.9; P = .02). Thirteen patients (11%) underwent reintervention for type IA endoleaks, with a time frame ranging from 3 days postoperatively to 11 years. There were three patients (2.4%) who experienced aneurysm rupture. Postoperative type IA endoleak was associated with lower survival at 1 year (79% vs 91%; relative risk, 2.5; 95% CI, 1.1-5.4; P = .02), but it did not affect long-term survival (log-rank, P = .45

  3. The imaging assessment and specific endograft design for the endovascular repair of ascending aortic dissection

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2016-07-01

    (10.4%, 22 (45.9%, 13 (27.1%, six (12.5%, and two (4.2% patients, respectively. Conclusion: In this selected number of Chinese patients, the suitability of endovascular repair has been demonstrated based on the CT imaging. Shorter, larger, and bare spring-free conical endografts were preferred in the ascending aortic pathology. Keywords: type A dissection, endovascular, endograft, design

  4. Validation of the Simbionix PROcedure Rehearsal Studio sizing module : A comparison of software for endovascular aneurysm repair sizing and planning

    NARCIS (Netherlands)

    Velu, Juliëtte F.; Groot Jebbink, Erik; de Vries, Jean-Paul P.M.; Slump, Cornelis H.; Geelkerken, Robert H.

    2017-01-01

    An important determinant of successful endovascular aortic aneurysm repair is proper sizing of the dimensions of the aortic-iliac vessels. The goal of the present study was to determine the concurrent validity, a method for comparison of test scores, for EVAR sizing and planning of the recently

  5. Partial renal coverage in endovascular aneurysm repair causes unfavorable renal flow patterns in an infrarenal aneurysm model

    NARCIS (Netherlands)

    van de Velde, Lennart; Donselaar, Esmé J.; Groot Jebbink, Erik; Boersen, Johannes T.; Lajoinie, Guillaume P.R.; de Vries, Jean-Paul P.M.; Zeebregts, Clark J.; Versluis, Michel; Reijnen, Michel M.P.J.

    2017-01-01

    Objective To achieve an optimal sealing zone during endovascular aneurysm repair, the intended positioning of the proximal end of the endograft fabric should be as close as possible to the most caudal edge of the renal arteries. Some endografts exhibit a small offset between the radiopaque markers

  6. Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms.

    Science.gov (United States)

    Al Adas, Ziad; Shepard, Alexander D; Nypaver, Timothy J; Weaver, Mitchell R; Maatman, Thomas; Yessayan, Lenar T; Balraj, Praveen; Kabbani, Loay S

    2018-03-20

    It is not clear whether endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) results in an increase in renal insufficiency during the long term compared with open repair (OR). We reviewed our experience with AAA repair to determine whether there was a significant difference in postoperative and long-term renal outcomes between OR and EVAR. A retrospective cohort study was conducted of all patients who underwent AAA repair between January 1993 and July 2013 at a tertiary referral hospital. Demographics, comorbidities, preoperative and postoperative laboratory values, morbidity, and mortality were collected. Patients with ruptured AAAs, preoperative hemodialysis, juxtarenal or suprarenal aneurysm origin, and no follow-up laboratory values were excluded. Preoperative, postoperative, 6-month, and yearly serum creatinine values were collected. Glomerular filtration rate (GFR) was calculated on the basis of the Chronic Kidney Disease Epidemiology Collaboration equation. Acute kidney injury (AKI) was classified using the Kidney Disease: Improving Global Outcomes guidelines. Change in GFR was defined as preoperative GFR minus the GFR at each follow-up interval. Comparison was made between EVAR and OR groups using multivariate logistics for categorical data and linear regression for continuous variables. During the study period, 763 infrarenal AAA repairs were performed at our institution; 675 repairs fit the inclusion criteria (317 ORs and 358 EVARs). Mean age was 73.9 years. Seventy-nine percent were male, 78% were hypertensive, 18% were diabetic, and 31% had preoperative renal dysfunction defined as GFR below 60 mL/min. Using a multivariate logistic model to control for all variables, OR was found to have a 1.6 times greater chance for development of immediate postoperative AKI compared with EVAR (P = .038). Hypertension and aneurysm size were independent risk factors for development of AKI (P = .012 and .022, respectively). Using a linear

  7. Low mortality rates after endovascular aortic repair expand use to high-risk patients.

    Science.gov (United States)

    Adkar, Shaunak S; Turner, Megan C; Leraas, Harold J; Gilmore, Brian F; Nag, Uttara; Turley, Ryan S; Shortell, Cynthia K; Mureebe, Leila

    2018-02-01

    The 2010 endovascular aneurysm repair (EVAR) trial 2 (EVAR 2) reported that patients with comorbidity profiles rendering them unfit for open aneurysm repair who underwent EVAR did not experience a survival advantage compared with those who did not undergo intervention. These patients experienced a 30-day mortality of 7.3%, whereas reports from similar cohorts reported far lower mortality rates. The primary objective of our study was to compare the incidence of 30-day mortality in low- and high-risk patients undergoing EVAR in a contemporary data set, using patient risk stratification criteria from EVAR 2. Secondarily, we sought to identify risk factors associated with a disproportionate contribution to 30-day mortality risk. Data were obtained from the 2005 to 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data Files (N = 24,813). Patients were included in the high-risk cohort with the presence of renal, respiratory, or cardiac preoperative criteria alone or in combination. Renal impairment criteria were defined as dialysis and creatinine concentration >2.26 mg/dL. Respiratory impairment criteria included history of chronic obstructive pulmonary disease and preoperative ventilator support. Cardiac impairment criteria included history of myocardial infarction, congestive heart failure, angina, and prior coronary intervention. Patient and procedural characteristics and 30-day postoperative outcomes were compared using Pearson χ 2 tests for categorical variables and Wilcoxon rank sum tests for continuous variables. Among 24,813 patients undergoing EVAR, 12,043 (48%) patients were characterized as high risk (at least one impairment criterion); 12,770 (52%) patients were stratified as low risk. The 30-day mortality rate was 1.9% in the high-risk cohort compared with the 7.3% reported by EVAR 2, and it was higher in the high-risk cohort compared with the low-risk cohort (1.9% vs 0.9%; P < .001). Whereas the

  8. Endovascular treatment of acute type B dissection complicating graft-bypass repair for aortic coarctation

    Directory of Open Access Journals (Sweden)

    Serkan Ertugay

    Full Text Available Objectives: The early dissection of the descending aorta after the repair of aortic coarctation is very rare. Herein, we present a special endovascular technique used for acute type B dissection complicating graft bypass for aortic coarctation. Methods: The 48 year-old male patient with the diagnosis of adult type aortic coarctation had bypass procedure between the aortic arch and the descending aorta. Six weeks after the first operation, the patient was readmitted with severe back pain and had the diagnosis of acute type B dissection which involved the descending aorta at the distal part of the graft anastomosis. Results: Two separate stent-grafts were deployed respectively 31 × 150 mm and 34 × 200 mm (C-TAG™ WL Gore&Asc., Flagstaff, AZ, USA. The previous Dacron bypass graft was used as a proximal landing zone for the first stent-graft. The distal landing zone for the second stent was the area between the celiac trunk and superior mesenteric artery. Therefore, the covered stent-graft was implanted to the celiac trunk (Viabahn™ 7 × 50 mm WL Gore&Asc, AZ, USA to maintain its patency before the deployment of the second graft. The segment of coarctation was closed with a vascular plug (Amplatzer™ vascular plug II to prevent persistent perfusion of aneurysmal false lumen. Conclusion: The endovascular approach offers multiple less invasive options based on a patient-specific problem. Keywords: Aortic coarctation, Bypass graft, Endovascular, Vascular plug

  9. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications

    DEFF Research Database (Denmark)

    Eggebrecht, Holger; Thompson, Matt; Rousseau, Hervé

    2009-01-01

    BACKGROUND: Single-center reports have identified retrograde ascending aortic dissection (rAAD) as a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). METHODS AND RESULTS: Between 1995 and 2008, 28 centers participating in the European Registry on Endovascular Aortic...

  10. [Outcomes of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures].

    Science.gov (United States)

    Wang, Mian; Chang, Guangqi; Yin, Henghui; Yao, Chen; Wang, Jinsong; Wang, Shenming

    2015-11-01

    To summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures. It was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching. Technical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was

  11. Suprarenal fixation resulting in intestinal malperfusion after endovascular aortic aneurysm repair.

    Science.gov (United States)

    Siani, Andrea; Accrocca, Federico; De Vivo, Gennaro; Marcucci, Giustino

    2016-05-01

    Superior mesenteric artery (SMA) and coeliac axis (CA) occlusion after endovascular abdominal aneurysm aortic repair (EVAR-AAA), using endograft with suprarenal fixation, are uncommon. However, we are reporting a case of visceral malperfusion, which occurred 7 days after successful EVAR with suprarenal fixation for symptomatic AAA. Endograft metal stent barbs caused severe stenosis of SMA and CA. A successful recovery of SMA was carried out by means of a balloon-expandable stent released through bare metal stent barbs. We believe that an unfavourable anatomy of a proximal aortic neck and visceral aorta may have caused a wrong stent strut deployment with the coverage of CA and SMA. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  12. The repair of a type Ia endoleak following thoracic endovascular aortic repair using a stented elephant trunk procedure.

    Science.gov (United States)

    Qi, Rui-Dong; Zhu, Jun-Ming; Liu, Yong-Min; Chen, Lei; Li, Cheng-Nan; Xing, Xiao-Yan; Sun, Li-Zhong

    2018-04-01

    Type Ia endoleaks are not uncommon complications that occur after thoracic endovascular aortic repair (TEVAR). Because aortic arch vessels prevent extension of the landing zone, it is very difficult to manipulate a type Ia endoleak using an extension cuff or stent-graft, especially when the aortic arch is involved. Here, we retrospectively review our experience of surgical treatment of type Ia endoleak after TEVAR using a stented elephant trunk procedure. From July 2010 to August 2016, we treated 17 patients diagnosed with a type Ia endoleak following TEVAR using stented elephant trunk procedure. The mean age of our patients was 52 ± 8 years. The mean interval between TEVAR and the open surgical repair was 38 ± 43 months. All cases of type Ia endoleak (100%) were repaired successfully. There were no in-hospital deaths. One case required reintubation and continuous renal replacement therapy due to renal failure; this patient recovered smoothly before discharge. One other patient suffered a stroke and renal failure and did not fully recover following discharge, or follow-up. During follow-up, there were 3 deaths. Acceptable results were obtained using a stented elephant trunk procedure in patients with a type Ia endoleak after TEVAR. This technique allowed us to repair the proximal aortic arch lesions, surgically correct the type Ia endoleak, and promote false lumen thrombosis in the distal aorta. Implantation of a stented elephant trunk, with or without a concomitant aortic arch procedure, is an alternative approach for this type of lesion. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  13. Computational Fluid Dynamics and Aortic Thrombus Formation Following Thoracic Endovascular Aortic Repair.

    Science.gov (United States)

    Nauta, Foeke J H; Lau, Kevin D; Arthurs, Christopher J; Eagle, Kim A; Williams, David M; Trimarchi, Santi; Patel, Himanshu J; Figueroa, Carlos A

    2017-06-01

    We present the possible utility of computational fluid dynamics in the assessment of thrombus formation and virtual surgical planning illustrated in a patient with aortic thrombus in a kinked ascending aortic graft following thoracic endovascular aortic repair. A patient-specific three-dimensional model was built from computed tomography. Additionally, we modeled 3 virtual aortic interventions to assess their effect on thrombosis potential: (1) open surgical repair, (2) conformable endografting, and (3) single-branched endografting. Flow waveforms were extracted from echocardiography and used for the simulations. We used the computational index termed platelet activation potential (PLAP) representing accumulated shear rates of fluid particles within a fluid domain to assess thrombosis potential. The baseline model revealed high PLAP in the entire arch (119.8 ± 42.5), with significantly larger PLAP at the thrombus location (125.4 ± 41.2, p fluid dynamics may assist in the prediction of aortic thrombus formation in hemodynamically complex cases and help guide repair strategies. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Impact of obesity on outcomes after open surgical and endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Johnson, Owen N; Sidawy, Anton N; Scanlon, James M; Walcott, Roger; Arora, Subodh; Macsata, Robyn A; Amdur, Richard L; Henderson, William G

    2010-02-01

    This study examined impact of obesity on outcomes after abdominal aortic aneurysm repair. Data were obtained from the Veterans Affairs National Surgical Quality Improvement Program. Body mass index (BMI) was categorized according to National Institutes of Health guidelines. Multivariate regression adjusted for 40 other risk factors to analyze trends in complications and death within 30 days. We identified 2,201 patients undergoing 1,185 open and 1,016 endovascular aneurysm repairs (EVAR) for abdominal aortic aneurysms from January 2004 through December 2005. BMI distribution was identical in both groups and reflected national population statistics: approximately 30% were normal (BMI 18.5 to 24.9), 40% were overweight (25.0 to 29.9), and 30% were obese class I (30.0 to 34.9), II (35.0 to 39.9), or III (>/=40.0). After open repair, obesity of any class was independently predictive of wound complications (adjusted odds ratio = 2.4; 95% CI, 1.5 to 5.3; p = 0.002). Class III obesity was also an independent predictor or renal complications (adjusted odds rato = 6.3; 95% CI, 2.2 to 18.0; p aggresive wound infection prevention measures.

  15. Orthotopic branched endovascular aortic arch repair in patients who cannot undergo classical surgery.

    Science.gov (United States)

    Czerny, Martin; Rylski, Bartosz; Morlock, Julia; Schröfel, Holger; Beyersdorf, Friedhelm; Saint Lebes, Bertrand; Meyrignac, Olivier; Mokrane, Fatima; Lescan, Mario; Schlensak, Christian; Hazenberg, Constatijn; Bloemert-Tuin, Trijntje; Braithwaite, Sue; van Herwaarden, Joost; Rousseau, Herve

    2018-01-16

    Our goal was to assess the results after orthotopic branched endovascular aortic arch repair using a new double-branch endoprosthesis in patients with thoracic aortic disease affecting the aortic arch who cannot undergo classical surgery. Within a 4-year period, 15 patients with thoracic aortic disease affecting the aortic arch were treated with the Bolton Relay plus double-branch endoprosthesis (Bolton Medical, Sunrise, FL, USA). We assessed clinical outcome, occurrence of endoleaks and the need for secondary interventions. The median logistic EuroSCORE I level was 13.6 (4.2; 22.8). The in-hospital mortality rate was 6.7%. A disabling stroke was observed in 1 (6.7%) patient, whereas non-disabling strokes occurred in 2 (13.3%) patients. Type I and III endoleaks occurred in 6.7%. The median follow-up period was 263 (1st quartile 84; 2nd quartile 564) days. Four patients died during the follow-up period. Aortic-related survival was 100%. Orthotopic branched endovascular aortic arch repair using the Bolton Relay Plus double-branch endoprosthesis is a safe and feasible technique enriching the armamentarium to treat patients with thoracic aortic disease who cannot undergo classical surgery. Aortic-related survival is excellent, and the occurrence of disabling stroke and endoleaks warranting treatment is low. Further studies are needed to assess the long-term durability of this new method. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm endoprosthesis.

    Science.gov (United States)

    Goodney, Philip P; Fillinger, Mark F

    2007-04-01

    Endovascular abdominal aortic aneurysm repair (EVAR) with the original-permeability Excluder (W.L. Gore & Associates, Flagstaff, Ariz) has been associated with postoperative sac expansion in the absence of endoleak. In these cases, we have performed an endovascular revision, relining the original endograft with another Excluder, in an effort to arrest sac expansion by reducing permeability. We have studied these cases to determine the effect of relining on aneurysm expansion. Patients who demonstrated sac expansion (>or=5 mm diameter, >or=5% three-dimensional volume) after EVAR with the original Excluder were evaluated. Between 1999 and 2004, the original-permeability endoprosthesis was used in 97 patients who underwent EVAR for asymptomatic abdominal aortic aneurysm (AAA). Sac expansion occurred in 24 patients, of which multiple imaging modalities showed 12 had expansion without demonstrable endoleak. Nine of the 12 have had endovascular relining, and five of these nine have >6 months follow-up to form the primary basis for this report. AAA size was stable or smaller in the first 6 months after the original EVAR for all patients. Once expansion began (typically in the time frame of 6 to 12 months), multimodality imaging showed no aneurysm spontaneously decreased in size without intervention, despite the absence of endoleak (n = 12). Expansion exceeded clinically significant thresholds at 30 months (mean) by diameter criteria and 22 months (mean) by three-dimensional volume criteria for the five patients with >6 months follow-up after relining. Endovascular relining was performed at a mean of 36 months, with a mean hospital stay of 1 day, and no morbidity or mortality. Over the entire duration of expansion (mean, 26 months), aneurysms expanded by 6.0 +/- 1 mm/year diameter and by 12% +/- 2%/year by three-dimensional volume. At a mean of 16 months follow-up after relining with another Excluder, the mean diameter decrease was 2.0 mm/year (P 6 months follow-up after

  17. Endovascular Aneurysm Repair Using a Reverse Chimney Technique in a Patient With Marfan Syndrome and Contained Ruptured Chronic Type B Dissection

    International Nuclear Information System (INIS)

    Ketelsen, Dominik; Kalender, Guenay; Heuschmid, Martin; Syha, Roland; Mangold, Stefanie; Claussen, Claus D.; Brechtel, Klaus

    2011-01-01

    We report endovascular thoracic and abdominal aneurysm repair (EVAR) with reverse chimney technique in a patient with contained ruptured type B dissection. EVAR seems feasible as a bailout option in Marfan patients with acute life-threatening disease.

  18. Endovascular treatment of type II endoleak following thoracic endovascular aortic repair for thoracic aortic aneurysm: Case report of squeeze technique to reach the aneurysmal sac

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hyun Jung; Kim, Chang Won; Lee, Tae Hong; Song, Seung Hwan; Lee, Chung Won; Chung, Sung Woon [Pusan National University Hospital, School of Medicine, Pusan National University, Busan (Korea, Republic of)

    2014-12-15

    Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

  19. Percutaneous endovascular abdominal aortic aneurysm repair within the infrarenal region. Preliminary report.

    Science.gov (United States)

    Iłżecki, Marek; Zubilewicz, Tomasz; Terlecki, Piotr; Przywara, Stanisław

    2013-10-01

    The aim of the study was to thoroughly evaluate the closure device ProStar XL in terms of its efficiency and safety in the percutaneous endovascular treatment of abdominal aortic aneurysms in the infrarenal section of the body. Additionally, it was crucial to assess if there were any occurrences of regional complications at any step of the procedure. It was also important to stipulate the estimated hospitalization period as well as the overall cost of the PEVAR treatment with the use of ProStar XL. The analysis included 21 cases with PEVAR performed in the infrarenal region. The final success was achieved in 98.2% of the cases. One PEVAR case (that constituted 0.2% of this group) was unsuccessful because of the bleeding while the placement of the sutures with the use of ProStar XL was being performed. This resulted in the emergency treatment of the CFA with the continuous stitch (Prolene 5-0). During the postoperative period the above described patient was given 2 units of the Packed Red Blood Cells (PRBC). However, this complication (unexpected bleeding) did not influence the length of the hospitalization period in any significant way. Percutaneous vascular closure device ProStar XL used in the treatment of the common femoral artery (CFA) constitutes a necessary and safe supplement for Endovascular Aortic Aneurysm Repair (EVAR). The implementation of ProStar XL closure device proves to significantly shorten the hospitalization period after the EVAR treatment. Additionally, the safety of the entire procedure is exponentially linked to the experience of the operating surgeon.

  20. Surgeon Modified Fenestrated Endovascular Abdominal Aortic Repair (F-EVAR for Subacute Multifocal Mycotic Abdominal and Iliac Artery Saccular Aneurysms

    Directory of Open Access Journals (Sweden)

    J.A. Sule

    Full Text Available Introduction: Endovascular repair of suprarenal abdominal aortic aneurysms (AAAs requires customized fenestrated stent grafts when they involve visceral vessels such as the renal (clinically ignored here in this specific scenario, celiac, and superior mesenteric arteries. Report: On table fenestrated endovascular abdominal aortic aneurysm repair (F-EVAR, using a parallel endograft approach, was performed for enlarging saccular subacute mycotic suprarenal and left common iliac artery aneurysms in a 58 year old man with recent methicillin sensitive Staphylococcus aureus (MSSA bacteremia, who was high risk for open surgical repair. Fenestrations were performed for the coeliac artery (CA and superior mesenteric artery (SMA using a Bovie® (Clearwater, FL, USA cautery device. The initial procedure was complicated by a type II endoleak that resolved spontaneously within 6 months of surgery. The patient remained well on follow up a year post surgery. Conclusion: On table surgeon modified F-EVAR is a safe and viable option for patients with subacute suprarenal mycotic abdominal aneurysms. Keywords: Aneurysm, Endovascular, Aortic, Mycotic, Surgeon modified, Fenestrated

  1. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Cantador, Alex Aparecido; Siqueira, Daniel Emilio Dalledone; Jacobsen, Octavio Barcellos; Baracat, Jamal; Pereira, Ines Minniti Rodrigues; Menezes, Fabio Hüsemann; Guillaumon, Ana Terezinha, E-mail: alex_cantador@yahoo.com.br [Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP (Brazil). Faculdade de Ciencias Medicas

    2016-07-15

    Objective: To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. (author)

  2. Neutrophil gelatinase-associated lipocalin and acute kidney injury in endovascular aneurysm repair or open aortic repair: a pilot study.

    Science.gov (United States)

    Rampoldi, Benedetta; Tessarolo, Serena; Giubbilini, Paola; Gaia, Paola; Corino, Samantha D; Mazza, Sarah; Rigolini, Roberta; Poli, Marco Dei; Vianello, Elena; Romanelli, Massimiliano M Corsi; Costa, Elena

    2018-02-15

    Acute kidney injury (AKI) occurs frequently after abdominal aortic surgery and there is currently no effective marker able to detect early onset. The aim of this study is to evaluate the ability of neutrophil gelatinase-associated lipocalin (NGAL) to early identify the development of acute renal damage in patients undergoing endovascular aneurysm repair (EVAR) or open aortic repair (OAR). Serial samples of blood and urine were obtained from 25 patients undergoing both EVAR and OAR. Seven male subjects with AKI and 18 subjects with no-AKI (17 males, 1 female) were included in the study. We determined concentrations of serum creatinine (sCr) and urinary, serum and whole blood NGAL (uNGAL, sNGAL, bNGAL) collected at baseline, and after 4 and 18 hours. AKI was defined according to the RIFLE criteria (risk, injury, failure, loss of kidney function, and end-stage kidney disease): increase by 50% in sCr or reduction of at least 25% of estimated glomerular filtration rate (eGFR) from baseline. Seven patients developed AKI in the stage Risk. There was no significant difference in sNGAL concentrations in the AKI group as compared to no-AKI group. However, the uNGAL/uCreatinine ratio and bNGAL concentrations were significantly higher after 18 hours in the AKI group (no-AKI 1.69 (0.91 - 2.47) vs AKI 3.2 (2.08 - 5.92) ng/mg for uNGAL/uCreatinine ratio, P = 0.036; and no-AKI 83 (59 - 131) vs AKI 164 (126 - 263) ng/mL for bNGAL, P = 0.029). Our results suggest that uNGAL, sNGAL and bNGAL, after abdominal aortic surgery, are not suitable as early biomarkers of AKI.

  3. Endovascular stent graft repair for thoracic aortic aneurysms: the history and the present in Japan.

    Science.gov (United States)

    Kawaguchi, Satoshi; Shimizu, Hideyuki; Yoshitake, Akihiro; Shimazaki, Taro; Iwahashi, Toru; Ogino, Hitoshi; Ishimaru, Shin; Shigematsu, Hiroshi; Yozu, Ryohei

    2013-01-01

    Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a stent-graft manufacturer, focusing primarily on fenestrated stent-grafts used in repairs at the distal arch, a site especially prone to aneurysm. In March 2008, TAG (W.L. Gore & Associates, Inc., Flagstaff, Arizona, USA) was approved as a stent graft for the thoracic area first in Japan, which was major turning point in treatment for thoracic aortic aneurysms. Subsequently, TALENT (Medtronic, Inc., Minneapolis, Minnesota, USA) was approved in May 2009, and TX2 (COOK MEDICAL Inc., Bloomington, Indiana, USA) in March 2011. Valiant as an improved version of TALENT was approved in November 2011, and TX2 Proform as an improved version of TX2 began to be supplied in October 2012. These stent grafts are excellent devices that showed good results in Western countries, and marked effectiveness can be expected by making the most of the characteristics of each device. A clinical trial in Japan on Najuta (tentative name) (Kawasumi Labo., Inc., Tokyo, Japan) as a line-up of fenestrated stent grafts that can be applied to distal arch aneurysms showing a high incidence, and allow maintenance of blood flow to the arch vessel was initiated. This trial was completed, and Najuta has just been approved in January of 2013 in Japan, and further development is expected. In the U.S., great efforts have recently been made to develop and manufacture excellent stent grafts for thoracic aneurysms, and rapid progress has been achieved. In particular, in the area of the aortic arch, in which we

  4. Spinal ischaemia after thoracic endovascular aortic repair with left subclavian artery sacrifice: is there a critical stent graft length?

    Science.gov (United States)

    Kari, Fabian A; Saravi, Babak; Krause, Sonja; Puttfarcken, Luisa; Wittmann, Karin; Förster, Katharina; Rylski, Bartosz; Maier, Sven; Göbel, Ulrich; Siepe, Matthias; Czerny, Martin; Beyersdorf, Friedhelm

    2017-08-24

    Thoracic endovascular aortic repair (TEVAR) is used for treatment of thoracic aortic pathologies, but the covered stent graft can induce spinal ischaemia depending on the length used. The left subclavian artery contributes to spinal cord collateralization and is frequently occluded by the stent graft. Our objective was to investigate the impact of covered stent graft length on the risk of spinal ischaemia in the setting of left subclavian artery sacrifice. Twenty-six pigs (German country race, mean body weight 36 ± 4 kg) underwent simulated descending aortic TEVAR via left lateral thoracotomy, with left subclavian artery and thoracic segmental artery occlusion in normothermia. Animals were assigned to treatment groups according to simulated stent graft length: TEVAR to T8 ( n  = 4), TEVAR to T9 ( n  = 4), TEVAR to T10 ( n  = 4), TEVAR to T11 ( n  = 7) and TEVAR to T12 ( n  = 1) and a sham group ( n  = 6). End points included spinal cord perfusion pressure, cerebrospinal fluid pressure and spinal cord blood flow using fluorescent microspheres. There were no group differences in spinal cord perfusion pressure drop or in spinal cord perfusion pressure regeneration potential at 3 h after the procedure: from a baseline average of 75 mmHg (95% confidence interval 71-83 mmHg) to 73 mmHg (67-75 mmHg) at 3 h in Group T10 versus from a baseline average of 67 mmHg (95% CI 50-81 mmHg) to 65 mmHg (95% confidence interval 48-81 mmHg) in Group T8. There were no differences in the spinal cord blood flow courses over time in the different groups nor was there any difference in cerebrospinal fluid pressure levels and cerebrospinal fluid pressure dynamics between groups. However, we did observe local blood flow distribution to the spinal cord that was inhomogeneous depending on the distance between the simulated stent graft end and the first thoracic anterior radiculomedullary artery. The risk of spinal ischaemia after serial

  5. Maximum Diameter Measurements of Aortic Aneurysms on Axial CT Images After Endovascular Aneurysm Repair: Sufficient for Follow-up?

    International Nuclear Information System (INIS)

    Baumueller, Stephan; Nguyen, Thi Dan Linh; Goetti, Robert Paul; Lachat, Mario; Seifert, Burkhardt; Pfammatter, Thomas; Frauenfelder, Thomas

    2011-01-01

    Purpose: To assess the accuracy of maximum diameter measurements of aortic aneurysms after endovascular aneurysm repair (EVAR) on axial computed tomographic (CT) images in comparison to maximum diameter measurements perpendicular to the intravascular centerline for follow-up by using three-dimensional (3D) volume measurements as the reference standard. Materials and Methods: Forty-nine consecutive patients (73 ± 7.5 years, range 51–88 years), who underwent EVAR of an infrarenal aortic aneurysm were retrospectively included. Two blinded readers twice independently measured the maximum aneurysm diameter on axial CT images performed at discharge, and at 1 and 2 years after intervention. The maximum diameter perpendicular to the centerline was automatically measured. Volumes of the aortic aneurysms were calculated by dedicated semiautomated 3D segmentation software (3surgery, 3mensio, the Netherlands). Changes in diameter of 0.5 cm and in volume of 10% were considered clinically significant. Intra- and interobserver agreements were calculated by intraclass correlations (ICC) in a random effects analysis of variance. The two unidimensional measurement methods were correlated to the reference standard. Results: Intra- and interobserver agreements for maximum aneurysm diameter measurements were excellent (ICC = 0.98 and ICC = 0.96, respectively). There was an excellent correlation between maximum aneurysm diameters measured on axial CT images and 3D volume measurements (r = 0.93, P < 0.001) as well as between maximum diameter measurements perpendicular to the centerline and 3D volume measurements (r = 0.93, P < 0.001). Conclusion: Measurements of maximum aneurysm diameters on axial CT images are an accurate, reliable, and robust method for follow-up after EVAR and can be used in daily routine.

  6. Survival After Endovascular Abdominal Aortic Aneurysm Repair in a Population with a Low Incidence of Coronary Artery Disease.

    Science.gov (United States)

    Sevilla, Nerea; Clara, Albert; Diaz-Duran, Carles; Ruiz-Carmona, Carlos; Ibañez, Sara

    2016-05-01

    Endovascular aortic aneurysm repair (EVAR) is a prophylactic procedure, so the decision to operate should consider, as recent guidelines suggest, the life expectancy of the patient. Several models for predicting life span have been already designed, but little is known about how intervened patients evolve in Southern European Countries, where the incidence of coronary artery disease, the main cause of death among these subjects, is low. We conducted a retrospective analysis of 176 consecutive patients who underwent elective EVAR at the Vascular Surgery Department of the Hospital del Mar (Barcelona, Spain) during 2000-2014. Cox regressions were performed to identify preoperative factors associated with long-term survival after EVAR, and a risk model was developed. Three- and five-year survival rates were 73.9 and 53.9 %, respectively. During the follow-up, 72 deaths (40.9 %) were registered, cancer being the most frequent cause (41.7 %). Preoperative variables negatively associated with long-term survival were serum creatinine ≥ 150 µmol/L (HR 2.5; 95 % CI 1.4-4.2), chronic obstructive pulmonary disease (HR 1.9; 95 % CI 1.2-3.1), atrial fibrillation (HR 2.0; 95 % CI 1.2-3.4), and prior cancer history (HR 1.9; 95 % CI 1.2-3.1). Distal pulses present in both lower limbs were marginally associated with survival (HR 0.65; 95 % CI 0.4-1.07). The survival predictive model showed a good discrimination capacity (C statistic = 0.703; 95 % CI 0.641-0.765). Long-term survival of patients submitted to EVAR in our setting was worse than expected and markedly related to cancer. Our study suggests that predictive models for long-term survival after EVAR may be influenced by regional characteristics of the intervened population. This effect should be taken in consideration in the decision-making process of these patients.

  7. An Artificial Neural Network Stratifies the Risks of Reintervention and Mortality after Endovascular Aneurysm Repair; a Retrospective Observational study.

    Directory of Open Access Journals (Sweden)

    Alan Karthikesalingam

    Full Text Available Lifelong surveillance after endovascular repair (EVAR of abdominal aortic aneurysms (AAA is considered mandatory to detect potentially life-threatening endograft complications. A minority of patients require reintervention but cannot be predictively identified by existing methods. This study aimed to improve the prediction of endograft complications and mortality, through the application of machine-learning techniques.Patients undergoing EVAR at 2 centres were studied from 2004-2010. Pre-operative aneurysm morphology was quantified and endograft complications were recorded up to 5 years following surgery. An artificial neural networks (ANN approach was used to predict whether patients would be at low- or high-risk of endograft complications (aortic/limb or mortality. Centre 1 data were used for training and centre 2 data for validation. ANN performance was assessed by Kaplan-Meier analysis to compare the incidence of aortic complications, limb complications, and mortality; in patients predicted to be low-risk, versus those predicted to be high-risk.761 patients aged 75 +/- 7 years underwent EVAR. Mean follow-up was 36+/- 20 months. An ANN was created from morphological features including angulation/length/areas/diameters/volume/tortuosity of the aneurysm neck/sac/iliac segments. ANN models predicted endograft complications and mortality with excellent discrimination between a low-risk and high-risk group. In external validation, the 5-year rates of freedom from aortic complications, limb complications and mortality were 95.9% vs 67.9%; 99.3% vs 92.0%; and 87.9% vs 79.3% respectively (p<0.001.This study presents ANN models that stratify the 5-year risk of endograft complications or mortality using routinely available pre-operative data.

  8. Pros and Cons of 3D Image Fusion in Endovascular Aortic Repair: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Goudeketting, Seline R; Heinen, Stefan G H; Ünlü, Çağdaş; van den Heuvel, Daniel A F; de Vries, Jean-Paul P M; van Strijen, Marco J; Sailer, Anna M

    2017-08-01

    To systematically review and meta-analyze the added value of 3-dimensional (3D) image fusion technology in endovascular aortic repair for its potential to reduce contrast media volume, radiation dose, procedure time, and fluoroscopy time. Electronic databases were systematically searched for studies published between January 2010 and March 2016 that included a control group describing 3D fusion imaging in endovascular aortic procedures. Two independent reviewers assessed the methodological quality of the included studies and extracted data on iodinated contrast volume, radiation dose, procedure time, and fluoroscopy time. The contrast use for standard and complex endovascular aortic repairs (fenestrated, branched, and chimney) were pooled using a random-effects model; outcomes are reported as the mean difference with 95% confidence intervals (CIs). Seven studies, 5 retrospective and 2 prospective, involving 921 patients were selected for analysis. The methodological quality of the studies was moderate (median 17, range 15-18). The use of fusion imaging led to an estimated mean reduction in iodinated contrast of 40.1 mL (95% CI 16.4 to 63.7, p=0.002) for standard procedures and a mean 70.7 mL (95% CI 44.8 to 96.6, p<0.001) for complex repairs. Secondary outcome measures were not pooled because of potential bias in nonrandomized data, but radiation doses, procedure times, and fluoroscopy times were lower, although not always significantly, in the fusion group in 6 of the 7 studies. Compared with the control group, 3D fusion imaging is associated with a significant reduction in the volume of contrast employed for standard and complex endovascular aortic procedures, which can be particularly important in patients with renal failure. Radiation doses, procedure times, and fluoroscopy times were reduced when 3D fusion was used.

  9. Remote ischemic preconditioning for renal and cardiac protection during endovascular aneurysm repair: a randomized controlled trial.

    Science.gov (United States)

    Walsh, Stewart R; Boyle, Jonathan R; Tang, Tjun Y; Sadat, Umar; Cooper, David G; Lapsley, Marta; Norden, Anthony G; Varty, Kevin; Hayes, Paul D; Gaunt, Michael E

    2009-12-01

    To report a randomized clinical trial designed to determine if remote ischemic preconditioning (IP) has the ability to reduce renal and cardiac damage following endovascular aneurysm repair (EVAR). Forty patients (all men; mean age 76+/-7 years) with abdominal aortic aneurysms averaging 6.3+/-0.8 cm in diameter were enrolled in the trial from November 2006 to January 2008. Eighteen patients (mean age 74 years, range 72-81) were randomized to preconditioning and completed the full remote IP protocol; there were no withdrawals. Twenty-two patients (mean age 76 years, range 66-80) were assigned to the control group. Remote IP was induced using sequential lower limb ischemia. Serum and urinary markers of renal and cardiac injury were compared between the groups. Urinary retinol binding protein (RBP) levels increased 10-fold from a median of 235 micromol/L to 2356 micromol/L at 24 hours (p = 0.0001). There was a lower increase in the preconditioned group, from 167 micromol/L to 413 micromol/L at 24 hours (p = 0.04). The median urinary albumin:creatinine ratio was significantly lower in the preconditioned group at 24 hours (5 versus 8.8, p = 0.06). There were no differences in the rates of renal impairment or major adverse cardiac events. Remote preconditioning reduces urinary biomarkers of renal injury in patients undergoing elective EVAR. This small pilot trial was unable to detect an effect on clinical endpoints; further trials are warranted.

  10. Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair.

    Science.gov (United States)

    Schuurmann, Richte C L; van Noort, Kim; Overeem, Simon P; Ouriel, Kenneth; Jordan, William D; Muhs, Bart E; 't Mannetje, Yannick; Reijnen, Michel; Fioole, Bram; Ünlü, Çağdaş; Brummel, Peter; de Vries, Jean-Paul P M

    2017-06-01

    To evaluate the association between aortic curvature and other preoperative anatomical characteristics and late (>1 year) type Ia endoleak and endograft migration in endovascular aneurysm repair (EVAR) patients. Eight high-volume EVAR centers contributed 116 EVAR patients (mean age 81±7 years; 103 men) to the study: 36 patients (mean age 82±7 years; 31 men) with endograft migration and/or type Ia endoleak diagnosed >1 year after the initial EVAR and 80 controls without early or late complications. Aortic curvature was calculated from the preoperative computed tomography scan as the maximum and average curvature over 5 predefined aortic segments: the entire infrarenal aortic neck, aneurysm sac, and the suprarenal, juxtarenal, and infrarenal aorta. Other morphological characteristics included neck length, neck diameter, mural neck calcification and thrombus, suprarenal and infrarenal angulation, and largest aneurysm sac diameter. Independent risk factors were identified using backward stepwise logistic regression. Relevant cutoff values for each of the variables in the final regression model were determined with the receiver operator characteristic curve. Logistic regression identified maximum curvature over the length of the aneurysm sac (>47 m -1 ; p=0.023), largest aneurysm sac diameter (>56 mm; p=0.028), and mural neck thrombus (>11° circumference; pIa endoleak. Aortic curvature is a predictor for late type Ia endoleak and endograft migration after EVAR. These findings suggest that aortic curvature is a better parameter than angulation to predict post-EVAR failure and should be included as a hostile neck parameter.

  11. The Preclose Technique in Percutaneous Endovascular Aortic Repair: A Systematic Literature Review and Meta-analysis

    International Nuclear Information System (INIS)

    Jaffan, Abdel Aziz A.; Prince, Ethan A.; Hampson, Christopher O.; Murphy, Timothy P.

    2013-01-01

    Purpose. To establish the efficacy and safety of the preclose technique in total percutaneous endovascular aortic repair (PEVAR).MethodsA systematic literature search of Medline database was conducted for series on PEVAR published between January 1999 and January 2012.ResultsThirty-six articles comprising 2,257 patients and 3,606 arterial accesses were included. Anatomical criteria used to exclude patients from undergoing PEVAR were not uniform across all series. The technical success rate was 94 % per arterial access. Failure was unilateral in the majority (93 %) of the 133 failed PEVAR cases. The groin complication rate in PEVAR was 3.6 %; a minority (1.6 %) of these groin complications required open surgery. The groin complication rate in failed PEVAR cases converted to groin cutdown was 6.1 %. A significantly higher technical success rate was achieved when arterial access was performed via ultrasound guidance. Technical failure rate was significantly higher with larger sheath size (≥20F). Conclusion. The preclose technique in PEVAR has a high technical success rate and a low groin complication rate. Technical success tends to increase with ultrasound-guided arterial access and decrease with larger access. When failure occurs, it is unilateral in the majority of cases, and conversion to surgical cutdown does not appear to increase the operative risk.

  12. Impaired renal function is associated with mortality and morbidity after endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Saratzis, Athanasios; Sarafidis, Pantelis; Melas, Nikolaos; Saratzis, Nikolaos; Kitas, George

    2013-10-01

    Renal function may be associated with poor outcome following endovascular abdominal aortic aneurysm repair (EVAR), but this relationship has not been adequately investigated. The aim of this study is to evaluate the association of estimated glomerular filtration rate (eGFR) with cardiovascular events and all-cause mortality after EVAR. Prospective cohort study of patients undergoing elective EVAR; eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and patients were divided in four groups (eGFR ≥ 90 mL/min/1.73 m(2), group 1; 60-89, group 2; 30-59, group 3; stroke, and vascular complications. Kaplan-Meier curves were constructed, and between-group comparisons were performed adjusted for variables that differed at baseline. A total of 383 patients (mean age, 69 ± 8 years; mean abdominal aortic aneurysm diameter, 6.2 ± 1.4 cm) were included. Over a mean follow-up of 34 ± 12 months, the following events occurred: 20 deaths (5.2%), 15 nonfatal myocardial infarctions (3.9%), 9 nonfatal strokes (2.3%), and 7 peripheral vascular complications (1.8%). Patients with an eGFR function is associated with an increase in cardiovascular events and mortality following elective EVAR. Copyright © 2013 Society for Vascular Surgery. All rights reserved.

  13. Thoracic Endovascular Aortic Repair into the False Lumen in Chronic Aortic Dissection.

    Science.gov (United States)

    Kamman, Arnoud V; Williams, David M; Patel, Himanshu J

    2017-07-01

    Deployment of a stent graft for the treatment of aortic dissections is normally performed in the true lumen. However, in some rare occasions landing in the false lumen may be appropriate. We present 2 different cases of chronic aortic dissection, where we opted to land the stent graft into the false lumen to treat the associated aneurysm. For the first case, the goal of thoracic endovascular aortic repair (TEVAR) was to exclude the aneurysm from within the false lumen because of a slit-like true lumen. In the second case, the visceral arteries came off the false lumen, with the renal vessels from the true lumen. False lumen TEVAR was performed, and the infrarenal aorta fenestrated, as to ensure adequate perfusion. These different clinical scenarios show how false lumen TEVAR for chronic dissections with associated aneurysms can be an alternative treatment approach and highlight the importance of assessing the origin of branch vessels and the possible necessity of reperfusion of these, before TEVAR is performed. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. The risk of endoleak following stent covering of the internal iliac artery during endovascular aneurysm repair

    International Nuclear Information System (INIS)

    Rajesparan, K.; Partridge, W.; Refson, J.; Abidia, A.; Aldin, Z.

    2014-01-01

    Aim: To investigate the risk of endoleak during endovascular aneurysm repair (EVAR) involving the distal common iliac artery (CIA) when the internal iliac artery (IIA) is covered without prior coil embolization. Materials and methods: Retrospective analysis of 145 (125 men, 20 women) consecutive EVAR cases. Clinical notes and radiological images were reviewed, and data collected on patient demographics, aneurysm morphology, covering of the IIA with or without embolization, presence of endoleaks, and patient symptoms relating to IIA ischaemia. Results: A total of 29 IIAs (10%) were covered in a total of 25 patients. Seven IIAs (24%) were embolized before stent covering (Embolization group), and 22 IIAs (76%) were covered only without embolization (Cover group). There was no statistically significant difference in the mean size of the abdominal aortic aneurysm diameter or CIA diameter between each group. No endoleaks from IIA retrograde filling were found in either group. Conclusion: The results of the present study do not support the traditional view that coverage of the IIA without prior embolization carries a high risk of endoleak, with no endoleaks seen in all 22 cases. Large-scale trials are required. However, the advent of branched-stenting techniques and the emergence of their success in long-term follow-up may preclude the former. - Highlights: • No EVAR endoleaks due to retrograde filling of the internal iliac artery (IIA). • No increased risk of endoleak with stent coverage of the IIA without embolisation. • Current evidence does not support traditional views

  15. Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience.

    Science.gov (United States)

    Spiliotopoulos, Konstantinos; Kokotsakis, John; Argiriou, Michalis; Dedeilias, Panagiotis; Farsaris, Dimosthenis; Diamantis, Theodore; Charitos, Christos

    2014-12-01

    Surveillance for patients undergoing thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) varies. Annual chest computed tomographic angiography (CTA) is often recommended but concerns about the risks and costs have emerged. The aim of this study was to examine the optimal follow-up frequency based on 11-year outcomes and surveillance experience. Seventy-six patients with BTAI received TEVAR from May 2002 to July 2013. Demographics, cardiovascular risk factors, Injury Severity Score (ISS), types, sizes, timing, and outcomes of stent grafts were collected retrospectively. Mean age was 39.7 years (range, 17-85 years); 8 (11%) were women. Mean ISS was 46.2 ± 18.5 (deceased, 61.0 ± 19.2; surviving, 44.2 ± 17.6; P = .023). Technical success was achieved in 71 patients (93.4%). All-cause mortality was 7 (9.2%), 1 (1.3%) of which was related to the procedure. Six were lost to follow-up (8%). To examine the effect of surveillance frequency on outcomes, after excluding the 2 most recent (6 months after scheduled annual visit). No significant differences were found for survival, graft-related complications, need for reintervention, except for postoperative hypertension, which was higher in the first group. All surviving patients had excellent outcomes, with no cerebrovascular accidents, paraplegia, or paraparesis; the median follow-up for both groups was 3 years (interquartile range 2.0-3.5, 1.5-5.4 years). Midterm outcomes of TEVAR for patients with stable repair after BTAI are excellent, both with timely (1.0-1.5 years) and delayed (>1.5 years) follow-up intervals after a median surveillance period of 3 years. A larger prospective randomized study could lead to a more relaxed, but equally safe surveillance schedule for these patients, lowering risks and costs. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  16. Anatomic severity grading score for primary descending thoracic aneurysms predicts procedural difficulty and aortic-related reinterventions after thoracic endovascular aortic repair.

    Science.gov (United States)

    Ammar, Chad P; Larion, Sebastian; Ahanchi, Sadaf S; Lavingia, Kedar S; Dexter, David J; Panneton, Jean M

    2016-10-01

    An anatomic severity grading (ASG) score for primary descending thoracic aortic aneurysms (DTAs) was developed. The objective of this study was to determine if an ASG score cutoff value for DTAs is predictive of procedural complexity, aortic-related reinterventions, and mortality in patients who undergo thoracic endovascular aortic repair (TEVAR). A retrospective review from 2008 to 2013 of patient records was conducted of all consecutive patients who underwent TEVAR for a primary DTA. A comprehensive scoring system of preoperative DTA morphology on the basis of computed tomography angiography images was established to identify and classify anatomic features that might influence outcome after TEVAR. ASG score calculations were achieved using preoperative computed tomography angiography images. Primary outcomes included primary technical success, aortic-related reinterventions, aneurysm-related mortality, and all-cause mortality. Secondary outcomes included procedural complexity (unplanned adjunctive procedures, number of endografts implanted, contrast volume, and procedure time), endoleak formation, endoleak requiring reintervention, stroke and paraplegia, and conversion to open repair. Of 469 patients with a diagnosis of a thoracic aortic aneurysm, 62 patients (13%) underwent TEVAR and had adequate preoperative imaging (mean age, 71 years). Applying the ASG score, we identified 39 patients (63%) with a score ≥24 (high-score group) and 23 patients (37%) with a score DTAs predicted procedure complexity and aortic-related reinterventions after TEVAR. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  17. Tailored endovascular repair of traumatic aortic disruptions with "stacked" abdominal aortic extension cuffs.

    Science.gov (United States)

    Allen, Keith B; Borkon, A Michael; Laster, Steven B; Aggarwal, Sanjeev; Davis, John R; Pak, Alexander F; Stewart, James R; Stuart, R Scott

    2012-01-01

    The management paradigm for traumatic aortic disruptions has evolved from open to endovascular repair. Thoracic stent grafts designed to treat aneurysmal disease, however, have disadvantages, including size mismatch in younger trauma patients and current standard lengths, which may needlessly necessitate coverage of at least 10 cm of thoracic aorta, increasing the risk of spinal cord ischemia. The "off-label" use of abdominal aortic extension cuffs to treat traumatic aortic disruptions may provide an advantage in this regard by better size matching for the younger trauma patient, reduced thoracic aortic coverage, and less cost to the institution. From 2008 to 2011, a total of 16 traumatic aortic disruptions were evaluated and managed with endovascular techniques. The last six were treated with abdominal aortic extensions cuffs (Excluder Extension Cuffs; W.L. Gore & Associates, Flagstaff, AZ) rather than traditional thoracic stent grafts. In addition to demographics and trauma-related data, additional endpoints evaluated in this retrospective review included operative time, number of cuffs used, stent cost data, procedural complications, and follow-up. All six patients (five men/one woman) with traumatic aortic disruption were successfully treated with complete exclusion of the disruption using abdominal aortic cuffs. There were no complications including death or spinal cord ischemia. The average age was 27 years (range, 18-44 years). The average number of cuffs used to cover the traumatic tear was 2.6 per patient (range, 2-3 cuffs per patient), covering an average of 5.3 cm of thoracic aorta (range, 4-6 cm). Mean procedure time was 70 minutes. Hospital cost for each cuff was $2200 (average total stent cost per patient, $5720). For comparison, a single 10-cm conformable thoracic aortic graft (CTAG) (Gore) costs $14,500. Average follow-up of all six patients for up to 3 years demonstrates no complications or migration of the stent grafts. Traumatic aortic

  18. Endovascular obliteration of a ruptured posterior spinal artery pseudoaneurysm.

    Science.gov (United States)

    Tanweer, Omar; Woldenberg, Rona; Zwany, Sarah; Setton, Avi

    2012-10-01

    Aneurysms of the posterior spinal artery (PSA) are rare lesions. Isolated PSA aneurysms, not in the setting of a high-flow environment, are even more rare. In the few reported cases, these lesions have been predominantly resected or observed. The authors report an isolated pseudoaneurysm of the PSA at the T-11 level presenting with subarachnoid hemorrhage. The patient underwent successful endovascular obliteration. To the authors' knowledge, this is the first report of an endovascular repair of an isolated PSA aneurysm.

  19. Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    International Nuclear Information System (INIS)

    Jung, Hye Doo; Lee, Yun Young; Lee, Seung Jin; Yim, Nam Yeol; Kim, Jae Kyu; Choi, Soo Jin Na; Jung, Sang Young; Chang, Nam Kyu; Lim, Jae Hoon

    2012-01-01

    To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta. This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types. There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p 0.043) showed a high incidence rate of complications within a year. The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

  20. Transarterial Endoleak Closure After Endovascular Thoracoabdominal Aneurysm Repair: When the "Sandwich" Goes Wrong.

    Science.gov (United States)

    Panoulas, Vasileios F; Montorfano, Matteo; Latib, Azeem; Giustino, Gennaro; Spagnolo, Pietro; Taramasso, Maurizio; Chieffo, Alaide; Civilini, Efrem; Chiesa, Roberto; Colombo, Antonio

    2016-02-01

    To describe the use of vascular plugs to close a complex type Ib endoleak following the sandwich procedure used in conjunction with endovascular thoracoabdominal aortic aneurysm (TAAA) repair. A 59-year-old man with a 6.5-mm TAAA was treated with initial deployment proximally of 2 Zenith TX2 stent-grafts. In preparation for the sandwich technique to preserve flow to the celiac trunk, a 10×100-mm Viabahn covered stent was delivered from a brachial access into the celiac trunk unprotected by the sheath of the introducer. The trigger wire system became snagged on the struts of the distal aortic stent-graft; when the wire was pulled, the proximal end of the Viabahn migrated outside the aortic stent-graft, which migrated upward. The main body extension intended for the aortic component of the sandwich technique was deployed close to the distal end of the aneurysm sac, but a large type Ib endoleak formed in the gutter between the Viabahn, aortic extension, and sac wall. The leak perfused the celiac trunk, and the procedure was terminated. Increasing sac size on 3-month imaging prompted closure of the leak with 2 type II Amplatzer vascular plugs aiming to occlude the endoleak outflow into the Viabahn and the endoleak outflow at the site of the gutter. Imaging follow-up at 6 months demonstrated successful exclusion of the TAAA with no residual endoleak and excellent perfusion of the celiac trunk. Transarterial treatment of complex endoleaks is feasible when preceded by meticulous imaging and detailed preprocedural planning. © The Author(s) 2015.

  1. Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature.

    Science.gov (United States)

    Uno, Kaname; Koike, Tomoyuki; Takahashi, Seiichi; Komazawa, Daisuke; Shimosegawa, Tooru

    2017-10-01

    Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastro-duodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient`s condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.

  2. Evaluation of Aneurysm Neck Angle Change After Endovascular Aneurysm Repair Clinical Investigations

    Energy Technology Data Exchange (ETDEWEB)

    Le, Trong Binh; Moon, Mi Hyoung [Inha University Hospital, Endovascular Training Center (Korea, Republic of); Jeon, Yong Sun, E-mail: radjeon@inha.ac.kr [Inha University Hospital, Inha University School of Medicine, Department of Radiology (Korea, Republic of); Hong, Kee Chun [Inha University School of Medicine, Department of Vascular Surgery (Korea, Republic of); Cho, Soon Gu [Inha University Hospital, Inha University School of Medicine, Department of Radiology (Korea, Republic of); Park, Keun-Myoung [Inha University School of Medicine, Department of Vascular Surgery (Korea, Republic of)

    2016-05-15

    PurposeTo evaluate the aneurysm neck angle changes and post-endovascular aneurysm repair (EVAR) complications.MethodsWe retrospectively analyzed 72 cases of elective EVAR for abdominal aortic aneurysm among 109 consecutive cases from December 2005 to April 2014. Patients were divided into angulated and non-angulated groups. The angulated group was defined as neck angulation ≥60°. Neck angle was evaluated pre- and post-EVAR during short- (within 1 month), mid- (3–6 months), and long-term (>1 year) follow-up. Aneurysm sac diameter change, aneurysm neck morphology other than angulation, endoleaks, and other post-procedural complications were also documented.ResultsA total of 34 patients were enrolled in the angulated group. There were no statistical differences in age, sex, follow-up duration, and aneurysm neck profile between the two groups (p > 0.05). Both groups showed statistically significant and consistent decreases in angulation during the follow-up period (p < 0.01). The angulated group revealed 22.45 % more straightening than the non-angulated group. Recoil of the Endurant device occurred in the angulated group. No statistically significant intergroup differences were observed in any endoleaks, complications, or re-intervention rates (p > 0.05). Pre-EVAR angle was the only predictor for post-procedural angle change (p < 0.001).ConclusionEVAR is applicable for patients with highly angulated aneurysm neck and provides consistent neck straightening over long-term follow-up. Recoil was evident in the angulated group using the Endurant device.

  3. A simulator for training in endovascular aneurysm repair: The use of three dimensional printers.

    Science.gov (United States)

    Torres, I O; De Luccia, N

    2017-08-01

    To develop an endovascular aneurysm repair (EVAR) simulation system using three dimensional (3D) printed aneurysms, and to evaluate the impact of patient specific training prior to EVAR on the surgical performance of vascular surgery residents in a university hospital in Brazil. This was a prospective, controlled, single centre study. During 2015, the aneurysms of patients undergoing elective EVAR at São Paulo University Medical School were 3D printed and used in training sessions with vascular surgery residents. The 3D printers Stratasys-Connex 350, Formlabs-Form1+, and Makerbot were tested. Ten residents were enrolled in the control group (five residents and 30 patients in 2014) or the training group (five residents and 25 patients in 2015). The control group performed the surgery under the supervision of a senior vascular surgeon (routine procedure, without simulator training). The training group practised the surgery in a patient specific simulator prior to the routine procedure. Objective parameters were analysed, and a subjective questionnaire addressing training utility and realism was answered. Patient specific training reduced fluoroscopy time by 30% (mean 48 min, 95% confidence interval [CI] 40-58 vs. 33 min, 95% CI 26-42 [p printers Form1+ (using flexible resin) and Makerbot (using silicone) provided the best performance based on simulator quality and cost. An EVAR simulation system using 3D printed aneurysms was feasible. The best results were obtained with the 3D printers Form1+ (using flexible resin) and Makerbot (using silicone). Patient specific training prior to EVAR at a university hospital in Brazil improved residents' surgical performance (based on fluoroscopy time, surgery time, and volume of contrast used) and increased their self confidence. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

    Science.gov (United States)

    Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

    2015-08-01

    Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for

  5. Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography.

    Science.gov (United States)

    Collins, John T; Boros, Michael J; Combs, Kristin

    2007-11-01

    Routine ultrasound surveillance is adequate and safe for monitoring endovascular aneurysm repairs (EVARs). A retrospective chart review including 160 endograft patients was performed from August 2000 to September 2005. All ultrasound examinations (n = 359) were performed by a board-certified vascular surgery group's accredited laboratory. Registered vascular technologists utilized the same equipment consisting of Siemens Antares high-definition ultrasonography with tissue harmonics and color flow Doppler. An identical protocol was followed by each technologist: scan body and both limbs of the endograft and distal iliac vessels, measure anterior-posterior aneurysm sac size, and detect intrasac pulsatility and color flow. Statistical analysis utilized Pearson's correlation coefficient and the paired t-test. Forty-one endoleaks were discovered out of the 359 exams (11.4%). There were type I (7, 17%), type II (26, 63%), and combined type I with type II (8, 20%) endoleaks. Correlation with computed tomography (CT) was obtained in 35 of these cases. CT discovered three endoleaks that were not seen with ultrasound. However, these particular ultrasound exams were inadequate due to additional factors (bowel gas, body habitus, hernia), which prompted CT investigation and, hence, endoleak discovery. Of the 41 endoleaks found on ultrasound, only 14 were seen on CT. Specifically, 26 type II endoleaks were seen with ultrasound versus only nine during CT. Additional factors addressed included comparison between ultrasound and CT of residual aneurysm sac measurements and conditions limiting ultrasound examination. Although criticized in the past, color flow ultrasonography is a safe and effective modality for surveillance of aortic endografts. Utilizing ultrasound to analyze abdominal aortic aneurysm (AAA) sac dimensions and endoleak detection is statistically sound for screening AAA status post-EVAR.

  6. Fitness plus American Society of Anesthesiologists grade improve outcome prediction after endovascular aneurysm repair.

    Science.gov (United States)

    Boult, Margaret; Cowled, Prue; Barnes, Mary; Fitridge, Robert A

    2017-09-01

    Although the American Society of Anesthesiologists (ASA) grade was established for statistical purposes, it is often used prognostically. However, older patients undergoing elective surgery are typically ASA III, which limits patient stratification. We look at the prognostic effect on early complications and survival of using ASA and self-reported physical fitness to stratify patients undergoing endovascular repair of abdominal aortic aneurysms. Data were extracted from a trial database. All patients were assigned a fitness level (A (fit) or B (unfit)) based on their self-reported ability to walk briskly for 1 km or climb two flights of stairs. Fitness was used to stratify ASA III patients, with fitter patients assigned ASA IIIA and less fit patients ASA IIIB. Outcomes assessed included survival, reinterventions, endoleak, all early and late complications and early operative complications. A combined ASA/fitness scale (II, IIIA, IIIB and IV) correlated with 1- and 3-year survival (1-year P = 0.001, 3-year P = 0.001) and early and late complications (P = 0.001 and P = 0.05). On its own, ASA predicted early complications (P = 0.0004) and survival (1-year P = 0.01, 3-year P = 0.01). Fitness alone was predictive for survival (1-year P = 0.001, 3-year P = 0.001) and late complications (P = 0.009). This study shows that even a superficial assessment of fitness is reflected in surgical outcomes, with fitter ASA III patients showing survival patterns similar to ASA II patients. Physicians should be alert to differences in fitness between patients in the ASA III group, despite similarities based on preexisting severe systemic disease. © 2017 Royal Australasian College of Surgeons.

  7. The financial implications of endovascular aneurysm repair in the cost containment era.

    Science.gov (United States)

    Stone, David H; Horvath, Alexander J; Goodney, Philip P; Rzucidlo, Eva M; Nolan, Brian W; Walsh, Daniel B; Zwolak, Robert M; Powell, Richard J

    2014-02-01

    Endovascular aneurysm repair (EVAR) is associated with significant direct device costs. Such costs place EVAR at odds with efforts to constrain healthcare expenditures. This study examines the procedure-associated costs and operating margins associated with EVAR at a tertiary care academic medical center. All infrarenal EVARs performed from April 2011 to March 2012 were identified (n = 127). Among this cohort, 49 patients met standard commercial instruction for use guidelines, were treated using a single manufacturer device, and billed to Medicare diagnosis-related group (DRG) 238. Of these 49 patients, net technical operating margins (technical revenue minus technical cost) were calculated in conjunction with the hospital finance department. EVAR implant costs were determined for each procedure. DRG 238-associated costs and length of stay were benchmarked against other academic medical centers using University Health System Consortium 2012 data. Among the studied EVAR cohort (age 75, 82% male, mean length of stay, 1.7 days), mean technical costs totaled $31,672. Graft implants accounted for 52% of the allocated technical costs. Institutional overhead was 17% ($5495) of total technical costs. Net mean total technical EVAR-associated operating margins were -$4015 per procedure. Our institutional costs and length of stay, when benchmarked against comparable centers, remained in the lowest quartile nationally using University Health System Consortium costs for DRG 238. Stent graft price did not correlate with total EVAR market share. EVAR is currently associated with significant negative operating margins among Medicare beneficiaries. Currently, device costs account for over 50% of EVAR-associated technical costs and did not impact EVAR market share, reflecting an unawareness of cost differential among surgeons. These data indicate that EVAR must undergo dramatic care delivery redesign for this practice to remain sustainable. Copyright © 2014 Society for Vascular

  8. Endovascular Repair of a Type III Thoracoabdominal Aortic Aneurysm in a Patient with Occlusion of Visceral Arteries

    International Nuclear Information System (INIS)

    Klonaris, Chris; Katsargyris, Athanasios; Giannopoulos, Athanasios; Georgopoulos, Sotiris; Tsigris, Chris; Michail, Othon; Marinos, George; Bastounis, Elias

    2007-01-01

    The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneus transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft

  9. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    International Nuclear Information System (INIS)

    Steingruber, I.E.; Neuhauser, B.; Seiler, R.; Greiner, A.; Chemelli, A.; Kopf, H.; Walch, C.; Waldenberger, P.; Jaschke, W.; Czermak, B.

    2006-01-01

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions

  10. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Steingruber, I.E. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)]. E-mail: iris.steingruber@uibk.ac.at; Neuhauser, B. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Seiler, R. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Greiner, A. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Chemelli, A. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Kopf, H. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Walch, C. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Waldenberger, P. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Jaschke, W. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Czermak, B. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)

    2006-09-15

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

  11. Endovascular repair of abdominal aortic aneurysm with severely angulated neck and tortuous artery access: case report and literature review.

    Science.gov (United States)

    Zeng, Qinglong; Huang, Lianjun; Huang, Xiaoyong; Peng, Mingliang

    2015-03-08

    Endovascular aneurysm repair has revolutionized the therapeutic strategy for abdominal aortic aneurysm. However, hostile proximal aneurysmal neck and tortuosity of access vessels remain challenges in selecting optimal stent-grafts in abdominal aortic aneurysms with difficult anatomy. A 65-year-old woman complained of intermittent abdominal pain for one week. Computed tomography angiogram demonstrated a tortuous infrarenal abdominal aortic aneurysm with a tapered neck and a 136° of infrarenal angulation. Aneurysmal dilatation and severe calcification of bilateral iliac arteries and tortuous aortoiliac access were also showed. Endovascular approach using Endurant stent-graft was attempted at an outside hospital, but failed because of the significant tortuosity of the abdominal aorta and iliac arteries. Since the patient refused to have open aneurysm repair, he was transferred to our hospital for further evaluation and possible EVAR with a different approach. EVAR was performed successfully using Gore Excluder stent-grafts (W.L. Gore & Associates, Flagstaff, AZ, USA). During the procedure, cannulation of the contralateral limb was unable to be achieved because of the tortuous aortoiliac course. Therefore, a snare was inserted from right radial artery, through the contralateral gate, to grasp the wire from left femoral artery. Two iliac stent-grafts were sequentially deployed with the lower end distal to the opening of the left internal iliac artery. Angiography confirmed complete sealing of the aneurysm with patency of bilateral renal arteries and external iliac arteries. The postoperative courses were uneventful and follow-up computed tomography angiogram at 6 months demonstrated patent bilateral femoral and renal arteries without endoleaks or stent migration. Although endovascular repair of aortic aneurysm with hostile neck and tortuous access is rather challenging, choosing flexible stent-grafts and suitable techniques is able to achieve an encouraging outcome.

  12. Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment.

    Science.gov (United States)

    Rudarakanchana, Nung; Van Herzeele, Isabelle; Bicknell, Colin D; Riga, Celia V; Rolls, Alexander; Cheshire, Nicholas J W; Hamady, Mohamad S

    2014-08-01

    This study evaluates a fully immersive simulated angiosuite for training and assessment of technical endovascular and human factor skills during a crisis scenario. Virtual reality (VIST-C, Mentice) simulators were integrated into a simulated angiosuite (ORCAMP, Orzone). Teams, lead by experienced (N = 5) or trainee (N = 5) endovascular specialists, performed simulated endovascular ruptured aortic aneurysm repair (rEVAR). Timed performance metrics were recorded as surrogate measures of performance. Participants (N = 22) completed postprocedure questionnaires evaluating face validity, as well as technical and human factor aspects, of the simulation on a Likert scale from 1 (not at all) to 5 (very much). Experienced team leaders were significantly faster than trainees in obtaining proximal control with an intra-aortic occlusion balloon (352 vs. 501 s, p = 0.047) and all completed the procedure within the allotted time, whilst no trainee was able to do so. Total fluoroscopy times were significantly lower in the experienced group (782 vs. 1,086 s, p = 0.016). Realism of the simulated angiosuite was scored highly by experienced team leaders (median 4/5, IQR 4-5). Participants found the simulation useful for acquiring technical (4/5, IQR 4-5) and communication skills (4/5, IQR 4-5) and particularly valuable for enhancing teamwork (5/5, IQR 4-5) and patient safety (5/5, IQR 4-5). This study shows feasibility of creation of a crisis scenario in a fully immersive angiosuite simulation and team performance of a simulated rEVAR. Performance metrics differentiated between experienced specialists and trainees, and the realism of the simulation exercise and environment were rated highly by experienced endovascular specialists. This simulation has potential as a powerful training and assessment tool with opportunities to improve team performance in rEVAR through both technical and human factor skills training.

  13. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    International Nuclear Information System (INIS)

    Saha, Prakash; Hughes, John; Patel, Ashish S.; Donati, Tommaso; Sallam, Morad; Patel, Sanjay D.; Bell, Rachel E.; Katsanos, Konstantinos; Modarai, Bijan; Zayed, Hany A.

    2015-01-01

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities

  14. Type 1a endoleak following Zone 1 and Zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration.

    Science.gov (United States)

    Kudo, Tomoaki; Kuratani, Toru; Shimamura, Kazuo; Sakamoto, Tomohiko; Kin, Keiwa; Masada, Kenta; Shijo, Takayuki; Torikai, Kei; Maeda, Koichi; Sawa, Yoshiki

    2017-10-01

    Type 1a endoleak is one of the most severe complications after thoracic endovascular aortic repair (TEVAR), because it carries the risk of aortic rupture. The association between bird-beak configuration and Type 1a endoleak remains unclear. The purpose of this study was to analyse the predictors of Type 1a endoleak following Zone 1 and Zone 2 TEVAR, with a particular focus on the effect of bird-beak configuration. From April 2008 to July 2015, 105 patients (mean age 68.6 years) who underwent Zone 1 and 2 landing TEVAR were enrolled, with a mean follow-up period of 4.3 years. The patients were categorized into 2 groups, according to the presence (Group B, n = 32) or the absence (Group N, n = 73) of bird-beak configuration on the first postoperative multidetector computed tomography. The Kaplan-Meier event-free rate curve showed that Type 1a endoleak and bird-beak progression occurred less frequently in Group N than in Group B. Five-year freedom from Type 1a endoleak rates were 79.7% and 100% for Groups B and N, respectively (P = 0.007). Multivariable logistic regression analysis showed that dissecting aortic aneurysm (odds ratio 3.72, 95% confidence interval 1.30-11.0; P = 0.014) and shorter radius of inner curvature (odds ratio 1.09, 95% confidence interval 0.85-0.99; P = 0.025) were significant risk factors for bird-beak configuration. Multivariable Cox proportional hazard regression showed that Z-type stent graft (hazard ratio 2.69, 95% confidence interval 1.11-6.51; P = 0.030) was a significant risk factor for bird-beak progression. Appropriate stent grafts need to be chosen carefully to prevent Type 1a endoleak and bird-beak configuration after landing Zone 1 and 2 TEVAR. Patients with bird-beak configuration on early postoperative multidetector computed tomography require closer follow-up to screen for Type 1a endoleak. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio

  15. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    Energy Technology Data Exchange (ETDEWEB)

    Saha, Prakash, E-mail: prakash.2.saha@kcl.ac.uk; Hughes, John, E-mail: johnhughes387@rocketmail.com; Patel, Ashish S., E-mail: ashish.s.patel@kcl.ac.uk; Donati, Tommaso, E-mail: tommaso.donati@gstt.nhs.uk; Sallam, Morad, E-mail: morad.sallam@gstt.nhs.uk; Patel, Sanjay D., E-mail: sanjay.patel@gstt.nhs.uk; Bell, Rachel E. [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Modarai, Bijan, E-mail: bijan.modarai@kcl.ac.uk; Zayed, Hany A., E-mail: hany.zayed@gstt.nhs.uk [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

    2015-08-15

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

  16. Endovascular repair of an abdominal aortic aneurysm in a patient with stenosis of bilateral common iliac artery stents.

    Science.gov (United States)

    Daab, Leo J; Aidinian, Gilbert; Weber, Michael A; Kembro, Ronald J; Cook, Patrick R

    2011-01-01

    The explosion in endovascular interventions for peripheral vascular disease has resulted in procedures being used by a multitude of specialties. Nonvascular surgeons performing these interventions can create scenarios that may make future vascular interventions difficult. In this article, we present a case report illustrating this point. A 68-year-old man with severe chronic obstructive pulmonary disease, coronary artery disease with prior myocardial infarction, and multiple abdominal operations presented with an abdominal aortic aneurysm. In our opinion, this patient was at a prohibitive operative risk for open repair. Review of his imaging results revealed a 6.7-cm infrarenal aneurysm with bilateral common iliac artery (CIA) stents (right: 8 mm; left: 6 mm) and 6-mm self-expanding stents extending from the right external iliac artery through the common femoral artery. A Cook Zenith Renu (30 × 108 mm) graft (Cook Medical Inc., Bloomington, IN) was advanced after serial dilation and balloon angioplasty of the stenotic right CIA stent. Left brachial access was used for arteriographic imaging. The left common femoral artery was accessed and the left CIA was coil-embolized to prevent backbleeding. A femoro-femoral artery crossover bypass was then performed after segmental resection of the right common femoral artery stent. The patient tolerated the procedure well and was discharged home on postoperative day 3. Subsequent postoperative computed tomography arteriogram after 1 month showed palpable pulses and no evidence of endoleak with flow in the femoro-femoral graft on clinical exam. This case demonstrates an endovascular intervention which limited the potential options available for aneurysm repair. Similar problems may become increasingly common as more providers offer endovascular interventions, thus emphasizing the importance of a collaborative approach to the patient with complex aorto-iliac occlusive disease and abdominal aortic aneurysm. It is the duty of the

  17. Third- versus Second-Generation Stent Graft for Endovascular Aneurysm Repair: A Device-Specific Analysis.

    Science.gov (United States)

    Bergonti, Marco; Teruzzi, Giovanni; Santagostino, Giulia; Grancini, Luca; Ferrari, Cristina; Trabattoni, Daniela; Lualdi, Alessandro; Bartorelli, Antonio

    2017-10-01

    Our purpose is to analyze the outcomes of endovascular aneurysm repair (EVAR) in patients treated with Excluder endograft (W.L. Gore and Associate, Flagstaff, AZ), comparing second generation, featuring SIM-PULL delivery system (ExSP) and third generation, featuring C3 (ExC3), concerning intraprocedural data and long-term outcomes. In our single-center, comparative study, we retrospectively analyzed all patients undergoing elective EVAR with Excluder from May 2008 to December 2015. This cohort was firstly divided according to the design of the endograft used, and then, two subgroups of complex procedures were identified according to International Standards. Preliminary end points were early- and mid-term outcomes. Primary end point was procedural data (i.e., procedural and fluoroscopy time, radiation dose (DAP), and contrast medium amount). The study included 64 patients (24 ExSP and 40 ExC3) with a mean follow-up of 31.6 ± 22.9 months. Patients in ExC3 group had significantly more risk factors (past or present history of smoking, P = 0.019), comorbidities (chronic heart failure and chronic kidney disease, both P = 0.032), as well as a more unfavorable anatomy (neck angulation, P = 0.035). Concerning preliminary outcome, no significant between-group difference was noted. As for intraoperative data, procedure duration was significantly shorter: 120 vs. 151 min (P = 0.002) in the overall population and 129 vs. 173 min (P = 0.004) in complex cases. A significant reduction was also found in fluoroscopy time and radiation exposure: 24,084 vs. 32,548 cGy/cm 2 (P = 0.020) in the overall population and 26,770 vs. 41,104 cGy/cm 2 (P = 0.003) in complex cases. No significant difference was found for contrast volume. The study shows that new C3 excluder enables to reduce radiation exposure and procedural time compared to the previous device. C3 excluder results are comparable to those of the previous device in spite of more comorbidities and complex anatomy

  18. Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis.

    Science.gov (United States)

    Alberta, Hillary B; Takayama, Toshio; Panthofer, Annalise; Cambria, Richard P; Farber, Mark A; Jordan, William D; Matsumura, Jon S

    2018-02-01

    We evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time. False-positive stent graft migration would be defined when these patients meet the standard definition for migration, even if the stent has not moved in relation to the elongating aorta. This retrospective study evaluated the aortic length of 23 patients treated with the conformable GORE TAG thoracic endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) in three clinical trials (dissection, traumatic injury, and aneurysm). Patients who met the standard definition for migration were selected. A standardized protocol was used to measure aortic centerline lengths, including the innominate artery (IA) to the most distal device ring, the IA to the celiac artery (CA), and the distal ring to the CA. Baseline lengths obtained from the first postoperative image were compared with length measurements obtained from the first interval at which they met the standard definition for migration. The conventional standards for migration using a single reference point were compared with the use of dual reference points. Of the 23 patients with endograft changes, 20 were deemed to have aortic elongation rather than true migration. The remaining three patients were deemed to have migration on the basis of the IA to distal ring position compared with the IA to CA length change. The IA to CA interval length change was markedly greater in those with elongation compared with migration (23.8 ± 8.4

  19. Variation in hospital costs and reimbursement for endovascular aneurysm repair: A Vascular Quality Initiative pilot project.

    Science.gov (United States)

    Lemmon, Gary W; Neal, Dan; DeMartino, Randall R; Schneider, Joseph R; Singh, Tej; Kraiss, Larry; Scali, Salvatore; Tassiopoulos, Apostolos; Hoel, Andrew; Cronenwett, Jack L

    2017-10-01

    Comparing costs between centers is difficult because of the heterogeneity of vascular procedures contained in broad diagnosis-related group (DRG) billing categories. The purpose of this pilot project was to develop a mechanism to merge Vascular Quality Initiative (VQI) clinical data with hospital billing data to allow more accurate cost and reimbursement comparison for endovascular aneurysm repair (EVAR) procedures across centers. Eighteen VQI centers volunteered to submit UB04 billing data for 782 primary, elective infrarenal EVAR procedures performed by 108 surgeons in 2014. Procedures were categorized as standard or complex (with femoral-femoral bypass or additional arterial treatment) and without or with complications (arterial injury or embolectomy; bowel or leg ischemia; wound infection; reoperation; or cardiac, pulmonary, or renal complications), yielding four clinical groups for comparison. MedAssets, Inc, using cost to charge ratios, calculated total hospital costs and cost categories. Cost variation analyzed across centers was compared with DRG 237 (with major complication or comorbidity) and 238 (without major complication or comorbidity) coding. A multivariable model to predict DRG 237 coding was developed using VQI clinical data. Of the 782 EVAR procedures, 56% were standard and 15% had complications, with wide variation between centers. Mean total costs ranged from $31,100 for standard EVAR without complications to $47,400 for complex EVAR with complications and varied twofold to threefold among centers. Implant costs for standard EVAR without complications varied from $8100 to $28,200 across centers. Average Medicare reimbursement was less than total cost except for standard EVAR without complications. Only 9% of all procedures with complications in the VQI were reported in the higher reimbursed DRG 237 category (center range, 0%-21%). There was significant variation in hospitals' coding of DRG 237 compared with their expected rates. VQI clinical

  20. Mortality in endovascular and open abdominal aneurysm repair - trends in Germany.

    Science.gov (United States)

    von Beckerath, Olga; Schrader, Sebastian; Katoh, Marcus; Luther, Bernd; Santosa, Frans; Kröger, Knut

    2018-01-01

    We analysed trends in mortality of endovascular (EVAR) and open aortic repair (OAR) in patients hospitalized for abdominal aortic aneurysms (AAA) in Germany from 2005 to 2015. We used national statistics published by the Federal Statistical Office in Germany to calculate mortality rate of patients hospitalized with ruptured (rAAA, n = 2,448 in 2005, n = 2,180 in 2015) and non-ruptured (iAAA, n = 11,626 in 2005, n = 14,205 in 2015) AAA. Considering only those who were treated with EVAR or OAR, treatment rates of iAAA with EVAR increased to 78.2 % in males and 72.6 % in females in 2015 and treatment rates of rAAA to 36.9 % and 40.7 %, respectively. In cases with iAAA, death rates associated with EVAR decreased in males from 2.1 to 1.1 % (p = 0.0005) in the period from 2005 to 2015 but not in females (1.8 % in 2005 and 2.3 % in 2015, p = 0.8511). Similar trends are seen in cases with rAAA (males 30.1 % and 24 %, p = 0.1034, females 36.4 to 37.3 %, p = 0.8511). Death rates associated with OAR increased in males from 4.7 % in 2005 to 5.7 % in 2015 (p = 0.0103) and tended to increase in females from 6.8 to 8.2 % (p = 0.1476). In cases of rAAA, there were no changes. EVAR treatment rates increased in cases with iAAA in both genders with age, as well as in males with rAAA, but not in females. OAR associated death rates increased with age in rAAA (from around 30 % in the sixth/seventh decade of life to almost 80 % in cases with patients over the age of 90) and in iAAA (from 1.1 to 20 %). The general increase in EVAR procedures in males and females hospitalized for rAAA and iAAA went along with a decrease in in-hospital mortality in males treated with EVAR for iAAA only and an increasing mortality in males treated with OAR for iAAA.

  1. The effects of combining fusion imaging, low-frequency pulsed fluoroscopy, and low-concentration contrast agent during endovascular aneurysm repair.

    Science.gov (United States)

    Dias, Nuno V; Billberg, Helen; Sonesson, Björn; Törnqvist, Per; Resch, Tim; Kristmundsson, Thórarinn

    2016-05-01

    This study evaluated the effects of a combined imaging protocol using low-frequency pulsed fluoroscopy, fusion imaging, and low-concentration iodine contrast for endovascular aneurysm repair (EVAR) of aortic aneurysms of varying complexity. The study retrospectively reviewed the data of 103 patients treated between May 2013 and November 2014 with the combined imaging protocol (group A) with low-dose fluoroscopy at 3.75 frames/s, fusion imaging, and iodine contrast of 140 mg iodine/mL. A control group (group B) consisted of 123 consecutive patients who underwent EVAR before the combined imaging protocol was introduced by matching the type of procedure. In group B, low-dose 7.5 frames/s fluoroscopy, no fusion imaging, and 200 mg iodine/mL contrast were used. All patients were reviewed for preoperative, intraoperative, and postoperative variables, with emphasis on intraoperative radiation (dose area product) and iodine exposure, fluoroscopy, and operation times, as well as technical success. Values are presented as median and interquartile range (IQR) when not stated otherwise. Group A included 22 infrarenal EVARs, 17 iliac branch devices, 10 thoracic endovascular aortic repairs, 21 fenestrated EVARs, and 33 thoracoabdominal branched/fenestrated EVARs. Groups A and B were similar in types of procedure, body mass index (P > .05), and intraoperative technical success (92% and 92%, respectively; P > .05). Operation time (230 [IQR, 138-331] minutes vs 235 [IQR, 158-364] minutes) and fluoroscopy time (66 [IQR, 33-101] minutes vs 72 [IQR, 42-102] minutes) were similar in both groups (P > .05), but radiation exposure (19,934 [IQR, 11,340-30,615] μGym(2) vs 32,856 [IQR, 19,562-55,677] μGym(2); P involvement of the superior mesenteric artery in the repairs (81% vs 17%; P product by 22%. Only four of the group A patients (3.9%) showed a decrease in the glomerular filtration rate ≥30% after EVAR, although 32% of the entire group had at least moderately impaired renal

  2. Endovascular repair of postoperative vascular graft related complications after aorto-iliac surgery

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Andersen, P E; Larsen, K E

    2014-01-01

    with anastomotic pseudoaneurysms without leak, of which three had proximal anastomotic pseudoaneurysms and one had distal iliac anastomotic pseudoaneurysm. Implanted stent graft were Endurant (Medtronic) bifurcated endoprostheses in three patients and Excluder (Gore) prosthesis in a two cases. Tubular Medtronic....... The mortality and morbidity is higher compared to the initial treatment. We present twelve patients with these complications which were treated by an endovascular approach. METHODS: From January 2008 through January 2013 our radiological records were searched for cases with post surgical vascular complications...... treated with endovascular intervention. These comprised of anastomotic pseudoaneurysm, suture leakage and arterial enteric fistulas. Patients with limb occlusions were not included in this study. RESULTS: Twelve patients with graft related complications treated with endovascular intervention were recorded...

  3. Outcomes of original and low-permeability Gore Excluder endoprosthesis for endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Tanski, William; Fillinger, Mark

    2007-02-01

    Because of concern about the percentage of enlarging abdominal aortic aneurysms (AAAs) after endovascular repair with the Excluder device (W.L. Gore & Assoc, Inc, Sunnyvale, Calif), the graft material was modified to reduce its permeability and released for commercial use in mid-2004. We studied all AAA repairs with Excluder endografts performed at our institution, including the original-permeability (OP) version (n = 99) and the low-permeability (LP) version (n = 48). All patients were followed up with serial computed tomography (CT) angiography and three-dimensional (3D) reconstruction. Morphologic measurements, including AAA diameter and 3D volume, were prospectively entered into a database to evaluate changes in AAA size over time. Owing to the length of available follow-up for the LP version, the primary end point was AAA size change at 6 and 12 months, evaluated by Mann-Whitney U test for unpaired samples. Preoperative and postoperative anatomy was similar in the two groups, including AAA diameter (OP, 5.6 +/- 1 cm; LP, 5.8 +/- 2 cm; P = .3), aortic neck length (OP, 21 +/- 1 mm; LP, 22 +/- 2 mm; P = .9), postoperative aortic seal zone (OP, 18 +/- 1 mm; LP, 16 +/- 1 mm, P > .1) and iliac seal zone (OP, 33 +/- 1 mm, LP 31 +/- 1 mm, P = .2). The rate of sac shrinkage differed significantly. Orthogonal diameter measurements showed a significant difference in the rate of shrinkage by 12 months postoperatively (OP, -2.1 +/- 1 mm; LP, -5.1 +/- 1 mm; P = .01). By 3D volume, the rate of shrinkage was considerably different between the two groups at both 6 and 12 months (12 months: OP, -6% +/- 1%; LP, -20 +/- 4%; P = .0006). There was no enlargement by diameter in either group at 6 or 12 months postoperative. By standard volume criteria, however, 12 of 99 patients in the OP group and one of 48 patients in the LP group had significant AAA enlargement < or =12 months (P = .04). Of these, four of 12 patients in the OP group had enlargement without apparent endoleak, even

  4. Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National Population-based Study.

    Science.gov (United States)

    Gunnarsson, K; Wanhainen, A; Djavani Gidlund, K; Björck, M; Mani, K

    2016-01-01

    In randomized trials, no peri-operative survival benefit has been shown for endovascular (EVAR) repair of ruptured abdominal aortic aneurysm (rAAA) when compared with open repair. The aim of this study was to investigate the effect of primary repair strategy on early and midterm survival in a non-selected population based study. The Swedish Vascular Registry was consulted to identify all rAAA repairs performed in Sweden in the period 2008-12. Centers with a primary EVAR strategy (treating > 50% of rAAA with EVAR) were compared with centers with a primary open repair strategy. Peri-operative outcome, midterm survival, and incidence of rAAA repair/100,000 inhabitants aged > 50 years were assessed. In total, 1,304 patients were identified. Three primary EVAR centers (pEVARc) operated on 236 patients (74.6% EVAR). Twenty-six primary open repair centers (pORc) operated 1,068 patients (15.6% EVAR). Patients treated at pEVARc were more often referrals (28.0% vs. 5.3%; p strategy at 30 days (pEVARc 28.0%, n = 66; pORc 27.4%, n = 296 [p = .87]), 1 year (pEVARc 39.9%, n = 93; pORc 34.7%, n = 366 [p = .19]), or 2 years (42.1%, n = 94; 38.3%, n = 394 [p = .28]), either overall or in subgroups based on age or referral status. Overall, patients treated with EVAR were older (mean age 76.4 vs. 74.0 years; p strategy, either peri-operatively or in the midterm. The study supports the early findings of the randomized controlled trials in a national population based setting. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  5. Dynamic aortic changes in patients with thoracic aortic aneurysms evaluated with electrocardiography-triggered computed tomographic angiography before and after thoracic endovascular aneurysm repair: preliminary results.

    NARCIS (Netherlands)

    Prehn, J. van; Bartels, L.W.; Mestres, G.; Vincken, K.L.; Prokop, M.; Verhagen, H.J.; Moll, F.L.; Herwaarden, J.A. van

    2009-01-01

    The purpose of this study was to utilize dynamic computed tomographic angiography (CTA) on pre- and postoperative thoracic endovascular aneurysm repair (TEVAR) patients to characterize cardiac pulsatility-induced aortic motion on essential TEVAR proximal sealing zones and to study the influence of

  6. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Ziheng, E-mail: wuziheng303@hotmail.com [Zhejiang University, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine (China); Xu, Liang, E-mail: maxalive@163.com [Zhejiang University, Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine (China); Qu, Lefeng, E-mail: qulefeng@gmail.com [The Second Military Medical University, Department of Vascular and Endovascular Surgery, Changzheng Hospital (China); Raithel, Dieter, E-mail: dieter.raithel@rzmail.uni-erlangen.de [Nuremberg Southern Hospital, Department of Vascular and Endovascular Surgery (Germany)

    2015-02-15

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.

  7. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  8. Endoleak detection after endovascular aneurysm repair using unenhanced MRI with flow suppression technique: Feasibility study in comparison with contrast-enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Kensaku; Saida, Tsukasa; Okamoto, Yoshikazu; Nasu, Katsuhiro; Minami, Manabu [University of Tsukuba, Department of Radiology Faculty of Medicine, Tsukuba, Ibaraki (Japan); Sato, Fujio [University of Tsukuba, Department of Cardiovascular Surgery, Faculty of Medicine, Tsukuba, Ibaraki (Japan); Uchikawa, Yoko [Hitachi General Hospital, Department of Radiology, Hitachi, Ibaraki (Japan); Konishi, Takahiro; Ishiguro, Toshitaka; Hiyama, Takashi [University of Tsukuba Hospital, Department of Radiology, Tsukuba, Ibaraki (Japan); Hoshiai, Sodai [Ibaraki Prefectural Central Hospital, Department of Radiology, Kasama, Ibaraki (Japan)

    2017-01-15

    To evaluate the feasibility of unenhanced motion-sensitized-driven equilibrium (MSDE)-prepared balanced turbo field echo (BTFE) sequences for detecting endoleaks after endovascular aneurysm repair (EVAR). Forty-six patients treated with EVAR for aortic and/or iliac arterial aneurysms underwent contrast-enhanced CT and MSDE-prepared BTFE sequences with and without flow suppression. Two independent observers reviewed these sequences and their subtraction images and assigned confidence levels for detecting endoleaks. Relative contrast values were calculated by dividing signal intensities by those of paraspinal muscles. CT provided the reference standard. CT showed types I and II endoleaks in one and ten patients, respectively. Areas under receiver operating characteristic curves were 0.92 and 0.97 for observers 1 and 2, respectively. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of both observers were 91 (10/11), 91(32/35), 91 (42/46), 77 (10/13) and 97 % (32/33), respectively. Relative contrast values of endoleaks and flowing blood significantly decreased by flow suppression on MSDE-prepared BTFE images (P = 0.002 and P < 0.0001 respectively), and were significantly higher than those of the excluded aneurysms on subtraction images (P = 0.003 and P = 0.001, respectively). Unenhanced MSDE-prepared BTFE sequences are feasible for detecting endoleaks. (orig.)

  9. Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR)

    International Nuclear Information System (INIS)

    Ogawa, Yukihisa; Hamaguchi, Shingo; Nishimaki, Hiroshi; Kon, Yuri; Chiba, Kiyoshi; Sakurai, Yuka; Murakami, Kenji; Arai, Yasunori; Miyairi, Takeshi; Nakajima, Yasuo

    2015-01-01

    BackgroundEndovascular aortic repair (EVAR) requires further intervention in 20-30 % of cases, often due to type II endoleak (T2EL). Management options for T2EL include transarterial embolization, direct puncture (DP), or transcaval embolization. We report the case of an 80-year-old man with T2EL who successfully underwent DP embolization.MethodsEmbolization by DP was performed with a transpedicular approach using an isocenter puncture (ISOP) method. An isocenter marker (ICM) was placed at a site corresponding to the aneurysm sac on fluoroscopy in two directions (frontal and lateral views). A vertebroplasty needle was inserted tangentially to the ICM under fluoroscopy and advanced to the anterior wall of the vertebral body. A 20 cm-length, 20-G-PTCD needle was inserted through the outer needle of the 13-G needle and advanced to the ICM. Sac embolization using 25 % N-buty-2-cyanoacrylate diluted with Lipiodol was performed. After complete embolization, rotational DA confirmed good filling of the sac with Lipiodol. The outer cannula and 13-G needle were removed and the procedure was completed.ResultsThe patient was discharged the next day. Contrast-enhanced computed tomography 1 and 8 months later showed no Lipiodol washout in the aneurysm sac, no endoleak recurrence, and no expansion of the excluded aneurysm.ConclusionDP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult

  10. Multimodality Imaging Approach towards Primary Aortic Sarcomas Arising after Endovascular Abdominal Aortic Aneurysm Repair: Case Series Report

    Energy Technology Data Exchange (ETDEWEB)

    Kamran, Mudassar, E-mail: kamranm@mir.wustl.edu; Fowler, Kathryn J., E-mail: fowlerk@mir.wustl.edu; Mellnick, Vincent M., E-mail: mellnickv@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Sicard, Gregorio A., E-mail: sicard@wudosis.wustl.edu [Washington University School of Medicine, Department of Surgery (United States); Narra, Vamsi R., E-mail: narrav@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

    2016-06-15

    Primary aortic neoplasms are rare. Aortic sarcoma arising after endovascular aneurysm repair (EVAR) is a scarce subset of primary aortic malignancies, reports of which are infrequent in the published literature. The diagnosis of aortic sarcoma is challenging due to its non-specific clinical presentation, and the prognosis is poor due to delayed diagnosis, rapid proliferation, and propensity for metastasis. Post-EVAR, aortic sarcomas may mimic other more common aortic processes on surveillance imaging. Radiologists are rarely knowledgeable about this rare entity for which multimodality imaging and awareness are invaluable in early diagnosis. A series of three pathologically confirmed cases are presented to display the multimodality imaging features and clinical presentations of aortic sarcoma arising after EVAR.

  11. Use of Suture-Mediated Closure Device in Percutaneous Direct Carotid Puncture During Chimney-Thoracic Endovascular Aortic Repair

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Gabriel, E-mail: dr.changabriel@gmail.com; Quek, Lawrence Hwee Han, E-mail: lawrence-quek@ttsh.com.sg [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore); Tan, Glenn Leong Wei, E-mail: glenn-tan@ttsh.com.sg [Tan Tock Seng Hospital, Department of General Surgery (Singapore); Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2016-07-15

    BackgroundInsertion of a carotid chimney graft during thoracic endovascular aortic repair (Ch-TEVAR) is a recognized technique to extend the proximal landing zone into the aortic arch in the treatment of thoracic aortic disease. Conventional technique requires surgical exposure of the carotid artery for insertion of the carotid chimney graft.MethodologyWe describe our experience in the use of a suture-mediated closure device in percutaneous Ch-TEVAR in four patients.ResultsSuccessful hemostasis was achieved in all four patients. No complications related to the carotid puncture were recorded.ConclusionWe conclude that using suture-mediated closure device for carotid closure appears feasible and deserves further studies as a potential alternative to conventional surgical approach.

  12. Successful Aortic Banding for Type IA Endoleak Due to Neck Dilatation after Endovascular Abdominal Aortic Aneurysm Repair: Case Report.

    Science.gov (United States)

    Tashima, Yasushi; Tamai, Koichi; Shirasugi, Takehiro; Sato, Kenichiro; Yamamoto, Takahiro; Imamura, Yusuke; Yamaguchi, Atsushi; Adachi, Hideo; Kobinata, Toshiyuki

    2017-09-25

    A 69-year-old man with a type IA endoleak that developed approximately 21 months after endovascular abdominal aortic aneurysm repair (EVAR) of a 46 mm diameter aneurysm was referred to our department. He had impaired renal function, Parkinson's disease, and previous cerebral infarction. Computed tomography angiography showed a type IA endoleak with neck dilatation and that the aneurysm had grown to 60 mm in diameter. We decided to perform aortic banding. The type IA endoleak disappeared after banding and the patient was discharged on postoperative day 10. Aortic banding may be effective for type IA endoleak after EVAR and less invasive for high-risk patients in particular.

  13. Retracted: Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair with Hyperbaric Oxygen and Therapeutic Hypothermia.

    Science.gov (United States)

    Urquieta, Emmanuel; Jye Poi, Mun; Varon, Joseph; Lin, Peter H

    2015-12-14

    This article has been officially retracted. The senior author, Emmanuel Urquieta, of the article entitled, "Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair with Hyperbaric Oxygen and Therapeutic Hypothermia," has requesed that the article, published online ahead of print (DOI: 10.1089/ther.2015.0025), be retracted because he discovered one of his coauthors mistakenly submitted the same article to the Journal of Vascular Surgery due to a miscommunication between them. The editorial leadership of Therapeutic Hypothermia and Temperature Management agree that the article must be retracted as a matter of proper scientific publishing protocol whereby an article may not be simultaneously submitted to two journals. The Editors commend Dr. Urquieta for willingly bringing this situation to their attention. Dr. Urquieta and his coauthors sincerely apologize to the Editors and the readership of Therapeutic Hypothermia and Temperature Management.

  14. The Burden of Hard Atherosclerotic Plaques Does Not Promote Endoleak Development After Endovascular Aortic Aneurysm Repair: A Risk Stratification

    International Nuclear Information System (INIS)

    Petersen, Johannes; Glodny, Bernhard

    2011-01-01

    Purpose: To objectify the influence of the atherosclerotic burden in the proximal landing zone on the development of endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) using objective aortic calcium scoring (ACS). Materials and Methods: This retrospective observation study included 267 patients who received an aortic endograft between 1997 and 2010 and for whom preoperative computed tomography (CT) was available to perform ACS using the CT-based V600 method. The mean follow-up period was 2 ± 2.3 years. Results: Type I endoleaks persisted in 45 patients (16.9%), type II in 34 (12.7%), type III in 8 (3%), and type IV or V in 3 patients, respectively (1.1% each). ACS in patients with type I endoleaks was not increased: 0.029 ± 0.061 ml compared with 0.075 ± 0.1349 ml in the rest of the patients, (p > 0.05; Whitney–Mann U-Test). There were significantly better results for the indication “traumatic aortic rupture” than for the other indications (p < 0.05). In multivariate logistic regression analyses, age was an independent risk factor for the development of type I endoleaks in the thoracic aorta (Wald 9.5; p = 0.002), whereas ACS score was an independent protective factor (Wald 6.9; p = 0.009). In the abdominal aorta, neither age nor ACS influenced the development of endoleaks. Conclusion: Contrary to previous assumptions, TEVAR and EVAR can be carried out without increasing the risk of an endoleak of any type, even if there is a high atherosclerotic “hard-plaque” burden of the aorta. The results are significantly better for traumatic aortic.

  15. Endovascular repair of postoperative vascular graft related complications after aorto-iliac surgery

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Andersen, P E; Larsen, K E

    2014-01-01

    with anastomotic pseudoaneurysms without leak, of which three had proximal anastomotic pseudoaneurysms and one had distal iliac anastomotic pseudoaneurysm. Implanted stent graft were Endurant (Medtronic) bifurcated endoprostheses in three patients and Excluder (Gore) prosthesis in a two cases. Tubular Medtronic...... endoprosthesis was implanted in one case and in two cases aortic cuff was used. Fluency periphery stent grafts were used in four cases. There was a 100% technical success. Intervention related early mortality was 8%. One patient with pseudoaneurysm died 28 months after endovascular treatment because of cardiac......-36 months) in the other 9 patients. There were no complications like endoleaks or limb occlusions. CONCLUSION: Endovascular treatment of vascular graft related postsurgical complications is a valuable therapeutic option followed by lower mortality and morbidity rates compared with re-operation. Short...

  16. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    NARCIS (Netherlands)

    Powell, J. T.; Sweeting, M. J.; Ulug, P.; Blankensteijn, J. D.; Lederle, F. A.; Becquemin, J.-P.; Greenhalgh, R. M.; Beard, J. D.; Buxton, M. J.; Brown, L. C.; Harris, P. L.; Rose, J. D. G.; Russell, I. T.; Sculpher, M. J.; Thompson, S. G.; Lilford, R. J.; Bell, P. R. F.; Whitaker, S. C.; Poole-Wilson, The Late P. A.; Ruckley, C. V.; Campbell, W. B.; Dean, M. R. E.; Ruttley, M. S. T.; Coles, E. C.; Halliday, A.; Gibbs, S. J.; Epstein, D.; Hannon, R. J.; Johnston, L.; Bradbury, A. W.; Henderson, M. J.; Parvin, S. D.; Shepherd, D. F. C.; Mitchell, A. W.; Edwards, P. R.; Abbott, G. T.; Higman, D. J.; Vohra, A.; Ashley, S.; Robottom, C.; Wyatt, M. G.; Byrne, D.; Edwards, R.; Leiberman, D. P.; McCarter, D. H.; Taylor, P. R.; Reidy, J. F.; Wilkinson, A. R.; Ettles, D. F.; Clason, A. E.; Leen, G. L. S.; Wilson, N. V.; Downes, M.; Walker, S. R.; Lavelle, J. M.; Gough, M. J.; McPherson, S.; Scott, D. J. A.; Kessell, D. O.; Naylor, R.; Sayers, R.; Fishwick, N. G.; Gould, D. A.; Walker, M. G.; Chalmers, N. C.; Garnham, A.; Collins, M. A.; Gaines, P. A.; Ashour, M. Y.; Uberoi, R.; Braithwaite, B.; Davies, J. N.; Travis, S.; Hamilton, G.; Platts, A.; Shandall, A.; Sullivan, B. A.; Sobeh, M.; Matson, M.; Fox, A. D.; Orme, R.; Yusef, W.; Doyle, T.; Horrocks, M.; Hardman, J.; Blair, P. H. B.; Ellis, P. K.; Morris, G.; Odurny, A.; Vohra, R.; Duddy, M.; Thompson, M.; Loosemore, T. M. L.; Belli, A. M.; Morgan, R.; Adiseshiah, M.; Brookes, J. A. S.; McCollum, C. N.; Ashleigh, R.; Aukett, M.; Baker, S.; Barbe, E.; Batson, N.; Bell, J.; Blundell, J.; Boardley, D.; Boyes, S.; Brown, O.; Bryce, J.; Carmichael, M.; Chance, T.; Coleman, J.; Cosgrove, C.; Curran, G.; Dennison, T.; Devine, C.; Dewhirst, N.; Errington, B.; Farrell, H.; Fisher, C.; Fulford, P.; Gough, M.; Graham, C.; Hooper, R.; Horne, G.; Horrocks, L.; Hughes, B.; Hutchings, T.; Ireland, M.; Judge, C.; Kelly, L.; Kemp, J.; Kite, A.; Kivela, M.; Lapworth, M.; Lee, C.; Linekar, L.; Mahmood, A.; March, L.; Martin, J.; Matharu, N.; McGuigen, K.; Morris-Vincent, P.; Murray, S.; Murtagh, A.; Owen, G.; Ramoutar, V.; Rippin, C.; Rowley, J.; Sinclair, J.; Spencer, S.; Taylor, V.; Tomlinson, C.; Ward, S.; Wealleans, V.; West, J.; White, K.; Williams, J.; Wilson, L.; Grobbee, D. E.; Bak, A. A. A.; Buth, J.; Pattynama, P. M.; Verhoeven, E. L. G.; van Voorthuisen, A. E.; Balm, R.; Cuypers, P. W. M.; Prinssen, M.; van Sambeek, M. R. H. M.; Baas, A. F.; Hunink, M. G.; van Engelshoven, J. M.; Jacobs, M. J. H. M.; de Mol, B. A. J. M.; van Bockel, J. H.; Reekers, J.; Tielbeek, X.; Wisselink, W.; Boekema, N.; Heuveling, L. M.; Sikking, I.; de Bruin, J. L.; Tielbeek, A. V.; Pattynama, P.; Prins, T.; van der Ham, A. C.; van der Velden, J. J. I. M.; van Sterkenburg, S. M. M.; ten Haken, G. B.; Bruijninckx, C. M. A.; van Overhagen, H.; Tutein Nolthenius, R. P.; Hendriksz, T. R.; Teijink, J. A. W.; Odink, H. F.; de Smet, A. A. E. A.; Vroegindeweij, D.; van Loenhout, R. M. M.; Rutten, M. J.; Hamming, J. F.; Lampmann, L. E. H.; Bender, M. H. M.; Pasmans, H.; Vahl, A. C.; de Vries, C.; Mackaay, A. J. C.; van Dortmont, L. M. C.; van der Vliet, A. J.; Schultze Kool, L. J.; Boomsma, J. H. B.; van Dop, H. R.; de Mol van Otterloo, J. C. A.; de Rooij, T. P. W.; Smits, T. M.; Yilmaz, E. N.; van den Berg, F. G.; Visser, M. J. T.; van der Linden, E.; Schurink, G. W. H.; de Haan, M.; Smeets, H. J.; Stabel, P.; van Elst, F.; Poniewierski, J.; Vermassen, F. E. G.; Freischlag, J. A.; Kohler, T. R.; Latts, E.; Matsumura, J.; Padberg, F. T.; Kyriakides, T. C.; Swanson, K. M.; Guarino, P.; Peduzzi, P.; Antonelli, M.; Cushing, C.; Davis, E.; Durant, L.; Joyner, S.; Kossack, The Late A.; LeGwin, Mary; McBride, V.; O'Connor, T.; Poulton, J.; Stratton, The Late S.; Zellner, S.; Snodgrass, A. J.; Thornton, J.; Haakenson, C. M.; Stroupe, K. T.; Jonk, Y.; Hallett, J. W.; Hertzer, N.; Towne, J.; Katz, D. A.; Karrison, T.; Matts, J. P.; Marottoli, R.; Kasl, S.; Mehta, R.; Feldman, R.; Farrell, W.; Allore, H.; Perry, E.; Niederman, J.; Randall, F.; Zeman, M.; Beckwith, The Late D.; O'Leary, T. J.; Huang, G. D.; Bader, M.; Ketteler, E. R.; Kingsley, D. D.; Marek, J. M.; Massen, R. J.; Matteson, B. D.; Pitcher, J. D.; Langsfeld, M.; Corson, J. D.; Goff, J. M.; Kasirajan, K.; Paap, C.; Robertson, D. C.; Salam, A.; Veeraswamy, R.; Milner, R.; Guidot, J.; Lal, B. K.; Busuttil, S. J.; Lilly, M. P.; Braganza, M.; Ellis, K.; Patterson, M. A.; Jordan, W. D.; Whitley, D.; Taylor, S.; Passman, M.; Kerns, D.; Inman, C.; Poirier, J.; Ebaugh, J.; Raffetto, J.; Chew, D.; Lathi, S.; Owens, C.; Hickson, K.; Dosluoglu, H. H.; Eschberger, K.; Kibbe, M. R.; Baraniewski, H. M.; Endo, M.; Busman, A.; Meadows, W.; Evans, M.; Giglia, J. S.; El Sayed, H.; Reed, A. B.; Ruf, M.; Ross, S.; Jean-Claude, J. M.; Pinault, G.; Kang, P.; White, N.; Eiseman, M.; Jones, The Late R.; Timaran, C. H.; Modrall, J. G.; Welborn, M. B.; Lopez, J.; Nguyen, T.; Chacko, J. K. Y.; Granke, K.; Vouyouka, A. G.; Olgren, E.; Chand, P.; Allende, B.; Ranella, M.; Yales, C.; Whitehill, T. A.; Krupski, The Late W. C.; Nehler, M. R.; Johnson, S. P.; Jones, D. N.; Strecker, P.; Bhola, M. A.; Shortell, C. K.; Gray, J. L.; Lawson, J. H.; McCann, R.; Sebastian, M. W.; Kistler Tetterton, J.; Blackwell, C.; Prinzo, P. A.; Lee, N.; Cerveira, J. J.; Zickler, R. W.; Hauck, K. A.; Berceli, S. A.; Lee, W. A.; Ozaki, C. K.; Nelson, P. R.; Irwin, A. S.; Baum, R.; Aulivola, B.; Rodriguez, H.; Littooy, F. N.; Greisler, H.; O'Sullivan, M. T.; Kougias, P.; Lin, P. H.; Bush, R. L.; Guinn, G.; Bechara, C.; Cagiannos, C.; Pisimisis, G.; Barshes, N.; Pillack, S.; Guillory, B.; Cikrit, D.; Lalka, S. G.; Lemmon, G.; Nachreiner, R.; Rusomaroff, M.; O'Brien, E.; Cullen, J. J.; Hoballah, J.; Sharp, W. J.; McCandless, J. L.; Beach, V.; Minion, D.; Schwarcz, T. H.; Kimbrough, J.; Ashe, L.; Rockich, A.; Warner-Carpenter, J.; Moursi, M.; Eidt, J. F.; Brock, S.; Bianchi, C.; Bishop, V.; Gordon, I. L.; Fujitani, R.; Kubaska, S. M.; Behdad, M.; Azadegan, R.; Ma Agas, C.; Zalecki, K.; Hoch, J. R.; Carr, S. C.; Acher, C.; Schwarze, M.; Tefera, G.; Mell, M.; Dunlap, B.; Rieder, J.; Stuart, J. M.; Weiman, D. S.; Abul-Khoudoud, O.; Garrett, H. E.; Walsh, S. M.; Wilson, K. L.; Seabrook, G. R.; Cambria, R. A.; Brown, K. R.; Lewis, B. D.; Framberg, S.; Kallio, C.; Barke, R. A.; Santilli, S. M.; d'Audiffret, A. C.; Oberle, N.; Proebstle, C.; Johnson, L. L.; Jacobowitz, G. R.; Cayne, N.; Rockman, C.; Adelman, M.; Gagne, P.; Nalbandian, M.; Caropolo, L. J.; Pipinos, I. I.; Johanning, J.; Lynch, T.; DeSpiegelaere, H.; Purviance, G.; Zhou, W.; Dalman, R.; Lee, J. T.; Safadi, B.; Coogan, S. M.; Wren, S. M.; Bahmani, D. D.; Maples, D.; Thunen, S.; Golden, M. A.; Mitchell, M. E.; Fairman, R.; Reinhardt, S.; Wilson, M. A.; Tzeng, E.; Muluk, S.; Peterson, N. M.; Foster, M.; Edwards, J.; Moneta, G. L.; Landry, G.; Taylor, L.; Yeager, R.; Cannady, E.; Treiman, G.; Hatton-Ward, S.; Salabsky, The Late B.; Kansal, N.; Owens, E.; Estes, M.; Forbes, B. A.; Sobotta, C.; Rapp, J. H.; Reilly, L. M.; Perez, S. L.; Yan, K.; Sarkar, R.; Dwyer, S. S.; Perez, S.; Chong, K.; Hatsukami, T. S.; Glickerman, D. G.; Sobel, M.; Burdick, T. S.; Pedersen, K.; Cleary, P.; Back, M.; Bandyk, D.; Johnson, B.; Shames, M.; Reinhard, R. L.; Thomas, S. C.; Hunter, G. C.; Leon, L. R.; Westerband, A.; Guerra, R. J.; Riveros, M.; Mills, J. L.; Hughes, J. D.; Escalante, A. M.; Psalms, S. B.; Day, N. N.; Macsata, R.; Sidawy, A.; Weiswasser, J.; Arora, S.; Jasper, B. J.; Dardik, A.; Gahtan, V.; Muhs, B. E.; Sumpio, B. E.; Gusberg, R. J.; Spector, M.; Pollak, J.; Aruny, J.; Kelly, E. L.; Wong, J.; Vasilas, P.; Joncas, C.; Gelabert, H. A.; DeVirgillio, C.; Rigberg, D. A.; Cole, L.; Marzelle, J.; Sapoval, M.; Favre, J.-P.; Watelet, J.; Lermusiaux, P.; Lepage, E.; Hemery, F.; Dolbeau, G.; Hawajry, N.; Cunin, P.; Harris, P.; Stockx, L.; Chatellier, G.; Mialhe, C.; Fiessinger, J.-N.; Pagny, L.; Kobeiter, H.; Boissier, C.; Lacroix, P.; Ledru, F.; Pinot, J.-J.; Deux, J.-F.; Tzvetkov, B.; Duvaldestin, P.; Jourdain, C.; DAVID, V.; Enouf, D.; Ady, N.; Krimi, A.; Boudjema, N.; Jousset, Y.; Enon, B.; Blin, V.; Picquet, J.; L'Hoste, P.; Thouveny, F.; Borie, H.; Kowarski, S.; Pernes, J.-M.; Auguste, M.; Desgranges, P.; Allaire, E.; Meaulle, P.-Y.; Chaix, D.; Juliae, P.; Fabiani, J. N.; Chevalier, P.; Combes, M.; Seguin, A.; Belhomme, D.; Baque, J.; Pellerin, O.; Favre, J. P.; Barral, X.; Veyret, C.; Peillon, C.; Plissonier, D.; Thomas, P.; Clavier, E.; Martinez, R.; Bleuet, F.; C, Dupreix; Verhoye, J. P.; Langanay, T.; Heautot, J. F.; Koussa, M.; Haulon, S.; Halna, P.; Destrieux, L.; Lions, C.; Wiloteaux, S.; Beregi, J. P.; Bergeron, P.; Patra, P.; Costargent, A.; Chaillou, P.; D'Alicourt, A.; Goueffic, Y.; Cheysson, E.; Parrot, A.; Garance, P.; Demon, A.; Tyazi, A.; Pillet, J.-C.; Lescalie, F.; Tilly, G.; Steinmetz, E.; Favier, C.; Brenot, R.; Krause, D.; Cercueil, J. P.; Vahdat, O.; Sauer, M.; Soula, P.; Querian, A.; Garcia, O.; Levade, M.; Colombier, D.; Cardon, J.-M.; Joyeux, A.; Borrelly, P.; Dogas, G.; Magnan, P.-É; Branchereau, A.; Bartoli, J.-M.; Hassen-Khodja, R.; Batt, M.; Planchard, P.-F.; Bouillanne, P.-J.; Haudebourg, P.; Bayne, J.; Gouny, P.; Badra, A.; Braesco, J.; Nonent, M.; Lucas, A.; Cardon, A.; Kerdiles, Y.; Rolland, Y.; Kassab, M.; Brillu, C.; Goubault, F.; Tailboux, L.; Darrieux, H.; Briand, O.; Maillard, J.-C.; Varty, K.; Cousins, C.

    2017-01-01

    The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair

  17. Surgical treatment and thoracic endovascular aortic repair in type A aortic dissection in a pregnant patient with Marfan syndrome.

    Science.gov (United States)

    Sterner, Doerthe; Probst, Chris; Mellert, Friedrich; Schiller, Wolfgang

    2014-07-01

    We report an acute aortic dissection type Stanford A extending down to both iliac arteries affecting a 32-year-old woman suspected to have Marfan syndrome during week 37 of pregnancy. In a multidisciplinary approach, and emergency Cesarean section was performed followed by an abdominal hysterectomy and a valve-sparing aortic root replacement using a reimplantation technique. The aorta was replaced up to the hemi arch. Because of the high suspicion of visceral ischemia as confirmed ex juvantibus, an endovascular stent graft was implanted. Molecular testing revealed a frameshift mutation and confirmed the diagnosis of Marfan syndrome. Both the patient and her healthy child underwent an uneventful recovery. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Carbon dioxide (CO2) angiography as an option for endovascular abdominal aortic aneurysm repair (EVAR) in patients with chronic kidney disease (CKD).

    Science.gov (United States)

    De Angelis, Chiara; Sardanelli, Francesco; Perego, Matteo; Alì, Marco; Casilli, Francesco; Inglese, Luigi; Mauri, Giovanni

    2017-11-01

    To assess feasibility, efficacy and safety of carbon dioxide (CO 2 ) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6 ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO 2 angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0 ± 8.0 mm. CO 2 angiography was performed by automatic (n = 7) or hand (n = 6) injection. The endograft was correctly placed and the AAA was excluded in all cases, without any surgical conversions. Two patients (15.4%) had an endoleak: one type-Ia, detected by CO 2 -DSA and effectively treated with prosthesis dilatation; one type-III, detected by CO 2 -DSA, confirmed using 10 ml of ICM, and conservatively managed. In one patient, CO 2 angiograms were considered of too low quality for guiding the procedure and 200 ml of ICM were administered. Overall, 11 patients (84.6%) underwent a successful EVAR under the guidance of the sole CO 2 angiography. No patients suffered from major complications, including those typically CO 2 -related. Two patients suffered from abdominal pain during the procedure secondary to a transient splanchnic perfusion's reduction due to CO 2 , and one patient had a worsening of renal function probably caused by a cholesterol embolization during the procedure. In patients with CKD, EVAR under CO 2 angiography guidance is feasible, effective, and safe.

  19. The Impact of Centralisation and Endovascular Aneurysm Repair on Treatment of Ruptured Abdominal Aortic Aneurysms Based on International Registries.

    Science.gov (United States)

    Budtz-Lilly, Jacob; Björck, Martin; Venermo, Maarit; Debus, Sebastian; Behrendt, Christian-Alexander; Altreuther, Martin; Beiles, Barry; Szeberin, Zoltan; Eldrup, Nikolaj; Danielsson, Gudmundur; Thomson, Ian; Wigger, Pius; Khashram, Manar; Loftus, Ian; Mani, Kevin

    2018-02-23

    Current management of ruptured abdominal aortic aneurysms (RAAA) varies among centres and countries, particularly in the degree of implementation of endovascular aneurysm repair (EVAR) and levels of vascular surgery centralisation. This study assesses these variations and the impact they have on outcomes. RAAA repairs from vascular surgical registries in 11 countries, 2010-2013, were investigated. Data were analysed overall, per country, per treatment modality (EVAR or open aortic repair [OAR]), centre volume (quintiles IV), and whether centres were predominantly EVAR (≥50% of RAAA performed with EVAR [EVAR(p)]) or predominantly OAR [OAR(p)]. Primary outcome was peri-operative mortality. Data are presented as either mean values or percentages with 95% CI within parentheses, and compared with chi-square tests, as well as with adjusted OR. There were 9273 patients included. Mean age was 74.7 (74.5-74.9) years, and 82.7% of patients were men (81.9-83.6). Mean AAA diameter at rupture was 7.6 cm (7.5-7.6). Of these aneurysms, 10.7% (10.0-11.4) were less than 5.5 cm. EVAR was performed in 23.1% (22.3-24.0). There were 6817 procedures performed in OAR(p) centres and 1217 performed in EVAR(p) centres. Overall peri-operative mortality was 28.8% (27.9-29.8). Peri-operative mortality for OAR was 32.1% (31.0-33.2) and for EVAR 17.9% (16.3-19.6), p  22 repairs per year), 23.3% (21.2-25.4) than in QII-V, 30.0% (28.9-31.1), p < .001. Peri-operative mortality after OAR was lower in high volume centres compared with the other centres, 25.3% (23.0-27.6) and 34.0% (32.7-35.4), respectively, p < .001. There was no significant difference in peri-operative mortality after EVAR between centres based on volume. Peri-operative mortality is lower in centres with a primary EVAR approach or with high case volume. Most repairs, however, are still performed in low volume centres and in centres with a primary OAR strategy. Reorganisation of acute vascular surgical services may improve

  20. Systolic Sac Pressure Index for the Prediction of Persistent Type II Endoleak for 12 Months After Endovascular Abdominal Aortic Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Ikoma, Akira, E-mail: yfb04322@nifty.com; Nakai, Motoki, E-mail: momonga@wakayama-med.ac.jp; Sato, Morio, E-mail: morisato@wakayama-med.ac.jp; Sato, Hirotatsu, E-mail: kuppa1220@yahoo.co.jp; Minamiguchi, Hiroki, E-mail: hiromina4@hotmail.com; Sonomura, Tetsuo, E-mail: sonomura@wakayama-med.ac.jp [Wakayama Medical University, Departments of Radiology (Japan); Nishimura, Yoshiharu, E-mail: nishim-y@wakayama-med.ac.jp; Okamura, Yoshitaka, E-mail: y-ok@wakayama-med.ac.jp [Wakayama Medical University, Thoracic and Cardiovascular Surgery (Japan)

    2016-04-15

    PurposeTo assess the relationship between the systolic sac pressure index (SPI) and the presence of endoleaks 12 months after endovascular abdominal aortic aneurysm repair (EVAR).Materials and MethodsWe performed a single-center prospective trial of consecutively treated patients. SPI (calculated as systolic sac pressure/systolic aortic pressure) was measured by catheterization immediately after EVAR. Contrast-enhanced computed tomography was scheduled 12 months after EVAR to detect possible endoleaks.ResultsData were available for 34 patients who underwent EVAR for an AAA. Persisting type II endoleak was found in 8 patients (endoleak-positive group) but not in the other 26 patients (endoleak-negative group). The mean ± standard deviation SPI was significantly greater in the endoleak-positive group than in the endoleak-negative group (0.692 ± 0.048 vs. 0.505 ± 0.081, respectively; P = .001). Receiver-operating characteristic curve analysis revealed that an SPI of 0.638 was the optimum cutoff value for predicting a persistent endoleak at 12 months with high accuracy (0.971; 33/34), sensitivity (1.00), and specificity (0.962) values. The mean change in AAA diameter was −4.28 ± 5.03 mm and 2.22 ± 4.54 mm in patients with SPI of <0.638 or ≥0.638, respectively (P = .002).ConclusionPatients with an SPI of ≥0.638 immediately after EVAR were more likely to have a persistent type II endoleak at 12 months with an accuracy of 0.971, and showed increases in aneurysm sac diameter compared with patients with an SPI of <0.638.

  1. The Influence of 4 or more Patent Lumbar Arteries on Persistent Type II Endoleak and Sac Expansion after Endovascular Aneurysm Repair.

    Science.gov (United States)

    Seike, Yoshimasa; Matsuda, Hitoshi; Fukuda, Tetsuya; Inoue, Yosuke; Omura, Atsushi; Uehara, Kyokun; Sasaki, Hiroaki; Kobayashi, Junjiro

    2018-03-06

    This study aimed to review our clinical results and determine how preoperative patent lumbar arteries (LAs) influence the occurrence of type II endoleaks or aneurysm sac enlargement after endovascular aneurysm repair (EVAR) and to identify the preoperative computed tomography findings of persistent type II endoleaks from patent LAs that indicate the need for preventive procedures during EVAR. A total of 293 patients who underwent EVAR for infrarenal abdominal aortic aneurysm (AAA) between August 2007 and July 2013 were reviewed. Follow-up data were available for 194 patients (76% male, mean age 78 ± 6.8 years), and the mean follow-up time was 57 ± 23 months. The number of patent LAs was identified as a significant positive predictor of persistent type II endoleaks (hazard ratio [HR], 1.4; 95% confidence interval [CI]: 1.2-1.7; P patent LAs resulted in a sensitivity of 87% and specificity of 48%. The rates of freedom from sac enlargement (≥5 mm) at 3 and 5 years after EVAR were significantly lower in patients with 4 or more patent LAs than in those with fewer (90% and 76% vs. 96% and 89%; P = 0.0008). The number of patent LAs is associated as a significant risk factor with the development of persistent type II endoleaks and sac enlargement after EVAR. Four or more patent LAs should be recognized as the group having an elevated risk of developing late sac enlargement after EVAR. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Intensive care unit admission after endovascular aortic aneurysm repair is primarily determined by hospital factors, adds significant cost, and is often unnecessary.

    Science.gov (United States)

    Hicks, Caitlin W; Alshaikh, Husain N; Zarkowsky, Devin; Bostock, Ian C; Nejim, Besma; Malas, Mahmoud B

    2018-04-01

    A large proportion of endovascular aortic aneurysm repair (EVAR) patients are routinely admitted to the intensive care unit (ICU) for postoperative observation. In this study, we aimed to describe the factors associated with ICU admission after EVAR and to compare the outcomes and costs associated with ICU vs non-ICU observation. All patients undergoing elective infrarenal EVAR in the Premier database (2009-2015) were included. Patients were stratified as ICU vs non-ICU admission according to location on postoperative day 0. Both patient-level (sociodemographics, comorbidities) and hospital-level (teaching status, hospital size, geographic location) factors were analyzed using univariate and multivariable logistic regression to determine factors associated with ICU vs non-ICU admission. Overall outcomes and hospital costs were compared between groups. Overall, 8359 patients underwent elective EVAR during the study period, including 4791 (57.3%) ICU and 3568 (42.7%) non-ICU admissions. Patients admitted to ICU were more frequently nonwhite and had more comorbidities, including congestive heart failure, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, and hypertension, than non-ICU patients (all, P postoperative adverse events, ICU admission after EVAR cost $1475 (95% confidence interval, $768-2183) more than non-ICU admission (P postoperative ICU admission is more closely associated with hospital practice patterns than with individual patient risk. Routine ICU admission after EVAR adds significant cost without reducing failure to rescue or in-hospital mortality. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  3. Hygroma following endovascular femoral aneurysm exclusion

    DEFF Research Database (Denmark)

    Wad, Morten; Pedersen, Brian Lindegaard; Lönn, Lars

    2013-01-01

    Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.......Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory....

  4. 3-D quantification of the aortic arch morphology in 3-D CTA data for endovascular aortic repair.

    Science.gov (United States)

    Wörz, Stefan; von Tengg-Kobligk, Hendrik; Henninger, Verena; Rengier, Fabian; Schumacher, Hardy; Böckler, Dittmar; Kauczor, Hans-Ulrich; Rohr, Karl

    2010-10-01

    We introduce a new model-based approach for the segmentation and quantification of the aortic arch morphology in 3-D computed tomography angiography (CTA) data for thoracic endovascular aortic repair (TEVAR). The approach is based on a model-fitting scheme using a 3-D analytic intensity model for thick vessels in conjunction with a two-step refinement procedure, and allows us to accurately quantify the morphology of the aortic arch. Based on the fitting results, we additionally compute the (local) 3-D vessel curvature and torsion as well as the relevant lengths not only along the 3-D centerline, but particularly also along the inner and outer contour. These measurements are important for preoperative planning in TEVAR applications. We have validated our approach based on 3-D synthetic as well as 3-D MR phantom images. Moreover, we have successfully applied our approach using 3-D CTA datasets of the human thorax and have compared the results with ground truth obtained by a radiologist. We have also performed a quantitative comparison with a commercial vascular analysis software.

  5. Patient-specific analysis of post-operative aortic hemodynamics: a focus on thoracic endovascular repair (TEVAR)

    Science.gov (United States)

    Auricchio, F.; Conti, M.; Lefieux, A.; Morganti, S.; Reali, A.; Sardanelli, F.; Secchi, F.; Trimarchi, S.; Veneziani, A.

    2014-10-01

    The purpose of this study is to quantitatively evaluate the impact of endovascular repair on aortic hemodynamics. The study addresses the assessment of post-operative hemodynamic conditions of a real clinical case through patient-specific analysis, combining accurate medical image analysis and advanced computational fluid-dynamics (CFD). Although the main clinical concern was firstly directed to the endoluminal protrusion of the prosthesis, the CFD simulations have demonstrated that there are two other important areas where the local hemodynamics is impaired and a disturbed blood flow is present: the first one is the ostium of the subclavian artery, which is partially closed by the graft; the second one is the stenosis of the distal thoracic aorta. Besides the clinical relevance of these specific findings, this study highlights how CFD analyses allow to observe important flow effects resulting from the specific features of patient vessel geometries. Consequently, our results demonstrate the potential impact of computational biomechanics not only on the basic knowledge of physiopathology, but also on the clinical practice, thanks to a quantitative extraction of knowledge made possible by merging medical data and mathematical models.

  6. The Role of Learning in Health Technology Assessments: An Empirical Assessment of Endovascular Aneurysm Repairs in German Hospitals.

    Science.gov (United States)

    Varabyova, Yauheniya; Blankart, Carl Rudolf; Schreyögg, Jonas

    2017-02-01

    Changes in performance due to learning may dynamically influence the results of a technology evaluation through the change in effectiveness and costs. In this study, we estimate the effect of learning using the example of two minimally invasive treatments of abdominal aortic aneurysms: endovascular aneurysm repair (EVAR) and fenestrated EVAR (fEVAR). The analysis is based on the administrative data of over 40,000 patients admitted with unruptured abdominal aortic aneurysm to more than 500 different hospitals over the years 2006 to 2013. We examine two patient outcomes, namely, in-hospital mortality and length of stay using hierarchical regression models with random effects at the hospital level. The estimated models control for patient and hospital characteristics and take learning interdependency between EVAR and fEVAR into account. In case of EVAR, we observe a significant decrease both in the in-hospital mortality and length of stay with experience accumulated at the hospital level; however, the learning curve for fEVAR in both outcomes is effectively flat. To foster the consideration of learning in health technology assessments of medical devices, a general framework for estimating learning effects is derived from the analysis. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

  7. Graft Distortion After Endovascular Repair of Abdominal Aortic Aneurysm: Association with Sac Morphology and Mid-Term Complications

    International Nuclear Information System (INIS)

    Gould, Derek Alan; Edwards, Richard David; McWilliams, Richard Gregory; Rowlands, Peter Christopher; Martin, Janis; White, Donagh; Fear, Simon; Bakran, Ali; Brennan, John; Gilling-Smith, Geoffrey; Harris, Peter Lyon

    2000-01-01

    Purpose: To investigate the incidence, significance, and mechanism of stent-graft distortion after endovascular repair (EVR) of abdominal aortic aneurysm.Methods: EVR of abdominal aortic aneurysm was performed in 51 cases (49 modular, bifurcated; 2 tube). Thirty-two patients were followed for 6 or more months and had equivalent baseline and follow-up images which could be used to determine changes in graft configuration. Sac dimensions were measured using computed tomographic (CT) images and graft-related complications were recorded.Results: Amongst 32 patients evaluated on follow-up, there was graft distortion in 24. Distorted grafts were significantly (p= 0.002) associated with sac diameter reduction (mean 5 mm) and sac length reduction (mean 8.1 mm). All graft-related complications occurred in the limbs of eight distorted grafts, with a mean reduction of sac length in this group of 7.8 mm on reformatted CT images.Conclusion: There was a highly significant association between graft distortion and limb complications, and reduced sac dimensions

  8. Validation of the Simbionix PROcedure Rehearsal Studio sizing module: A comparison of software for endovascular aneurysm repair sizing and planning.

    Science.gov (United States)

    Velu, Juliëtte F; Groot Jebbink, Erik; de Vries, Jean-Paul P M; Slump, Cornelis H; Geelkerken, Robert H

    2017-02-01

    An important determinant of successful endovascular aortic aneurysm repair is proper sizing of the dimensions of the aortic-iliac vessels. The goal of the present study was to determine the concurrent validity, a method for comparison of test scores, for EVAR sizing and planning of the recently introduced Simbionix PROcedure Rehearsal Studio (PRORS). Seven vascular specialists analyzed anonymized computed tomography angiography scans of 70 patients with an infrarenal aneurysm of the abdominal aorta, using three different sizing software packages Simbionix PRORS (Simbionix USA Corp., Cleveland, OH, USA), 3mensio (Pie Medical Imaging BV, Maastricht, The Netherlands), and TeraRecon (Aquarius, Foster City, CA, USA). The following measurements were included in the protocol: diameter 1 mm below the most distal main renal artery, diameter 15 mm below the lowest renal artery, maximum aneurysm diameter, and length from the most distal renal artery to the left iliac artery bifurcation. Averaged over the locations, the intraclass correlation coefficient is 0.83 for Simbionix versus 3mensio, 0.81 for Simbionix versus TeraRecon, and 0.86 for 3mensio versus TeraRecon. It can be concluded that the Simbionix sizing software is as precise as two other validated and commercially available software packages.

  9. Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

    International Nuclear Information System (INIS)

    England, Andrew; Butterfield, John S.; McCollum, Charles N.; Ashleigh, Raymond J.

    2008-01-01

    The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters 18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs ≥18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs ≥18 mm (p = 0.232). One-year freedom from IRSI was 92% ± 3% and 84% ± 9% for the <18-mm and ≥18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

  10. Can Surgeons Assess CT Suitability for Endovascular Repair (EVAR) in Ruptured Abdominal Aortic Aneurysm? Implications for a Ruptured EVAR Trial

    International Nuclear Information System (INIS)

    Rayt, Harjeet; Lambert, Kelly; Bown, Matthew; Fishwick, Guy; Morgan, Robert; McCarthy, Mark; London, Nick; Sayers, Robert

    2008-01-01

    The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% of cases (95% CI, 23.1-68.5%; 9/20 scans; κ = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.

  11. Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair

    International Nuclear Information System (INIS)

    Belenky, Alexander; Haddad, Menashe; Idov, Igor; Knizhnik, Michael; Litvin, Sergey; Bachar, Gil N.; Atar, Eli

    2009-01-01

    The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization-only if the superior and inferior mesenteric arteries are patent-is a good and safe way to elongate the neck and enable EVAR.

  12. Mortalidade relacionada ao tratamento endovascular do aneurisma da aorta abdominal com o uso dos modelos revisados Procedure-related mortality of endovascular abdominal aortic aneurysm repair using revised reporting standards

    Directory of Open Access Journals (Sweden)

    Gosen Gabriel Konig

    2007-03-01

    Full Text Available OBJETIVO: O objetivo do estudo foi avaliar a definição da mortalidade relacionada ao procedimento após tratamento endovascular do aneurisma de aorta abdominal (EVAR como definido pelo Committee for Standardized Reporting Practices in Vascular Surgery. MÉTODO: Dados de pacientes com aneurisma de aorta abdominal foram analisados do banco de dados EUROSTAR. Os pacientes foram submetidos ao EVAR entre junho de 1996 a fevereiro de 2004 e foram estudados retrospectivamente. A probabilidade explicita da causa de morte foi registrada. O intervalo entre a operação, alta hospitalar ou intervenção secundária até a morte foi registrado. RESULTADOS: De um total de 5612 pacientes, 589 (10,5% faleceram após o EVAR em acompanhamento total e qualquer causa de morte foi inclusa. Cento e quarenta e um pacientes (12,5% morreram devido a causa relacionada ao aneurisma, sendo que 28 (4,8% foram rupturas, 25 (4,2% infecções do implante e 88 (14,9% foram pacientes que morreram num prazo de 30 dias após o procedimento inicial (definição atualmente utilizada, também conhecido como resultado clínico a curto prazo. Além disso, 25 pacientes faleceram após 30 dias, mas continuavam ainda hospitalizados (ou transferidos a home-care para reavaliação posterior, ou necessitaram intervenção secundária. Levando em conta a duração da admissão ao hospital e a mortalidade imediata após o procedimento relacionada a intervenções secundárias, 49 mortes tardias também podem ser relacionadas ao EVAR. CONCLUSÃO: Morte tardia compõe uma proporção considerável da mortalidade relacionada ao EVAR dentro do tempo de análise revisado.OBJECTIVE: The aim of this study was to evaluate the definition of Procedure-related mortality after endovascular aneurysm repair (EVAR as defined by the Committee for Standardized Reporting Practices in Vascular Surgery. METHODS: Data on patients with an AAA were taken from the EUROSTAR database. The patients underwent EVAR

  13. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    NARCIS (Netherlands)

    Powell, Janet T; Sweeting, Michael J; Ulug, P; Blankensteijn, Jan D.; Lederle, F A; Becquemin, J.P.; Greenhalgh, R.M.; Grobbee, DE|info:eu-repo/dai/nl/071889256

    BACKGROUND: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. METHODS: An individual-patient data meta-analysis of four multicentre randomized trials of EVAR

  14. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    NARCIS (Netherlands)

    J.T. Powell (Janet); Sweeting, M.J.; Ulug, P.; Blankensteijn, J.D.; F.A. Lederle (Frank); Becquemin, J.-P.; Greenhalgh, R.M.

    2017-01-01

    textabstractBackground: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods: An individual-patient data meta-analysis of four multicentre randomized

  15. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    NARCIS (Netherlands)

    Powell, J.T.; Sweeting, M.J.; Ulug, P.; Blankensteijn, J.D.; Lederle, F.A.; Becquemin, J.P.; Greenhalgh, R.M.; Evar, D.O.; Schultze Kool, L.J.; et al.,

    2017-01-01

    BACKGROUND: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. METHODS: An individual-patient data meta-analysis of four multicentre randomized trials of EVAR

  16. The education system to master endovascular aortic repair in Japan - the Japanese Committee for Stentgraft Management.

    Science.gov (United States)

    Obitsu, Y; Ishimaru, S; Shigematsu, H

    2010-03-01

    The Japanese Committee for Stentgraft Management (JACSM) was established with the aim of ensuring the safe and proper reach of commercial stent grafts following their regulatory approval. This study examines the validity of the practice standards developed by JACSM. JACSM comprises 10 associations related to endovascular treatment. Based on the practice standards developed by JACSM, the status of practising institutions, practising surgeons, supervising surgeons and the results of follow-up surveys were analysed. In the 2.5 years following the establishment of JACSM, 298 institutions have fulfilled the practice standards. The number of practising surgeons reached 493, and the number of supervising surgeons reached 177. There were 3089 registered cases up to June 2009. The present study analysed 1570 cases registered in the 2 years from July 2006 to June 2008. The hospital mortality rate was low (0.4%) in the follow-up surveys. Early results following the introduction of stent grafts were generally good. The procedure spread safely without the learning curve seen in the initial stages following introduction of new medical materials, indicating that the practice standards were appropriate.

  17. A ruptured pancreaticoduodenal artery aneurysm repaired by combined endovascular and open techniques.

    Science.gov (United States)

    Teng, Wang; Sarfati, Mark R; Mueller, Michelle T; Kraiss, Larry W

    2006-11-01

    Aneurysms of the pancreaticoduodenal arteries (PDA) are rare, accounting for man was transferred to our hospital with a 1-day history of abdominal pain and syncope. On admission, an abdominal and pelvis computerized tomographic (CT) scan identified a large mesenteric hematoma, a 1.9 cm PDA aneurysm, and an occluded celiac axis. Mesenteric angiography revealed no active aneurysm leak and a stenotic superior mesenteric artery (SMA) origin. All hepatic blood flow originated from the stenotic SMA via markedly enlarged PDA collaterals. The patient was brought to the operating room, where absence of the celiac axis was confirmed. An aorto-to-proper hepatic and SMA bypass was performed using a bifurcated polyester graft. The next day, the patient was brought to the angiography suite, where the PDA aneurysm was coiled. Postprocedure CT scans confirmed thrombosis of the aneurysm. Ruptured mesenteric artery aneurysms are a challenging problem for the vascular surgeon. PDA aneurysms are rare and often occur in an unfavorable location. There appears to be an association with anatomic anomalies of the mesenteric circulation. Prompt invasive and noninvasive diagnostic studies aid in the definitive management of this often fatal problem. Combined endovascular and open techniques can be used for successful treatment.

  18. Celiac Artery Stenting in the Treatment of Intestinal Ischemia Due to the Sacrifice of the Dominant Inferior Mesenteric Artery During Endovascular Aortic Repair.

    Science.gov (United States)

    Su, Zijie; Pan, Tianyue; Lian, Weishuai; Guo, Daqiao; Dong, Zhihui; Fu, Weiguo

    2016-08-01

    A 42-year-old man had intestinal ischemia 7 weeks after endovascular abdominal aortic aneurysm repair due to sacrifice of the inferior mesenteric artery, which had compensated for the intestinal blood supply because of the total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). He was diagnosed in the active phase of Takayasu arteritis, and an emergency endovascular treatment was performed. After the SMA failed to be recanalized, a stent was successfully placed into the CA; this choice was made based on the preexisting collaterals between them. The symptoms were relieved shortly after the operation. The Kirk arcade, the Barkow arcade, and the enlarged pancreaticoduodenal arcade were visualized on the follow-up computed tomography angiography. Based on this case, a short review of celiomesenteric and intermesenteric collateral circulations is presented. © The Author(s) 2016.

  19. Endovascular Repair of Ascending Aortic Pseudoaneurysm With Custom-Designed Endograft.

    Science.gov (United States)

    Piffaretti, Gabriele; Cottini, Marzia; Carrafiello, Gianpaolo; Castelli, Patrizio; Beghi, Cesare; Mariscalco, Giovanni

    2015-08-01

    Open repair of ascending aortic pseudoaneurysm (AscAP) carries high risks and mortality rate. Previous papers reported the off-label use of standard thoracic or abdominal endograft in very selected cases. We present the case of a 57-year-old man with an AscAP successfully managed with a new custom-designed endograft. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Endovascular repair of thoracoabdominal aortic aneurysms with a novel multibranch stent-graft design: preliminary experience.

    Science.gov (United States)

    Kinstner, C; Teufelsbauer, H; Neumayer, C; Domenig, C; Wressnegger, A; Wolf, F; Funovics, M

    2014-08-01

    The aim of this paper was to report our preliminary experience in outcome, safety and mid-term results in the treatment of thoracoabdominal aortic aneurysms (TAAA) with a novel multibranchstentgraft (E-xtra DESIGN ENGINEERING, JOTEC, Germany). Eight patients (mean age 66 years, 2 female) with TAAA (Crawford type I: 2 cases, type III: 3 cases, type IV: 3 cases), mean aneurysm diameter 61 mm, growth over 5 mm per year were treated. Implantation was performed under general anesthesia and surgical exposition of the common femoral artery. Brachial access was percutaneous in 5/8 patients. Balloon-expandable (Advanta V12) bridging stent-grafts were employed and lined with self-expanding nitinol stents. All patients except type IV TAAA received a spinal drainage catheter. The device was successfully deployed in 8/8 patients. 29/32 visceral branches were engaged. One stenosed celiac trunk was left untreated without further consequences, two renal arteries which could not be cannulated were revascularized with iliorenal bypass. One patient needed surgical revision of groin hematoma, one patient suffered from permanent protopathic sensory deficit. No renal complications occurred. Since the primary implantation was deliberately kept short and amount of contrast agent was minimised, four patients needed a secondary percutaneous procedure (Palmaz stent implantation for type I endoleak, re-PTA or additional bridging stent-graft implantation for type III endoleak). The assisted primary success rate was 8/8. Mean follow-up was 18 months. Success was stable in 7/8 patients, one patient shows type V endoleak with 5mm sac expansion. No mortality or complication occurred during follow-up. The JOTEC E-xtra DESIGN ENGINEERING multibranch stent-graft is a promising new candidate for endovascular TAAA treatment with sufficient safety and efficacy. Its short delivery time suggests its use in patients with rapid aneurysm growth or high anxiety.

  1. Correção endovascular de dissecção de aorta ascendente Endovascular repair of ascending aortic dissection

    Directory of Open Access Journals (Sweden)

    José Carlos Dorsa Vieira Pontes

    2013-03-01

    Full Text Available Paciente de 84 anos com dissecção de aorta torácica tipo A de Stanford comprometendo todo o arco aórtico e aorta descendente. Proposto e aceito o tratamento endovascular em função da gravidade do quadro clínico. Procedeu-se à dissecção das artérias femorais comum bilateralmente. A aortografia confirmou a exclusão da falsa luz e a patência dos óstios coronarianos.Woman, 84 years-old, with Stanford type A thoracic aortic dissection committing aortic arch and descending aorta. Proposed and accepted endovascular treatment according to the severity of the clinical picture. Common femoral artery dissection bilaterally was done. Aortography confirmed the exclusion of the false lumen and patency of the coronary ostia.

  2. Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank.

    Science.gov (United States)

    Reuben, Brian C; Whitten, Matthew G; Sarfati, Mark; Kraiss, Larry W

    2007-12-01

    The application of endovascular technology for the emergency treatment of traumatic vascular injuries is a new frontier. This study examines recent nationwide use of endovascular therapy in acute arterial traumatic injuries. This retrospective study used the National Trauma Data Bank (NTDB). Cases with a diagnosis of arterial vascular injury were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification, and procedure codes for endovascular therapy were selected. A descriptive analysis and multiple regressions were performed to identify variables predictive of outcomes. From 1994 to 2003, 12,732 arterial injuries were identified. Between 1997 (when the first endovascular repair was recorded in the NTDB) and 2003, 7286 open arterial repairs and 281 endovascular repairs were recorded for an overall utilization rate for endovascular procedures of 3.7%. The yearly number of endovascular procedures registered in the NTDB increased 27-fold, from four in 1997 to 107 in 2003. Use of stents substantially increased from 12 in 2000 to 30 in 2003; endograft use increased from one in 2000 to 37 in 2003. Nearly equal numbers of blunt (n = 134) and penetrating (n = 111) injuries were treated. The injury severity score (median, interquartile range [IRQ]) was significantly lower in patients who underwent an endovascular procedure at 13 (IRQ, 9 to 26) for trauma vs patients requiring an open procedure at 20 (IRQ, 10 to 34; P undergoing endovascular repair (8.7 +/- 7.2 vs 13.0 +/- 16.1, P undergoing endovascular procedures (odds ratio, 0.18; P = .029) including those with an arterial injury of the torso or head and neck (odds ratio, 0.51, P = .007). Total length of hospital stay also tended to be lower for patients undergoing endovascular procedures by 18% (P = .064). The use of endovascular therapy in the setting of acute trauma is increasing in a dramatic fashion and is being used to treat a wide variety of vessels injured by blunt

  3. Selective coverage of the left subclavian artery without revascularization in patients with bilateral patent vertebrobasilar junctions during thoracic endovascular aortic repair.

    Science.gov (United States)

    Lee, Minwook; Lee, Do Yun; Kim, Man-Deuk; Won, Jong Yun; Yune, Young-Nam; Lee, Taek Yeon; Choi, Donghoon; Ko, Young-Guk

    2013-05-01

    The primary purpose of the current study was to evaluate the safety and effectiveness of selective coverage of the left subclavian artery (LSCA) without revascularization during thoracic endovascular aortic repair (TEVAR) in patients with bilateral patent vertebrobasilar junctions. The secondary purpose was to assess morphologic change of the vertebral artery (VA) after the procedure. Among 126 patients who underwent TEVAR between 2006 and 2011, 29 patients requiring LSCA coverage without preemptive revascularization were retrospectively analyzed in this study. The patients were a mean age of 63.1 years (range, 45-84 years). The mean follow-up period was 19.9 months (range, 1-63 months). Bilateral patent vertebrobasilar junctions were evaluated by contrast-enhanced computed tomography (CT), time-of flight magnetic resonance angiography, or conventional angiography. Neurologic complications, such as spinal cord ischemia (SCI) or cerebrovascular accidents, were analyzed. Preprocedural and postprocedural changes in VAs were evaluated on follow-up contrast-enhanced CT. The overall 30-day mortality was 6.9% (2 of 29). None of the patients had SCI or a stroke of posterior circulation alone. Cerebrovascular accidents from embolic infarctions occurred in two patients (7.4%). Transient left arm ischemic symptoms were present in five patients (18.5%), but none required secondary interventions. Delayed development of type I endoleak occurred due to stent deformity in one patient, who underwent surgery. One patient required reintervention after the 10-month follow-up contrast-enhanced CT showed a pseudoaneurysm had developed at the distal margin of the previously placed stent graft. Hypertrophy of the right VA after TEVAR was seen in seven of 27 patients (25.9%); two patients showed bilateral hypertrophy of VAs. LSCA coverage without revascularization can be safely performed during TEVAR in patients with bilateral patent vertebrobasilar junctions. Hypertrophy of the right VA

  4. [Simultaneous endovascular aortic aneurysm repair and coronary artery bypass grafting in a patient with abdominal aortic aneurysm and left main trunk lesion].

    Science.gov (United States)

    Nakao, Yoshihisa; Mitsuoka, Hiroshi; Masuda, Mikio; Shintani, Tsunehiro; Higashi, Shigeki

    2010-10-01

    To patients with severe coronary artery disease (CAD) and expanding large abdominal aortic aneurysm (AAA), simultaneous coronary artery bypass grafting (CABG) and AAA repair has been recommended. A 68-year-old woman had a CAD and an AAA 71 mm in diameter which was enlarging. Coronary angiography showed severe stenoses in the left main trunk (LMT), the left anterior descending artery and the circumflex artery. On-pump beating CABG and AAA repair with endovascular aneurysm repair (EVAR) were performed simultaneously, because intraaortic balloon pumping (IABP) might be needed due to severe stenoses of LMT. Just after EAVR, on-pump beating CABG was performed. The patient was discharged 15 days after the operation. It was suggested that a simultaneous operation of CABG and EVAR might be safe and effective for high risk patients with CAD and AAA.

  5. Endovascular repair of an innominate artery pseudoaneurysm using the Valiant Mona LSA branched graft device

    Directory of Open Access Journals (Sweden)

    Josh A. Sibille, MD

    2017-03-01

    Full Text Available A 60-year-old woman involved in a motor vehicle collision presented with a traumatic pseudoaneurysm of the innominate artery origin in addition to multiple concomitant injuries. She was classified as a high-risk candidate for open repair. An experimental thoracic branched graft device was used for coverage of the injury with the addition of a right carotid-to-left carotid-to-left subclavian artery bypass. Follow-up imaging showed resolution of the pseudoaneurysm and patency of her bypass grafts. This is the first described use of the Mona LSA Branch Thoracic Stent Graft System (Medtronic, Minneapolis, Minn in the innominate artery.

  6. Innovative postmarket device evaluation using a quality registry to monitor thoracic endovascular aortic repair in the treatment of aortic dissection.

    Science.gov (United States)

    Beck, Adam W; Lombardi, Joseph V; Abel, Dorothy B; Morales, J Pablo; Marinac-Dabic, Danica; Wang, Grace; Azizzadeh, Ali; Kern, John; Fillinger, Mark; White, Rodney; Cronenwett, Jack L; Cambria, Richard P

    2017-05-01

    United States Food and Drug Administration (FDA)-mandated postapproval studies have long been a mainstay of the continued evaluation of high-risk medical devices after initial marketing approval; however, these studies often present challenges related to patient/physician recruitment and retention. Retrospective single-center studies also do not fully represent the spectrum of real-world performance nor are they likely to have a sufficiently large enough sample size to detect important signals. In recent years, The FDA Center for Devices and Radiological Health has been promoting the development and use of patient registries to advance infrastructure and methodologies for medical device investigation. The FDA 2012 document, "Strengthening the National System for Medical Device Post-market Surveillance," highlighted registries as a core foundational infrastructure when linked to other complementary data sources, including embedded unique device identification. The Vascular Quality Initiative (VQI) thoracic endovascular aortic repair for type B aortic dissection project is an innovative method of using quality improvement registries to meet the needs of device evaluation after market approval. Here we report the organization and background of this project and highlight the innovation facilitated by collaboration of physicians, the FDA, and device manufacturers. This effort used an existing national network of VQI participants to capture patients undergoing thoracic endovascular aortic repair for acute type B aortic dissection within a registry that aligns with standard practice and existing quality efforts. The VQI captures detailed patient, device, and procedural data for consecutive eligible cases under the auspices of a Patient Safety Organization (PSO). Patients were divided into a 5-year follow-up group (200 acute; 200 chronic dissections) and a 1-year follow-up group (100 acute; 100 chronic). The 5-year cohort required additional imaging details, and the 1-year

  7. Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2011-01-01

    Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results

  8. Investigation of reference levels and radiation dose associated with abdominal EVAR (endovascular aneurysm repair) procedures across several European Centres

    Energy Technology Data Exchange (ETDEWEB)

    Tuthill, E.; Rainford, L. [University College Dublin, Diagnostic Imaging, School of Medicine, Dublin (Ireland); O' Hora, L.; O' Donohoe, M. [Mater Misericordiae University Hospital, Dublin (Ireland); Panci, S. [San Giovanni di Dio Hospital, Florence (Italy); Gilligan, P.; Fox, E. [Mater Private Hospital, Dublin (Ireland); Campion, D. [Mauriziano-Umberto Hospital, Turin (Italy); Trenti, R. [Policlinico S. Orsola-Malpighi, Bologna (Italy); Catania, D. [AITRI, Association of Italian Interventional Radiographers, Milan (Italy)

    2017-11-15

    Endovascular aneurysm repair (EVAR) is considered the treatment of choice for abdominal aortic aneurysms with suitable anatomy. In order to improve radiation safety, European Directive (2013/59) requires member states to implement diagnostic reference levels (DRLs) in radio-diagnostic and interventional procedures. This study aimed to determine local DRLs for EVAR across five European centres and identify an interim European DRL, which currently remains unestablished. Retrospective data was collected for 180 standard EVARs performed between January 2014 and July 2015 from five specialist centres in Ireland (n=2) and Italy (n=3). Data capture included: air kerma-area product (P{sub KA}), total air kerma at the reference point (K{sub a,r}), fluoroscopic time (FT), number of acquisitions, frame rate of acquisition, type of acquisition, patient height, weight, and gender. The mean values for each site A, B, C, D, and E were: P{sub KA}s of 4343 ± 994 μGym{sup 2}, 18,200 ± 2141 μGym{sup 2}, 11,423 ± 1390 μGym{sup 2}, 7796 ± 704 μGym{sup 2}, 31,897 ± 5798 μGym{sup 2}; FTs of 816 ± 92 s, 950 ± 150 s, 708 ± 70 s, 972 ± 61 s, 827 ± 118 s; and number of acquisitions of 6.72 ± 0.56, 10.38 ± 1.54, 4.74 ± 0.19, 5.64 ± 0.36, 7.28 ± 0.65, respectively. The overall pooled 75th percentile P{sub KA} was 15,849 μGym{sup 2}. Local reference levels were identified. The pooled data has been used to establish an interim European DRL for EVAR procedures. (orig.)

  9. Using multiple classifiers for predicting the risk of endovascular aortic aneurysm repair re-intervention through hybrid feature selection.

    Science.gov (United States)

    Attallah, Omneya; Karthikesalingam, Alan; Holt, Peter Je; Thompson, Matthew M; Sayers, Rob; Bown, Matthew J; Choke, Eddie C; Ma, Xianghong

    2017-11-01

    Feature selection is essential in medical area; however, its process becomes complicated with the presence of censoring which is the unique character of survival analysis. Most survival feature selection methods are based on Cox's proportional hazard model, though machine learning classifiers are preferred. They are less employed in survival analysis due to censoring which prevents them from directly being used to survival data. Among the few work that employed machine learning classifiers, partial logistic artificial neural network with auto-relevance determination is a well-known method that deals with censoring and perform feature selection for survival data. However, it depends on data replication to handle censoring which leads to unbalanced and biased prediction results especially in highly censored data. Other methods cannot deal with high censoring. Therefore, in this article, a new hybrid feature selection method is proposed which presents a solution to high level censoring. It combines support vector machine, neural network, and K-nearest neighbor classifiers using simple majority voting and a new weighted majority voting method based on survival metric to construct a multiple classifier system. The new hybrid feature selection process uses multiple classifier system as a wrapper method and merges it with iterated feature ranking filter method to further reduce features. Two endovascular aortic repair datasets containing 91% censored patients collected from two centers were used to construct a multicenter study to evaluate the performance of the proposed approach. The results showed the proposed technique outperformed individual classifiers and variable selection methods based on Cox's model such as Akaike and Bayesian information criterions and least absolute shrinkage and selector operator in p values of the log-rank test, sensitivity, and concordance index. This indicates that the proposed classifier is more powerful in correctly predicting the risk of

  10. Endovascular abdominal aortic aneurysm repair: surveillance of endoleak using maximum transverse diameter of aorta on non-enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Nagayama, Hiroki; Sueyoshi, Eijun; Sakamoto, Ichiro; Uetani, Masataka [Dept. of Radiology, Nagasaki Univ. School of Medicine, Nagasaki (Japan)], E-mail: sueyo@nagasaki-u.ac.jp

    2012-07-15

    Background. Repeat volumetric analysis of abdominal aortic aneurysm (AAA) after endovascular AAA repair (EVAR) is time-consuming and requires advanced processing, dedicated equipment, and skilled operators. Purpose. To clarify the validity of measuring the maximal short-axis diameter (Dmax) of AAA in follow-up non-enhanced axial CT as a means of detecting substantial endoleaks after EVAR. Material and Methods. CT images were retrospectively reviewed in 47 patients (7 women, 40 men; mean age, 76.2 years) who had no endoleak on initial contrast-enhanced CT after EVAR. Regular follow-up CT studies were performed every 6 months. At each CT study, the Dmax on the CT axial image was measured and compared with that on the last CT (115 data-sets). Contrast-enhanced CT was regarded as the standard of reference to decide the presence or absence of endoleaks. The appearance of endoleak was defined as the end point of this study. Results. Endoleaks were detected in 17 patients during the follow-up period. Mean Dmax changes for 6 months were significant between positive and negative endoleak cases (1.8 {+-} 1.9 vs. -1.1 {+-} 3.0 mm, P < 0.0001). When the Dmax change {<=} 0 mm for 6 months was used as the threshold for negative endoleak, the sensitivity, specificity, positive predictive value, and negative predictive value were 74.5, 82.4, 96.1, and 35.9%, respectively. When Dmax change {<=}-1 mm was used as the threshold, the sensitivity, specificity, PPV, and NPV were 38.8, 100, 100, and 22.1%, respectively. Conclusion. Contrast-enhanced CT is not required for the evaluation of endoleaks when the Dmax decreases by at least 1 mm over 6 months after EVAR.

  11. Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report

    Directory of Open Access Journals (Sweden)

    Yuminaga Yuigi

    2012-01-01

    Full Text Available Abstract Introduction Iliocaval fistulas can complicate an iliac artery aneurysm. The clinical presentation is classically a triad of hypotension, a pulsatile mass and heart failure. In this instance, following presentation with multiorgan failure, management included the immediate use of an endovascular stent graft on discovery of the fistula. Case presentation A 62-year-old Caucasian man presented to our tertiary hospital for management of iatrogenic trauma due to the insertion of a central venous line into his right common carotid artery, causing transient ischemic attack. Our patient presented to a peripheral hospital with fever, nausea, vomiting, acute renal failure, acute hepatic dysfunction and congestive heart failure. A provisional diagnosis of sepsis of unknown origin was made. There was a 6.5 cm×6.5 cm right iliac artery aneurysm present on a non-contrast computed tomography scan. An unexpected intra-operative diagnosis of an iliocaval fistula was made following the successful angiographic removal of the central line to his right common carotid artery. Closure of the iliocaval fistula and repair of the iliac aneurysm using a three-piece endovascular aortic stent graft was then undertaken as part of the same procedure. This was an unexpected presentation of an iliocaval fistula. Conclusion Our case demonstrates that endovascular repair of a large iliac artery aneurysm associated with a caval fistula is safe and effective and can be performed at the time of the diagnostic angiography. The presentation of an iliocaval fistula in this case was unusual which made the diagnosis difficult and unexpected at the time of surgery. The benefit of immediate repair, despite hemodynamic instability during anesthesia, is clear. Our patient had two coronary angiograms through his right femoral artery decades ago. Unusual iatrogenic causes of iliocaval fistulas secondary to previous coronary angiograms with wire and/or catheter manipulation should be

  12. Impact of hospital volume and type on outcomes of open and endovascular repair of descending thoracic aneurysms in the United States Medicare population.

    Science.gov (United States)

    Patel, Virendra I; Mukhopadhyay, Shankha; Ergul, Emel; Aranson, Nathan; Conrad, Mark F; Lamuraglia, Glenn M; Kwolek, Christopher J; Cambria, Richard P

    2013-08-01

    Favorable outcomes of thoracic endovascular aortic repair (TEVAR) compared with open repair for descending thoracic aortic aneurysms (DTAs) have led to increasing TEVAR use. We evaluated the effect of case volume and hospital teaching status on clinical outcomes of intact DTA repair. The Medicare Provider Analysis and Review (MEDPAR) data set (2004 to 2007) was queried to identify open repair or TEVAR for DTA. Hospitals were stratified by DTA volume into high volume (HV; ≥ 8 cases/y) or low volume (LV; <8 cases/y) and teaching or nonteaching. The effect of hospital variables on the primary study end point of 30-day mortality and secondary end points of 30-day complications and long-term survival after open repair and TEVAR DTA repair were studied using univariate testing, multivariable regression modeling, Kaplan-Meier survival analysis, and Cox proportional hazards regression modeling. We identified 763 hospitals performing 3554 open repairs and 3517 TEVARs. Overall DTA repair increased (P < .01) from 1375 in 2004 to 1987 in 2007. The proportion of hospitals performing open repair significantly decreased from 95% in 2004 to 57% in 2007 (P < .01), whereas those performing TEVAR increased (P < .01) from 24% to 76%. Overall repair type shifted from open (74% in 2004, the year before initial commercial availability of TEVAR) to TEVAR (39% open in 2007; P < .01). The fraction of open repairs at LV hospitals decreased from 56% in 2004 to 44% in 2007 (P < .01), whereas TEVAR increased from 24% in 2004 to 51% in 2007 (P < .01). Overall mortality during the study interval for open repair was 15% at LV hospitals vs 11% at HV hospitals (P < .01), whereas TEVAR mortality was similar, at 3.9% in LV vs 5.5% in HV hospitals (P = .43). LV was independently associated with increased mortality after open repair (odds ratio, 1.4; 95% confidence interval, 1.1-1.8; P < .01) but not after TEVAR. There was no independent effect of hospital teaching status on mortality or complications

  13. Successful endovascular aneurysm repair for abdominal aortic aneurysm in a patient with severe coronary artery disease undergoing off-pump coronary artery bypass grafting.

    Science.gov (United States)

    Kim, Sun Min; Cho, Jae Yeong; Kim, Ju Han; Park, Keun-Ho; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun; Jeong, Myung Ho

    2014-04-01

    It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD.

  14. Endovascular Repair of a Perforation of the Vena Caval Wall Caused by the Retrieval of a Gunther Tulip Filter After Long-Term Implantation

    International Nuclear Information System (INIS)

    Morishita, Hiroyuki; Yamagami, Takuji; Matsumoto, Tomohiro; Takeuchi, Yoshito; Sato, Osamu; Nishimura, Tsunehiko

    2011-01-01

    Symptomatic penetration of the inferior vena cava (IVC) wall reportedly occurs in 0.3% of patients in whom a filter has been implanted, and it causes injury to the adjacent structures (Bogue et al. in Pediatr Radiol 39(10):1110–1113, 1; Brzezinski et al. in Burns 32(5):640–643, 2). We succeeded in the endovascular repair of perforation of the IVC wall occurring during the retrieval of a penetrated Gunther tulip vena cava filter (Cook, Bjaeverskov, Denmark) after long-term implantation.

  15. Contrast Enhanced Ultrasound can Replace Computed Tomography Angiography for Surveillance After Endovascular Aortic Aneurysm Repair

    DEFF Research Database (Denmark)

    Bredahl, K; Taudorf, M; Lönn, L

    2016-01-01

    were also detected by CEUS; however, three out of 11 patients were missed by DUS and underwent re-intervention: limb extension, re-cuff, and attempt to coil lumbar leaks. Endoleaks missed by CEUS or CTA were type II endoleaks without sac expansion. CONCLUSION: In surveillance programs after EVAR...... August 2011 and 31 October 2014 were prospectively and consecutively enrolled. CEUS was added to the existing surveillance protocol, which included DUS, plain abdominal X-ray, and CTA at 3 and 12 months after stent implantation. RESULTS: In 278 patients, endoleaks were detected in 68, 69, and 46 cases...... by CTA, CEUS, and DUS, respectively. The sensitivity and specificity of DUS and CEUS were 46% and 93%, and 85% and 95%, respectively. CEUS and CTA were diagnostically equivalent, as opposed to DUS and CTA (p = .002). Endoleaks detected by CTA led to re-intervention in 11 (4%) patients. These endoleaks...

  16. Durability of endovascular infrarenal aneurysm repair: when does late failure occur and why?

    Science.gov (United States)

    Chuter, Timothy A M

    2009-06-01

    The first commercially available stent grafts were unable to withstand the hemodynamic forces of the vascular environment. The past 15 years have seen a gradual improvement in long-term stent graft performance as designs evolved through the elimination of features associated with late failure and the replication of features associated with durable success. Clinical experience provides the following principles on which to base device design and implantation techniques. Few patients have an adequate length of non-dilated aorta distal to the aneurysm to allow implantation of an aorto-aortic stent graft; bifurcated stent grafts are usually required for AAA repair. Friction, column strength and tissue ingrowth do not prevent migration of the stent graft from its attachment within the neck into the aneurysm; some form of active fixation is required, usually in the form of barbs. Any movement between the apex of a stent and the overlying graft material will erode the fabric; stents and grafts need to move as a single unit. Nitinol is versatile, but fragile; Nitinol components must be polished to eliminate all surface irregularities and they cannot be subjected to compression loading, or excessive pulsatile movement. The neck of an aneurysm is unstable; it will dilate unless protected by a securely fixed, non-compliant stent graft. The aneurysm does not heal; freedom from risk of rupture depends on durable depressurization of the sac. The sole objective of image-based follow-up is the early detection, and catheter-based correction, of device failure. Once any given design has been in use long enough to identify its failure modes, the frequency of follow-up studies can be adjusted accordingly. However, it takes a long time to identify all the potential forms of late failure, and pre-clinical testing remains an imprecise science. New, or recently modified, devices cannot necessarily be assumed to be as durable as their predecessors.

  17. Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy.

    Science.gov (United States)

    Greaves, Nicholas S; Moore, Aiden; Seriki, Dare; Ghosh, Jonathan

    2018-04-01

    The aim was the evaluation of mid-term efficacy and safety outcome measures for the Ovation (Endologix, Santa Rosa, CA, USA) stent graft system in the management of infrarenal abdominal aortic aneurysms (iAAA) with adverse anatomy. A retrospective observational study of all patients undergoing elective iAAA repair was carried out from 2012 to 2017 using Ovation Prime or iX stent grafts with a minimum of 3 months follow-up at a single UK vascular centre. Post-operative surveillance involved computed tomography scans at 3 months and 1 year, with duplex ultrasound yearly thereafter. Outcome measures were established with retrospective analysis of pre- and post-operative imaging, and included peri-operative mortality, major adverse events, limb complications, aneurysm diameter change, and endoleak rates. All patients were within Ovation instructions for use (IFU), and assessment was made to determine whether aneurysms had anatomical features considered adverse for other commonly used stent graft platforms. Ovation stent grafts were implanted in 52 patients (79% male, mean age 75.7 years) with a mean aneurysm diameter of 62.5 mm (range 55-107 mm). There was 100% technical deployment success. The 30 day mortality was 0% and there was no aneurysm related mortality during follow-up (median 24 months, range 3-48 months). There were no type I or III endoleaks, but 19% developed type II endoleaks with one patient requiring re-intervention. No iliac limb occlusions were identified but one case required relining for limb kinking. All 52 cases were within the IFU for Ovation but only 12% met the IFU criteria for the Cook and Medtronic devices. The mid-term experience with Ovation demonstrates safe, durable treatment of iAAAs, including those with unfavourable anatomy, frequently off IFU for other commonly used devices. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

  18. Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA).

    Science.gov (United States)

    Zhang, Simeng; Feng, Jiaxuan; Li, Haiyan; Zhang, Yongxue; Lu, Qingsheng; Jing, Zaiping

    2016-08-01

    Endovascular aneurysm repair (EVAR) is an alternative treatment for ruptured abdominal aortic aneurysms (rAAA) in hemodynamically (hd) stable patients. Treatment for patients with hd-unstable rAAA remains controversial. The aim of this study was to compare the outcomes of EVAR and open surgery (OS) in hd-stable and hd-unstable rAAA patients using meta-analysis. The first part of this study included 48 articles that reported the treatment outcomes of rAAA managed with EVAR (n = 9610) and OS (n = 93867). The second part, which is the focus of this study, included 5 out of 48 articles, which further reported treatment results in hd-stable (n = 198) and hd-unstable (n = 185) patients. When heterogeneity among the groups was observed, a random-effects model was used to calculate the adjusted odds ratios (OR) or in cases of non-heterogeneity, a fixed-effects model analysis was employed. In the first part of this study, the in-hospital mortality rate was found to be lower in the EVAR group than in the OS group (29.9 vs 40.8 %; OR 0.59; 95 % CI 0.52-0.66; P OS. The total mortality was 147/383 (38.4 %), while the mortality of the EVAR group and the OS group was 25.7 % (39/152) and 46.8 % (108/231), respectively. In the hd-stable group, the in-hospital mortality after EVAR was significantly lower than that after OS [18.9 % (18/95) vs 28.2 % (29/103); OR 0.47; 95 % CI 0.22-0.97; P = 0.04]. For the hd-unstable rAAA patients, the in-hospital mortality after EVAR was significantly lower than that after OS [36.8 % (21/57) vs 61.7 % (79/128); OR 0.40; 95 % CI 0.20-0.79; P OS, EVAR in hd-unstable rAAA patients is associated with improved outcomes. Available publications are currently limited; thus, the best treatment strategy for this subgroup of patients remains unclear. Further clinical studies are needed to provide more detailed data, such as the shock index and long-term results.

  19. Robotic endovascular surgery.

    Science.gov (United States)

    Au, Stephanie; Ko, Koel; Tsang, Josephine; Chan, Yiu Che

    2014-01-01

    The purpose of this review is to compare conventional endovascular procedures and the robotic endovascular approach in aortic aneurysm repair. Despite advantages over open surgery, conventional endovascular surgery has limitations. To develop an alternative, efforts have been focused on robotic endovascular systems. Two of the 3 studies comparing procedure times demonstrated reduced procedure time in the robotic group, by 6 times (p robotic procedures reduced fluoroscopic exposure time by 12 minute (p robotic surgery was reduced up to 10 times (p robotic performance score showed a better performance score in the robotic endovascular group (p = 0.007). These results demonstrate that the robotic technique has multiple advantages over the conventional procedure, including improved catheter stability, a shorter learning curve, reduced procedure time, and better performance in cannulating tortuous vessels. However, robotic endovascular technology may be limited by the cost of the system, the size of the catheter, and the setup time required preoperatively. Further comparative studies between conventional and robotic approaches regarding cost-effectiveness, safety, and performance in cases involving complex anatomy and fenestrated stent grafts are essential. Nevertheless, this revolutionary technology is increasingly popular and may be the next milestone in endovascular surgery.

  20. CASE REPORT CASE CASE Endovascular stent grafting of ...

    African Journals Online (AJOL)

    Endovascular stent graft repair for the treatment of post-traumatic aortic rupture is emerging as a safe, ... motor vehicle accidents; of all patients sustaining such injury, 85% will die before reaching hospital. Fifty per cent of the ... to undertake an endovascular repair of the thoracic pseudo-aneurysm. Endovascular procedure.

  1. Endovascular repair of inadvertent arterial injury induced by central venous catheterization using a vascular closure device: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, So Hee; Jang, Woo Jin; Oh, Ju Heyon; Song, Yun Gyu [Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Korea, Republic of)

    2017-04-15

    Central venous catheterization can cause various complications. Inadvertent subclavian artery catheterization was performed during insertion of a central venous catheter in a 73-year-old man suffering from panperitonitis due to small-bowel perforation. Endovascular treatment was conducted to treat the injured subclavian artery with a FemoSeal vascular closure device.

  2. Polar orientation of renal grafts within the proximal seal zone affects risk of early type IA endoleaks after chimney endovascular aneurysm repair.

    Science.gov (United States)

    Tran, Kenneth; Ullery, Brant W; Itoga, Nathan; Lee, Jason T

    2018-04-01

    The objective of this study was to describe the polar orientation of renal chimney grafts within the proximal seal zone and to determine whether graft orientation is associated with early type IA endoleak or renal graft compression after chimney endovascular aneurysm repair (ch-EVAR). Patients who underwent ch-EVAR with at least one renal chimney graft from 2009 to 2015 were included in this analysis. Centerline three-dimensional reconstructions were used to analyze postoperative computed tomography scans. The 12-o'clock polar position was set at the takeoff of the superior mesenteric artery. Relative polar positions of chimney grafts were recorded at the level of the renal artery ostium, at the mid-seal zone, and at the proximal edge of the graft fabric. Early type IA endoleaks were defined as evidence of a perigraft flow channel within the proximal seal zone. There were 62 consecutive patients who underwent ch-EVAR (35 double renal, 27 single renal) for juxtarenal abdominal aortic aneurysms with a mean follow-up of 31.2 months; 18 (29%) early type IA "gutter" endoleaks were identified. During follow-up, the majority of these (n = 13; 72%) resolved without intervention, whereas two patients required reintervention (3.3%). Estimated renal graft patency was 88.9% at 60 months. Left renal chimney grafts were most commonly at the 3-o'clock position (51.1%) at the ostium, traversing posteriorly to the 5- to 7-o'clock positions (55.5%) at the fabric edge. Right renal chimney grafts started most commonly at the 9-o'clock position (n = 17; 33.3%) and tended to traverse both anteriorly (11 to 1 o'clock; 39.2%) and posteriorly (5 to 7 o'clock; 29.4%) at the fabric edge. In the polar plane, the majority of renal chimney grafts (n = 83; 85.6%) traversed 90 degrees were independently associated with early type IA endoleaks (odds ratio, 11.5; 95% confidence interval, 2.1-64.8) even after controlling for other device and anatomic variables. Polar orientation of the chimney

  3. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    ... into the artery. Then use a dye to define the extent of the aneurysm. Use x-rays ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  4. The midterm experience of tapered stent grafts in the endovascular management of iliac artery aneurysms with unfavorable anatomy.

    Science.gov (United States)

    Aldin, Zaid; Kashef, Elika; Jenkins, Michael; Gibbs, Richard; Wolfe, John; Hamady, Mohamad

    2012-02-01

    We report our experience and the midterm results of a modern technique for endovascular management of isolated iliac artery aneurysms (IAAs) with unfavorable neck anatomy, which involves the inversion of an iliac leg of a Zenith stent graft. Patients who underwent endovascular IAA repair from 2002 to 2010 were reviewed. A total of 12 patients, with a mean age of 77.6 years, underwent endovascular repair of 13 IAAs. Mean size of the aneurysms was 54.6 mm (range 34-133 mm). Mean proximal neck diameter was 18 mm (range 15-22 mm). In 7 patients, the length of the proximal neck was <15 mm (10-14 mm). Only 1 patient developed thrombosis of the stent graft immediately after the operation. Patients were followed up for a mean of 31.5 months (range 18-72 months). Our midterm results demonstrate the durability of this technique in the management of iliac aneurysms with unfavorable anatomy.

  5. Five-year outcomes of the PYTHAGORAS U.S. clinical trial of the Aorfix endograft for endovascular aneurysm repair in patients with highly angulated aortic necks.

    Science.gov (United States)

    Malas, Mahmoud B; Hicks, Caitlin W; Jordan, William D; Hodgson, Kim J; Mills, Joseph L; Makaroun, Michel S; Belkin, Michael; Fillinger, Mark F

    2017-06-01

    Early and midterm outcomes of the Prospective Aneurysm Trial: High Angle Aorfix Bifurcated Stent Graft (PYTHAGORAS) trial in patients with highly angulated aortic necks (≥60 degrees) have already been published and shown comparable outcomes to other endografts in normal anatomy. Herein, we present the long-term outcomes of the PYTHAGORAS trial of Aorfix (Lombard Medical, Irvine, Calif) for patients with highly angulated aortic neck anatomy. The Aorfix endograft is a highly conformable nitinol/polyester device designed for transrenal fixation. The U.S. trial enrolled 218 patients and observed all patients at 1 month, 6 months, and 12 months and then annually for a total of 5 years. Endovascular aneurysm repair (EVAR)-specific complications were compared between the standard-angle (PYTHAGORAS trial of the Aorfix endograft is the first EVAR clinical trial to include a majority of highly angulated (≥60 degrees) infrarenal aortic necks and is the first to produce evidence after 5 years of implantation. Despite predictors of worse short- and long-term outcomes, pertinent outcomes were better than or similar to those of trials with less severe anatomy. These results support the use of this "on-label" endovascular option, particularly in patients with highly angulated aortic neck anatomy. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  6. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  7. Brain aneurysm repair

    Science.gov (United States)

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  8. Planning, Execution, and Follow-up for Endovascular Aortic Aneurysm Repair Using a Highly Restrictive Iodinated Contrast Protocol in Patients with Severe Renal Disease.

    Science.gov (United States)

    Gallitto, Enrico; Faggioli, Gianluca; Gargiulo, Mauro; Freyrie, Antonio; Pini, Rodolfo; Mascoli, Chiara; Ancetti, Stefano; Vento, Vincenzo; Stella, Andrea

    2018-02-01

    The cumulative amount of iodinated contrast medium necessary for endovascular repair (EVAR) planning, operative procedure, and subsequent follow-up is a threat for the onset of end-stage renal disease in patients with preoperative impaired kidney function. The purpose of this study was to describe a mini-invasive approach aimed to minimize the exposure of these patients to iodinated contrast medium and the subsequent risk of renal function worsening. From 2012 to 2015, all patients with abdominal aortic aneurysm (AAA) at high surgical risk and fit for standard EVAR (simple aortic-iliac anatomy: proximal and distal neck length ≥15 mm, no severe angulation), underwent EVAR through the following "near-zero contrast" approach, if their glomerular filtration rate (GFR) was <30 mL/min: preoperative planning was performed by noncontrast-enhanced computed tomography and duplex ultrasound (DU); the origin of renal/hypogastric arteries and aortic bifurcation was evaluated and matched with vertebral bone landmarks and the endograft deployed accordingly, using <20 cc of isotonic iodinate contrast medium and contrast-enhancement DU (CEUS). Follow-up was by DU/CEUS at 1, 6, and 12 months. Primary end points were technical success (TS: renal/hypogastric artery patency, absence of type I/III endoleaks, iliac stenosis/kinking, intraoperative mortality, and conversion), 30-day mortality, and new onset of permanent dialysis with renal function evaluation at 1, 6, and 12 months. Secondary end points were type II endoleaks, reinterventions, AAA, and renal-related mortality during the follow-up. Eighteen patients (median age: 74 years, interquartile range [IQR]: 6, male: 78%, American Society of Anaesthesiologists [ASA] IV: 100%) were enrolled. The median AAA diameter and preoperative GFR were 66 mm (IQR: 13) and 22 mL/min (IQR: 4), respectively. Infrarenal (n = 10) and suprarenal fixation (n = 8) endografts were implanted, with a mean dose of iodinate contrast medium

  9. 3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy.

    Science.gov (United States)

    Tam, Matthew D B S; Laycock, Stephen D; Brown, James R I; Jakeways, Matthew

    2013-12-01

    To describe rapid prototyping or 3-dimensional (3D) printing of aneurysms with complex neck anatomy to facilitate endovascular aneurysm repair (EVAR). A 75-year-old man had a 6.6-cm infrarenal aortic aneurysm that appeared on computed tomographic angiography to have a sharp neck angulation of ~90°. However, although the computed tomography (CT) data were analyzed using centerline of flow, the true neck length and relations of the ostial origins were difficult to determine. No multidisciplinary consensus could be reached as to which stent-graft to use owing to these borderline features of the neck anatomy. Based on past experience with rapid prototyping technology, a decision was taken to print a model of the aneurysm to aid in visualization of the neck anatomy. The CT data were segmented, processed, and converted into a stereolithographic format representing the lumen as a 3D volume, from which a full-sized replica was printed within 24 hours. The model demonstrated that the neck was adequate for stent-graft repair using the Aorfix device. Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.

  10. Thoracic endovascular aortic repair and off-pump coronary artery bypass grafting after renal transplantation: a case report.

    Science.gov (United States)

    Yanase, Yohsuke; Muraki, Satoshi; Koyanagi, Tetsuya; Watanabe, Noriyasu; Kurimoto, Yoshihiko

    2011-01-01

    Twelve years after receiving a renal transplant, a 50-year-old woman developed asthmatic symptoms. Chest CT revealed a descending thoracic aortic aneurysm. She had undergone percutaneous coronary intervention to treat the left anterior descending artery 10 years earlier. Coronary artery angiography revealed restenosis of the left anterior descending artery (99%, #6 in-stent). Because cardiopulmonary bypass may cause problems for transplanted kidney, we performed off-pump coronary artery bypass grafting (left internal thoracic artery to left anterior descending artery) and thoracic endovascular graft placement to treat the aortic aneurysm. Considering that the artery of the transplanted kidney was attached to the right iliac artery, and then the left common femoral artery was selected as the access root for GORE TAG(®) endografts (34 × 200 and 34 × 150 mm) (stentgrafts were deployed for the descending aortic artery). Postoperative angiography showed a patent bypass graft. Postoperative CT confirmed the absence of endoleaks. The postoperative course was uneventful, and she was discharged without complications. Ischemic heart disease and descending thoracic aortic aneurysm in recipients of kidney transplants can be treated using off-pump coronary bypass grafting and thoracic endovascular graft placement. The transplanted kidney was protected without using cardiopulmonary bypass (CPB).

  11. Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers.

    Science.gov (United States)

    Ehlert, Bryan A; Durham, Christopher A; Parker, Frank M; Bogey, William M; Powell, Charles S; Stoner, Michael C

    2011-12-01

    Thoracic endovascular aortic repair (TEVAR) devices are increasingly being utilized to treat aortic pathologies outside of the original Food & Drug Administration (FDA) approval for nonruptured descending thoracic aorta aneurysms (DTAs). The objective of this study was to evaluate the outcomes of patients undergoing TEVAR, elucidating the role of surgical and pathologic variables on morbidity and mortality. National Surgical Quality Improvement Program (NSQIP) data were reviewed for all patients undergoing endovascular thoracic aorta repair from 2005 to 2007. The patients' operative indication and surgical complexity were used to divide them into study and control populations. Comorbid profiles were assessed utilizing a modified Charlson Comorbidity Index (CCI). Thirty-day occurrences of mortality and serious adverse events (SAEs) were used as study endpoints. Univariate and multivariate models were created using demographic and clinical variables to assess for significant differences in endpoints (P ≤ .05). A total of 440 patients undergoing TEVAR were identified. When evaluating patients based on operative indication, the ruptured population had increased mortality and SAE rates compared to the nonruptured DTA population (22.6% vs 6.2%;P < .01 and 35.5% vs 9.1%;P < .01, respectively). Further analysis by surgical complexity revealed increased mortality and SAE rates when comparing the brachiocephalic aortic debranching population to the noncovered left subclavian artery population (23.1% vs 6.5%; P = .02 and 30.8% vs 9.1%; P < .01, respectively). Multivariate analysis demonstrated that operative indication was not a correlate of mortality or SAEs (odds ratio [OR], 0.95; P = .92 and OR, 1.42; P = .39, respectively); however, brachiocephalic aortic debranching exhibited a deleterious effect on mortality (OR, 8.75; P < .01) and SAE rate (OR, 6.67; P = .01). The operative indication for a TEVAR procedure was not found to be a predictor of poor patient outcome

  12. Tratamento do aneurisma da aorta toracoabdominal com endoprótese ramificada para as artérias viscerais Branched endovascular stent graft for thoracoabdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    André Simi

    2007-03-01

    AATA com endoprótese ramificada é factível. A melhora dos recursos técnicos e da qualidade dos materiais poderá ampliar a indicação desse procedimento como alternativa à cirurgia aberta.We report a case of branched stent graft system for endovascular repair of thoracoabdominal aortic aneurysm (TAAA. A 68-year-old female patient, smoker, hypertensive, with a large TAAA and multiple comorbid conditions that restricted indication for conventional surgery. The aneurysm originated from the descending thoracic aorta, extending until the infrarenal abdominal aorta, involving the emergence of visceral arteries, celiac trunk, superior and renal mesenteric arteries. The TAAA was treated with the endovascular technique using a branched stent graft. This stent graft was customized based on the anatomical characteristics of the aorta and on the position of visceral branches, which were obtained by tomographic angiography, with the aim of excluding the aneurysm and maintaining perfusion of visceral arteries. The procedure was performed under regional and general anesthesia in the surgical room, preceded by cerebrospinal fluid drainage under fluoroscopic guidance. The femoral arteries, which were previously dissected, were used to implement the branched stent graft and for radiological control. Through the stent graft branches, secondary extensions were implanted, with covered stents, to the respective visceral arteries, which were approached via left axillary artery. Total operative time was 14 hours, 4 hours and 30 minutes of fluoroscopy time and 120 mL of iodinated contrast. The patient became hemodynamically unstable after the surgery. Transesophageal echocardiogram showed a type A retrograde dissection of the thoracic aorta, followed by spontaneous thrombosis of the false lumen. Control tomography showed exclusion of the TAAA and patency of the bypasses to visceral branches, with no endoleaks. The patient was discharged on the 13th postoperative day. Branched

  13. The β-d-Endoglucuronidase Heparanase Is a Danger Molecule That Drives Systemic Inflammation and Correlates with Clinical Course after Open and Endovascular Thoracoabdominal Aortic Aneurysm Repair: Lessons Learnt from Mice and Men

    Directory of Open Access Journals (Sweden)

    Lukas Martin

    2017-06-01

    Full Text Available Thoracoabdominal aortic aneurysm (TAAA is a highly lethal disorder requiring open or endovascular TAAA repair, both of which are rare, but extensive and complex surgical procedures associated with a significant systemic inflammatory response and high post-operative morbidity and mortality. Heparanase is a β-d-endoglucuronidase that remodels the endothelial glycocalyx by degrading heparan sulfate in many diseases/conditions associated with systemic inflammation including sepsis, trauma, and major surgery. We hypothesized that (a perioperative serum levels of heparanase and heparan sulfate are associated with the clinical course after open or endovascular TAAA repair and (b induce a systemic inflammatory response and renal injury/dysfunction in mice. Using a reverse-translational approach, we assessed (a the serum levels of heparanase, heparan sulfate, and the heparan sulfate proteoglycan syndecan-1 preoperatively as well as 6 and 72 h after intensive care unit (ICU admission in patients undergoing open or endovascular TAAA repair and (b laboratory and clinical parameters and 90-day survival, and (c the systemic inflammatory response and renal injury/dysfunction induced by heparanase and heparan sulfate in mice. When compared to preoperative values, the serum levels of heparanase, heparan sulfate, and syndecan-1 significantly transiently increased within 6 h of ICU admission and returned to normal within 72 h after ICU admission. The kinetics of any observed changes in heparanase, heparan sulfate, or syndecan-1 levels, however, did not differ between open and endovascular TAAA-repair. Postoperative heparanase levels positively correlated with noradrenalin dose at 12 h after ICU admission and showed a high predictive value of vasopressor requirements within the first 24 h. Postoperative heparan sulfate showed a strong positive correlation with interleukin-6 levels day 0, 1, and 2 post-ICU admission and a strong negative correlation with

  14. Renal function after elective infrarenal aortic aneurysm repair in patients with pelvic kidneys.

    Science.gov (United States)

    Bui, Trung D; Wilson, Samuel E; Gordon, Ian L; Fujitani, Roy M; Carson, John; Montgomery, Russell S

    2007-03-01

    Pelvic kidneys complicate aortic reconstructions because of increased risk of renal ischemia. Strategies for protection include shunting, cooling, and reliance on collaterals. A review identified two congenital pelvic kidney (not solitary) and five transplanted kidney patients who underwent elective abdominal aortic aneurysm repair. For congenital pelvic kidneys, topical cooling was used in one patient while no preservation was performed for the other patient. Three transplanted kidney patients were shunted, and one had endovascular repair. Postoperative creatinine values were compared to preoperative values. The two congenital pelvic kidney patients had no significant elevation of creatinine postoperatively. The transplanted kidney patient who underwent endovascular repair had no increase in creatinine postoperatively. All transplanted kidney patients who had open repair had significant but transient increase in creatinine postoperatively. Three patients who were shunted intraoperatively had normalization of creatinine. The patient who had persistent elevation of creatinine at discharge was not shunted. Aortorenal shunting or endovascular repair in transplanted pelvic kidney patients maintains renal function. For patients with congenital pelvic kidneys and adequate collaterals, cooling and collateral perfusion is usually sufficient. Though experience is limited, endovascular repair is likely to be superior to open repair in minimizing renal ischemia.

  15. Endovascular tubular stent-graft placement for isolated iliac artery aneurysms.

    Science.gov (United States)

    Okada, Takuya; Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

    2012-02-01

    To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

  16. Endovascular repair of posttraumatic multiple femoral-femoral and popliteal-popliteal arteriovenous fistula with Viabahn and excluder stent graft

    Directory of Open Access Journals (Sweden)

    Šarac Momir

    2011-01-01

    . Also, numerous metallic balls - grains of shotgun were present. After the preoperative preparation under local infiltrative anesthesia, transfemoral endovascular reconstruction was done of the surface femoral and popliteal artery by the use of stent grafts Viabahn 6 × 50 mm and excluder PXL 161 007. Within the immediate postoperative course a significant reduction of the leg edema and disappearance of thrill occurred, and, latter, healing of ulceration, and disappearance of signs of the foot ischemia. Also, patient's both cardiac and breathing functions became normal. Conclusion. In patients with chronic traumatic AV fistulas in the femoropopliteal region, especially with multiple fistulas, the gold standard is their endovascular reconstruction which, although being minimally traumatic and invasive, offers a complete reconstruction besides keeping integrity of both distal and proximal circulation in the leg.

  17. Retrograde type A dissection: a serious complication due to thoracic aortic endovascular stent-graft repair for Stanford type B aortic dissection

    International Nuclear Information System (INIS)

    Wang Guoquan; Zhai Shuiting; Li Tianxiao; Shi Shuaitao; Zhang Kewei; Li Kun

    2011-01-01

    Objective: to discuss the possible causes and prevention of retrograde type A dissection occurred after thoracic aortic endovascular stent-graft repair (TEVAR) for symptomatic type B dissection. Methods: During the period from January 2005 to January 2011, TEVAR was carried out in 189 patients (157 males and 32 females) with symptomatic type B dissection. The average age of the patients was (51.2±13.5) years, ranged from 26 to 78 years. A follow-up lasting for 3-63 months (mean 32 months) was conducted in 135 patients (71.43%). Fifty-four patients lost in touch with the authors (28.57%). The occurrence of retrograde type A dissection after TEVAR was calculated and the possible causes were analyzed. Results: After TEVAR retrograde type A dissection occurred in two patients (1.48%), and both were males. One patient developed retrograde type A dissection in perioperative period, and the patient refused to have surgery. Conservative treatment was employed for over three years and be was still alive so far. The other patient developed retrograde type A dissection one month after TEVAR, and emergency surgery was performed. The patient was followed up for three months and he was still alive. Conclusion: The retrograde type A dissection occurred after TEVAR may be closely related to the stent-graft device, to the interventional manipulations and to the vascular disorders. Close attention should be paid to the direct damage produced by the stent-graft device to the vascular wall. (authors)

  18. Endovascular Repair of Saccular Ascending Aortic Aneurysm After Orthotopic Heart Transplantation Using an Investigational Zenith Ascend Stent-Graft.

    Science.gov (United States)

    Oderich, Gustavo S; Pochettino, Alberto; Mendes, Bernardo C; Roeder, Blayne; Pulido, Juan; Gloviczki, Peter

    2015-08-01

    To report the use of an investigational stent-graft to treat an ascending aortic aneurysm in a patient with a heart transplant. A 48-year-old man presented with a 3.5×1.5-cm saccular aneurysm in the mid anterior ascending aorta, abutting the sternum. The patient's history was notable for placement of a left ventricular assist device followed by orthotopic heart transplantation 2 years prior to treat end-stage familial dilated cardiomyopathy. Under compassionate use, a custom-designed ascending aortic stent-graft (Zenith Ascend) was successfully delivered via an 18-F system and deployed just distal to the origin of the left main coronary artery under pulmonary artery catheter-guided rapid ventricular pacing. The patient was discharged the next day, and 6-month follow-up was unremarkable. Imaging at 5 months showed an excluded aneurysm sac with no endoleak or migration. The ideal ascending aortic stent-graft should be low profile, conformable to the arch anatomy, with short tip delivery system and a stepwise deployment mechanism that allows precise placement relative to the ostia of the coronary arteries and the innominate artery. This case illustrates the advancement of endovascular techniques to the most challenging segment of the aorta to decrease morbidity and mortality in high-risk patients. © The Author(s) 2015.

  19. Surgeon leadership in the coding, billing, and contractual negotiations for fenestrated endovascular aortic aneurysm repair increases medical center contribution margin and physician reimbursement.

    Science.gov (United States)

    Aiello, Francesco; Durgin, Jonathan; Daniel, Vijaya; Messina, Louis; Doucet, Danielle; Simons, Jessica; Jenkins, James; Schanzer, Andres

    2017-10-01

    Fenestrated endovascular aneurysm repair (FEVAR) allows endovascular treatment of thoracoabdominal and juxtarenal aneurysms previously outside the indications of use for standard devices. However, because of considerable device costs and increased procedure time, FEVAR is thought to result in financial losses for medical centers and physicians. We hypothesized that surgeon leadership in the coding, billing, and contractual negotiations for FEVAR procedures will increase medical center contribution margin (CM) and physician reimbursement. At the UMass Memorial Center for Complex Aortic Disease, a vascular surgeon with experience in medical finances is supported to manage the billing and coding of FEVAR procedures for medical center and physician reimbursement. A comprehensive financial analysis was performed for all FEVAR procedures (2011-2015), independent of insurance status, patient presentation, or type of device used. Medical center CM (actual reimbursement minus direct costs) was determined for each index FEVAR procedure and for all related subsequent procedures, inpatient or outpatient, 3 months before and 1 year subsequent to the index FEVAR procedure. Medical center CM for outpatient clinic visits, radiology examinations, vascular laboratory studies, and cardiology and pulmonary evaluations related to FEVAR were also determined. Surgeon reimbursement for index FEVAR procedure, related adjunct procedures, and assistant surgeon reimbursement were also calculated. All financial analyses were performed and adjudicated by the UMass Department of Finance. The index hospitalization for 63 FEVAR procedures incurred $2,776,726 of direct costs and generated $3,027,887 in reimbursement, resulting in a positive CM of $251,160. Subsequent related hospital procedures (n = 26) generated a CM of $144,473. Outpatient clinic visits, radiologic examinations, and vascular laboratory studies generated an additional CM of $96,888. Direct cost analysis revealed that grafts

  20. Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients.

    Science.gov (United States)

    Pecoraro, Felice; Lachat, Mario; Hofmann, Michael; Cayne, Neal S; Chaykovska, Lyubov; Rancic, Zoran; Puippe, Gilbert; Pfammatter, Thomas; Mangialardi, Nicola; Veith, Frank J; Bettex, Dominique; Maisano, Francesco; Neff, Thomas A

    2017-06-01

    Surgical repair of aneurysmal disease involving the ascending aorta, aortic arch and eventually the descending aorta is generally associated with significant morbidity and mortality. A less invasive approach with the ascending wrapping technique (WT), supra-aortic vessel debranching (SADB) and thoracic endovascular aneurysm repair (TEVAR) in zone 0 was developed to reduce the associated risk in these patients. During a 10-year period, consecutive patients treated by the ascending WT, SADB and TEVAR in zone 0 were included. All patients were considered at high risk for conventional surgery. Measured outcomes included perioperative deaths and morbidity, maximal aortic transverse diameter (TD) and its postoperative evolution, endoleak, survival, freedom from cardiovascular reinterventions, SADB freedom from occlusion and aortic valve function during follow-up. Median follow-up was 37.4 [mean = 34; range, 0-65; standard deviation (SD) = 20] months. Twenty-six cases were included with a mean age of 71.88 ( r  = 56-87; SD = 8) years. A mean of 2.9 supra-aortic vessels (75) per patient was debranched from the ascending aorta. The mean time interval from WT/SADB and TEVAR was 29 ( r  = 0-204; SD = 48) days. TEVAR was associated with chimney and/or periscope grafts in 6 (23%) patients, and extra-anatomical supra-aortic bypasses were performed in 6 (23%) patients. Perioperative mortality was 7.7% (2/26). Neurological events were registered in 3 (11.5%) cases, and a reintervention was required in 3 (11.5%) cases. After the WT, the ascending diameter remained stable during the follow-up period in all cases. At mean follow-up, significant shrinkage of the arch/descending aorta diameter was observed. A type I/III endoleak occurred in 3 cases. At 5 years, the rates of survival, freedom from cardiovascular reinterventions and SADB freedom from occlusion were 71.7, 82.3 and 96%, respectively. The use of the ascending WT, SADB and TEVAR in selected patients

  1. A multiregional registry experience using an electronic medical record to optimize data capture for longitudinal outcomes in endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Hye, Robert J; Inui, Tazo S; Anthony, Faith F; Kiley, Mary-Lou; Chang, Robert W; Rehring, Thomas F; Nelken, Nicolas A; Hill, Bradley B

    2015-05-01

    Registries have been proven useful to assess clinical outcomes, but data entry and personnel expenses are challenging. We developed a registry to track patients undergoing endovascular aortic aneurysm repair (EVAR) in an integrated health care system, leveraging an electronic medical record (EMR) to evaluate clinical practices, device performance, surgical complications, and medium-term outcomes. This study describes the registry design, data collection, outcomes validation, and ongoing surveillance, highlighting the unique integration with the EMR. EVARs in six geographic regions of Kaiser Permanente were entered in the registry. Cases were imported using a screening algorithm of inpatient codes applied to the EMR. Standard note templates containing data fields were used for surgeons to enter preoperative, postoperative, and operative data as part of normal workflows in the operating room and clinics. Clinical content experts reviewed cases and entered any missing data of operative details. Patient comorbidities, aneurysm characteristics, implant details, and surgical outcomes were captured. Patients entered in the registry are followed up for life, and all relevant events are captured. Between January 2010 and June 2013, 2112 procedures were entered in the registry. Surgeon compliance with data entry ranges from 60% to 90% by region but has steadily increased over time. Mean aneurysm size was 5.9 cm (standard deviation, 1.3). Most patients were male (84%), were hypertensive (69%), or had a smoking history (79%). The overall reintervention rate was 10.8%: conversion to open repair (0.9%), EVAR revision (2.6%), other surgical intervention (7.3%). Of the reinterventions, 27% were for endoleaks (I, 34.3%; II, 56.9%; III, 8.8%; IV and V, 0.0%), 10.5% were due to graft malfunction, 3.4% were due to infection, and 2.3% were due to rupture. Leveraging an EMR provides a robust platform for monitoring short-term and midterm outcomes after abdominal aortic aneurysm repair

  2. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years.

    Science.gov (United States)

    Powell, J T; Sweeting, M J; Ulug, P; Blankensteijn, J D; Lederle, F A; Becquemin, J-P; Greenhalgh, R M

    2017-02-01

    The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0-6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus

  3. Determination of Endograft Apposition, Position, and Expansion in the Aortic Neck Predicts Type Ia Endoleak and Migration After Endovascular Aneurysm Repair.

    Science.gov (United States)

    Schuurmann, Richte C L; van Noort, Kim; Overeem, Simon P; van Veen, Ruben; Ouriel, Kenneth; Jordan, William D; Muhs, Bart E; 't Mannetje, Yannick W; Reijnen, Michel M P J; Fioole, Bram; Ünlü, Çağdaş; Brummel, Peter; de Vries, Jean-Paul P M

    2018-03-01

    To describe the added value of determining changes in position and apposition on computed tomography angiography (CTA) after endovascular aneurysm repair (EVAR) to detect early caudal displacement of the device and to prevent type Ia endoleak. Four groups of elective EVAR patients were selected from a dataset purposely enriched with type Ia endoleak and migration (>10 mm) cases. The groups included cases of late type Ia endoleak (n=36), migration (n=9), a type II endoleak (n=16), and controls without post-EVAR complications (n=37). Apposition of the endograft fabric with the aortic neck, shortest distance between the fabric and the renal arteries, expansion of the main body (or dilatation of the aorta in the infrarenal sealing zone), and tilt of the endograft toward the aortic axis were determined on the first postoperative and the last available CTA scan without type Ia endoleak or migration. Differences in these endograft dimensions were compared between the first vs last scan and among the 4 groups. No significant differences in endograft configurations were observed among the groups on the first postoperative CTA scan. On the last CTA scan before a complication arose, the position of the fabric relative to the renal arteries, expansion of the main body, and apposition of the fabric with the aortic neck were significantly different between the type Ia endoleak (median follow-up 15 months) and migration groups (median follow-up 23 months) compared with the control group (median follow-up 19 months). Most endograft dimensions had changed significantly compared with the first postoperative CTA scan for all groups. Apposition had increased in the control group but had decreased significantly in the type Ia endoleak and migration groups. Progressive changes in dimensions of the endograft within the infrarenal neck could be detected on regular CTA scans before the complication became urgent in many patients.

  4. Parallel-Stenting Technique in a Sandwich Configuration for Hypogastric Artery Preservation during Endovascular Aneurysm Repair: An In Vitro Study.

    Science.gov (United States)

    Yugueros, Xavier; Mestres, Gaspar; Pasquadibisceglie, Savino; Alomar, Xavier; Apodaka, Ana; Riambau, Vincent

    2017-10-01

    The aim of the study was to identify the best conditions in iliac sandwich procedure for hypogastric artery preservation during endovascular aneurysm repair, testing different devices, different oversizing (OS) degrees as well as different methods to measure it. Four external iliac devices (16-mm Endurant and 12-mm Aorfix limb extensions; 11- and 13-mm Viabahn endografts) were tested with 2 distinct internal iliac stent grafts (8-mm Advanta V12 and 8-mm Viabahn) inside different proximal silicon iliac limb models (10, 12, 14, 16, and 18 mm), simulating an iliac sandwich procedure for hypogastric preservation. After remodeling all devices in a saline bath at 37°C, the combinations were computed tomography scanned. Gutter size, parallel-stent compression, and inadequate parallel-stent deployment or infolding were recorded. Oversizing between both parallel stents and the iliac limb models were examined in terms of added diameter, perimeter, and area being additionally compared. All three sizing methods (diameter, perimeter, and area) were highly correlated (diameter OS to perimeter and area OS correlation coefficient 0.998 and 0.997, respectively, P  75%) showed a significant tendency toward smaller gutters (38.9, 12.2, 5.4, and 2.6 mm 2 , respectively, P parallel-stent compression (13.5%, 28.9%, 43.9%, and 55.1%, P parallel-stent compression. No clear recommendations in material selection can be performed. All sizing methods are highly correlated and predictable. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy: A Korean Multicenter Retrospective Study.

    Science.gov (United States)

    Jeon, Yong Sun; Cho, Young Kwon; Song, Myung Gyu; Seo, Tae-Seok; Kim, Jeong Ho; Song, Soon-Young; Lee, Sam Yeol

    2018-04-01

    We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal ® stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle > 60°). We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32-87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan-Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. The primary technical success rate (success within 24 h after EVAR) was 100% (24/24). The survival rate was 96 ± 8% at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18% at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001). Kilt-based EVAR with Seal ® stent-grafts for AAAs with a severely angulated neck (angle > 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.

  6. Unusual rapid evolution of type B aortic dissection in a marfan patient following heart transplantation: successful endovascular treatment.

    Science.gov (United States)

    Botta, L; Russo, V; Grigioni, F; Arpesella, G; Rocchi, G; Di Bartolomeo, R; Fattori, R

    2006-10-01

    A patient with Marfan syndrome with previous Bentall operation for mitral and tricuspid valve repair, required orthotopic cardiac transplantation for end stage cardiomyopathy. Postoperatively he suffered type-B aortic dissection, despite normal aortic diameters. Following sudden increase of aortic diameters, two years later, he underwent successful stent graft implantation. In patients with Marfan syndrome, post transplantation morbidity is high, with a 40% incidence of thoracic aortic dissection. This case highlights the potential of endovascular approach for treating post-transplantation aortic dissection.

  7. Osteomyelitis and Discitis Following Translumbar Repair of a Type II Endoleak

    Energy Technology Data Exchange (ETDEWEB)

    Sella, David M., E-mail: Sella.david@mayo.edu; Frey, Gregory T., E-mail: Frey.gregory@mayo.edu; Giesbrandt, Kirk, E-mail: giesbrandt.kirk@mayo.edu [Mayo Clinic, Department of Radiology (United States)

    2016-03-15

    Here we present the case of an 80-year-old man who developed a type II endoleak following endovascular abdominal aortic aneurysm repair. Initial attempts at treating the endoleak via a transarterial approach were unsuccessful; therefore the patient underwent percutaneous translumbar endoleak embolization. Approximately 1 month following the translumbar procedure, he developed back pain, with subsequent workup revealing osteomyelitis and discitis as a complication following repair via the translumbar approach.

  8. Estudo comparativo entre tratamento endovascular e cirurgia convencional na correção eletiva de aneurisma de aorta abdominal: revisão bibliográfica Endovascular elective treatment of the abdominal aortic aneurysm versus conventional open repair: a comparative study

    Directory of Open Access Journals (Sweden)

    Ana Carolina P. Simão

    2009-12-01

    Full Text Available O tratamento eletivo do aneurisma de aorta abdominal é recomendado pela alta morbiletalidade decorrente da eventual ruptura. O objetivo deste trabalho foi comparar o reparo endovascular eletivo com a cirurgia aberta e avaliar as mortalidades hospitalar e perioperatória, em 1 ano, por todas as causas e relacionadas ao aneurisma, a permanência hospitalar, as complicações, as taxas de sobrevida, conversão e reintervenção, a durabilidade do enxerto, o custo-benefício e a relação desses dados com o treinamento da equipe médica responsável pelo tratamento. Realizou-se uma revisão da literatura sobre reparo endovascular versus cirurgia convencional. Foram observados vantagem na sobrevivência perioperatória e menor estresse pós-cirúrgico; no entanto, os benefícios iniciais são perdidos por complicações e reintervenções tardias. Trabalhos baseados nas primeiras gerações de endopróteses superestimam as taxas de mortalidade em curto prazo, complicações e reintervenções. A durabilidade do enxerto, a real vantagem na sobrevida e o custo-benefício são incertos, e outros estudos são necessários para o seguimento em longo prazo.The elective treatment of the abdominal aortic aneurysm is recommended due to the high morbidity and mortality of a possible rupture. The objective of this study was to compare the elective endovascular aneurysm repair with open repair and to analyze the in-hospital and perioperative mortality rate during 1 year related to all causes and to the aneurysm, as well as the postoperative length of hospital stay, complications, survival rates, conversion and reintervention, graft durability, cost-benefit ratio, and relation with the medical team’s experience. A review of the scientific literature about endovascular versus open repair was carried out. We found a higher rate of perioperative survival and less postoperative stress; nevertheless, the initial benefits were lost due to late complications and

  9. Neck diameter and inner curve seal zone predict endograft-related complications in highly angulated necks after endovascular aneurysm repair using the Aorfix endograft.

    Science.gov (United States)

    Wang, Sophie; Hicks, Caitlin W; Malas, Mahmoud B

    2018-03-01

    Many studies have found that preoperative aneurysm anatomy can determine the postoperative complication rates for endovascular aneurysm repair (EVAR). With continual improvement in endograft technology, patients with challenging anatomy are increasingly able to undergo successful treatment with EVAR. This study aimed to quantify the influence of proximal neck anatomy on contemporary outcomes in a cohort of abdominal aortic aneurysm patients with highly angulated aneurysm necks. The study included 205 patients originally enrolled in the Prospective Aneurysm Trial: High Angle Aorfix Bifurcated Stent Graft (PYTHAGORAS) trial, the largest study to date to enroll patients with aortic aneurysm neck angles >60 degrees. Anatomic parameters included measurements of the proximal aneurysm neck as well as seal zones modeled in preoperative computed tomography scans. Follow-up up to 5 years postoperatively was available, for which stent-related complications (defined as sac expansion, stent migration, and type Ia endoleak) were assessed. Predictive anatomic parameters were assessed by Cox regression models, and a final multivariate model was created to predict complications. The cohort was also stratified by neck diameter for further comparison of complication rates. Of 205 patients enrolled in the trial, 67 stent-related complications occurred in 36 patients (17.6%) at 5 years after EVAR. Median follow-up was 48 months. Demographic and medical comorbidities did not predict risk of complications, nor did proximal neck length or neck angle. Independent predictors of post-EVAR complications included increasing proximal neck diameter (hazard ratio, 1.14; 95% confidence interval, 1.03-1.27; P < .05) and decreasing seal zone inner curve length (hazard ratio, 1.03; 95% confidence interval, 1.01-1.06; P < .05), which yielded a fair discriminatory utility (concordance, 0.67). Stratification by median neck diameter of 22.5 mm yielded two groups; patients with larger aortic necks

  10. Endovascular abdominal aortic repair for AAA. Anatomical suitability and limitation in Japanese population according to the inclusion criteria of Zenith AAA stent graft

    International Nuclear Information System (INIS)

    Kitagawa, Atsushi; Okita, Yutaka; Okada, Kenji

    2009-01-01

    Since 2007, the EVAR (endovascular abdominal aortic repair) grafts, Zenith, Excluder and Powerlink had been commercially available in Japan. However, a small iliac artery, typical of Japanese population especially in women, was a limiting factor to indicate EVAR. We analyzed the suitability of EVAR in Japanese population according to the inclusion criteria of Zenith AAA stent graft in the current study. From January 2006 to December 2007, 106 AAA (abdominal aortic aneurysm) patients (88 men, 18 women) with a mean age of 73 years were investigated in our institution by multi-slice CT scan in terms of suitability of EVAR, then we measured their abdominal aorta and iliac artery parameters as follows; proximal neck diameter (PND) and length (PNL), common iliac artery diameter (CIAD) and length (CIAL), suprarenal (SNA) and infrarenal neck angulation (INA), external iliac artery diameter (EIAD) and aortic length from the lowest renal artery to the aortic bifurcation (AOL). The inclusion criteria for Zenith AAA stent graft treatment were; PND: 18-28 mm, PNL more than 15 mm, unilateral CIAD less than 20 mm, CIAL at least 10 mm, SNA less than 45 degree and INA less than 60 degree, unilateral EIAD more than 7.5 mm. The indication of EVAR was 25.5% (27/106 patients), and was especially very low in women (5.6%) strictly according to the inclusion criteria of the Zenith AAA stent graft. The main reason of exclusion of EVAR was proximal short neck (40.5%), small iliac artery (30.4%) and infrarenal aortic neck angulation (29.1%). In our analysis, female AAA patients had small PNL and EIAD with angulated neck compared with male AAA ones. Anatomical suitability of EVAR in Japanese population strictly following by the inclusion criteria of Zenith AAA stent graft was low due to their characteristic differences from the European Union (EU) and the United States (US) patients, such as short proximal neck, steep neck angulation and small iliac artery, especially in women. More flexible

  11. Identification of predictive CT angiographic factors in the development of high-risk type 2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms

    International Nuclear Information System (INIS)

    Loewenthal, D.; Herzog, L.; Rogits, B.; Bulla, K.; Pech, M.; Ricke, J.; Dudeck, O.; Weston, S.; Meyer, F.; Halloul, Z.

    2015-01-01

    An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR). Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n = 80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n = 50). Statistical analysis comprised a univariate and multivariate analysis. Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4 ± 3.8 mm; HRG 23.6 ± 2.5 mm; p = 0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7 ± 18.0 %; HRG 25.3 ± 17.5 %; p = 0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3 %; HRG 92.0 %; p = 0.003) and their diameter (LRG 3.3 ± 0.7 mm; HRG 3.8 ± 0.9 mm; p = 0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7 ± 1.4; HRG 3.6 ± 1.2; univariate: p = 0.01; multivariate: p = 0.006) as well as their diameter (LRG 2.1 ± 0.4 mm; HRG 2.4 ± 0.4 mm; univariate: p < 0.001; multivariate: p = 0.006) were highly significantly associated with the development of type 2 endoleaks of the HRG. The most important predictive factors for the development of high-risk type 2 endoleaks were mainly the number and the diameter of the LAs which perfused the AAA.

  12. Mid-term Outcomes of Endovascular Repair of Ruptured Thoraco-abdominal Aortic Aneurysms with Off the Shelf Branched Stent Grafts.

    Science.gov (United States)

    Hongku, Kiattisak; Sonesson, Björn; Björses, Katarina; Holst, Jan; Resch, Timothy; Dias, Nuno V

    2018-03-01

    To assess the mid-term outcomes and feasibility of branched endovascular repair (b-EVAR) of ruptured thoracoabdominal aortic aneurysms (rTAAAs). All patients undergoing b-EVAR of rTAAAs between 2011 and 2016 were included. Pre-, intra and postoperative imaging was reviewed to assess technical success, outcomes, and feasibility of b-EVAR in the emergent setting. Eleven emergency b-EVAR of rTAAAs (10 aneurysms and 1 chronic dissection) were performed using off-the-shelf (OTS) branched stentgrafts. Only 18% of patients complied to the anatomical instruction-for-use of the OTS device; a small aortic lumen and occluded target vessels were the main violations. Median operative time was 430 (IQR 395-629) minutes. Technical failure was 36% including one intraoperative death, one target vessel catheterization failure, one type Ia and one type III endoleak. Thirty-day mortality was 27%. Only early re-intervention was for the type Ia endoleak. Spinal cord ischemia occurred in 4 patients (30%), of which 2 recovered completely. Median clinical follow-up were 15 (IQR 7-39) months respectively. The median clinical follow-up index (FUI) was 0.65 (0.32-0.95). Overall survival was 75 ± 21.7% at 18 months. Four branch occlusions occurred; one renal stent occlusion led to permanent hemodialysis. Branch patency was 87.5 ± 8.3% and 72.2 ± 12% at 1 and 2 years, respectively. One stentgraft migrated but no late major endoleak occurred. Emergency b-EVAR of rTAAA with OTS device is feasible despite a low anatomical suitability. With proper adjunctive procedures, it can be offered to most hemodynamically stable patients. These time-consuming complex procedures are not suitable for unstable patients. Often the procedure is done as life-saving in the emergency setting and reinterventions may be needed later. Consequently, the success rates are lower than in the elective setting. These results need to be confirmed by larger studies and longer follow-up. Copyright © 2017 European

  13. Source of errors and accuracy of a two-dimensional/three-dimensional fusion road map for endovascular aneurysm repair of abdominal aortic aneurysm.

    Science.gov (United States)

    Kauffmann, Claude; Douane, Frédéric; Therasse, Eric; Lessard, Simon; Elkouri, Stephane; Gilbert, Patrick; Beaudoin, Nathalie; Pfister, Marcus; Blair, Jean François; Soulez, Gilles

    2015-04-01

    To evaluate the accuracy and source of errors using a two-dimensional (2D)/three-dimensional (3D) fusion road map for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm. A rigid 2D/3D road map was tested in 16 patients undergoing EVAR. After 3D/3D manual registration of preoperative multidetector computed tomography (CT) and cone beam CT, abdominal aortic aneurysm outlines were overlaid on live fluoroscopy/digital subtraction angiography (DSA). Patient motion was evaluated using bone landmarks. The misregistration of renal and internal iliac arteries were estimated by 3 readers along head-feet and right-left coordinates (z-axis and x-axis, respectively) before and after bone and DSA corrections centered on the lowest renal artery. Iliac deformation was evaluated by comparing centerlines before and during intervention. A score of clinical added value was estimated as high (z-axis 5 mm). Interobserver reproducibility was calculated by the intraclass correlation coefficient. The lowest renal artery misregistration was estimated at x-axis = 10.6 mm ± 11.1 and z-axis = 7.4 mm ± 5.3 before correction and at x-axis = 3.5 mm ± 2.5 and z-axis = 4.6 mm ± 3.7 after bone correction (P = .08), and at 0 after DSA correction (P artery was estimated at x-axis = 2.4 mm ± 2.0 and z-axis = 2.2 mm ± 2.0. Score of clinical added value was low (n = 11), good (n= 0), and high (n= 5) before correction and low (n = 5), good (n = 4), and high (n = 7) after bone correction. Interobserver intraclass correlation coefficient for misregistration measurements was estimated at 0.99. Patient motion before stent graft delivery was estimated at x-axis = 8 mm ± 5.8 and z-axis = 3.0 mm ± 2.7. The internal iliac artery misregistration measurements were estimated at x-axis = 6.1 mm ± 3.5 and z-axis = 5.6 mm ± 4.0, and iliac centerline deformation was estimated at 38.3 mm ± 15.6. Rigid registration is feasible and fairly accurate. Only a partial reduction of vascular

  14. Endovascular treatment of type B dissection in patients with Marfan syndrome: mid-term outcomes and aortic remodeling.

    Science.gov (United States)

    Eid-Lidt, Guering; Gaspar, Jorge; Meléndez-Ramírez, Gabriela; Cervantes S, Jorge; González-Pacheco, Hector; Dámas de Los Santos, Félix; Meave-González, Aloha; Ramírez Marroquín, Samuel

    2013-12-01

    To evaluate the mid-term outcomes, and the aortic remodeling in Marfan syndrome (MFS) patients with type B dissection that were treated with endovascular repair. MFS is a relative contraindication to thoracic endovascular aortic repair (TEVAR). Mid-term aortic outcomes data in MFS after TEVAR are limited, and the occurrence of late events remains unclear. Of 89 patients that underwent TEVAR between September 2002 and February 2011, 10 patients with mid-term follow-up fulfilled the Ghent criteria for MFS and complicated type B dissection. High risk for open surgery was documented in 90%. The mean age was 35.1 ± 9.4 years and all patients presented with acute aortic syndrome complicating a chronic type B dissection (DeBakey type IIIb). Five patients underwent a Bentall surgical procedure previous to endovascular repair, and in four patients initial TEVAR was followed by surgery of the ascending aorta. Treatment was limited to endovascular repair in only one patient. In-hospital mortality was 10%. At a mean follow-up of 59.6 ± 38.9 months, the cumulated mortality was of 20% and late mortality 11.1%. The rate of secondary endoleak was 44.4%, and late reintervention of 33.3%. Survival freedom from cardiovascular death at 8 years was 80.0%, and positive remodeling was documented in 37.5% of patients. Our results suggest that TEVAR is feasible, safe, and associated with a high reintervention rate and reduced rate of positive aortic remodeling in patients with Marfan syndrome. Survival at 8 years was comparable to contemporary series of open repair. Copyright © 2013 Wiley Periodicals, Inc.

  15. Tratamento endovascular do aneurisma da aorta abdominal infrarrenal em pacientes com anatomia favorável para o procedimento: experiência inicial em um serviço universitário Endovascular treatment of infrarenal abdominal aortic aneurysm in patients with favorable anatomy for the repair: initial experience in a university hospital

    Directory of Open Access Journals (Sweden)

    José Manoel da Silva Silvestre

    2011-03-01

    Full Text Available CONTEXTO: Desde sua introdução, em 1991, o reparo endovascular do aneurisma da aorta abdominal infrarrenal tem se tornado uma alternativa atraente para o tratamento dessa doença. Avaliar nossos resultados iniciais quanto à segurança e eficácia dessa técnica nos levou à realização deste estudo. OBJETIVOS: Analisar a mortalidade perioperatória, a sobrevida tardia, as reoperações, as taxas de perviedade e o comportamento do saco aneurismático em pacientes com anatomia favorável para a realização do procedimento. MÉTODOS: Trata-se de um estudo longitudinal, observacional e retrospectivo realizado entre outubro de 2004 e janeiro de 2009 com 41 pacientes que foram submetidos à correção endovascular do aneurisma de aorta abdominal infrarrenal por apresentarem anatomia favorável para o procedimento. Foram analisados os achados dos exames diagnósticos, o tratamento e o seguimento em todos os pacientes. RESULTADOS: Foram implantadas, com sucesso, 31 (75,6% próteses bifurcadas e 10 (24,5% monoilíacas, de 5 diferentes marcas. O diâmetro médio dos aneurismas fusiformes era de 62 mm. A mortalidade perioperatória foi de 4,8% e a sobrevida tardia, 90,2%. Durante o acompanhamento médio de 30 meses, 2 (4,8% pacientes necessitaram de reintervenção, um por migração da endoprótese e outro por vazamento tipo II. Dois (4,8% pacientes apresentaram oclusão de ramo da prótese. Oito (19,5% vazamentos foram diagnosticados e não houve nenhuma rotura dos aneurismas. CONCLUSÃO: Apesar do pequeno número de pacientes, os resultados observados parecem justificar a realização do procedimento endovascular nos pacientes com anatomia favorável.BACKGROUND: Since its introduction in 1991, endovascular repair of infrarenal aortic aneurysms has become an attractive option to treat this disease. The evaluation of our initial results about safety and efficacy of this technique has led us to carry out this study. OBJECTIVES: To analyze

  16. Impact of study design on outcome after endovascular abdominal aortic aneurysm repair. A comparison between the randomized controlled DREAM-trial and the observational EUROSTAR-registry.

    NARCIS (Netherlands)

    Leurs, L.J.; Buth, J.; Harris, P.L.; Blankensteijn, J.D.

    2007-01-01

    BACKGROUND: Patients with abdominal aortic aneurysm (AAA) can be treated by transfemoral endovascular intervention and by conventional open surgery. Level-one evidence of the safety and efficacy of one treatment mode over the other is only provided by a randomised controlled trial (RCT). Results

  17. Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors

    International Nuclear Information System (INIS)

    Kawatani, Yohei; Nakamura, Yoshitsugu; Mochida, Yoshihiko; Yamauchi, Naoya; Hayashi, Yujiro; Taneichi, Tetsuyoshi; Ito, Yujiro; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    Endovascular stent graft placement has become a major treatment for thoracic and abdominal aneurysms. While endovascular therapy is less invasive than open surgery, it involves the use of a contrast medium. Contrast media can cause renal impairment, a condition termed as contrast-induced nephropathy (CIN). This study sought to evaluate the incidence and risk factors of CIN following endovascular stent graft placement for aortic aneurysm repair. The study included 167 consecutive patients who underwent endovascular stent graft placement in our hospital from October 2013 to June 2014. CIN was diagnosed using the European Society of Urogenital Radiology criteria. Patients with and without CIN were compared. Chi-squared tests, t-tests, and multivariate logistic regression analyses were performed. Thirteen patients (7.8%) developed CIN. Left ventricular dysfunction and intraoperative blood transfusion were significantly more frequent in the CIN group (P = 0.017 and P = 0.032, resp.). Multivariate analysis showed that left ventricular dysfunction had the strongest influence on CIN development (odds ratio 9.34, P = 0.018, and 95% CI = 1.46–59.7). Patients with CIN also experienced longer ICU and hospital stays. Measures to improve renal perfusion flow should be considered for patients with left ventricular dysfunction who are undergoing endovascular stent graft placement

  18. Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave Endovascular repair of abdominal aortic aneurysm and left common iliac artery in a patient with severe hemophilia C

    Directory of Open Access Journals (Sweden)

    Sergio Quilici Belczak

    2012-03-01

    Full Text Available A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%. O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.Factor XI deficiency, also known as hemophilia C, is a rare hereditary blood disease that manifests with persistent bleeding after surgery, trauma, menorrhagia, and dental extractions. This article reports an endovascular repair of a patient diagnosed with an aortic and left common iliac aneurysm, with severe factor XI deficiency (factor XI activity below 20%. The procedure was successfully performed with management of the coagulation disorder by preoperative and postoperative infusion of plasma and laboratory control of the coagulation.

  19. Preservação das artérias hipogástricas com endoprótese ramificada no tratamento endovascular de aneurismas aorto-ilíacos The Zenith iliac bifurcation Device (IBD for preservation of the internal iliac arteries during endovascular repair of aortic-iliac aneurysms

    Directory of Open Access Journals (Sweden)

    Emanuel Dias

    2010-12-01

    Full Text Available Introdução: Os doentes com indicação para tratamento endovascular de aneurismas da aorta abdominal (EVAR apresentam frequentemente artérias ilíacas comuns ectasiadas ou aneurismáticas, o que impossibilita a sua utilização como zona de encoragem distal da endoprótese. Em cerca de 15 a 30% dos casos pode existir necessidade de oclusão/embolização de uma ou de ambas as hipogástricas, com extensão da endoprótese para a artéria ilíaca externa. Isto tem sido associado a casos de claudicação glútea, isquémia intestinal, deficits neurológicos, e de disfunção vesical, intestinal e eréctil. O uso de endopróteses com ramo para a artéria hipogástrica apresenta-se como uma recente inovação que permite a preservação desta artéria e evitar estas complicações. Caso clínico: Homem de 63 anos, com antecedentes de cirurgia aórtica com interposição protésica aorto-aórtica em 2008 por aneurisma da aorta abdominal (AAA infra-renal, admitido para tratamento endovascular de aneurisma das artérias ilíaca comum e hipogástrica direitas, com 3,3 cm de maior diâmetro. O doente foi submetido a colocação por via femoral de endoprótese Zenith® ramificada para bifurcação ilíaca com preservação da artéria hipogástrica. Conclusões: A utilização de endopróteses ramificadas para a bifurcação ilíaca durante a correcção endovascular de aneurismas aorto-ilíacos para ser uma forma segura e pouco complexa de garantir a preservação das artérias hipogástricas e minimizar as complicações associadas à sua oclusão.Introduction: A significant portion of patients presenting for endovascular aneurysm repair of the abdominal aorta (EVAR have aneurysmatic or ectasied common iliac arteries, raising distal anchorage issues. In these cases, it may be necessary occlusion / embolization of one or both hipo gastric arteries with extension of the endoprothesis to the external iliac artery. This procedure has been associated to

  20. Transcarotid Artery Endovascular Reconstruction of the Aortic Arch by Modified Bifurcated Stent Graft for Stanford Type A Dissection

    Directory of Open Access Journals (Sweden)

    Wei Guo

    2007-10-01

    Full Text Available A 40-year-old man with Stanford type B dissection underwent his first endovascular repair (EVAR in April 2004 by Talent thoracic stent graft. He had an uncomplicated recovery and maintained good blood pressure control. However, a new retrograde dissection appeared in September 2004. The new dissection involved his aortic arch and ascending thoracic aorta to the opening of the coronary arteries. To reconstruct the aortic arch, bypasses between the right common carotid artery (RCCA, left common carotid artery and left subclavian artery were performed before endovascular repair. A modified bifurcated Talent stent graft was deployed from the RCCA to the ascending thoracic aorta with a long limb in the innominate artery and a short limb in the aortic arch. A further two pieces of graft were deployed via the common femoral artery. The ascending thoracic aorta and aortic arch were reconstructed completely by the bifurcated stent graft. The final angiography confirmed that there was good stent graft configuration, normal blood flow, and stable haemodynamics. No endoleak or other major complications were encountered. This result indicated that it is possible to reconstruct the aortic arch with a bifurcated stent graft and could be a new endovascular repair model for complex thoracic aortic aneurysm and dissection.

  1. X-ray endovascular repair of the venous bed of the pyelonephritically contracted kidney in the treatment of nephrogenic and chronic renal failure

    International Nuclear Information System (INIS)

    Galkin, E.V.; Gladkov, V.V.; Inozemtsev, G.S.

    2000-01-01

    For compensation for chronic ischemia of the pyelonephritically contracted kidney the X-ray endovascular venous revascularization was used for the first time. The surgical intervention was to stenosis the subsegmental veins of the diseased kidney resulting in recanalization of the arterial system. Outcomes of X-ray treatment were analyzed in 38 patients with chronic degree I-II renal failure and nephrogenic hypertension. In 35 (92.1 %) patients of them, there was improvement in the clinical picture of the underlying disease and in the filtrating and reabsorbing function of the kidney operated on, an increase in its sizes, and decrease in systemic blood pressure [ru

  2. Spontaneous rupture of superficial femoral artery repaired with endovascular stent-grafting with use of rendez-vous technique, followed by delayed infection.

    Science.gov (United States)

    Fanelli, Fabrizio; Cannavale, Alessandro; Gazzetti, Marianna; Fantozzi, Cristiano; Taurino, Maurizio; Speziale, Francesco

    2013-02-01

    This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

  3. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed...... reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding...

  4. Endovascular Treatment of an Aortobronchial Fistula

    International Nuclear Information System (INIS)

    Numan, Fueruezan; Arbatli, Harun; Yagan, Naci; Demirsoy, Ergun; Soenmez, Binguer

    2004-01-01

    A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure

  5. Fatores envolvidos na migração das endopróteses em pacientes submetidos ao tratamento endovascular do aneurisma da aorta abdominal Factors involved in the migration of endoprosthesis in patients undergoing endovascular aneurysm repair

    Directory of Open Access Journals (Sweden)

    Marcelo José de Almeida

    2010-06-01

    Full Text Available A migração da endoprótese é complicação do tratamento endovascular definida como deslocamento da ancoragem inicial. Para avaliação da migração, verifica-se a posição da endoprótese em relação a determinada região anatômica. Considerando o aneurisma da aorta abdominal infrarrenal, a área proximal de referência consiste na origem da artéria renal mais baixa e, na região distal, situa-se nas artérias ilíacas internas. Os pacientes deverão ser monitorizados por longos períodos, a fim de serem identificadas migrações, visto que estas ocorrem normalmente após 2 anos de implante. Para evitar migrações, forças mecânicas que propiciam fixação, determinadas por características dos dispositivos e incorporação da endoprótese, devem predominar sobre forças gravitacionais e hemodinâmicas que tendem a arrastar a prótese no sentido caudal. Angulação, extensão e diâmetro do colo, além da medida transversa do saco aneurismático, são importantes aspectos morfológicos do aneurisma relacionados à migração. Com relação à técnica, não se recomenda implante de endopróteses com sobredimensionamento excessivo (> 30%, por provocar dilatação do colo do aneurisma, além de dobras e vazamentos proximais que também contribuem para a migração. Por outro lado, endopróteses com mecanismos adicionais de fixação (ganchos, farpas e fixação suprarrenal parecem apresentar menos migrações. O processo de incorporação das endopróteses ocorre parcialmente e parece não ser suficiente para impedir migrações tardias. Nesse sentido, estudos experimentais com endopróteses de maior porosidade e uso de substâncias que permitam maior fibroplasia e aderência da prótese à artéria vêm sendo realizados e parecem ser promissores. Esses aspectos serão discutidos nesta revisão.Migration of the endoprosthesis is defined as the misplacement of its initial fixation. To assess the migration, the position of the

  6. Endovascular Treatment for Pseudoaneurysms after Surgical Correction of Aortic Coarctation

    Directory of Open Access Journals (Sweden)

    M. Rabellino

    2011-01-01

    Full Text Available Late complications after surgical repair of aortic coarctation are not uncommon. Among these complications pseudoaneurysms are the most frequent complications, occurring between 3 and 38%. Reoperation in these patients is associated with high morbidity and mortality. In the last decade, endovascular techniques emerged as an alternative to conventional surgery with excellent results. We report the case of two patients who presented with pseudoaneurysms after surgical correction for aortic coarctation, which were treated by endovascular means.

  7. Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up.

    Science.gov (United States)

    Mehmedagic, Irma; Santén, Stefan; Jörgensen, Sophie; Acosta, Stefan

    2016-11-11

    Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. Nested case-control study. Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. This study cohort of patients who underwent advanced endovascular aortic repair was rather homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not.

  8. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation

    Energy Technology Data Exchange (ETDEWEB)

    Bilos, Linda, E-mail: linda.bilos@regionorebrolan.se; Pirouzram, Artai; Toivola, Asko; Vidlund, Mårten; Cha, Soon Ok; Hörer, Tal [Örebro University Hospital and Örebro University, Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health (Sweden)

    2017-01-15

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  9. MDCT angiography of thoracic aorta endovascular stent-grafts: pearls and pitfalls.

    Science.gov (United States)

    Hoang, Jenny K; Martinez, Santiago; Hurwitz, Lynne M

    2009-02-01

    The objective of our study was to review expected findings and complications after thoracic endovascular aortic repair on CT angiography (CTA). Luminal and extraluminal changes to the thoracic aorta occur after endovascular stent-grafting. The radiologist can facilitate appropriate management by detecting and differentiating expected CTA findings from complications.

  10. Influence of Gender on Abdominal Aortic Aneurysm Repair in the Community.

    Science.gov (United States)

    Nevidomskyte, Daiva; Shalhub, Sherene; Singh, Niten; Farokhi, Ellen; Meissner, Mark H

    2017-02-01

    Women have been shown to experience inferior outcomes following intact and ruptured abdominal aortic aneurysm (AAA) treatment in endovascular aneurysm repair (EVAR) and open surgical repair (OSR) groups. The goal of our study was to compare gender-specific presentation, management, and early outcomes after AAA repair using a statewide registry. We utilized the Washington State's Vascular Interventional Surgical Care and Outcomes Assessment Program registry data collected in 19 hospitals from July 2010 to September 2013. Demographics, presentation, procedural data, and outcomes in elective and emergent AAA repair groups were analyzed. We identified 1,231 patients (19.6% women) who underwent intact (86.4%) or ruptured AAA (13.6%) repairs. Nine thousand seventy-two (79.0%) patients had EVAR and 259 (21.0%) had OSR. Men and women were of equivalent age and had similar comorbidities, except that women had less coronary artery disease (P aneurysm diameters (5.8 ± 1.1 vs. 6.2 ± 1.8 cm, P aneurysm size. Men were more likely to undergo EVAR, with significant differences in elective (82.1% vs. 74.1%, P = 0.01), but not ruptured repair. Women had significantly higher mortality rates following elective EVAR (3.1% vs. 0.6%, P = 0.01), but not after ruptured or elective open repair. Following elective EVAR, women were less likely to be discharged to home after longer hospital stays (3 vs. 2 days, P aneurysm diameter, and similar medical comorbidities, women experience substantially worse hospital outcomes primarily driven by elective endovascular procedures. Utilization of endovascular techniques in women still remains lower compared with men. Improvement of elective outcomes in women will likely depend on technical advancements in repair techniques and management strategies that may differ between genders. Published by Elsevier Inc.

  11. Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: A preliminary study on long-term multiple follow-ups.

    Science.gov (United States)

    Xu, Huanming; Li, Zhenfeng; Dong, Huiwu; Zhang, Yilun; Wei, Jianyong; Watton, Paul N; Guo, Wei; Chen, Duanduan; Xiong, Jiang

    2017-12-01

    Thoracic endovascular aortic repair (TEVAR) is commonly applied in type-B aortic dissection. For patients with dissection affects descending aorta and extends downward to involve abdominal aorta and possibly iliac arteries, false lumen (FL) expansion might occur post-TEVAR. Predictions of dissection development may assist in medical decision on re-intervention or surgery. In this study, two patients are selected with similar morphological features at initial presentation but with different long-term FL development post-TEVAR (stable and enlarged FL). Patient-specific models are established for each of the follow-ups. Flow boundaries and computational validations are obtained from Doppler ultrasound velocimetry. By analyzing the hemodynamic parameters, the false-to-true luminal pressure difference (PDiff) and particle relative residence time (RRT) are found related to FL remodeling. It is found that (i) the position of the first FL flow entry is the watershed of negative-and-positive PDiff and, in long-term follow-ups, and the position of largest PDiff is consistent with that of the greatest increase of FL width; (ii) high RRT occurs at the FL proximal tip and similar magnitude of RRT is found in both stable and enlarged cases; (iii) comparing to the RRT at 7days post-TEVAR, an increase of RRT afterwards in short-term is found in the stable case while a slight decrease of this parameter is found in the enlarged case, indicating that the variation of RRT in short-term post-TEVAR might be potential to predict long-term FL remodeling. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  12. Endovascular treatment of isolated common iliac artery aneurysms with short necks using bifurcated stent-grafts.

    Science.gov (United States)

    Wi, Jin; Ko, Young-Guk; Kim, Jung-Sun; Choi, Donghoon; Hong, Myeong-Ki; Lee, Do-Youn; Jang, Yangsoo; Shim, Won-Heum

    2010-07-01

    Elective surgical repair has traditionally been considered to be the treatment of choice for the exclusion of isolated iliac artery aneurysms (IAAs). Recently, endovascular repair has evolved as an alternative to surgical repair, especially in patients at high surgical risk. However, in the absence of sufficient proximal necks, iliac artery aneurysms are not suitable for direct deployment of a tubular-shaped endograft. Here we report two cases of IAAs with short proximal necks that were excluded using an endovascular bifurcated stent-graft. The bifurcated stent-graft was successfully deployed with complete exclusion of the aneurysm. In neither case was there evidence of procedural failures. There were no signs of significant complications. We conclude that endovascular repair of IAAs with short proximal necks is feasible and efficient using an endovascular bifurcated stent-graft.

  13. Endoleak, a specific complication of the endovascular treatment of aortic aneurysms

    OpenAIRE

    BRULS, Samuel; CREEMERS, Etienne; TROTTEUR, Geneviève; Firket, Laurent; Chauveau, R.; Magotteaux, Paul; DESIRON, Quentin; Defraigne, Jean-Olivier

    2011-01-01

    Endoleaks represent the most common complication of endovascular aortic aneurysm repair. With the increasing use of endovascular techniques for aortic aneurysm repair, the prevalence of endoleaks has risen. While maintaining pressurization of the aneurysm sac, endoleaks expose to persistent risks of an evolution towards rupture. Long-term surveillance with imaging studies is necessary to reduce the incidence of these specific complications that may require intervention. The objective of this ...

  14. Coronary risk in candidates for abdominal aortic aneurysm repair: a word of caution.

    Science.gov (United States)

    Borioni, Raoul; Tomai, Fabrizio; Pederzoli, Alessio; Fratticci, Laura; Barberi, Filippo; De Luca, Leonardo; Albano, Marzia; Garofalo, Mariano

    2014-11-01

    Current guidelines do not recommend routine coronary evaluation preceding abdominal aortic aneurysms (AAA) repair in low-risk patients. The purpose of the present study is to report the incidence of coronary lesions in candidates for AAA repair with a Revised Cardiac Risk (Lee) Index (RCRI) coronary angiography and myocardial revascularization (percutaneous coronary intervention, PCI; coronary artery bypass grafting, CABG) before elective open or endovascular AAA repair (January 2005-December 2012). Severe coronary artery disease (CAD) was revealed in 43 patients (28.9%), who underwent successful myocardial revascularization by means of PCI (n.35) or off-pump CABG (n.8). The incidence of severe CAD in patients resulted at low risk on the basis of risk models was approximately 25%. The incidence of severe CAD in asymptomatic patients was 29.8%. Endovascular (n.52, 35.1%) and open (n.96, 64.9%) AAA repair was performed with low morbidity (0.6%) and mortality (0.6%) in 148 patients. The long-term estimated survival (freedom from fatal cardiovascular events) was 97% at 60 months and 82% at 90 months. The incidence of severe correctable CAD is not negligible in low-risk patients scheduled for AAA repair. Waiting for further recommendations based on large population studies of vascular patients, a more extensive indication to coronary angiography and revascularization should be considered in many candidates for AAA repair.

  15. Tratamento endovascular de aneurismas cirsoideos do couro cabeludo Endovascular treatment of scalp cirsoid aneurysms

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2010-08-01

    Full Text Available OBJETIVO: Relatar os resultados da aplicação de técnicas endovasculares no tratamento de aneurismas cirsoideos do couro cabeludo. MATERIAIS E MÉTODOS: Quatro pacientes com diagnóstico de aneurismas cirsoideos foram submetidos ao tratamento por via endovascular. Todos os quatro pacientes incluídos nesta série tinham malformações arteriovenosas e foram tratados apenas com embolização. RESULTADOS: Três pacientes foram submetidos a tratamento endovascular mediante embolização transarterial e um foi tratado por punção direta da porção venosa. Os resultados clínicos e cosméticos foram satisfatórios em todos os pacientes. Não houve recidiva clínica durante o período de acompanhamento. CONCLUSÃO: A via endovascular é uma alternativa segura e eficaz no tratamento dos aneurismas cirsoideos. Embora possa ser efetivamente utilizado como uma alternativa adjuvante ou complementar à cirurgia, especialmente quando é necessário lidar com aferências profundas, a maioria dos casos pode ser totalmente curada apenas com a terapêutica endovascular. A escolha do método de tratamento deve ser baseada em uma variedade de características próprias da lesão, incluindo sua angioarquitetura, tamanho e apresentação clínica.OBJECTIVE: To report results of the application of endovascular techniques in the management of scalp cirsoid aneurysms. MATERIALS AND METHODS: Four patients diagnosed with cirsoid aneurysms were submitted to treatment by endovascular approach. All the four patients included in the present series had arteriovenous malformations and were treated solely by embolization. RESULTS: Three of the patients underwent endovascular treatment by transarterial embolization and one was treated by direct puncture of the venous segment. Both clinical and cosmetic outcomes were satisfactory in all of the patients. Clinical relapse was not observed along the follow-up period. CONCLUSION: The endovascular approach is safe and effective in

  16. A novel technique combining laparoscopic and endovascular approaches using image fusion guidance for anterior embolization of type II endoleak

    OpenAIRE

    Zubair, M. Mujeeb; Chinnadurai, Ponraj; Loh, Francis E.; Loh, Thomas M.; Lumsden, Alan B.; Bechara, Carlos F.

    2016-01-01

    Type II endoleak (T2E) leading to aneurysm sac enlargement is one of the challenging complications associated with endovascular aneurysm repair. Recent guidelines recommend embolization of T2E associated with aneurysmal sac enlargement. Various percutaneous and endovascular techniques have been reported for embolization of T2E. We report a novel technique for T2E embolization combining laparoscopic and endovascular approaches using preoperative image fusion. We believe our technique provides ...

  17. Hybrid endovascular treatment of an aortic root and thoracoabdominal aneurysm in a high-risk patient with Marfan syndrome.

    Science.gov (United States)

    Gelpi, Guido; Mazzaccaro, Daniela; Romagnoni, Claudia; Contino, Monica; Antona, Carlo

    2013-05-01

    This report describes the hybrid endovascular treatment of an aortic root dilatation and a thoracoabdominal aneurysm in a high-risk patient with Marfan syndrome. A 50-year-old male, in hemodialysis for polycystic kidney and polycystic liver, was referred to our department for aortic root dilatation of 5 cm and a 6.3-cm thoracoabdominal aneurysm . He already underwent surgical repair of abdominal aortic aneurysm 10 years ago, complicated by pseudoaneurysm of the proximal anastomosis that had been treated in another center, with an endoprosthesis. The patient underwent aortic root replacement, aortic valve sparing operation, and rerouting of the superior mesenteric artery and celiac trunk to the ascending aorta. The thoracoabdominal aneurysm was excluded with an endoprosthesis few days after the surgical step. The 12-month computed tomography scan confirmed the complete exclusion of the thoracoabdominal aneurysm.

  18. Noninvasive evaluation of the effectiveness of endovascular AAA exclusion.

    NARCIS (Netherlands)

    Laan, M.J. van der; Teutelink, A.; Wixon, C.L.; Blankensteijn, J.D.

    2003-01-01

    PURPOSE: To evaluate the relationship between aneurysm sac pressure and endograft wall motion in vitro and in vivo and to compare this to sac volume changes after endovascular aneurysm repair. METHODS: In a flow model of an aneurysm with a stent-graft in situ, sac pressure was incrementally

  19. Endovascular Treatment of Ruptured Abdominal Aneurysm into the Inferior Vena Cava in Patient After Stent Graft Placement

    International Nuclear Information System (INIS)

    Juszkat, Robert; Pukacki, Fryderyk; Zarzecka, Anna; Kulesza, Jerzy; Majewski, Waclaw

    2009-01-01

    We report the case of a patient who underwent endovascular repair and then reintervention as a result of the presence of a persistent endoleak complicated by an aortocaval fistula. A 76-year-old patient with a history of endovascular treatment for abdominal aortic aneurysm 2 years earlier had a palpable abdominal mass, high-output cardiac failure, and renal failure. A computed tomographic scan and angiography revealed bending of the right iliac limb, a type I endoleak, and rupture of the aneurysm into the inferior vena cava with aortocaval fistula formation. An iliac extension was positioned in the right external iliac artery. The procedure was finished successfully. Control angiography showed normal flow within the endoprosthesis, and both iliac arteries were without signs of endoleakage and aortocaval fistula. Ectatic common iliac artery may lead to a late distal attachment site endoleak. The application of a stent graft in cases of secondary aortocaval fistula after stent graft repair is a good option, particularly in emergency cases.

  20. Endovascular Aneurysm Repair Treatment of Aortoiliac Aneurysms

    DEFF Research Database (Denmark)

    Taudorf, Mikkel; Rasmussen, John Bøje Grønvall; Schroeder, Torben V

    2016-01-01

    , and a branch iliac device was placed in 25 limbs. Gluteal claudication developed in 38% of limbs treated with IIA exclusion but in none of the limbs treated with branch iliac devices (P fluoroscopy time, and use of iodine contrast material did not differ between the two groups...

  1. Endovascular Therapy in Trauma

    Science.gov (United States)

    2014-11-23

    These can be complicated by thrombosis , embolism, and acute arterial insufficiency. Injuries involving the adventitia lead to pseudoaneurysm formation...common carotid, mesenteric , and iliac) and extremity vessel injury can also be accomplished endovascular stent-graft tech- niques (Fig. 1). As

  2. Perioperative and Late Outcomes after Endovascular Treatment for Isolated Iliac Artery Aneurysms.

    Science.gov (United States)

    Bianchini Massoni, Claudio; Freyrie, Antonio; Gargiulo, Mauro; Tecchio, Tiziano; Mascoli, Chiara; Gallitto, Enrico; Faggioli, Gianluca; Pini, Rodolfo; Azzarone, Matteo; Perini, Paolo; Stella, Andrea

    2017-10-01

    The aim of the study is to report early and follow-up outcomes of the endovascular treatment with iliac endografts for isolated iliac artery aneurysms (IIAAs). Records of patients who underwent elective endovascular repair for IIAA (both primary and para-anastomotic) from 2005 to 2015 in 2 Italian centers were retrospectively examined. Demographic data, preoperative patient comorbidities, iliac aneurysm characteristics, contralateral iliac axis involvement, patency of hypogastric arteries and inferior mesenteric artery (IMA), and data of endovascular treatment were obtained for analysis. Early end points were technical success (TS), perioperative morbidity, clinical success (CS), freedom from reintervention (FFR) and survival. Follow-up end points were CS, FFR, survival, evolution of the aneurysmal sac, and endoleak (EL). Thirty-two IIAAs were treated through an endovascular approach in 30 patients (male 96.7%; mean age 74.2 years ± 7.6, range 55-86). Aneurysms were para-anastomotic in 11 (34.4%) cases. Mean diameter was 42.9 ± 15.6 mm (range 30-100). Twenty (62.5%) aneurysms involved exclusively the common iliac artery, 7 (21.9%) the hypogastric, and 5 (15.6%) both arteries. Ipsilateral hypogastric artery was stenotic or occluded in 4 (12.5%) and 1 (3.1%) patient, respectively. Contralateral hypogastric artery was occluded in 2 (6.3%) cases. IMA was patent in 9 (30%) patients. The ostium of the hypogastric artery was preserved in 5 cases (15.6%) and voluntarily covered in 27 (84.4%). Endovascular embolization of hypogastric artery was obtained with a plug device in 8 cases (25%). Hypogastric surgical revascularization was performed in 2 cases (6.3%). TS was 96.9%. Thirty-day morbidity was 6.3% (2/32). CS was 96.9% (1 endograft limb stenosis). Thirty-day FFR was 90.6% (1 transluminal angioplasty, 2 inguinal revisions). Thirty-day survival was 100%. At 1, 3, and 6 years, CS was 93.4%, 85.6%, and 85.6%, respectively (1 endograft limb thrombosis, 1 endograft

  3. Fístula aortoesofágica após correção endovascular da dissecção de aorta torácica tipo B de Stanford Aortic-esophageal fistula after endovascular repair of Stanford type B thoracic aortic dissection

    Directory of Open Access Journals (Sweden)

    Cláudia Gurgel Marques

    2010-01-01

    Full Text Available A correção endovascular da dissecção de aorta tipo B tem se mostrado como uma nova alternativa para reduzir o trauma cirúrgico. No entanto, as complicações de médio e longo prazo, tais como a fístula aortoesofágica, são ainda pouco conhecidas e pouco relatadas. O objetivo deste trabalho é descrever três casos de fístula aortoesofágica após o tratamento endovascular de 23 casos de dissecção de aorta descendente conduzidos pela equipe de Cirurgia Vascular da Santa Casa de São Paulo em um estudo retrospectivo. Esses pacientes apresentavam características em comum, como dissecção crônica, pós-operatório imediato sem intercorrências, necessidade de reintervenções, oclusão de troncos arteriais como a artéria subclávia, mesentérica, tronco celíaco, e, ainda, uma rápida evolução para o óbito após os primeiros sinais de fístula. Portanto, embora raramente descrita na literatura, a ocorrência de fístula aortoesofágica é uma complicação de causa até o momento indefinida do tratamento endovascular da dissecção de aorta descendente que merece atenção, dada sua recorrência e evolução fatal.Endoluminal stent-graft for type B aortic dissection is a new alternative to reduce surgical trauma. However, medium- and long-term complications are still little known and poorly reported, such as the aortic-esophageal fistula. The objective of this study is to describe three cases of aortic-esophageal fistula after the endovascular treatment of 23 cases of descending aortic dissection conducted by the vascular surgery team of Santa Casa de São Paulo in a retrospective study. These patients presented some common characteristics: chronic dissection, successful early outcome, need of reinterventions, occlusion of arterial trunks such as subclavian artery, mesenteric artery, celiac trunk, and finally, a fast fatal course after the first fistula-related symptoms. Therefore, despite rarely described in the literature, aortic

  4. Endovascular Treatment Strategies in Aortoiliac Occlusion

    International Nuclear Information System (INIS)

    Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri; Gumus, Burcak

    2009-01-01

    The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

  5. Endovascular treatment of head and neck arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Dmytriw, A.A. [University Health Network, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Ter Brugge, K.G.; Krings, T.; Agid, R. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2014-03-15

    Head and neck arteriovenous malformations (H and N AVM) are associated with considerable clinical and psychosocial burden and present a significant treatment challenge. We evaluated the presentation, response to treatment, and outcome of patients with H and N AVMs treated by endovascular means at our institution. Patients with H and N AVMs treated by endovascular means from 1984 to 2012 were evaluated retrospectively. These included AVMs involving the scalp, orbit, maxillofacial, and upper neck localizations. Patient's clinical files, radiological images, catheter angiograms, and surgical reports were reviewed. Eighty-nine patients with H and N AVMs (46 females, 43 males; 48 small, 41 large) received endovascular therapy. The goals of treatment were curative (n = 30), palliative (n = 34), or presurgical (n = 25). The total number of endovascular treatment sessions was 244 (average of 1.5 per patient). The goal of treatment was met in 92.1 % of cases. Eventual cure was achieved in 42 patients accounting for 58.4 % (52/89) of all patients who underwent treatment for any goal. Twenty-eight of these patients were cured by embolization alone (28/89, 31.4 %) of which 18 were single-hole AVFs. Twenty-four were cured by planned surgical excision after presurgical embolization (24/89, 27 %). Seven patients (7/89, 7.2 %) suffered transient and two (2/89, 2.2 %) permanent endovascular treatment complications. Endovascular treatment is effective for H and N AVMs and relatively safe. It is particularly effective for symptom palliation and presurgical aid. Embolization is curative mostly in small lesions and single-hole fistulas. In patients with large non-curable H and N AVMs, endovascular therapy is often the only palliative option. (orig.)

  6. Headache and endovascular procedures.

    Science.gov (United States)

    de Biase, Stefano; Longoni, Marco; Gigli, Gian Luigi; Agostoni, Elio

    2017-05-01

    The International Classification of Headache Disorders (ICHD-3 beta) includes headache attributed to intracranial endovascular procedures (EVPs). The aim of this review is to describe the clinical and pathophysiological aspects of headache related to vascular lesions and EVPs. Current studies regarding this issue are contradictory, although generally favouring headache improvement after EVPs. Further large studies are needed to adequately assess the effect of EVPs on headache.

  7. Endovascular Treatment for Pseudoaneurysms after Surgical Correction of Aortic Coarctation

    OpenAIRE

    Rabellino, M.; Zander, T.; González, G.; Baldi, S.; Cheves, H.; Estigarribia, A.; Llorens, R.; Carreira, J. M.; Maynar, M.

    2011-01-01

    Late complications after surgical repair of aortic coarctation are not uncommon. Among these complications pseudoaneurysms are the most frequent complications, occurring between 3 and 38%. Reoperation in these patients is associated with high morbidity and mortality. In the last decade, endovascular techniques emerged as an alternative to conventional surgery with excellent results. We report the case of two patients who presented with pseudoaneurysms after surgical correction for aortic coar...

  8. Endovascular management of an acquired aortobronchial fistula following aortic bypass for coarctation.

    LENUS (Irish Health Repository)

    O'Sullivan, Katie E

    2013-09-20

    Aortobronchial fistula (ABF) in the setting of aortic coarctation repair is very rare but uniformly fatal if untreated. Endovascular stenting of the descending aorta is now the first-choice approach for ABF presenting with haemoptysis and offers a less-invasive technique with improved outcomes, compared with open repair. We report a case of late ABF occurring following bypass for aortic coarctation. Management focused on two key manoeuvres: use of a covered endovascular stent to occlude the aortic bypass thus controlling the fistula and dilatation and stenting of native coarctation.

  9. Aortic dissection. Basic aspects and endovascular management

    International Nuclear Information System (INIS)

    Jaramillo, Nicolas I; Alviar, Carlos I

    2005-01-01

    Treatment of thoracic aortic pathology is complicated by the morbidity associated to the surgical procedure and to the frailty of an elderly and difficult population. Surgical operation in this kind of population frequently bears a significant incidence of death and long-term disability. In an effort to reduce the incidence of negative outcomes, minimally invasive techniques in the form of endovascular stenting have been introduced during the past decade. The technology, originally described by Parodi, and initially designed for its use in abdominal aortic aneurysms, has been adapted for the treatment of thoracic aortic aneurysms. Furthermore, an improved understanding of the pathophysiology and the natural history of thoracic aortic disease as well as the analysis of the outcomes have facilitated our treatment decisions in terms of the timing for an appropriate intervention. Treatment of thoracic aortic dissection using endovascular Stent is one of the more recent advances in this condition and is receiving increasing attention, as it is a less invasive alternative to an open surgical repair. Although this technology is still innovative, significant improvements have been made lately in the design and deployment of the endovascular Stent-grafts. These prostheses have been increasingly used to treat aneurysms, dissections and traumatic ruptures, as well as giant penetrating ulcers and intramural hematomas of the descending thoracic aorta with good early and mid-term outcomes. The rareness, complexity and severity of the pathology and the theoretically high risk of complications should render the surgeon extremely cautious especially with young patients. Conceptually, the endo luminal treatment in the acute phase seems to be the solution and will probably become a preferred therapy while technical refinement is under way. Worldwide experience is growing and with this a better understanding of the indications and limitations of this innovative therapy will be

  10. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

    International Nuclear Information System (INIS)

    Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Caronno, Roberto; Castelli, Patrizio; Cuffari, Salvatore; Fugazzola, Carlo

    2006-01-01

    Purpose. To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). Methods. During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Results. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Conclusions. Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment

  11. Safety, efficacy, and cost of surgery for patients with unruptured aneurysms deemed unsuitable for endovascular therapy.

    Science.gov (United States)

    Zweifel, Christian; Sacho, Raphael Hillel; Tymianski, Rachel; Radovanovic, Ivan; Tymianski, Michael

    2015-12-01

    Open surgery is a frequent option given to patients with unruptured intracranial aneurysms (UIAs) unsuitable for endovascular repair. Since the risk of rupture of UIAs is generally low, we determined whether the risks and costs of surgery in this patient subset are warranted. The safety, efficacy, and costs of minimally invasive surgery by minicraniotomy were evaluated in 102 consecutive patients with anterior circulation UIAs deemed unsuitable for endovascular repair by an interdisciplinary conference of surgeons and neurointerventionalists. Data from 107 UIA patients treated by endovascular means in the same period were used as the standard. Surgical patients comprised a different subset of aneurysms, with more MCA and fewer paraophthalmic aneurysms (54 vs. 6, p < 0.0001 and 4 vs. 60, p < 0.0001, for minicraniotomy and endovascular, respectively). However, surgery incurred shorter anesthesia time (197.7 vs. 149.3 min, p < 0.0001), higher rates of complete aneurysm obliteration (94.57 vs. 66.67 %, p < 0.0001), and lower overall hospital costs ($8,287 CAD vs. $17,732 CAD, p < 0.0001) than the endovascular cohort. There were no treatment-related surgical deaths, but one patient had an mRS of 3 after 6 months due to temporal lobe epilepsy and memory problems. This compared favorably with the endovascular cohort in which two patients died due to treatment (mRS = 6) and one suffered a severe stroke (mRS = 5 at 6 months). For patients counseled to undergo treatment but have UIAs unsuitable for endovascular repair, surgery is safe, effective, and cost-efficient.

  12. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    International Nuclear Information System (INIS)

    Villegas, Miguel O.; Mereles, Alberto Pérez; Tamashiro, Gustavo A.; Dini, Andrés E.; Mollón, Ana P.; De Cándido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A.

    2013-01-01

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2–L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  13. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.; Dini, Andres E.; Mollon, Ana P.; De Candido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A., E-mail: joseantoniodiaz@hotmail.com [Hospital Nacional Prof. Alejandro Posadas, Department of Cardiology, Section of Hemodinamia (Argentina)

    2013-04-15

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  14. ENDOVASCULAR HEMOSTASIS IN UTERINE BLEEDING IN PATIENTS WITH UTERINE LEIOMYOMA

    Directory of Open Access Journals (Sweden)

    M. M. Damirov

    2017-01-01

    Full Text Available We report results of treatment for 72 patients with uterine leiomyoma (LM of various sizes and location, who had arrived with excessive uterine bleeding. All patients underwent urgent or urgently-delayed endovascular hemostasis by performing uterine arteries embolization (UAE. We analyzed clinical features of the disease after UAE in various sizes of tumors and studied immediate and long-term results of UAE in patients with LM.

  15. Endovascular and surgical treatment of spinal dural arteriovenous fistulas

    International Nuclear Information System (INIS)

    Andres, Robert H.; University of Berne; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA; University of Berne; Barth, Alain; Medical University of Graz, Department of Neurosurgery, Graz; University of Berne; Guzman, Raphael; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA; University of Berne; Remonda, Luca; El-Koussy, Marwan; Schroth, Gerhard; University of Berne; Seiler, Rolf W.; Widmer, Hans R.; University of Berne

    2008-01-01

    The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization. The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years). Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p<0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected. We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team. (orig.)

  16. A novel technique combining laparoscopic and endovascular approaches using image fusion guidance for anterior embolization of type II endoleak

    Directory of Open Access Journals (Sweden)

    M. Mujeeb Zubair, MD

    2017-03-01

    Full Text Available Type II endoleak (T2E leading to aneurysm sac enlargement is one of the challenging complications associated with endovascular aneurysm repair. Recent guidelines recommend embolization of T2E associated with aneurysmal sac enlargement. Various percutaneous and endovascular techniques have been reported for embolization of T2E. We report a novel technique for T2E embolization combining laparoscopic and endovascular approaches using preoperative image fusion. We believe our technique provides a more direct access to the lumbar feeding vessels that is typically challenging with transarterial or translumbar embolization techniques.

  17. A novel technique combining laparoscopic and endovascular approaches using image fusion guidance for anterior embolization of type II endoleak.

    Science.gov (United States)

    Zubair, M Mujeeb; Chinnadurai, Ponraj; Loh, Francis E; Loh, Thomas M; Lumsden, Alan B; Bechara, Carlos F

    2017-03-01

    Type II endoleak (T2E) leading to aneurysm sac enlargement is one of the challenging complications associated with endovascular aneurysm repair. Recent guidelines recommend embolization of T2E associated with aneurysmal sac enlargement. Various percutaneous and endovascular techniques have been reported for embolization of T2E. We report a novel technique for T2E embolization combining laparoscopic and endovascular approaches using preoperative image fusion. We believe our technique provides a more direct access to the lumbar feeding vessels that is typically challenging with transarterial or translumbar embolization techniques.

  18. Initial Experience With Covered Endovascular Reconstruction of the Aortic Bifurcation in Conjunction With Chimney Grafts

    NARCIS (Netherlands)

    Dijkstra, Martijn; Goverde, Peter C. J. M.; Holden, Andrew; Zeebregts, Clark J.; Reijnen, Michel M. J. P.

    2017-01-01

    Purpose: To show feasibility of the covered endovascular repair of the aortic bifurcation (CERAB) technique in conjunction with chimney grafts in aortic side branches for complex aortoiliac occlusive disease. Methods: Two European centers and one facility located in New Zealand participated in a

  19. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Veith, F.J.; Lachat, M.; Mayer, D.; Malina, M.; Holst, J.; Mehta, M.; Verhoeven, E.L.; Larzon, T.; Gennai, S.; Coppi, G.; Lipsitz, E.C.; Gargiulo, N.J.; Vliet, J.A. van der; Blankensteijn, J.D.; Buth, J.; Lee, W.A.; Biasiol, G.; Deleo, G.; Kasirajan, K.; Moore, R.; Soong, C.V.; Cayne, N.S.; Farber, M.A.; Raithel, D.; Greenberg, R.K.; Sambeek, M.R. van; Brunkwall, J.S.; Rockman, C.B.; Hinchliffe, R.J.

    2009-01-01

    BACKGROUND: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. OBJECTIVE: To clarify these we examined a

  20. Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

    NARCIS (Netherlands)

    Veith, Frank J.; Lachat, Mario; Mayer, Dieter; Malina, Martin; Holst, Jan; Mehta, Manish; Verhoeven, Eric L. G.; Larzon, Thomas; Gennai, Stefano; Coppi, Gioacchino; Lipsitz, Evan C.; Gargiulo, Nicholas J.; van der Vliet, J. Adam; Blankensteijn, Jan; Buth, Jacob; Lee, W. Anthony; Biasi, Giorgio; Deleo, Gaetano; Kasirajan, Karthikeshwar; Moore, Randy; Soong, Chee V.; Cayne, Neal S.; Farber, Mark A.; Raithel, Dieter; Greenberg, Roy K.; van Sambeek, Marc R. H. M.; Brunkwall, Jan S.; Rockman, Caron B.; Hinchliffe, Robert J.

    2009-01-01

    Background: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. Objective: To clarify these we examined a

  1. Management and outcomes of isolated renal artery aneurysms in the endovascular era

    NARCIS (Netherlands)

    Buck, Dominique B; Curran, Thomas; McCallum, John C; Darling, Jeremy; Mamtani, Rishi; van Herwaarden, JA|info:eu-repo/dai/nl/304814733; Moll, Frans L|info:eu-repo/dai/nl/070246882; Schermerhorn, Marc L

    2016-01-01

    OBJECTIVE: Isolated renal artery aneurysms are rare, and controversy remains about indications for surgical repair. Little is known about the impact of endovascular therapy on selection of patients and outcomes of renal artery aneurysms. METHODS: We identified all patients undergoing open or

  2. [Endovascular stent-grafting for mycotic thoracic aortic aneurysm].

    Science.gov (United States)

    Okada, S; Kaneko, T; Ezure, M; Satoh, Y; Hasegawa, Y; Koike, N; Okonogi, S; Takihara, H

    2009-02-01

    We report 3 cases of endovascular stent-grafting (ESG) for mycotic thoracic aortic aneurysm. The case 1 was a rupture of pseudoaneurysm of the descending aorta caused by mediastinitis due to perforation of esophageal ulcer. The patient underwent emergent ESG for temporary control of the rupture. He underwent esophagus reconstruction 5 month after ESG. The case 2 was admitted due to inflammatory reaction. She was diagnosed with mycotic descending aortic aneurysm and underwent elective ESG because of her old age. Her postoperative course was uneventful and no infection recurred. The case 3 underwent ESG for a ruptured mycotic descending aortic aneurysm. But 113 days after ESG, he underwent ESG again for a ruptured endoleak of the stentgraft. His blood culture demonstrated methillin-resistant Staphylococcus aureus (MRSA). He died of rupture to bronchus and esophagus at 18th day after ESG. We believe that ESG is useful in high risk patients for temporary management of the rupture.

  3. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Nayeemuddin, M.; Pherwani, A.D.; Asquith, J.R.

    2012-01-01

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  4. Transient postoperative atrial fibrillation after abdominal aortic aneurysm repair increases mortality risk

    Science.gov (United States)

    Kothari, Anai N.; Halandras, Pegge M.; Drescher, Max; Blackwell, Robert H.; Graunke, Dawn M.; Kliethermes, Stephanie; Kuo, Paul C.; Cho, Jae S.

    2016-01-01

    Objective The purpose of this study was to determine whether new-onset transient postoperative atrial fibrillation (TPAF) affects mortality rates after abdominal aortic aneurysm (AAA) repair and to identify predictors for the development of TPAF. Methods Patients who underwent open aortic repair or endovascular aortic repair for a principal diagnosis AAA were retrospectively identified using the Healthcare Cost and Utilization Project-State Inpatient Database (Florida) for 2007 to 2011 and monitored longitudinally for 1 year. Inpatient and 1-year mortality rates were compared between those with and without TPAF. TPAF was defined as new-onset atrial fibrillation that developed in the postoperative period and subsequently resolved in patients without a history of atrial fibrillation. Cox proportional hazards models, adjusted for age, gender, comorbidities, rupture status, and repair method, were used to assess 1-year survival. Predictive models were built with preoperative patient factors using Chi-squared Automatic Interaction Detector decision trees and externally validated on patients from California. Results A 3.7% incidence of TPAF was identified among 15,148 patients who underwent AAA repair. The overall mortality rate was 4.3%. The inpatient mortality rate was 12.3% in patients with TPAF vs 4.0% in those without TPAF. In the ruptured setting, the difference in mortality was similar between groups (33.7% vs 39.9%, P = .3). After controlling for age, gender, comorbid disease severity, urgency (ruptured vs nonruptured), and repair method, TPAF was associated with increased 1-year postoperative mortality (hazard ratio, 1.48; P predict an individual's probability of developing TPAF at the point of care. Conclusions The development of TPAF is associated with an increased risk of mortality in patients undergoing repair of nonruptured AAA. Predictive modeling can be used to identify those patients at highest risk for developing TPAF and guide interventions to improve

  5. The Candy-Plug Technique: Technical Aspects and Early Results of a New Endovascular Method for False Lumen Occlusion in Chronic Aortic Dissection.

    Science.gov (United States)

    Rohlffs, Fiona; Tsilimparis, Nikolaos; Fiorucci, Beatrice; Heidemann, Franziska; Debus, Eike Sebastian; Kölbel, Tilo

    2017-08-01

    To describe the technical aspects and early results of the Candy-Plug technique for endovascular false lumen occlusion in chronic aortic dissection. A retrospective single-center study analyzing 18 consecutive patients (mean age 63 years, range 44-76; 16 men) with thoracic false lumen aneurysm in chronic aortic dissection. All patients underwent thoracic endovascular aortic repair with false lumen occlusion using the Candy-Plug technique. Primary endpoints consisted of technical success (successful deployment) and clinical success (no false lumen backflow). Secondary endpoints included 30-day mortality and morbidity as well as aortic remodeling during follow-up. Technical success was 100%. Additional intraprocedural false lumen embolization at the Candy-Plug level was needed in 1 patient due to persisting false lumen backflow on the final angiogram (clinical success 94%). There were no intraprocedural complications. In the perioperative period, there were 3 minor complications: transient mild spinal cord ischemia, cervical hematoma after carotid-subclavian bypass, and a common femoral artery pseudoaneurysm. No deaths or reinterventions occurred. Complete distal false lumen occlusion was present on postoperative computed tomography in 15 patients, while 3 had minor contrast enhancement in the distal false lumen. Over a mean 9-month follow-up (range 0-26), 1 patient died due to rupture. Follow-up >6 months was available in 10 patients (mean 14.7 months, range 7-26): 7 patients showed aortic remodeling, while aneurysm size was stable in 3 patients. The Candy-Plug technique is a feasible endovascular method to achieve false lumen occlusion and aortic remodeling in chronic aortic dissection. It is associated with low morbidity and mortality due to its minimal invasiveness.

  6. Immediate endovascular treatment of an aortoiliac aneurysm ruptured into the inferior vena cava.

    Science.gov (United States)

    Kopp, Reinhard; Weidenhagen, Rolf; Hoffmann, Ralf; Waggershauser, Tobias; Meimarakis, Georgios; Andrassy, Joachim; Clevert, Dirk; Czerner, Stephan; Jauch, Karl-Walter

    2006-07-01

    An aortocaval fistula is a severe complication of an aortoiliac aneurysm, usually associated with high perioperative morbidity and mortality during open operative repair. We describe the successful endovascular treatment of a symptomatic infrarenal aortic aneurysm ruptured into the inferior vena cava with secondary interventional coiling of a persistent type II endoleak because of retrograde perfusion of the inferior mesenteric artery. Endovascular exclusion of ruptured abdominal aneurysms seems to be a valuable treatment option for selected patients even with complicated vascular conditions like an aortocaval fistula.

  7. Endovascular stenting for primary aortobronchial fistula in association with massive hemoptysis.

    Science.gov (United States)

    Kokotsakis, John; Misthos, Panagiotis; Athanasiou, Thanos; Romana, Constantina; Skouteli, Elian; Lioulias, Achilles; Kaskarelis, Ioannis

    2007-01-01

    Aortobronchial fistula is a potentially lethal complication secondary to the repair of a descending thoracic aneurysm or the placement of a prosthetic graft. Few cases have been reported. Very rarely, primary aortobronchial fistula occurs in a patient who has no history of cardiac surgical intervention. Herein, we present the cases of 2 patients whose massive, life-threatening bleeding from primary aortobronchial fistulae was successfully treated with endovascular stenting. Endovascular stenting is an emerging treatment method that can be used in this emergency setting with promising results and without early graft-related sequelae.

  8. Endovascular treatment of PICA aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mukonoweshuro, W.; Laitt, R.D.; Hughes, D.G. [Radiology Dept., Greater Manchester Neurosciences Unit, Hope Hospital, Salford, Manchester (United Kingdom)

    2003-03-01

    Endovascular treatment of aneurysms of the posterior inferior cerebellar artery (PICA) avoids manipulation of the brainstem or lower cranial nerves and should therefore carry a lower risk of neurological morbidity than surgical clipping. We reviewed our experience of 23 patients with PICA aneurysms treated by endovascular occlusion with Guglielmi detachable coils and documented their long-term outcome on follow-up. We observed a 28 day procedure-related neurological morbidity of 13% (3/23 patients). One patient suffered permanent neurological complications. There were no procedure-related deaths. None of our patients suffered a re-bleed from their treated aneurysms. Our series shows endovascular treatment of ruptured PICA aneurysms to be safe and effective. (orig.)

  9. Endovascular surgery in Marfan syndrome: CON.

    Science.gov (United States)

    Kouchoukos, Nicholas T

    2017-11-01

    The frequency of endovascular stent grafting procedures to treat various conditions of the thoracic aorta has increased dramatically over the past three decades. Stent grafting has been applied on a limited basis in patients with Marfan syndrome and other connective tissue disorders, despite recommendations from current guidelines and expert consensus statements against its use in this setting. A review of publications reporting outcomes after stent grafting of the descending thoracic aorta in Marfan patients with acute or chronic aortic dissection indicates that these procedures can be accomplished with rates of early mortality, stroke and spinal cord ischemic injury that are comparable to those observed in patients who do not have Marfan syndrome. However, the rates of primary treatment failure (principally endoleak), secondary treatment failure, need for open repair and late death among the Marfan patients are substantially higher than those observed in patients without this condition. In addition, the rates of retrograde aortic dissection and development of stent-graft induced new entry (SINE), are also greater among patients with Marfan syndrome. All of these findings argue strongly against the routine use of endovascular grafts in Marfan patients with type B or residual type A dissection. Few data are available to assess the role of endografting in Marfan patients with aneurysmal disease, but the progressive aortic dilatation noted in these patients argues strongly against its use in this setting as well. At present, the available data indicate that there is no justification for elective stent grafting in Marfan patients with aortic dissection or aneurysm. The only reasonable indications for primary aortic stent grafting are in the setting of acute aortic dissection or rupture, where the intervention is considered life-saving and rarely, considering the relatively young age of these patients, where the risk of open operation is considered to be prohibitive.

  10. Retroperitoneal aortic hemorrhage caused by penetration of an endovascular stent-graft anchoring barb.

    Science.gov (United States)

    Twine, Christopher P; Winterbottom, Andrew; Shaida, Nadeem; Boyle, Jonathan R

    2013-08-01

    To report a rare case of acute intraoperative retroperitoneal hemorrhage secondary to aortic penetration by the suprarenal anchoring barb on a stent-graft. A 75-year-old patient on dual antiplatelet therapy for coronary stents and low-molecular-weight heparin for atrial thrombus underwent elective endovascular repair of a 6.7-cm infrarenal abdominal aortic aneurysm. A device with suprarenal fixation and metal anchoring barbs was implanted, and a molding balloon was used that at no time covered the proximal bare metal stents or barbs. In recovery, the patient became tachycardic and hypotensive. After resuscitation, imaging identified an anterior barb penetrating the aortic wall, causing the acute retroperitoneal hemorrhage. A decision to treat conservatively rather than resort to open surgery was difficult but ultimately influenced by the patients' high risk for open surgery. The patient was treated by aggressive reversal of heparin and platelet transfusion, and the bleed settled spontaneously. Major surgery and subsequent morbidity may be avoided by medical management of what would appear to be a surgical problem.

  11. Delayed neurological deficits after endovascular placement of a pipeline embolisation device: clinical manifestation and treatment.

    Science.gov (United States)

    Sablani, Naveen; Hasan, Maryam Mumtaz; Shrestha, Ashik; Farkas, Jeffrey

    2018-03-23

    Endovascular treatment has been the mainstay of therapy for repair of both ruptured and unruptured cerebral aneurysms. Flow diverter devices offer a new option for the treatment of complex aneurysms that were previously not amenable to coiling. Procedural adverse effects include intracranial haemorrhage and ischaemic stroke, which usually occur on the same day. Delayed complications are rare. We report a case of a patient who underwent placement of a pipeline embolisation device and developed delayed neurological deficits, which were thought to be an inflammatory reaction to the hydrophilic coating used in guidewires and microcatheters. Our patient was treated with a course of steroids, with improvement of her neurological deficits and resolution of MRI findings. As the use of flow diverter devices has increased, variable and delayed complications of such therapy are increasingly being reported in the literature. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Carotid artery sacrifice for unclippable and uncoilable aneurysms: endovascular occlusion vs common carotid artery ligation.

    Science.gov (United States)

    Elhammady, Mohamed Samy; Wolfe, Stacey Quintero; Farhat, Hamad; Ali Aziz-Sultan, Mohammad; Heros, Roberto C

    2010-11-01

    Optimal treatment of intracranial aneurysms involves complete occlusion of the aneurysm with preservation of the parent artery and all of its branches. Attempts to occlude the aneurysm and preserve the parent artery may be associated with a higher level of risk than parent vessel occlusion or trapping. To evaluate our series of patients with large and giant aneurysms who underwent treatment via endovascular coiling with parent artery sacrifice or surgical ligation of the common carotid artery (CCA) and gain insight into the advantages and risks of each of these alternatives. We retrospectively reviewed all patients with aneurysms who underwent carotid sacrifice via endovascular occlusion or surgical CCA ligation during an 8-year period at our institution. Twenty-seven patients with large and giant aneurysms of the internal carotid artery underwent carotid artery sacrifice via endovascular occlusion (n = 15) or CCA ligation (n = 12). Of the patients who underwent endovascular occlusion, 3 developed groin complications, 1 developed a new sixth nerve palsy, 1 died from vasospasm related to subarachnoid hemorrhage, and 1 died secondary to rupture of an associated 3-mm anterior communicating artery aneurysm 5 days postoperatively. Of the patients undergoing CCA ligation, 1 patient developed a partial hypoglossal palsy. Clinical improvement of presenting symptoms was observed in all surviving patients regardless of the method of treatment. Complete aneurysm obliteration was documented in all patients during the initial hospital stay. The mean radiographic long-term follow-up was 14.2 months, which was available in 20 of the 25 surviving patients (80%). Complete obliteration was confirmed at follow-up in all but 2 patients with large cavernous aneurysms; 1 was initially treated with endovascular occlusion and the other with carotid ligation. Parent artery sacrifice is still a viable treatment for some complex aneurysms of the internal carotid artery. CCA ligation is a

  13. Heparin-induced thrombocytopenia and endovascular procedures: report of two cases Trombocitopenia induzida por heparina e tratamento endovascular: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Christiane Campolina Furquim Werneck

    2009-09-01

    Full Text Available Heparin-induced thrombocytopenia (HIT is a transient disorder caused by platelet-activating antibodies against platelet factor 4 (PF4-heparin complexes. Clinically it translates into arterial or venous thrombosis and carries high morbidity and mortality. The use of large doses of heparin during endovascular repair of abdominal aortic aneurysm could increase the incidence of HIT. We report two cases associating the use of heparin during endovascular repair of abdominal aortic aneurysm with the development of HIT.Trombocitopenia induzida por heparina (TIH é um distúrbio transitório causado pela ativação de anticorpos anti-plaquetários contra o fator plaquetário 4 (FP4 combinado com a molécula de heparina, formando complexos que clinicamente se traduzem em tromboses arteriais ou venosas com alta morbimortalidade. O uso de altas doses de heparina durante procedimentos endovasculares para o tratamento de aneurisma de aorta abdominal pode aumentar a incidência de TIH. Relatamos dois casos em que o uso de heparina durante tratamento endovascular de aneurisma de aorta abdominal estava associado ao aparecimento de TIH.

  14. Comparative Cost Analysis for Surgical and Endovascular Treatment of Unruptured Intracranial Aneurysms in South Korea.

    Science.gov (United States)

    Kim, Myungsoo; Park, Jaechan; Lee, Joomi

    2015-06-01

    A cost comparison of the surgical clipping and endovascular coiling of unruptured intracranial aneurysms (UIAs), and the identification of the principal cost determinants of these treatments. This study conducted a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of UIAs between January 2011 and May 2014. The medical records, radiological data, and hospital cost data were all examined. When comparing the total hospital costs for surgical clipping of a single UIA (n=188) and endovascular coiling of a single UIA (n=188), surgical treatment [mean±standard deviation (SD) : ₩8,280,000±1,490,000] resulted in significantly lower total hospital costs than endovascular treatment (mean±SD : ₩11,700,000±3,050,000, p<0.001). In a multi regression analysis, the factors significantly associated with the total hospital costs for endovascular treatment were the aneurysm diameter (p<0.001) and patient age (p=0.014). For the endovascular group, a Pearson correlation analysis revealed a strong positive correlation (r=0.77) between the aneurysm diameter and the total hospital costs, while a simple linear regression provided the equation, y (₩)=6,658,630+855,250x (mm), where y represents the total hospital costs and x is the aneurysm diameter. In South Korea, the total hospital costs for the surgical clipping of UIAs were found to be lower than those for endovascular coiling when the surgical results were favorable without significant complications. Plus, a strong positive correlation was noted between an increase in the aneurysm diameter and a dramatic increase in the costs of endovascular coiling.

  15. Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation.

    Science.gov (United States)

    Tretter, Justin T; Jones, Thomas K; McElhinney, Doff B

    2015-09-01

    Aortic wall complications can occur in unrepaired aortic coarctation (CoA) and after surgical repair or endovascular treatment. This review summarizes the available literature and current understanding of aortic wall injury (AWI) surrounding the management of CoA, focusing specifically on acute and follow-up AWI after endovascular treatment. There have been 23 reported cases of aortic rupture after endovascular treatment for CoA, including angioplasty alone, bare metal stenting, and primary covered stent therapy. Even if these published cases represent only a minority of ruptures that have actually occurred, the incidence is substantially treatment of CoA seems to be declining in frequency with increasing experience and improving technology, it remains one of the most important potential adverse outcomes. Long-term surveillance for new AWI and monitoring of existing AWI is mandatory, with institution of appropriate treatment when necessary. A central research focus in this population should be determination of the appropriate treatment for both native and recurrent CoA across various ages with regard to limiting recurrent CoA and preventing associated aortic wall complications, in addition to determining the appropriate treatment of various AWI. Consistent definitions and reporting are necessary to truly understand the incidence of, risk factors for, and measures protective against AWI after angioplasty or stent implantation for CoA. © 2015 American Heart Association, Inc.

  16. Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

    Energy Technology Data Exchange (ETDEWEB)

    Muehlenbruch, Georg, E-mail: gmuehlenbruch@ukaachen.de; Nikoubashman, Omid; Steffen, Bjoern; Dadak, Mete [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, University Hospital (Germany); Palmowski, Moritz [RWTH Aachen University, Department of Nuclear Medicine, University Hospital (Germany); Wiesmann, Martin [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, University Hospital (Germany)

    2013-02-15

    Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.

  17. Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

    International Nuclear Information System (INIS)

    Mühlenbruch, Georg; Nikoubashman, Omid; Steffen, Björn; Dadak, Mete; Palmowski, Moritz; Wiesmann, Martin

    2013-01-01

    Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.

  18. Endovascular stent grafting: a review

    International Nuclear Information System (INIS)

    Kribs, S.

    2001-01-01

    Endovascular stent grafts are intravascular devices composed of surgical graft material and a metallic frame, (Fig. 1). Their main application has been to treat aneurysms, but they have been used in vascular trauma and are being investigated for use in occlusive disease. Their advantage in treating aneurysms over conventional surgical treatment is that they are loaded into relatively small delivery systems (Fig. 2) and can be introduced to the area of interest from a remote site - usually the femoral artery. This avoids the morbidity of surgical exposure in difficult sites, such as the thoracic aorta, and lessens the cardiovascular stress to patients by eliminating the need to surgically cross-clamp the vessel being treated. The first description of abdominal aortic aneurysm exclusion by an endovascular stent graft was provided by Parodi and colleagues in 1991. Much of the early clinical experience in endovascular stent grafting was obtained from centres in Australia and Europe, and they are now reporting midterm follow-up data. There are now many centres in Canada and the United States involved in endovascular research and practice. (author)

  19. Repeated transluminal endovascular Inoue stent graft placement for progressive dilatation of prosthetic graft that had been repaired with Inoue stent graft placement for dilatation 23 years after extraanatomical bypass.

    Science.gov (United States)

    Anzai, Tomohiro; Shimizu, Hideyuki; Yozu, Ryohei; Hashimoto, Subaru; Kuribayashi, Sachio; Inoue, Kanji

    2007-02-01

    A 76-year-old man had undergone aneurysm exclusion and ascending abdominal aortic extraanatomical bypass for a thoracoabdominal aortic aneurysm in 1978. In 1983 hemoptysis occurred, and resection and closure of the central stump of the aorta and a left lower lobectomy were performed. Dilatation (phi50 mm) of a prosthetic graft (Cooley Graft phi18 mm) used for extraanatomical bypass was noted in 2001 and was repaired by placement of an Inoue stent graft. However, the aneurysm diameter increased further (phi70 mm), although no endoleak was noted: Placement of an Inoue stent graft covering the whole length of the prosthetic graft was repeated in 2006. The postoperative course was smooth, no endoleak occurred, and the patient was discharged 2 weeks after surgery.

  20. Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques.

    Science.gov (United States)

    Eslami, Mohammad H; Rybin, Denis; Doros, Gheorghe; McPhee, James T; Farber, Alik

    2016-02-01

    In this study, we evaluated if increase in utilization of endovascular surgery has affected in-hospital mortality rates among patients with acute mesenteric ischemia. The National Inpatient Sample (2003-2011) was queried for acute mesenteric ischemia using ICD-9 code for acute mesenteric ischemia (557.1). This cohort was divided into patients treated with open vascular surgery (open vascular group) and by endovascular therapies (endovascular group) based on the ICD-9CM procedure codes. Multivariable logistic regression was used to determine temporal trend for mortality while adjusting for confounding variables. There was 1.45-fold increase in utilization of endovascular techniques in this study. In-hospital mortality rate, total median charges and length of stay were significantly lower among the endovascular group than the open vascular group despite having significantly higher Elixhauser comorbidities index (3 ± 0.1 vs. 2.7 ± 0.1, p = .003). Over the course of the study period, there was no change in the overall mortality rate despite higher endovascular utilization. Factors associated with increased mortality included age, open surgical repair (Odds ratio: 1.45, 95% Confidence Interval: 1.10-1.91, p = .016) and bowel resection Odds ratio: 2.88, 95% Confidence Interval: 2.01-4.12). The mortality rate for acute mesenteric ischemia remains unchanged throughout this contemporary study. Open surgical intervention, bowel resection and age were associated with increased mortality. Endovascular group patients had better survival despite higher morbidity indices. © The Author(s) 2015.

  1. Frequency of concomitant ischemic heart disease and risk factor analysis for an early postoperative myocardial infarction after elective abdominal aortic aneurysm repair.

    Science.gov (United States)

    Han, Seung Rim; Kim, Young-Wook; Heo, Seon-Hee; Woo, Shin-Young; Park, Yang Jin; Kim, Dong Ik; Yang, Jeonghoon; Choi, Seung-Hyuk; Kim, Duk-Kyung

    2016-03-01

    We aimed to see the frequency of concomitant ischemic heart disease (IHD) in Korean patients with abdominal aortic aneurysm (AAA) and to determine risk factors for an early postoperative acute myocardial infarction (PAMI) after elective open or endovascular AAA repair. We retrospectively reviewed a database of patients who underwent elective AAA repair over the past 11 years. Patients were classified into 3 groups: control group; group I, medical IHD treatment; group II, invasive IHD treatment. Rates of PAMI and mortality at 30 days were compiled and compared between groups according to the type of AAA repair. Six hundred two elective repairs of infrarenal or juxtarenal AAAs were enrolled in this study. The patients were classified into control group (n = 398, 66.1%), group I (n = 73, 12.1%) and group II (n = 131, 21.8%). PAMI developed more frequently after open surgical repair (OSR) than after endovascular aneurysm repair (EVAR) (5.4% vs. 1.3%, P = 0.012). In OSR patients (n = 373), PAMI developed 2.1% in control group, 18.0% in group I and 7.1% in group II (P < 0.001). In EVAR group (n = 229), PAMI developed 0.6% in control group, 4.3% in group I and 2.2% in group II (P = 0.211). On the multivariable analysis of risk factors of PAMI, PAMI developed more frequently in patients with positive functional stress test. The prevalence of concomitant IHD was 34% in Korean AAA patients. The risk of PAMI was significantly higher after OSR compared to EVAR and in patients with IHD compared to control group. Though we found some risk factors for PAMI, these were not applied to postoperative mortality rate.

  2. Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara; Bovio, Giulio [IRCCS San Martino University Hospital-IST-National Institute for Cancer Research, Department of Radiology and Interventional Radiology (Italy); Fornaro, Rosario [IRCCS San Martino University Hospital-IST-National Institute for Cancer Research, Department of Surgery (Italy)

    2013-06-15

    Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

  3. Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

    International Nuclear Information System (INIS)

    Ferro, Carlo; Rossi, Umberto G.; Seitun, Sara; Bovio, Giulio; Fornaro, Rosario

    2013-01-01

    Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

  4. Systemic hypersensitivity reaction to endovascular stainless steel stent.

    Science.gov (United States)

    Univers, Junior; Long, Chandler; Tonks, Stephen A; Freeman, Michael B

    2018-02-01

    Endovascular intervention has become the mainstay for treatment of most patients suffering from peripheral vascular disease. We describe a patient with a known nickel allergy who underwent placement of a stainless steel stent for aortoiliac occlusive disease. Despite our attempt to avoid a nickel-containing stent, the patient developed a diffuse rash consistent with a nickel or metal allergy. A review of stainless steel metallurgy revealed that nickel, cobalt, and titanium are frequently used to provide anticorrosive properties to stainless steel. The clinical significance of the use of nickel-alloy stents in the setting of patients with a nickel allergy is discussed. Published by Elsevier Inc.

  5. Early experience of endovascular treatment of peripheral vascular disease

    International Nuclear Information System (INIS)

    Ashraf, T.; Yousuf, K.; Karim, M.T.

    2015-01-01

    Atherosclerotic peripheral arterial disease (PAD) is prevalent affecting up to 16% of the population aged 55 years or older. Endovascular intervention for the treatment of limb ischemia has become the first line therapy but in Pakistan it is in embryonic stage due to dearth of trained persons and dedicated centres. This study was conducted to evaluate procedural success and early outcome of endovascular treatment of peripheral vascular disease. Methods: A prospective single arm multicentre study was conducted at the National Institute of Cardiovascular Disease and National Medical Centre, Karachi, Pakistan from January 2013 to June 2014. A total of 25 patients were enrolled in the study that underwent endovascular treatment. Out of 25 patients 23 (92%) had critical limb ischemia (CLI) as per TASC II classification (A to D) and 2 (8%) had carotid lesion with history of TIA. Patients of acute limb ischemia and stroke were excluded. Ankle brachial index (ABI) was classified as normal (0.9-1.3), mild (0.7-0.9), moderate (0.4-0.69), severe (<0.4). Outcome was taken as immediate success and symptoms, amputation of limb among CLI patients and incidence of stroke in patients with carotid artery lesion at end of six months. Results: Among aortoiliac, femoropopliteal and tibioperoneal lesions, tibioperoneal lesions at six months were found to be more symptomatic 6 (86%) and amputation 4 (57%). Two carotid lesions at follow up were asymptomatic without stroke. Conclusion: Endovascular treatment of peripheral vascular lesions, i.e., aortoiliac, femoropopliteal tibioperoneal and carotid lesions were satisfactory in immediate outcome. Tibioperoneal lesions were more symptomatic and limb amputation at six months. (author)

  6. Endovascular treatment for arterial injuries of skull base

    International Nuclear Information System (INIS)

    Li Tianxiao; Bai Weixing; Zai Suiting; Wang Ziliang; Xue Jiangyu

    2008-01-01

    Objective: To explore the role of endovascular techniques in treatment for arterial injuries of skull base. Methods: A total of 53 consecutive cases suffered from skull base arterial injuries were enrolled in our hospital from Oct 2004 to May 2007, including 44 male and 9 female cases with average age of 23.3 years. Thirty-nine cases presented with pulsatile exophthalmos and intracranial vascular murmur, cerchnus and dysphagia in another 9, epistaxis in the remaining 5 cases. Diagnosis of 39 carotid cavernous fistulae (CCF)and 14 carotid pseudoaneurysm were performed by angiography (DSA). Alternative endovascular procedures were performed depending on lesions characteristics and follow-up was done by telephone and outpatient work up. Results: Procedures were performed involving 56 carotid arteries in all 53 cases including 34 CCF with embolization of detachable balloon(33 cases), 3 with balloon and coils, and 3 by stent-graft placement. 8 carotid pseudoaneurysms were cured by parent artery occlusion with balloon, 2 experienced endovascular isolation with balloon and coils, and 4 with stent-graft. Follow-up for mean 9.5 months (range from 2 to 25 months) revealed that the chief symptoms of 45 cases (85%) were relieved within 6 months after the procedure but ocular movement and visual disorder remained in 8 cases (15%)till 12 months. Six pseudoaneurysms and 3 residual leak were found in reexamination, of which 2 cases underwent intervention again 2 and 3 months later due to dural arterial-venous fistula in cavernous sinus, respectively. Conclusions: Endovascular treatment is safe and effective therapeutic option with minimal invasion for skull base arterial injuries. Detachable balloon embolization is the first choice for CCF and carotid pseudoaneurysm. Spring coil packing and stent-graft implantation should be in alternation as combination for special cases. (authors)

  7. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

    DEFF Research Database (Denmark)

    Weigang, Ernst; Parker, Jack A T C; Czerny, Martin

    2011-01-01

    Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subcla...

  8. Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Jens, Sjoerd, E-mail: s.jens@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands); Conijn, Anne P., E-mail: a.p.conijn@amc.uva.nl; Frans, Franceline A., E-mail: f.a.frans@amc.uva.nl [Academic Medical Center, Departments of Radiology and Surgery (Netherlands); Nieuwenhuis, Marieke B. B., E-mail: m.b.nieuwenhuis@amc.uva.nl; Met, Rosemarie, E-mail: rosemariemet@hotmail.com [Academic Medical Center, Department of Radiology (Netherlands); Koelemay, Mark J. W., E-mail: m.j.koelemaij@amc.uva.nl; Legemate, Dink A., E-mail: d.a.legemate@amc.uva.nl [Academic Medical Center, Department of Surgery (Netherlands); Bipat, Shandra, E-mail: s.bipat@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThis study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.MethodsA prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.ResultsIn total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.ConclusionsOverall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes.

  9. Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia

    International Nuclear Information System (INIS)

    Jens, Sjoerd; Conijn, Anne P.; Frans, Franceline A.; Nieuwenhuis, Marieke B. B.; Met, Rosemarie; Koelemay, Mark J. W.; Legemate, Dink A.; Bipat, Shandra; Reekers, Jim A.

    2015-01-01

    PurposeThis study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.MethodsA prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.ResultsIn total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.ConclusionsOverall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes

  10. Endovascular blood flow measurement system

    Science.gov (United States)

    Khe, A. K.; Cherevko, A. A.; Chupakhin, A. P.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    In this paper an endovascular measurement system used for intraoperative cerebral blood flow monitoring is described. The system is based on a Volcano ComboMap Pressure and Flow System extended with analogue-to-digital converter and PC laptop. A series of measurements performed in patients with cerebrovascular pathologies allows us to introduce “velocity-pressure” and “flow rate-energy flow rate” diagrams as important characteristics of the blood flow. The measurement system presented here can be used as an additional instrument in neurosurgery for assessment and monitoring of the operation procedure. Clinical data obtained with the system are used for construction of mathematical models and patient-specific simulations. The monitoring of the blood flow parameters during endovascular interventions was approved by the Ethics Committee at the Meshalkin Novosibirsk Research Institute of Circulation Pathology and included in certain surgical protocols for pre-, intra- and postoperative examinations.

  11. Thoracoabdominal aortic aneurysm repair in patients with marfan syndrome.

    Science.gov (United States)

    Mommertz, G; Sigala, F; Langer, S; Koeppel, T A; Mess, W H; Schurink, G W H; Jacobs, M J

    2008-02-01

    We assessed the surgical outcome of descending thoracic aortic aneurysm repair (DTAA) and thoracoabdominal aortic aneurym (TAAA) repair in patients with Marfan syndrome. During a six year period, 206 patients underwent DTAA and TAAA repair. In 22 patients, Marfan syndrome was confirmed. The median age was 40 years with a range between 18 and 57 years. The extend of the aneurysms included 6 DTAA (1 with total arch, 2 with distal hemi-arch), 11 type II TAAA (2 with total arch, 3 with distal hemi-arch), 4 type III and one type IV TAAA. All patients suffered from previous type A (n=6) or type B (n=16) aortic dissection and 15 already underwent aortic procedures like Bentall (n=7) and ascending aortic replacement (n=8). All patients were operated on according to the standard protocol with cerebrospinal fluid drainage, distal aortic and selective organ perfusion and monitoring motor evoked potentials. In patients undergoing simultaneous arch replacement (via left thoracotomy), transcranial Doppler and EEG assessed cerebral physiology during antegrade brain perfusion. In four patients circulatory arrest under moderate hypothermia was required. In-hospital mortality did not occur. Major postoperative complications like paraplegia, renal failure, stroke and myocardial infarction were not encountered. Mean pre-operative creatinine level was 125mmol/L, which peaked to a mean maximal level of 130 and returned to 92mmol/L at discharge. Median intubation time was 1.5 days (range 0.33-30 days). Other complications included bleeding requiring surgical intervention (n=1), arrhythmia (n=2), pneumonia (n=2) and respiratory distress syndrome (n=1). At a median follow-up of 38 months all patients were alive. Using CT surveillance, new or false aneurysms were not detected, except in one patient who developed a visceral patch aneurysm six years after open type II repair. Surgical repair of descending and thoracoabdominal aortic aneurysms provides excellent short- and mid-term results in

  12. Endovascular Treatment for Aneurysmal Subarachnoid Hemorrhage with Neurogenic Pulmonary Edema in the Acute Stage.

    Science.gov (United States)

    Meguro, Toshinari; Tanabe, Tomoyuki; Muraoka, Kenichiro; Terada, Kinya; Hirotsune, Nobuyuki; Nishino, Shigeki

    2016-01-01

    Severe neurogenic pulmonary edema (NPE) can occur in a variety of brain insults, including subarachnoid hemorrhage (SAH), and severe case of NPE can cause devastating consequences. But the literature on the treatment strategy about aneurysmal SAH with NPE is very scant. We present that SAH patients with severe NPE, who were treated first by embolization of aneurysm followed by insertion of lumbar spinal drainage, had comparatively good outcome. We present 12 consecutive cases of aneurysmal SAH with NPE in the acute stage, which were treated by endovascular treatment between April 2002 and December 2012. We classified the patients according to the Hunt and Hess grading system as follows: grade-3 (1 patient), grade-4 (4 patients), and grade-5 (7 patients). All patients needed respiratory management, with the assistance of a ventilator, and underwent endovascular treatment for the ruptured aneurysms within 72 hours from onset. For all the patients, immediately after the endovascular treatment, we performed lumbar spinal drainage. The pulmonary edema disappeared rapidly after respiratory management and endovascular treatment. The outcomes were as follows: good recovery (GR; 3 patients), moderate disability (MD; 4 patients), severe disability (SD; 3 patients), and death (D; 2 patients). Five patients (42%) developed pneumonia, and we postponed extubation until recovery from pneumonia. The cause for severe disability and death was symptomatic vasospasm and primary brain damage. No patients had rebleeding from ruptured aneurysms. Endovascular treatment for ruptured aneurysm and placement of lumbar spinal drainage is an excellent treatment option for severe SAH with NPE.

  13. Sequential Hybrid Repair of Aorta and Bilateral Common Iliac Arteries Secondary to Chronic Aortic Dissection with Extensive Aneurysmal Degeneration in a Marfan Patient.

    Science.gov (United States)

    Hinojosa, Carlos A; Anaya-Ayala, Javier E; Laparra-Escareno, Hugo; Lizola, Rene; Torres-Machorro, Adriana

    2017-09-01

    Marfan syndrome is a connective tissue disorder associated with aortic dissection, aneurysmal degeneration and rupture. These cardiovascular complications represent the main cause of mortality, therefore repair is indicated. We present a 35-year-old woman who experienced acute onset of chest pain. Her imaging revealed a chronic DeBakey type I dissection with aortic root dilation and descending thoracic aneurysmal degeneration. She underwent a Bentall procedure and endovascular exclusion of the descending thoracic aortic aneurysm. She was closely followed and 2 years later a computed tomography angiography (CTA) revealed the aneurysmal degeneration of the thoracoabominal aorta and bilateral iliac arteries. The patient underwent a composite reconstruction using multi-visceral branched and bifurcated Dacron grafts. At 5 years from her last surgery, a CTA revealed no new dissection or further aneurysmal degenerations. Aortic disease in Marfan patients is a complex clinical problem that may lead to secondary or tertiary aortic reconstructions; close follow-up is mandatory.

  14. Identification of predictive CT angiographic factors in the development of high-risk type 2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms; Identifikation praediktiver CT-angiographischer Faktoren fuer die Entstehung eines Hochrisiko Typ-2 Endoleaks nach endovaskulaerem Aortenrepair bei Patienten mit infrarenalen Bauchaortenaneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Loewenthal, D.; Herzog, L.; Rogits, B.; Bulla, K.; Pech, M.; Ricke, J.; Dudeck, O. [Magdeburg Univ. (Germany). Radiology and Nuclear Medicine; Weston, S. [Magdeburg Univ. (Germany). Biometry and Medical Informatics; Meyer, F.; Halloul, Z. [Magdeburg Univ. (Germany). General, Visceral and Vascular Surgery

    2015-01-15

    An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR). Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n = 80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n = 50). Statistical analysis comprised a univariate and multivariate analysis. Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4 ± 3.8 mm; HRG 23.6 ± 2.5 mm; p = 0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7 ± 18.0 %; HRG 25.3 ± 17.5 %; p = 0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3 %; HRG 92.0 %; p = 0.003) and their diameter (LRG 3.3 ± 0.7 mm; HRG 3.8 ± 0.9 mm; p = 0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7 ± 1.4; HRG 3.6 ± 1.2; univariate: p = 0.01; multivariate: p = 0.006) as well as their diameter (LRG 2.1 ± 0.4 mm; HRG 2.4 ± 0.4 mm; univariate: p < 0.001; multivariate: p = 0.006) were highly significantly associated with the development of type 2 endoleaks of the HRG. The most important predictive factors for the development of high-risk type 2 endoleaks were mainly the number and the diameter of the LAs which perfused the AAA.

  15. Successful endovascular treatment of a hemodialysis graft pseudoaneurysm by covered stent and direct percutaneous thrombin injection.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-07-25

    Vascular access for hemodialysis remains a challenge for nephrologists, vascular surgeons, and interventional radiologists alike. Arteriovenous fistula and synthetic grafts remain the access of choice for long-term hemodialysis; however, they are subject to complications from infection and repeated needle cannulation. Pseudoaneurysms are an increasingly recognized adverse event. At present, there are many minimally invasive methods to repair these wall defects. We present a graft pseudoaneurysm, which required a combination of endovascular stent graft placement and percutaneous thrombin injection for successful occlusion.

  16. ORIGINAL ARTICLES Endovascular treatment of cerebral ...

    African Journals Online (AJOL)

    ORIGINAL ARTICLES. Endovascular treatment of cerebral aneurysms - a cost analysis. David Le Feuvre, Allan Taylor. Objectives. To determine if endovascular treatment of cerebral aneurysms is cost effective when compared with conventional surgical treatment. Design. A retrospective study. Subjects. Seventeen patients ...

  17. A look into the endovascular crystal ball

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith

    2009-01-01

    This paper summarizes the highlights of the 15th International Workshop of Endovascular Surgery, held in Ajaccio in June 2008. This is an annual event that attracts leading endovascular therapists from both sides of the Atlantic Ocean as well as a contingency from down-under. The layout of this m...

  18. Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

    Directory of Open Access Journals (Sweden)

    Yi-Pei Tai

    2010-08-01

    Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

  19. Increasing endovascular intervention for claudication: impact on vascular surgery resident training.

    Science.gov (United States)

    Keeling, W Brent; Stone, Patrick A; Armstrong, Paul A; Kearney, Heather; Klepczyk, Lisa; Blazick, Elizabeth; Back, Martin R; Johnson, Brad L; Bandyk, Dennis F; Shames, Murray L

    2006-08-01

    To audit the caseloads of vascular surgery residents in the management of disabling claudication and assess the influence of endovascular procedures on overall operative experience. A retrospective review was conducted of vascular surgery resident experience in the open and endovascular management of lower limb claudication during two 3-year periods (January 2000 to December 2002 and January 2003 to December 2005). The time periods differed with regard to number of surgical faculty with advanced endovascular skills (3 in the first period and 4 in the second) and the availability of portable operating room angiography equipment. During the 6-year period, the operative logs of vascular surgery residents indicated participation in 283 procedures [170 (60%) open surgical interventions, including 146 suprainguinal procedures] performed for claudication. The number of procedures increased by 62% (pocclusive disease increased 4-fold (14 versus 56 interventions, p=0.01) compared to a decrease in open (bypass grafting, endarterectomy) surgical repair (45 to 31 procedures, p=0.22). The greatest change in resident experience was in endovascular intervention of infrainguinal occlusive disease: the case volume increased from 4 to 39 procedures (p=0.07) during the 2 time intervals. By contrast, the number of open surgical bypass procedures was similar (45 versus 49) in each 3-year period. An audit of resident experience demonstrated intervention for claudication has increased during the past 6 years. The increased operative experience reflects more endovascular treatment (atherectomy, angioplasty, stent-graft placement) of femoropopliteal and aortoiliac occlusive disease, but no decrease in open surgical operative experience for claudication. This increase in endovascular intervention may be related to a decrease in the threshold for intervention.

  20. Percutaneous Endovascular Radiofrequency Ablation for Malignant Portal Obstruction: An Initial Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Tian-Tian, E-mail: matthewwu1979@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Li, Hu-Cheng, E-mail: hucheng-li-surgery@126.com [The 307th Hospital of PLA, General Surgery Department (China); Zheng, Fang, E-mail: fang-zheng-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Ao, Guo-Kun, E-mail: guokun-ao-radiology@126.com; Lin, Hu, E-mail: hu-lin-radiology@126.com [The 309th Hospital of PLA, Radiology Department (China); Li, Wei-Min, E-mail: weimin-li-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China)

    2016-07-15

    PurposeThe Habib™ VesOpen Catheter is a new endovascular radiofrequency ablation (RFA) device used to treat malignant portal obstruction. The purpose of this study was to evaluate the clinical feasibility and safety of RFA with this device.MethodsWe collected the clinical records and follow-up data of patients with malignant portal obstruction treated with percutaneous endovascular portal RFA using the Habib™ VesOpen Catheter. Procedure-related complications, improvement of symptoms, portal patency, survival, and postoperative biochemical tests were investigated.ResultsThe 31 patients enrolled in the study underwent 41 successful endovascular portal RFA procedures. Patients were divided into a portal-stenting (PS) group (n = 13), which underwent subsequent portal stenting with self-expandable metallic stents, and a non-stenting (NS) group (n = 18), which did not undergo stenting. No procedure-related abdominal hemorrhage or portal rupture occurred. Postablation complications included abdominal pain (n = 26), fever (n = 13), and pleural effusion (n = 15). Improvements in clinical manifestations were observed in 27 of the 31 patients. Of the 17 patients experiencing portal restenosis, 10 underwent successful repeat RFA. The rate of successful repeat RFA was significantly higher in the NS group than in the PS group. Median portal patency was shorter in the PS group than in the NS group. No mortality occurred during the 4 weeks after percutaneous endovascular portal RFA.ConclusionsPercutaneous endovascular portal RFA is a feasible and safe therapeutic option for malignant portal obstruction. Prospective investigations should be performed to evaluate clinical efficacy, in particular, the need to evaluate the necessity for subsequent portal stenting.

  1. Political issues in endovascular surgery.

    Science.gov (United States)

    Rutherford, R B

    1992-08-01

    "Political issues" may determine the relative progress if not the ultimate success and acceptance of endovascular surgery as much as its intrinsic merits. These issues include turf battles, commercialization of newly developing technologies, unethical advertising, and self-serving reporting practices in presenting clinical results. Acceptable indications, methods of evaluating results, standardized reporting practices, appropriate "gold standards" for comparison, and controlled trials (without premature release) are recommended, as well as an emphasis on the future need for proper training and credentialing and quality assurance programs.

  2. The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

    Science.gov (United States)

    Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

    2017-08-01

    Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

  3. CONTEMPORARY ENDOVASCULAR TREATMENT OF INTRACRANIAL ANEURYSMS

    Directory of Open Access Journals (Sweden)

    Dragan Stojanov

    2015-06-01

    Full Text Available In the past twenty years we have witnessed a revolution in the treatment of intracranial aneurysms. Endovascular technique and materials have rapidly developed since the approval of Guglielmi detachable coils in 1995 which now allow successful treatment of most aneurysms. The development of intracranial stents and balloons for stent-assisted coiling and balloon-remodeling technique further expanded the spectrum of aneurysms treatable with endovascular technique. For these reasons, the aim of this review was to describe endovascular technique and materials which we use in our daily practice, to show benefits of endovascular treatment and to discus complications of endovascular treatment and surgical treatment of intracranial aneurysms. Endovascular treatment is more comfortable for the patient not only because it is minimally invasive but also because it does not require long hospitalization equal to that after surgical treatment. It is a fact that with further development of endovascular materials, this a procedure will have even a more significant place in the treatment of intracranial aneurysms.

  4. Endovascular treatment of a spontaneous aneurysm in the axillary artery.

    Science.gov (United States)

    Park, Sung Kyun; Hwang, Jeong Kye; Park, Sun Cheol; Kim, Sang Dong

    2015-01-01

    Spontaneous aneurysm in the axillary artery is extremely rare. The standard treatment for axillary artery aneurysm has been surgical repair, but endovascular management of select aneurysms using stent grafts has become more prevalent with the development of endoluminal technology. We report the case of a 36-year old man with a spontaneous aneurysm in the axillary artery. He experienced a tingling sensation and intermittent pain in the left upper extremity and had no history of trauma to the axilla. We performed endovascular treatment [placement of a Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA)] for a spontaneous aneurysm in the axillary artery. Following the procedure, his symptoms disappeared completely. After 6, 12 and 24 months, we carried out computed tomography angiography; all scans showed no complications. Now, the patient has no symptoms related to aneurysm in the axilla. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  5. Metal-induced generalized pruriginous dermatitis and endovascular surgery.

    Science.gov (United States)

    Giménez-Arnau, A; Riambau, V; Serra-Baldrich, E; Camarasa, J G

    2000-07-01

    Metal contact allergy is a common problem in the general population. Diagnostic and therapeutic medical-surgical procedures in which metals can be responsible for eczema are diverse. Endovascular aortic surgery is still an experimental but less invasive technique. A generalized eczematous dermatitis elicited by metal of an endovascular prosthesis is presented. An abdominal aortic aneurysm was diagnosed in a 79-year-old woman. Endoluminal repair with a straight Vanguard endograft was successful. 3 weeks later, she suffered a severe episode of erythema and eczema on the legs. Since then, she complained of continuous pruritus with eczema and excoriated papules. The dermatitis and also the patch test pathology showed eczema. Patch testing was positive to nickel sulfate and cobalt chloride. An endograft semi-quantitative metal analysis was performed with plasma-induction joint mass-spectrometry. The self-expanding metal stent was mainly composed of nickel (approximately 55%) and titanium (21%) with reinforcing thread of platinum. Antimony was detected only in the polyester textile. These results are consistent with Nitinol composition. The need for preoperative patch testing for metals is controversial. Enquiry about metal allergy is recommended before endoluminal surgical procedures. In the near future, the design of endografts must take into account the possibility of this sort of reaction.

  6. Advances in endovascular aneurysm treatment: are we making a difference?

    International Nuclear Information System (INIS)

    Katz, Jeffrey M.; Ougorets, Igor; Tsiouris, Apostolos J.; Biondi, Alessandra; Salvaggio, Kimberly A.; Gobin, Y. Pierre; Stieg, Philip E.; Riina, Howard A.

    2005-01-01

    Recent advancements in endovascular aneurysm repair, including bioactive and expansile coils and intracranial stents, hold promise for improved aneurysm occlusion rates. We report the immediate and midterm clinical and angiographic outcomes of a consecutive series of patients treated since the advent of these technologies. Clinical and radiological records of 134 patients with 142 aneurysms treated between 2001 and 2004 were retrospectively evaluated by an independent neurologist. Endovascular procedures were analyzed by an independent neuroradiologist blinded to all clinical information. Seventy-two ruptured and 60 un-ruptured saccular aneurysms, nine fusiform and one post-traumatic aneurysm were treated. Matrix coils were used in 53% of saccular aneurysms and HydroCoils in 13% of all aneurysms. Neuroform stents were deployed in 19% of aneurysms. Angiographic total or subtotal occlusion was achieved in 76% of cases and in 96% at last follow-up. Aneurysm recanalization was observed in 14% over a mean follow-up of 12 months, and 18% of aneurysms were retreated. Clinically relevant complications occurred in 6.0%, resulting in procedure-related morbidity of 0.6% and 0.6% mortality at 6 months. No aneurysm bled over a cumulative 1,347 months of observation. Newer embolization technologies can be exploited successfully even in more complex aneurysms with very low morbidity and mortality. (orig.)

  7. Endovascular management performed percutaneously of isolated iliac artery aneurysms

    International Nuclear Information System (INIS)

    Wolf, Florian; Loewe, Christian; Cejna, Manfred; Schoder, Maria; Rand, Thomas; Kettenbach, Joachim; Dirisamer, Albert; Lammer, Johannes; Funovics, Martin

    2008-01-01

    Purpose: To report about the endovascular treatment of isolated iliac artery aneurysms (IIAA) with stentgraft placement and transluminal or CT-guided embolization of the internal iliac artery or the combination of these methods. Methods and materials: Over a period of 5.6 years, 36 interventions were performed in 20 patients with 23 IIAAs. In a retrospective analysis patient records were reviewed. The CT-angiography follow-up was evaluated for the presence of re-perfusion of the IIAA and for change of aneurysm diameter. Results: Primary success was achieved in 15/23 aneurysms (65%), and secondary success in 21/23 aneurysms (91%). In 5/23 cases two interventions and in 1/23 cases three interventions were necessary to achieve secondary success. Embolization alone, as a therapy for aneurysms involving only the internal iliac artery, had a success rate of 27%. No procedure-related minor or major complications occurred. Mean decrease of aneurysm size during a mean observation period of 14.1 months was 6.9% which was not significant (p = 0.3; 95% confidence interval +7-21%). Conclusion: Endovascular therapy of isolated iliac artery aneurysms performed percutaneously has become a treatment alternative to open surgical repair. This method is feasible and safe with low procedure-related morbidity and mortality. However, on average more than one intervention has to be performed to achieve successful permanent exclusion of the aneurysm and embolization alone in isolated internal iliac artery aneurysms is not sufficient

  8. Bifurcated-bifurcated aneurysm repair is a novel technique to repair infrarenal aortic aneurysms in the setting of iliac aneurysms.

    Science.gov (United States)

    Shin, Susanna Hewon; Starnes, Benjamin Ware

    2017-11-01

    Up to 40% of abdominal aortic aneurysms (AAAs) have coexistent iliac artery aneurysms (IAAs). In the past, successful endovascular repair required internal iliac artery (IIA) embolization, which can lead to pelvic or buttock ischemia. This study describes a technique that uses a readily available solution with a minimally altered off-the-shelf bifurcated graft in the IAA to maintain IIA perfusion. From August 2009 to May 2015, 14 patients with AAAs and coexisting IAAs underwent repair with a bifurcated-bifurcated approach. A 22-mm or 24-mm bifurcated main body device was used in the IAA with extension of the "contralateral" limb into the IIA. Intraoperative details including operative time, fluoroscopy time, and contrast agent use were recorded. Outcome measures assessed were operative technical success and a composite outcome measure of IIA patency, freedom from reintervention, and clinically significant endoleak at 1 year. Fourteen patients underwent bifurcated-bifurcated repair during the study period. Technical success was achieved in 93% of patients, with successful treatment of the AAA and IAA and preservation of flow to at least one IIA. The procedure was performed with a completely percutaneous bilateral femoral approach in 92% of patients. Three patients had a type II endoleak on initial follow-up imaging, but none were clinically significant. There were no cases of bowel ischemia or erectile dysfunction. One patient had buttock claudication ipsilateral to IIA coil embolization (contralateral to bifurcated iliac repair and preserved IIA) that resolved by 6-month follow-up. Two patients required reinterventions. One patient presented to his first follow-up visit on postoperative day 25 with thrombosis of the right external iliac limb ipsilateral to the bifurcated iliac repair, which was successfully treated with thrombectomy and stenting of the limb. This same patient presented at 83 months with growth of the preserved IIA to 3.9 cm and underwent coil

  9. Endovascular treatment of intracranial aneurysm

    International Nuclear Information System (INIS)

    Wang Zhigang; Li Guoxin; Qu Yuanming; Tang Jun; Liu Zuoqin

    2001-01-01

    Objective: To setup an endovascular treatment of intracranial aneurysm with detachable balloon and micro-coil. Methods: Trans-femoral artery Seldinger's catheterization was used. Balloons and free MDS, GDC micro-coils were pushed into the aneurysm or carrying arteries. Results: No mortality occurred in authors' group. Internal carotid arteries (ICA) were occluded with detachable balloons in 5 aneurysms at sinus segment of ICA and 4 traumatic pseudo-aneurysms. No complications occurred. 9 aneurysms were completely occluded with micro-coils and 2 were partly (95%) occluded. 2 patients got mild paralysis due to vasospasm or mal detaching of MDS coils. Conclusions: Balloon occlusion of ICA for treatment of aneurysm at sinus segment is safe and effective in case of having abundant collateral circulation. Coil occlusion of intracranial aneurysm is a promising method of endovascular treatment. Compared with MDS, GDC coil is safer but expensive. Free coil is not very safe theoretically, but can be used with careful consideration as it is much cheaper

  10. Endovascular Treatment of Deep Vein Thrombosis.

    Science.gov (United States)

    Javier, Julian J

    2014-10-01

    Venous thromboembolism (VTE) is associated with substantial morbidity and mortality. Conventional treatment with anticoagulation therapy may undertreat the condition. Patients with VTE are at risk for recurrence with increasing time passage. Endovascular approaches exist for treating VTE, including deep vein thrombosis, but it is unclear which patients are appropriate candidates for endovascular versus medical approaches. Many new endovascular technologies are in development, and new oral anticoagulants are also on the market. Clinicians must be mindful of these new products and use them appropriately to better manage VTE. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Endovascular neurosurgery in the United States: a survey of 59 vascular neurosurgeons with endovascular training.

    Science.gov (United States)

    Lanzino, Giuseppe; Rabinstein, Alejandro A

    2011-01-01

    We sought to assess general aspects of endovascular neurosurgery training, practice, and management for the treatment of intracranial aneurysms, arteriovenous malformations, acute ischemic stroke, and extracranial or intracranial occlusive disease within neurosurgery training and practice in the United States. A questionnaire was sent electronically to 80 U.S. neurosurgeons with endovascular training. Fifty-nine surveys (74%) were returned. Survey responses illustrated different practice patterns and varying management of cerebrovascular disorders by neurosurgeons with endovascular training. Our findings provide a snapshot of current neurosurgical endovascular practices in the United States. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Immediate endovascular stent-graft repair of an acute traumatic ...

    African Journals Online (AJOL)

    Enrique

    Acute rupture of the thoracic aorta after blunt injury carries a high initial mortality: up to 90% of patients die at the scene of the accident or before they reach the hospital.1-4. Traditional protocols have advocated emergency surgery for survivors reaching hospital, but this is accompanied by high operative mortality rates.

  13. Classic and endovascular surgical management of isolated iliac artery aneurysms.

    Science.gov (United States)

    Gabrielli, R; Irace, L; Felli, M M G; Alunno, A; Rizzo, A R; Faccenna, F; Laurito, A; Gattuso, R; Venosi, S; Jabbour, J; Gossetti, B

    2007-04-01

    Isolated iliac artery aneurysm is a rare pathology that is often asymptomatic for long periods; this late diagnosis exposes patients to a high risk of death following aneurysm rupture. The aim of this study was to establish the most suitable diagnostic approach, the correct indications for treatment, and the most appropriate tactics and surgical technique. Twenty-eight patients were observed over 13 years. Aneurysmal involvement was unilateral in 22 cases and bilateral in the remaining 6 patients. Preoperative diagnostic tests included eco-colour Doppler (ECD) and angio-CT in all cases, with angio-MR and angiography as more selective procedures. Seventeen patients underwent conventional open surgery with prosthetic replacement of the aneurysmatic tract, 7 patients were treated using endovascular exclusion, and lastly 4 were monitored over time. There was no perioperative mortality for either treatment. During the postoperative period following conventional open surgery, complications included one case of severe respiratory failure, one microembolism of the lower limb, and 2 periprosthetic hematoma. During the follow-up, we observed one pseudo-aneurysm, 3 cases of retrograde ejaculation and one patient with erectile dysfunction after traditional surgery; there was one minor endoleak after endovascular exclusion. Our experience suggests that ECD is a useful method for arriving at an early diagnosis, while angio-CT imaging is essential for a correct preoperative study. Aneurysms with a diameter equal or greater than 3 cm or that present annual increases in excess of 5 mm represent a correct indication for treatment. Conventional open surgery is the treatment of choice for young patients in good general conditions. Endovascular exclusion is indicated when the patient's clinical conditions contraindicate open surgery and the morphology of the aneurysmal arterial district allows the endoprosthesis to be safely implanted.

  14. Management and outcome of cardiac and endovascular cystic echinococcosis.

    Directory of Open Access Journals (Sweden)

    Marta Díaz-Menéndez

    2012-01-01

    Full Text Available BACKGROUND: Cystic echinococcosis (CE can affect the heart and the vena cava but few cases are reported. METHODS: A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995-2009 is reported. RESULTS: Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4-93 months. One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications. CONCLUSIONS: Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.

  15. Persistent type I endoleak after endovascular treatment with Chimney technique

    Directory of Open Access Journals (Sweden)

    Ana Isabel Azevedo

    2016-09-01

    Full Text Available Thoracic endovascular aortic repair (TEVAR is increasingly used in the treatment of acute type B aortic dissection. Type Ia endoleaks are a common complication of the procedure, but its clinical significance as well as the best treatment strategy remain poorly defined. We present a case of a type Ia endoleak following TEVAR in the treatment of acute type B aortic dissection. Chimney technique approach was used in an attempt to seal the endoleak. Although technical success was suboptimal, the patient remained clinically stable and event free. Data regarding the natural course and management of type Ia endoleaks following TEVAR for aortic dissection are sparse. Future research is required to establish the clinical and technical determinants of the need to treat these endoleaks as well as the best treatment strategy.

  16. Drip, Ship, and On-Demand Endovascular Therapy for Acute Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Man-Seok Park

    Full Text Available The "drip and ship" approach can facilitate an early initiation of intravenous thrombolysis (IVT for acute ischemic stroke (AIS at community hospitals. New endovascular treatment modalities, such as stent retrieval, have further improved the rate of safe and successful recanalization. We assessed the clinical outcomes of on-demand endovascular therapy in patients with AIS who were transported to a comprehensive stroke center under the "drip and ship" paradigm.This retrospective study evaluated prospectively registered patients with acute large vessel occlusions in the anterior circulation who underwent endovascular recanalization after IVT at our regional comprehensive stroke center between January 2011 and April 2014. Clinical outcomes and neuroradiological findings were compared between patients who received IVT at the center (direct visit, DV and at a community hospital (drip and ship, DS.Baseline characteristics such as age, initial National Institutes of Health Stroke Scale (NIHSS score, and risk factors for stroke were similar, and most patients underwent endovascular therapy with a Solitaire stent (81.9% vs. 89.3% for DV and DS, respectively, P = 0.55. The average initial NIHSS score was 12.15 ± 4.1 (12.06 vs. 12.39 for DV and DS, respectively, P = 0.719. The proportions of long-term favorable outcomes (modified Rankin Scale score ≤ 2 at 90 days and successful recanalization (Thrombolysis in Cerebral Ischemia score ≥ 2b were not significantly different (P = 0.828 and 0.158, respectively. The mortality rates and occurrences of symptomatic intracerebral hemorrhage were not significantly different (P = 0.999 and 0.267, respectively.The "drip and ship" approach with subsequent endovascular therapy is a feasible treatment concept for patients with acute large vessel occlusion in the anterior circulation that could help improve clinical outcomes in patients with AIS.

  17. Modification of an endovascular stent graft for abdominal aortic aneurysm

    Science.gov (United States)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  18. Vascular training and endovascular practice in Europe

    DEFF Research Database (Denmark)

    Liapis, C.D.; Avgerinos, E.D.; Sillesen, H.

    2009-01-01

    OBJECTIVE: To evaluate the influence of the status of vascular surgery (VS) training paradigms on the actual practice of endovascular therapy among the European countries. METHODS: An email-based survey concerning vascular surgery training models and endovascular practices of different clinical...... specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. RESULTS: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1....... Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted...

  19. Vascular training and endovascular practice in Europe

    DEFF Research Database (Denmark)

    Liapis, C.D.; Avgerinos, E.D.; Sillesen, H.

    2009-01-01

    specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. RESULTS: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1....... Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted......% respectively. Countries with independent vascular certification, despite their lower average endovascular index (procedures per 100,000 population), reported a higher growth rate of aortic endovascular procedures (VS independent 132% vs VS non-independent 87%), within a four-year period (2003-2007). Peripheral...

  20. Penetrating Atherosclerotic Ulcer of the Abdominal Aorta Involving the Celiac Trunk Origin and Superior Mesenteric Artery Occlusion: Endovascular Treatment

    International Nuclear Information System (INIS)

    Ferro, Carlo; Rossi, Umberto G.; Petrocelli, Francesco; Seitun, Sara; Robaldo, Alessandro; Mazzei, Raffaele

    2011-01-01

    We describe a case of endovascular treatment in a 64-year-old woman affected by a penetrating atherosclerotic ulcer (PAU) of the abdominal aorta with a 26-mm pseudoaneurysm involving the celiac trunk (CT) origin and with superior mesenteric artery (SMA) occlusion in the first 30 mm. The patient underwent stenting to treat the SMA occlusion and subsequent deployment of a custom-designed fenestrated endovascular stent-graft to treat the PAU involving the CT origin. Follow-up at 6 months after device placement demonstrated no complications, and there was complete thrombosis of the PAU and patency of the two branch vessels.

  1. Acute vasculitis after endovascular brachytherapy

    International Nuclear Information System (INIS)

    Fajardo L-G, Luis F.; Prionas, Stavros D.; Kaluza, Grzegorz L.; Raizner, Albert E.

    2002-01-01

    Purpose: Angioplasty effectively relieves coronary artery stenosis but is often followed by restenosis. Endovascular radiation (β or γ) at the time of angioplasty prevents restenosis in a large proportion of vessels in swine (short term) and humans (short and long term). Little information is available about the effects of this radiation exposure beyond the wall of the coronary arteries. Methods and Materials: Samples were obtained from 76 minipigs in the course of several experiments designed to evaluate endovascular brachytherapy: 76 of 114 coronary arteries and 6 of 12 iliac arteries were exposed to endovascular radiation from 32 P sources (35 Gy at 0.5 mm from the intima). Two-thirds of the vessels had angioplasty or stenting. The vessels were systematically examined either at 28 days or at 6 months after radiation. Results: We found an unexpected lesion: acute necrotizing vasculitis in arterioles located ≤2.05 mm from the target artery. It was characterized by fibrinoid necrosis of the wall, often associated with lymphocytic exudates or thrombosis. Based on the review of perpendicular sections of tissue samples, the arterioles had received between 6 and 40 Gy. This arteriolar vasculitis occurred at 28 days in samples from 51% of irradiated coronary arteries and 100% of irradiated iliac arteries. By 6 months, the incidence of acute vasculitis decreased to 24% around the coronary arteries. However, at that time, healing vasculitis was evident, often with luminal narrowing, in 46% of samples. Vasculitis was not seen in any of 44 samples from unirradiated vessels (0%) and had no relation to angioplasty, stenting, or their sequelae. This radiation-associated vasculitis in the swine resembles the localized lymphocytic vasculitis that we have reported in tissues of humans exposed to external radiation. On the other hand, it is quite different from the various types of systemic vasculitis that occur in nonirradiated humans. Conclusion: Endoarterial brachytherapy

  2. Endovascular Management of Acute Limb Ischemia.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  3. [Macroscopic hematuria secondary to nutcracker syndrome and successful endovascular treatment].

    Science.gov (United States)

    Hinojosa, Carlos A; Anaya-Ayala, Javier E; Boyer-Duck, Estefanía; Laparra-Escareno, Hugo; Torres-Machorro, Adriana; Lizola, Rene

    2017-12-01

    Nutcracker syndrome is a rare entity, and in the majority of cases is the result of extrinsic compression of the left renal vein between the superior mesenteric artery and the aorta, associated with functional stenosis. To present the case of a 19-year-old female with no significant medical history with confirmed diagnosed of nutcracker syndrome treated successfully by endovascular means. She was referred to the Vascular Surgery Department with a 6-month history of macroscopic haematuria, after other aetiologies were ruled out. Abdominal computed tomography angiography revealed compression of the left renal vein; the patient underwent endovascular treatment, and a 12×16 mm balloon expandable stent was placed with immediate angiographic improvement, decreased pressure gradients and progressive resolution of haematuria. At one year, she remains symptom-free. Nutcracker syndrome is uncommon, and a high index of suspicion is needed. Macroscopic haematuria is not always present, and in our case stent placement demonstrated effectiveness in the resolution of symptoms at 12 months' follow--up. We also present a brief review of the literature. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  4. Supra-aortic interventions for endovascular exclusion of the entire aortic arch.

    Science.gov (United States)

    Andrási, Terézia B; Grossmann, Marius; Zenker, Dieter; Danner, Bernhard C; Schöndube, Friedrich A

    2017-07-01

    Our aim was to analyze the outcomes of endovascular exclusion of the entire aortic arch (proximal landing in zone 0, distal landing in zone III or beyond, after Ishimaru) in which complete surgical debranching of the supra-aortic vessels (I), endovascular supra-aortic revascularization (chimney, fenestrated, or branched grafts) with partial surgical debranching (II), or total endovascular supra-aortic revascularization (III) was additionally performed. Publications describing endovascular repair of the aortic arch (2000-2016) were systematically searched and reviewed. From a total of 53 relevant studies including 1853 patients, only 1021 patients undergoing 35 different total aortic arch procedures were found eligible for further evaluation and included in group I, II, or III (429, 190, and 402 patients, respectively). Overall early mortality was higher in group I vs groups II and III (P = .001; 1 - β = 95.6%) but exceeded in group III (18.6%) and group II (14.0%) vs group I (8.0%; P = .044; 1 - β = 57.4%) for diseases involving zone 0. Mortality was higher in all subgroups treated for zone 0 disease compared with corresponding subgroups treated for zone I to zone III disease. The incidence of cerebral ischemic events was increased in groups I and II vs group III (7.5% and 11% vs 1.7%; P = .0001) and correlated with early mortality (R 2  = .20; P = .033). The incidence of type II endoleaks and endovascular reintervention was similar between groups and correlated with each other (R 2  = .37; P = .004). Type Ia endoleak occurred more often in groups II and III than in group I (7.1% and 12.1% vs 5.8%; P = .023) and correlated with midterm mortality (R 2  = .53; P = .005). Retrograde type A dissection was low in all groups, whereas aneurysm growth was higher in group III (2.6%, 4.2%, 10.7%; P = .002), correlating with midterm mortality (R 2  = .311; P = .009). Surgical revision slightly correlated with surgical complications (R 2  = .18; P = .044

  5. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Su, I. Chang [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Taipei Cathay General Hospital, Division of Neurosurgery, Department of Surgery, Taipei (China); Willinsky, Robert A.; Agid, Ronit [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada); Fanning, Noel F. [Cork University Hospital, Department of Interventional Neuroradiology, Cork (Ireland)

    2014-06-15

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development. We performed a retrospective analysis of consecutively treated unruptured aneurysms between January 2000 and December 2011. The presence and evolution of wall enhancement and perianeurysmal edema on MRI after endovascular treatment were analyzed. Variable factors were compared among aneurysms with and without edema. One hundred thirty-two unruptured aneurysms in 124 patients underwent endovascular treatment. Eighty-five (64.4 %) aneurysms had wall enhancement, and 9 (6.8 %) aneurysms had perianeurysmal brain edema. Wall enhancement tends to persist for years with two patterns identified. Larger aneurysms and brain-embedded aneurysms were significantly associated with wall enhancement. In all edema cases, the aneurysms were embedded within the brain and had wall enhancement. Progressive thickening of wall enhancement was significantly associated with edema. Edema can be symptomatic when in eloquent brain and stabilizes or resolves over the years. Our study demonstrates the prevalence and some appreciation of the natural history of aneurysmal wall enhancement and perianeurysmal brain edema following endovascular treatment of unruptured aneurysms. Aneurysmal wall enhancement is a common phenomenon while perianeurysmal edema is rare. These phenomena are likely related to the presence of inflammatory reaction near the aneurysmal wall. Both phenomena are usually asymptomatic and self-limited, and prophylactic treatment is not recommended. (orig.)

  6. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms

    International Nuclear Information System (INIS)

    Su, I. Chang; Willinsky, Robert A.; Agid, Ronit; Fanning, Noel F.

    2014-01-01

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development. We performed a retrospective analysis of consecutively treated unruptured aneurysms between January 2000 and December 2011. The presence and evolution of wall enhancement and perianeurysmal edema on MRI after endovascular treatment were analyzed. Variable factors were compared among aneurysms with and without edema. One hundred thirty-two unruptured aneurysms in 124 patients underwent endovascular treatment. Eighty-five (64.4 %) aneurysms had wall enhancement, and 9 (6.8 %) aneurysms had perianeurysmal brain edema. Wall enhancement tends to persist for years with two patterns identified. Larger aneurysms and brain-embedded aneurysms were significantly associated with wall enhancement. In all edema cases, the aneurysms were embedded within the brain and had wall enhancement. Progressive thickening of wall enhancement was significantly associated with edema. Edema can be symptomatic when in eloquent brain and stabilizes or resolves over the years. Our study demonstrates the prevalence and some appreciation of the natural history of aneurysmal wall enhancement and perianeurysmal brain edema following endovascular treatment of unruptured aneurysms. Aneurysmal wall enhancement is a common phenomenon while perianeurysmal edema is rare. These phenomena are likely related to the presence of inflammatory reaction near the aneurysmal wall. Both phenomena are usually asymptomatic and self-limited, and prophylactic treatment is not recommended. (orig.)

  7. Indication of endovascular treatment of type B aortic dissection - Literature review

    Science.gov (United States)

    Duarte, João Jackson; Pontes, José Carlos Dorsa Vieira; Benfatti, Ricardo Adala; Ferrachini, Adriana Lugo; Karakhanian, Walter Kegham; Razuk Filho, Álvaro

    2014-01-01

    Aortic dissection is a cardiovascular event of high mortality if not early diagnosed and properly treated. In Stanford type A aortic dissection, there is the involvement of the ascending aorta, whereas in type B the ascending aorta is not affected. The treatment of type A aortic dissection is mainly surgical. The hospital mortality of type B aortic dissection surgical treatment is approximately 20%, while medical therapy is 10%. However, half the patients who are discharged from hospital after medical treatment, progress to aortic complications in the following years, and the mortality in three to five years may reach 25-50%. In addition, the surgical treatment of aortic complications after medical treatment, has also a significant mortality. This way, the endovascular treatment comes up as an interesting alternative of a less invasive treatment for this disease. They presented a mortality rate lower than 10% with more than 80% success rate of occlusion and thrombosis of the false lumen. The INSTEAD TRIAL, which randomized patients with uncomplicated type B aortic dissection for optimal medical therapy and endovascular treatment in addition to optimal medical therapy, showed that after three years of follow up, patients who underwent endovascular treatment had lower mortality and aorta-related complications. Therefore, there is a current tendency to recommend the endovascular treatment as a standard for the treatment of type B aortic dissection PMID:25372915

  8. Endovascular Stent Graft Placement in the Treatment of Ruptured Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta: Case Report and Review of the Literature

    International Nuclear Information System (INIS)

    Dogan, Sozen; Memis, Ahmet; Kale, Arzum; Buket, Suat

    2009-01-01

    We report a successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement. This procedure is starting to be accepted as an alternative method to surgery, and we review similar cases in the literature.

  9. Endovascular management of peripheral arterial trauma in patients presenting in hemorrhagic shock.

    Science.gov (United States)

    Trellopoulos, G; Georgiadis, G S; Aslanidou, E A; Nikolopoulos, E S; Pitta, X; Papachristodoulou, A; Lazarides, M K

    2012-08-01

    This study investigated patients who sustained peripheral arterial trauma, presented with clinical signs of shock, and underwent urgent endovascular repair (endo-R). Eighteen patients (11 men) aged 62.8 ± 17.5 y (range: 24-78 years) with severe peripheral arterial injuries or spontaneous ruptures who presented with clinical signs of shock were treated on an emergency basis at two institutions from August 2003 to August 2009. The injury mechanism and clinical presentation were assessed in all patients. The time interval from the initial event to the procedure, the time interval from hemodynamic instability to endo-R (HI-to-endo-RTI), the artery involved in the approach to the injured vessel, the method of endo-R, and the endo-R duration were recorded. Stent grafting and/or embolization of the injured vessel were performed. The outcome was assessed mainly by clinical examination and duplex scanning. The duration of follow-up ranged from 6 d to 60 mo (27.4 ± 17.8 mo, mean ± SD). Mechanisms of injury included 13 iatrogenic (9 catheter-related) injuries, 2 spontaneous hemorrhages, and 1 case each of gunshot wound, fall injury, and car accident. Traumatic lesions were in the external carotid (N.=1), vertebral (N.=1), subclavian (N.=3), common iliac (N.=1), external iliac (N.=5), internal iliac (N.=3), profunda femoral (N.=1), superficial femoral (N.=2), and popliteal (N.=1) arteries. Stent grafts and embolotherapy were successfully deployed in 12 and 4 patients, respectively, with complete exclusion of the bleeding site. One patient received both treatments and another patient received balloon occlusion therapy. Technical success with no procedural complications occurred in all cases. The mean event-to-procedure time interval, HI-to-endo-RTI, and operative time were 147 min, 42.2 ± 48.2 min (range: 3-180 min), and 40.0 ± 29.6 min (range: 5-110 min), respectively. Thirteen patients had an uneventful postoperative course while three patients died (mortality rate: 17

  10. Endovascular Treatment of Incoercible Epistaxis and Epidural Cerebral Hematoma

    Science.gov (United States)

    Bortoluzzi, M.; Pavia, M.

    2006-01-01

    Summary A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle meningeal artery. The procedure stopped the epistaxis and no further enlargement of the EDH was observed, avoiding its surgical treatment. Endovascular surgery may be an effective procedure to stop the arterial meningeal bleeding sustaining acute EDH and may be a useful tool in the management of special cases of post traumatic EDH. PMID:20569576

  11. Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

  12. DNA repair

    International Nuclear Information System (INIS)

    Setlow, R.

    1978-01-01

    Some topics discussed are as follows: difficulty in extrapolating data from E. coli to mammalian systems; mutations caused by UV-induced changes in DNA; mutants deficient in excision repair; other postreplication mechanisms; kinds of excision repair systems; detection of repair by biochemical or biophysical means; human mutants deficient in repair; mutagenic effects of UV on XP cells; and detection of UV-repair defects among XP individuals

  13. Outcomes after open repair for ruptured abdominal aortic aneurysms in patients with friendly versus hostile aortoiliac anatomy

    NARCIS (Netherlands)

    van Beek, S. C.; Reimerink, J. J.; Vahl, A. C.; Wisselink, W.; Reekers, J. A.; Legemate, D. A.; Balm, R.

    2014-01-01

    In patients with a ruptured abdominal aortic aneurysm (RAAA), anatomic suitability for endovascular aneurysm repair (EVAR) depends on aortic neck and iliac artery characteristics. If the aortoiliac anatomy is unsuitable for EVAR ("hostile anatomy"), open repair (OR) is the next option. We

  14. Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Johansson, M.; Cesarini, K.G.; Ronne-Engstroem, E.; Enblad, P.; Norbaeck, O.; Gal, G.; Tovi, M.; Solander, S.; Contant, C.F.

    2004-01-01

    Subarachnoid hemorrhage (SAH) is not an unusual disease in an elderly population. The clinical outcome has improved over time. It has been suggested that elderly SAH patients would benefit from endovascular aneurysm treatment. The aim of this study was to evaluate technical results and clinical outcome in a series of elderly SAH-patients treated with endovascular coil embolization. Sixty-two patients (≥ 65 years) presenting with aneurysmal SAH underwent early endovascular coil embolization at Uppsala University Hospital between September 1996 and December 2000. In all 62 cases included in the study, endovascular coil embolization was considered the first line of treatment. Admission variables, specific information on technical success, degree of occlusion and procedural complications, and outcome figures were recorded. Clinical grade on admission was Hunt and Hess (H and H) I-II in 39%, H and H III in 27% and H and H IV-V in 34% of the patients. The proportion of posterior circulation aneurysms was 24%. Coil embolization was successfully completed in 94%. The degree of occlusion of the treated aneurysm was complete occlusion in 56%, neck remnant in 21%, residual filling in 11%, other remnant in 5% and not treated in 6%. The rate of procedural complications was 11%. Outcome after 6 months was favorable in 41%, severe disability in 36% and poor in 22%. Favorable outcome was achieved in 57% of the H and H I-II patients, 47% of the H and H III patients and 17% of the H and H IV-V patients. Endovascular aneurysm treatment can be performed in elderly patients with SAH with a high level of technical success, acceptable aneurysm occlusion results, an acceptable rate of procedural complications and fair outcome results. (orig.)

  15. Evaluation of diffusion-perfusion mismatch for determining indication for emergency endovascular revascularization

    International Nuclear Information System (INIS)

    Masuda, Atsushi; Miki, Takanori; Matsumoto, Hiroaki

    2010-01-01

    We evaluated the usefulness of assessing by diffusion-perfusion mismatch (D/P mismatch) whether there is adaptation of neuroendovascular revascularization for acute ischemic stroke out of intravenous tissue plasminogen activator (IV t-PA). We retrospectively analyzed 24 patients who underwent D/P mismatch and endovascular treatment between October 2005 and September 2008. This investigation included stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score less than 4. Sixteen acute ischemic stroke patients had an NIHSS score greater than 5. Eight patients (50%) had a favorable neurological outcome (modified Rankin Scale 0 to 2). Eight acute ischemic stroke patients had an NIHSS score equal to or less than 4. Four patients who underwent emergency endovascular treatment on admission had a favorable neurological outcome, but 3 patients treated for progressive stroke after admission all had a poor prognosis. Evaluating D/P mismatch was useful for determining the adaptation of emergency neuroendovascular revascularization for acute ischemic stroke out of IV t-PA. Acute ischemic stroke patients with an NIHSS score equal to or less than 4 and diffusion/perfusion mismatch need careful observation to enable endovascular treatment immediately after progressive stroke. (author)

  16. Hybrid repair of penetrating aortic ulcer associated with right aortic arch and aberrant left innominate artery arising from aneurysmal Kommerell's diverticulum with simultaneous repair of bilateral common iliac artery aneurysms.

    Science.gov (United States)

    Guo, Yuanyuan; Yang, Bin; Cai, Hongbo; Jin, Hui

    2014-02-01

    We present the first case of a hybrid endovascular approach to a penetrating aortic ulcer on the left descending aorta with a right aortic arch and aberrant left innominate artery arising from an aneurysmal Kommerell's diverticulum. The patient also had bilateral common iliac artery aneurysms. The three-step procedure consisted of a carotid-carotid bypass, followed by endovascular exclusion of the ulcer and the aneurysmal Kommerell's diverticulum, and then completion by covering the iliac aneurysms. The patient had no complications at 18 months after surgery. In such rare configurations, endovascular repair is a safe therapeutic option. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. CT Imaging Findings and Their Relevance to the Clinical Outcomes After Stent Graft Repair of Penetrating Aortic Ulcers: Six-year, Single-center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of); Angle, John F.; Park, Auh Whan; Anderson, Curtis; Sabri, Saher S.; Turba, Ulku C. [University of Virginia Health System, Division of Angiography, Interventional Radiology and Special Procedures, Department of Radiology (United States); Kern, John A.; Cherry, Kenneth J. [University of Virginia Health System, Department of Surgery (United States); Matsumoto, Alan H., E-mail: ahm4d@virginia.edu [University of Virginia Health System, Division of Angiography, Interventional Radiology and Special Procedures, Department of Radiology (United States)

    2012-12-15

    Purpose: To present the computed tomographic (CT) imaging findings and their relevance to clinical outcomes related to stent graft placement in patients with penetrating aortic ulcers (PAUs). Methods: Medical and imaging records and imaging studies were reviewed for consecutive patients who underwent stent graft repair of a PAU. The distribution and characteristics of the PAU, technical success of stent graft repair, procedure-related complications, associated aortic wall abnormalities, and outcomes of the PAUs at follow-up CT scans were evaluated. Results: Fifteen patients underwent endovascular treatment for PAU. A total of 87% of the PAUs were in the proximal (n = 8) or distal (n = 5) descending thoracic aorta. There was a broad spectrum of PAU depth (mean, 7.9 {+-} 5.6 mm; range 1.5-25.0 mm) and diameter (mean, 13.5 {+-} 9.7 mm; range 2.2-41.0 mm). Atherosclerosis of the thoracic aorta and intramural hematoma were associated in 53 and 93% of the patients, respectively. Technical success was achieved in 100%. Two or more stent grafts were used in five patients. Endoleaks were observed in two patients within 2 weeks of the procedure, both of which resolved spontaneously. At follow-up CT scanning, regression and thrombosis of the PAUs were observed in all patients. The average patient survival was 61.8 months, with an overall mortality of 13% (2 of 15) at follow-up. Neither death was related to the endograft device or the PAU. Conclusion: Endovascular stent graft placement was safe and effective in causing regression and thrombosis of PAUs in this small series of patients. Two or more stent grafts were used in five patients (33%) with associated long-segmental atherosclerotic changes of the thoracic aorta or intramural hematoma.

  18. Endovascular Treatment of a Gastroduodenal Artery Pseudoaneurysm Rupture after a Car Accident

    Directory of Open Access Journals (Sweden)

    Sofia Dutra

    2017-09-01

    Full Text Available The authors present a case of a 39-year-old man with alcoholic chronic pancreatitis that was admitted in the emergency department after a car accident, complaining of abdominal pain and looking pale. The patient was hemodinamically unstable, requiring blood transfusions. He underwent computed tomography angiogram of the abdomen and pelvis, showing a pseudoaneurysm of the gastroduodenal artery and a hemoperitoneum. He was referred to our interventional radiology unit and submitted to endovascular treatment, consisting of ‘backdoor’ and ‘frontdoor’ embolization of the gastroduodenal artery and pseudoaneurysm neck with coils, with total exclusion in control angiography. With this case description we intend to highlight the rarity of the pseudoaneurysm rupture of the gastroduodenal artery and to emphasize the importance of an interventional radiology response that had a fundamental role in the endovascular treatment, in an emergency context.

  19. Diabetic Foot Limb Salvage-A Series of 809 Attempts and Predictors for Endovascular Limb Salvage Failure.

    Science.gov (United States)

    Lo, Zhiwen Joseph; Lin, Zhimin; Pua, Uei; Quek, Lawrence Han Hwee; Tan, Bien Ping; Punamiya, Sundeep; Tan, Glenn Wei Leong; Narayanan, Sriram; Chandrasekar, Sadhana

    2018-02-09

    To review patient characteristics and outcomes of in-patient diabetic foot limb salvage and identify risk factors predicting for endovascular limb salvage failure. Retrospective study of limb salvage attempts in 809 patients between August 2013 and July 2015. Sixty-eight percent of our study population were male with mean age at 65 years and 73% presented with Rutherford grade 6 critical limb ischemia, with the remaining 27% Rutherford grade 5. Eighty-one percent had toe pressures of less than 50 mm Hg, 64% had infrainguinal trans-Atlantic inter-society consensus (TASC II) C or D lesions while 78% had infrapopliteal TASC II C or D lesions. Seven hundred seventy-seven patients (96%) underwent endovascular-first approach limb salvage, with 95% requiring infrapopliteal angioplasty, with 84% of them requiring 2-vessel or 3-vessel revascularization. Thirty-two patients (4%) underwent surgical bypass limb salvage, with 63% performed as salvage procedures for failed angioplasties. The mean in-patient stay was 12.3 days within the endovascular group and 31.1 days within the bypass group (P diabetic foot peripheral arterial disease presented with Rutherford grade 6 disease, with mostly TASC II C or D lesions and required infrapopliteal revascularization. As most patients had multiple comorbidities and were poor surgical candidates, the majority underwent endovascular-first approach revascularization. Independent predictors of endovascular limb salvage failure include ESRF, toe pressures <50 mm Hg, infrainguinal TASC II patterns C or D, and indirect angiosome revascularization. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Endovascular treatment for intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Zhang Qiang; Li Shenmao; Ji Xunming; Miao Zhongrong; Zhu Fengshui; Zhi Xinglong; Ling Feng

    2007-01-01

    Objective: To evaluate the efficacy and risk of endovascular treatment for intracranial venous sinus thrombosis. Methods: Twenty seven patients with intracranial venous sinus thrombosis confirmed by CT, MRI, MRV and/or DSA, from 2004 September to 2006 September, were treated with anticoagulant therapy but without response and then followed by multiple modalities including endovascular treatment. Nineteen of them accepted intravenous thrombolysis and mechanical thrombus maceration, another 5 accepted intravenous thrombolysis, mechanical thrombus maceration and intraarterial thrombolysis and the last 3 with stenting. Results: After thrombolysis, symptoms and signs of 23 patients improved obviously and headache disappeared in 18 of them, but with only mild degree in other 5 and no improvement in 3. Twenty one patients among them achieved recanalization of sinuses completely as confirmed on postprocedural angiography, MRI and MRV studies taken prior to hospital discharge and other 3 achieved recanalization of sinuses partly. Conclusion: Endovascular treatment is an effective and safe measure for potentially catastrophic intracranial dural sinus thrombosis. (authors)

  1. Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

    Science.gov (United States)

    Sharma, Megha U.; Ganjoo, Pragati; Singh, Daljit; Tandon, Monica S.; Agarwal, Jyotsna; Sharma, Durga P.; Jagetia, Anita

    2017-01-01

    Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. Results: Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). Conclusion: Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures. PMID:28413524

  2. Emergency endovascular management of acute thoracic aortic pathology A safe and feasible option.

    Science.gov (United States)

    Ahmed, Z; McHugh, S M; Elmallah, A; Colgan, M P; O'Callaghan, A; O'Neill, S M; Madhavan, P; Martin, Z

    2017-12-01

    Endovascular repair has revolutionised the emergency treatment of thoracic aortic disease. We report our 10 year experience using this treatment in emergency cases. A prospectively maintained vascular database was analysed. Patients' medical records and CT images stored on the hospital PACS system were also reviewed. Statistical analysis was done using IBM SPSS V21. There were a total of 59 thoracic aortic stenting procedures of which 33 (60% males with a mean age of 58 yrs) were performed for emergency thoracic pathologies: traumatic transection (n = 10), ruptured aneurysm (n = 6), non-traumatic dissection (n = 8) and penetrating aortic ulcer (n = 9). All patients had self-expanding endografts implanted. Two patients required debranching procedures before the endovascular treatment. Thirty-day mortality was 12.1% (4/33). 70% of patients received a single device. There were 7 procedure related complications, 6 requiring re-intervention: thoracotomy and drainage in 2 patients, proximal graft extension in 2, open drainage of groin haematoma in 1 and open repair of a common femoral artery pseudo-aneurysm in one patient. In total 23 patients were transferred from 11 centres nationwide. There were no mortalities or other complications related to patient transfer from peripheral centres. Although acute thoracic aortic pathology is life threatening, appropriate blood pressure management and treatment of associated injuries can result in favourable outcomes. Endovascular repair is a safe and effective treatment option which enables patients to be treated with reduced morbidity and mortality. Transfer of patients with acute pathology to a tertiary centre can safely be performed. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  3. A case that underwent bilateral video-assisted thoracoscopic ...

    African Journals Online (AJOL)

    No Abstract Available A case that underwent bilateral video-assisted thoracoscopic surgical (VATS) biopsy combined with pneumonectomy is presented. The patient developed hypoxia during the contralateral VATS biopsy. His hypoxia was treated with positive expiratory pressure (PEEP) to the dependent lung and apneic ...

  4. Aortic aneurysm endovascular treatment with the parallel graft technique from the aortic arch to the iliac axis.

    Science.gov (United States)

    Fadda, Gian F; Marino, Mario; Kasemi, Holta; DI Angelo, Costantino L; Dionisi, Carlo P; Cammalleri, Valeria; Setacci, Carlo

    2017-05-26

    The chimney technique has been developed for the treatment of complex aortic aneurysms. We analyzed the midterm to long-term outcomes of this approach from a single- centre experience. From October 2008 to July 2016, 58 patients underwent endovascular aortic aneurysm repair using the chimney technique. Indications for treatment were thoracic aortic aneurysm (TAA) (n = 11), thoracoabdominal aortic aneurysm (TAAA) (n = 2), pararenal aortic aneurysm (PAAA) (n= 15), aortoiliac/isolated hypogastric artery aneurysm (n = 25), type I endoleak after previous TEVAR/EVAR (n=4), proximal pseudoaneurysm after AAA open repair (n = 1). Elective (82.8%) and emergent (17.2%) procedures were included. The immediate technical success was 100%. Single, double and triple chimneys were performed in 46, 10 and 2 patients, respectively. Overall, 61 target vessels (3 left common carotid arteries, 8 left subclavian arteries, 3 celiac trunks, 3 superior mesenteric arteries, 19 renal arteries and 25 hypogastric arteries) were involved. Post-operative mortality was 0. No neurologic complications were registered. Primary patency rate of the chimney stent/stent graft was 98.3%. Low flow type I endoleak was observed in 4 patients (6.9%). Post-operative chimney graft re-intervention rate was 1.7%. The median follow up was 32±20 months (range 3- 96 months). Overall estimated survival at 12, 50 and 80 months was 100%, 89% and 44%, respectively. Estimated freedom from endoleak at 1, 12, 24 and 36 months was 96.5%, 95%, 95% and 93%, respectively. One HA stent graft occluded at the 3rd month of follow up. No reintervention was performed. Our experience with the chimney technique for aortic aneurysms from the aortic arch to the iliac axis shows promising and durable mid- and long term results. Endograft oversizing, associated with the chimney graft diameter and length choice remain fundamental to reduce the risk of the most frequent procedure complications: type I endoleak and CG occlusion.The wider

  5. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    . All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed...

  6. Endovascular Neurosurgery: Personal Experience and Future Perspectives.

    Science.gov (United States)

    Raymond, Jean

    2016-09-01

    From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress. We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Endovascular embolization of mirror brain aneurysms

    International Nuclear Information System (INIS)

    Sirakov, S.; Penkov, M.; Sirakov, A.; Todorov, Y.; Ninov, K.; Minkin, K.; Bachvarov, Ch.

    2016-01-01

    Aneurysms of the vertebral artery are rare, constituting 0.5 to 3% of all intracranial aneurysms and less than 20% of those of the posterior brain circulation. Bilateral - mirror aneurysms on vertebral artery are extremely rare and unusual lesions, but are often seen and treated in the setting of acute subarachnoid hemorrhage or stroke in the posterior circulation. The treatment of such aneurysms of the vertebral artery with their specific anatomical location is great challenge to traditional neurosurgery. We present our experience with endovascular approach with this pathology. Key words: Mirror Brain Aneurysm. Endovascular Embolization

  8. Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series

    Energy Technology Data Exchange (ETDEWEB)

    D’Oria, Mario, E-mail: mario.doria88@outlook.com; Sgorlon, Giada; Calvagna, Cristiano; Zamolo, Francesca; Chiarandini, Stefano; Adovasio, Roberto; Griselli, Filippo [University Hospital of Cattinara, Vascular and Endovascular Surgery Unit (Italy)

    2017-04-15

    We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances.

  9. Hypospadias repair

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003000.htm Hypospadias repair To use the sharing features on this page, please enable JavaScript. Hypospadias repair is surgery to correct a defect in ...

  10. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  11. Normal preoperative white blood cell count is predictive of outcomes for endovascular procedures.

    Science.gov (United States)

    Amaranto, Daniel J; Wang, Edward C; Eskandari, Mark K; Morasch, Mark D; Rodriguez, Heron E; Pearce, William H; Kibbe, Melina R

    2011-11-01

    An abnormally elevated preoperative white blood cell count (WBC) has been associated with postoperative morbidity and mortality. However, it is unknown if a normal WBC is predictive of postoperative outcomes following vascular interventions. Thus, the objective of this study is to determine if a WBC within the normal range is predictive of outcomes following vascular interventions. The medical records of patients undergoing endovascular and open repair of carotid stenosis, aortic aneurysm, and peripheral arterial disease from 1999 to 2009 were retrospectively reviewed. Major adverse events (MAE) were defined as death, stroke, and myocardial infarction. Of 1773 cases with normal preoperative WBC (3.5-10.5 K/μL), there were 804 [45.3%] endovascular and 969 [54.7%] open vascular surgeries. Patients with complications (55) or MAE (19) after endovascular intervention had higher preoperative WBC compared with patients without complications (WBC 7.7 ± 1.47 vs 7.1 ± 1.57, respectively, P = .002) or MAE (WBC 8.3 ± 1.26 vs 7.1 ± 0.06, respectively, P = .001). No difference was observed for patients who received open surgery. Patients undergoing endovascular intervention were 2.3, 4.8, and 22 times more likely to experience complications (P = .004), MAE (P = .003), or death (P = .036) when WBC exceeded 7.5 K/μL. Multivariate analysis showed that preoperative normal WBC was an independent predictor of complications, MAE, and death in patients after endovascular procedures but only for death in patients after open vascular procedures. This study demonstrates a strong linear correlation between an increasing preoperative WBC within the normal range and an increased risk for postoperative complications and death following endovascular interventions. The study also found a significant curvilinear U-shaped relation between a normal preoperative WBC and death in the open surgical cohort, with patients in the very low and very high normal WBC range at an increased risk of death

  12. Reoperations after tricuspid valve repair: re-repair versus replacement.

    Science.gov (United States)

    Hwang, Ho Young; Kim, Kyung-Hwan; Kim, Ki-Bong; Ahn, Hyuk

    2016-01-01

    Data demonstrating results of reoperation after initial tricuspid valve repair are scarce. We evaluated outcomes of tricuspid reoperations after tricuspid valve repair and compared the results of tricuspid re-repair with those of tricuspid valve replacement (TVR). From 1994 to 2012, 53 patients (56±15 years, male:female =14:39) underwent tricuspid reoperations due to recurrent tricuspid regurgitation (TR) after initial repair. Twenty-two patients underwent tricuspid re-repair (TAP group) and 31 patients underwent TVR (TVR group). Early mortality occurred in 6 patients (11%). Early mortality and incidence of postoperative complications were similar between the 2 groups. There were 14 cases of late mortality including 9 cardiac deaths. Five- and 10-year free from cardiac death rates were 82% and 67%, respectively, without any intergroup difference. Recurrent TR (> moderate) developed in 6 TAP group patients and structural valve deterioration occurred in 1 TVR group patient (P=0.002). Isolated tricuspid valve surgery (P=0.044) and presence of atrial fibrillation during the follow-up (P=0.051) were associated with recurrent TR after re-repair. However, the overall tricuspid valve-related event rates were similar between the 2 groups with 5- and 10-year rates of 61% and 41%, respectively. Tricuspid valve reoperation after initial repair resulted in high rates of operative mortality and complications. Long-term event-free rate was similar regardless of the type of surgery. However, great care might be needed when performing re-repair in patients with atrial fibrillation and those who had isolated tricuspid valve disease due to high recurrence of TR after re-repair.

  13. Bronchoscopic guidance of endovascular stenting limits airway compression.

    Science.gov (United States)

    Ebrahim, Mohammad; Hagood, James; Moore, John; El-Said, Howaida

    2015-04-01

    Bronchial compression as a result of pulmonary artery and aortic arch stenting may cause significant respiratory distress. We set out to limit airway narrowing by endovascular stenting, by using simultaneous flexible bronchoscopy and graduated balloon stent dilatation, or balloon angioplasty to determine maximum safe stent diameter. Between August 2010 and August 2013, patients with suspected airway compression by adjacent vascular structures, underwent CT or a 3D rotational angiogram to evaluate the relationship between the airway and the blood vessels. If these studies showed close proximity of the stenosed vessel and the airway, simultaneous bronchoscopy and graduated stent re-dilation or graduated balloon angioplasty were performed. Five simultaneous bronchoscopy and interventional catheterization procedures were performed in four patients. Median age/weight was 33 (range 9-49) months and 14 (range 7.6-24) kg, respectively. Three had hypoplastic left heart syndrome, and one had coarctation of the aorta (CoA). All had confirmed or suspected left main stem bronchial compression. In three procedures, serial balloon dilatation of a previously placed stent in the CoA was performed and bronchoscopy was used to determine the safest largest diameter. In the other two procedures, balloon testing with simultaneous bronchoscopy was performed to determine the stent size that would limit compression of the adjacent airway. In all cases, simultaneous bronchoscopy allowed selection of an ideal caliber of the stent that optimized vessel diameter while minimizing compression of the adjacent airway. In cases at risk for airway compromise, flexible bronchoscopy is a useful tool to guide endovascular stenting. Maximum safe stent diameter can be determined without risking catastrophic airway compression. © 2014 Wiley Periodicals, Inc.

  14. REHEARSAL Using Patient-Specific Simulation to Improve Endovascular Efficiency.

    Science.gov (United States)

    Wooster, Mathew; Doyle, Adam; Hislop, Sean; Glocker, Roan; Armstrong, Paul; Singh, Michael; Illig, Karl A

    2018-04-01

    To determine whether rehearsal using patient-specific information loaded onto an endovascular simulator prior to carotid stenting improves procedural efficiency and outcomes. Patients scheduled for carotid artery stenting who had adequate preoperative computed tomography (CT) imaging were considered for enrollment. After obtaining informed consent, patients were randomized to control versus rehearsal groups. Those in the rehearsal group had their CT scans loaded into an endovascular simulator (Angio Mentor) followed by case rehearsal by the attending on the simulator within 24 hours prior to the procedure; control patients underwent routine carotid stenting without rehearsal. Contrast usage, fluoroscopy time, and timing of procedural steps were recorded by a blinded observer during the actual case to determine benefit. Fifteen patients were enrolled, with 6 patients randomized to the rehearsal group and 9 to the control. All measures showed improvement in the rehearsal group: Mean contrast volume (59.2 vs 76.9 mL), fluoroscopy time (11.4 vs 19.4 minutes), overall operative time (31.9 vs 42.5 minutes), time to common carotid sheath placement (17.0 vs 23.3 minutes), and total carotid sheath dwell time (14.9 vs 19.2 minutes) were all lower (more favorable) in the rehearsal group. The study was terminated early due to the lack of simulator access, and all P values were thus greater than .05 due to the lack of power. No strokes or other adverse events occurred in either group. Case-specific simulator rehearsal using patient-specific imaging prior to carotid stenting is associated with numerically less contrast usage, operative time, and radiation exposure, although this study was underpowered.

  15. Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion

    International Nuclear Information System (INIS)

    Acosta, S.; Sonesson, B.; Resch, T.

    2009-01-01

    The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.

  16. Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

    International Nuclear Information System (INIS)

    Chiramel, George Koshy; Keshava, Shyamkumar Nidugala; Moses, Vinu; Kekre, Nitin; Tamilarasi, V; Devasia, Anthony

    2015-01-01

    To evaluate the effectiveness of endovascular management in iatrogenic renal injuries with regard to clinical status on follow-up and requirements for repeat angiography and embolization. This retrospective study included patients who were referred for endovascular management of significant hemorrhage following an iatrogenic injury. Data was recorded from the Picture Archiving and Communication system (PACS) and electronic medical records. The site and type of iatrogenic injury, imaging findings, treatment, angiography findings, embolization performed, clinical status on follow-up, and requirement for repeat embolization were recorded. The outcomes were clinical resolution, nephrectomy, or death. Clinical findings were recorded on follow-up visits to the clinic. Statistical analysis was performed using descriptive statistics. Seventy patients were included in this study between January 2000 and June 2012. A bleeding lesion (a pseudoaneurysm or arteriovenous fistula) was detected during the first angiogram in 55 patients (78.6%) and was selectively embolized. Fifteen required a second angiography as there was no clinical improvement and five required a third angiography. Overall, 66 patients (94.3%) showed complete resolution and 4 patients (5.7%) died. Three patients (4.3%) underwent nephrectomy for clinical stabilization even after embolization. There were no major complications. The two minor complications resolved spontaneously. Angiography and embolization is the treatment of choice in iatrogenic renal hemorrhage. Upto 20% of initial angiograms may not reveal the bleed and repeat angiography is required to identify a recurrent or unidentified bleed. The presence of multiple punctate bleeders on angiography suggests an enlarging subcapsular hematoma and requires preoperative embolization and nephrectomy

  17. Endovascular treatment of symptomatic intracranial atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Syed I Hussain

    2011-02-01

    Full Text Available Abstract: Symptomatic intracranial atherosclerotic disease (ICAD is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis greater than 70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and or stenting is a safe, suitable and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and or stenting of symptomatic intracranial atherosclerotic disease.

  18. Endovascular treatment of ruptured distal posterior inferior ...

    African Journals Online (AJOL)

    Results: All patients were treated by endovascular treatment, seven cases got endosaccular coiling and four cases got parent artery occlusion at the same time. All the patients were followed up one to four years. Recurrences occurred in 1 patient two years post-treatment, and were successfully retreated by endosaccular ...

  19. Repair of Lateral Wall Insufficiency.

    Science.gov (United States)

    Vaezeafshar, Reza; Moubayed, Sami P; Most, Sam P

    2018-03-01

    Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted. To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair. This case-control study was conducted in a tertiary referral center. In group 1, there were 44 patients who underwent septorhinoplasty to repair LWI between February 1, 2014, and May 31, 2016. In group 2, there were 44 age- and sex-matched patients who underwent cosmetic septorhinoplasty without LWI repair. Data analysis was conducted from February 1, 2014, to May 31, 2016. Open septorhinoplasty. Nasal Obstruction Symptom Evaluation (NOSE) scores and LWI grades. Forty-four patients (8 men and 36 women, with a mean [SD] age of 46 [16] years) who underwent open septorhinoplasty to repair LWI and 44 age- and sex-matched patients (composed of 8 men and 36 women, with a mean [SD] age of 41 [12] years) were included in the study. The mean (SD) preoperative NOSE scores were 69.4 (22) in group 1 and 20.5 (20.8) in group 2 (P system enables surgeons to localize LWI, tailor the surgical treatment to the patient, and monitor improvements in the postoperative period. 3.

  20. Atrioventricular septal defect (AVSD) : A study of 219 patients who underwent surgery for AVSD at Rikshospitalet from 1979 to 1999

    OpenAIRE

    Skraastad, Ingrid Birthe Bendixen; Skraastad, Berit Kristine

    2010-01-01

    Background: The present study evaluates 219 consecutive patients that underwent surgical repair for AVSD in a long term follow-up. Methods: The patients had a surgical correction for AVSD at Rikshospitalet from January 1979 to December 1999. The follow-up was closed in January 2009. AVSD with additional defects and syndromes were included. Results: Forty-two patients died during the observational period. Early mortality was 12.8% and late mortality was 6.4%. Early mortality declined f...

  1. Emergency treatment of acute rupture of the descending thoracic aorta using endovascular stent-grafts.

    Science.gov (United States)

    Amabile, Philippe; Rollet, Gilles; Vidal, Vincent; Collart, Frédéric; Bartoli, Jean-Michel; Piquet, Philippe

    2006-11-01

    Open surgical management of acute rupture of the descending thoracic aorta (DTA) is associated with high mortality and morbidity. Endovascular stent-grafts (ESGs) could provide a less invasive treatment alternative to conventional open surgery. The purpose of this report detailing our experience using ESG for treatment of acute rupture of the DTA is to determine the indications for endovascular repair. From June 2000 to April 2005, 17 patients presenting rupture of the DTA were treated using commercially available ESGs at our institution. There were two women and 15 men, with a mean age of 41.9 +/- 20.5 years. The cause of aortic rupture was traumatic in 13 cases and nontraumatic in four. Treatment was undertaken immediately in 10 cases and delayed in seven (range 5-68 days, mean 23.5). In one patient, the proximal neck landing zone was prepared prior to endovascular repair. No patients died during the postoperative period. The technical success rate was 84%. One patient developed a proximal type 1 endoleak at the end of the procedure. Three complications, i.e., two iliac dissections and one femoral artery rupture, occurred during the procedure. No paraplegia was observed. Mean follow-up was 13.3 months (range 1-41). One patient treated for traumatic rupture was lost from follow-up 21 months after initial treatment. No procedure-related complication was observed in this traumatic rupture group. Control computed tomographic scan at 13 months following the procedure demonstrated no evidence of periprosthetic leak or false aneurysm. In the nontraumatic rupture group, two patients died of aortic rupture and one treated for aortobronchial fistula developed recurrent hemoptysis 23 months after initial treatment and required placement of two additional ESGs. The immediate outcome of covered stent-graft placement for management of acute aortic rupture of the DTA is good. However, long-term surveillance is mandatory, especially in patients treated for nontraumatic aortic

  2. Miscellaneous Endovascular Treatment of Ruptured Hepatic Artery Pseudoaneurysms after Pylorus Preserving Pancreaticoduodenectomy

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ung Rae; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University Medical Center, Catholic of Daegu University School of Medicine, Daegu (Korea, Republic of); Ahn, Eun Joung; Kim, See Hyung; Kim, Young Hwan [Dept. of Radiology, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2012-03-15

    To assess the feasibility and safety of the endovascular treatment of ruptured hepatic artery pseudoaneurysms after pylorus preserving pancreaticoduodenectomy (PPPD). Thirteen patients with hepatic artery pseudoaneurysm after PPPD were enrolled. Various endovascular techniques were used depending on the sites and morphologies of the pseudoaneurysms. Five cases were treated by coil embolization, five with stent-graft, one by thrombin injection and coil embolization, one with stent-graft and coil embolization, and one with N-butyl cyanoacrylate (NBCA) injection. Computed tomography scans and liver function test were performed after the procedures. Pseudoaneurysm exclusion and bleeding cessation was achieved in all patients. In four patients that underwent coil or NBCA embolization of the hepatic artery, aspartate transaminase (AST) and alanine transaminase (ALT) were markedly elevated. Two of these four patients with narrowing of the portal vein due to surrounding hematoma died of hepatic infarction or hepatic abscess. In other nine patients, AST and ALT were unchanged. In the 11 surviving patients, normal hepatic function and complete pseudoaneurysm disappearance were achieved during follow-up. Endovascular treatment of ruptured hepatic artery pseudoaneurysms can be considered as a feasible and safe method. However, complete occlusion of the hepatic artery with coils should be avoided in patients with inadequate portal flow.

  3. Endovascular Management of Deep venous Thrombosis of Lower Extremity in Patients with Malignant Disease

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Su Jin; Kim, Jae Kyu; Jang, Nam Kyu; Han, Seung Min; Kang, Heoung Keun; Choi, Soo Jin Nah [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-07-15

    To evaluate the efficacy of endovascular management of lower extremity deep vein thrombosis (DVT) in patients with malignant disease. Between January 2002 and January 2008, six consecutive patients (5 male and 1 female, mean age-65 years) with lower extremity DVT and malignant disease underwent endovascular management. The duration of symptoms lasted 4-120 days (mean-31 days; 20 days or less in four patients and more than 20 days in two). A catheter-directed thrombolysis was performed via the ipsilateral popliteal vein or common femoral vein, used alone or combined with a percutaneous mechanical thrombectomy. Angioplasty or stent placement was performed in residual stenosis or occlusion of the vein. The follow-up period lasted 1-14 months (mean 7.6 months) and was performed via a color Doppler ultrasonography or computed tomographic venography. Technical success and relief from symptoms was achieved within two days was achieved in five patients. Minor hemorrhagic complications occurred in two cases: hematuria and a hematoma at the puncture site. Upon follow-up, a recurrent DVT occurred in three patients as well as a patent venous flow in two. One patient died within 1 month due to a metastatic mediastinal lymphadenopathy. Endovascular management of the lower extremity DVT is effective for quickly eliminating a thrombus, relieving symptoms, and decreasing hemorrhagic complications in patients with malignant disease.

  4. Preliminary clinical study on endovascular treatment of posterior inferior cerebellar artery aneurysms

    International Nuclear Information System (INIS)

    Zhao Bing; Zhong Ming; Tan Xianxi; Zheng Kuang; Zhang Mingsheng; Yin Jian; He Wengen

    2009-01-01

    Objective: To study the methods and results of endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms. Methods: Twenty-one patients with PICA aneurysms were treated with endovascular treatment. The locations of aneurysm on PICA were evaluated through the DSA. Eight patients received single coil embolization, 5 received liquid Glue embolization, 2 received coil embolization combined with liquid Glue, 2 received coil embolization assisted with stents, and 4 underwent occlusion of the parent PICA. Outcome was evaluated with the Glasgow outcome scale (GOS). Results: There were complete (100%) occlusion in 5 patients, near complete (> 90%) occlusion in 2, and incomplete (85%) occlusion in 1 in single coil embolization. Seven patients with Glue embolization (n=5) or combination with coils (n=2) exhibited complete (100%) occlusion. There were near complete (>90%) occlusion in 2 cases with coil assisted with stents. Complete occlusion of the parent PICA was achieved in 3 patients, and near complete occlusion of PICA in one case. One patient suffered from new neurological deficits, and one patient treated with coils and stents died. None of the patients suffered from re-bleeding. There patients received follow-up during a mean period of (22 ± 8) months. Overall long-term outcome was good (GOS score 4 or 5) in 17 patients, poor (GOS score 2 or 3) in 3, and fatal (GOS score 1 ) in one case. Conclusions: According to the location of aneurysms on PICA, aneurysms can be effectively and safely treated with endovascular embolization. (authors)

  5. Surgical Clipping versus Endovascular Intervention for the Treatment of Subarachnoid Hemorrhage Patients in New York State.

    Directory of Open Access Journals (Sweden)

    Kimon Bekelis

    Full Text Available Randomized trials have demonstrated a survival benefit for endovascular treatment of ruptured cerebral aneurysms. We investigated the association of surgical clipping and endovascular coiling with outcomes in subarachnoid hemorrhage (SAH patients in a real-world regional cohort.We performed a cohort study involving patients with ruptured cerebral aneurysms, who underwent surgical clipping, or endovascular coiling from 2009-2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS database. An instrumental variable analysis was used to investigate the association of treatment technique with outcomes.Of the 4,098 patients undergoing treatment, 2,585 (63.1% underwent coiling, and 1,513 (36.9% underwent clipping. Using an instrumental variable analysis, we did not identify a difference in inpatient mortality [marginal effect (ME, -0.56; 95% CI, -1.03 to 0.02], length of stay (LOS (ME, 1.72; 95% CI, -3.39 to 6.84, or the rate of 30-day readmissions (ME, -0.30; 95% CI, -0.82 to 0.22 between the two treatment techniques for patients with SAH. Clipping was associated with a higher rate of discharge to rehabilitation (ME, 0.63; 95% CI, 0.24 to 1.01. In sensitivity analysis, mixed effect regression, and propensity score adjusted regression models demonstrated identical results.Using a comprehensive all-payer cohort of patients in New York State presenting with aneurysmal SAH we did not identify an association of treatment method with mortality, LOS or 30-day readmission. Clipping was associated with a higher rate of discharge to rehabilitation.

  6. Mortality after open aortic aneurysm surgery by Australasian surgeons trained in the endovascular era.

    Science.gov (United States)

    Beiles, C Barry; Walker, Stuart

    2016-07-01

    Reduced exposure of trainees to open repair (OR) of abdominal aortic aneurysm (AAA) during training has been considered detrimental to outcome. The Australasian experience is examined. The Australasian Vascular Audit (AVA) was interrogated for AAA procedures between 1 January 2010 and 31 December 2014. Surgeons completing training before 2006 (group 1) were compared with those attaining their qualification subsequently (group 2). The Australian Institute of Health and Welfare (AIHW) database was also interrogated to confirm the trends over time of open and endovascular repair (EVAR) since 2000. Actual exposure to OR and EVAR of AAA by trainees from 2010 to 2014 was also extracted. One hundred and forty-six surgeons in group 1 performed 3049 OR compared with 997 for the 66 surgeons in group 2. Overall mortality for group 1 was 9.8% and for group 2, 15% (P Australasian College of Surgeons.

  7. Endovascular treatment of Brucella-infected abdominal aortic aneurysm: A case report.

    Science.gov (United States)

    Zhang, Tao; Ji, Donghua; Wang, Feng

    2017-10-01

    In very rare cases, a primary infected abdominal aortic aneurysm (IAAA) is caused by a species of Brucella. In this report, we report such a case that was successfully treated with a novel approach. To the best of our knowledge, this was the first case occurring in China, in which an infection of the abdominal aortic aneurysm was caused by a Brucella species. The clinical findings included high fever, fatigue, and abdominal pain. The diagnosis was confirmed by computed tomography angiography and by bacteriologic isolation from the patient's blood culture. The patient was given endovascular aneurysm repair (EVAR) and Brucella-sensitive antibiotics for 6 weeks. During the 10-month follow-up, the patient's clinical course remained uneventful. Our case study supports the premise that endovascular aneurysm repair is an appropriate alternative strategy to treat an infected abdominal aortic aneurysm. Compared with conventional surgical treatment, EVAR with long-term oral antibiotics is a simpler, less traumatic, and more efficient procedure. However, this needs to be further evaluated through long-term follow-up.

  8. Meningocele repair

    Science.gov (United States)

    ... is surgery to repair birth defects of the spine and spinal membranes. Meningocele and myelomeningocele are types of spina bifida . Description For both meningoceles and myelomeningoceles, the surgeon ...

  9. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    International Nuclear Information System (INIS)

    Raupach, J.; Lojik, M.; Chovanec, V.; Renc, O.; Strýček, M.; Dvořák, P.; Hoffmann, P.; Guňka, I.; Ferko, A.; Ryška, P.; Omran, N.; Krajina, A.; Čabelková, P.; Čermáková, E.; Malý, R.

    2016-01-01

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %

  10. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    Energy Technology Data Exchange (ETDEWEB)

    Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz; Renc, O., E-mail: ondrejrenc@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Strýček, M., E-mail: m.strycek@gmail.com [Faculty of Medicine at Charles University (Czech Republic); Dvořák, P., E-mail: petr.dvorak@fnhk.cz; Hoffmann, P., E-mail: hoffmpet@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Guňka, I., E-mail: gunka@email.cz; Ferko, A., E-mail: a.ferko@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Surgery (Czech Republic); Ryška, P., E-mail: ryska@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Omran, N., E-mail: nidal81@gmail.com [Faculty of Medicine at Charles University and University Hospital, Department of Cardiac Surgery (Czech Republic); Krajina, A., E-mail: krajina@fnhk.cz; Čabelková, P., E-mail: pavla.cabelkova@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Čermáková, E., E-mail: cermakovae@lfhk.cuni.cz [Faculty of Medicine at Charles University, Computer Technology Center (Czech Republic); Malý, R., E-mail: malyr@volny.cz [Faculty of Medicine at Charles University and University Hospital, Department of Medicine (Czech Republic)

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  11. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  12. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  13. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  14. Analysis of the MELD Score Impact in the Outcome of Endovascular Portal Vein Reconstruction.

    Science.gov (United States)

    Torres-Machorro, Adriana; Guerrero-Hernandez, Manuel; Anaya-Ayala, Javier E; Torre, Aldo; Laparra-Escareno, Hugo; Cuen-Ojeda, Cesar; Garcia-Alva, Ramón; Hinojosa, Carlos A

    Endovascular therapy represents a less invasive alternative to open surgery for reconstruction of the portal vein (PV) and the spleno-mesenteric venous confluence to treat Portal hypertension. The objective of this study is to determine if the Model for End-Stage Liver Disease (MELD) score is a useful method to evaluate the risk of morbidity and mortality during endovascular approaches. Patients that underwent endovascular reconstruction of the PV or spleno-mesenteric confluence were identified retrospectively. Data were collected from November 2011 to August 2016. The MELD score was calculated using international normalized ratio, serum billirubin and creatinine. Patients were grouped into moderate (≤ 15) and high (> 15) MELD. Associations of the MELD score on the postprocedural morbidity, mortality and vessels patency were assessed by two-sided Fisher's exact test. Seventeen patients were identified; MELD score distribution was: ≤ 15 in 10 patients (59%) and > 15 in 7 (41%). Even distribution of severe PV thrombosis was treated in both groups, performing predominately jugular access in the high MELD score group (OR 0.10; 95%; CI 0.014-0.89; p = 0.052) in contrast to a percutaneous transhepatic access in the moderate MELD score group. Analysis comparing moderate and high MELD scores was not able to demonstrate differences in mortality, morbidity or patency rates. MELD score did not prove to be a useful method to evaluate risk of morbidity and mortality; however a high score should not contraindicate endovascular approaches. In our experience a high technical success, good patency rates and low complication rates were observed.

  15. Hemorrhagic risk of emergent endovascular treatment plus stenting in patients with acute ischemic stroke.

    Science.gov (United States)

    Dorado, Laura; Castaño, Carlos; Millán, Mònica; Aleu, Aitziber; de la Ossa, Natàlia Pérez; Gomis, Meritxell; López-Cancio, Elena; Vivas, Elio; Rodriguez-Campello, Ana; Castellanos, Mar; Dávalos, Antoni

    2013-11-01

    Several endovascular revascularization strategies have been described for the treatment of acute ischemic stroke (AIS). One of them is stenting when a very narrow stenosis with high reocclusion risk remains after recanalization. This study describes the risk of symptomatic intracerebral hemorrhage (SICH) after emergent stenting in patients with AIS treated with endovascular therapies. Consecutive patients who underwent endovascular treatment over a 37-month period were retrospectively analyzed. Patients were classified in 2 groups: (1) patients in whom a stent was deployed; and (2) patients without stenting. Double antiplatelet treatment with aspirin and clopidogrel was administered at the time of stenting. SICH was defined as any hemorrhagic transformation with National Institutes of Health Stroke Scale (NIHSS) score worsening 4 points or more (European-Australasian Acute Stroke Study II criteria). A total of 143 patients were included (mean age: 66.1±11.7 years, median NIHSS score: 18). Acute phase stenting was performed in 24 subjects (16.8%): 4 intracranial (3 in basilar artery, 1 in middle cerebral artery) and 20 extracranial (internal carotid artery). SICH occurred in 11 patients, 5 of 24 (20.8%) in patients with stenting and in 3 of 119 (2.5%) without (P=.008). No differences were found with respect to baseline NIHSS score or intravenous tissue plasminogen activator administration. Acute phase stenting emerged as an independent predictor of SICH after adjustment for potential confounders and procedure duration: odds ratio 7.3 (confidence interval 1.4-36.8, P=.016). Our findings suggest that emergent stenting in endovascular treatment of AIS is associated with SICH. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Manejo endovascular de la aorta torácica Endovascular treatment of thoracic aorta

    Directory of Open Access Journals (Sweden)

    Juan G Barrera

    2006-10-01

    Full Text Available En comparación con el tratamiento convencional, la terapia endovascular en aneurisma de aorta torácica, presenta los mejores resultados, por lo que se convierte en el tratamiento de elección para la patología de aorta torácica descendente endovascular, por su baja morbimortalidad perioperatoria. El tratamiento quirúrgico por vía retroperitoneal y/o endovascular para aneurisma de aorta abdominal infrarrenal, resulta ser especialmente seguro en pacientes octogenarios o con alta morbilidad. Esta cohorte institucional presenta resultados perioperatorios y en el seguimiento, similares a los reportados en la literatura mundial.Compared with the conventional treatment, endovascular therapy in thoracic aortic aneurysm shows the best results, being the election treatment for the pathology of the descending thoracic aorta, due to its low peri-operative morbid-mortality. Surgical treatment by retro-peritoneal route and/or endovascular for infra-renal abdominal aortic aneurysm is especially safe in octogenarian patients or in those with a high mortality rate. This institutional cohort show peri-operative and follow-up results similar to those reported in the world literature.

  17. Endovascular treatment of spine and spinal cord lesions

    International Nuclear Information System (INIS)

    Berenstein, A.

    1992-01-01

    Completing this comprehensive series on endovascular interventional angiography, Volume 5 focuses on the vascular abnormalities of the spine and spinal cord. It is based on the detailed functional vascular anatomy described in Volume 3 and the principles and function of endovascular treatment described in Volumes 1-4. As in the companion volumes, the unique approach gives view of the disease itself, its anatomical features and its clinical presentation. The technical aspects of the interventional or endovascular neuroradiology are built upon the solid analysis of the disease and its angioarchitecture. The recent developments in endovascular procedures, such as aneurysm treatment, angioplasty, and vascular recanalizations, are reviewed. (orig.). 118 figs. in 442 separate illustrations

  18. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms....... endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms...... aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated...

  19. The endovascular treatment of brain arteriovenous malformations.

    Science.gov (United States)

    Valavanis, A; Yaşargil, M G

    1998-01-01

    Advances in superselective microcatheterization techniques, which took place in the past decade, established superselective endovascular exploration as an integral and indispensable tool in the pretherapeutic evaluation of brain AVMs. The strict and routine application of superselective angiography furthered our knowledge on the angioarchitecture of brain AVMs, including vascular composition of the nidus, types of feeding arteries and types and patterns of venous drainage. In addition, various types of weak angioarchitectural elements, such as flow-related aneurysms, intranidal vascular cavities and varix formation proximal to high-grade stenosis of draining veins, could be identified as factors predisposing for AVM rupture. A wide spectrum of secondary angiomorphological changes induced by the arteriovenous shunt of the nidus and occurring up- and downstream of the nidus have been identified as manifestations of high-flow angiopathy. These data help to better predict the natural history, understand the widely variable clinical presentation and to define therapeutic targets of brain AVMs. Correlation of the topography of the AVM as demonstrated by MR with the angioarchitecture as demonstrated by superselective angiography provided a system for topographic-vascular classification of brain AVMs, which proved very useful for patient selection and definition of therapeutic goals. This study showed, that 40% of patients with brain AVMs can be cured by embolization alone with a severe morbidity of 1.3% and a mortality of 1.3%. Part of theses patients can, however, be cured equally effective by microsurgery or radiosurgery. Which modality will be chosen for a particular patient will mainly depend on the locally available expertise and experience, but also on the preference of the patient following its comprehensive information about the chances for cure and the risks associated with each of these therapeutic modalities. Embolization has a significant role in the

  20. Intestinal infarction: A complication of endovascular therapy

    Energy Technology Data Exchange (ETDEWEB)

    England, Andrew [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)]. E-mail: andrew.england@smtr.nhs.uk; Butterfield, John S. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Sukumar, Sathi [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Thompson, David [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Roulson, Jo-An [Department of Histopathology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Pritchard, Susan [Department of Histopathology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Ashleigh, Raymond J. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)

    2007-08-15

    This report presents a rare case of intestinal infarction following endovascular therapy. A female patient who had undergone an internal carotid artery stenting procedure presented suddenly with abdominal pain. Radiological and clinical examinations at the time suggested a picture of intestinal ischaemia, in view of the patient's general conditions and co-existing morbidities surgical intervention was not considered to be an option. The patient died 4 days after the carotid stenting procedure, post-mortem examination revealed infarction of the ileum and caecum. The learning outcomes are if performing endovascular therapy in a patient with diffuse atherosclerotic disease early consideration of intestinal ischaemia should be given to any patient who presents with acute post-procedural abdominal pain.

  1. Intestinal infarction: A complication of endovascular therapy

    International Nuclear Information System (INIS)

    England, Andrew; Butterfield, John S.; Sukumar, Sathi; Thompson, David; Roulson, Jo-An; Pritchard, Susan; Ashleigh, Raymond J.

    2007-01-01

    This report presents a rare case of intestinal infarction following endovascular therapy. A female patient who had undergone an internal carotid artery stenting procedure presented suddenly with abdominal pain. Radiological and clinical examinations at the time suggested a picture of intestinal ischaemia, in view of the patient's general conditions and co-existing morbidities surgical intervention was not considered to be an option. The patient died 4 days after the carotid stenting procedure, post-mortem examination revealed infarction of the ileum and caecum. The learning outcomes are if performing endovascular therapy in a patient with diffuse atherosclerotic disease early consideration of intestinal ischaemia should be given to any patient who presents with acute post-procedural abdominal pain

  2. Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation.

    Science.gov (United States)

    Ohm, Joon-Young; Ko, Gi-Young; Sung, Kyu-Bo; Gwon, Dong-Il; Ko, Heung Kyu

    2017-09-01

    The purpose of this article is to evaluate and compare the safety and efficacy of endovascular management of the portal vein (PV) via percutaneous transsplenic access versus percutaneous transhepatic access in liver transplantation (LT) recipients. A total of 18 patients who underwent endovascular management of PV via percutaneous transhepatic (n = 8) and transsplenic (n = 10) access were enrolled. Transsplenic access was chosen if the spleen was located in a normal position, the splenic vein (SpV) was preserved, and the target lesion did not involve confluence of the superior mesenteric and SpVs. Accessibility of the percutaneous transsplenic puncture was confirmed via ultrasound (US) in the angiography suite. All procedures were performed under local anesthesia. Percutaneous transhepatic or transsplenic access was performed using a 21-gauge Chiba needle under US and fluoroscopic guidance, followed by balloon angioplasty, stent placement, or variceal embolization. The access tract was embolized using coils and a mixture (1:2) of glue and ethiodized oil. Transhepatic or transsplenic access was successfully achieved in all patients. A total of 12 patients underwent stent placement; 3 had balloon angioplasty only; 2 had variceal embolization only; and 1 had variceal embolization followed by successful stent placement. Regarding major complications, 1 patient experienced a SpV tear with extravasation during transsplenic balloon angioplasty, which was successfully managed using temporary balloon inflation, followed by transfusion. Clinical success was achieved in 9 of 11 (82%) patients who exhibited clinical manifestations. The remaining 7 patients who underwent prophylactic endovascular management were healthy. In conclusion, endovascular management of PV via percutaneous transsplenic access is a relatively safe and effective alternative that does not damage the liver grafts of LT recipients. Liver Transplantation 23 1133-1142 2017 AASLD. © 2017 by the American

  3. Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Torres-Blanco, Álvaro, E-mail: atorres658@yahoo.es; Edo-Fleta, Gemma; Gómez-Palonés, Francisco; Molina-Nácher, Vicente; Ortiz-Monzón, Eduardo [Hospital Universitario Dr. Peset, Department of Angiology, Endovascular and Vascular Surgery (Spain)

    2016-03-15

    PurposeThe purpose of the study was to assess the safety and midterm effectiveness of endovascular treatment in Trans-Atlantic Inter-Society Consensus II (TASC-II) D femoropopliteal occlusions in patients with critical limb ischemia (CLI).MethodsPatients with CLI who underwent endovascular treatment for TASC-D de novo femoropopliteal occlusive disease between September 2008 and December 2013 were selected. Data included anatomic features, pre- and postprocedure ankle-brachial index, duplex ultrasound, and periprocedural complications. Sustained clinical improvement, limb salvage rate, freedom from target lesion revascularization (TLR), and freedom from target extremity revascularization (TER) were assessed by Kaplan–Meier estimation and predictors of restenosis/occlusion with Cox analysis.ResultsThirty-two patients underwent treatment of 35 TASC-D occlusions. Mean age was 76 ± 9. Mean lesion length was 23 ± 5 cm. Twenty-eight limbs (80 %) presented tissue loss. Seventeen limbs underwent treatment by stent, 13 by stent-graft, and 5 by angioplasty. Mean follow-up was 29 ± 20 months. Seven patients required major amputation and six patients died during follow-up. Eighteen endovascular and three surgical TLR procedures were performed due to restenosis or occlusion. Estimated freedom from TLR and TER rates at 2 years were 41 and 76 %, whereas estimated primary and secondary patency rates were 41 and 79 %, respectively.ConclusionsEndovascular treatment for TASC II D lesions is safe and offers satisfying outcomes. This patient subset would benefit from a minimally invasive approach. Follow-up is advisable due to a high rate of restenosis. Further follow-up is necessary to know the long-term efficacy of these procedures.

  4. Frequency of Helicobacter pylori in patients underwent endoscopy

    Directory of Open Access Journals (Sweden)

    Ahmet Tay

    2012-06-01

    Full Text Available Objectives: The aim of this study was to investigate thefrequency of Helicobacter pylori in patients underwent endoscopyeastern Anatolia.Materials and methods: The patients whose endoscopicantral biopsies were taken for any reason in our endoscopyunit in February-June 2010 period were includedand retrospectively investigated. The frequency of Helicobacterpylori was determined as separating the patientsaccording to general, sex and the age groups. Antral biopsieswere stained with hematoxylin-eosin and modified giemsamethod and examined under light microscope andreported as (+ mild, (++ moderate, (+++ severe positiveaccording to their intensities.Results: Biopsy specimens of 1298 patients were includedinto the study. The mean age was 47.5 ± 17.5 years(range 14-88 and 607 of these patients (47% were male.Histopathological evaluation revealed that, 918 of the patientswere (71% positive and 379 (29% were negativefor Helicobacter pylori. Approximately 60% of our patientshad mild, 29% had moderate and 11% had severe positivityfor Helicobacter pylori. No significant difference wasfound in the frequency of Helicobacter pylori betweenwomen and men. The frequencies of Helicobacter pyloriwere 73.2%, 71.5%, 68.6% and 70.4%, respectively, inthe age groups of 14-30 years, 31-45 years, 46-60 yearsand 61-88 years.Conclusion: The frequency of Helicobacter pylori was71% in Eastern Anatolia Region. No statistically significantdifference was found between genders and agegroups in term of the frequency of Helicobacter pylori.

  5. Benefit of endovascular stenting for aortic coarctation on systemic hypertension in adults.

    Science.gov (United States)

    Hamid, Tahir; Motwani, Manish; Schneider, Heiko; Dua, Jaspal Singh; Hoschtitzky, Andreas; Clarke, Bernard; Mahadevan, Vaikom S

    2015-12-01

    Endovascular stenting is a recognised treatment strategy for aortic coarctation (CoA) in adults. We assessed systemic hypertension control and the need for antihypertensive therapy after CoA stenting in adults. Data were collected prospectively on 54 patients (36 men; mean age: 34 ± 16 years) who underwent endovascular stenting for CoA over a 7-year period. Five patients were excluded as they did not attend follow-up appointments. Patients underwent clinical examination, including right arm systolic blood pressure (SBP) and 24-hour ambulatory blood pressure monitoring at baseline, 6-12 weeks and 9-12 months. There was a significant fall in mean peak-to-peak systolic gradient (PG) across the CoA after stenting (26 ± 11 mmHg vs. 5 ± 4 mmHg; P25 mmHg before stenting); baseline SBP was significantly higher in severe versus non-severe patients (160 mmHg vs. 148 mmHg; P=0.02). The absolute reduction in PG after stenting was significantly higher in the severe group (31 ± 7 mmHg vs. 14 ± 5 mmHg; P<0.0001), but there was no significant difference in SBP between groups at 6-12 weeks (141 mmHg vs. 135 mmHg; P=0.21) or 9-12 months (139 mmHg vs. 139 mmHg; P=0.96). Endovascular stenting of CoA results in a significant reduction in SBP at 6-12 weeks, which is sustained at 9-12 months, with similar outcomes in severe and non-severe CoA groups. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  7. Open Embolectomy of Large Vessel Occlusion in the Endovascular Era: Results of a 12-Year Single-Center Experience.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Nitta, Junpei; Miyaoka, Yoshinari; Nagm, Alhusain; Tsutsumi, Keiji; Ito, Kiyoshi; Hongo, Kazuhiro

    2017-06-01

    Mechanical endovascular embolectomy using stent retrievers has gained popularity for treatment of large vessel occlusion in acute ischemic stroke. Use of open embolectomy as a direct surgical treatment has been limited, likely owing to the technical difficulty, therapeutic time window, and time-consuming procedure. We retrospectively reviewed clinical and radiographic records of patients who underwent open embolectomy for major artery occlusion at an acute stage. Clinical features, complications, and outcome of patients were analyzed. From January 2004 to September 2016, 153 patients underwent 157 open embolectomies for major artery occlusion. Complete recanalization was achieved in 96.2% of patients. A favorable outcome was observed in 43.9%. Cerebral aneurysm along the occluded artery was observed in 11 patients with 12 aneurysms. Open embolectomy resulted in a high complete recanalization rate with an acceptable safety profile. Open embolectomy is a safe and durable method of cerebral recanalization in patients with embolic stroke and can be considered as a potential treatment if endovascular embolectomy cannot be performed. The details of the occluded arteries presented here will be useful for endovascular surgeons to prevent complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Endovascular treatment of cerebral aneurysms - a cost analysis | Le ...

    African Journals Online (AJOL)

    The average cost for endovascular treatment per patient was R37 041. Surgical treatment was more expensive at R44 104, a difference of 16%. Conclusions. Despite the high cost of endovascular devices, appropriate use of this technology ultimately offers less expensive treatment than microsurgical clipping of aneurysms.

  9. The creation of the optimal dedicated endovascular suite

    NARCIS (Netherlands)

    Sikkink, C. J. J. M.; Reijnen, M. M. P. J.; Zeebregts, C. J.

    Background. During the last decade endovascular therapy has been established as an alternative treatment for a variety of vascular diseases. Neither the classic operating room (OR), nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues

  10. Simulation and augmented reality in endovascular neurosurgery: lessons from aviation.

    Science.gov (United States)

    Mitha, Alim P; Almekhlafi, Mohammed A; Janjua, Major Jameel J; Albuquerque, Felipe C; McDougall, Cameron G

    2013-01-01

    Endovascular neurosurgery is a discipline strongly dependent on imaging. Therefore, technology that improves how much useful information we can garner from a single image has the potential to dramatically assist decision making during endovascular procedures. Furthermore, education in an image-enhanced environment, especially with the incorporation of simulation, can improve the safety of the procedures and give interventionalists and trainees the opportunity to study or perform simulated procedures before the intervention, much like what is practiced in the field of aviation. Here, we examine the use of simulators in the training of fighter pilots and discuss how similar benefits can compensate for current deficiencies in endovascular training. We describe the types of simulation used for endovascular procedures, including virtual reality, and discuss the relevant data on its utility in training. Finally, the benefit of augmented reality during endovascular procedures is discussed, along with future computerized image enhancement techniques.

  11. Hydrocele repair

    Science.gov (United States)

    ... about 4 to 7 days. Outlook (Prognosis) The success rate for hydrocele repair is very high. The ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  12. Craniosynostosis repair

    Science.gov (United States)

    ... children having an open repair may need a transfusion) Reaction to medicines Risks for this surgery are: Infection in the brain Bones connect together again, and more surgery is needed Brain swelling Damage to brain tissue

  13. Ptosis repair.

    Science.gov (United States)

    Ng, John; Hauck, Matthew J

    2013-02-01

    Acquired blepharoptosis presents as both a functional and cosmetic problem commonly encountered by facial plastic surgeons. Ptosis repair can be both challenging and frustrating, especially given ever-increasing demands for an optimal cosmetic surgical result. The authors present a brief overview of key points to consider when attempting to achieve excellent blepharoptosis repair outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  14. Stent-graft repair for blunt traumatic aortic injury: functional and survival outcomes.

    Science.gov (United States)

    González Sánchez, S; Martín Conejero, A; Moñux Ducajú, G; Martínez López, I; Hernando Rydings, M; Serrano Hernando, F J

    2013-02-01

    Traumatic aortic injury is usually lethal, most often because of serious associated wounds. The short- and midterm outcome of endovascular exclusion was assessed as the current treatment of choice due to a lower mortality and morbidity than open surgical treatment. We reviewed the cases of 8 patients (5 male, mean age 33 years) undergoing endovascular