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Seminars in Vascular Surgery

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https://www.readbyqxmd.com/read/27989321/patient-selection-for-endovascular-sac-sealing-of-abdominal-aortic-aneurysm
#1
REVIEW
Robert K Fisher, Francesco Torella, Andrew England, Richard G McWilliams
Endovascular sealing is a developing technique for treatment of abdominal aortic aneurysm that draws on novel concepts utilizing polymer filling of endobags within the aorto-iliac lumen. The morphologic indications and patient selection, while similar to those of endovascular aneurysm repair, differ in some regards. The Instructions for Use for the Nellix sealing device may expand the indications for aneurysm treatment and are closely scrutinized in this article. The authors draw on current evidence and their own experience and opinion in the discussion around appropriate patient selection and its influence on outcomes after endovascular aneurysm sealing...
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27989320/introduction-the-endovascular-aneurysm-sealing-revolution
#2
EDITORIAL
Francesco Torella, Robert K Fisher, Richard G McWilliams
No abstract text is available yet for this article.
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27989319/percutaneous-interventions-following-endovascular-aneurysm-sac-sealing-endoleak-embolization-and-limb-related-adverse-events
#3
REVIEW
S Ameli-Renani, R A Morgan
The Nellix endovascular aneurysm sealing system is a novel alternative to conventional endovascular aneurysm repair for aortic aneurysm management using paired balloon-expandable endografts supported by polymer-filled endobags to achieve sealing and anatomic fixation. Part of the promise of endovascular aneurysm sealing is increased resistance to lateral and longitudinal forces and a potential for reduced rates of device-related failures, particularly endoleaks. Initial efficacy data on this device are encouraging, but our knowledge of its associated complications and their management is limited...
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27989318/appearance-of-the-nellix-endoprosthesis-on-postoperative-imaging-implications-for-patient-and-device-surveillance
#4
REVIEW
N J Hilliard, P Hayes, A P Winterbottom
The Nellix stent graft has novel features that influence interpretation of imaging follow-up, in particular, the use of endobags that seal the aneurysm sac. The polymer within the endobags contains a small amount of contrast medium, which causes a predictable temporal change in appearances. Understanding of these features allows correct image evaluation. In this article, we review the appearance of Nellix on computed tomography, ultrasound, magnetic resonance imaging, and plain radiography. We describe the special considerations that are important to consider when reviewing imaging, including endobag position and seal, endobag configuration, endobag and polymer maturation, and endobag gas...
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27989317/extended-use-of-endovascular-aneurysm-sealing-chimneys-for-juxtarenal-aneurysms
#5
REVIEW
K M Stenson, J L De Bruin, P J E Holt, I M Loftus, M M Thompson
Hostile infrarenal aortic neck anatomy presents a challenge for the endovascular treatment of abdominal aortic aneurysm. Open surgical repair has been seen as the gold standard treatment for juxtarenal abdominal aortic aneurysm; however, endovascular techniques are now becoming more prevalent, particularly in patients deemed high risk for morbidity and mortality with open repair. The morphology of an aneurysm is a determinant of long-term outcomes, and short aneurysm necks are associated with poorer outcomes and a higher rate of secondary reinterventions...
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27989316/treating-iliac-aneurysm-using-the-nellix-endovascular-sac-sealing-system
#6
REVIEW
Marwan Youssef, Sebastian Zerwes, Rudolf Jakob, Fritz Dünschede, Bernhard Dorweiler, Christian F Vahl
As endovascular treatment of abdominal aortic aneurysms has become established, there has been growing focus on treatment of the aneurysmal iliac artery. Isolated, large iliac aneurysms >30 mm pose a risk of rupture, but, in addition, 20% to 30% of abdominal aortic aneurysms are associated with iliac aneurysmal dilatation, which can compromise long-term outcomes. Endovascular solutions are evolving and until recently have utilized standard stent graft technology. The endovascular aortic sealing system was introduced as a new, effective method for the treatment of infrarenal aortic aneurysms...
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27989315/extended-use-of-endovascular-aneurysm-sealing-for-ruptured-abdominal-aortic-aneurysms
#7
REVIEW
Dittmar Böckler, Andrew Holden, Dainis Krievins, Jean-Paul P M de Vries, Andreas S Peters, Philipp Geisbüsch, Michel Reijnen
Endovascular repair of abdominal aortic aneurysms (EVAR) is now an established treatment modality for suitable patients presenting with aneurysm rupture. EVAR for ruptured aneurysms reduces transfusion, mechanical ventilation, intensive care. and hospital stay when compared with open surgery. In the emergency setting, however, EVAR is limited by low applicability due to adverse clinical or anatomical characteristics and increased need for reintervention. In addition, ongoing bleeding from aortic side branches post-EVAR can cause hemodynamic instability, larger hematomas, and abdominal compartment syndrome...
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27989314/clinical-outcomes-after-nellix-endovascular-aneurysm-sealing
#8
REVIEW
Andrew Holden
The published evidence on clinical outcomes of Nellix Endovascular Aneurysm Sealing for elective abdominal aortic aneurysm repair has confirmed low procedural morbidity and reintervention rate. This early clinical experience with Nellix is encouraging, despite the device and procedural steps being in evolution, and patients being treated outside of the recommended instructions for use. The long-term follow-up of a treated patient cohort is now available and demonstrates low aneurysm-related mortality and morbidity...
September 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823595/status-of-branched-grafts-for-thoracic-aortic-arch-endovascular-repair
#9
REVIEW
W Anthony Lee
The aortic arch is one of the most anatomically complex segments of the thoracoabdominal aorta due the plurality of vital branch configurations, intrinsic and highly variable three-dimensional curvature, and involvement in a variety of thoracic aortic pathologies, such as aneurysmal degeneration, penetrating ulcer, and media wall dissection. Pathologies that extend the repair proximal to the left common carotid artery require more complex branch vessel management beyond a carotid-subclavian bypass. This article will review the current status of branched aortic arch endografts...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823594/off-the-shelf-fenestrated-and-branched-stent-graft-designs-for-abdominal-aortic-aneurysm-repair
#10
REVIEW
Bernardo C Mendes, Animesh Rathore, Mauricio S Ribeiro, Gustavo S Oderich
Endovascular repair of pararenal and thoracoabdominal aortic aneurysms with fenestrated and branched stent grafts has been increasingly utilized with high technical success and low morbidity and mortality. Freedom from branch-related events has been reported at 89% in 5 years, including any branch-related endoleak, stenosis, kink, disconnection, or occlusion. Patient-specific stent grafts have the advantage of fitting patients' anatomy, but require a 6- to 8-week period for customization. Off-the-shelf stent grafts have been developed based on a relative predictability of renal-mesenteric vessels...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823593/snorkel-endovascular-abdominal-aortic-aneurysm-repair-versus-fenestrated-endovascular-aneurysm-repair-is-it-a-competition
#11
REVIEW
Adam Tanious, Jason T Lee, Murray Shames
The endovascular treatment of juxtarenal abdominal aortic aneurysm (AAA) can be performed by either a standard endovascular stent graft with additional snorkle grafts to aorta branches (snorkel endovascular aneurysm repair) or implantation of a fenestrated stent graft (fenestrated endovascular aneurysm repair). While many vascular surgeons consider snorkel endovascular aneurysm repair and fenestrated endovascular aneurysm repair to be competing techniques or alternate strategies, published procedural outcomes suggest more complementary roles...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823592/secondary-interventions-after-endovascular-aneurysm-sac-sealing-endoleak-embolization-and-limb-related-interventions
#12
REVIEW
Seyed Ameli-Renani, R A Morgan
The Nellix endovascular aneurysm sealing system is a novel alternative to conventional endovascular aneurysm repair for aortic aneurysm management using paired balloon expandable endografts supported by polymer-filled endobags to achieve sealing and anatomic fixation. Part of the promise of endovascular aneurysm sealing is increased resistance to lateral and longitudinal forces and thus a potential for reduced rates of device-related failures, particularly endoleaks. Initial efficacy data on this device are encouraging, but our knowledge of its associated complications and their management is limited...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823591/nellix-endovascular-aneurysm-sealing-system-device-description-technique-of-implantation-and-literature-review
#13
REVIEW
Nayara Cioffi Batagini, David Hardy, Daniel G Clair, Lee Kirksey
Clinical outcome reports document that from 30% to 60% of endovascular aneurysm repair procedures are performed outside of US Food and Drug Administration-approved Instruction for Use, or "off label." Endovascular aneurysm repair performed outside of Instruction for Use has a significantly higher rate of device failure, potentially requiring device reintervention and even planned or emergent explant. The Nellix device has the potential to reduce the rate of aneurysm device failure through its novel design. The objective of this article was to introduce the Nellix EndoVascular Aneurysm Sealing System and indications for use and describe the technique of implantation...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823590/endovascular-aneurysm-sealing-addresses-several-limitations-of-conventional-endovascular-aneurysm-repair
#14
REVIEW
Zachary W Kostun, Edward Y Woo
Endovascular aneurysm repair has enabled a broad population of patients with infrarenal abdominal aortic aneurysm to be treated by a less-invasive technique. However, endovascular aneurysm repair has therapeutic limitations, including the need for lifelong surveillance and a higher rate of secondary interventions than open repair. These outcomes can promote patient dissatisfaction and result in increased health care costs and associated morbidity and mortality. The primary reason for secondary interventions is continued abdominal aortic aneurysm sac enlargement due to endoleaks...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823589/intervention-after-endovascular-aneurysm-repair-endosalvage-techniques-including-perigraft-arterial-sac-embolization-and-endograft-relining
#15
REVIEW
Andrew Barleben, Tazo Inui, Erik Owens, John S Lane, Dennis F Bandyk
Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysm (AAA). However, persistent AAA sac endoleak following EVAR can result in sac diameter increase requiring re-intervention in up to one-third of cases and even result in aneurysm rupture. In this case review, we summarize and detail endovascular re-interventions for each type of endoleak. We also detail specific options including stent-graft relining for indeterminate, Type III, and Type IV endoleaks and perigraft arterial sac embolization to induce thrombosis and resolve acute Type I, II, or III endoleaks...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823588/ruptured-abdominal-aortic-aneurysm-is-endovascular-aneurysm-repair-the-answer-for-everybody
#16
REVIEW
Faisal Aziz
Treatment paradigms for elective repair of asymptomatic abdominal aortic aneurysms (AAA) have evolved during the past 2 decades, with endovascular aneurysm repair as the preferred treatment modality. The patient care strategy for emergent treatment for ruptured AAA is not as straightforward, due in part to surgeon expertise and stent-graft availability at the institution. Although most reports have extrapolated elective endovascular aneurysm repair feasibility data to the ruptured AAA patient and the aneurysm anatomy, these expectations should be interpreted with caution...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823587/overview-of-aortic-aneurysm-management-in-the-endovascular-era
#17
REVIEW
Aurelia Calero, Karl A Illig
Management of aortic aneurysm disease has changed in the endovascular era, with the majority of patients opting for stent-graft repair of abdominal and thoracic aneurysms. An understanding of this vascular condition is important for primary care, emergency medicine, medicine specialists, and vascular surgeons alike. Awareness of the patient risk factors for aneurysmal degeneration, sac rupture, and medical management allows physicians to screen appropriate patient populations, which decreases aneurysm-related mortality due to rupture...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823586/infrarenal-endovascular-aneurysm-repair-new-developments-and-decision-making-in-2016
#18
REVIEW
Matthew R Smeds, Kristofer M Charlton-Ouw
New developments in infrarenal abdominal aortic aneurysm stent-graft devices have made more patients eligible for endovascular aneurysm repair (EVAR). Recent US Food and Drug Administration approval for fenestrated endograft repair and impending approval for iliac branch devices extend the proximal and distal landing zones. Better deployment systems allow for partial deployment of endografts to facilitate repositioning, and more flexible designs allow for treatment of angulated infrarenal aneurysm necks and tortuous iliac arteries...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823585/association-of-diabetes-mellitus-with-presence-expansion-and-rupture-of-abdominal-aortic-aneurysm-curiouser-and-curiouser-cried-alice
#19
REVIEW
Hisato Takagi
Both coronary artery and peripheral artery disease are representative atherosclerotic diseases that are positively associated with presence of abdominal aortic aneurysm (AAA). Diabetes mellitus, which is one of major risk factors of coronary artery and peripheral artery diseases, however, has been curiously suggested to be negatively associated with AAA, despite the positive associations of coronary artery and peripheral artery diseases with presence of AAA. In the present article, we overviewed epidemiologic evidence (meta-analyses) regarding the associations of diabetes mellitus with presence, expansion, and rupture of AAA through a systematic literature search...
March 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/27823584/virtual-roundtable-on-endovascular-aortic-aneurysm-repair
#20
EDITORIAL
Peter R Nelson
No abstract text is available yet for this article.
March 2016: Seminars in Vascular Surgery
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