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https://www.readbyqxmd.com/read/28685522/next-generation-post-evar-follow-up-regime
#1
Rita Soares Ferreira, Frederico Bastos Gonçalves
Durability of endovascular aneurysm repair is critical, since a significant proportion of patients suffer from procedure-related complications and secondary interventions after repair of abdominal aortic aneurysms. Therefore, regular follow up including imaging is recommended. The rationale behind current surveillance programs is to allow early detection and elective treatment of complications. However, current recommendations are laborious and resource consuming, may be deleterious to many patients and are largely inefficient...
July 7, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28662928/surveillance-after-endovascular-aortic-repair
#2
Feras Zaiem, Jehad Almasri, Mouaffaa Tello, Larry J Prokop, Elliot L Chaikof, Mohammad Hassan Murad
OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the optimal modality and frequency of surveillance after endovascular aortic repair (EVAR) in adult patients with abdominal aortic aneurysms. METHODS: We searched for studies of post-EVAR surveillance in MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Scopus through May 10, 2016. The outcomes of interest were endoleaks, mortality, limb ischemia, renal complications, late rupture, and aneurysm-related mortality...
June 26, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28656809/a-systematic-review-of-predictors-of-reintervention-after-evar-guidance-for-risk-stratified-surveillance
#3
Shaneel R Patel, Chris Allen, Matthew J Grima, Jack R W Brownrigg, Benjamin O Patterson, Peter J E Holt, Matt M Thompson, Alan Karthikesalingam
BACKGROUND: Current surveillance protocols after endovascular aneurysm repair (EVAR) are ineffective and costly. Stratifying surveillance by individual risk of reintervention requires an understanding of the factors involved in developing post-EVAR complications. This systematic review assessed risk factors for reintervention after EVAR and proposals for stratified surveillance. METHODS: A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed using EMBASE and MEDLINE databases to identify studies reporting on risk factors predicting reintervention after EVAR and proposals for stratified surveillance...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28598495/ultrasonography-for-endoleak-detection-after-endoluminal-abdominal-aortic-aneurysm-repair
#4
REVIEW
Iosief Abraha, Maria Laura Luchetta, Rita De Florio, Francesco Cozzolino, Giovanni Casazza, Piergiorgio Duca, Basso Parente, Massimiliano Orso, Antonella Germani, Paolo Eusebi, Alessandro Montedori
BACKGROUND: People with abdominal aortic aneurysm who receive endovascular aneurysm repair (EVAR) need lifetime surveillance to detect potential endoleaks. Endoleak is defined as persistent blood flow within the aneurysm sac following EVAR. Computed tomography (CT) angiography is considered the reference standard for endoleak surveillance. Colour duplex ultrasound (CDUS) and contrast-enhanced CDUS (CE-CDUS) are less invasive but considered less accurate than CT. OBJECTIVES: To determine the diagnostic accuracy of colour duplex ultrasound (CDUS) and contrast-enhanced-colour duplex ultrasound (CE-CDUS) in terms of sensitivity and specificity for endoleak detection after endoluminal abdominal aortic aneurysm repair (EVAR)...
June 9, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28580349/ultrasound-fusion-imaging-with-real-time-navigation-for-the-surveillance-after-endovascular-aortic-aneurysm-repair
#5
Jin Hyun Joh, Sang-Ah Han, Sang-Hyun Kim, Ho-Chul Park
Ultrasound can be an effective alternative to computed tomography for surveillance following endovascular aneurysm repair (EVAR). Recently, ultrasound fusion imaging with the real-time navigation system was introduced. Here we described 3 patients who underwent post-EVAR surveillance using this novel technique. Complete coregistration was achieved in all patients. The origin of left renal artery was selected for the target of coregistration. Ultrasound fusion imaging was useful to differentiate the confusing lesion and to evaluate the complete resolution of endoleak and newly developed delayed endoleak...
June 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28579278/higher-30-day-mortality-in-patients-with-familial-abdominal-aortic-aneurysm-after-evar
#6
K M van de Luijtgaarden, F Bastos Gonçalves, S E Hoeks, J D Blankensteijn, D Böckler, R J Stolker, H J M Verhagen
OBJECTIVES: To determine the influence of a positive family history for aneurysms on clinical success and mortality after endovascular aneurysm repair (EVAR). METHODS: From 2009 to 2011, 1262 patients with abdominal aortic aneurysms (AAA) treated by EVAR were enrolled in a prospective, industry sponsored clinical registry ENGAGE. Patients were classified into familial and sporadic AAA patients according to baseline clinical reports. Clinical characteristics, aneurysm morphology, and follow-up were registered...
June 1, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28578623/definition-of-type-ii-endoleak-risk-based-on-preoperative-anatomical-characteristics
#7
Michele Piazza, Francesco Squizzato, Tommaso Miccoli, Sandro Lepidi, Mirko Menegolo, Franco Grego, Michele Antonello
PURPOSE: To define the risk for type II endoleak (EII) after endovascular aneurysm repair (EVAR) based on preoperative anatomical characteristics. METHODS: Between January 2008 and December 2015, 189 patients (mean age 78.4±7.6 years; 165 men) underwent standard EVAR. Mean aneurysm diameter was 5.7±0.7 cm and mean volume 125.2±45.8 cm(3). Patients were assigned to the "at-risk" group (n=123, 65%) when at least one of the following criteria was present: patency of a >3-mm inferior mesenteric artery (IMA), patency of at least 3 pairs of lumbar arteries, or patency of 2 pairs of lumbar arteries and a sacral artery or accessory renal artery or any diameter patent IMA; otherwise, patients were entered in the "low-risk" group (n=66, 35%)...
June 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28549961/preliminary-results-of-aorfix-tm-stent-graft-to-treat-infrarenal-abdominal-aortic-aneurysms-with-severe-proximal-aortic-neck-angulation
#8
Pietro Volpe, Mafalda Massara, Antonino Alberti, Santo Marino, Alberto Volpe, Daniela Mazzaccaro, Silvia Stegher, Giovanni Nano
BACKGROUND: We report a preliminary experience about endovascular aortic repair (EVAR) of infrarenal abdominal aneurysm (iAAA) with severe proximal aortic neck angulation using the Aorfix(TM) stent graft. METHODS: Data of consecutive patients with iAAA with severe proximal neck angulation submitted to endovascular repair between September 2012 and December 2014 in two Italian centres of Vascular and Endovascular Surgery were retrospectively reviewed and outcomes analyzed using the software JMP 5...
May 23, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28535732/duplex-ultrasound-surveillance-after-uncomplicated-endovascular-abdominal-aortic-aneurysm-repair
#9
Jacob S Schaeffer, Irina Shakhnovich, Kyle N Sieck, Kara J Kallies, Clark A Davis, Thomas H Cogbill
OBJECTIVES: Health-care costs and risks of radiation and intravenous contrast exposure challenge computed tomography angiography (CTA) as the standard surveillance method after endovascular abdominal aortic aneurysm repair (EVAR). We reviewed our experience using Duplex ultrasound scan (DUS) as an initial and subsequent surveillance technique after uncomplicated EVAR. METHODS: The medical records of patients who underwent EVAR from 2004 to 2014 with at least 1 postoperative imaging study were retrospectively reviewed...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28501665/a-dedicated-surveillance-program-improves-compliance-with-evar-follow-up
#10
Jade Cohen, Akila Pai, Timothy M Sullivan, Peter Alden, Jason Q Alexander, Andrew Cragg, Jesse M Manunga, Stephenson, Nedaa Skeik, Jessica M Titus
INTRODUCTION: Current recommendations suggest lifetime followup for EVAR patients to avoid consequences associated with endoleak and aneurysm enlargement. Followup compliance has been reported between 43-92%, with most single-center studies citing successful followup surveillance at less than 60%. We investigated followup completeness with a defined surveillance program and subsequent secondary intervention prevalence from a single center. METHODS: Our surveillance program notified patients of the need for followup imaging and surgeon review...
May 10, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28501663/under-utilization-of-routine-ultrasound-surveillance-after-endovascular-aortic-aneurysm-repair
#11
Matthew W Mell, Trit Garg, Laurence C Baker
INTRODUCTION AND OBJECTIVES: Since 2009 the Society for Vascular Surgery has advocated annual surveillance imaging with ultrasound (US) after the first post-operative year for uncomplicated endovascular aneurysm repairs (EVAR). We sought to describe diffusion of US into long-term routine surveillance and to estimate potential cost savings among Medicare beneficiaries after EVAR. METHODS: Using Medicare claims data we identified patients receiving EVAR from 2002 to 2010 and included only those who did not subsequently have re-interventions, late aneurysm-related complications or death...
May 10, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28436300/ten-year-single-centre-experience-with-type-ii-endoleaks-intervention-versus-observation
#12
Ikram-Ul Haq, Arun Kelay, Meryl Davis, Jocelyn Brookes, Tara M Mastracci, Jason Constantinou
Our objective was to determine the relative merits of intervention or observation of type II endoleaks (T2Ls). A retrospective analysis was performed on 386 infra-renal endovascular aneurysm repair (IR-EVAR) patients from 2006 to 2015. Annual surveillance imaging of patients undergoing EVAR at our centre were analysed, and all endoleaks were subjected to a multidisciplinary team meeting for consideration and treatment. In the 10-year time frame, 386 patients (79.5±8.7 years) underwent an IR-EVAR. Eighty-one patients (21...
April 1, 2017: Vascular Medicine
https://www.readbyqxmd.com/read/28390913/could-preoperative-neck-anatomy-influence-follow-up-of-evar
#13
A Giménez-Gaibar, E González-Cañas, T Solanich-Valldaura, C Herranz-Pinilla, S Rioja-Artal, E Ferraz-Huguet
OBJECTIVE: Assess the clinical utility of strict CT-scan surveillance at 1, 6, 12 and 24 months after endovascular abdominal aneurysm repair (EVAR). Consider whether the anatomy of abdominal aortic aneurysm (AAA) neck (favourable/hostile) requires more imaging control. METHODS: Retrospective study 2006-2013. AAA patients who underwent EVAR with aortobiiliac endoprostheses. EXCLUSION CRITERIA: Other types of devices, hybrid techniques, open surgery...
April 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28216351/the-fate-of-endovascular-aortic-aneurysm-repair-after-5%C3%A2-years-monitored-with-duplex-ultrasound-imaging
#14
Danielle M Pineda, Zachary M Phillips, Keith D Calligaro, Emilia Krol, Matthew J Dougherty, Douglas A Troutman, Alan Dietzek
BACKGROUND: Interventions for aortic aneurysm sac growth have been reported across multiple time points after endovascular aortic aneurysm repair (EVAR). We report the long-term outcomes of patients after EVAR monitored with duplex ultrasound (DUS) imaging with respect to the need for and type of intervention after 5 years. METHODS: We report a series of patients who were monitored with DUS imaging for a minimum of 5 years after EVAR. DUS imaging was performed in an accredited noninvasive vascular laboratory, and computed tomography angiography was only performed for abnormal DUS findings...
February 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28073666/standard-endovascular-aneurysm-repair-in-patients-with-wide-infrarenal-aneurysm-necks-is-associated-with-increased-risk-of-adverse-events
#15
MULTICENTER STUDY
Nelson F G Oliveira, Frederico M Bastos Gonçalves, Marie Josee Van Rijn, Quirina de Ruiter, Sanne Hoeks, Jean-Paul P M de Vries, Joost A van Herwaarden, Hence J M Verhagen
OBJECTIVE: Endovascular aneurysm repair (EVAR) has progressively expanded to treat more challenging anatomies. Although EVAR in patients with wide infrarenal necks has been reported with acceptable results, there is still controversy regarding the longer-term outcomes. Our aim is to determine the impact of infrarenal neck diameter on midterm outcome following EVAR with a single endograft with suprarenal fixation. METHODS: A retrospective case-control study was designed using data from a prospective multicenter database...
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28051289/failure-modes-and-secondary-endovascular-interventions-after-endovascular-aortic-repair
#16
REVIEW
Timothy Resch
Endovascular repair has a firmly established role in the treatment of aortic disease. The development of endovascular devices to treat even complex aortic disease has broadened the panorama of repair significantly but has also introduced new forms of repair failure. Standard devices for EVAR and TEVAR have also been enhanced, providing better adaptation to the anatomy treated, smaller delivery systems, more intuitive delivery designs as well as improved features to facilitate precise delivery of the device...
April 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28031671/endovascular-management-of-type-i-endoleak-with-fenestrated-aortic-cuff-and-afterwards-treatment-of-endoleak-type-iii
#17
Stevo Duvnjak
Endovascular aortic repair (EVAR) has become preferable treatment of abdominal aortic aneurysms because of proven mortality reduction as well as complications reduction compared with open surgery. Endoleak remains a primary complication of EVAR, however, and occurs in 20 to 25% of the patients. EVAR patients thus undergo lifelong surveillance for the presence of aneurysm expansion and endoleaks usually via computed tomographic angiography. We describe the endovascular management of an enlarged aneurysmal sac size 3 years after EVAR due to combined endoleak of types 1 and 3...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28027890/iliac-seal-zone-dynamics-and-clinical-consequences-after-endovascular-aneurysm-repair
#18
F Bastos Gonçalves, N F Oliveira, M Josee van Rijn, K H J Ultee, S E Hoeks, S Ten Raa, R J Stolker, H J M Verhagen
OBJECTIVE: To evaluate the dynamics of the iliac attachment zone after EVAR, and the association with clinical events. METHODS: A tertiary institution's prospective EVAR database was searched to identify common iliac arteries at risk. Internally validated measurements were made, using centre lumen line reconstructions. Iliac dilatation and endograft limb retraction were the main endpoints. Associations between dilatation, retraction, oversizing, and distal seal length were investigated...
February 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28017805/management-of-immediate-post-endovascular-aortic-aneurysm-repair-type-ia-endoleaks-and-late-outcomes
#19
Ali F AbuRahma, Stephen M Hass, Zachary T AbuRahma, Michael Yacoub, Albeir Y Mousa, Shadi Abu-Halimah, L Scott Dean, Patrick A Stone
BACKGROUND: Post-endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzed management and late outcomes of these endoleaks. STUDY DESIGN: This was a retrospective review of prospectively collected data from EVAR patients during a 10-year period. All post-EVAR type Ia endoleaks on completion angiogram were identified (group A) and their early (30-day) and late outcomes were compared with outcomes of patients without endoleaks (group B)...
April 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28017583/three-dimensional-contrast-enhanced-ultrasound-improves-endoleak-detection-and-classification-after-endovascular-aneurysm-repair
#20
COMPARATIVE STUDY
Christopher Lowe, Abeera Abbas, Steven Rogers, Lee Smith, Jonathan Ghosh, Charles McCollum
BACKGROUND: Three-dimensional contrast-enhanced ultrasound (3D-CEUS) is a novel technology allowing surgeons to view duplex ultrasound images in three dimensions with ultrasound contrast highlighting blood flow in endoleaks after endovascular aneurysm repair (EVAR). It potentially reduces the need for computed tomography angiography (CTA) and catheter angiography. This study compares 3D-CEUS with both CTA and the final vascular multidisciplinary team (MDT) diagnosis using all available imaging...
May 2017: Journal of Vascular Surgery
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