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Evar surveillance

Hyun-Chel Joo, Seung-Hyun Lee, Byung-Chul Chang, Sak Lee, Kyung-Jong Yoo, Young-Nam Youn
BACKGROUND: With the increasing use of endovascular aortic repair, secondary interventions after aortic stent grafting remain a concern. We retrospectively reviewed open conversion cases with complications following endovascular abdominal aortic repair (EVAR). METHODS: EVAR due to infra-renal abdominal aortic aneurysm (AAA) was performed in 566 patients between January 1994 and May 2015. A retrospective review of EVAR requiring late open conversion (>1 month after implant) was conducted...
March 12, 2018: Journal of Cardiovascular Surgery
Charles S Briggs, Joshua A Sibille, Halim Yammine, Jocelyn K Ballast, William Anderson, Tzvi Nussbaum, Timothy S Roush, Frank R Arko
OBJECTIVE: Endovascular aneurysm repair (EVAR) has been shown to reduce mortality in the emergent repair of ruptured abdominal aortic aneurysms (AAAs). However, long-term survival data for this group of patients are lacking with contemporary endovascular endografts. The purpose of this study was to evaluate both 30-day mortality rates and 1-year survival in patients undergoing emergent EVAR in a 43-facility hospital system with a quaternary referral center with an established ruptured aneurysm protocol...
March 8, 2018: Journal of Vascular Surgery
Janet T Powell, Michael J Sweeting, Pinar Ulug, Matthew M Thompson, Robert J Hinchliffe
OBJECTIVE/BACKGROUND: The aim was to describe the re-interventions after endovascular and open repair of rupture, and investigate whether these were associated with aortic morphology. METHODS: In total, 502 patients from the IMPROVE randomised trial (ISRCTN48334791) with repair of rupture were followed-up for re-interventions for at least 3 years. Pre-operative aortic morphology was assessed in a core laboratory. Re-interventions were described by time (0-90 days, 3 months-3 years) as arterial or laparotomy related, respectively, and ranked for severity by surgeons and patients separately...
March 1, 2018: European Journal of Vascular and Endovascular Surgery
Julia Dangelmaier, Daniel Bar-Ness, Heiner Daerr, Daniela Muenzel, Salim Si-Mohamed, Sebastian Ehn, Alexander A Fingerle, Melanie A Kimm, Felix K Kopp, Loic Boussel, Ewald Roessl, Franz Pfeiffer, Ernst J Rummeny, Roland Proksa, Philippe Douek, Peter B Noël
OBJECTIVES: After endovascular aortic repair (EVAR), discrimination of endoleaks and intra-aneurysmatic calcifications within the aneurysm often requires multiphase computed tomography (CT). Spectral photon-counting CT (SPCCT) in combination with a two-contrast agent injection protocol may provide reliable detection of endoleaks with a single CT acquisition. METHODS: To evaluate the feasibility of SPCCT, the stent-lined compartment of an abdominal aortic aneurysm phantom was filled with a mixture of iodine and gadolinium mimicking enhanced blood...
February 19, 2018: European Radiology
Richard L Hallett, Brant W Ullery, Dominik Fleischmann
Abdominal aortic aneurysm (AAA) is a relatively common, potentially life-threatening disorder. Rupture of AAA is potentially catastrophic with high mortality. Intervention for AAA is indicated when the aneurysm reaches 5.0-5.5 cm or more, when symptomatic, or when increasing in size > 10 mm/year. AAA can be accurately assessed by cross-sectional imaging including computed tomography angiography and magnetic resonance angiography. Current options for intervention in AAA patients include open surgery and endovascular aneurysm repair (EVAR), with EVAR becoming more prevalent over time...
February 19, 2018: Abdominal Radiology
Georg Böning, Roman A Rotzinger, Johannes F Kahn, Patrick Freyhardt, Diane M Renz, Martin Maurer, Florian Streitparth
Background Endovascular aneurysm repair (EVAR) requires lifelong surveillance by computed tomography angiography (CTA). This is attended by a substantial accumulation of radiation exposure. Iterative reconstruction (IR) has been introduced to approach dose reduction. Purpose To evaluate adaptive statistical iterative reconstruction (ASIR) at different levels of tube voltage concerning image quality and dose reduction potential in follow-up post EVAR. Material and Methods One hundred CTAs in 67 patients with EVAR were examined using five protocols: protocol A (n = 40) as biphasic standard using filtered back projection (FBP) at 120 kV; protocols B (n = 40), C (n = 10), and D1 (n = 5) biphasic using ASIR at 120, 100, and 80 kV, respectively; and protocol D2 (n = 5) with a monophasic splitbolus ASIR protocol at 80 kV...
January 1, 2018: Acta Radiologica
Danielle M Pineda, Keith D Calligaro, Sam Tyagi, Douglas A Troutman, Matthew J Dougherty
OBJECTIVE: Type II endoleaks (T2ELs) are commonly observed after endovascular aneurysm repair (EVAR). We sought to determine whether time at onset of T2ELs correlated with the need to intervene based on sac expansion or rupture. METHODS: Between 1998 and 2015, 462 EVARs performed at our institution had duplex ultrasound surveillance in our accredited noninvasive vascular laboratory. Computed tomography and arteriography were reserved for abnormal duplex ultrasound findings...
February 2018: Journal of Vascular Surgery
Rajesh Patel, Janet T Powell, Michael J Sweeting, David M Epstein, Jessica K Barrett, Roger M Greenhalgh
BACKGROUND: Short-term survival benefits of endovascular aneurysm repair (EVAR) compared with open repair (OR) of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is soon lost. Survival benefit of EVAR was unclear at follow-up to 10 years. OBJECTIVE: To assess the long-term efficacy of EVAR against OR in patients deemed fit and suitable for both procedures (EVAR trial 1; EVAR-1); and against no intervention in patients unfit for OR (EVAR trial 2; EVAR-2)...
January 2018: Health Technology Assessment: HTA
Louise de la Motte, Mårten Falkenberg, Mark J Koelemay, Lars Lönn
AIM: Indications for re-interventions after endovascular aneurysm repair (EVAR), as well as their occurrence in number and time, are important to establish in order to optimize patient selection, post-procedure surveillance and also to guide improvements in endograft designs. The aim of this report was to present an overview of current data on re-interventions after elective EVAR. METHODS: Qualitative review of studies reporting on re-interventions after elective EVAR, identified by a systematic literature search in MEDLINE, EMBASE and the Cochrane Library for publications from 2010 to 13th of November 2017...
January 9, 2018: Journal of Cardiovascular Surgery
G Kalender, Milan Lisy, U A Stock, A Endisch, A Kornberger
Patients who undergo endovascular repair of aortic aneurysms (EVAR) require life-long surveillance because complications including, in particular, endoleaks, aneurysm rupture, and graft dislocation are diagnosed in a certain share of the patient population and may occur at any time after the original procedure. Radiation exposure in patients undergoing EVAR and post-EVAR surveillance has been investigated by previous authors. Arriving at realistic exposure data is essential because radiation doses resulting from CT were shown to be not irrelevant...
2017: International Journal of Vascular Medicine
Trong Binh Le, Keun-Myoung Park, Yong Sun Jeon, Kee Chun Hong, Soon Gu Cho
PURPOSE: To identify prevalence and evaluate outcomes of delayed endoleak (DEL) compared with early endoleak (EEL) after endovascular aortic aneurysm repair (EVAR). MATERIALS AND METHODS: Data of 164 patients who underwent elective EVAR at a single center were retrospectively analyzed. DEL was defined as any type of endoleak that was first detected ≥ 12 months after EVAR. Patients who had < 1 year of follow-up were excluded. Endoleak was classified into a more aggressive category if a patient had > 1 type of endoleak...
December 14, 2017: Journal of Vascular and Interventional Radiology: JVIR
Bruno Gossetti, Ombretta Martinelli, Michelangelo Ferri, Roberto Silingardi, Fabio Verzini
OBJECTIVE: Because of advances in technology and experience of the operator, endovascular aneurysm repair (EVAR) has supplanted open repair to treat abdominal aortic aneurysm (AAA). The low 30-day mortality and morbidity of EVAR make the endovascular approach particularly suitable for patients at high surgical risk. However, endoleak or endograft migration requiring secondary intervention or open surgical conversion is a limitation of EVAR. The Nellix system (Endologix, Inc, Irvine, Calif) has been designed to seal the entire AAA to overcome these limitations with EVAR...
December 11, 2017: Journal of Vascular Surgery
Nick Z P Ng, Tze Tec Chong
Introduction: While hypertension, pericardial, myocardial, and coronary artery disease are common cardiovascular manifestations of systemic lupus erythematosus (SLE), aortic aneurysms (AA) are rare but increasingly diagnosed, with the true incidence unknown. Case report: A 40 year old female suffering from SLE with a 5.3 cm saccular eccentric infrarenal abdominal aortic aneurysm (AAA) was treated successfully with endovascular aneurysm repair (EVAR) using the Medtronic Endurant II bifurcated stent graft and followed up 2 years post-operatively...
2017: EJVES Short Reports
John Nathan Gifford, Hsueh Wen Cheong, Wey Chyi Teoh
We report in the case of a patient with an intra-abdominal aortic aneurysm treated with endovascular aneurysm repair (EVAR) who developed renal impairment during the period of follow up. The repair was complicated with an early-onset type II endoleak which later evolved into a late-onset type I endoleak. It was treated with proximal extension of stent graft, with treatment success and follow-up documented on contrast enhanced ultrasound (CEUS). This case illustrates the usefulness of CEUS in post-EVAR surveillance and emphasizes the need for life-long monitoring as late-onset complications are not uncommon...
November 4, 2017: Journal of Clinical Ultrasound: JCU
Kenneth Tran, Brant W Ullery, Nathan Itoga, Jason T Lee
OBJECTIVE: 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). METHODS: 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...
October 23, 2017: Journal of Vascular Surgery
Benjamin S Brooke, Adam W Beck, Larry W Kraiss, Andrew W Hoel, Andrea M Austin, Amir A Ghaffarian, Jack L Cronenwett, Philip P Goodney
Importance: Ensuring that patients undergo surveillance imaging after surgery is a key quality metric after many vascular procedures. It is unclear whether hospital participation in a national quality improvement registry such as the Vascular Quality Initiative (VQI) achieves this goal. Objective: To determine if hospital participation in the VQI registry is associated with increased rates of surveillance imaging after vascular procedures. Design, Setting, and Participants: A quasi-experimental study used Medicare claims to study 2174 US hospitals in which 1 530 102 patients had undergone an endovascular abdominal aortic aneurysm repair (EVAR), 1 403 067 patients had undergone a lower extremity bypass (LEB) or peripheral vascular intervention (PVI), and 294 942 patients had undergone carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedures between January 1, 2007, and December 31, 2012...
October 11, 2017: JAMA Surgery
Mahim I Qureshi, Alun H Davies
Endovascular aneurysm repair (EVAR) has become the intervention of choice for supra-threshold aortic aneurysms due to the lower 30-day mortality of EVAR as compared with open surgery, despite no long-term longevity gains. Trials such as EVAR-1 that established the current status of endovascular aortic intervention often excluded participants over the age of 80, and specific studies of EVAR in the elderly reveal higher mortality than accepted averages. Analyses of the cost-effectiveness of EVAR have not demonstrated superiority of endovascular intervention over open repair, in particular when considering complications such as endoleak...
January 1, 2017: Vascular
Eleanor Atkins, Ranjeet Narlawar, Francesco Torella, George A Antoniou
BACKGROUND: Our objective was to quantify variability across the UK in the management of a complex abdominal aortic aneurysm (AAA). METHODS: An online survey was emailed to all members of the Vascular Society for Great Britain and Ireland. The survey presented a vignette of a 63-year-old woman with significant respiratory co-morbidity whose computed tomographic (CT) angiogram demonstrated a 54 mm AAA with a short (7 mm) proximal neck but no other adverse morphological features for a standard or complex endovascular aneurysm repair (EVAR)...
September 11, 2017: International Angiology: a Journal of the International Union of Angiology
M Dickfos, K Garnham, J Jenkins
Endovascular aneurysm repair (EVAR) is a widely accepted and used technique for the treatment of abdominal aortic aneurysms (AAA). However, it comes with a unique set of complications, two of the rarer being infection and aorto-enteric fistula formation. Due to the infrequency of the situation, there are currently no guidelines for their management. A 75-year-old male presented with vague abdominal pain and fevers. He was diagnosed with an infected abdominal aortic EVAR stent graft on computer tomography imaging...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
Y Han, S Zhang, J Zhang, C Ji, H-H Eckstein
OBJECTIVES: This meta-analysis and systematic review aimed to highlight the results of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) to assess safety and effectiveness in patients older than 80 years of age compared with younger patients. METHODS: PRISMA guidelines were used; quality was appraised, and data were extracted and analysed following the Cochrane collaboration. The MEDLINE and Embase databases were searched on December 31, 2016...
October 2017: European Journal of Vascular and Endovascular Surgery
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