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Evar surveillance

Florent Lalys, Vincent Durrmann, Aurélien Duménil, Cemil Göksu, Alain Cardon, Elodie Clochard, Antoine Lucas, Adrien Kaladji
PURPOSE: Type II endoleaks (T2Es) remain the Achilles heel of Endovascular Aneurysm Repair (EVAR), involving a close follow-up and sometimes leading to reintervention. Identifying risk factors impacting T2Es is of concern to improve decision-making and optimize follow-up. However, it has led to contradictory results, with supporting evidence for the majority of factors being weak. METHODS: A systematic review and meta-analysis was conducted to study risk factors of T2Es following EVAR to identify risk factors and measure their dedicated strength of association...
November 26, 2016: Annals of Vascular Surgery
H Roos, C Sandström, G Koutouzi, A Jeppsson, M Falkenberg
BACKGROUND: Endoleaks of type Ib and III are relatively common causes of re-intervention after EVAR. The aim was to determine underlying causes and identify anatomical factors associated with these re-interventions. METHODS: A total of 444 patients with standard bifurcated stent grafts were included in a retrospective observational study. Patients requiring additional iliac stent grafts (n = 24) were compared to those who did not (n = 420). Pre- and post-operative CT examinations were reviewed in patients with additional iliac stents...
November 21, 2016: European Journal of Vascular and Endovascular Surgery
Konstantinos Spanos, Christos Karathanos, Athanasios Athanasoulas, Vasileios Sapeltsis, Athanasios D Giannoukas
BACKGROUND: Lifelong surveillance after Endovascular Aortic Aneurysm repair (EVAR) is recommended to monitor the effectiveness and durability of the treatment. The aim of this study was to assess patients' compliance with the follow-up imaging protocol, the presence of any factors associated with compliance and the potential influence of imaging-protocol adherence on outcomes. EVIDENCE ACQUISITION: MEDLINE, CENTRAL, and Cochrane databases and keys references were searched...
November 23, 2016: Journal of Cardiovascular Surgery
Anna E Boniakowski, Randall R De Martino, Dawn M Coleman, Jonathan L Eliason, Phillip P Goodney, John E Rectenwald
OBJECTIVE: The natural history of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) remains elusive; as such, treatment guidelines are ill defined. The purpose of this study was to better delineate the natural history of T2EL after EVAR for rAAA in an effort to determine the need for reintervention and optimal surveillance. METHODS: A retrospective record review was conducted of all patients undergoing EVAR for rAAA in two large tertiary care academic vascular centers...
December 2016: Journal of Vascular Surgery
Mohamed S Kuziez, Luis A Sanchez, Mohamed A Zayed
Type II endoleaks occur commonly following endovascular aneurysm repair (EVAR). Although they remain enigmatic, multiples studies have evaluated preoperative risk factors and strategies for prevention of type II endoleaks. Prophylactic treatment of type II endoleaks can include embolization of accessory arteries, as well as complete aneurysmal sac occlusion. Regular post-operative surveillance and screening for type II endoleaks with triple-phase CTA is the standard of care. Aneurysm size and growth rate are factors that predict whether a persistence type II endoleak is hemodynamically significant, and whether it requires treatment with percutaneous trans-lumbar or trans-arterial embolization techniques...
September 2016: Journal of Cardiovascular Diseases & Diagnosis
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
K K Bredahl, M Taudorf, L Lönn, K C Vogt, H Sillesen, J P Eiberg
OBJECTIVE/BACKGROUND: Surveillance after endovascular aortic aneurysm repair (EVAR) is mandatory and computed tomography angiography (CTA) is considered the standard imaging modality, although patients are exposed to ionizing radiation and nephrotoxic contrast medium. The primary aim of this study was to determine the diagnostic efficacy of duplex ultrasound (DUS) and contrast enhanced ultrasound (CEUS) using CTA as the gold standard. The secondary aim was to determine the clinical consequences of endoleaks missed by DUS and CEUS, or CTA...
December 2016: European Journal of Vascular and Endovascular Surgery
Rajesh Patel, Michael J Sweeting, Janet T Powell, Roger M Greenhalgh
BACKGROUND: Short-term survival benefits of endovascular aneurysm repair (EVAR) versus open repair of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is lost after a few years. We investigated whether EVAR had a long-term survival benefit compared with open repair. METHODS: We used data from the EVAR randomised controlled trial (EVAR trial 1), which enrolled 1252 patients from 37 centres in the UK between Sept 1, 1999, and Aug 31, 2004...
October 12, 2016: Lancet
Sotirios Giannakakis, George Galyfos, Georgios Geropapas, Stavros Kerasidis, Gerasimos Papacharalampous, Georgios Kastrisios, Chrisostomos Maltezos
A 75-year-old patient with severe comorbidities was treated with an Endurant(®) (Medtronic, USA) II endograft due to a ruptured abdominal aortic aneurysm (AAA). After four years of unremarkable follow-up, bilateral limb separation was detected. The patient underwent endovascular bridging without any complication. Although rarely detected in newer grafts, late bilateral type IIIa endoleaks can present and should be promptly repaired. Complex or ruptured AAAs treated with off-label use of endografts should be under closer surveillance using imaging tools for potential endoleaks or aneurysm sac growth...
September 2016: Vascular Specialist International
Qiang Guo, Jichun Zhao, Bin Huang, Ding Yuan, Yi Yang, Guojun Zeng, Fei Xiong, Xiaojiong Du
PURPOSE: To analyze the literature comparing ultrasound [duplex (DUS) or contrast-enhanced (CEUS)] or magnetic resonance imaging (MRI) with computed tomography angiography (CTA) for endoleak detection and aneurysm diameter measurement after endovascular aneurysm repair (EVAR). METHODS: A systematic review identified 31 studies that included 3853 EVAR patients who had paired scans (DUS or CEUS vs CTA or MRI vs CTA) within a 1-month interval for identification of endoleaks during EVAR surveillance...
August 19, 2016: Journal of Endovascular Therapy
G Peach, J Romaine, P J E Holt, M M Thompson, C Bradley, R J Hinchliffe
BACKGROUND: The aim of this study was to present preliminary data on quality of life (QoL), symptoms and treatment satisfaction gathered using three new abdominal aortic aneurysm (AAA)-specific patient-reported outcome measures (PROMs). METHODS: Patients with AAA were recruited from five National Health Service Trusts to complete the three new PROMs: the AneurysmDQoL, AneurysmSRQ and AneurysmTSQ. Patients were either under surveillance or had undergone AAA repair (open or endovascular) during the preceding 24 months...
July 2016: British Journal of Surgery
Mark Scaife, Triantafillos Giannakopoulos, Georges E Al-Khoury, Rabih A Chaer, Efthymios D Avgerinos
Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging...
2016: Frontiers in Surgery
Thomas Nyheim, Lars E Staxrud, Jørgen J Jørgensen, Kristin Jensen, Hilde M Olerud, Gunnar Sandbæk
BACKGROUND: Endovascular aneurysm repair (EVAR) is becoming the mainstay treatment of abdominal aortic aneurisms (AAA). The postoperative follow-up regime includes a lifelong series of CT angiograms (CTAs) at different intervals in addition to EVAR, which will confer significant cumulative radiation exposure over time. PURPOSE: To examine the impact of age and follow-up regime over time on cumulative radiation exposure and attributable cancer risk after EVAR. MATERIAL AND METHODS: We calculated a mean effective dose (ED) for the EVAR procedure, CTA, and plain abdominal X-rays (PAX)...
June 8, 2016: Acta Radiologica
Naseem Helo, Arthur C Chang, Christine Hyun, Kenneth S Chon, Alex C Yi
Endoleaks remain a main concern in endovascular aneurysm repair. A potential false positive in the diagnosis of endoleak surveillance includes "billowing," a phenomenon of the polytetrafluoroethylene plastic outer fabric of the stent graft is seen separated from the struts of the metallic endoskeleton. Contrast presents beyond the endoskeleton but is still contained within the graft. This is secondary to intermittent attachment of the graft to the endoskeleton, and is only found in the Endologix Powerlink. The finding of billowing has been previously reported and is a common knowledge by those who deploy the stent graft...
August 2016: Annals of Vascular Surgery
Gary W Lemmon, Rahgu L Motaganahalli, Tiffany Chang, James Slaven, Ben Aumiller, Bradford J Kim, Michael C Dalsing
OBJECTIVE: Type III (T-III) endoleaks following endovascular aneurysm repair (EVAR) remain a major concern. Our center experienced a recent concentration of T-III endoleaks requiring elective and emergency treatment and prompted our review of all EVAR implants over a 40-month period from April 2011 until August 2014. This report represents a single center experience with T-III endoleak management with analysis of factors leading to the T-III-related failure of EVAR. METHODS: A retrospective review of all the operative reports, medical records, and computed tomography scans were reviewed from practice surveillance...
September 2016: Journal of Vascular Surgery
Kaley Pippin, Jacqueline Hill, Jianghua He, Philip Johnson
PURPOSE: This study aims to determine incidence and outcomes of type II endoleaks (T2E) after endovascular abdominal aortic aneurysm repair (EVAR). METHODS: A retrospective review of procedural angiograms, computed tomography angiography, and medical records of 202 patients who underwent EVAR with the Gore Excluder stent graft was performed to determine presence and outcomes of T2E. RESULTS: Median follow-up time for 163 patients meeting inclusion criteria [136 males (83%)] was 24...
September 2016: Clinical Imaging
Christos V Ioannou, Nikolaos Kontopodis, Ioannis Peteinarakis, Dimitrios Tsetis
PURPOSE: To establish the feasibility of indirectly estimating aneurysm sac pressurization from recordings of aortic pulsatile wall motion (PWM) using M-mode ultrasonography before and after endovascular aneurysm repair (EVAR). METHODS: Twenty consecutive patients (mean age 72 years; 19 men) scheduled for EVAR in a single institution underwent M-mode ultrasonography 1 day before EVAR to record PWM of the abdominal aortic aneurysm wall during the cardiac cycle, along with simultaneous blood pressure measurements...
August 2016: Journal of Endovascular Therapy
Jong-Beom Shin, Mi-Hwa Park, Sang-Ho Jeong, Sung Woo Kwon, Sung-Hee Shin, Seong-Ill Woo, Sang-Don Park
Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years...
March 2016: Vascular Specialist International
Islah Ud Din, Usman Shaikh, Robert K Fisher, Richard G McWilliams
PURPOSE: To report a complication of renal stent crushing during open aneurysmorrhaphy performed 10 years after fenestrated endovascular aneurysm repair (FEVAR). CASE REPORT: A 67-year-old male patient underwent elective FEVAR of a juxtarenal aortic aneurysm. Uncovered balloon-expandable stents were placed through the fenestrations for the superior mesenteric and right renal arteries; the left renal artery received a Jostent covered balloon-expandable stent. The uncovered right renal stent was noted to be crushed on the first imaging after FEVAR, but was left untreated; the right kidney was thereafter significantly smaller than the left...
June 2016: Journal of Endovascular Therapy
Yannick W 't Mannetje, Pieter P H L Broos, Roy F A van Poppel, Marc R H M van Sambeek, Joep A W Teijink, Philippe W M Cuypers
OBJECTIVE: Lifelong yearly surveillance is advised after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. This follow-up requires a substantial amount of health care resources. The aim of this paper was to assess the occurrence of stent graft-related complications and secondary interventions during a minimum 10-year follow-up after elective EVAR. METHODS: Patients who were treated in a high-volume endovascular center in The Netherlands with the Talent infrarenal stent graft (Medtronic Vascular, Santa Rosa, Calif) between June 1999 and February 2005 were included...
September 2016: Journal of Vascular Surgery
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