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Evar surveillance

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
Karolina Stefaniak, Michal Stanisic, Marcin Gabriel, Grzegorz Oszkinis
Endovascular implantation of a stent graft in the abdominal aorta (endovascular aneurysm repair - EVAR) is a widely accepted alternative to open surgery in treatment of abdominal aortic aneurysms. Although EVAR is connected with a significant reduction in the risk of peri- and post-operative complications, it does not eliminate them totally. Long-term surveillance of post-EVAR patients is aimed at early detection of and fast reaction to a group of complications called endovascular leaks. Currently, the gold standard in leak diagnostics is computed tomography angiography (CTA)...
2016: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Christopher J Hammond, Asim H Shah, Andrew Snoddon, Jai V Patel, D Julian A Scott
INTRODUCTION: Post-EVAR surveillance has a major impact upon patients, carers and healthcare resources. We hypothesised that elective indication, on-IFU anatomy, use of a modern device or normal first CTA, or a combination of these categories, might predict a rate of secondary intervention low enough to alter current surveillance protocols. METHODS: Patients undergoing EVAR in our institution between 01.05.2007 and 28.02.2013 were assessed. Data on indication (elective, emergency), anatomy relative to IFU, device, first month CTA result, secondary intervention and mortality were obtained...
June 2016: Cardiovascular and Interventional Radiology
Ruby C Lo, Dominique B Buck, Jeremy Herrmann, Allen D Hamdan, Mark Wyers, Virendra I Patel, Mark Fillinger, Marc L Schermerhorn
OBJECTIVE: Type II endoleaks are common after endovascular aneurysm repair (EVAR), but their clinical significance remains undefined and their management controversial. We determined risk factors for type II endoleaks and associations with adverse outcomes. METHODS: We identified all EVAR patients in the Vascular Study Group of New England abdominal aortic aneurysm database. Patients were subdivided into two groups: (1) those with no endoleak or transient type II endoleak and (2) persistent type II endoleak or new type II endoleak (no endoleak at completion of case)...
April 2016: Journal of Vascular Surgery
Ali F AbuRahma, Michael Yacoub, Stephen M Hass, Joseph AbuRahma, Albeir Y Mousa, L Scott Dean, Ravi Viradia, Patrick A Stone
OBJECTIVE: Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes. METHODS: Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months...
March 2016: Journal of Vascular Surgery
Johanna Laturnus, Nelson Oliveira, Frederico Basto Gonçalves, Geert W Schurink, Hence Verhagen, Michael J Jacobs, Barend M E Mees
Endovascular aneurysm repair (EVAR) has become the primary treatment option for elective abdominal aortic aneurysms. However, a significant number of patients require secondary interventions to maintain adequate aneurysm exclusion and ultimately prevent death from abdominal aortic aneurysm (AAA) rupture. To maintain success and offer timely secondary intervention, intensive image surveillance has been recommended. These rigorous surveillance regimens are costly and may have deleterious effects from radiation and contrast exposure...
April 2016: Journal of Cardiovascular Surgery
Mudassar Kamran, Kathryn J Fowler, Vincent M Mellnick, Gregorio A Sicard, Vamsi R Narra
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...
June 2016: Cardiovascular and Interventional Radiology
Sasan Partovi, Mathias Kaspar, Markus Aschwanden, Charles Lopresti, Shivanshu Madan, Heiko Uthoff, Stephan Imfeld, Daniel Staub
An increasing number of patients with abdominal aortic aneurysms (AAAs) are undergoing endovascular aortic repair (EVAR) instead of open surgery. These patients require lifelong surveillance, and the follow-up imaging modality of choice has been traditionally computed tomography angiography (CTA). Repetitive CTA imaging is associated with cumulative radiation exposure and requires the administration of multiple doses of nephrotoxic contrast agents. Contrast-enhanced ultrasound (CEUS) has emerged as an alternative strategy in the follow-up of patients with EVAR and demonstrates high sensitivity and specificity for detection of endoleaks...
December 2015: Cardiovascular Diagnosis and Therapy
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