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https://www.readbyqxmd.com/read/29105814/late-onset-type-i-endoleak-characterized-by-contrast-enhanced-ultrasound-after-endovascular-repair-of-aortic-aneurysm
#1
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
https://www.readbyqxmd.com/read/29074111/polar-orientation-of-renal-grafts-within-the-proximal-seal-zone-affects-risk-of-early-type-ia-endoleaks-after-chimney-endovascular-aneurysm-repair
#2
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
https://www.readbyqxmd.com/read/29049809/association-of-quality-improvement-registry-participation-with-appropriate-follow-up-after-vascular-procedures
#3
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
https://www.readbyqxmd.com/read/28994633/endovascular-aneurysm-repair-in-the-elderly-first-do-no-harm
#4
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
https://www.readbyqxmd.com/read/28895367/is-management-of-complex-abdominal-aortic-aneurysms-consistent-across-the-uk-a-questionnaire-based-survey
#5
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
https://www.readbyqxmd.com/read/28876594/salmonella-typhimurium-infected-abdominal-aortic-aneurysm-endovascular-repair-with-secondary-aortoenteric-fistula-formation
#6
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
https://www.readbyqxmd.com/read/28822680/outcomes-of-endovascular-abdominal-aortic-aneurysm-repair-in%C3%A2-octogenarians-meta-analysis-and-systematic-review
#7
REVIEW
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
https://www.readbyqxmd.com/read/28782417/improving-patient-compliance-with-post-evar-surveillance-may-prevent-late-rupture
#8
REVIEW
Alicia L Skervin, Chung S Lim, Kaji Sritharan
Endovascular aneurysm repair (EVAR) has gained increasing popularity in the treatment of infrarenal abdominal aortic aneurysm. Despite its favorable early outcomes, the long-term efficacy of EVAR remains a concern. Late rupture is the ultimate treatment failure and continues to complicate EVAR. Univariate and multivariate analyses have identified factors predictive of late rupture. The importance of EVAR surveillance to prevent late complications is equally widely acknowledged. This article aims to present our current understanding of the precipitating factors of late rupture after EVAR and explores whether the key to its prevention lies within improving patient factors, particularly compliance to follow-up appointments or whether physicians hold the solution...
October 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28765015/the-impact-of-compliance-with-imaging-follow-up-on-mortality-after-endovascular-abdominal-aortic-aneurysm-repair-a-population-based-cohort-study
#9
C de Mestral, R Croxford, N Eisenberg, G Roche-Nagle
OBJECTIVE: Compliance with regular imaging follow-up after endovascular aortic aneurysm repair (EVAR) is inconsistent, and evidence of benefit from scheduled long-term surveillance is limited. This study sought to characterize the association between post-EVAR imaging frequency and long-term survival. METHODS: Using administrative health databases for the province of Ontario, Canada, a cohort of patients was identified who underwent EVAR between 2004 and 2014. Minimum appropriate imaging follow-up (MAIFU) was defined as a CT scan or ultrasound of the abdomen within 90 days of EVAR as well as every 15 months thereafter...
July 29, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28685522/next-generation-post-evar-follow-up-regime
#10
REVIEW
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...
December 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28662928/surveillance-after-endovascular-aortic-repair
#11
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
#12
REVIEW
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...
August 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28598495/ultrasonography-for-endoleak-detection-after-endoluminal-abdominal-aortic-aneurysm-repair
#13
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
#14
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
#15
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
#16
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%)...
August 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28549961/preliminary-results-of-aorfix%C3%A2-stent-graft-to-treat-infrarenal-abdominal-aortic-aneurysms-with-severe-proximal-aortic-neck-angulation
#17
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 aortic aneurysm (iAAA) with severe proximal aortic neck angulation (NA) using the Aorfix™ stent graft. METHODS: Data of consecutive patients with iAAA with severe proximal NA submitted to endovascular repair between September 2012 and December 2014 in 2 Italian centers of Vascular and Endovascular Surgery were retrospectively reviewed, and outcomes were analyzed using the software JMP 5...
May 24, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28535732/duplex-ultrasound-surveillance-after-uncomplicated-endovascular-abdominal-aortic-aneurysm-repair
#18
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...
July 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28501665/a-dedicated-surveillance-program-improves-compliance-with-endovascular-aortic-aneurysm-repair-follow-up
#19
Jade Cohen, Akila Pai, Timothy M Sullivan, Peter Alden, Jason Q Alexander, Andrew Cragg, Jesse M Manunga, Elliot J Stephenson, Nedaa Skeik, Jessica M Titus
BACKGROUND: Current recommendations suggest lifetime follow-up for endovascular aortic aneurysm repair (EVAR) patients to avoid consequences associated with endoleak and aneurysm enlargement. Follow-up compliance has been reported between 43% and 92%, with most single-center studies citing successful follow-up surveillance at less than 60%. We investigated follow-up 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 follow-up imaging and surgeon review...
October 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28501663/underutilization-of-routine-ultrasound-surveillance-after-endovascular-aortic-aneurysm-repair
#20
Matthew W Mell, Trit Garg, Laurence C Baker
BACKGROUND: Since 2009, the Society for Vascular Surgery has advocated annual surveillance imaging with ultrasound (US) after the first postoperative year for uncomplicated endovascular aneurysm repairs (EVARs). 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 reinterventions, late aneurysm-related complications, or death...
October 2017: Annals of Vascular Surgery
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