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Stefano Bonardelli, Franco Nodari, Maurizio De Lucia, Emanuele Botteri, Alice Benenati, Edoardo Cervi
Aim: Conversion to open repair becomes the last option in case of endovascular repair of abdominal aneurysm failure, when radiological interventional procedures are unfeasible. While early conversion to open repair generally derives from technical errors, aetiopathogenesis and results of late conversion to open repair often remain unclear. Methods: We report data from our Institute's experience on late conversion to open repair. Twenty-two late conversion to open repairs out of 435 consecutive patients treated during a 18 years period, plus two endovascular repair of abdominal aneurysms performed in other centres, are analysed...
January 2018: JRSM Cardiovascular Disease
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...
February 2018: Journal of Vascular and Interventional Radiology: JVIR
Alexander S Fairman, Grace J Wang, Benjamin M Jackson, Paul J Foley, Scott M Damrauer, Venkat Kalapatapu, Michael A Golden, Ronald M Fairman
OBJECTIVE: Published rates of reintervention after endovascular aneurysm repair (EVAR) range from 10% to 30%. We evaluated a single university center's experience with reinterventions in the context of Food and Drug Administration (FDA)-approved and trial devices. METHODS: Retrospective data collection was performed for patients who underwent infrarenal EVAR and required reintervention from 2000 to 2016. Trial devices included those used in FDA feasibility and pivotal trials...
April 2018: Journal of Vascular Surgery
Tommaso Cambiaghi, Domenico Baccellieri, Daniele Mascia, Germano Melissano, Roberto Chiesa, Andrea Kahlberg
BACKGROUND: Endotension can present a real challenge for the long-term success of endovascular aortic repair (EVAR). Sometimes, it can be associated with liver dysfunction and consequent plasmatic alterations as in the 2 cases reported here. METHODS: Significant and progressive abdominal aortic aneurysms (AAA) sac enlargement, without radiologic signs of endoleak, was observed in 2 patients during a 3-year follow-up after EVAR. The first was a 70-year-old man affected by viral liver cirrhosis and the second was a 71-year-old man with cirrhosis due to alcoholic liver disease...
July 6, 2017: Annals of Vascular Surgery
Davy R Sudiono, Rigo Hoencamp, Jaap Ottevanger, Daniel Eefting, Edwin van der Linden
Endovascular aneurysm repair (EVAR) is first-choice treatment for many patients with abdominal aortic aneurysms. Complications unique to endovascular treatment include endoleak and endotension, which can eventually lead to rupture. We present two cases of late aortic rupture after EVAR, where both patients had recent preceding catheter-directed thrombolysis with urokinase for acute limb ischemia. These cases suggest a relation between thrombolytic therapy and aortic rupture after EVAR, and we should therefore be aware of this possible complication...
October 2017: Cardiovascular and Interventional Radiology
Paolo Perini, Alessandro de Troia, Tiziano Tecchio, Matteo Azzarone, Claudio Bianchini Massoni, Pierfranco Salcuni, Antonio Freyrie
OBJECTIVE: The aim of this study was to report the technical aspects and outcomes of late open conversion (LOC) after endovascular aneurysm repair (EVAR) in a single center by using exclusively infrarenal clamping of the endograft as an alternative to suprarenal or supraceliac aortic clamping. METHODS: A retrospective analysis of EVAR requiring late explantation (>30 days) from January 1996 to October 2016 was performed. Patients' demographics, type of endograft, duration of implantation, reason for removal, extent of stent graft removal, type of reconstruction, 30-day mortality, postoperative complications, and long-term survival were obtained for analysis...
October 2017: Journal of Vascular Surgery
Konstantinos P Donas, Elena Marchiori, Mirjam Inchingolo, Giovanni Torsello
Endoleaks and persistent aneurysm sac expansion, also known as endotension, remain the Achilles heel of endovascular aneurysm repair (EVAR). The present article reports on a surgical treatment of 1 patient with endotension after chimney EVAR for a symptomatic juxtarenal aortic aneurysm. The surgical exploration revealed no signs of inflammation or infection and excluded any endoleak, confirming the term "endotension". After 1 year, the absence of sac expansion or endoleak was confirmed, with stable maximum diameter...
May 2017: Annals of Vascular Surgery
Yosuke Takahashi, Yasuyuki Sasaki, Yasuyuki Bito, Manabu Motoki, Takashi Murakami, Toshihiko Shibata
We herein report two cases of perigraft effusion mimicking graft infection after debranching thoracic endovascular repair for an anastomotic pseudoaneurysm of the distal ascending aorta. Both patients presented with a bulging tumor on the sternum. Enhanced computed tomography showed no endoleak, but extension of periprosthetic graft fluid to a subcutaneous sternal wound was present. We suspected a deep sternal wound infection; however, cultures of débrided tissues were negative. After drainage of the subcutaneous fluid or negative pressure wound therapy, both patients were doing well without recurrence of effusion...
April 2017: Journal of Vascular Surgery
Siem A Dingemans, Frederik H W Jonker, Frans L Moll, Joost A van Herwaarden
The aim of this study is to give an overview of current knowledge regarding abdominal aortic aneurysm (AAA) growth after endovascular aortic aneurysm repair (EVAR) that could potentially lead to aortic rupture. A search on Pubmed was performed. A total of 705 articles were found after initial search, of which 49 were included in the final selection. Reports on the incidence of aneurysm enlargement after EVAR vary between 0.2% and 41%. Continuous growth could lead to rupture of the aneurysm sac. There are several supposed risk factors for growth after EVAR...
February 2016: Annals of Vascular Surgery
Pierre Maitrias, Adrien Kaladji, Didier Plissonnier, Sébastien Amiot, Jean Sabatier, Marc Coggia, Jean-Luc Magne, Thierry Reix
BACKGROUND: Persistent type II endoleaks (T2Ls) with sac enlargement after endovascular abdominal aortic aneurysm repair are still of concern in view of the potential for rupture. Current treatments (embolization and stent graft [SG] explantation) are associated with lack of efficacy or high perioperative morbidity and mortality. This study evaluated an alternative technique that combines sacotomy, ligation of patent back-bleeding vessels, and SG preservation for T2L or unspecified endoleak repair...
April 2016: Journal of Vascular Surgery
Stuart Blackwood, Doran Mix, Ankur Chandra, Alan M Dietzek
OBJECTIVE: Unexplained aneurysm growth despite multimodality imaging after endovascular aneurysm repair is often attributed to endotension. We tested a hypothesis that endotension may be from a type Ia endoleak pressurizing the aneurysm sac, without net forward flow, not visualized on standard angiographic imaging. METHODS: A patient-specific aortic aneurysm phantom was constructed of polyvinyl alcohol using three-dimensional molding techniques. A bifurcated stent graft was implanted, and the phantom was connected to a hemodynamic simulator for testing...
September 2016: Journal of Vascular Surgery
Konstantinos P Donas, Giovanni Torsello, Kristin Weiss, Theodosios Bisdas, Markus Eisenack, Martin Austermann
OBJECTIVE: The aim of this study was to prospectively evaluate the early and late 7-year experience with the Endurant bifurcated stent graft system (Medtronic, Santa Rosa, Calif) in patients with abdominal aortic aneurysms. METHODS: Between November 14, 2007, and December 2013, 712 consecutive high-risk patients with abdominal aortic aneurysms underwent elective or urgent placement of an Endurant bifurcated endograft in our institution. The included patients were consecutive (all comers) and treated independently from their morphologic eligibility for use of the Endurant device based on the instructions for use...
October 2015: Journal of Vascular Surgery
M Björck
No abstract text is available yet for this article.
April 2015: European Journal of Vascular and Endovascular Surgery
Amedeo Anselmi, Vito Giovanni Ruggieri, Majid Harmouche, Olivier Fouquet, Adrien Kaladji, Erwan Flécher, Xavier Beneux, Antoine Lucas, Jean-Philippe Verhoye
BACKGROUND: We describe a 1-step treatment of extensive arch and descending aortic aneurysm by combination of frozen elephant trunk (FET) (hybrid endoprosthesis) and of conventional endoprosthesis deployment. METHODS: In a single-center, prospective, treatment-only study, the clinical data of 4 patients receiving combined FET and distal endoprosthesis deployment in the descending aorta were prospectively collected. Thoracic endoprostheses were deployed either retrogradely (off-pump from the femoral arterial access) or antegradely (from the aortic arch during hypothermic arrest)...
July 2015: Annals of Vascular Surgery
Akihiro Yoshitake, Takashi Hachiya, Takahito Itoh, Hiroto Kitahara, Mio Kasai, Shinji Kawaguchi, Hideyuki Shimizu
Here, we describe a case of nonvisualized type III endoleak masquerading as endotension that was diagnosed by opening the aneurysm sac during surgery and successfully treated surgically. A 79-year-old man underwent endovascular aneurysm repair (EVAR) 4 years previously for an aneurysm that had enlarged gradually without endoleak. An open surgical operation was performed. The sac pressure was 132 mm Hg-similar to the preoperative systolic blood pressure-and nonpulsatile. After the aneurysm sac was opened without clamping the aorta, a type III endoleak from the suture point of the prosthetic endograft was detected...
April 2015: Annals of Vascular Surgery
Gen-huan Yang, Bao Liu, Rong Zeng, Leng Ni, Chang-wei Liu
When more abdominal aortic aneurysms are repaired by endovascular approaches, the post-operative endotension without endoleak increase along with the extended follow-up. An early detection of such endotension and a proper differentiation from endoleaks are particularly important for the treatment decision-making. This article reviews the mechanism, diagnosis, and management of endotension.
October 2014: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Spiridon Botsios, Yvonne Bausback, Michael Piorkowski, Martin Werner, Daniela Branzan, Dierk Scheinert, Andrej Schmidt
OBJECTIVES: Endovascular treatment of the infrarenal abdominal aorta (endovascular repair, EVAR) has emerged as an alternative to open surgery. However, a small subset of patients exists who undergo conversion either in the first 30 postoperative days or later during the course of postoperative surveillance. In the present study, we review our experience with late conversion operations. METHODS: Between December 2004 and August 2012, 411 EVARs were performed. During the same time interval, nine patients (males) with a mean age of 71 years (range, 59-79 years) required late open conversion...
October 2014: Interactive Cardiovascular and Thoracic Surgery
Moon Il Lee, Woo Young Shin, Yun Mee Choe, Jae Young Park, Jang Yong Kim, Yong Sun Jeon, Soon Gu Cho, Kee Chun Hong
Endotension is an unpredictable late complication of endovascular aortic aneurysm repair (EVAR). This case report will discuss the successful treatment of enlarged aneurysmal sac due to endotension using the relining technique. An 81-year-old male complained of nondecreasing huge aneurysm sac. He had undergone EVAR for infrarenal abdominal aortic aneurysm 7 years prior and no endoleak was found through follow-up. Initially computed tomography-guided sac aspiration was tried, but in vain, Relining using the double barrel technique and tubular endograft for modular diconnection, which was unexpectedly found in the original endograft, were performed sucessfully...
March 2014: Annals of Surgical Treatment and Research
Kimihiko Kichikawa, Shinichi Iwakoshi, Hirofumi Ito, Shigeo Ichihashi
Endoleak is a common complication after thoracic endovascular aortic repair (TEVAR) or endovascular aortic repair (EVAR), occurring in up to 30% of cases, and therefore lifelong imaging surveillance is important. Endoleak is defined as the persistence of blood flow outside the lumen of the stent graft, but within the aneurysm, which can be classified into five categories. Typical features of the different types of endoleak are discussed as well as the imaging modalities to detect and classify an endoleak and the endovascular treatment options...
March 2014: Nihon Geka Gakkai Zasshi
G García, A Tapia, M De Blas
An abdominal aortic aneurysm (AAA) is a localized abnormal enlargement of the abdominal aorta with fatal consequences if not treated on time. The endovascular aneurysm repair (EVAR) is a minimal invasive therapy that reduces recovery times and improves survival rates in AAA cases. Nevertheless, post-operation difficulties can appear influencing the evolution of treatment. The objective of this work is to develop a pilot computer-supported diagnosis system for an automated characterization of EVAR progression from CTA images...
June 2014: Computer Methods and Programs in Biomedicine
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