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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...
October 14, 2016: 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
George S Georgiadis, Dimitrios Charalampidis, Efstratios I Georgakarakos, George A Antoniou, George Trellopoulos, Theodosia Vogiatzaki, Miltos K Lazarides
Advances in abdominal aortic aneurysm (AAA) endograft device technology have contributed to improved outcomes and durability of endovascular aortic aneurysm repair (EVAR), even in complex infrarenal aortic anatomies. However, stent graft failure secondary to endoleaks, migration, endotension and sac enlargement are persistent problems that can result in aneurysm rupture following EVAR.A symptomatic infrarenal AAA (4mm proximal neck) was treated initially with an Ovation Prime™ device (TriVascular, Inc., Santa Rosa, CA) in an off-label fashion, leading to type Ia endoleak moderately reduced by additional proximal neck ballooning...
February 2014: International Journal of Artificial Organs
Eric J Turney, Sean P Steenberge, Sean P Lyden, Matthew J Eagleton, Sunita D Srivastava, Timur P Sarac, Rebecca L Kelso, Daniel G Clair
OBJECTIVE: With more than a decade of use of endovascular aneurysm repair (EVAR), we expect to see a rise in the number of failing endografts. We review a single-center experience with EVAR explants to identify patterns of presentation and understand operative outcomes that may alter clinical management. METHODS: A retrospective analysis of EVARs requiring late explants, >1 month after implant, was performed. Patient demographics, type of graft, duration of implant, reason for removal, operative technique, length of stay, complications, and in-hospital and late mortality were reviewed...
April 2014: Journal of Vascular Surgery
Vincent E Kirkpatrick, Samuel E Wilson, Russell A Williams, Ian L Gordon
BACKGROUND: Standard surveillance after endovascular abdominal aortic aneurysm repair (EVAR) consists of periodic computed tomographic arteriographies (CTAs) usually performed at postoperative months 1, 6, and 12, and then annually. This imaging regimen is expensive and exposes patients to the hazards of radiation and intravenous contrast. We hypothesized that a normal 1-month CTA after EVAR with no endoleak or other significant abnormality predicts a low rate of future complications, which would justify a reduction in frequency of subsequent CTAs...
May 2014: Annals of Vascular Surgery
Jean-Philippe Verhoye, Amedeo Anselmi, Adrien Kaladji, Erwan Flécher, Antoine Lucas, Jean-François Heautot, Xavier Beneux, Olivier Fouquet
OBJECTIVES: To describe the early and mid-term clinical and instrumental results of the frozen elephant trunk (FET) procedure using the recent Evita Open Plus hybrid endoprosthesis for elective one-stage treatment of extensive thoracic aortic disease. METHODS: We reviewed 16 patients undergoing FET for post-dissection aneurysm (50%), true aneurysm (31%) or other aetiologies (19%), through median sternotomy and hypothermic circulatory arrest. An average 14 ± 7.6-month follow-up with regular contrast-enhanced control computed tomography scans was available...
May 2014: European Journal of Cardio-thoracic Surgery
Shipra Arya, Dawn M Coleman, Jordan Knepper, Peter K Henke, Gilbert R Upchurch, John E Rectenwald, Enrique Criado, Jonathan L Eliason, Katherine A Gallagher
BACKGROUND: With the growing prevalence of endovascular repair for abdominal aortic aneurysm (AAA), the number of patients requiring graft explantation is increasing. Therefore, knowledge related to outcomes after explantation may lead to improvement in surgical options. In this study we compare our experience with explantation of aortic endografts, based on indication. METHODS: The medical records of all aortic procedures performed at our center were queried during the period from 2002 to 2012...
October 2013: Annals of Vascular Surgery
F Filippi, C Tirotti, N Stella, L Rizzo, M Taurino
Endovascular aortic aneurysm repair is an effective alternative to open surgical repair in high risk patient. Endotension is an unpredictable late and rare complication of EVAR. Clinical significance and choice of technique for treatment are controversial. At present, there are no cases of endotension-related aneurysmal sac rupture reported in literature, altough it is frequently associated with late surgical conversion. In this case report is described a case of a patient treated with a first generation Gore Excluder(TM) endograft for abdominal aortic aneurysm, with late aneurysmal sac enlargement without evidence of endoleak and subsequent contained rupture without anemia and shock...
April 2013: Vascular
Konstantinos P Donas, Felice Pecoraro, Theodosios Bisdas, Mario Lachat, Giovanni Torsello, Zoran Rancic, Martin Austermann, Dieter Mayer, Thomas Pfammatter, Stefan Puchner
PURPOSE: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and periscope grafts during endovascular repair. METHODS: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2...
February 2013: Journal of Endovascular Therapy
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