Complete percutaneous treatment of AAA may have some advantages over open femoral artery access, but it is not free from risk. Percutaneous treatment of AAA can be completed successfully in most patients, but should be performed at an institution where conversion to an open procedure can be completed expeditiously if necessary.

PAA treated with ligation and exclusion bypass grafting often expand and can become symptomatic. This may be analogous to type II endoleak or endotension noted after aortic endovascular repair. We recommend PAA excision or endoaneurysmorrhaphy when feasible.

clinicaltrials.gov Identifier: NCT00094575.

No abstract

Branched endoprostheses for endovascular repair of pararenal and thoracoabdominal aortic aneurysms are undergoing evaluation in prospective clinical trials. Duplex ultrasound has been a cornerstone of surveillance for vascular reconstructions. This paper describes the development and deployment of a standardized duplex imaging protocol to evaluate individuals who have undergone endovascular repair of their thoracoabdominal aortic aneurysm. Ultrasound imaging is performed after an 8 to 12 hour fast to minimize the presence of bowel gas and allow for optimal imaging of abdominal vascular structures. Doppler measurements of peak systolic and end diastolic velocity are made at specific arterial segments in the aorta and the celiac, superior mesenteric, and renal arteries. Resistive indices are also recorded in the segmental and arcuate arteries of both kidneys. Pulsed-wave Doppler is used to record spectral Doppler data and color Doppler is used to image all arterial segments and ensure proper placement of the Doppler sample volume and ensure correct angle of interrogation. Implementation of a standardized duplex ultrasound imaging protocol can be used to image and follow individuals who have received the Thoracoabdominal Branch Endoprosthesis (TAMBE) device and branched endovascular aneurysm repair (BEVAR). Ultrasound may provide complementary findings and may add information to the computed tomography angiography imaging for following these individuals.