Aneurysm Pulsatility After Endovascular Exclusion - An Experimental Study Using Human Aortic Aneurysms

Abstract

Orra HA, Puech-Leão P, da Silva ES, Silva DG. Aneurysm pulsatility after endovascular exclusion -an experimental study using human aortic aneurysms. Clinics. 2008;63(1):67-70. OBJECTIVE:To measure the pulsatility of human aneurysms before and after complete exclusion with an endograft. METHOD: Five aortic aneurysms obtained during necropsy were submitted to pulsatile perfusion before and after implantation of a bifurcated endograft. The specimens were contained in a closed chamber filled with saline solution. A vertical tube attached to the chamber was used to measure volume dislocation in each systole. Mural thrombus was kept intact, and the space around the device was filled with human blood. After each experiment, the aneurysm was opened to check for the correct positioning and attachment of the device. RESULTS: The level of the saline column oscillated during pulsation in each case, with respective amplitudes of 17, 16, 13, 7, and 25 cm before the endograft insertion. After the insertion, the amplitudes dropped to 13, 12, 9, 3.5, and 23 cm, respectively. The differences were not significant. During the post-experimental examination, all devices were found to be in position and well attached to the neck and iliacs. No endoleak was detected during perfusion or by visual inspection. CONCLUSION: Pulsation of an endograft is transmitted to the aneurysm wall even in the absence of endoleak, and should not be interpreted as procedural failure.

Endovascular Infrarenal Aortic Aneurysm Repair Combined With Laparoscopic Cholecystectomy

“…3 If we treat the cholecystopathy alone, the aneurysm might rupt after the operation because of collagenase activity on the aortic wall following the intra-abdominal procedure. 7 Simultaneous repair through an intraperitoneal route may cause infection in the prosthesis, 5 especially in cases such as the one discussed in this paper, in which silent acute cholecystitis (oligosymptomatic) was diagnosed only during the operation, along with extravasation of its infected content. If the procedure had been carried out using an intraperitoneal route, the prosthesis would certainly have become contaminated.…”

“…If we choose to treat only the aneurysm by an intraperitoneal route, the patient may present acute cholecystitis during the immediate postoperative period,1,5 although endovascular techniques reduce this complication 3. If we treat the cholecystopathy alone, the aneurysm might rupt after the operation because of collagenase activity on the aortic wall following the intra-abdominal procedure 7. Simultaneous repair through an intraperitoneal route may cause infection in the prosthesis,5 especially in cases such as the one discussed in this paper, in which silent acute cholecystitis (oligosymptomatic) was diagnosed only during the operation, along with extravasation of its infected content.…”

Single centre experience with Excluder® stent graft; 17-year outcome

“… 40 , 41 This is probably caused by the progression of the disease as well as by material failure due to constant forces present in the aorta, distortion of anatomy due to new hemodynamics, dilatation of the common iliac arteries or progress of previous iliac arteries ectasia. 42 , 43 , 44 The follow-up protocol should be carefully adjusted since higher post-EVAR imaging frequency has been associated with a lower risk of death but attributed to higher cost and irradiation dose. 4 , 24 , 45 The current recommendations propose imaging at 30 days after the procedure and yearly thereafter if no complications are detected.…”