Lombard Aorfix high angulation device, sac behavior following implantation

McGillicuddy, Edward A.; Fillinger, Mark F.; Robinson, William P.; Hodgson, Kim J.; Jordan, William D.; Beck, Adam W.; Malas, Mahmoud B.; Belkin, Michael

doi:10.1016/j.jvs.2016.12.063

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…The evidence on a relationship between the preoperative AAA diameter and remodeling after EVAR varies greatly between different published studies—as shown in a recent review [ 13 ]. When focusing on studies reporting specifically on AAA remodeling one-year after EVAR, two studies found no correlation, while two others observed that a larger preoperative AAA diameter was related to an increased likelihood of AAA shrinkage [ 22 , 23 , 24 , 25 ]—consistent with the findings of this analysis. However, this observation might be distorted by the focus of this study, namely comparing shrinking with stable AAA after EVAR, consequently excluding growing AAAs.…”

Section: Discussionsupporting

confidence: 82%

“…A recent systematic review demonstrated that two other studies that investigated AAA remodeling one-year after EVAR did not find significant relations between infrarenal angulation and AAA remodeling—in contrast to this study [ 13 ]. However, both studies were not comparable to this study as one study focused only on the Lombard Aorfix high angulation device and used another definition for neck angle [ 25 ], while the other study demonstrated smaller infrarenal angles with an undescribed measurement method of these angles [ 24 ].…”

Section: Discussionmentioning

confidence: 89%

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Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Rijswijk

Jebbink

Holewijn

et al. 2022

JCM

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Recent studies demonstrate that patients with a shrinking abdominal aortic aneurysm (AAA), one-year after endovascular repair (EVAR), have better long-term outcomes than patients with a stable AAA. It is not known what factors determine whether an AAA will shrink or not. In this study, a range of parameters was investigated to identify their use in differentiating patients that will develop a shrinking AAA from those with a stable AAA one-year after EVAR. Hundred-seventy-four patients (67 shrinking AAA, 107 stable AAA) who underwent elective, infrarenal EVAR were enrolled between 2011–2018. Long-term survival was significantly better in patients with a shrinking AAA, compared to those with a stable AAA (p = 0.038). Larger preoperative maximum AAA diameter was associated with an increased likelihood of developing AAA shrinkage one-year after EVAR—whereas older age and larger preoperative infrarenal β angle were associated with a reduced likelihood of AAA shrinkage. However, this multivariate logistic regression model was only able to correctly identify 66.7% of patients with AAA shrinkage from the total cohort. This is not sufficient for implementation in clinical care, and therefore future research is recommended to dive deeper into AAA anatomy, and explore potential predictors using artificial intelligence and radiomics.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 89%

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Rijswijk

Jebbink

Holewijn

et al. 2022

JCM

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“…For the grade of neck thrombus, mixed results were found. When scored as 1=mild and 3=severe, a higher thrombus grade was found to be significantly related to more sac enlargement at 4 years after EVAR (OR=0.11, 95%CI 0.02-0.76, p=0.02), which was not yet present at 1 year after EVAR 24 . Also, when the neck thrombus grade was expressed as the absolute degrees of neck thrombus circumference in a different population, a high degree was significantly more present in patients without AAA shrinkage (p=0.003) 19 .…”

Section: Anatomical Predictorsmentioning

confidence: 89%

“…The main findings of each study on the correlation of the anatomical parameter with AAA sac growth and shrinkage are presented in Table III [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . A total of 27 anatomical parameters were Preoperative neck thrombus was indicated to predict less AAA sac shrinkage after EVAR 19,24,26,33 . The presence of this neck thrombus was found to be predictive of less AAA shrinkage at 6, 12, and 24 months after EVAR in two independent studies (p<0.05) 19,33 .…”

Section: Anatomical Predictorsmentioning

confidence: 99%

A systematic review of anatomic predictors of abdominal aortic aneurysm remodeling after endovascular repair

Rijswijk

Jebbink

Zeebregts

et al. 2022

Journal of Vascular Surgery

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The Lombard Aorfix (Lombard Medical, Inc, Oxfordshire, United Kingdom) was developed to accommodate highly angulated aortic necks and was approved to treat proximal necks up to 90°. 9 , 10 The Anaconda endovascular graft (Vascutek, Terumo, Inchinnan, Scotland) was designed with hypothetic zero body columnar strength and high flexibility and the IFU advised for infrarenal angulation <90°. 11 Finally, the Medtronic Endurant endograft (Medtronic cardiovascular, Santa Rosa, Calif, USA) has been described to conform well to challenging anatomies, with IFU including infrarenal angle up to 75° with a neck length more than 15 mm.…”

Section: Discussionmentioning

confidence: 99%

Endovascular aortic repair with the Gore Excluder Conformable endograft in severe neck angulation: Preliminary experience and technical aspects

et al. 2020

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Objectives Endovascular procedures are now the standard of care for endovascular aortic aneurysm repair but treatment of hostile proximal neck anatomy is still challenging. New endografts were brought to the market specifically designed to accommodate severe neck angulation. Authors describe a preliminary experience and early results using the Gore Excluder Conformable endograft (W. L. Gore & Associates, Flagstaff, Ariz) and its active control system in severe neck angulation with a standardized technical approach to achieve precise deployment in this hostile anatomy. Methods From June 2019 to May 2020, five patients with abdominal aortic aneurysm and severe neck angulation (≥70°) were treated with the Gore Excluder Conformable endograft at two different centers. Deployment of this endograft in this kind of anatomy should be aggressive starting over the level of renal arteries due to risk of distal migration downward on the external curvature and difficulty in upward repositioning. Authors suggested a standard technique with a routine through-and-through axillary–femoral approach, using a floppy guidewire together with preventive cannulation of the lower renal artery if a short neck (<15 mm) is associated. Results Endovascular aortic procedures were successfully completed in all patients. Final deployment of the stent graft using our standardized technical approach was extremely precise in all cases even if redeployment of the graft was necessary in all cases. No other secondary procedures were needed. At 30 days, no type IA endoleak was recorded and no aneurysm-related secondary procedures were performed. Median follow-up for this group of patients was 5.2 months (range 1–11). Early results revealed no type IA endoleak and no migration at Ct angiogram. No aneurysm-related secondary procedures were required. Conclusion Routine use of through-and-through axillary–femoral guidewire associated with selective pre-cannulation of the lower renal artery allows a precise deployment of the Gore Excluder Conformable endograft in difficult anatomies possibly affecting early outcomes.

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Lombard Aorfix high angulation device, sac behavior following implantation

Abstract: In this study cohort, there is a low incidence of sac expansion with the Aorfix device. We were unable to demonstrate an association between neck length/angulation and sac expansion.

Cited by 7 publications

References 33 publications

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair

A systematic review of anatomic predictors of abdominal aortic aneurysm remodeling after endovascular repair

Endovascular aortic repair with the Gore Excluder Conformable endograft in severe neck angulation: Preliminary experience and technical aspects

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