A Canadian multicenter experience describing outcomes after endovascular abdominal aortic aneurysm repair stent graft explantation

Dubois, Luc; Harlock, John; Gill, Heather L.; Chen, Jerry C.; Rhéaume, Pascal; Jetty, Prasad; Boyd, April J.; Roche-Nagle, Graham; Hill, Andrew; Kopriva, David; Lee, Min; Nutley, Mark; Gowing, R; Kapila, Vasrun

doi:10.1016/j.jvs.2021.01.049

Cited by 24 publications

(8 citation statements)

References 32 publications

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“…Reported benefits of partial explantation throughout the literature include reduced visceral ischaemia through clamping of the endograft at a lower level compared to native aorta above the level of the endograft (which is often suprarenal), reduced operative time and reduced potential for aortic or visceral artery injury from the process of stent removal. 41,43 The present review found the majority of partial explants were performed in the setting of endoleaks, particularly type I and type II. This appeared to facilitate the preservation of proximal or distal endograft seal zones.…”

Section: Discussionmentioning

confidence: 84%

The failing endograft-A systematic review of aortic graft explants and associated outcomes

et al. 2022

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Objective The prominent use of endovascular stent grafts in the management of abdominal aortic aneurysms is associated with increased descriptions of late complications such as graft infection and endoleaks, which can confer significant morbidity and mortality. Failed endovascular management of late complications often requires open conversion and graft explantation. This systematic review sought to highlight the peri- and post-operative course of patients undergoing aortic graft explants to inform readers of the associated morbidity and mortality of patients undergoing this procedure. Methods The review was conducted in accordance with PRISMA guidelines. A search of the PubMed, Google Scholar and Ovid MEDLINE databases from January 1995 to April 2021 was performed with a combination of MeSH terms pertaining to endovascular aneurysm repair and open conversion. Articles were screened and included based on pre-determined selection criteria. Results A total of 818 studies were identified, with 41 meeting inclusion criteria. These studies examined a total of 1324 patients, 84.3% of whom were male with a mean age of 74 years at explantation. Mean time to graft explantation was 36 months, with a mean aneurysm size of 66 mm. The majority of aortic explants were performed for persistent endoleaks (68%), and 10% for infection. There was high morbidity with the procedure, with high rates of post-operative complications (mean, 37%) and 30-day mortality (11%). The most common complications included renal (15%), respiratory (12%) and cardiac (9%). Most explanted grafts were first-generation endografts. Morbidity and mortality rates were reduced in patients undergoing elective explants compared to emergent procedures (3.3% compared to 43.4%). Conclusion Aortic graft explant remains a highly co-morbid procedure, with high rates of peri- and post-operative complications and mortality. The number of explant procedures reported over the past 25 years has increased, reflecting the prominent use of EVAR in the management of AAAs. Whilst remaining a highly co-morbid procedure, patients undergoing elective explants had markedly reduced rates of mortality and morbidity compared to emergent explants. Thus, clinical focus should be on identifying patients who require graft explantation early to perform these procedures in an elective setting.

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Section: Discussionmentioning

confidence: 84%

The failing endograft-A systematic review of aortic graft explants and associated outcomes

et al. 2022

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“…Meanwhile, urgent/emergency OSC following EVAR has a significantly higher risk of 30-day mortality than nonelective primary open AAA repair (37% versus 24%). 4,20,[24][25][26] Other contemporary review articles have demonstrated high mortality and morbidity of OSC following EVAR. 21,27,28) Decisions around OSC should be carefully made, but the prognosis will be poor if a rupture occurs.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Sac Enlargement Due to Type II Endoleaks Following Endovascular Aneurysm Repair

Onitsuka

Ito

2023

Annals of Vascular Diseases

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An aneurysm sac enlargement caused by type II endoleak (T2EL) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms may cause serious complications such as rupture. Consequently, methods that preoperatively prevent or postoperatively treat T2EL have been employed. When significant aneurysm enlargement occurs due to persistent T2EL, embolization is first performed through several access points. However, although these endovascular reinterventions have a high technical success rate and are safe, their effectiveness remains questionable. When such endovascular procedures fail to stabilize sac enlargement, open surgical conversion (OSC) becomes the last-resort treatment option. We review several strategies of OSC for the repair of T2EL following EVAR. Among the three main OSC procedures, namely, complete endograft removal, partial endograft removal, and complete endograft preservation, partial endograft removal under infrarenal clamping was considered the most appropriate owing to its less invasiveness and durability.

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“…8 The eventual treatment of those cases is often considered to be the conversion to open abdominal aortic repair. 9,10 Regarding the CT as target vessel in EVAR, its approach and treatment can be tricky, resulting in EL and occlusion as complications. 2,11 Especially an occlusion of the CT can lead to fatal consequences such as ischemia of the proximal gastrointestinal tract and dysfunction of visceral organs, including liver.…”

Section: Discussionmentioning

confidence: 99%

“…8 The eventual treatment of those cases is often considered to be the conversion to open abdominal aortic repair. 9,10…”

Section: Discussionmentioning

confidence: 99%

Realignment of Migrated Celiac Stent Graft After Branched Stent Graft Implantation Through Retrograde Cannulation of the Superior Mesenteric Artery Using a Single Vascular Access

et al. 2022

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Purpose: The purpose of the study was to present an endovascular management of a type IIIc endoleak (EL) in a patient with migration of the bridging stent graft of the celiac trunk (CT) after branched aortic aneurysm repair with retrograde cannulation of the superior mesenteric artery (SMA). Technique: The therapy was applied in a 62-year-old man who underwent a branched EVAR 2 years ago. Meanwhile, the patient was treated due to type Ia EL 6 months ago. The patient suffered in the last days from unclear hemorrhage clinically correlated with weakness. In the computed tomography angiography (CTA), an EL IIIc with a migration of the bridging stent graft from the CT branch was displayed. As vascular access, the left axillar artery was used. Due to the misaligned bridging stent graft, an antegrade cannulation was impossible, so cannulation was performed retrograde through the SMA using pancreaticoduodenal and gastroduodenal arteries. Thereafter, the EL could be repaired with bridging stent grafts. The postinterventional control showed a satisfying reconstruction without EL or embolization. Conclusion: Most of the complications such as type IIIc EL after complex endovascular repair can also be treated endovascularly. This sophisticated treatment requires that necessary materials and experience are available.

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A Canadian multicenter experience describing outcomes after endovascular abdominal aortic aneurysm repair stent graft explantation

Cited by 24 publications

References 32 publications

The failing endograft-A systematic review of aortic graft explants and associated outcomes

The failing endograft-A systematic review of aortic graft explants and associated outcomes

Surgical Treatment of Sac Enlargement Due to Type II Endoleaks Following Endovascular Aneurysm Repair

Realignment of Migrated Celiac Stent Graft After Branched Stent Graft Implantation Through Retrograde Cannulation of the Superior Mesenteric Artery Using a Single Vascular Access

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