Abdominal aortic aneurysm size regression after endovascular repair is endograft dependent

Bertges, Daniel J.; Chow, Kira; Wyers, Mark C.; Landsittel, Doug; Frydrych, Anthony V.; Stavropoulos, W.; Tan, Walter A.; Rhee, Robert Y.; Fillinger, Mark F.; Fairman, Ronald M.; Makaroun, Michel S.

doi:10.1067/mva.2003.212

Cited by 90 publications

(87 citation statements)

References 32 publications

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“…Changes in aneurysm diameter remain an important marker of aneurysm exclusion, and device-specific dif- van ferences have been reported. 13,26,28,29 Certain stent-graft makes (e.g., Zenith) are associated with shrinkage more than others. The persistence of differences after risk adjustment (e.g., for endoleak) in this study might suggest an additional role for device components, such as fabric, in influencing postoperative changes in aneurysm size.…”

Section: Discussionmentioning

confidence: 99%

“…Progressive changes in arterial anatomy during follow-up, such as neck dilatation or aneurysmal transformation of iliac landing zones, may compromise stent-graft function later on. 14,15,24,[28][29][30] Physician-related factors, such as diagnostic insight, judgment of suitability for treatment, and operating experience, also influence outcome. 31 All of these factors have been constantly changing as endovascular repair has evolved, creating a potential confounding effect upon comparative analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Primarily unsupported devices (EVT/Ancure) might be expected to have the highest incidence of stent-graft limb occlusion 13,16,28 because the lack of device support predisposes to angulation and kinking, with resulting stenosis and thrombosis in the graft. 32 In contrast, this analysis showed that they in fact fared slightly better than the other firstgeneration endografts.…”

Section: Discussionmentioning

confidence: 99%

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Risk-Adjusted Outcome Analysis of Endovascular Abdominal Aortic Aneurysm Repair in a Large Population:How Do Stent-Grafts Compare?

Marrewijk

Leurs

Vallabhaneni

et al. 2005

Journal of Endovascular Therapy

116

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ࡗ ࡗPurpose: To compare differences in the applicability and incidence of postoperative adverse events among stent-grafts used for repair of infrarenal aortic aneurysms.Methods: An analysis of 6787 patients from the EUROSTAR Registry database was conducted to compare aneurysm morphological features, patient characteristics, and postoperative events for the AneuRx, EVT/Ancure, Excluder, Stentor, Talent, and Zenith devices versus the Vanguard device (control) and each other. Annual incidence rates of complications were determined, and risks were compared using the Cox proportional hazards analysis. Results:The annual incidence rates were: device-related endoleak (types I and III) 6% (range 4%-10%), type II endoleak 5% (range 0.3%-11%), migration 3% (range 0.5%-5%), kinking 2% (range 1%-5%), occlusion 3% (range 1%-5%), rupture 0.5% (range 0%-1%), and all-cause mortality 7% (range 5%-8%). After adjustment for factors influencing outcome, AneuRx, Excluder, Talent, and Zenith devices were associated with a lower risk of migration, kinking, occlusion, and secondary intervention compared to the Vanguard device. Significant increased risk for conversion (EVT/Ancure) and reduced risk of aneurysm rupture (AneuRx and Zenith) and all-cause mortality (Excluder) were found compared to the Vanguard device. Conclusions: Significant differences exist between stent-grafts of different labels in terms of applicability and complications during intermediate to long-term follow-up. Since each stent-graft has its drawbacks, no single label can be identified as the best. It is reassuring that developments in stent-grafts indeed result in better performance than the early stentgrafts. However, a single device incorporating all the perceived improvements should still be pursued. J Endovasc Ther 2005;12:417-429

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk-Adjusted Outcome Analysis of Endovascular Abdominal Aortic Aneurysm Repair in a Large Population:How Do Stent-Grafts Compare?

Marrewijk

Leurs

Vallabhaneni

et al. 2005

Journal of Endovascular Therapy

116

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“…Two current methods used to treat AAAs are (a) open surgical repair by replacing the diseased segment with a synthetic arterial graft or (b) endovascular repair by deploying a stent that is designed to shield the aneurysmal wall from the hemodynamic loads. Particularly provocative is the observation that some endovascularly treated AAAs actually regress, with decreases in size up to 8% (194,195). Given that an AAA actively grows and remodels during most of its natural history, this suggests that a stent can alter the applied loads in such a way that G&R may reverse the natural course of enlargement, which usually ends in rupture.…”

Section: Closurementioning

confidence: 99%

Intracranial and Abdominal Aortic Aneurysms: Similarities, Differences, and Need for a New Class of Computational Models

Humphrey

Taylor

2008

Annu. Rev. Biomed. Eng.

269

238

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Intracranial and abdominal aortic aneurysms result from different underlying disease processes and exhibit different rupture potentials, yet they share many histopathological and biomechanical characteristics. Moreover, as in other vascular diseases, hemodynamics and wall mechanics play important roles in the natural history and possible treatment of these two types of lesions. The goals of this review are twofold: first, to contrast the biology and mechanics of intracranial and abdominal aortic aneurysms to emphasize that separate advances in our understanding of each disease can aid in our understanding of the other disease, and second, to suggest that research on the biomechanics of aneurysms must embrace a new paradigm for analysis. That is, past biomechanical studies have provided tremendous insight but have progressed along separate lines, focusing on either the hemodynamics or the wall mechanics. We submit that that there is a pressing need to couple in a new way the separate advances in vascular biology, medical imaging, and computational biofluid and biosolid mechanics to understand better the mechanobiology, pathophysiology, and treatment of these lesions, which continue to be responsible for significant morbidity and mortality. We shall refer to this needed new class of computational tools as Fluid-Solid-Growth (FSG) Models.

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“…Abdominal aortic size regression after endovascular repair depended on the type of endograft. 13,14 A dense intraluminal thrombus may prevent a rapid regression of the AAA; however, several authors reported that the rate of change was unrelated to the amount of preoperative thrombus within in. 3,15 In untreated aneurysms, the individual expansion rate is unpredictable while the mean expansion rate has been documented.…”

Section: Discussionmentioning

confidence: 94%

Factors Affecting the Regression of Surgically Replaced Abdominal Aortic Aneurysms

Matsushita¹,

Ikezawa²

2006

Surg Today

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Abdominal aortic aneurysm size regression after endovascular repair is endograft dependent

Abstract: Long-term morphologic changes after endovascular aneurysm repair depend on endograft type.

Cited by 90 publications

References 32 publications

Risk-Adjusted Outcome Analysis of Endovascular Abdominal Aortic Aneurysm Repair in a Large Population:How Do Stent-Grafts Compare?

Risk-Adjusted Outcome Analysis of Endovascular Abdominal Aortic Aneurysm Repair in a Large Population:How Do Stent-Grafts Compare?

Intracranial and Abdominal Aortic Aneurysms: Similarities, Differences, and Need for a New Class of Computational Models

Factors Affecting the Regression of Surgically Replaced Abdominal Aortic Aneurysms

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