Aortic aneurysm sac pressure measurements after endovascular repair using an implantable remote sensor: initial experience and short-term follow-up

Aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. Stents and an aortic endoprosthesis are placed in the renal arteries. This method is primarily used when open surgery is too risky. The mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. The expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. Its diagnosis is made by exclusion. We present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. Following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. A second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. Endotension is a possible cause of aneurysm rupture and death.

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“…Aneurysm sac pressure measured by an implantable remote sensor may help to elucidate endotension causes 11 .…”

Section: Discussionmentioning

confidence: 99%

Endotension: rupture of abdominal aortic aneurysm

et al. 2012

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“…6 Hoppe et al showed 1-month follow-up data (follow-up ranging 19-44 days). 5 Ellozy et al 3 reported results using the Impressure Transducer with a mean of 11 months. Only sporadic information is provided in the long term.…”

Section: Ross Milner MD Maywood Illmentioning

confidence: 98%

“…4,5 The first 4 reported only on intraoperative use in a series of 19 patients. Although statistically significant correlation coefficients were found in all the comparisons between pressure sensors and catheter measurements, values largely ranged from 0.50 to 0.96.…”

Section: Ross Milner MD Maywood Illmentioning

confidence: 99%

“…The second case series reported on postoperative monitoring for endoleaks using the CardioMEMS EndoSure sensor in 12 patients with 30-day follow-up. 5 Delivery of the sensor was complicated in 7% with no obtainable pressure reading. 5 In the APEX study (Acute Pressure measurement to confirm aneurysm sac Exclusion) the initial sensor pressure measurements matched with the angiographic catheter pressure measurements of type I and III endoleak.…”

Section: Ross Milner MD Maywood Illmentioning

confidence: 99%

“…5 Delivery of the sensor was complicated in 7% with no obtainable pressure reading. 5 In the APEX study (Acute Pressure measurement to confirm aneurysm sac Exclusion) the initial sensor pressure measurements matched with the angiographic catheter pressure measurements of type I and III endoleak. However, of 90 enrolled patients, results were not reported in 14 due to "protocol violations, typically a missed measurement."…”

Section: Ross Milner MD Maywood Illmentioning

confidence: 99%

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Are intrasac pressure measurements useful after endovascular repair of abdominal aortic aneurysms?

Milner

Rango

Verzini

et al. 2011

Journal of Vascular Surgery

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Few would argue with the need for long-term follow-up after endovascular repair of abdominal aortic aneurysms. A small risk of reintervention persists and the challenge remains to identify those patients that will require additional procedures to prevent subsequent complications. The ideal follow-up regimen remains elusive. Up until this point, most regimens have consisted of radiologic imaging, with either computed tomography (CT) scans or ultrasonography to identify continued aneurysm perfusion (endoleaks) and document sac dynamics, either shrinkage, growth, or stability. However, aneurysm sac growth or shrinkage serves only as a surrogate measurement for pressurization, and although it is uniformly believed that attachment site endoleaks require treatment, it remains controversial as to how to determine which type II endoleaks pressurize an aneurysm sufficiently to require therapy. In response to these difficulties, several manufacturers have developed pressure sensors that can be implanted at the time of the initial repair. They have been shown capable of measuring intrasac pressures that have appropriately responded to reinterventions for endoleaks. However, are they the answer we are looking for? Are they ready for widespread use? Do they offer a reliable and consistent measure of intrasac pressure that can be trusted to determine the need, or lack of need, for further therapy? Our debaters will try to convince us one way or another.

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Aortic Endoleak Following Endovascular Aortic Repair

Bauknight

Patel

2021

Transradial Access in Interventional Radiology

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Aortic aneurysm sac pressure measurements after endovascular repair using an implantable remote sensor: initial experience and short-term follow-up

Cited by 27 publications

References 25 publications

Endotension: rupture of abdominal aortic aneurysm

Endotension: rupture of abdominal aortic aneurysm

Are intrasac pressure measurements useful after endovascular repair of abdominal aortic aneurysms?

Aortic Endoleak Following Endovascular Aortic Repair

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