Endograft Limb Occlusion in EVAR: Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA

Taudorf, Mikkel; Jensen, Louise Kruse; Vogt, Katja; Gronvall, John A.; Schroeder, Torben V.; Lönn, Lars

doi:10.1016/j.ejvs.2014.04.018

Cited by 97 publications

(36 citation statements)

References 19 publications

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“…Compared with unilateral limb occlusion, bilateral limb occlusion is relatively uncommon, with a reported incidence ranging from 0% to 0.6% and accounting for 0% to 15% of endograft occlusion cases. 2,3,[6][7][8] Total occlusion of the main body of the bifurcated stent graft is a rare condition and no previous studies have been reported on its detailed therapeutic process.…”

Section: Resultsmentioning

confidence: 99%

“…3,7) Notably, Gore Excluder endoprosthesis (W.L. Gore & Associates, Flagstaff, Arizona), one of the currently available third-generation endografts, has been reported to more suitable for complex iliac anatomy, with a limb occlusion incidence of 0%-1.4%, 4,9) which is lower than that of Zenith stent graft (4.8%-5.5%) 4,6,8) or Endurant endograft (Medtronic Inc, Minneapolis, Minnesota) (3.4%). 7) Treatment modalities for endograft limb occlusion are determined by the area and length of thrombosis, pattern of disease progression, clinical presentation, and severity of leg ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Endograft occlusion, a serious late complication following EVAR, has been reported to have an incidence ranging from 1.1% to 7.1%. [1][2][3][4][5][6][7][8][9] Typically, endograft limb occlusion occurs unilaterally. If endograft occlusion occurs acutely in the bilateral limb or the main body of the endograft, its pathological condition may be similar to that of acute occlusion of the abdominal aorta, a emergency treatment.…”

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.Keywords: abdominal aortic endograft, total occlusion, axillobifemoral bypass life-threatening disease associated with high morbidity and mortality. Here we report a case of abdominal aortic endograft total occlusion that was successfully managed with axillobifemoral bypass; in addition, we discuss the treatment strategies for this critical situation. Case ReportA 72-year-old man was admitted to an emergency department of a district hospital, complaining of sudden bilateral lower extremity numbness and severe rest pain. At the age of 62, he had undergone mechanical valve replacement for aortic valve stenosis and permanent pacemaker insertion for sick sinus syndrome at the same hospital. Sixteen months ago, he had undergone abdominal aortic endograft implantation for infrarenal abdominal aortic aneurysm at a different hospital. Preoperative computed tomography (CT) showed the maximum aneurysm diameter of 62 mm, the neck angulation 10) of 77°, and the terminal aorta diameter of 21 mm (Fig. 1). A Zenith endovascular graft (Cook Inc., Bloomington, Indiana) was implanted through the right femoral approach. The procedure was performed successfully and the postoperative course was uneventful. A postoperative CT showed the neck angulation of 56° and the terminal aorta diameter of 21 mm (Fig. 1). The patient was discharged from the hospital with no endoleak. Subsequently, he had been regularly followed-up for anticoagulation therapy at a local hospital. He had not experienced intermittent claudication previously.On further examination at the district hospital, a CT showed an abdominal endograft implanted from below the orifice of the renal arteries to the bilateral common iliac arteries with complete occlusion at the mid-portion of the main body (Fig. 2). The neck angulation was 54°, and the terminal aorta diameter of 21 mm (Fig. 2). Preoperative echocardiography showed that there was no obvious thrombus in the left atrium and the left ventricle, and around the mechanical aortic valve. A diagnosis of acute endograft occlusion was made. The patient was transferred to our hospital 4 h after the onset of symptoms for

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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“…10,11 The inclusion and exclusion criteria are listed in Table 1. Iliac axis tortuosity was considered according to the definition of Taudorf et al 12 CT angiography (CTA) was the standard preoperative imaging modality to assess for endograft sizing and aneurysm repair. All CTA sequences were processed using a 3D centre-line reconstruction by 3Surgery ™ 4.0 platform (3mension Medical Imaging).…”

Section: Methodsmentioning

confidence: 99%

Endovascular Aneurysm Repair Using Anaconda Repositionable Aortic Stent Graft Assisted Exclusively by Intravascular Ultrasound Imaging

Barbera

Rosa

Valentino

et al. 2019

Vascular and Endovascular Review

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Arteriography with contrast medium (CM) injection is normally employed to visualise the lowest renal artery during endovascular aneurysm repair (EVAR). Intravascular ultrasound (IVUS) has been proposed as an alternative, real-time imaging diagnostic technique to arteriography. In this study, we evaluated the feasibility of EVAR using Anaconda repositionable aortic stent graft (Vascutek) assisted by IVUS (Volcano Visions, Philips) during intraluminal navigation without CM. From January 2016 to December 2017, 25 patients with infrarenal abdominal aortic aneurysms, identified through anatomical inclusion criteria, underwent EVAR. All of the patients had an arteriogram at the end of the EVAR procedure to confirm aortic stent graft patency and to exclude type 1 endoleaks. The primary objective was the technical and clinical success of this CM-free aortic stent graft delivery procedure. At the end of the period, 150 target vessels were evaluated. IVUS versus angio-CT sensitivity and specificity rate were 97.3% and 100%, respectively. The primary technical success was obtained in 88% of the cases. Three patients (12%) needed CM injection to complete the procedure and there were no cases of type 1 endoleak. Primary clinical success was 100%. During follow-up at a mean of 20 months, none of the patients died or had complications. We conclude that a full EVAR procedure is feasible using only IVUS navigation and repositionable aortic stent graft without CM injection in anatomically selected cases.

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“…In this issue of European Journal of Vascular and Endovascular Surgery, Taudorf and colleagues analyze a series of 504 patients treated exclusively with bifurcated Zenith endografts for elective AAA, 5 with a 3.6% rate of ELO (18 patients). Besides body mass index as the sole significant difference between patients with and without ELO, limb occlusion was more common in those limbs extended to external iliac artery (EIA) than to common iliac artery (CIA).…”

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confidence: 99%

Commentary on: “Endograft Limb Occlusion in EVAR: Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA”

Rančić

2014

European Journal of Vascular and Endovascular Surgery

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Endograft Limb Occlusion in EVAR: Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA

Abstract: A tortuous vessel on the preoperative CTA is associated with an increased risk of limb occlusion after EVAR. Adjunctive stenting of iliac segments deemed at risk is suggested, which is achieved without compromise of the aneurysm repair.

Cited by 97 publications

References 19 publications

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Endovascular Aneurysm Repair Using Anaconda Repositionable Aortic Stent Graft Assisted Exclusively by Intravascular Ultrasound Imaging

Commentary on: “Endograft Limb Occlusion in EVAR: Iliac Tortuosity Quantified by Three Different Indices on the Basis of Preoperative CTA”

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