Endoleaks after endovascular graft treatment of aortic aneurysms: Classification, risk factors, and outcome

Wain, Reese A.; Marin, Michael L.; Ohki, Takao; Sánchez, Luis A.; Lyon, Ross T.; Rozenblit, Alla M.; Suggs, William D.; Yuan, John G.; Veith, Frank J.

doi:10.1016/s0741-5214(98)70293-9

Cited by 212 publications

(114 citation statements)

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“…[1][2][3][4][5][6][7] Endoleaks remain the major drawback and have been reported with all systems used. The etiology is not uniform and neither is their natural history or management.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The Achilles heel of this approach, however, remains the incomplete exclusion of the aneurysm from circulation in a significant number of patients. 5,6 Blood flow persists in the aneurysmal sac around the endograft and implies the continuous exposure of the sac to arterial pressure. The clinical significance of such "endoleaks" or perigraft flow remains unsettled: some aneurysms continue to expand and in some cases rupture while others remain stable or even shrink in size.…”

mentioning

confidence: 99%

“…The clinical significance of such "endoleaks" or perigraft flow remains unsettled: some aneurysms continue to expand and in some cases rupture while others remain stable or even shrink in size. [5][6][7][8] The proper management of this problem is also not well established, with conversion to open repair the only certain cure.…”

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confidence: 99%

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Untitled

2001

Perspectives in Vascular Surgery

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The Achilles heel of endovascular management of abdominal aortic aneurysms (AAA) remains the frequent development of endoleaks. We reviewed our experience over 4 years with two devices used to treat 158 patients with AAA. Forty-one endoleaks were noted for a total incidence of 27%. Two-thirds resolved spontaneously over a 6-month observation period. Proximal endoleaks were associated with neck angulation and most resolved on their own. Distal endoleaks were persistent and required coiling to obliterate the flow around the graft. Other endoleaks were self-limited in general. The incidence of endoleaks decreased significantly with experience and recent cases show no significant differences among the two devices. Long-term follow-up of treated or spontaneously sealed endoleaks reveals shrinkage of the AAA sac similar to patients with no endoleaks. We conclude that the incidence of endoleaks can be reduced with experience and an aggressive management policy can limit their potential danger. Keywords Abdominal aortic aneurysm, endovascular repair, complications, endoleaks, treatmentThe last decade has witnessed an unprecedented revolution in the treatment of abdominal aortic aneurysms (AAA) using an endovascular, less invasive approach. [1][2][3][4] The technique has been embraced quickly by patients and physicians alike. The devices have been refined with the development of commer-1 M.M., Professor of

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“…[1][2][3][4][5][6][7] Endoleaks remain the major drawback and have been reported with all systems used. The etiology is not uniform and neither is their natural history or management.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Untitled

2001

Perspectives in Vascular Surgery

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“…Aortic calcification has been correlated with atherosclerotic disease in patients with abdominal aortic aneurysm 6 and with the prevalence of claudication and aortic aneurysm in hemodialysis patients 7 . In addition to being a possible risk factor in arterial disease progression, calcification also has important consequences for the treatment options by preventing or complicating endovascular surgical repair 8,9 In this study, aortic calcification is measured in patients with peripheral arterial disease and abdominal aortic aneurysm in search for possible risk factors.…”

Section: Introductionmentioning

confidence: 99%

Role of homocysteine in aortic calcification and osteogenic cell differentiation

Campenhout¹,

Moran²,

Parr³

et al. 2009

Atherosclerosis

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Background-The role of homocysteine in atherosclerosis is unclear. We examined the relationship between plasma homocysteine and infrarenal aortic calcification, the presence of homocysteine in human atheroma and the influence of homocysteine on osteogenic differentiation in vitro.Methods and Results-In 194 patients with symptomatic peripheral artery disease or abdominal aortic aneurysm, fasting plasma total homocysteine was independently associated with the severity of infrarenal aortic calcification measured by Computer Tomography Angiography (odds ratio 1.91, 95% confidence interval 1.17-3.21 for calcification ≥ median). Homocysteine was identified in all 60 atheroma biopsies from 16 patients undergoing endarterectomy, and concentrations were significantly greater in the calcified biopsies (p=0.003). In vitro studies demonstrated that 100μmol/ L homocysteine doubled the calcium deposition by mesenchymal stem cells during 16 days incubation in osteogenic medium (74±4 compared to 42±5 μg calcium/well without homocysteine, p<0.001). Homocysteine also stimulated monocytic THP1 cells to promote aortic smooth muscle cell calcification as evidenced by significant higher calcium deposition and alkaline phosphatase activity compared to incubation without homocysteine (p ≤ 0.05).Conclusions-Homocysteine plays an important role in vascular calcification via multiple mechanisms. The presence of homocysteine in atheroma and its ability to enhance osteogenic cell differentiation may partly explain the association of homocysteine with atherosclerotic events.

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“…This gives rise to what is termed an ''endoleak.'' Endoleak formation due to back bleeding from abdominal branches is currently a matter of worldwide scrutiny as far as diagnosis and treatment is concerned (White et al, , 1998Resch et al, 1998;Sato et al, 1998;Wain et al, 1998). Inadvertent occlusion of important aortic branches, however, may also follow stenting of an aneurysm, thereby theoretically producing peripheral ischemia in the territory supplied by the artery, e.g., following occlusion of the inferior mesenteric artery during aneurysm repair .…”

Section: Introductionmentioning

confidence: 99%