Endoluminal Grafting of Abdominal Aortic Aneurysms: Causes of Failure and Their Prevention

Abstract

The failures of endoluminal grafting have been analyzed. Methods of avoiding access problems, balloon malfunction, and stent dislodgment have been defined and recommendations made.

Conversion to Open Surgery After Endovascular Abdominal Aortic Aneurysms Repair

“…The current absolute indications for conversion to OS are determined; as primary (immediate) in case of stentgraft implantation failure leading to the inability to deploy the prosthesis and exclude the aneurysmal sac from the direct blood flow or resulting in aortic rupture or obstruction of both iliac arteries, and as secondary for hemodynamically high flow persistent endoleak, continued AAA growth without evidence of endoleak and infected stentgraft 7,10,13 . Appropriate patient selection, correct sizing of prostheses and good procedural technique are of importance in EVAR failure and thus in the prevention of the risk involved in the conversion to OS [32][33][34] . When extreme AAA morphological indication is neccessary (in high risk patients with acute AAA repair indication), the application of a combination of EVAR and primary planned associated surgery (combined strategy) is recommended to prevent complications 14,[35][36][37][38][39] .…”

Endoleaks and the unending saga of a clever new terminology that has proved counterproductive

“…1,2 The phenomenon was increasingly recognized in the mid-1990s as several authors noted the presence of "leaks" to signify persistence (or recurrence) of paragraft flow. [3][4][5] White et al were first to describe the growing problem with clarity and coined a brand-new term 6 : "We propose a preferable, novel terminologyendoleak -for this new phenomenon, which is associated only with endoluminal grafts." The clever new term was received enthusiastically and adopted rapidly the world over.…”

“…If Dr Criado is correct, and the sky is indeed falling, 1 then it is highly unlikely that the solution lies in the simple substitution of a new neologism ("sac flow") 2 for an older and well-tried neologism ("endoleak"). 3 On the other hand, if the folk of Baltimore are truly facing an ongoing "unending saga," including "unnecessary scare and anguish," resulting in both "physicians and patients panicked," 2 then it may be best to initially look for a local solution, since such a state of panic does not appear to be widespread! I fail to perceive how the term "sac flow" could simply solve this problem, since by Dr Criado's own logic, many outside the vascular community would now be forced to reinterpret new "deep-rooted mental images" of flowing blood and sacs.…”

“…We proposed the term endoleak in 1996 precisely for the purpose of differentiating this new condition from the phenomenon of ruptured or leaking abdominal aortic aneurysm (AAA), 3 and as an aid in providing a specific defined term and a classification system to help determine the long-term outcomes for the various types of endoleak that were being recognized in the early years of endovascular grafting. 4,5 For example, this classification has helped enormously in showing that type II endoleaks do not require intervention in the high majority of cases.…”

Three-Dimensional Intravascular Ultrasound Assessment of Abdominal Aortic Aneurysm Necks

“…[1][2][3] Intravascular ultrasound (IVUS) has been acknowledged as a powerful imaging tool, providing information regarding dimensions of the abdominal aorta and vessel wall morphology. [4][5][6] It has been proposed that 3-dimensional (3D) IVUS imaging may have clinical potential in the assessment of AAA dimensions.…”