Endoluminal Stent–Grafts for Infrarenal Abdominal Aortic Aneurysms

Blum, Ulrich; Voshage, Götz; Lämmer, Johannes; Beyersdorf, Friedhelm; Töllner, Dierck; Kretschmer, G.; Spillner, G; Polterauer, P; Nagel, Gudrun; Hölzenbein, Thomas; Thurnher, Siegfried; Langer, Mathias

doi:10.1056/nejm199701023360103

Cited by 641 publications

(336 citation statements)

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“…Endovascular abdominal aortic aneurysm repair with metal endoprosthesis (EVAR) has become particularly significant as an alternative to traditional surgery, due to less early mortality and complications and a low rate of aneurysm rupture [1,2,[12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

David

Cantisani

Grazhdani³

et al. 2016

J Ultrasound

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Objective To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in comparison to CT angiography (CTA) to identify and classify endoleaks following abdominal aortic aneurism repair with endoprosthesis. Materials and methods A retrospective analysis of 181 patients treated with EVAR, from September 2009 to September 2014, was performed. Patients were evaluated with CEUS, CTA and angiography in the cases requiring treatment. Sac diameter, sac integrity, identification and classification of endoleaks were taken into consideration. Sensitivity, specificity, accuracy and negative predictive values were considered for each modality of endoleak identification. Results Forty-two endoleaks (23.2%; type II: 39 cases, type III: 3 cases) were documented. Sensitivity and specificity of CEUS and CT were, respectively, 97.6 and 90.5, 100 and 100%. In two cases, CEUS was able to better classify endoleaks compared to CT. Conclusions CEUS accuracy to identify endoleaks following EVAR is similar to CT. CEUS should be considered as an effective modality for the long-term surveillance of EVAR because of its capability to correctly classify endoleaks with no ionizing radiation exposure.Keywords Contrast-enhanced ultrasound Á CT Á Endoleak Riassunto Obiettivi dello studio Valutare l'accuratezza dell'ecocontrastografia (CEUS), confrontandola con angiografia con tomografia computerizzata (CT) per l'identificazione degli endoleak dopo trattamento di aneurisma dell'aorta addominale con endoprotesi. Materiali Da Settembre 2008 a Dicembre 2014, 181 pazienti consecutivi trattati con EVAR sono stati valutati con CEUS, CTA, ed anche con angiografia nei casi da ritrattare. Sono stati valutati: diametro della sacca, valutazione dell'integrita della sacca, identificazione e classificazione degli endoleaks. Sensibilità, specificità, accuratezza e valore predittivo negativo sono stati valutati per ogni modalita nell'identificazione degli endoleak. Risultati Quarantadue endoleak (23.2%; tipo II: 39 casi, tipo III: 3 casi) sono stati documentati. La Sensibilita della CEUS e della TC e stata rispettivamente del 97.6, 90.5%, mentre la specificita per entrambe e stata del 100%. In due casi la CEUS e stata in grado di classificare meglio gli endoleak rispetto alla CT. La sacca aneurismatica presentava alla CEUS e CDUS un diametro massimo compreso tra 39-82 mm, mentre alla TC tra 38 e 78 mm, senza significativa differenza tra le due metodiche. Conclusioni L'accuratezza della CEUS nell'identificazione degli endoleak e nella misurazione della sacca dopo EVAR, e simile alla TC con maggiore sensibilita ma analoga specificita. La CEUS e da considerarsi una modalita efficace per la sorveglianza a lungo termine degli EVAR in quanto capace di classificare correttamente gli endoleak senza esposizione a radiazioni ionizzanti.Parolechiave Contrast-enhanced ultrasound Á CT Á Endoleak

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Section: Discussionmentioning

confidence: 99%

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

David

Cantisani

Grazhdani³

et al. 2016

J Ultrasound

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“…The initial use of aorto-aortic tube endograft determined early failure of EVAR for distal aortic attachment site complications and device migrations (24). Nevertheless MAY et al (11) in their experience concluded that there are risks inherent in the endograft method rather than iatrogenic complications that occur as a learning curve phenomenon : new devices have modified the type of the adverse events but not their incidence. Our collective data confirm this opinion since we observed a straight correlation between the number of EVAR and the incidence of critical events.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of satisfactory medium-term results (9)(10)(11)(12)(13)(14)(15), recent studies have revealed some limits inherent to the procedure. The problems are related to the safety and integrity of the devices, the disconnection of its components, the graft migration and infection, the obstruction of iliac limbs and to aneurysm sac expansion in presence, in the majority of cases, of sac reperfusion (endoleaks) (16,-18).…”

mentioning

confidence: 99%

Early Complications in Endovascular Treatment of Abdominal Aortic Aneurysm

Gabrielli

Baudo

Molinari

et al. 2004

Acta Chirurgica Belgica

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Abstract.Objective : The incidence of perioperative complications during endovascular repair of abdominal aortic aneurysm (EVAR) is reported in limited series. The aim of this study is to evaluate a multi-center survey of unexpected intraprocedural critical events of EVAR. Methods : A questionnaire relative to intraprocedural complications during EVAR was sent to major vascular surgery divisions in Italy. Eleven answered to the survey. The data obtained are relative to 1696 procedures. Results : A wide range of incidence of critical events was observed, from a lower value of 2.7% to a higher value of 68.8% (mean 21.16%). The problems relative to the insertion phase of the delivery system were 7.7%. Endoleaks were reported in 5.5% of cases. Stent graft release was problematic in 0.4% of cases and in another 0.4% there was a problem in shaft retrieval. Unintentional coverage of renal or polar arteries occurred in 0.8% of the procedures ; hypogastric arteries were unwillingly excluded in 2.7% of cases. Aortic or iliac artery rupture had an incidence of 0.7% ; arterial dissection occurred in 0.9%, atheroembolism in 0.5%, lower limb ischemia due to graft limb kinks in 0.7% and to occlusion in 0.9%. Conclusions : Perioperative critical events represent a serious problem only in few cases of EVAR ; they are common but in many cases not predictable ; in most circumstances they can be easily corrected with adjunctive manoeuvres during the same procedure. There is a highly significant correlation between the total workload and the incidence of critical events ; these do not appear to be related to the learning curve.

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“…However, currently available devices have large and nonsteerable delivery systems, which can cause iliofemoral injuries during insertion of the device at a rate of 5% to 17%. [6][7][8] Note that the majority of these patients did not have significant iliofemoral disease identified prior to the endovascular intervention. Unsuitable iliofemoral conduits are particularly problematic with large devices, which are required for thoracic aortic aneurysms.…”

Section: Facilitating Endovascular Device Deliverymentioning

confidence: 99%

Untitled

2001

Perspectives in Vascular Surgery

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The eligibility for endovascular stent-graft repair in patients with aortic pathologies is dictated by the presence of favorable vascular anatomy. The two main anatomic features predicting successful repair are the presence of adequate attachment sites for the device anchoring and the availability of the relatively normal access vessels for safe device navigation. This chapter describes some of the complex vascular anatomies, which can initially impede aortic endovascular repair, and the maneuvers to circumvent these initial obstacles, increasing the overall pool of patients eligible for endovascular repair of complex aortic diseases. Keywords Abdominal aortic aneurysm, endoluminal graft, stent graftIn the United States, there are approximately 200,000 new cases of abdominal aortic aneurysms (AAAs) diagnosed per year, and approximately 50,000 patients per year who have operations to have their aneurysm repaired. Thoracic aortic aneurysms have been diagnosed more frequently than in past, perhaps due to more liberal usage of imaging tests.With aging of the population, the prevalence of aortic aneurysms is increasing. One in ten men over the age of 80 has enlargement of the abdominal aorta. 1 The natural course of the aneurysms is to enlarge and rupture as the aneurysmal transverse diameter grows. Beginning with the origi-1

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Endoluminal Stent–Grafts for Infrarenal Abdominal Aortic Aneurysms

Cited by 641 publications

References 39 publications

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

Early Complications in Endovascular Treatment of Abdominal Aortic Aneurysm

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