Endotension after endovascular aneurysm repair: The Ancure experience

Meier, George H.; Parker, Frank M.; Godziachvili, Vasso; DeMasi, Richard J.; Parent, F. Noel; Gayle, Robert G.

doi:10.1067/mva.2001.117145

Cited by 77 publications

(67 citation statements)

References 18 publications

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“…Even without any detectable endoleaks, and the aneurysm sac may grow due to endotension or undetectable endoleaks, this aneurysm sac may rupture and cause death. In the event of an aneurysm sac rupture, after a chimney procedure, no endovascular procedure is safe, and open surgery that was once avoided now has a higher risk and is characterized by even greater technical difficulties 3,5,[8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

“…These include increased porosity of the prosthesis 5 , direct transmission of pressure from the stent to the lumen of the aneurysm sac 4,8 , and a low flow endoleak which is undetectable by the imaging methods 2,9 . Mennander et al found five patients (3.1%) with endotension within 160 patients who underwent endovascular aneurysm repair, and endoleaks were not detected.…”

Section: Discussionmentioning

confidence: 99%

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Endotension: rupture of abdominal aortic aneurysm

et al. 2012

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endotension: rupture of abdominal aortic aneurysm

et al. 2012

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“…10 Initial theories suggested that direct systemic pressure on the endograft can be transmitted to the aneurysm wall. 11,12 Yet even thrombosed sac rupture with a good endograft seal does not necessarily result in a life-threatening event. There are several documented cases of sac rupture without hemorrhage or hemodynamic compromise with findings of thrombotic contents within the abdomen on exploration.…”

Section: Discussionmentioning

confidence: 99%

Delayed Migration of a Thrombosed Aortic Endograft Within a Thrombosed Aneurysm Sac Resulting in Continued Sac Expansion and Rupture

Skripochnik

Labropolous

Loh

2016

Journal of Vascular Surgery

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We present the case of delayed migration of a thrombosed aortic endograft within a thrombosed aneurysm sac that expanded and ruptured. Dilation of the aortic neck likely led to endograft migration and exposure of the occluded endograft and aneurysm sac to systemic pressure. Although no endoleak was identified, a key finding on ultrasound showed mobility of the sac thrombus. This may be an indicator of flow within the sac that may predict potential for rupture. Despite thrombosis of the aortic sac and endograft, the risk of rupture still lingers, and thus continued surveillance of occluded endografts may be prudent. (J Vasc Surg Cases and Innovative Techniques 2017;3:115-8.) Endovascular aneurysm repair (EVAR) is the standard of care for abdominal aortic aneurysms (AAAs). Early landmark trials showed increased reintervention rate and late mortality secondary to late rupture in the EVAR group.

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“…CDU scan demonstrates the same endoleak. Meier et al (2001), suggested that spectral Doppler waveform (SDW) patterns can differentiate endoleaks that spontaneously seal from those that persist. They suggested that bidirectional to-from waveforms in endoleaks type 2 may precede occlusion, while…”

Section: Sensitivitymentioning

confidence: 99%