Endovascular Management of Abdominal Aortic Aneurysms: the Year in Review

Abstract

Endovascular aneurysm repair (EVAR) has become the predominant method of treatment for abdominal aortic aneurysms (AAA). The use of conscious sedation with local anesthesia and percutaneous femoral access has further decreased the morbidity of the procedure. Current devices can more effectively manage increasingly "hostile" aneurysm necks, while chimney grafts or dedicated fenestrated stent-grafts can be used for juxta-renal disease with favorable results. However, endovascular repair does present a new set of challenges, and endoleaks remain an area of concern. While there is general consensus that type I and type III endoleaks require treatment, type II endoleaks are the topic of ongoing research and debate. Development of devices and techniques to prevent and treat endoleak continues to progress. Advances in contrast-enhanced ultrasound are reducing reliance on computed tomography for post-operative monitoring. This is an important step in this population at high risk for the development of kidney failure. Despite these many innovations, further research is needed to optimize the care of patients with AAA.

Mortality, Length of Stay, and Cost Implications of Procedural Bleeding After Percutaneous Interventions Using Large-Bore Catheters

“…Better preventive and bleeding avoidance strategies are needed if the full benefits of these new techniques are to be achieved. 5,[13][14][15]…”

“…Receiving 1 or more transfusions was associated with increased in-hospital mortality (adjusted odds ratio, 1.92; 95% CI, 1.63-2.21; P < .001), length of stay (adjusted multiplicative difference, 2.10; 95% CI, 11.96-2.25; P < .001), and health care cost (adjusted multiplicative difference, 1.72; 95% CI, 1.64-1.81; P < .001), compared with receiving no transfusion. The risk of dying (22.02% to 38.56% vs 8.21%), length of stay (median [IQR], 8 [2][3][4][5][6][7][8][9][10][11][12][13][14][15] to 13 [7][8][9][10][11][12][13][14][15]…”

Post-Traumatic Ostial Avulsion of a Polar Inferior Renal Artery Treated by Endovascular Covered Aortic Stenting

“…Percutaneous access is associated with a lower frequency of groin infection or lymphocele, and a shorter procedure time and hospital length of stay compared with open surgery. The use of conscious sedation with local anesthesia and percutaneous femoral access has further decreased the morbidity of procedure [8]. Complications of endovascular repair include further aortic wall injury, access complications and contrast-induced nephropathy, but this treatment is associated with less perioperative morbidity and mortality [6].…”

Evidence Based Training Strategies to Improve Clinical Practice in Endovascular Aneurysm Repair

“…This allows physicians to routinely test and optimise their strategies, to choose appropriate devices and identify potential problems in advance, both in basic and more complex cases. 47,48 A recent RCT showed that patient specific rehearsal using VR simulation effectively allows both experienced and less experienced endovascular teams to actively rehearse procedures and to adapt their treatment plans (e.g., C-arm angles for visualisation of landing zones, orientation of contralateral limb). It also enhances teamwork and reduces both minor (e.g., asking for the wrong endovascular tool) and major errors (e.g., inadvertently overstenting the internal iliac artery).…”