Endovascular repair of abdominal aortic aneurysms: Device-specific outcome

Abstract

There are significant differences in frequency of limb occlusion and endoleak between groups with different endovascular devices. Knowledge of these and other differences is instructional in development of next-generation endovascular devices, incorporating design features linked to satisfactory outcome while abandoning those associated with device failure.

Risk-Adjusted Outcome Analysis of Endovascular Abdominal Aortic Aneurysm Repair in a Large Population:How Do Stent-Grafts Compare?

“…10,[13][14][15]19,26,27 The analysis reproduced the widely recognized differences in the incidence of type II endoleak with different stent-graft models. 13,26 Additionally, differences were also observed in relation to device-related endoleaks between different endografts, some persisting after risk adjustment. Lower incidences of device-related endoleak reflect a combination of maintaining proximal and distal seal and fixation and also better modular stability.…”

“…[11][12][13][14][15][16]26 Based upon small numbers, these studies identified several factors that potentially influence outcome. Patient-related risk factors, such as age and comorbidities, mainly influence short-term results.…”

“…Changes in aneurysm diameter remain an important marker of aneurysm exclusion, and device-specific dif- van ferences have been reported. 13,26,28,29 Certain stent-graft makes (e.g., Zenith) are associated with shrinkage more than others. The persistence of differences after risk adjustment (e.g., for endoleak) in this study might suggest an additional role for device components, such as fabric, in influencing postoperative changes in aneurysm size.…”

What is the significance of endoleaks and endotension

“…To avoid type II endoleak, IMA or large lumbar arteries can be embolized before stent grafting [15,16] (Fig. 5).…”

“…Endotension with sac enlargement raises the the possibility of an aneurysm rupture. The phenomenon of endotension is unusual, and is seen in only 2% to 5% of patients after EVR [11,[13][14][15]. At present, the significance of endoleaks and their relationship to aneurysm enlargement and rupture is unclear.…”