Endovascular treatment of abdominal aortic aneurysms: 6 years of experience at a single centre

Fossaceca, Rita; Guzzardi, Giuseppe; Cerini, Paolo; Terlizzi, M. Di; Malatesta, Emanuele; Filice, Letícia de Souza Castro; Brustia, Piero; Carriero, Alessandro

doi:10.1007/s11547-012-0905-8

Cited by 3 publications

(15 citation statements)

References 38 publications

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“…During the study period we treated, elective and emergency, intravascularly, a total of 270 patients with AAA [17], 60 patients with TAA [18], and 36 patients with isolated iliac aneurysms [19].…”

Section: Methodsmentioning

confidence: 99%

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Fossaceca

Guzzardi

Cerini

et al. 2013

Cardiovasc Intervent Radiol

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Objective This study was designed to evaluate the effectiveness of endovascular treatment (EVAR) for ruptured abdominal aortic aneurysms (rAAAs). Methods Between September 2005 and December 2012, 44 patients with rAAA suitable for endovascular repair underwent emergency EVAR. We did not consider hemodynamic instability to be a contraindication for EVAR. Results Successful stent-graft deployment was achieved in 42 patients, whereas 2 required open surgical conversion. The overall 30-day mortality was 10 of 44 patients (5/34 in stable patients, 5/10 in unstable patients). Postoperative complications were observed in 7 of 44 patients (16 %): 5 patients developed abdominal compartment syndrome requiring decompressive laparotomy; 1 patient developed bowel ischemia; 1 patient had limb ischemia, and 1 had hemodynamic shock. Mean length of intensive care unit stay was 2.9 (range 2-8) days, and mean length of hospital stay was 8.6 (range 0-18) days. At a mean follow-up of 22.2 (range 1-84) months, the overall incidence of endoleak was 23.5 %: 1 type I and 7 type II endoleaks. Conclusions Our study demonstrates that EVAR of rAAA is associated with acceptable mortality and morbidity rates in dedicated centers.

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Section: Methodsmentioning

confidence: 99%

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Fossaceca

Guzzardi

Cerini

et al. 2013

Cardiovasc Intervent Radiol

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“…The majority of studies (17/27 studies with a total of 6770 participants) did not specify the type of AAA or reported only that participants had 'abdominal aortic aneurysm'. 40,41,67,69,[72][73][74][76][77][78][79][80][81][82][86][87][88][89][90] In four studies, participants (total of 898) were reported to have infrarenal AAAs; 70,71,84,85 in two studies participants (total of 295) were reported to have iliac artery aneurysms; 66,83 in two other studies, participants (total of 195) were reported to have asymptomatic aneurysms; 77,79 in three studies, participants (total of 45) were reported to have symptomatic aneurysms; 75,77,79 and, in two studies, participants (total of 39) were reported to have ruptured AAAs. 68,75…”

Section: Length Of Follow-upmentioning

confidence: 97%

“…The 22 cohort studies published in full were of mixed quality (Figure 3). 40,41,[68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] The individual study-level results are detailed in Appendix 6. For the majority of studies, over half or more of the ReBIP criteria were not met, or the information provided in the studies was insufficient to determine if the criteria were met, and were, therefore, judged as being of low or moderate quality.…”

Section: Cohort Studiesmentioning

confidence: 99%

“…Nine of the included studies were conducted in the USA, 40,[69][70][71]73,80,81,87,88 six studies were conducted in Italy, 66,75,76,83,86,89 three studies were conducted in Germany, 68,77,84 three studies were conducted in the UK, 41,78,82 two studies were conducted in France, 72,85 one study was conducted in the Czech Republic, 79 one study was conducted in Norway 67 and one study was conducted throughout Europe. 74 The location was not reported in one study.…”

Section: Countrymentioning

confidence: 99%

“…Only three studies included CEU with or without CDU as a part of their surveillance strategy. 75,76,86 Of these, one study included CEU used alone at 6 months and in combination with CTA annually thereafter, 75 one study used CEU along with CTA and CDU at 1, 3, 6 and 12 months and annually thereafter 86 and, in the remaining study, the use of CEU instead of CDU was restricted to selective cases only. 76 Two of the three studies did not report the technique, 76,86 and one reported the use of SonoVue [sulphur hexafluoride microbubbles (Bracco UK, High Wycombe, UK)].…”

Section: Cohort Studiesmentioning

confidence: 99%

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Contrast-enhanced ultrasound and/or colour duplex ultrasound for surveillance after endovascular abdominal aortic aneurysm repair: a systematic review and economic evaluation

Brazzelli

Hernández

Sharma

et al. 2018

Health Technol Assess

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Background Endovascular abdominal aortic aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive than open surgery, but may be associated with important complications. Patients receiving EVAR require long-term surveillance to detect abnormalities and direct treatments. Computed tomography angiography (CTA) has been the most common imaging modality adopted for EVAR surveillance, but it is associated with repeated radiation exposure and the risk of contrast-related nephropathy. Colour duplex ultrasound (CDU) and, more recently, contrast-enhanced ultrasound (CEU) have been suggested as possible, safer, alternatives to CTA. Objectives To assess the clinical effectiveness and cost-effectiveness of imaging strategies, using either CDU or CEU alone or in conjunction with plain radiography, compared with CTA for EVAR surveillance. Data sources Major electronic databases were searched, including MEDLINE, EMBASE, Science Citation Index, Scopus’ Articles-in-Press, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database from 1996 onwards. We also searched for relevant ongoing studies and conference proceedings. The final searches were undertaken in September 2016. Methods We conducted a systematic review of randomised controlled trials and cohort studies of patients with AAAs who were receiving surveillance using CTA, CDU and CEU with or without plain radiography. Three reviewers were involved in the study selection, data extraction and risk-of-bias assessment. We developed a Markov model based on five surveillance strategies: (1) annual CTA; (2) annual CDU; (3) annual CEU; (4) CDU together with CTA at 1 year, followed by CDU on an annual basis; and (5) CEU together with CTA at 1 year, followed by CEU on an annual basis. All of these strategies also considered plain radiography on an annual basis. Results We identified two non-randomised comparative studies and 25 cohort studies of interventions, and nine systematic reviews of diagnostic accuracy. Overall, the proportion of patients who required reintervention ranged from 1.1% (mean follow-up of 24 months) to 23.8% (mean follow-up of 32 months). Reintervention was mainly required for patients with thrombosis and types I–III endoleaks. All-cause mortality ranged from 2.7% (mean follow-up of 24 months) to 42% (mean follow-up of 54.8 months). Aneurysm-related mortality occurred in < 1% of the participants. Strategies based on early and mid-term CTA and/or CDU and long-term CDU surveillance were broadly comparable with those based on a combination of CTA and CDU throughout the follow-up period in terms of clinical complications, reinterventions and mortality. The economic evaluation showed that a CDU-based strategy generated lower expected costs and higher quality-adjusted life-year (QALYs) than a CTA-based strategy and has a 63% probability of being cost-effective at a £30,000 willingness-to-pay-per-QALY threshold. A CEU-based strategy generated more QALYs, but at higher costs, and became cost-effective only for high-risk patient groups. Limitations Most studies were rated as being at a high or moderate risk of bias. No studies compared CDU with CEU. Substantial clinical heterogeneity precluded a formal synthesis of results. The economic model was hindered by a lack of suitable data. Conclusions Current surveillance practice is very heterogeneous. CDU may be a safe and cost-effective alternative to CTA, with CTA being reserved for abnormal/inconclusive CDU cases. Future work Research is needed to validate the safety of modified, more-targeted surveillance protocols based on the use of CDU and CEU. The role of radiography for surveillance after EVAR requires clarification. Study registration This study is registered as PROSPERO CRD42016036475. Funding The National Institute for Health Research Health Technology Assessment programme.

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Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

et al. 2016

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Postoperative mortality was 6.3 % in the wIFU group while it was 7.8 % in the oIFU group. There was not a statistically significant difference in the rate of postoperative mortality (p = 0.653). Technical success was 98.6 % in the wIFU group while it was 94.5 % in the oIFU group. All the patients of the wIFU group were treated with a stent-graft with under-renal sealing while in the oIFU group always an over-renal stent-graft was used. No deaths related to the aneurysm were highlighted at follow-up in both groups. There was a statistically significative difference between the two groups regarding intraoperative occlusion of renal arteries (wIFU = 1.1 %; oIFU = 4.7 %; p < 0.05) and in the development of type I endoleak (wIFU = 2.8 %; oIFU = 8.8 %; p < 0.05) CONCLUSION: EVAR in patients with hostile neck is feasible and effective with an acceptable rate of complications.

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Endovascular treatment of abdominal aortic aneurysms: 6 years of experience at a single centre

Abstract: Consistent with the literature data, our study confirms the safety and long-term efficacy of EVAR for treating AAA.

Cited by 3 publications

References 38 publications

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Contrast-enhanced ultrasound and/or colour duplex ultrasound for surveillance after endovascular abdominal aortic aneurysm repair: a systematic review and economic evaluation

Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience

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