Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE)

Pratesi, Carlo Alberto; Esposito, Davide; APOSTOLOU, Dimitrios; Attisani, Luca; Bellosta, Raffaello; Benedetto, Filippo; BLANGETTI, Ilaria; Bonardelli, Stefano; Casini, Andrea; Fargion, Aaron Thomas; Favaretto, Elisabetta; Freyrie, Antonio; Frola, Edoardo; Miele, Vittorio; NIOLA, Raffaella; NOVALI, Claudio; PANZERA, Chiara; Pegorer, Matteo; Perini, Paolo; Piffaretti, Gabriele; Pini, Rodolfo; ROBALDO, Alessandro; Sartori, Michelangelo; STIGLIANO, Alfonso; Taurino, Maurizio; Veroux, Pierfrancesco; Verzini, Fabio; ZANINELLI, Erica; Orso, Massimiliano

doi:10.23736/s0021-9509.22.12330-x

Cited by 21 publications

(4 citation statements)

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“…Almost all the patients included in this review underwent a surveillance imaging protocol consisting of computed tomographic angiography (CTA). The great majority of the selected studies referred to guidelines suggested criteria to define a challenging neck anatomy [ 16 , 17 , 18 , 19 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of course, not all patients could be a candidate for this type of treatment, and open repair still could be considered the standard of care in patients fit for surgery [ 16 , 17 , 18 , 19 ]. However, from a technical point of view, standard EVAR could be safely and effectively performed (and consequently proposed) to those patients judged unfit for open surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, because EVAR durability is related to the maintenance of a seal between the stent graft and the aortic neck, some authors suggested that challenging the neck could affect long-term outcomes, increasing the risk of type Ia endoleak, reintervention, and aneurysm-related mortality rates [ 11 , 12 , 13 , 14 , 15 ]. As a result of these long-term results, current guidelines suggest limiting or even refraining from adopting EVAR in patients with challenging aortic necks [ 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Is Evar Feasible in Challenging Aortic Neck Anatomies? A Technical Review and Ethical Discussion

Sirignano

Ceruti

Aloisi

et al. 2022

JCM

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Background: Endovascular aneurysm repair (EVAR) has become an accepted alternative to open repair (OR) for the treatment of abdominal aortic aneurysm (AAA) despite “hostile” anatomies that may reduce its effectiveness. Guidelines suggest refraining from EVAR in such circumstances, but in clinical practice, up to 44% of EVAR procedures are performed using stent grafts outside their instruction for use (IFU), with acceptable outcomes. Starting from this “inconsistency” between clinical practice and guidelines, the aim of this contribution is to report the technical results of the use of EVAR in challenging anatomies as well as the ethical aspects to identify the criteria by which the “best interest” of the patient can be set. Materials and Methods: A literature review on currently available evidence on standard EVAR using commercially available endografts in patients with hostile aortic neck anatomies was conducted. Medline using the PubMed interface and The Cochrane Library databases were searched from 1 January 2000 to 6 May 2021, considering the following outcomes: technical success; need for additional procedures; conversion to OR; reintervention; migration; the presence of type I endoleaks; AAA-related mortality rate. Results: A total of 52 publications were selected by the investigators for a detailed review. All studies were either prospective or retrospective observational studies reporting the immediate, 30-day, and/or follow-up outcomes of standard EVAR procedures in patients with challenging neck anatomies. No randomized trials were identified. Fourteen different endo-grafts systems were used in the selected studies. A total of 45 studies reported a technical success rate ranging from 93 to 100%, and 42 the need for additional procedures (mean value of 9.04%). Results at 30 days: the incidence rate of type Ia endoleak was reported by 37 studies with a mean value of 2.65%; 31 studies reported a null migration rate and 32 a null conversion rate to OR; in 31 of the 35 studies that reported AAA-related mortality, the incidence was null. Mid-term follow-up: the incidence rate of type Ia endoleak was reported by 48 studies with a mean value of 6.65%; 30 studies reported a null migration rate, 33 a null conversion rate to OR, and 28 of the 45 studies reported that the AAA-related mortality incidence was null. Conclusions: Based on the present analysis, EVAR appears to be a safe and effective procedure—and therefore recommendable—even in the presence of hostile anatomies, in patients deemed unfit for OR. However, in order to identify and pursue the patient’s best interest, particular attention must be paid to the management of the patient’s informed consent process, which—in addition to being an essential ethical-legal requirement to legitimize the medical act—ensures that clinical data can be integrated with the patient’s personal preferences and background, beyond the therapeutic potential of the proposed procedures and what is generically stated in the guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Evar Feasible in Challenging Aortic Neck Anatomies? A Technical Review and Ethical Discussion

Sirignano

Ceruti

Aloisi

et al. 2022

JCM

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“…This can be due to loss of the proximal or distal sealing (type Ia and Ib endoleak, respectively), to retrograde perfusion through side branches (type II endoleak), to endograft component disconnection or rupture (type III endoleak). Clinical practice protocols regarding the optimal follow-up strategy are heterogeneous, as there is no agreement as to which method should be preferred [ 3 , 4 , 5 ]. In fact, computed tomography angiography (CTA) has good accuracy and reproducibility, but it is burdened by high cumulative dose radiation exposure and contrast agent nephrotoxicity, especially if used annually over a long period of time.…”

Section: Introductionmentioning

confidence: 99%

Role of Contrast-Enhanced Ultrasound in the Follow-Up after Endovascular Abdominal Aortic Aneurysm Repair

et al. 2022

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Background: The aim of this study was to assess whether contrast-enhanced ultrasound (CEUS) shows a false negative rate close to zero and therefore is suitable as the main non-invasive follow-up strategy for long-term monitoring after endovascular aortic repair (EVAR). Methods: We included all consecutive patients who underwent CEUS as follow-up after EVAR at our center between January 2017 and December 2021.The follow-up protocol consisted of Duplex ultrasound (DUS) with CEUS at 1, 3, 6 months postoperatively and every 6 months thereafter. Results: A total of 125 patients underwent 228 CEUS. The aneurysm sac showed shrinkage in 80 (64%) patients, stability in 32 (25.6%), and enlargement in 13 (10.4%). A total of 29 (23.2%) patients showed type 2 endoleak, 6 (4.8%) patients showed type 1 endoleak and 3 (2.4%) patients showed type 3 endoleak. Thirteen patients underwent one or more reinterventions. The sensitivity of CEUS vs. DUS was 100% vs. 75% (p > 0.0001). In classifying type 2 endoleak, CEUS compared to DUS showed a sensitivity of 93.2% vs. 59.4% and a specificity of 99.3% vs. 99.3%. CEUS showed a higher sensitivity compared to DUS in the detection of type 2 endoleak. CEUS permits the identification of a subset of patients requiring a stricter follow-up protocol.

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Outcomes and Economic Impact of Hypogastric Artery Management During Elective Endovascular Aortic Repair for Aorto-Iliac Aneurysms

Attisani

Villa

Bellosta

et al. 2023

Annals of Vascular Surgery

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Guidelines on the management of abdominal aortic aneurysms: updates from the Italian Society of Vascular and Endovascular Surgery (SICVE)

Cited by 21 publications

References 122 publications

Is Evar Feasible in Challenging Aortic Neck Anatomies? A Technical Review and Ethical Discussion

Is Evar Feasible in Challenging Aortic Neck Anatomies? A Technical Review and Ethical Discussion

Role of Contrast-Enhanced Ultrasound in the Follow-Up after Endovascular Abdominal Aortic Aneurysm Repair

Outcomes and Economic Impact of Hypogastric Artery Management During Elective Endovascular Aortic Repair for Aorto-Iliac Aneurysms

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