Impact of transrenal aortic endograft placement on endovascular graft repair of abdominal aortic aneurysms

Early (12 months) results suggest similar clinical performance of the Endurant stent graft system in endovascular treatment of AAAs with friendly and hostile anatomies, however, demonstrating more intra- and perioperative adversities for the last group. Larger prospective studies or even randomized trials comparing different new generation graft models are required to evaluate the comparable long-term results and possible expansion of EVAR indications for this specific endograft in adverse anatomies.

Section: Discussionmentioning

confidence: 99%

Early results of the Endurant endograft system in patients with friendly and hostile infrarenal abdominal aortic aneurysm anatomy

Georgiadis

Trellopoulos

Antoniou

et al. 2011

“…To date, several observational studies have reported the efficacy and safety of suprarenal endograft fixation. [280][281][282][283][284] Moreover, almost 50% and 87% of endografts used in the DREAM and EVAR-1 trials, respectively, were performed with endografts that used suprarenal fixation. Significantly, rates of renal dysfunction appear to be equivalent for endografts with transrenal nitinol or stainless steel stents and not significantly different among patients undergoing EVAR with infrarenal or suprarenal fixation.…”

Section: Endovascular Repairmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

625

520

DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

“…In addition, a proximal uncovered portion allows for transrenal fixation, which may assist with the treatment of aneurysms with short aortic necks. 8,9 The Talent enhanced Low Profile System (eLPS; Medtronic Vascular, Santa Rosa, Calif), with the CoilTrac delivery system, received approval for use in EVAR from the United States Food and Drug Administration (FDA) in April 2008 based on data derived from the pivotal trial and the CoilTrac confirmatory study. The pivotal trial evaluated the safety and efficacy of the Talent eLPS compared with a historical open repair control group.…”

mentioning

confidence: 99%

Five-year results for the Talent enhanced Low Profile System abdominal stent graft pivotal trial including early and long-term safety and efficacy

Turnbull

Criado

Sánchez

et al. 2010

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