Limb Graft Occlusion Following EVAR: Clinical Pattern, Outcomes and Predictive Factors of Occurrence

Cochennec, Frédéric; Becquemin, Jean‐Pierre; Desgranges, Pascal; Allaire, Éric; Kobeiter, H.; Roudot‐Thoraval, Françoise

doi:10.1016/j.ejvs.2007.01.009

Cited by 163 publications

(151 citation statements)

References 23 publications

(13 reference statements)

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“…Compared with unilateral limb occlusion, bilateral limb occlusion is relatively uncommon, with a reported incidence ranging from 0% to 0.6% and accounting for 0% to 15% of endograft occlusion cases. 2,3,[6][7][8] Total occlusion of the main body of the bifurcated stent graft is a rare condition and no previous studies have been reported on its detailed therapeutic process.…”

Section: Resultsmentioning

confidence: 99%

“…Second-or third-generation endografts have been reported to have lower incidences of graft occlusion than firstgeneration endografts. 3,7) Notably, Gore Excluder endoprosthesis (W.L. Gore & Associates, Flagstaff, Arizona), one of the currently available third-generation endografts, has been reported to more suitable for complex iliac anatomy, with a limb occlusion incidence of 0%-1.4%, 4,9) which is lower than that of Zenith stent graft (4.8%-5.5%) 4,6,8) or Endurant endograft (Medtronic Inc, Minneapolis, Minnesota) (3.4%).…”

Section: Discussionmentioning

confidence: 99%

“…1,3,7) Open surgical repair procedures include embolectomy with or without endograft replacement, anatomic bypass, and extra-anatomic bypass, such as femorofemoral crossover bypass and axillofemoral bypass. 1,3,7) If remnant thrombus is expected to remain in an endogarft after successful thrombectomy, additional endograft insertion would have been a preferable treatment option to reestablish the anatomic blood route. 11) We initially tried to open embolectomy; however, the clot in the endograft limbs could not be removed.…”

Section: Discussionmentioning

confidence: 99%

“…Endograft occlusion, a serious late complication following EVAR, has been reported to have an incidence ranging from 1.1% to 7.1%. [1][2][3][4][5][6][7][8][9] Typically, endograft limb occlusion occurs unilaterally. If endograft occlusion occurs acutely in the bilateral limb or the main body of the endograft, its pathological condition may be similar to that of acute occlusion of the abdominal aorta, a emergency treatment.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.Keywords: abdominal aortic endograft, total occlusion, axillobifemoral bypass life-threatening disease associated with high morbidity and mortality. Here we report a case of abdominal aortic endograft total occlusion that was successfully managed with axillobifemoral bypass; in addition, we discuss the treatment strategies for this critical situation. Case ReportA 72-year-old man was admitted to an emergency department of a district hospital, complaining of sudden bilateral lower extremity numbness and severe rest pain. At the age of 62, he had undergone mechanical valve replacement for aortic valve stenosis and permanent pacemaker insertion for sick sinus syndrome at the same hospital. Sixteen months ago, he had undergone abdominal aortic endograft implantation for infrarenal abdominal aortic aneurysm at a different hospital. Preoperative computed tomography (CT) showed the maximum aneurysm diameter of 62 mm, the neck angulation 10) of 77°, and the terminal aorta diameter of 21 mm (Fig. 1). A Zenith endovascular graft (Cook Inc., Bloomington, Indiana) was implanted through the right femoral approach. The procedure was performed successfully and the postoperative course was uneventful. A postoperative CT showed the neck angulation of 56° and the terminal aorta diameter of 21 mm (Fig. 1). The patient was discharged from the hospital with no endoleak. Subsequently, he had been regularly followed-up for anticoagulation therapy at a local hospital. He had not experienced intermittent claudication previously.On further examination at the district hospital, a CT showed an abdominal endograft implanted from below the orifice of the renal arteries to the bilateral common iliac arteries with complete occlusion at the mid-portion of the main body (Fig. 2). The neck angulation was 54°, and the terminal aorta diameter of 21 mm (Fig. 2). Preoperative echocardiography showed that there was no obvious thrombus in the left atrium and the left ventricle, and around the mechanical aortic valve. A diagnosis of acute endograft occlusion was made. The patient was transferred to our hospital 4 h after the onset of symptoms for

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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show abstract

“…Sivamurthy et al (10) retrospectively reviewed 248 patients who underwent EVAR from 1999 to 2004, including 13 instances of limb thrombosis in 13 patients with a total incidence of 5.2% in patients and 2.7% in limbs. Cochennec et al (11) reviewed 460 AAA patients who were selectively treated with a variety of commercially available stent grafts from 1995 to 2005. They used 369 bifurcated and 91 AUI grafts (829 limbs) in their study and found that 36 limbs in 33 patients (in 7.2% of patients and 4.3% of limbs) were occluded.…”

Section: Discussionmentioning

confidence: 99%

Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort

Wang

Zhai

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The present study investigated the incidence, causes, treatment and prevention of limb graft occlusion following endovascular aortic repair (EVAR). A total of 66 cases of abdominal aortic aneurysm receiving EVAR at our department from January 2005 to December 2013 were enrolled. After EVAR, patients received routine antiplatelet therapy of 75 mg PLAVIX for 6 months and then 100 mg Aspirin for another 6 months by oral administration. According to previous clinical experiences, antiplatelet therapy is able to effectively reduce the incidence of iliac occlusion after EVAR. A total of 61 bifurcated grafts and 5 aortauniilac grafts (127 limbs in total) were used. Physical examination, ankle-brachial-index and computer tomographic angiography were performed at 10 days, at 3, 6 and 12 months and annually thereafter. It was found that 7 limbs in 7 patients (10.6% of patients, 5.5% of limbs) were occluded between 20 days and 12 months (average, 7.8±5.3 months) after EVAR. Acute and severe ischemia was found in 2 cases, claudication was in found 3 cases, asthenia in both legs was found in 1 case and 1 case was asymptomatic. Femoral-femoral bypass, femoral-femoral bypass and stenting, aorto-iliac/femoral bypass, thrombectomy and conservative treatment were performed in 1 patient each and thrombectomy together with stenting was performed in 2 cases. Limb graft occlusion was not rare after EVAR. Treatment of this complication included surgery and endovascular therapy such as bypass, thrombectomy and thrombolysis. In conclusion, aggressive pre-emptive treatment including angioplasty and stenting prevented occlusion in certain cases.

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Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool

Perrin

Demanget

Badel

et al. 2015

Numer Methods Biomed Eng

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The mechanical behavior of aortic stent grafts plays an important role in the success of endovascular surgery for aneurysms. In this study, finite element analysis was carried out to simulate the expansion of five marketed stent graft iliac limbs and to evaluate quantitatively their mechanical performances. The deployment was modeled in a simplified manner according to the following steps: (i) stent graft crimping and insertion in the delivery sheath, (ii) removal of the sheath and stent graft deployment in the aneurysm, and (iii) application of arterial pressure. In the most curved aneurysm and for some devices, a decrease of stent graft cross-sectional area up to 57% was found at the location of some kinks. Apposition defects onto the arterial wall were also clearly evidenced and quantified. Aneurysm inner curve presented significantly more apposition defects than outer curve. The feasibility of finite element analysis to simulate deployment of marketed stent grafts in curved aneurysm models was demonstrated. The study of the influence of aneurysm tortuosity on stent graft mechanical behavior shows that increasing vessel curvature leads to stent graft kinks and inadequate apposition against the arterial wall. Such simulation approach opens a very promising way toward surgical planning tools able to predict intra and/or post-operative short-term stent graft complications.

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Limb Graft Occlusion Following EVAR: Clinical Pattern, Outcomes and Predictive Factors of Occurrence

Cited by 163 publications

References 23 publications

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Limb graft occlusion following endovascular aortic repair: Incidence, causes, treatment and prevention in a study cohort

Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool

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