Management of abdominal aortic aneurysm in nonagenarians: A single-centre experience

Pasqui, Edoardo; Donato, Gianmarco de; Giannace, Giovanni; Panzano, Claudia; Setacci, Carlo; Palasciano, Giancarlo

doi:10.1177/1708538120936831

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…Endovascular aneurysm repair has been established as fundamental alternative to OR, allowing to treat patients with a minimally invasive technique. Time has permitted to develop new technologies capable of threating difficult anatomies ( 26 – 29 ) and very high-risk patients ( 30 ). A similar sexual dysfunction has been reported after EVAR, but the recovery to the preoperative level was faster with EVAR than after OR ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Erectile Dysfunction in Patients With Abdominal Aortic Aneurysm: An Exploratory Study

Donato

Pasqui

Gargiulo

et al. 2022

Front. Cardiovasc. Med.

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IntroductionErectile dysfunction (ED) is defined as the recurrent inability to achieve and maintain a satisfactory erection for sexual intercourse. Many studies have highlighted that ED shares common cardiovascular risk factors with cardiovascular disease. No data are reported about the prevalence of ED in patients with the abdominal aortic aneurysm (AAA). The aim of our study was to investigate the preoperative information given about sexual functions of patients undergoing endovascular aneurysm repair (EVAR) and to compare it with the presence and severity of steno-occlusive atherosclerotic lesions of the pelvic arterial tree at pre-operative Computed Tomography Angiography (CTA).MethodsWe prospectively enrolled all men patients who underwent elective EVAR from September to November 2021. Preoperative ED was evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Preoperative imaging was routinely performed with CTA scan of the abdominal aorta and iliac-pelvic district. An innovative score of pelvic arterial disease associated to AAA was defined, dividing the iliac district in 4 zones attributing a grading of severity for each zone bilaterally (score ranges 0–24). Linear regression analysis was used to correlate IIEF-5 score to anatomical score of pelvic arterial steno-occlusive disease.ResultsA total of 25 patients were enrolled. Median age was 74 ± 5.3 years. IIEF-5 average score was 14.8 ± 7.1. Eight cases (32%) had severe ED; one case (4%) had moderate, five patients (20%) had mild to moderate ED; five patients (20%) had mild ED, and 6 (24%) patients had no ED. CTA evaluation revealed an average anatomical score of 7.9 ± 4.5. Pelvic disease was considered moderate-severe in 20 cases (80%) and not significant in 20% (five cases). Linear regression analysis confirmed the hypothesis that a more diseased pelvic arterial tree was correlated to a more severe ED (Y = −1.531* × + 26.35 [slope CI: −1.946 to −1.117, p < 0.0001]).ConclusionAlthough typically unreported, the prevalence of ED associated to AAA was found to be high. A vasculogenic origin of ED in patients with AAA is plausible and may be easily confirmed by the evaluation of pelvic arterial distribution at angio-CT performed for EVAR planning. Our proposed “MAPPING AND SCORING SHEET” may help to identify the vasculogenic origin of ED in AAA patients.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Erectile Dysfunction in Patients With Abdominal Aortic Aneurysm: An Exploratory Study

Donato

Pasqui

Gargiulo

et al. 2022

Front. Cardiovasc. Med.

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“…The patient was hospitalized to perform in the following days an endovascular repair of the AAA with the implantation of a bifurcated aortic endograft. [23,24]. In the next hours, the patient started to be hemodynamically unstable with significant hemoglobin loss.…”

Section: Pre-rupture Patient-specific Model Reconstructionmentioning

confidence: 99%

Image-Based Numerical Investigation in an Impending Abdominal Aneurysm Rupture

Boniforti

Cesaroni

Magini

et al. 2022

Fluids

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Blood flow dynamics plays a crucial role in the growth and rupture of abdominal aortic aneurysms. The aim of this study was to analyze the possibility of predicting aneurysmal rupture by numerical investigations based on diagnostic images. The blood flow dynamics was analyzed in a patient-specific abdominal aortic aneurysm, reconstructed from CT images of an aneurysm while it was rupturing. The patient-specific geometry was virtually repaired in order to obtain a non-ruptured model representative of the geometry immediately preceding the rupture. To reproduce physiological conditions, numerical simulations were performed under pulsatile flow conditions, and blood was modelled as a non-Newtonian fluid, using the Carreau rheological model. Hemodynamic parameters that influence the rupture of the aneurysm were investigated, and their possible association with vascular disease was discussed. The results of the numerical simulations indicated regions of slow recirculation and low values of Time Averaged Wall Shear Stress (TAWSS) in the region of rupture. Unlike literature results, a high Oscillatory Shear Index (OSI) was not clearly found in this region. Nevertheless, just in the region where the rupture will occur, high values of Endothelial Cell Activation Potential index (ECAP) were found. This index is therefore extremely significant for assessing the vulnerability of the aortic wall and locating the critical rupture region.

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“…EVAR represents a minimally invasive technique that has overcome some critical issues of open surgical repair such as higher intraoperative and perioperative risk; the necessity of general anesthesia; intensive care unit stay; and higher cardiac, pulmonary, and renal complications [ 7 ]. These advantages led to a constant increase in the AAA treatment feasibility, especially in elderly patients with a substantial number of comorbidities that could be treated with reasonable perioperative risks [ 8 ] and good early and mid-term outcomes [ 9 ] even in emergency settings [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Abdominal Aortic Aneurysm Repair With Ovation Alto Stent Graft: Protocol for the ALTAIR (ALTo endogrAft Italian Registry) Study

Donato¹,

Pasqui²,

Sirignano³

et al. 2022

JMIR Res Protoc

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Background Since 2010, the Ovation Abdominal Stent Graft System has offered an innovative sealing option for abdominal aortic aneurysm (AAA) by including a sealing ring filled with polymer 13 mm from the renal arteries. In August 2020, the redesigned Ovation Alto, with a sealing ring 6 mm closer to the top of the fabric, received CE Mark approval. Objective This registry study aims to evaluate intraoperative, perioperative, and postoperative results in patients treated by the Alto stent graft (Endologix Inc.) for elective AAA repair in a multicentric consecutive experience. Methods All consecutive eligible patients submitted to endovascular aneurysm repair (EVAR) by Alto Endovascular AAA implantation will be included in this analysis. Patients will be submitted to EVAR procedures based on their own preferences, anatomical features, and operators experience. An estimated number of 300 patients submitted to EVAR with Alto stent graft should be enrolled. It is estimated that the inclusion period will be 24 months. The follow-up period is set to be 5 years. Full data sets and cross-sectional images of contrast-enhanced computed tomography scan performed before EVAR, at the first postoperative month, at 24 or 36 months, and at 5-year follow-up interval will be reported in the central database for a centralized core laboratory review of morphological changes. The primary endpoint of the study is to evaluate the technical and clinical success of EVAR with the Alto stent graft in short- (90-day), mid- (1-year), and long-term (5-year) follow-up periods. The following secondary endpoints will be also addressed: operative time; intraoperative radiation exposure; contrast medium usage; AAA sac shrinkage at 12-month and 5-year follow-up; any potential role of patients’ baseline characteristics, valuated on preoperative computed tomography angiographic study, and of device configuration (number of component) in the primary endpoint. Results The study is currently in the recruitment phase and the final patient is expected to be treated by the end of 2023 and then followed up for 5 years. A total of 300 patients will be recruited. Analyses will focus on primary and secondary endpoints. Updated results will be shared at 1- and 3-5-year follow-ups. Conclusions The results from this registry study could validate the safety and effectiveness of the new design of the Ovation Alto Stent Graft. The technical modifications to the endograft could allow for accommodation of a more comprehensive range of anatomies on-label. Trial Registration ClinicalTrials.gov NCT05234892; https://clinicaltrials.gov/ct2/show/NCT05234892 International Registered Report Identifier (IRRID) PRR1-10.2196/36995

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Management of abdominal aortic aneurysm in nonagenarians: A single-centre experience

Cited by 8 publications

References 19 publications

Prevalence of Erectile Dysfunction in Patients With Abdominal Aortic Aneurysm: An Exploratory Study

Prevalence of Erectile Dysfunction in Patients With Abdominal Aortic Aneurysm: An Exploratory Study

Image-Based Numerical Investigation in an Impending Abdominal Aneurysm Rupture

Endovascular Abdominal Aortic Aneurysm Repair With Ovation Alto Stent Graft: Protocol for the ALTAIR (ALTo endogrAft Italian Registry) Study

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