Midterm outcomes of endovascular repair for abdominal aortic aneurysms with the on-label use compared with the off-label use of an endoprosthesis

Matsumoto, Takuya; Tanaka, Shinichi; Okadome, Jun; Kyuragi, Ryoichi; Fukunaga, Ryota; Kawakubo, Eisuke; Itoh, Hiroyuki; Okazaki, Jin; Shirabe, Ken; Fukuda, Atsushi; Maehara, Yoshihiko

doi:10.1007/s00595-014-0978-1

Cited by 19 publications

(21 citation statements)

References 14 publications

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“…14,15 The "pave and crack" technique has been proposed as a minimally invasive alternative to open retroperitoneal exposure of the access vessels when the other endovascular techniques described above fail to overcome access difficulties. 5,16 This approach may possibly eliminate the need for open surgical ilio-femoral conduits as shown in the current series where no anatomical restrictions were assumed to limit the applicability of the EC. However, this policy can make the procedure more challenging when the anatomical complexity of the iliac occlusive disease increases, such as with highly calcified occlusions combined with tortuosity.…”

Section: Discussionmentioning

confidence: 80%

Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results

Asciutto

Aronici

Resch

et al. 2017

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 80%

Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results

Asciutto

Aronici

Resch

et al. 2017

European Journal of Vascular and Endovascular Surgery

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“…Before this study, Schanzer et al found potential IFU adherence as high as 69% and as low as 42% based on preoperative imaging without knowledge of device use, with other smaller but more detailed studies showing IFU adherence between 69.3% and 58.1%. [7][8][9][10][11][12] Our observation of fewer patients being treated within IFU compared with earlier studies likely reflects the realities of patient presentation at an institution referred a large percentage of patients with more challenging anatomy. In addition, a long-standing investigational device exemption meant it was more likely that many patients had devices placed outside IFU, especially earlier in the studied period.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have attempted to look at the relationship between adherence to IFU and EVAR outcomes, but as of yet, there has failed to be a consensus on the matter. [6][7][8][9][10][11] In this study, we examined detailed anatomic as well as clinical data in an institutionally maintained database of patients undergoing EVAR to determine the effects of IFU adherence on patient outcomes.…”

mentioning

confidence: 99%

No major difference in outcomes for endovascular aneurysm repair stent grafts placed outside of instructions for use

Beckerman

Tadros

Faries

et al. 2016

Journal of Vascular Surgery

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Despite most EVAR patients being treated outside of IFU, there was no difference in outcomes with respect to all-cause mortality or aneurysm-related mortality. In addition, with the exception of perioperative blood transfusions, there was no association between IFU adherence and late-onset rupture, need for reintervention, rates of endoleak, aneurysm sac enlargement, or most other major complications.

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“…35 Iliac conduits (ie, "crack and pave" technique with endo-conduits and open retroperitoneal exposure and graft placement) have been adopted in order to establish adequate access and facilitate endovascular interventions. 36,37 Previous studies have shown that iliac conduits are required in 7.1% to 13.4% of abdominal aortic aneurysm repairs, 14,38 while 10% of thoracic endovascular aortic repairs (TEVAR) need an iliac conduit. 16 In this study, the combined iliac conduit utilization rate to treat abdominal and/or thoracic aortic pathologies was 17%.…”

Section: Discussionmentioning

confidence: 99%

Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis

et al. 2021

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Purpose: The treatment of thoracoabdominal aortic aneurysm has largely shifted to endovascular techniques. However, severe iliofemoral arterial disease often presents a challenge during these interventions. As a result, iliac conduits have been introduced to facilitate aortic endovascular therapy. The goal of the current study was to gauge utilization and to analyze iliac artery conduit outcomes to facilitate endovascular therapy to treat aortic pathologies. Materials and Methods: A meta-analysis of 14 studies was conducted with the use of random effects modeling. The incidence of periprocedural adverse events was gauged based on iliac conduit vs nonconduit cases and planned vs unplanned iliac conduit placement. Outcomes of interest included length of hospital stay, morbidity and mortality associated to conduits, and all-cause mortality. Results: Iliac conduits, either open or endo-conduits, were utilized in 17% (95% CI: 9%–27%) of 16,855 cases, with technical successful rate of 94% (95% CI: 80%–100%). Periprocedural complications occurred in 32% (95% CI: 22%–42%) of the cases, with overall bleeding complication rate being 10% (95% CI: 5%–16%). Female patients, positive history for smoking, pulmonary disease, and peripheral artery disease at baseline were associated with more frequent utilization of iliac conduits. Conduit use was associated with longer hospitalization, higher periprocedural all-cause mortality (OR: 2.85; 95% CI: 1.75–4.64; p<0.001), and bleeding complication rate (OR: 2.38; 95% CI: 1.58–3.58; p<0.001). Sensitivity analysis among conduit cases showed that planned conduits were associated with fewer periprocedural complications compared to unplanned conduits (OR: 0.38; 95% CI: 0.20–0.73; p=0.004). Conclusion: Iliac conduit placement is a feasible strategy, associated with high technical success to facilitate complex aortic endovascular repair. However, periprocedural adverse event rate, including bleeding complications is not negligible. All-cause mortality and morbidity rates among cases that require iliac conduits should be strongly considered during clinical decision making. High-quality comparative analyses between iliac conduit vs nonconduit cases and between several types of iliac conduit grafts aiming at facilitating endovascular aortic repair are still needed to determine the best strategy to address challenging iliac artery accesses.

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Midterm outcomes of endovascular repair for abdominal aortic aneurysms with the on-label use compared with the off-label use of an endoprosthesis

Abstract: Most midterm outcomes of EVAR in which the endografts were used off-label were similar to those associated with on-label use of the devices. Off-label use of EVAR endoprostheses is feasible, but requires the use of special techniques in patients with challenging anatomical features.

Cited by 19 publications

References 14 publications

Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results

Endoconduits with “Pave and Crack” Technique Avoid Open Ilio-femoral Conduits with Sustainable Mid-term Results

No major difference in outcomes for endovascular aneurysm repair stent grafts placed outside of instructions for use

Iliac Conduits for Endovascular Treatment of Aortic Pathologies: A Systematic Review and Meta-analysis

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