Open Surgical and Endovascular Conduits for Difficult Access During Endovascular Aortic Aneurysm Repair

Oderich, Gustavo S.; Picada-Correa, Mateus; Pereira, Alexandre Araújo

doi:10.1016/j.avsg.2012.03.006

Cited by 20 publications

(14 citation statements)

References 41 publications

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“…Standard surgical precautions should be taken to avoid ureteral injury and sympathetic plexus injury on the left side in men. Despite their advantages, however, surgical conduits should be used judiciously, given their reported association with longer operative times, hernias, prosthetic remnant infection, and prolonged recovery [22].…”

Section: Surgical Conduitsmentioning

confidence: 99%

“…Alternatively, snared brachial-femoral wire access allows for a "body-floss" effect to stabilize the advancement of the delivery system through acutely angulated, redundant iliac arteries [27,28]. For the brachial-femoral technique, it is useful to have an extended shaft brachial sheath to prevent the wire from transecting the subclavian-aortic junction or other angulated arterial segments [22].…”

Section: Alternative Adjunctive Techniquesmentioning

confidence: 99%

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Endovascular Aortic Aneurysm Repair in Patients with Aortoiliac Occlusive Disease

Mangum¹,

Fereydooni²,

Nassiri³

2019

Vascular Access Surgery - Tips and Tricks

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Although endovascular aortic aneurysm repair (EVAR) has become an attractive, minimally invasive option for patients with abdominal aortic aneurysms (AAA), significant challenges in arterial access exist in patients with concomitant aortoiliac occlusive disease (AIOD), particularly for more advanced TASC C and D lesions. Under these circumstances, endograft delivery is possible but requires extensive preoperative planning and intraoperative techniques including but not limited to surgical conduit creation, plain balloon angioplasty, endoconduit placement, and subintimal recanalization. Newer generation aortic endografts have also shown promise in accommodating compromised access vessels. Concomitant AIOD and compromised access vessels complicate EVAR and increase operative time and complexity. Therefore, extreme caution, meticulous preoperative planning, familiarity and facility with the various surgical and endovascular options needed to circumvent these obstacles are essential for safe and effective delivery of EVAR in this high-risk subset of patients. The purpose of this chapter is to present standard approaches for access in patients undergoing EVAR; discuss how advanced AIOD precludes routine access; and present various methods to overcome difficult access in patients undergoing EVAR.

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Section: Surgical Conduitsmentioning

confidence: 99%

Section: Alternative Adjunctive Techniquesmentioning

confidence: 99%

Endovascular Aortic Aneurysm Repair in Patients with Aortoiliac Occlusive Disease

Mangum¹,

Fereydooni²,

Nassiri³

2019

Vascular Access Surgery - Tips and Tricks

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show abstract

“…15 It is usually performed under general anesthesia to take abdominal incision, layer by layer separation of soft tissue to show AAA proximal and distal aneurysm neck and expose AAA. 16 Compared with EVAR, OSR may increase the risk of ureteric or iliac vein injury, especially in obese patients or in case of previous abdominal operations, but it has lower costs than EVAR, which brings convenience and reduces economic burden to patients for the treatment of AAA. 17 EVAR and OSR are furnished with different advantages and shortcomings, and their efficacies in the treatment of different diseases are discrepant.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Efficacy of Endovascular Aneurysm Repair Versus Open Surgical Repair in Middle/High-Risk Patients With Abdominal Aortic Aneurysm

Zhang

Song²,

Wang³

2016

American Journal of Therapeutics

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To explore the efficacy of endovascular aneurysm repair (EVAR) compared with traditional open surgical repair (OSR) in the treatment of middle/high-risk patients with abdominal aortic aneurysm (AAA). With a retrospective method, we analyzed the clinical data of 57 patients with middle/high-risk AAA admitted to Linyi People's Hospital Affiliated to Shandong University from January 2010 to January 2014. Twenty-eight of the 57 patients received EVAR and 29 others received OSR. Statistical analysis was conducted by the design of spreadsheet according to preoperative, intraoperative, perioperative, and postoperative follow-up relevant information. Our study showed that the difference in baseline characteristics of different therapies in middle/high-risk AAA patients was not statistically significant in preoperative period (P > 0.05). In intraoperative period, the efficacy of middle/high-risk AAA patients in EVAR group was significantly superior to OSR group in terms of blood loss, blood transfusion, and general anesthesia rate (all P < 0.01). In perioperative period, the ICU observation time and the average fasting time of middle/high-risk AAA patients in EVAR group were remarkably lower than OSR group (all P < 0.01), but the average hospital stay and the operation cost of middle/high-risk AAA patients in EVAR group were notably higher than OSR group. In postoperative follow-up period, OSR group was identified with a lower incidence of surgery-related complications than EVAR group (P < 0.05), but EVAR group was demonstrated with a higher survival rate than OSR group (P < 0.05); after 12 months of follow-up, SF-36 scale scores in OSR group were higher than EVAR group (P < 0.05). In conclusion, EVAR may have a better short-term effect, whereas OSR may have a better long-term effect in the treatment of middle/high-risk AAA patients.

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“…However, endovascular treatment can be difficult to perform due to challenging anatomical characteristics. Angulation of the common iliac artery or external iliac artery commonly interferes with endovascular treatment for aortic aneurysm, while aortic angulation rarely causes difficulty in performing surgery [ 2 , 3 ]. We report the operative procedure for a case of severe aortic angulation in which traditional TEVAR would have been difficult.…”

Section: Introductionmentioning

confidence: 99%

Thoracic endovascular aortic repair of a severely angulated aorta using a double-wire technique

et al. 2016

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When endovascular treatment is performed, angulation of the access route for a device can make the operative procedure difficult. We encountered a case in which we successfully completed thoracic endovascular aortic repair (TEVAR) in a patient with severely angulated aorta by applying ‘double-wire technique’. The patient was an 80-year-old woman. An aneurysm with a 71-mm diameter was observed in the descending aorta. We performed TEVAR. Device delivery could not be achieved by a conventional procedure using one guide wire since the peripheral aorta was severely angulated. Therefore, in addition to a guide wire for main body, a stiff wire and a stiff sheath were introduced to straighten the angulation. The device was successfully introduced and TEVAR was completed. We used the Relay Plus® that facilitates tracking through the angulation. The device has a dual structure consisting of a hard sheath and a flexible sheath. We performed TEVAR successfully.

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Open Surgical and Endovascular Conduits for Difficult Access During Endovascular Aortic Aneurysm Repair

Cited by 20 publications

References 41 publications

Endovascular Aortic Aneurysm Repair in Patients with Aortoiliac Occlusive Disease

Endovascular Aortic Aneurysm Repair in Patients with Aortoiliac Occlusive Disease

Comparison of Efficacy of Endovascular Aneurysm Repair Versus Open Surgical Repair in Middle/High-Risk Patients With Abdominal Aortic Aneurysm

Thoracic endovascular aortic repair of a severely angulated aorta using a double-wire technique

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