The Incidence of Para-Anastomotic Aneurysm After Open Repair Surgery for Abdominal Aortic Aneurysm Through Routine Annual Computed Tomography Imaging

Serizawa, Fukashi; Ohara, Masato; Kotegawa, Teruki; Watanabe, S.; Shimizu, Takuya; Akamatsu, Daijirou

doi:10.1016/j.ejvs.2021.01.010

Cited by 5 publications

(3 citation statements)

References 14 publications

(13 reference statements)

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“…For instance, open repair includes the option of the reimplantation of segmental arteries, which is not possible in endovascular treatment. On the other hand, in open repair there is the postoperative risk of paraanastomotic aneurysm development, especially in the case of a proximal anastomosis close to the healthy aorta [19]. Also, open repair is more frequently associated with intra-, and postoperative systemic hypoperfusion due to blood loss or a more severe systemic inflammatory response, in turn increasing the risk of SCI [20,21].…”

Section: Discussionmentioning

confidence: 99%

Increased Aortic Exclusion in Endovascular Treatment of Complex Aortic Aneurysms

Verhagen

Eefting

Rijswijk

et al. 2023

JCM

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Purpose: Perioperative risk assessments for complex aneurysms are based on the anatomical extent of the aneurysm and do not take the length of the aortic exclusion into account, as it was developed for open repair. Nevertheless, in the endovascular repair (ER) of complex aortic aneurysms, additional segments of healthy aorta are excluded compared with open repair (OR). The aim of this study was to assess differences in aortic exclusion between the ER and OR of complex aortic aneurysms, to subsequently assess the current classification for complex aneurysm repair. Methods: This retrospective observational study included patients that underwent complex endovascular aortic aneurysm repair by means of fenestrated endovascular aneurysm repair (FEVAR), fenestrated and branched EVAR (FBEVAR), or branched EVAR (BEVAR). The length of aortic exclusion and the number of patent segmental arteries were determined and compared per case in ER and hypothetical OR, using a Wilcoxon signed-rank test. Results: A total of 71 patients were included, who were treated with FEVAR (n = 44), FBEVAR (n = 8), or BEVAR (n = 19) for Crawford types I (n = 5), II (n = 7), III (n = 6), IV (n = 7), and V (n = 2) thoracoabdominal or juxtarenal (n = 44) aneurysms. There was a significant increase in the median exclusion of types I, II, III, IV, and juxtarenal aneurysms (p < 0.05) in ER, compared with hypothetical OR. The number of patent segmental arteries in the ER of type I–IV and juxtarenal aneurysms was significantly lower than in hypothetical OR (p < 0.05). Conclusion: There are significant differences in the length of aortic exclusion between ER and hypothetical OR, with the increased exclusion in ER resulting in a lower number of patent segmental arteries. The ER and OR of complex aortic aneurysms should be regarded as distinct modalities, and as each approach deserves a particular risk assessment, future efforts should focus on reporting on the extent of exclusion per treatment modality, to allow for appropriate comparison.

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Section: Discussionmentioning

confidence: 99%

Increased Aortic Exclusion in Endovascular Treatment of Complex Aortic Aneurysms

Verhagen

Eefting

Rijswijk

et al. 2023

JCM

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“…The true rate of proximal aortic para-anastomotic aneurysms following open AAA repair is unknown since a significant number of these patients are irregularly followed. A recent study by Serizawa et al 5 found, in a cohort of patients with mean follow-up of 7.1 years, under routine follow-up, an incidence of para-anastomotic aneurysms of 2.2 and 3.6% at 5 and 10 years, respectively. However, rates as high as 10 to 15% have been described.…”

Section: Endovascular Repair Of Late Abdominal Aortic Open Repair Com...mentioning

confidence: 93%

“…1,2 Contrary to endovascular aortic repair, in which the disease segment is excluded from the circulation but not resected, requiring lifetime disease progression surveillance, follow-up after open repair is not as standardized and is frequently overlooked. [3][4][5] This leads to a significant number of late complications after open repair being missed, diagnosed at a very late stage, or even presenting as urgent complications such as aortic rupture or aorto-enteric fistula. To address this, some societies have advocated for longterm follow-up with computed tomography (CT) imaging at 5 years after open aortic repair.…”

Section: Introductionmentioning

confidence: 99%

Secondary Endovascular Conversions for Failed Open Repair

Melo,

Spath,

Stana

et al. 2023

Aorta (Stamford)

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Late aortic and graft-related complications after open aortic repair are not infrequent and a significant number of them are missed, diagnosed at a very late stage, or present as urgent complications such as aortic rupture or aorto-enteric fistula. Once a late complication is diagnosed and reintervention is necessary, both open and endovascular strategies are possible. Open reintervention is complex and usually associated with very high rates of morbidity and mortality. Endovascular techniques may offer several solutions for these cases, which may be tailored to the patient and specific complication. In this review, we aim to summarize current indications, options, and strategies for endovascular salvage after failed or complicated open surgical repair.

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Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms

Wanhainen,

Van Herzeele,

Bastos Goncalves

et al. 2024

European Journal of Vascular and Endovascular Surgery

114

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The Incidence of Para-Anastomotic Aneurysm After Open Repair Surgery for Abdominal Aortic Aneurysm Through Routine Annual Computed Tomography Imaging

Cited by 5 publications

References 14 publications

Increased Aortic Exclusion in Endovascular Treatment of Complex Aortic Aneurysms

Increased Aortic Exclusion in Endovascular Treatment of Complex Aortic Aneurysms

Secondary Endovascular Conversions for Failed Open Repair

Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms

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