Zenith AAA endovascular graft: intermediate-term results of the US multicenter trial

Greenberg, Roy K.; Chuter, Timothy A.M.; Sternbergh, W. Charles; Fearnot, Neal E.

doi:10.1016/j.jvs.2004.02.032

Cited by 213 publications

(166 citation statements)

References 36 publications

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“…A relationship between aneurysm size and endoleaks was previously reported (1,2). Most type II endoleaks spontaneously disappear over time, but 10%-25% persist for more than six months after EVAR (3)(4)(5)(6). Persistent endoleaks with aneurysmal sac expansion are at high risk of rupture because of the continuously elevated intra-aneurysmal pressure and require a second intervention, such as embolization (7)(8)(9)(10)(11).…”

mentioning

confidence: 85%

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Nakaï

Ikoma²,

Sato³

et al. 2015

Diagn Interv Radiol

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Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair CARDIOVASCULAR IMAGINGORIGINAL ARTICLE PURPOSE We aimed to identify the risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair (EVAR). METHODSWe retrospectively reviewed contrast-enhanced computed tomography (CT) images of 143 patients who were followed for ≥6 months after EVAR. Sac expansion was defined as an increase in sac diameter of 5 mm relative to the preoperative diameter. Univariate and multivariate analyses were performed to identify associated risk factors for late sac expansion after EVAR from the following variables: age, gender, device, endoleak, antiplatelet therapy, internal iliac artery embolization, and preprocedural variables (aneurysm diameter, proximal neck diameter, proximal neck length, suprarenal neck angulation, and infrarenal neck angulation). RESULTSUnivariate analysis revealed female gender, endoleak, aneurysm diameter ≥60 mm, suprarenal neck angulation >45°, and infrarenal neck angulation >60° as factors associated with sac expansion. Multivariate analysis revealed endoleak, aneurysm diameter ≥60 mm, and infrarenal neck angulation >60° as independent predictors of sac expansion (P < 0.05, for all). CONCLUSIONOur results suggest that patients with small abdominal aortic aneurysms (<60 mm) and infrarenal neck angulation ≤60° are more favorable candidates for EVAR. Intraprocedural treatments, such as prophylactic embolization of aortic branches or intrasac embolization, may reduce the risk of sac expansion in patients with larger abdominal aortic aneurysms or greater infrarenal neck angulation.T he aim of endovascular abdominal aortic aneurysm repair (EVAR) is to prevent rupture of an abdominal aortic aneurysm (AAA) by depressurizing the aneurysm and excluding it from the systemic circulation using a stent-graft. Aneurysmal sac reduction is a reliable marker for the long-term prognosis after EVAR. Although most aneurysmal sacs shrink after EVAR, some sacs continue to expand. A relationship between aneurysm size and endoleaks was previously reported (1, 2). Most type II endoleaks spontaneously disappear over time, but 10%-25% persist for more than six months after EVAR (3-6). Persistent endoleaks with aneurysmal sac expansion are at high risk of rupture because of the continuously elevated intra-aneurysmal pressure and require a second intervention, such as embolization (7-11). However, it is difficult to predict sac expansion and persistent endoleak before performing EVAR. Although intraoperative intrasac thrombin injection and prophylactic embolization of aortic branches such as the inferior mesenteric artery and lumbar artery are reported to reduce the incidence of type II endoleak, the efficacy and clinical benefit of these procedures in terms of late postoperative aneurysm shrinkage have not been fully evaluated (12)(13)(14)(15). Therefore, the purpose of this study was to identify the risk factors associated with late...

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mentioning

confidence: 85%

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Nakaï

Ikoma²,

Sato³

et al. 2015

Diagn Interv Radiol

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“…However, research on the interference of stent wires with renal artery ostium or renal blood flow is scarce. While mid-and long-term results of suprarenal fixation of stent grafts seem satisfactory [7,8], the long-term safety of suprarenal stent grafts is still not fully understood. This is mainly because of the unknown effect of suprarenal stent wires on renal artery ostium from a long-term point of view.…”

Section: Discussionmentioning

confidence: 99%

“…Suprarenal fixation of stent grafts involves placing an uncovered suprarenal component above the renal arteries with aim of acquiring proximal fixation without compromising the renal blood flow or renal function. Although short to midterm results are satisfactory, long-term safety of the suprarenal fixation of stent grafts is yet to be determined [7,8].…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

Sun

Chaichana

2009

Cardiovasc Intervent Radiol

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Investigation of hemodynamic effect of stent wires on renal arteries in patients with abdominal aortic aneurysms treated with suprarenal stent grafts 2 Abstract Purpose: The purpose of the study was to investigate the hemodynamic effect of stent struts (wires) on renal arteries in patients with abdominal aortic aneurysms (AAA) treated with suprarenal stent grafts. Materials and Methods:Two sample patients with AAA undergoing multislice CT angiography pre-and post-suprarenal fixation of stent grafts were selected for inclusion in the study. Eight juxtarenal models focusing on the renal arteries were generated from the multislice CT datasets. Four types of configurations of stent wires crossing the renal artery ostium, namely single wire centrally crossing, single wire peripherally crossing, Vshaped wire centrally crossing and multiple wires peripherally crossing were simulated in the segmented aorta models. The blood flow pattern, flow velocity, wall pressure and wall shear stress at the renal arteries pre-and post-stent grafting were analyzed and compared using a two-way fluid structure interaction analysis. The stent wire thickness was simulated with a diameter of 0.4 mm, 1.0 mm and 2.0 mm, and hemodynamic analysis was performed at different cardiac cycles. Results:The interference of stent wires with renal blood flow was mainly determined by the thickness of stent wires, and the type of configuration of stent wires crossing the renal ostium. The flow velocity was reduced by 20-30% in most of the situations when the stent wire thickness increased to 1.0 mm and 2.0 mm. Of 4 types of configuration, the single wire crossing centrally resulted in the highest reduction of flow velocity, ranging from 21% to 28.9% among three different wire thicknesses. Wall shear stress was also dependent on the wire thickness, which decreased significantly when the wire thickness reached 1.0 and 2.0 mm.3 Conclusion: Our preliminary study showed that the hemodynamic effect of suprarenal stent wires in patients with AAA treated with suprarenal stent grafts was determined by the thickness of suprarenal stent wires. Research findings in our study are useful for follow-up of patients treated with suprarenal stent grafts to ensure long-term safety of the suprarenal fixation.

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“…[3][4][5][6][7][8][9][10][11] Furthermore, the development of devices, expansion of indications, and improved clinical results with regard to EVR are anticipated. Particularly in the case of thoracic aortic diseases, EVR offers the theoretical advantage of being minimally invasive compared with conventional open surgery under cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

“…The initial and midterm results for repair using these handmade SGs for thoracic and abdominal aortic diseases in high-risk patients are considered to be satisfactory. [3][4][5][6][7][8][9][10][11][24][25][26][27][28][29][30] However, endoleaks were the reason for poor initial results, whereas the reason for poor midterm results was migration. Furthermore, all endoleaks and migrations occurred during our early phase of surgeries using flexible SGs that were designed on the basis of a concept identical to the commercially available SGs wherein 1 device can be used to treat various aortic contours.…”

Section: Discussionmentioning

confidence: 99%

Initial and Midterm Results for Repair of Aortic Diseases With Handmade Stent Grafts

Onitsuka

Tanaka

Akashi

et al. 2006

Circ J

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Zenith AAA endovascular graft: intermediate-term results of the US multicenter trial

Cited by 213 publications

References 36 publications

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

Initial and Midterm Results for Repair of Aortic Diseases With Handmade Stent Grafts

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