Staged Fenestrated Endovascular Aneurysm Repair Using Femoral Conduits in a Patient with Aortoiliac Occlusive Disease and Contemporary Literature Review.

The modern open surgical management of abdominal aortic aneurysm (AAA) has changed little since its inception in the 1950s. Endoaneurysmorrhaphy, first described by Rudolph Matas in 1888, involved ligating the branches of an aneurysm from within the aneurysm sac. Approximately 25 years later at the

Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association

The disturbances in hemostasis are often in open surgical repair (OR) and endovascular repair (EVAR) of an abdominal aortic aneurysm (AAA). These changes may influence the perioperative and early postoperative period inducing serious complications. The aim of this study was to compare the impact of OR and EVAR of AAA on clot quality assessed by rotational thromboelastometry (ROTEM®) tests. The study included 40 patients who underwent elective AAA surgery and were devided into two groups (the OR and the EVAR group - 20 patients in each group). The ROTEM ® test was performed in 4 points: point 1 - 10 min before starting anesthesia in both groups; point 2 - 10 min after aortic clapming in the OR group and 10 min after the stent-graft trunk release in the EVAR group; point 3 - 10 min after the releasing of aortic clamp in the OR group and 10 min after stentgraft placement and releasing the femoral clamp in the EVAR group; point 4 - one hour after the procedure in both groups. Three ROTEM® tests were performed as: extrinsically activated assay with tissue factor (EXTEM), intrinsically activated test using kaolin (INTEM), and extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM). All tests included the assessment of the maximum clot firmness (MCF) and the platelet component of clot strength was presented as maximal clot elasticity (MCE). No significant difference in age, gender and diameter of AAA between groups was found. The time required for the procedure was significantly longer and loss of blood was greater in the OR group than in the EVAR group (p < 0.001). The significant deviation of MCF values in EXTEM test was found mainly in the point 3 (p ≤ 0.004) with significant difference between groups (p < 0.001). A significant difference of MCF values in INTEM test between groups was found in the points 3 and 4 (p < 0.001), which were dose-dependent by heparin sulfate. The MCF values in FIBTEM test were more prominent in the OR group than in the EVAR group without significant difference. The significant changes of MCF values in the FIBTEM test were found during time in both groups (p < 0.001). The values of MCE were lower in both groups, but without significant changes and difference between groups (p = 0.105). The disorders of hemostatic parameters assessed by ROTEM® tests are present in both the OR and the EVAR groups being more prominent in OR of AAA. Vigilant monitoring of hemostatic parameters evaluated by ROTEM® tests could help in administration of the adequate and target therapy in patients who underwent EVAR or OR of AAA.

Primary aortoenteric fistula following endovascular aortic repair due to type II endoleak

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Effectiveness of open versus endovascular abdominal aortic aneurysm repair in population settings: A systematic review of statewide databases

Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the united states during 2001

Rate of Secondary Intervention After Open Versus Endovascular Abdominal Aortic Aneurysm Repair

Endovascular infrarenal aortic aneurysm repair: Perhaps we've gone about it all wrong

The limits of endovascular aortic aneurysm repair

Recommendations on the Use of Open Surgical and Endovascular Aneurysm Repair for the Management of Unruptured Abdominal Aortic Aneurysm from the Guideline Development Committee Appointed by the UK National Institute for Health and Care Excellence

Recently published long-term outcomes of the UK Endovascular Abdominal Aortic Aneurysm Repair (EVAR) trial investigators and the Dutch Randomized Endovascular Aneurysm Repair group have continued to demonstrate the superiority of EVAR in the perioperative period, but they have failed to establish long-term sustainable durability compared to open repair because of increased graft-related complications and reinterventions.1,2 In 2005, thoracic endovascular aneurysm repair (TEVAR) was approved in the United States for the treatment of descending thoracic aortic aneurysms (DTAAs). This approval, based on the results of a phase II trial3 evaluating the GORE TAG endovascular prosthesis (W.L. Gore and Associates, Newark, Delaware), led to a nationwide explosion in the use of thoracic endovascular techniques for managing DTAAs.4 Physicians had already been performing EVAR for more than a decade. Whereas EVAR was initially used to repair abdominal aneurysms with a favorable anatomy, its use later expanded to include complex cases involving a short aneurysmal neck, a tortuous aorta, and (more recently) aneurysmal rupture. Although TEVAR has only a brief history, a similar trend is obvious: This approach is being used with reasonable success to treat dissections and even ruptured aneurysms5; in addition, various new debranching techniques are allowing TEVAR to be applied to portions of the aorta previously deemed unapproachable. Article see p 2718 Najibi and colleagues6 reported the results of the first study to compare TEVAR with open aortic repair. Their series comprised 18 patients, and the control group included a historic cohort of patients who had undergone open aortic repair during the previous 3 years. Short-term follow-up data showed that the endovascular group had significantly shorter operative times, shorter hospital and intensive-care–unit stays, and less operative blood loss. Subsequently, Bavaria and associates7 reported the results of a phase II multicenter trial that assessed GORE …

Obesity is Not an Independent Factor for Adverse Outcome after Abdominal Aortic Aneurysm Repair

Early and delayed rupture after endovascular abdominal aortic aneurysm repair in a 10-year multicenter registry

Abdominal aortic aneurysms (AAA) are a common disorder with an estimated incidence of 4–7% in western countries. The goal is to repair these when they meet size requirement to prevent impending rupture which carries significant mortality and morbidity. Endovascular abdominal aortic aneurysm repair (EVAR) is gradually replacing open repair. The decreased mortality and morbidity with endovascular repair have been confirmed by multiple trials. Furthermore, the constant evolution of endovascular technology has allowed for management of complex aneurysms in patients who are poor candidates for open repair with the use of fenestrated EVAR (FEVAR), chimney EVAR (ch-EVAR), and physician-modified endografts (PMEG). In this chapter, we will review the indications of endovascular treatment for AAA, current endovascular devices available for treatment, preoperative planning, operative technique, postoperative surveillance, and postoperative complications.KeywordsAbdominal aortic aneurysms (AAA)Endovascular abdominal aortic aneurysm repair (EVAR)Open repair of aortic aneurysmFenestrated endovascular abdominal aortic aneurysm repair (FEVAR)Chimney endovascular abdominal aortic aneurysm repair (ch-EVAR)Physician-modified endografts (PMEG)