Asymptomatic Infrarenal Aortic Aneurysm Research Articles

Long-term Outcomes of Elective Endovascular Repair of Asymptomatic Infrarenal Aortic Aneurysms with the Zenith Stentgraft

Long-term Outcomes of Elective Endovascular Repair of Asymptomatic Infrarenal Aortic Aneurysms with the Zenith Stentgraft

Feasability of contrast-enhanced ultrasound with image fusion of CEUS and MS-CT for endovascular grafting in infrarenal abdominal aortic aneurysm in a single patient

Currently methods to reduce radiation and contrast media application in endovascular repair of aortic aneurysms (EVAR) are investigated. First positive results for real-time contrast medium-enhanced ultrasonography (CEUS) guided endovascular aortic repair have been reported. Acombination with image fusion of CEUS and preoperative multi-slice computed tomography (MS-CT) might offer added safety regarding stent-graft positioning and sealing of the landing zones.EVAR was performed in apatient with an asymptomatic infrarenal aortic aneurysm and apenetrating aortic ulcer in the neck region. The precise placement of the stent-graft was performed with CEUS using image fusion and native intraprocedural angiographic fluoroscopy and confirmed with digital subtraction angiography (DSA) using iondinated contrast media. At follow-up, CEUS was used to exclude endoleaks and stent-graft failure or malposition.The precise CEUS-guided placement of the stent-graft was technically successful. No artifacts due to electrical noise and metallic parts of the operating table and surgical instruments occurred. The amount of iodinated contrast media was reduced as intraoperative follow-up was performed using CEUS.CEUS with image fusion combined with intraprocedural angiographic fluoroscopy enables accurate stent-graft placement without use of any nephrotoxic contrast media. This allows EVAR in patients with renal insufficiency or allergic reactions to contrast media.

Preclose Percutaneous Endurant™ Endografting with the Proglide™ Device: a Safe and Feasible Combination

Background : Endovascular repair of abdominal aortic aneurysms has been revolutionized over the last two decades. Opening the doors for a percutaneous approach by avoiding surgical exposure of the vascular access site. The goal of this report is to analyze the feasibility and efficacy of using Perclose Proglide™ through a preclose technique in a percutaneous approach to Endurant™ endografting for Asymptomatisch infrarenal aortic aneurysms in an elective setting. Methods : Between April 2011 and April 2014, 45 consecutive patients underwent percutaneous endovascular aortic aneurysm repair (PEVAR) for an asymptomatic infrarenal aortic aneurysm. Closure of percutaneous access sites was ensured with Perclose Proglide in a “preclose” technique. Data were collected in a prospective maintained database with a follow-up period of one month. Patient demographics, aneurysmal characteristics, procedural details and complications were recorded.Results : A total of 170 Proglide devices were used to close 85 access sites. Adequate hemostasis was obtained in 96.5 percent (82 of 85 access sites). Conversion to a femoral cutdown was necessary in 2.4% (2 of 85 access sites). The mean hospitalization was 2.6 days and 86.7 percent of patients were discharged within 2 days. The incidence of post-procedural access-related complications was 2.2%.Conclusions : PEVAR using the Perclose Proglide in preclosing 14Fr to 20Fr access sites for Endurant endografting in the treatment of asymptomatic infrarenal aortic aneurysms is feasible and effective. Moreover, the percutaneous approach allows for procedures to be performed under local anesthesia, while providing a low risk for access-related complications and a relatively short hospitalization.

Ultrasound-guided trans-hepatic embolization of a renal artery pseudoaneurysm in a patient with acquired solitary kidney and with chronic renal failure secondary to phenacetin abuse

A patient with a pseudoaneurysm of the right renal artery underwent treatment with percutaneous approach. No complications were observed. Based on the experience described in this report, a percutaneous ultrasound guided approach can be proposed in selected patients. Renal insufficiency and allergic reactions are potential contraindications to angiography with conventional ionic iodinated contrast dye in patients who need endovascular stent-graft placement. Real-time contrast-enhanced ultrasound (CEUS) guided endovascular procedures may provide an alternative to overcome these limitations. We report an endovascular renal artery repair in a solitary kidney patient with an asymptomatic infrarenal aortic aneurysm and renal insufficiency due to phenacetin abuse. The precise placement of the stent-graft was performed with CEUS and intraprocedural angiographic fluoroscopy without the use of any nephrotoxic contrast dye. During follow-up, CEUS was used to exclude endoleaks, stent-graft failure or malposition.

Search for Serum Biomarkers Associated with Abdominal Aortic Aneurysm Growth – A Pilot Study

Introduction Serological biomarkers could reflect asymptomatic infrarenal aortic aneurysm (AAA) activity and guide patient management. Report Serum concentrations of C-reactive protein (CRP), alpha 1-antitrypsin and lipoprotein(a) were measured in blood samples from 35 AAA patients and 35 controls and correlated with the aortic diameter and AAA growth in the previous 12 months. We found a positive correlation between CRP and AAA diameter ( r = 0.46; p = 0.007) and alpha 1-antitrypsin and AAA growth ( r = 0.55; p = 0.004). Conclusions Alpha 1-antitrypsin may be a promising biomarker of AAA growth.

Contrast-enhanced Ultrasound for Endovascular Grafting in Infrarenal Abdominal Aortic Aneurysm in a Single Patient with Risk Factors for the Use of Iodinated Contrast

Renal insufficiency and allergic reactions to contrast media are potential contraindications to angiography with conventional ionic iodinated contrast media in endovascular stent-graft placement. Real-time contrast medium-enhanced ultrasonographic (US) guidance of endovascular aortic repair might provide an alternative to overcome these limitations. The authors report on endovascular aortic repair in a patient with an asymptomatic infrarenal aortic aneurysm and renal insufficiency. The precise placement of the stent-graft was performed solely with contrast-enhanced US and intraprocedural angiographic fluoroscopy without the use of any nephrotoxic contrast media. At follow-up, contrast-enhanced US was used to exclude endoleaks and stent-graft failure or malposition.

Carbon dioxide angiography for endovascular grafting in high-risk patients with infrarenal abdominal aortic aneurysms

Allergic reactions to contrast media, preexisting renal dysfunction, and hyperthyroidism are relative contraindications for angiography with conventional contrast medium. Carbon dioxide (CO2) angiography is an alternative method in high-risk patients because CO2 is nontoxic, without allergic potential, and not iodic. CO2-related complications are extremely rare. Because renal insufficiency often occurs in vascular patients, this method will become increasingly important for endovascular surgery. We report on three consecutive patients with asymptomatic infrarenal aortic aneurysm and concomitant renal dysfunction or allergic reactions to standard contrast media. Aortic stent grafts were deployed under CO2 angiographic control without complications or worsening of renal function. (J Vasc Surg 2001;33:646-9.)

The ileocolic artery as a separate aortic branch in a patient with an aortic aneurysm

The infrarenal aorta does not usually have important arterial branches which have to be reimplanted during aortic surgery. Only when both hypogastric arteries are occluded may it be considered necessary to reimplant a patent inferior mesenteric artery in order to prevent colonic ischaemia. Accessory renal arteries should also be reattached to the aortic graft to prevent renovascular hypertension. All other aortic branches, like lumbar arteries, can be oversewn. Normally, the coeliac trunk and the superior ruesenteric artery and all the collaterals between these two systems, combined with the collateral system from the inferior mesenteric artery and/or hypogastric arteries are sufficient to preserve intestinal viability. 1'2 We report a patient, undergoing repair of an asymptomatic infrarenal aortic aneurysm, who had an ileocolic artery as a separate dominant arterial branch from the aorta. This anatomical variation has not been reported before. 1-3

Haemodynamic and metabolic response to endovascular repair of infra-renal aortic aneurysms

We have examined whether or not endovascular insertion of a bifurcated aorto-iliac graft resulted in greater intraoperative haemodynamic and metabolic stability than that achieved during conventional open graft placement. We studied 20 patients prospectively during surgery for asymptomatic infra-renal aortic aneurysm. All patients received the same anaesthetic technique. Haemodynamic data were collected continuously using indwelling radial artery and pulmonary artery catheters, allowing calculation of mean arterial pressure (MAP), cardiac output (CO) and systemic vascular resistance (SVR). Blood samples were obtained for measurement of serum lactate concentrations. Variables were compared within each group before and after specific critical events, namely occlusion of femoral or aortic blood flow, or both, and sequential reperfusion of each lower limb. Patients undergoing open repair showed significant changes in CO, MAP and SVR related to aortic cross-clamping and lower limb reperfusion, and a significant increase in blood lactate concentration after distal tissue reperfusion. The only significant changes during endovascular repair were a transient increase in SVR secondary to application of the femoral artery clamps, and sequential decreases when each limb was reperfused. Endovascular aneurysm repair imposed significantly less intraoperative haemodynamic and metabolic stress on the patient compared with conventional open surgery.