Efficacy Of Endovascular Aortic Repair Research Articles

Safety and Efficacy of Endovascular Aortic Repair for Abdominal Aortic Aneurysms with a Hostile Neck Anatomy.

This study aimed to investigate the safety and efficacy of endovascular aortic repair (EVAR) for the treatment of an abdominal aortic aneurysm (AAA) with a hostile neck anatomy (HNA). From January 1, 2015 to December 31, 2019, a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study. Based on the morphological characteristics of the proximal neck anatomy, the patients were divided into the HNA group and the friendly neck anatomy (FNA) group. The patients were followed up for up to 4 years. The average follow-up time was 1056.1±535.5 days. Type I endoleak occurred in 4 patients in the HNA group, and 2 patients in the FNA group. Neither death nor intraoperative switch to open repair occurred in either group. The time of the operation was significantly longer in the HNA group (FNA vs. HNA, 99.2±51.1 min vs. 117.5±63.8 min, P=0.011). There were no significant differences in short-term clinical success rate (P=0.228) or midterm clinical success rate (P=0.889) between the two groups. The overall mortality rate was 10.4%, and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period (P=0.889). EVAR was feasible and safe in patients with an AAA with a proximal HNA. The early and midterm results were promising; however, further studies are needed to verify the long-term effectiveness of EVAR.

The Comparison of Endovascular and Open Surgical Treatment for Ruptured Abdominal Aortic Aneurysm in Terms of Safety and Efficacy on the Basis of a Single-Center 30-Year Experience.

Ruptured abdominal aortic aneurysm (rAAA) is a critical condition with a high mortality rate. Over the years, endovascular aortic repair (EVAR) has evolved as a viable treatment option in addition to open repair (OR). The primary objective of this study was to compare the safety and efficacy of EVAR and OR for the treatment of rAAA based on a comprehensive analysis of our single-centre 30-year experience. Patients treated for rAAA at the Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Germany from 1 January 1993 to 31 December 2022 were included. Relevant information was retrieved from archived medical records. Patient survival and surgery-related complications were analysed. None of the patient-specific markers, emergency department-associated parameters, and co-morbidities were associated with patient survival. The 30-day and in-hospital mortality was higher in the OR group vs. in the EVAR group (50% vs. 8.7% and 57.1% vs. 13%, respectively). OR was associated with more frequent occurrence of more severe complications when compared to EVAR. Overall patient survival was 56 ± 5% at 12 months post-surgery (52 ± 6% for OR vs. 73 ± 11% for EVAR, respectively) (p < 0.05). Patients ≥70 years of age showed poorer survival in the OR group, with a 12-month survival of 42 ± 7% vs. 70 ± 10% for patients <70 years of age (p < 0.05). In the EVAR group, this age-related survival advantage was not found (12-month survival: ≥70 years: 67 ± 14%, <70 years: 86 ± 13%). Gender-specific survival was similar regardless of the applied method of care. OR was associated with more severe complications in our study. EVAR initially outperformed OR for rAAA regarding patient survival while re-interventions following EVAR negatively affect survival in the long-term. Elderly patients should be treated with EVAR. Gender does not seem to have a significant impact on survival.

Endovascular versus Open Repair for Abdominal Aortic Aneurysm

Background: Abdominal aortic aneurysm (AAA) is a dilation of the aorta due to aortic wall continues to weaken. If left untreated to withstand the forces of the luminal blood pressure resulting in progressive dilatation and rupture with a mortality of 50 – 80%. Objective: This study aimed to assess the efficacy of Endovascular Aortic Repair (EVAR) against Open Surgical Repair (OSR), of infra-renal AAA regarding the type of anesthesia, operative time, blood loss, hospital stay, and complications. Patient and Methods: From January 2016 to December 2017 in Al-Azhar University Hospital and Military Hospitals in Cairo, we assigned 30 patients with AAA ≥5.5 cm in diameter to undergo either EVAR or OSR; in two equal groups. Patients were followed up for type of anesthesia, operative time, blood loss, hospital stay, morbidity, mortality, and complications. Results: Regarding comorbidities, 90% were smokers, 83.3% were diabetic, 76.7% had hypertension (HTN), and 66.7% had ischemic heart disease (IHD). Regarding intra-operative complications, the overall complications rate was 23.3%, with 3.3% had arrhythmias, 3.3% had distal emboli, and 16.7% had hemorrhages and received a blood transfusion. There was a non-significant difference as regards gender, marital status, smoking, and Diabetes Mellitus between the 2 groups. A comparative study between the 2 groups revealed a significant increase in age, HTN, and IHD in the EVAR group, compared to the OSR group, with a significant statistical difference. A comparative study between the 2 groups revealed a significant decrease in AAA size and operative time in the EVAR group, compared to the OSR group, with a significant statistical difference. A comparative study between the 2 groups revealed a non-significant difference as regards intra-operative complications and blood transfusion. A comparative study between the 2 groups revealed a significant decrease in the Intensive Care Unit (ICU) and ward stay in the EVAR group; compared to the OSR group. Conclusion: EVAR compared to conventional surgery has some benefits, such as lower hospital stay, ICU stay, blood loss, rates of hospital mortality, rates of complications, and re-intervention.

Strategy of surgical management on abdominal aortic aneurysm combined with gastrointestinal malignancy

The incidence of concomitant abdominal aortic aneurysm (AAA) combined with gastrointestinal malignancy is rare, but it still represents an issue of controversy regarding the optimal treatment. It is unclear whether to treat the AAA and gastrointestinal malignancy simultaneously or in a staged manner as both options offer advantages but also carry some substantial risks. This study attempts a historical review of the surgical practice during the past decades by reviewing the existing literatures on this topic. In general, the most symptomatic lesion or the most life threatening condition should be treated firstly. Large aneurysm should usually be resected in preference to gastrointestinal malignancy unless the tumor is locally advanced, perforated or likely to result in intestinal obstruction. If both lesions are complicated there may be a case for simultaneous treatment. The evolution of vascular stents and the reported efficacy of endovascular aortic repair (EVAR) provide an alternative method for treating high risk patients. If the anatomical criteria are satisfied, EVAR combined with laparoscopic operation could become the optimal solution for the concomitant AAA and gastrointestinal malignancy patients, especially those who require minimally invasive treatment. Key words: Abdominal aortic aneurysm; Gastrointestinal malignancy; Surgical procedures, operative; Endovascular aortic repair

Endovascular repair of abdominal aortic aneurysm with hostile proximal neck anatomy

Objective To analyze the safety and efficacy of endovascular aortic repair (EVAR) for abdominal aortic aneurysm(AAA) with hostile aortic proximal landing anatomy. Methods The clinical and imaging data of 147 AAA patients [135 males, (68.7 ± 8.9) years old, range 43-85 years old] with hostile aortic proximal landing anatomy treated by EVAR from January 2012 to December 2014 in our center were retrospectively analyzed. The range of maximum aneurysm diameter was 45-100 mm; the length range of proximal aneurysm neck was 7-32 mm; the width range of proximal aneurysm neck was 15-30 mm, and the infrarenal angulation was 10°-90°. In addition, there were atherosclerotic changes in the proximal neck in 43 cases. Follow-up protocol consisted of evaluation of clinical symptoms and cTA at 3, 6 and 12 months and annually thereafter. Results The technical success rate was 100%. Different procedures were adopted among patients, with 113 cases of EVAR, 3 cases of fenestrated EVAR and 24 cases of chimney EVAR. The intra-operative type Ia endoleak was observed in 32 cases, in which 25 of them were successfully treated by balloon angioplasty and the other 9 patients were treated with Cuff extension. During the mean follow-up period of 18 months (6-42 months), the accumulative survival rate was 98.0%(144/147), the patency rate of stents was 99.3% (146/147), and the thrombosis rate of aneurysm was 97.3% (143/147). Two patients died because of aneurysm rupture, and another case died of unknown reason. Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac stent in 1 case, and type Ⅲ endoleak in another case. No other complications such as misplace of stent grafts, no bilateral limb ischemia and stent infection were observed during follow-up. Conclusions EVAR is a safe and effective option to treat AAA with hostile aortic proximal landing anatomy. Choosing the most suitable stent-graft, the combination of various interventional techniques and close postoperative follow-up are the key points for successful treatment. Key words: Aortic aneurysm, abdominal; Angioplasty

Endovascular Aortic Repair Combined with Chimney Technique in the Treatment of Stanford Type B Aortic Dissection Involving Aortic Arch

In this study, we sought to explore the efficacy of endovascular aortic repair combined with the chimney technique in the treatment of Stanford type B aortic dissection involving the aortic arch. Between June 2009 and June 2012, 41 consecutive patients were treated with chimney technique at our institute for aortic arch dissection with the primary entry tear adjacent to the orifices of the supra-aortic arteries. The chimney technique was used to reconstruct the left subclavian artery (n=5) and the left common carotid artery (n=34). Additionally, in 2 cases, the double chimney technique was used to simultaneously reconstruct the innominate artery and the left common carotid artery. Eight of the 41 patients had undergone emergent surgery. All the patients survived the surgery, and the mean follow-up period was 17.3±6.1months. None of the patients had type I endoleak. Four patients had type II endoleak, and 3 of them underwent implantation of the patent ductus arteriosus occluder in the left subclavian artery. Among these 3 patients, one patient who was pregnant with Marfan syndrome and pregnancy-induced hypertension required additional medication for recovery. None of the patients had any severe neurological complications, left ischemia of the subclavian artery, migration of the stent graft, or occlusion of the stent grafts. Thus, endovascular aortic repair combined with the chimney technique appears to be a feasible, safe, and effective treatment option for the management of Stanford type B aortic dissection involving the aortic arch.

In-Hospital Efficacy of Endovascular Aortic Repair in Patients With Impending Rupture versus Contained Rupture of Abdominal Aortic Aneurysms

The purpose of our study was to compare the efficacy of endovascular aortic repair (EVAR) in patients with impending rupture of abdominal aortic aneurysm (IRAAA) versus contained rupture of abdominal aortic aneurysm (CRAAA). Of the 21 patients who underwent EVAR for infrarenal AAA from January 2009 toMay 2011, 11 did so for IRAAA and 10 for CRAAA. We compared their demographic andaneurysmal characteristics, comorbidities, complications, and clinical outcomes during hospitalization. The CRAAA group was younger than the IRAAA group. There were no group differences in AAA size, operation time, volume of contrast agent, length of hospital stay (LOHS), or preoperative LOHS. A small difference in mean intraoperative blood loss of ∼4 mL was noted, but was recognized as clinically insignificant. ICU stay and postoperative LOHS were greater in the CRAAA than in the IRAAA. One patient in the IRAAA group had a mild headache after EVAR. Four patients in the CRAAA group had postoperative complications: 1 had acute renal dysfunction; 1 had retroperitoneal infection; 1 had respiratory failure and myocardial infarction; and 1 died of respiratory tract infection and respiratory and cardiac failure. Patients undergoing EVAR for CRAAA have a higher incidence of postprocedural severe complications and death than patients undergoing EVAR for IRAAA.