Endovascular Treatment Of Abdominal Aortic Aneurysms Research Articles

Low-profile versus standard-profile stent grafts in the treatment of abdominal aortic aneurysm: a case-matched study.

Endovascular aortic repair (EVAR) is nowadays a widespread method of managing abdominal aortic aneurysm (AAA). Low-profile stent grafts (LPSGs) enable treatment of patients with complex and anatomically challenging aneurysms, and facilitate a percutaneous and thus less invasive procedure. To assess the outcomes of EVAR with low-profile versus standard-profile stent grafts (SPSGs). Thirty-one patients with abdominal aortic aneurysms (AAA) were treated by endovascular aortic repair (EVAR) using LPSGs. The control group of patients treated with SPSGs was matched with MedCalc software. The clinical records and the preoperative and follow-up computed tomography angiography of patients who underwent endovascular treatment of AAA were included in this study. Patients in the LPSG group had significantly more often low access vessel diameter (< 6 mm) compared to the SPSG group (38.7% vs. 6.7%, p = 0.003). In 1-year follow-up, there was no rupture, no infection, no conversion to open repair and no aneurysm-related death. Five secondary interventions were necessary in the SPSG group and only 1 in the LPSG group (p = 0.09). Type of stent graft was not a risk factor of perioperative complications, presence of endoleak or reintervention (p > 0.05). Risk factors for perioperative complications were COPD and conical neck (OR = 6.3, 95% CI: 1.5-25, p = 0.01 and OR = 6.2, 95% CI: 1-39.76, p = 0.04). The risk factor for endoleak was lower maximal aneurysm diameter. The risk factor for reintervention was proximal neck diameter (OR = 0.77, 95% CI: 0.-0.97, p = 0.03). Our study showed that use of LPSGs is a safe and viable method for patients with narrow access vessels who are not eligible for standard-profile systems.

Impact of Cross-Limb Stent-Graft Configuration on Hemodynamics in Abdominal Aortic Aneurysm Interventional Therapy.

The cross-limb (CL) technique is a commonly used endovascular treatment for addressing unfavorable anatomical features in patients with abdominal aortic aneurysm (AAA). The configuration of CL stent-graft plays a critical role in determining the postoperative hemodynamic properties and physiological behaviors, which ultimately impact the efficacy and safety of endovascular AAA treatment. This study aims to investigate the relationship between hemodynamics and CL stent-graft configuration from a hemodynamic perspective. Five distinct geometric models of cross-limb (CL) stent-graft configurations were constructed by optimizing the real clinical computed tomography angiography (CTA) data. These models varied in main body lengths and cross angles and were used to perform numerical simulations to analyze various hemodynamic parameters. Flow pattern, distribution of wall shear stress (WSS)-related parameters, localized normalized helicity (LNH), pressure drop, and the displacement force of all models were examined in this paper. In patient-specific cases, helical flow and WSS increase with the main body. However, it also generated secondary flow in localized areas, leading to increased oscillation in the WSS direction. Notably, increasing the stent graft's main body length or decreasing the cross angle reduced the displacement force exerted on the stent-graft. Reducing the cross angle did not significantly alter the hemodynamic characteristics. In the clinical practice of CL deployment, it is crucial to carefully consider the stent-graft configuration and the patient specific to achieve optimal postoperative outcomes. This study provides valuable insights for guiding stent selection and treatment planning in patients with abdominal aortic aneurysm undergoing CL techniques, from a hemodynamic perspective.

A Single Centre Long Term Follow Up of the Nellix Endovascular Aneurysm Sealing System

To evaluate the clinical performance at long term follow up of endovascular aneurysm sealing (EVAS, Endologix Inc. Nellix, Irvine, CA, USA) in the treatment of abdominal aortic aneurysm (AAA). Observational, prospective, single centre study of primary AAA interventions with EVAS (n= 117) from November 2013 to November 2016. Endpoints were primary technical success, Nellix device failure, freedom from open surgical conversion (OSC), freedom from secondary intervention, sac rupture, total mortality, and aneurysm related mortality at long term follow up. The median age was 75 years (interquartile range [IQR] 70, 81 years) and 83% were male. The median AAA diameter was 58 mm (IQR 54, 60 mm). The median length of follow up was 6.2 years (IQR 5.6, 6.8 years). Primary technical success was 100%. Median time to Nellix failure was 5.6 years (IQR 3.3, 7.4 years). Freedom from Nellix failure at five and seven years was 54% (95% confidence interval [CI] 54.2 - 63.8%) and 36% (95% CI 22.3 - 49.7%), respectively. Freedom from OSC at five and seven years was 63% (95% CI 53.2 - 72.8%) and 59% (95% CI 47 - 71%), respectively. The secondary intervention rate was 11.4/100 person years. Freedom from secondary intervention at five and seven years was 52% (95% CI 42.2 - 61.8%) and 51% (95% CI 41.2 - 60.8%), respectively. The cumulative mortality rate at five and seven years was 36% and 54%, respectively. Secondary sac rupture occurred in 9.4% (11/117) with a rate of 2/100 person years. Aneurysm related mortality was 12% (14/117) with a rate of 2.5/100 person years. The median survival was four years (IQR 3, 5.6 years). Thirty day mortality for acute OSC was 67% (n= 3) and 17.1% (6/35) for elective OSC. Long term follow up showed an increased failure rate. Diligent surveillance after endovascular AAA treatment is mandatory, especially when promising new devices are put into clinical use.

Hybrid endovascular and laparoscopic treatment of infrarenal abdominal aortic aneurysms

The endovascular treatment of abdominal aortic aneurysms (EVAR) comprises a reintervention rate of almost 20% related to endoleaks, mostly of type 2. We propose a new approach of the treatment of AAAs which associates EVAR and the laparoscopic ligation of all the collaterals of the aneurysmal sac. This technique (LEVAR) aims to benefit from the advantages of an aortic stentgraft while avoiding the complications related to type 2 endoleaks.

Nationwide Experience with EVAS Relining of Previous Open or Endovascular AAA Treatment in The Netherlands

Relining of a previously placed surgical graft or endograft for an abdominal aortic aneurysm (AAA) is a reintervention to treat progression of disease or failure of the primary (endo)graft. Endovascular Aneurysm Sealing (EVAS) relining is a technique with potential advantages due to the absence of a bifurcation, the possibility for a unilateral approach, and sealing concept of the endobags. The purpose of this study was to describe the nationwide experience with EVAS relining of previous AAA repair in the Netherlands. A retrospective analysis of all patients who underwent EVAS relining in 7 high volume vascular centres in the Netherlands between 2014 and 2019 was performed. Primary outcomes were technical and clinical success. Secondary outcomes were perioperative outcomes, complications and survival. Thirty-three patients underwent EVAS relining of open (n=10) or endovascular (n=23) repair. 26 were elective cases, 5 were urgent and 2 were acute (ruptured). Mean time between primary treatment and EVAS relining was 99 ± 74 months. Indications after open repair were proximal progression of disease (n=7) and graft defect (n=3). Indications after EVAR were type IA (n=10), type IB (n=3), type IIIA (n=4), type IIIB (n=3) endoleak, and endotension (n=3). 18 patients underwent regular EVAS, 4 unilateral EVAS and 11 chimney-EVAS. In-hospital mortality was 6% (both patients with rAAA). Technical success was achieved in 97%. Median follow-up after EVAS relining was 20 months (range 0-43). Freedom from reintervention at 1-year and 2-year were 83% and 61% and the estimated survival 79% and 71%, respectively. EVAS relining after open repair had a clinical success of 90% at 1-year and of 70% at latest follow-up, while after EVAR clinical success rates were 70% and 52%, respectively. EVAS relining of previous AAA repair is associated with high technical success, however with limited clinical success at median follow-up of 20 months. Clinical success was higher in patients with EVAS relining after open repair than after EVAR. In patients with failed AAA repair, EVAS relining should only be considered, when established techniques such as fenestrated repair or open conversion are not available or indicated.

One-year results of the INSIGHT study on endovascular treatment of abdominal aortic aneurysms

ObjectiveEndovascular repair of abdominal aortic aneurysms (AAAs) using the INCRAFT AAA Stent Graft System was safe and effective in regulatory approval studies. We herein report on the 1-year results of a real-world clinical study. MethodsThe INSIGHT study is a multi-center, prospective, open label, post-approval study conducted to continually evaluate the safety and performance of the INCRAFT System. Between 2015 and 2016, 150 consecutive patients with AAA at 23 centers in Europe were treated with the device in routine clinical practice. The primary endpoint was freedom from major adverse events (MAEs), namely death, myocardial infarction, cerebrovascular accident, and renal failure, within 30 days of the index procedure. End point data were assessed by a core laboratory. The secondary end points included technical success at the conclusion of the procedure and clinical success. ResultsAll 150 patients studied (mean age, 73.6 ± 8.0 years; 89.3% men) met the primary end point without MAEs at 30-day follow-up. Technical success was achieved in 99.3% of patients without stent fractures at 30 days. Among the 146 patients eligible for 1-year follow-up, the MAE rate was 8.2% (ie, 12 patients suffered 13 MAEs: cerebrovascular accident in 8, myocardial infarction in 1, and 4 died, resulting in a 2.7% all-cause mortality rate). There were no reports of new onset renal failure requiring dialysis. Only 2.7% of patients had type I endoleak, and no type III endoleaks were identified through 1 year. The rate of clinical success at 1 year was 91.8%. ConclusionsThe 1-year results of this multicenter real-world study underscore the safety and effectiveness of endovascular treatment of AAA with the INCRAFT System in routine clinical practice.

Treatment of recurrent iliac branch occlusion after endovascular repair of abdominal aortic aneurysm diagnosed by contrast- enhanced ultrasound combined with computed tomography angiography: a case report

Endovascular treatment of abdominal aortic aneurysm (AAA) has been in use for several decades and has become the main treatment for this disease. Iliac branch occlusion (IBO) is a common complication after endovascular treatment. The diagnosis and guidance of contrast-enhanced ultrasound (CEUS) combined with computed tomography angiography (CTA) in the treatment of recurrent IBO after endovascular aneurysm repair (EVAR) are rarely reported. In this case, CEUS gave important hints on the cause of IBO. We present a 67-year-old male patient who was diagnosed with AAA in 2020 and underwent endovascular treatment in the same period. There was no family history of AAA. The operation process was successful. The CTA re-examination one month after operation showed that the aneurysm was well isolated without obvious endoleak. However, the patient developed intermittent claudication of both lower limbs after operation, but did not receive relevant diagnosis and treatment. Four months after surgery, the patient's claudication symptoms of the left lower limb were significantly worse than before, and CTA review revealed left IBO. The left ankle brachial index (ABI) was too low to detect the value. A femoral artery thrombectomy was performed and a stent was extended distal to the left iliac stent. The claudication symptoms improved after surgery. Unfortunately, only two months later, the patient developed rest pain in the left lower limb. CTA examination showed that the left iliac branch was occluded again. The problem in the proximal end of the left iliac branch was observed by CEUS before re-operation, which was also confirmed by digital subtraction angiography (DSA) after thrombectomy. The blood flow was significantly improved after the angle of the proximal iliac branch was adjusted by stent placement. The patient did not show claudication symptoms again during follow-up. Through CEUS, we identified the pathogenic causes which could not be reflected in CTA and formulated the correct treatment plan. The risk factors of IBO after EVAR are mostly hidden in the process of the initial operation. CEUS can provide more information about postoperative hemodynamics than CTA. The role of CEUS in postoperative follow-up of endovascular treatment of AAA needs to be further explored.

Configuration of vascular services: a multiple methods research programme

Configuration of vascular services: a multiple methods research programme

What factors counteract mid-term survival following endovascular repair of abdominal aortic aneurysms?

IntroductionEndovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used, and has become the standard treatment option for AAA.AimTo evaluate the outcomes and predictors of survival of endovascular treatment of AAA in the short- and medium-term.Material and methodsA total of 222 patients having endovascular AAA repair between January 2013 and December 2019 by the same surgical team were included in the study. Patient demographics, perioperative and follow-up data including mortality, complications, and need for secondary intervention were collected. The primary endpoint was all-cause mortality. Kaplan-Meier analysis was conducted for survival and Cox regression models were assessed for predictors of survival.ResultsThe median age was 70 years, with male predominance (202 patients, 91%). Thirty-day mortality was 1.8%. Median follow-up to the primary endpoint was 20 months (range: 1–80 months). Survival rates at 1, 3, and 5 years were 93.5%, 81.4%, and 62.2%, respectively. Freedom from secondary intervention rates were 95.5% at 1 year, 88.7% at 3 years, and 82.1% at 5 years. Cox proportional hazard models showed that preoperative creatinine levels ≥ 1.8 mg/dl (hazard ratio (HR) = 2.68, 95% CI: 1.21–6.42, p = 0.027), haemoglobin levels < 10 gr/dl (HR = 3.38, 95% CI: 1.16–9.90, p = 0.026), ejection fraction < 30% (HR = 5.67, 95% CI: 1.29–24.86, p = 0.021), and AAA diameter ≥ 6.0 cm (HR = 2.20, 95% CI: 1.01–4.81, p = 0.049) were independently associated with mid-term survival.ConclusionsEVAR is a safe procedure with low postoperative morbidity and mortality. This study confirms that the mid-term survival and results are favourable. However, the analysed factors in this study that predict reduced survival (high preoperative creatinine, low haemoglobin, low ejection fraction and larger aneurysms) should be judged when planning endovascular repair of AAA.

Medicare costs for endovascular abdominal aortic aneurysm treatment in the Vascular Quality Initiative

BackgroundReintervention after endovascular repair (EVR) of abdominal aortic aneurysms is common. However, the cumulative financial impact of reintervention after EVR on a national scale is poorly defined. Our objective was to describe the cost to Medicare for aneurysm treatment (EVR plus reinterventions) among a cohort of patients with known follow-up for 5 years after repair. MethodsWe identified patients who underwent EVR within the Vascular Quality Initiative who were linked to their respective Medicare claims file (n = 13,995). We excluded patients who underwent EVR after September 30, 2010, and those who had incomplete Medicare coverage (n = 12,788). The remaining cohort (n = 1207) had complete follow-up until death or 5 years (Medicare data available through September 30, 2015). We then obtained and compiled the corresponding Medicare reimbursement data for the index EVR hospitalization and all subsequent reinterventions. ResultsWe studied 1207 Medicare patients who underwent EVR and had known follow-up for reinterventions for 5 years. The mean age was 76.2 years (±7.1 years), 21.6% of patients were female, and 91.1% of procedures were elective. The Kaplan-Meier reintervention rate at 5 years was 18%. Among patients who underwent reintervention, 154 (73.7%) had a single reintervention, 40 (19.1%) had two reinterventions, and 15 (7.2%) had three or more reinterventions. The median cost to Medicare for the index EVR hospitalization was $25,745 (interquartile range, $21,131-$28,774). The median cost for subsequent reinterventions was $22,165 (interquartile range, $17,152-$29,605). The cumulative cost to Medicare of aneurysm treatment (EVR plus reinterventions) increased in a stepwise fashion among patients who underwent multiple reinterventions, with each reintervention being similar in cost to the index EVR. ConclusionsThe overall cost incurred by Medicare to reimburse for each reintervention after EVR is roughly the same as for the initial procedure itself, meaning that Medicare cost projections would be greater than $100,000 for any individual who undergoes an EVR with three reinterventions. The long-term financial impact of EVR must be considered by surgeons, patients, and healthcare systems alike as these cumulative costs may hinder the fiscal viability of an EVR-first therapeutic approach and highlight the need for judicious patient selection paradigms.

Contrast-Enhanced ultrasound in endovascular aneurysm repair follow-Up: Our experience

Background: Endovascular aneurysm repair (EVAR) is actually the most common surgical technique used in the treatment of abdominal aortic aneurysm (AAA), worldwide. In EVAR, as we know, the most common complication is endoleak (EL), which is the most common cause of failure in the endovascular treatment of AAA. We can deduce that the surveillance and mid-term/long-term follow-up is mandatory and very important to detect EL. Contrast-enhanced ultrasound (CEUS) has been proposed as the gold standard in EVAR follow-up because its ability to detect EL (especially if they are at low flow like type II) and because it is a cheap technique, reducing direct costs and X-ray exposure to the patients. Methods: We started using CEUS as the first-level examination to detect EL in every EVAR patients. CEUS is performed at 3–6–12 months after EVAR and then annually. Computed tomography scan is performed to every patient, to confirm the diagnosis of EL and in any case of sac enlargement without evidence of EL during CEUS. The procedure consists in the administration of 2.5 ml SonoVue® (Bracco Farmaceutici-Milano) bolus followed by 5 ml sodium chloride 0.9% and is performed on Philips IU22 (Philips, Netherlands). We used to start collecting time at the end of the bolus injection. Results: In our 31 patient population, we recorded 13 cases of EL (41.93%), in particular, 3 cases of type I-III (9.68%) and 10 cases of type II (32.25%); in the whole group, sensibility and specificity (Se and Sp) of CEUS to detect EL (not type-specific) were 92% and 100%, respectively. These data are as other data of more important case-series. Conclusions: CEUS is considered the gold standard technique to detect early EL for more authors worldwide. In our experience, we can confirm this matter because CEUS has high Se and Sp (about 100%, in any cases).

Dutch Experience with Evas Relining after Failure of Open or Endovascular AAA Treatment

Introduction - Endovascular Aortic Repair (EVAR) has become the most frequently used procedure for the treatment of an abdominal aortic aneurysm (AAA). Distal endograft migration, endoleak and stentgraft stenosis are common complications of EVAR with possible fatal outcome if left untreated. Endovascular aneurysm sealing (EVAS) is a novel alternative for EVAR and preliminary results are promising and have shown a low rate of endoleaks compared to EVAR. The objective of the current study is to describe the Dutch experience with relining a failed open or endovascular AAA with EVAS.

Suitability of EVAR with Hostile Neck

AbstractBackground: Endovascular treatment of abdominal aortic aneurysms (EVAR) is now considered first line of treatment for abdominal aortic aneurysm (AAA) mainly due to the lower morbidity and mortality, hostile neck is a major obstacle in treating such patients, however many endovascular methods are available to overcome such obstacle, EVAR out of IFU is considered one of the lines of management. Further evaluation is needed.Aim of Study: Aim of this study was to evaluate the effectiveness of endovascular treatment of AAA with hostile neck anatomy, with commenting on the perioperative compli-cations, mortality and morbidity.Material and Methods: This study was done retrospectively over a period of 18 months including 10 patients who had endovascular treatment of abdominal aortic aneurysms with hostile neck anatomy.Results: 10 patients were included in this study primary technical success was achieved in 90% of cases while the last case needed aortic cuff as an adjunctive procedure. One case required re-intervention within 30 days post-operative due to limb graft occlusion, managed by femoro-femoral bypass. At one year follow up mortality was 10%.Conclusion: EVAR for AAA patients with HNA is feasible; patients with single feature of HNA showed the best outcome, while patients with more than one feature required the usage of adjunctive techniques for proximal sealing and were more liable to develop post-operative complications.

Endovascular Exclusion of Abdominal Aortic Aneurysms and Simultaneous Resection of Colorectal Cancer

No consensus exists on the optimal strategy for treatment of abdominal aortic aneurysm (AAA) associated with colorectal cancer (CRC). The purpose of this study was to evaluate the results of endovascular treatment of AAA with simultaneous resection of CRC. Twenty-two consecutive patients presenting with AAA associated with a CRC were treated by endovascular AAA exclusion and simultaneous CRC resection. Median diameter of the aneurysm was 6.5cm (range, 4.8-8cm). Two patients (9%) had grade I cancer, 5 patients (23%) grade II, 13 patients (59%) grade III, and 2 patients (9%) grade IV. The 2 surgical procedures were performed under the same general anesthesia. Aneurysm exclusion was achieved using an infrarenal aorto-bi-iliac endoprosthesis (13 patients) and using an aorto-bi-iliac endoprosthesis with suprarenal fixation (9 patients), with 1 patient receiving bilateral renal chimney stent implantation. In all cases, vascularization of the hypogastric arteries was preserved. After AAA exclusion, colic resection was carried out by laparotomy with right colectomy (7 patients) and anterior rectocolic resection (15 patients). In all patients, AAA exclusion was controlled by a computed tomographic angioscan (CTA) at 1 month and duplex ultrasound every 6 months, and at some later stage, it was through inclusion of CTA as part of oncology surveillance. The mean duration of follow-up was 42months (10-120months). The primary endpoint was composite and regrouped any death occurring during the first 30days after procedures, any type I endoleak, any aortic reintervention, and any AAA-related mortality. No patient died during the first 30 postoperative days, and no patient was lost to follow-up. No aortic endoprosthesis infection and no type I endoleak were observed. Five endoleaks arising from the lumbar arteries (n=4) or from the inferior mesenteric artery (n=1) were identified. As they were not associated with an increase of the AAA diameter >5mm, they were not treated. 1 colic anastomotic leak and 2 incisional abscesses were successfully cured by local care only. Nine patients (41%) died of cancer evolution during the follow-up period. In this series, treatment of AAA and CRC during the same operative session yields results comparable to those observed when surgery is performed in 2 distinct operative sessions. Synchronous treatment reduced waiting time of colic resection. It may also shorten total hospitalization duration, although this last hypothesis is not supported by comparison with a control group.

Endovascular treatment of late complications of open surgical repair in abdominal aortic and iliac segment

Introduction. Promising results of endovascular abdominal aortic aneurysm treatment prompts one to consider applying the method in order to manage complications following the previous open procedures in the aorto-iliac segment. The study aimed at assessing the technical feasibility of applying endovascular methods to manage complications in this group. Material and methods. From December 2009 to August 2018, 26 patients (24 males, 2 females) with a mean age of 72 years, underwent endovascular procedures as reinterventions to manage paraanastomotic aneurysms and new true aneurysms in aorto-iliac segment. Twenty one bifurcated, two branched devices and five tube stent-grafts have been implanted. Results. One immediate open conversion was performed. Eventually, in all of the analysed cases, perianastomotic pseudoaneurysms and true aneurysms were successfully managed. Two cases of type I endoleaks were noticed and managed intraoperatively. No deaths occurred in the perioperative period. In six patients, there were early local complications and early general complications were reported in eight patients. The average length of hospital stay was seven days. Patients have been followed up for 6 to 90 months. No endoleaks nor stent-graft migrations have been reported. Five deaths have been noted not connected with the secondary intervention. Sixteen patients remain in follow-up. Conclusions. Endovascular perianastomotic aneurysm treatment is technically feasible and associated with a low risk of perioperative complications, and a high surgical efficacy. When planning the reintervention, one should take into account the altered anatomy of the aorto-iliac segment. Familiarity with the equipment and experience in the endovascular techniques is of crucial significance.

Expression in Whole Blood Samples of miRNA-191 and miRNA-455-3p in Patients with AAA and Their Relationship to Clinical Outcomes after Endovascular Repair

The purpose of this study was to quantify and evaluate the expression response of miRNA-191 and miRNA-455-3p endovascular repair of abdominal aortic aneurysm (AAA) based in whole blood samples. This report describes a prospective study of a single center of 30 patients with AAA who underwent endovascular repair. Blood samples were collected preoperatively and 6months postoperatively. The differential expression of the miRNAs was performed by the real-time polymerase chain reaction method, after extraction of the RNA from the blood samples at the 2 moments. In addition, bioinformatic tools were used to determine pathophysiological pathways related to AAA. The miR-191 and miR-455-3p were overexpressed preoperatively. After 6months postoperatively, miR-191 (median 0.98, IQR 0.5-2.1, P<0.0001) and miR-455-3p (median 1.4, IQR 0.6-3.1, P=0.0003) presented a significant reduction in their expressions. There was no correlation between the diameter of the aneurysm and the expression of the miRNAs studied. In addition, analysis of the influence of the various types of devices used for the endovascular treatment of AAA showed no significant differences in the expression of miR-191 and miR-455-3p. Exclusion of the aneurysmal sac after endovascular treatment induces a decrease in the expression of the studied miRNAs in whole blood samples, which suggests a possible use of them as biomarkers of therapeutic success.

Risk factors and short and medium-term survival after open and endovascular repair of abdominal aortic aneurysms.

Background Infrarenal abdominal aortic aneurysms (AAA) are responsible for high rates of rupture-associated morbidity and mortality and can be treated by open or endovascular surgery. Objectives To analyze risk factors and survival associated with surgical and endovascular AAA treatment methods. Methods A retrospective, longitudinal study involving 41 patients who underwent endovascular or open AAA repair, whether elective or emergency, over a 48-month period, with analysis of preoperative comorbidities, 30-day and 1-year survival, in-hospital mortality, length of hospital stay, transfusion of blood products, duration of surgery, and development of acute kidney failure. Inferential statistics and survival analysis considered a 95% CI and p < 0.05 as significant. Results Twelve of the 41 patients were treated with open surgery and 29 with endovascular techniques. The majority were male (75%), with an average age of 71 (range: 56 – 90 years). There were no differences in demographic or risk factors between the groups. Overall survival rates for open and endovascular repair were different for both 30 days (37 vs. 72%, p = 0.01) and 360 days (37 vs. 67%, p = 0.01). However, survival rates in elective cases were similar at 30 days (71 vs. 76%, p = 0.44) and 360 days (both 71%, p = 0.34). Endovascular repair showed shorter length of hospital stay (3.0 vs. 4.4 days; p = 0.02) and duration of surgery (111 vs. 163 min; p < 0.01) compared to open repair. Conclusions There was no difference in short- or medium-term survival of AAA patients treated electively with endovascular or open surgery. Hospital stays and duration of surgery were both shorter with minimally invasive treatment.

Resultados preliminares sobre cambios en la rigidez arterial tras reparación endovascular de aneurismas de aorta con endoprótesis bifurcadas, ramificadas y con sistema de sellado

IntroductionPatients with diagnosis of abdominal aortic aneurysm (AAA) are known to have an increased cardiovascular risk. Open surgery has been the traditional approach however, endovascular repair has widely expanded due to the lower peri-operative risk. Arterial stiffness has been suggested to change and elevate after aortic stent-graft implantation. Material and methodsAs part of a study registered in National Institutes of Health website (ClinicalTrials.gov) with NCT02642952, a description is presented of 3 groups with endovascular treatment of AAA with different endografts and mechanisms. GroupA with standard bifurcated endograft, groupB with a branched (4 branches) device, and groupC with a sac sealing device. Each group included 2 patients. A report is presented on the individual changes of arterial stiffness measured by carotid-radial pulse wave velocity (PWV) and Augmentation Index (AIx). ResultsAll the patients included were men, older than 70 years, with AAA greater than 55mm, and high-risk (ASAIII) patients. We observed a variable change in carotid-radial PWV and IA@75 in the postoperative period in all patients studied. ConclusionsIt seems that endovascular devices in the treatment of AAAs are implicated in the change of arterial stiffness measurements. More randomised studies, with larger samples comparing the different types of endografts are required. The long-term impact on cardiovascular outcomes needs further investigation.

Comparison of Renal Complications between Endografts with Suprarenal and Infrarenal Fixation

Surgeons have multiple grafts options available for the endovascular treatment of abdominal aortic aneurysm (EVAR), and some hypothesize that suprarenal fixation endografts may result in higher rates of renal complications than infrarenal endografts. This study aimed to compare the outcomes of contemporary suprarenal and infrarenal endografts. The Targeted Vascular Module of the National Surgical Quality Improvement Project was utilised to identify patients undergoing EVAR for infrarenal aneurysm from 2011 to 2013. Pre-operative and operative variables and 30 day outcomes were compared among suprarenal (Zenith and Endurant) and infrarenal fixation devices (Excluder). Renal complications included creatinine increase > 2mg/dL or new dialysis, as defined by NSQIP. Multivariate regression was completed to account for patient demographics, comorbidities, and operative characteristics. A total of 3587 patients were evaluated including 2273 (63%) with suprarenal grafts and 1314 (37%) with infrarenal grafts. Patients with suprarenal grafts were less commonly white (84% vs. 88%, p<.01) and more commonly male (83% vs. 80%, p=.03). There were no differences in age or comorbidities. Renal complications (1.1% vs. 0.1%, p<.01) and length of stay more than 2 days (34% vs. 25%, p<.01) occurred more commonly after suprarenal fixation. After adjustment, suprarenal grafts had significantly higher rates of renal complications (OR, 12.0; 95% CI, 1.6-91) and length of stay more than 2 days (OR, 1.4; 95% CI, 1.2-1.7). Overall rates of renal complications following EVAR are low. Patients selected for suprarenal stent grafts are at increased risk of renal complications and prolonged length of stay, which may be due to selection bias, deployment techniques, or the presence of a bare stent overlying the renal arteries. Further studies are necessary to evaluate the mechanism and duration of renal dysfunction and important long-term outcomes of interest.

Evaluation the Aortic Aneurysm Remodeling After a Successful Stentgraft Implantation

SummaryBackgroundRoutine imaging follow-up after endovascular treatment of abdominal aortic aneurysms (EVAR) is mainly aimed at detection of endoleaks. The aim of the study was to assess changes in the size of the abdominal aortic aneurysm sack using CT angiography (CTA) after successful treatment using endovascular stent graft implantation.Material/MethodsA retrospective analysis of CTA results included 102 patients aged 54–88, who had no postoperative complications. Patients underwent CTA before EVAR and after the treatment (mean time between studies, 7.6 months). The largest cross-sectional area of the aneurysm sac was measured using a curved multiplanar reconstruction. A change of the aneurysm cross-sectional over 10% was considered significant.ResultsThe average cross-sectional area decreased after EVAR by 3% and this change was not statistically significant. Regression of the cross-sectional area was observed in 18.6% of patients, progression was in 23.5%, and no change was seen in 57.8%. Cross-sectional areas before and after EVAR were significantly correlated (r=0.75, p<0.0001). There was no correlation between the cross-sectional area change after EVAR and patients’ age or the time between the treatment and the follow-up CTA. Cross-sectional area before the treatment predicted changes in the aneurysm size after EVAR (p=0.0045).ConclusionsRemodeling of abdominal aortic aneurysms after EVAR is not uniform. The change of aneurysm size depends on the initial aneurysm size but not on the time from EVAR. The size of the aneurysm after EVAR should not be considered as a measure of the treatment efficacy.