Procedural and long-term outcomes of elective endovascular abdominal aortic aneurysm repair in octogenarians / Resultados perioperatorios y a largo plazo de la reparación electiva endovascular del aneurisma de aorta abdominal en octogenarios

Abstract Objective: The aim of the study was to compare the immediate and long-term outcomes of endovascular aneurysm repair (EVAR) between patients under and over the age of 80 with abdominal aortic aneurysm (AAA). Methods: From 2011 to 2017, we conducted a retrospective cohort study with AAA patients who received elective EVAR. Primary outcomes included hospital mortality, length of stay, acute kidney injury, and the need for re-interventions. Secondary outcomes included aneurysm-related mortality, acute myocardial infarction, stroke, acute limb ischemia, and prolonged mechanical ventilation. Results: A total of 77 (62.6%) patients under the age of 80 years old and 46 (37.4%) octogenarians were included in the study. The male gender and AAA diameter did not differ among groups (92.2% vs. 82.6%, p = 0.11 and 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectively). The younger patients had a higher prevalence of tobacco use (72.7% vs. 41.7%, p = 0.01). There were no deaths during the index hospitalization. The incidence of reinterventions (5.3% vs. 15.2%, p = 0.11) and acute kidney injury (14.3% vs. 23.9%, p = 0.18) did not differ between groups, but the length of stay was longer for octogenarian patients (3 days [2-4] vs. 2 days [2-3, p = 0.04]). Endoleaks were the most common cause for re-interventions (81.8%), with a prevalence of 34% across the entire cohort. There were no differences in any of the secondary outcomes between groups. Conclusion: In octogenarian patients with AAA, EVAR represents a safe procedure both during the index hospitalization and during long-term follow-up.

Resumen Objetivo: Comparar los resultados inmediatos y a largo plazo de la reparación endovascular del aneurisma de aorta abdominal (REVA) entre pacientes menores de 80 años y octogenarios. Método: Cohorte retrospectiva que incluyó pacientes con aneurisma de aorta abdominal (AAA) sometidos a REVA electiva desde 2011 hasta 2017. Se evaluaron como punto finales primarios la mortalidad hospitalaria, la duración de la estadía hospitalaria, la incidencia de insuficiencia renal aguda y el requerimiento de reintervenciones. Los puntos finales secundarios incluyeron la mortalidad asociada al aneurisma, infarto agudo de miocardio, accidente cerebrovascular, isquemia arterial aguda de las extremidades y ventilación mecánica prolongada. Resultados: Se incluyeron 77 (62.6%) pacientes menores de 80 años y 46 (37.4%) octogenarios. La prevalencia de sexo masculino y el diámetro del AAA no difirieron entre ambos grupos (92.2% vs. 82.6%, p = 0.11 y 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectivamente). Los pacientes más jóvenes presentaron una mayor prevalencia de tabaquismo (72.7% vs. 41.7%, p = 0.01). No se registraron muertes durante la hospitalización índice. La incidencia de reintervenciones (5.3% vs. 15.2%, p = 0.11) e insuficiencia renal aguda (14.3% vs. 23.9%, p = 0.18) no difirieron entre ambos grupos, pero la estadía hospitalaria fue más prolongada en pacientes octogenarios (3 días [2-4 días] vs. 2 días [2-3 días], p = 0.04). La causa más frecuente de reintervenciones fue la presencia de endofugas (81.8%), con una prevalencia del 34% en toda la cohorte. No se observaron diferencias en ninguno de los puntos finales secundarios entre ambos grupos. Conclusión: En pacientes octogenarios con AAA, la REVA presentó un buen perfil de seguridad perioperatorio y a largo plazo.

Manejo del aneurisma de aorta abdominal sintomático no roto: últimos adelanto / Management of symptomatic unruptured abdominal aortic aneurysms: state of the art

RESUMEN El aneurisma de aorta abdominal (AAA) sintomático no roto es una patología que involucra a aquellos pacientes con AAA intacto, pero que presentan dolor abdominal y/o lumbar atribuido al aneurisma. Esta forma de presentación clínica es po tencialmente mortal dado que su etiopatogenia comprende cambios agudos en la pared aórtica, incluyendo inflamación, lo que incrementa la probabilidad de ruptura inminente. Está claro que estos pacientes deben ser derivados a reparación del AAA. Sin embargo, el momento de la intervención es controvertido. Por lo tanto, el objetivo del presente trabajo fue revisar la información actualizada sobre el abordaje diagnóstico-terapéutico del AAA sintomático no roto.

ABSTRACT Symptomatic unruptured abdominal aortic aneurysm (AAA) refers to a group of patients with intact AAA but who present abdominal and/or lumbar pain attributed to the aneurysm. This form of clinical presentation is potentially fatal since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increases the probability of impending rupture. It is clear that these patients should be referred to AAA repair. However, the timing of the intervention is contro versial. Therefore, the aim of the present work was to review updated information on the diagnostic-therapeutic approach of symptomatic unruptured AAA.

Fast-track protocol of endovascular aneurysm repair for ruptured abdominal aortic aneurysm / 中国医师进修杂志

Objective:To analyze the effective and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA) at one tertiary center, and to improve the outcomes of RAAA under fast-track protocol.Methods:Nineteen cases of RAAA in the 940th Hospital of Joint Logistic Support Force of PLA from January 2014 to December 2020 were reviewed retrospectively. EVAR-fist strategy was employed from the emergency room to the operating room by using fast-track protocol. Preoperative management, anatomic characteristics, choice of anesthesia, operative procedures and postoperative complications were collected and analyzed. Abdominal compartment syndrome (ACS) and hospital mortality were paid special attention.Results:Nineteen cases were undergone EVAR procedures. The age was (73.4 ± 7.4) years old, and the AAA size was (67.8 ± 13.6) mm. Two cases underwent cardiopulmonary resuscitation at emergency department. General anesthesia was used in 13 patients and local anaesthesia in 6 patients. Successful stent graft deployment was achieved in all cases. The duration from emergency room to operating room was (84.8 ± 22.4) min. The hospital stay time was (9.7 ± 5.7) d. The hospital mortality was 5/19. The 5 deaths were reviewed: 3 died for multiple organ failure, 1 for irreversible shock, and 1 for ongoing bleeding.Conclusions:Excellent results were confirmed by using EVAR-first strategy for RAAA. The management of hemodynamically unstable state, standardized endovascular procedure, fast-track program and multidiscipline team collaboration were the very important determining factors for the implementation of EVAR. Focused efforts to reduce RAAA mortality are warranted.

Retrospective Study of The Outcome of Primary Repair of Arteriovenous Fistula (AVF) Aneurysm and Pseudoaneurysm in Secondary Hospital Setting (Kajian Retrospektif Pembaikian Primer Ateriovenous Fistula (AVF) Aneurisma dan Pseudoaneurisma di Hospital Sekunder) / Jurnal Sains Kesihatan Malaysia

@#Aneurysms and pseudoaneurysm are commonly encountered with arteriovenous vascular access for haemodialysis. They are difficult complications to manage. Due to the limited number of vascular centers available, patients were unable to seek treatment until further complications arise. The technique of partial aneurysmectomy and primary repair was adopted as the method of repair in this study. A total of 20 cases underwent the surgery from 2019 to 2020. Among the 20 cases, one patient had two pseudoaneurysms at different location which requires her to undergo the procedure twice. The successful cannulation rate post repair was 70% whereas the overall complication rate was 35% which might be attributed to the small sample size. Overall, this study demonstrated that AVF aneurysm and pseudoaneurysm can be safely treated with this approach and can be done effectively in non-vascular centers by general surgeons.

Effects of Aneurysmal Neck Angle on Stent Displacement after Endovascular Repair of Abdominal Aortic Aneurysm / 医用生物力学

Objective To study the effects of aneurysmal neck angle on stent displacement after endovascular repair of abdominal aortic aneurysm (AAA). Methods The CT images of 28 patients were selected to establish preoperative AAA model, postoperative AAA model and covered stent model respectively, and the models were divided into non-severe angulation group ( n = 14) and severe angulation group ( n = 14) according to the preoperative angle of tumor neck. The geometric shape of each model was measured, and the changes of AAA geometric parameters and postoperative stent displacements before and after surgery were analyzed. The displacement force of the model during the first follow-up was calculated by hemodynamic simulation. Results Significant differences were found in tumor length, maximum diameter, displacement force, tumor neck length and tumor volume between two groups of patients (P 0. 05). For the incidence of internal leakage, there were 2 cases in non-severe angulation group and 4 cases in severe angulation group (P>0. 05).Conclusions Severe neck angulation can lead to a significant increase in support displacement force and decrease in proximal anchorage zone, and thus increase the possibility of support displacement. It is suggested that doctors should strengthen postoperative follow-up for patients with severe neck angulation and be vigilant of the occurrence of long-term internal leakage in clinic.

Translocation of the Isolated Left Vertebral Artery during Thoracic Endovascular Stent-Graft Repair / 日本心臓血管外科学会雑誌

Spinal cord injury (SCI) is a main concern in patients who undergo thoracic endovascular therapy (TEVAR), because the blood flow of the vertebro-basilar artery may be reduced due to the left subclavian artery (LSA) occlusion. If the left vertebral artery originates directly from the aorta, which is called the isolated left vertebral artery (ILVA), a technical consideration for strategies regarding blood perfusion of the ILVA during TEVARs is required. We hereby aim to report three patients (No.1, No.2, and No.3) who underwent an ILVA translocation and TEVAR with Zone 2 landing for aortic dissection. The diameter of the ILVA was 4.2, 2.3, and 2.2 mm, respectively, and the right vertebral artery (RVA) was dominant in all cases. In Patient No.1 and No.2 (ILVA diameter: 4.2 and 2.3 mm, respectively), the ILVA was anastomosed directly to the left common carotid artery. In Patient No.2, the translocated ILVA was occluded resulting in SCI, but the SCI improved when blood pressure was augmented. In Patient No.3 (ILVA diameter: 2.2 mm), the saphenous vein graft was interposed between the ILVA and the bypass artery because the ILVA diameter was small, but postoperatively, the ILVA remained patent, and no paraplegia was observed. The occlusion of ILVA could cause SCI, even if the RVA is larger than the LVA. Reconstruction of the ILVA is a critical procedure to prevent postoperative SCIs in patients undergoing TEVARs.

Two Cases of Combined Performance of Endovascular Aortic Aneurysm Repair (EVAR) and Off-Pump Coronary Artery Bypass Grafting (OPCAB) / 日本心臓血管外科学会雑誌

Concomitant occurrence of coronary arterial disease (CAD) with abdominal aortic aneurysm (AAA) is not rare. Combined performance of open surgery (OS) of AAA repair and coronary arterial bypass grafting (CABG) has been reported to be effective as the way to avoid the risk of rupture of the aneurysm and acute coronary syndrome (ACS), while it's highly invasive. We successfully performed a combination performance of endovascular aneurysm repair (EVAR) and off-pump CABG (OPCAB) with the support of an intra-aortic balloon pump (IABP) in 2 cases with AAA and unstable angina pectoris (UAP). It was suggested that this strategy is a reasonable clinical option for the patient with UAP complicated with large AAA.

Treatment of Concomitant Intra-abdominal Malignancy and Abdominal Aortic Aneurysm / 中国医学科学院学报

Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.

Perfusion management of thoracoabdominal aortic aneurysm repair using partial femoral to femoral cardiopulmonary bypass / 中华胸心血管外科杂志

Objective:Analysis the protective effect of the partial femoral to femoral cardiopulmonary bypass(CPB) on thoracoabdominal aortic aneurysm repair(TAAAR).Methods:From September 2016 to August 2020, 50 cases of TAAAR under partial CPB were performed at our hospital. Thirty males and 20 females with an average age of(40.5±12.4) years old(ranging 21 to 69 years old) were involved. Partial CPB without selective organ perfusion were applied at the early stage. Since November 2019, the adjunct of perfuse the celiac and superior mesenteric artery with warm blood and irrigate the renal artery with 4℃ HTK solution was used in TAAAR, and 25 patients were operated under this adjunct.Results:The average CPB time was(116.9±35.4) min, the lowest central body temperature during the partial CPB was(34.7±0.7)℃. Total early postoperative mortality was 6%(3/50, 3 deaths in partial CPB alone group). Paraplegia occurred in 4 cases(8%), new happened postoperative hemodialysis was in 6 cases(16%). Among the hemodialysis event, 2 cases(8%, 2/25) were in the group with selective organ perfusion, and 4 cases(16%, 4/25) in the group without using the adjunct.Conclusion:Mild hypothermic partial cardiopulmonary bypass combined with selective organ perfusion have protective effects on spinal cord and abdominal organ in patients underwent TAAAR.

Stent graft infection after endovascular repair of abdominal aortic aneurysm: a case report and literature review

Aortic end graft (EVAR) infection isa challenging management problem in aortic surgery with 0.2% to 0.7% incidence, which is similar to aortic graft infection after open abdominal aortic aneurysm (AAA) repair. Although much attention has been given to the more common problem of endo leak management, yet only sporadic case reports have been reported about the late complication of endograft infection. We reported a case of elderly Saudi male, known to have multiple medical problems presented to our emergency department with severe progressive abdominal pain, vomiting, and fever over the last 7 days. He was evaluated and diagnosed as septic shock due to and infected stent graft following Endovascular Aneurysm Repair of abdominal aortic aneurysm, 4 years ago, with peritonitis. He underwent emergency laparotomy and a left paraaortic abscess was drained and a part of exposed metals of the stent graft found. Other intraperitoneal abcesses were drained and abdomen closed over drains. Patient remained under ICU care, but unfortunately deteriorated and died 3 days postoperatively.

Relationship between Aneurysm Volumetric Changes and Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair / 中国医学科学院学报

To evaluate the relationship of volumetric changes and endoleaks after endovascular aneurysm repair(EVAR)for abdominal aortic aneurysms(AAAs). We retrospectively evaluated the clinical and imaging data of 54 patients who had underwent EVAR within 1 month after their aneurysms were detected.All patients received abdominal and pelvic enhanced computed tomography(CTA)for two follow-up visits in Peking Union Medical College Hospital from July 2014 to February 2019.Three-dimensional volumes and maximum diameters on axial CT of the aortic aneurysms were calculated by dedicated semi-automated 3D segmentation software before surgery(V and D),in the 4 postoperative month(Vand D),and in the 12 postoperative month(Vand D),respectively.The presence or absence of endoleak for each patient with the V/V,V/V,and V/V were calculated to assess the significance of volume changes with respect to endoleaks and the correlation between volume changes and maximum diameter changes on axial CT images. Of the 54 patients,endoleaks were found in 11 patients at the first follow-up visit(4 months after surgery),among whom 8 patients were arranged a second follow-up visit(12 months after surgery),during which endoleaks were found in 5 patients.Fifteen of 43 non-leaked patients underwent a second CTA examination,which revealed endoleak in one case.Patients who did exhibit endoleaks[ =11,V/V=1.086(1.033,1.116)]showed significant increases in aneurysm volume when compared with those who did not exhbit endoleaks[ =43,V/V=1.019(0.970,1.065)]at the first follow-up visit(=-2.695,=0.007),although no significant difference was found with regard to volume changes between endoleaks(=6,V/V=1.1±0.2,V/V=1.0±0.1)and non-endoleaks(=17,V/V=1.0±0.1,V/V=1.0±0.1)at the second follow-up visit(=0.725,=0.476)as well as between these two follow-up visits(=-0.021,=0.984).V and D were moderately correlated with V and D,respectively(=0.5,<0.001)and strongly correlated with V and D,respectively(=0.8,<0.001).V and D were strongly correlated with V and D,respectively(=0.8,<0.001). The changes of aneurysm volume cannot reliably reflect the occurrence of endoleaks.The change of maximum axial diameter of aneurysm has certain correlation with the changes of aneurysm volume.

Single-center study comparing short and mid-term results of evar in old and young populations

Abstract Objective: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. Methods: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). Results: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). Conclusion: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.

Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case Series

PURPOSE: The AFX2 endograft is a unibody, bifurcated stent graft that can be used to lower complications in certain patients. In this study, we retrospectively reviewed consecutive cases in which the AFX2 system was used to overcome the challenges of narrow distal aorta, as well as to reduce procedure time and contrast medium dose. Furthermore, we compared the results with matched patients treated using the Endurant II endograft system.MATERIALS AND METHODS: This was a retrospective observational study of nine patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR) using the AFX2 device between June 2017 and April 2018 at Seoul National University Hospital. The patients had narrow distal aorta (n=3), reversed tapered neck (n=1), iliac artery aneurysm (n=2), chronic kidney disease patients (n=2), and impending rupture (n=1). Seven matched patients were treated using the Endurant II graft.RESULTS: In the AFX2 group, the mean procedure time was 87.2 minutes, mean blood loss volume was 157.7 mL, and mean volume of contrast medium used was 48.3 mL. In the Endurant II group, the mean procedure time was 140.0 minutes, mean blood loss volume was 175.0 mL, and mean volume of contrast medium used was 119.3 mL.CONCLUSION: Our preliminary experiences with selected AAA patients treated using the AFX2 endovascular repair system showed good outcomes compared with similar patients treated using the Endurant II system. Therefore, the AFX2 may be a good option to perform EVAR in patients of advanced age who have chronic kidney failure or narrow distal aorta.

Total Endovascular Therapy of Abdominal Aortic Aneurysm, Peripheral Artery Disease, and Chronic Mesenteric Ischemia: A Challenging Case

We presented a challenging case of a patient diagnosed with abdominal aortic aneurysm (AAA), peripheral artery disease, and chronic mesenteric ischemia (CMI). Herein, we describe the treatment in this high-risk patient diagnosed with CMI who also had critical limb ischemia and his AAA had rapidly expanded. First we performed angioplasty and celiac arterial stenting. Afterwards, we proceeded to perform balloon angioplasty of the iliac arteries and chimney endovascular aneurysm repair (Ch-EVAR) preserving the inferior mesenteric artery (IMA). The patient was discharged three days later and his IMA remained patent eighteen months post-operation. A thorough pre-operative assessment is essential in such challenging cases. Minimally invasive procedures like endovascular therapy and the chimney technique extend the prognoses in high-risk patients.

Endovascular treatment for primary infected aortic aneurysms: single center 8-year experience / 中华普通外科杂志

To assess the efficacy and outcome of endovascular aortic repair (EVAR for the treatment of primary infected aortic aneurysms (PIAAs).Methods The clinical data of 15 consecutive patients presenting with PIAA from Apr 2010 to Apr 2018 were retrospectively reviewed.Results 10 were male out of 15 patients ranging from 55 to 80 years old.The aneurysms were located in thoracoabdominal aorta in 1 case,abdominal aorta in 10 cases and left common iliac artery in 4 cases.Positive microbial cultures were reported in 13 patients,including Salmonella species in 12 and Streptococcus in 1.Eleven patients received preoperative antibiotics therapy before elective EVAR for more than 1 week.Four patients underwent emergency EVAR due to ruptured aneurysms.Postoperative antibiotic therapy was given for at least six months.There was no death within 30 days.Mean follow-up time was 44.6 months.Infection relapsed in 6 patients during follow-up.Infection-related death occurred in 3 cases.3 of them were healed.Conclusions EVAR combined with aggressive antibiotic strategy is feasible for the treatment of PIAAs,particularly in high-risk surgical patients or in the acute setting of rupture.

Long-term efficacy of fibrin sealant treating proximal type Ⅰ endoleak after endovascular aneurysm repair in abdominal aortic aneurysm / 中华普通外科杂志

Objective To observe the long-term efficacy of human fibrin sealant (FS) in the treatment of proximal type Ⅰ endoleak after endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm (AAA).Methods The clinical data of 104 AAA patients with proximal type Ⅰ endoleak receiving EVAR + FS in Changhai Hospital from 2003 to 2012 was retrospectively analyzed,among those 77 cases were with less than 15 mm proximal neck,21 cases with greater than 60 degrees proximal neck angulation,37 cases with severe calcification or thrombosis in proximal neck.After failure of conventional endoleak therapy FS was injected through AAA catheter and long-term efficacy was evaluated by CTA during the follow-up.Results Intra-sac pressure decreased significantly after FS injection.Three patients (2.9％)died perioperatively.Postoperative 1'-,3' and 5 year survival rate was 91.8％,80.6％ and 60.2％respectively.Maximum diameter of AAA decreased from (58.78 ± 13.41) mm to (52.6-± 12.2) mm.There was no FS injection related complications.Conclusion Intra-sac injection of FS is an effective,economical and safe method for treating post-EVAR endoleak,especially for AAA with relatively short and twisted aneurysm neck.

Total percutaneous endovascular aneurysm repair (pEVAR): the initial experience in Hospital Kuala Lumpur

Introduction: There has been a paradigm shift in the treatment of AAA with the advent of endovascular aneurysm repair (EVAR). Rapid progress and evolution of endovascular technology has brought forth smaller profile devices and closure devices. Total percutaneous endovascular aneurysm repair (pEVAR) involves the usage of suture-mediated closure devices (SMCDs) at vascular access sites to avoid a traditional surgical cutdown. Materials And Methods: We retrospectively reviewed our experience of pEVAR between April 2013 and July 2014. Primary success of the procedure was defined as closure of a common femoral artery (CFA) arteriotomy without the need for any secondary surgical or endovascular procedure within 30 days. Results: In total there were 10 pEVAR cases performed in the study period, one case in Queen Elizabeth Hospital during visiting vascular service. Patients have a mean age of 73.4 year old (66-77 year old) The mean abdominal aortic size was 7.2 cm (5.6-10.0cm). Mean femoral artery diameter was 9.0 mm on the right and 8.9 mm on the left. Mean duration of surgery was 119 minutes (98- 153 minutes). 50% of patients were discharged at post-operative day one, 30%- day two and 20%- day three. Primary success was achieved in 9 patients (90%) or in 19 CFA closures (95%). No major complication was reported. Discussion: We believe that with proper selection of patients undergoing EVAR, pEVAR offers a better option of vascular access with shorter operative time, less post- operative pain, shorter hospital stay and minimises the potential complications of a conventional femoral cutdown.

Early Experiences of Sandwich Technique to Preserve Pelvic Circulation during Endovascular Aneurysm Repair

PURPOSE: To report experiences of the sandwich technique (ST) for preservation of pelvic flow during endovascular repair of complex aortic or aortoiliac aneurysms. MATERIALS AND METHODS: Eight patients underwent elective endovascular aneurysm repair (EVAR) using the ST between March 2013 and February 2017. The anatomic indications for the ST were complex aortoiliac aneurysms (5 cases), abdominal aortic aneurysms (AAA) with non-diseased short common iliac arteries (2 cases) and AAA with unilateral occluded iliac artery (1 case). The ST was performed through both femoral and brachial approach. Patient clinical and radiologic data were collected and analyzed. RESULTS: Eight patients (7 male; mean age, 73.4 years) were followed over a mean period of 277 days (range, 9–1,106 days). The technical success rate was 100%. The primary patency rate of the iliac stent-grafts was 88% (14/16 cases). One internal iliac and 1 external iliac stent-graft occlusion was observed during the early postoperative period. There was 1 gutter endoleak which disappeared spontaneously within 4 days, and there were 2 type II endoleaks: one treated by coil embolization after 13 months, and the other observed without treatment. There were no cases of sac growth or aneurysm-related deaths, and no cases of buttock claudication or impotence. CONCLUSION: The ST is a safe and feasible technique to preserve pelvic circulation during endovascular treatment of complex aortoiliac aneurysms. The need to expand the indications for complex EVARs with adjunctive procedures, such as the ST is highlighted in situations where branched/fenestrated device availability is limited.

Initial Clinical Experience with the Endologix AFX Unibody Stent Graft System for Treating Patients with Abdominal Aortic Aneurysms: A Case Controlled Comparative Study

PURPOSE: The newly designed unibody AFX endograft system for endovascular aortic aneurysm repair is the only graft with anatomical fixation to the aortic bifurcation in comparison to most other grafts that use the infrarenal neck as the main fixation point. The aim of this study was to assess the preliminary results of the AFX stent-graft system used with infrarenal aortic component and compare them with those obtained in patients treated with a well established endograft of the same material and pure infrarenal fixation as the Gore Excluder. MATERIALS AND METHODS: A retrospective analysis of prospectively collected data from March 2014 to December 2014 identified 10 elective abdominal aortic aneurysm patients treated with the AFX endograft, in comparison to a matched group of 20 patients treated with the Excluder stent-graft. Endpoints included technical and clinical success, freedom from any secondary intervention, any type of endoleak and aneurysm related death. RESULTS: Primary technical success was achieved in all patients and no 30-day device related complications or deaths were occurred. The two groups were similar in terms of radiation burden, contrast media, duration of the procedure, post implantation syndrome and in-hospital stay. During a median follow-up period of 23 months (range, 18–26 months) there were no differences in clinical success, freedom from reintervention and aneurysm related death. No type I endoleak was observed in either group. Five of the 6 type II endoleaks (1 in the AFX and 4 in the Excluder group) spontaneously resolved, while in only one patient (Excluder) the endoleak remained without however any change in aneurysm sac diameter (log rank=0.34). CONCLUSION: The initial experience with the AFX stent graft system is promising, with successful aneurysm exclusion and good short-term results. Further and larger studies are needed to fully evaluate the sort as well as the long-term results.

The value of contrast enhanced ultrasound in diagnosing type Ⅰ and Ⅱ endoleaks after endovascular abdominal aortic aneurysm repair / 中华超声影像学杂志

Objective To investigate the role of contrast enhanced ultrasound (CEUS) in detecting type Ⅰ and Ⅱ endoleaks after endovascular abdominal aortic aneurysm repair (EVAR).Methods PostEVAR patients who met the inclusion criteria were enrolled.All of patients underwent CEUS and computer tomography angiography (CTA) examination.The following parameters were evaluated:ultrasound contrast agent within aneurysmal sac,location and source of endoleaks,wash-in time of endoleaks and stentgraft since contrast agent injection.Analysis was performed to observe different types of endoleak features in CEUS.Results Nine cases were enrolled and all the cases had endoleaks.Three cases were type Ⅰ,6 cases were type Ⅱ.The wash-in time of type Ⅱ endoleaks delayed 9.8 seconds compared to type Ⅰ,and the results of CEUS diagnosis were consistent with CTA.Conclusions CEUS is an effective way to detect endoleaks.This technique can be used as a supplement for CTA in follow-up of post-EVAR patients.