Diagnosis and surgical treatment of abdominal aortic vascular endograft infections: an analysis of 13 cases / 中华普通外科杂志

Objective:To evaluate the diagnosis and surgical treatment of abdominal aortic vascular endograft infections.Methods:Clinical data of 13 patients of abdominal aortic vascular endograft infections undergoing surgical treatment at Department of Vascular Surgery, Peking University People's Hospital from Jan 2015 to Jan 2021 was retrospectively analyzed.Results:All 13 patients underwent infected graft resection under axillobifemoral bypass. Three patients died perioperatively and 10 recovered. Eight patients were followed-up,with bypass graft being occluded and another one with bypass graft infections exposure.Conclusions:Abdominal aortic vascular endograft infections are catastrophic diseases with high surgical difficulty and risk. Extra-anatomic reconstruction with graft removal is a safe and effective treatment for the eradication of infection.

A case study of nursing cooperation in axillobifemoral bypass surgery treating stent-graft infection after endovascular repair of abdominal aortic aneurysm / 中国实用护理杂志

Objective@#To summarize the nursing cooperation of axillobifemoral bypass surgery treating stent graft infection after endovascular aortic repair of abdominal aortic aneurysm.@*Methods@#To review a case of stent graft infection after endovascular aortic repair of abdominal aortic aneurysm and summarize the nursing cooperation of this patient retrospectively.@*Results@#After the medical care tacit cooperation and the infection protection, the procedure was successfully completed. The artificial blood vessels of the patient were unobstructed after the operation, and the pulse of both dorsalis pedis arteries was strong.@*Conclusions@#Axillobifemoral bypass surgery poses the characteristicsof long duration and complex. Designation of appropriate nursing measures, such as multi-incision management, thrombosis preventing and prevention of ischemia based on potential complications, are essentials of successful operation.

Successful Re-intervention for Endograft Collapse after TEVAR / 日本心臓血管外科学会雑誌

<p>A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.</p>

Endovascular repair of an iliac artery aneurysm after endovascular aneurysm repair with handmade iliac branch device:a case report / 北京大学学报(医学版)

SUMMARY An involved internal iliac artery is usually embolized when performing endovascular aneu -rysm repair for aortoiliac or isolated iliac artery aneurysm .This can lead to complications such as buttock claudication ,colon ischaemia and erectile dysfunction .Iliac branch device ( IBD ) is an endograft de-signed specifically for iliac bifurcation to preserve internal iliac flow .It was performed with high technical success rates and encouraging mid-term patency .Here we report a case of right iliac aneurysm developed 3 years after endovascular aneurysm repair for an aortoiliac aneurysm , with the patient ’ s left internal ar-tery been sacrificed then .Using a handmade IBD , we excluded the aneurysm without occlusion of the ip-silateral internal iliac artery or any type of endoleak .Both the design and deployment of this IBD are dis-tinctive that we would like to share our experience with all the colleagues .

Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review

This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked (<15 mm) juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, using “juxtarenal abdominal aortic aneurysm” and “treatment” as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality), except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck <15 mm.

Endovascular Management of Spontaneous Superficial Femoral Artery Pseudoaneurysm in a Renal Allograft Patient

We report a case of a superficial femoral artery pseudoaneurysm in 52-year old patient with a history of having renal allograft. The pseudoaneurysm spontaneously developed while standing up from squatting position after defecation, and it was successfully managed by an endovascular repair with an endograft. This case suggests that an atherosclerotic superficial femoral artery is vulnerable to torsion and tension movement during changing position from squatting to standing, which is repeatedly practiced by the people using the Korean traditional toilet. The endovascular therapy is also recommended for elderly patients with poor clinical conditions such as having a renal allograft and diffuse atherosclerosis of peripheral arteries.

Tratamiento endovascular de las lesiones traumáticas de la aorta descendente con endoprótesis Apollo®: Experiencia de diez años / Endovascular treatment of descending aortic traumatic lesions with the Apollo® endograft: Ten years experience

Introducción: Las heridas traumáticas de la aorta torácica tienen una alta mortalidad. Su tratamiento es factible si el diagnóstico es rápido y preciso. El abordaje endovascular es una alternativa menos invasiva, con una menor tasa de complicaciones según la literatura. Se presenta una serie de pacientes con traumatismos tratados por este método con la colocación de endoprótesis Apollo®, en el Centervasc - Río de Janeiro, acompañado de seguimiento a largo plazo. Materiales y métodos: Se recogieron de forma prospectiva y retrospectiva los datos de seis pacientesconsecutivos (edad media 37.6 años, entre 19 y 56 años) de los pacientes con lesiones traumáticas de la aorta torácica descendente (5 trauma contuso y uno penetrante) tratados por método endovascular, con carácter de urgencia, con la implantación de endoprótesis recta Apollo® (Nano endoluminal, SC, Brasil) entre 2000 y 2006. Se analizaron las características demográficas de los pacientes, el tipo de trauma, los aspectos técnicos del implante, resultados angiográficos inmediatos y complicaciones tempranas o tardías. Como complicaciones, se consideraron la aparición de flujo persistente periprotésico o intrasaco (endofuga), las fallas estructurales de los dispositivos, la incidencia de paraplegia y la muerte hasta julio de 2010, un período mínimo de 4 años y un máximo de 10 años. Resultados: En cuatro pacientes, el tratamiento se llevó a cabo en menos de 14 hs. tras el traumaen un caso después de 36 horas y en otro caso, sólo 14 días después del evento inicial. Los procedimientos fueron realizados bajo anestesia general sin el drenaje de líquido cefalorraquídeo, con abordaje quirúrgico femoral unilateral asociado a la punción contralateral de la femoral común.La heparinización sistémica se utilizó sólo si no había evidencia de una hemorragia interna o trauma en la cabeza. Ningún paciente experimentó una conversión a procedimiento quirúrgico abierto...

Introdução: As lacerações traumáticas da aorta torácica tem elevada mortalidade imediata. O seu tratamento é factível se o diagnóstico for rápido e preciso. A abordagem endovascularé a alternativa menos invasiva e com menor índice de complicações segundo a literatura. Apresentamos uma série de pacientes vítimas de trauma tratados por este método, com implante de endopróteses Apollo®, no Centervasc-Rio, acompanhados em longo prazo.Materiais e Métodos: Foram coletados de forma prospectiva e retrospectiva os dados de seis pacientes consecutivos (idade média de 37,6 anos, entre 19 e 56 anos) portadores de lesõestraumáticas da aorta torácica descendente (5 traumas contusos e 1 penetrante) tratados pelo método endovascular, em caráter de emergência, com implante de Endopróteses Retas Apollo® (Nano Endoluminal, SC, Brasil) entre 2000 e 2006. Foram analisadas as características demográficas dos pacientes, o tipo de trauma, os aspectos técnicos do implante, os resultadosangiográficos imediatos e as complicações precoces ou tardias. Como complicações considerou-seo surgimento de persistência de fluxo periprotético ou intra saco (endoleak), falhas estruturais dos dispositivos, a ocorrência de paraplegia e de óbito até julho de 2010, com seguimento mínimode 4 anos e máximo de 10 anos.Resultados: Em quatro pacientes o tratamento foi realizado em menos de 14h após o trauma, em um caso após 36h e em um caso, somente 14 dias após o evento inicial. Os procedimentosforam realizados sob anestesia geral, sem drenagem liquórica, com acesso cirúrgico femoral unilateral associado a punção femoral comum contralateral. Heparinização sistêmica somente foi empregada se não houvesse evidência de hemorragia interna ou de trauma cranioencefálico. Nenhum paciente foi submetido a conversão para o procedimento cirúrgico aberto...

Introduction: Traumatic injuries of the thoracic aorta have a high mortality. The treatment is feasible if the diagnosis is prompt and accurate. The endovascular approach is a less invasive alternative,with a lower rate of complications according to the literature. A series of patients with injuries and treated by the placement of the Apollo® endograft were treated at the Centervasc - Río deJaneiro, together with a long-term follow up. Materials and methods: Prospective and retrospective data were collected of six consecutive patients(mean age 37.6 years, range 19 and 56 years) with traumatic lesions of the descending aorta (5 blunt trauma and 1 penetrating trauma) treated in emergency by endovascular approach implanting an Apollo® endograft (Nano endoluminal, SC, Brazil) between 2000 and 2006. The demographiccharacteristics of the patients, the type of trauma, the technical aspects of the endograft, the immediate angiographic results, and early and late complications were analyzed. Among the complications up to July 2010 for a minimum of 4 and a maximum of 10 years we can mentionthe presence of periprothesic or in the sac (endoleak) flow, structural failures of the devices, the incidence of paraplegia and death. Results: In four patients the procedure was carried out within less than 14 hours after the initial trauma and in one case after 36 hours. In another case, 14 days after the index event. Procedures were carried out under general anesthesia without cerebrospinal fluid drainage, with unilateral femoral approach combined with the contralateral puncture of the common femoral. Systemic heparinization was used only under evidence of internal hemorrhage or head trauma. No patient had to be converted to an open surgical procedure...

EVAR utilizando Nellix, la endoprótesis con sellamiento en el saco / EVAR using the Nellix sa-sealing endoprosthesis

La endoprótesis Nellix es un nuevo dispositivo endoluminal diseñado para tratar los aneurismas aorto-ilíacos, sellando el saco del aneurisma, eliminando así la endofuga mientras se mantiene el flujo normal de las extremidades inferiores. Se compone de dos conductos dilatables por balón,cada uno rodeado por una endobolsa, que se llena in situ con un polímero. Cada conducto soporta la luz del flujo sanguíneo a través del saco del aneurisma hacia las arterias ilíacas. La endobolsa con polímero se mantiene alrededor de la luz y llena el saco del aneurisma, bloqueando el flujoretrógrado de las ramas laterales, anclando el dispositivo en el saco del aneurisma sin necesidad de fijación proximal y distal; además provee estabilidad posicional. Por lo tanto, este dispositivo puede ser utilizado para tratar no sólo los pacientes con cuello aórtico y anatomía ilíaca estándar,sino también en aquellos con anatomías adversas. Se presenta la primera experiencia clínica de Nellix en 34 pacientes durante el período 2008-2010. Los resultados auguran un buen futuro y la pronta aprobación por la Comunidad Europea.

A endoprótese Nellix é um novo dispositivo endoluminal desenhado para tratar os aneurismas aorto-ilíacos, fechando completamente a bolsa de aneurisma, eliminando assim a endofuga,enquanto é mantido o fluxo normal das extremidades inferiores. Compõe-se de dois condutos ampliáveis por um balão, cada um rodeado por uma endobolsa, que se enche “in situ” com umpolímero. Cada conduto suporta a luz do fluxo sanguíneo através da bolsa de aneurisma até as artérias ilíacas. A endobolsa com polímero é mantida ao redor da luz e enche a bolsa de aneurisma, bloqueando o fluxo retrógrado dos ramos laterais, funcionando como dispositivo âncora na bolsa de aneurisma, sem necessidade de fixação proximal e distal, e além disso proporciona estabilidade posicional. Portanto, este dispositivo pode ser utilizado para tratar não somente pacientes com colo aórtico e anatomia ilíaca standard, como também aqueles com anatomias adversas. Apresenta-se a primeira experiência clinica de Nellix em 34 pacientes durante o período 2008-2010. Os resultados auguram um bom futuro e a breve aprovação da Comunidade Européia.

The Nellix endoprosthesis is a new endoluminal device designed to treat aorto-iliac aneurysms by sealing the aneurysm sac, thus eliminating the endoleak space, while maintaining normal flow to the lower extremities. It consists of dual, balloon-expandable endoframes, each surroundedby an endobag, which is filled with an in-situ curing polymer. Each endoframe supports the blood flow lumen through the aneurysm sac to the iliac arteries. The polymer containing endobags surround the flow lumen and fill the aneurysm sac, blocking retrograde flow from side-branches, anchoringthe device within the aneurysm sax without the need for proximal and distal fixation, and further providing it with positional stability. Thus, this device can be used to treat not only patients with standard aortic neck and iliac anatomy but also those with adverse anatomies.We report the first clinical experience with Nellix in 34 patients during 2008-2010. The outcomes augur well and a speedy approval by the European Community.

Experiencia multicéntrica con la endoprótesis de relay™ bolton con escotadura distal: Un avance en la cirugía endovascular de la aorta torácica / Multicenter experience with distal scallop relay™ bolton endograft: A step forward in thoracic endografting

La corrección endovascular se ha propuesto como una alternativa efectiva a la reparación abierta para el tratamiento de varias patologías de aorta. La migración craneal es una de las cuestiones críticas relativas a durabilidad a largo plazo. Las endoprótesis hechas a medida fueron propuestas para mejorar la durabilidad y la fijación distal de cruzar el diafragma. El objetivo de ese trabajoes evaluar la viabilidad técnica y experiencia con los dispositivos hechos a medida usando la plataforma de la endoprótesis torácica Relay™ Bolton como una alternativa para el cuello distal de configuración subóptima, para mejorar la fijación distal y sellado en el cuello corto distal. Métodos: Desde enero de 2006 a junio 2009, 57 pacientes (40 hombres), han sido tratados en Europa con la endoprótesis de torácica Relay™ Bolton sob medidia. Cuarenta y cinco pacientespresentaron aneurisma de aorta torácica, nueve presentaron disección Tipo B, y tres tenían pseudoaneurisma. Resultados: Hubo despliegue con éxito en todos los casos, salvo una rotación parcial en una anatomía extremadamente tortuosa. Se logró suceso técnico en 96,4%. Buen sellado y ningún caso de mortalidad, paraplejía o embolización visceral fueron observados. En un seguimiento mediode 6 meses no se registraron complicaciones. Conclusiones: La endoprótesis de Relay™ Bolton con escotadura distal representa una alternativa viable para cuellos cortos distal. Este enfoque aumenta la aplicabilidad de endoprótesis y mejora la durabilidad de las endoprótesis torácicas en el cuello corto distal.

A correção endovascular foi proposta como uma alternativa efetiva para a cirurgia de reparação aberta para o tratamento de várias patologias da aorta. A migração cranial é uma das questões críticas relativas à durabilidade a longo prazo. As endopróteses sob medida foram propostas para melhorar a durabilidade e a fixação distal de cruzar o diafragma. O objetivo desse trabalho é avaliar a viabilidade técnica e experiència com os dispositivos sob medida, usando a plataforma da endoprótese torácica Relay™ Bolton como uma alternativa para o colo distal de configuração subóptima, para melhorar a fixação distal e fechamento completo do colo curto distal. Métodos: De janeiro de 2006 a junho de 2009, 57 pacientes (40 homens), foram tratados na Europa com a endoprótese torácica de Relay™ Bolton sob medida. Quarenta e cinco pacientes apresentaram aneurisma de aorta torácica, nove apresentaram dissecção Tipo B e três, pseudoaneurisma. Resultados: Constatou-se êxito em todos os casos, exceto uma rotação parcial em uma anatomia extremamente tortuosa. Obteve-se sucesso técnico em 96,4%. Bom fechamento completo e não apresentou nenhum caso de mortalidade, paraplegia ou embolização visceral. Em um acompanhamento médio de 6 meses não foram registradas complicações. Conclusões: A endoprótese de Relay™ Bolton com entalhe distal representa uma alternativa viável para colo curto distal. Este enfoque aumenta a aplicabilidade da endoprótese e melhora a durabilidade das endopróteses torácicas no colo curto distal.

Thoracic endografting has been proposed as an effective alternative to open repair to treat several aortic pathologies. Cranial migration is one of the critical issues concerning long term durability. The scalloped thoracic endograft was proposed to improve distal sealing and fixation crossing the diaphragm. The objective of this study was to evaluate technical feasibility and experience with a custom-made scalloped thoracic endograft using the Relay platform (Bolton Medical, Sunrise, FL) in selected cases. From January 2006 to June 2009, 57 patients (40 men) were treated in Europe with a customized distal scalloped thoracic endograft. Fortyfive patients presented with thoracic aortic aneurysm, nine presented with Type B dissection, and three had a pseudoaneurysm. Successful and accurate deployment was achieved in all cases except one partial rotation in an extremely tortuous anatomy. Technical success was achieved in 96.4%. Good sealing and no mortality, paraplegia, or visceral embolization were observed. At a mean follow-up of 6 months, no complications were registered. The Relay endograft with the distal scallop represents a feasible alternative for distal short necks. This approach may increase the applicability and durability of the endograft in short distal necks.

Tratamiento endovascular de lesiones traumáticas de troncos supra aórticos / Endovascular treatment of traumatic supra aortic trunk lesions

Introduction: Traumatic lesions of supra aortic trunks (SAT) have an elevated morbidity and mortality, and its treatment is technically challenging. Endovascular techniques offer an effective solution with a lower risk, making it an attractive alternative. Objectives: Retrospective review of all the patients with SAT lesions treated with endovascular techniques. Results: Between March 2000 to August 2009, 8 patients were treated, 6 men, mean age 33.6 years. Three patients suffered blunt and 5 a penetrating trauma. The injured vessels were subclavian artery in 5, brachiocephalic trunk in two and common carotid in one. Of the 5 patients with subclavian artery injury, three had associated brachial plexus injury. Six patients were treated with an endo-graft and one with coil-embolization. One patient suffered an early partial collapse of his endograft, requiring an additional bare metal stent to maintain patency. In this series there was neither neurological morbidity nor operative mortality. Follow-up is 24.3 months, and primary assisted patency is 100 percent at 21.9 months with two patients lost to follow-up. Conclusions: Endovascular treatment of SAT lesions is effective, showing low morbidity and mortality with a good mid-term patency.

Introducción: Las lesiones traumáticas de troncos supra aórticos (TSA) tienen elevada morbimor-talidad, y su tratamiento presenta un desafío técnico. Las técnicas endovasculares se presentan como una alternativa atractiva y de menor riesgo para su solución efectiva. Objetivos: Evaluar los resultados del tratamiento endovascular de las lesiones de TSA. Material y Método: Se revisaron retrospectivamente todos los pacientes sometidos a tratamiento endovascular de lesiones de TSA. Resultados: Entre Marzo de 2000 y Agosto de 2009 se intervinieron 8 pacientes, 6 hombres, edad promedio 33,6 años. El mecanismo traumático fue contuso en 3 y penetrante en 5. Los vasos afectados fueron arteria subclavia en 5, tronco braquiocefálico en 2 y carótida común en uno. De los pacientes con lesión subclavia, tres presentaron compromiso de plexo braquial asociado. Siete pacientes fueron tratados con implante de endoprótesis y uno mediante embolización. Un paciente requirió un stent no cubierto para tratar el colapso parcial precoz de una endoprótesis. No hubo morbilidad neurológica de novo ni mortalidad operatoria. El seguimiento clínico promedio es 24,3 meses. Dos pacientes se perdieron al seguimiento. La permeabilidad primaria asistida es 100 por ciento a 21,9 meses. Conclusiones: El tratamiento endovascular de lesiones de TSA es efectivo, con baja morbimortalidad y con buena permeabilidad a mediano plazo.

Tratamiento endovascular de transecciones agudas de la aorta descendente / Endovascular treatment of acute traumatic aortic rupture

Background: Traumatic rupture of the thoracic aorta as a result from high-speed deceleration injury is associated with a mortality rate of 80 percent to 90 percent at the scene of the accident. Survivors usually have life-threatening injuries to other organ systems. Standard open repair is associated with a high penoperative morbidity and mortality. Endografting offers a less invasive alternative to open surgical repair. Aim: To evaluate results of endovascular management of acute traumatic descending thoracic aortic ruptures. Methods: Between August 2002 and March 2010, patients treated for this trauma were reviewed. Results: 16 patients (fourteen males mean age 42.7 +/- 15.8 years, range 24-74) underwent endovascular treatment of an acute aortic rupture. Associated traumas in fifteen patients were: severe brain (7), spleen (4), liver (1), kidney (3) and large bone (9) injuries. Motor vehicle accidents caused 13 of the injuries and fall from height 3. Rupture was diagnosed with admission CT sean and confirmed by intraoperative angiogram. Patients were treated with thoracic aortic endograft, in 11 cases the left subclavian artery was covered with no need for further revascularization. Technical success was 100 percent, no procedure-related mortality or paraplegia was observed. One patient died 5 days after the procedure due to severe associated injuries. During a mean follow-up of 30.8 months (range 1-80), no deaths, complications or need for further interventions presented. Conclusion: Endovascular treatment of acute traumatic aortic isthmic rupture is encouraging and compares favorably to open surgical approach with low morbidity and mortality rates.

Los accidentes por desaceleración súbita se asocian a transección de la aorta torácica, falleciendo 85-90 por ciento de ellos en el sitio del suceso. Los que sobreviven presentan habitualmente politraumatismo asociado grave, teniendo la reparación quirúrgica convencional de la aorta una alta morbimortalidad. La reparación endovascular es una alternativa menos invasiva y de menor morbi-mortalidad. Objetivo: Analizar los resultados de la reparación endovascular de transecciones agudas de la aorta torácica. Pacientes y Métodos: Se revisan los antecedentes de los pacientes tratados entre agosto de 2002 y marzo de 2010. Resultados: Tratamos 16 pacientes (14 hombres, 42,7 +/- 15,8 años, extremos 24-74) con transección traumática aguda de aorta torácica descendente. Quince presentaban lesiones asociadas: traumatismo encéfalo-craneano (7), fractura de huesos largos (9), laceración esplénica (4), hepática (1), renal (3). La causa del accidente fue vehicular en 13 casos y caída de altura en 3. El diagnóstico fue realizado mediante tomograña axial computada al ingreso y luego angiograña en la sala de operaciones. El tratamiento consistió en la cobertura de la zona de transección mediante el implante de una endoprótesis, siendo necesario cubrir la arteria subclavia izquierda en 11 casos, sin requerir revascularización de la extremidad. El éxito técnico fue 100 por ciento, no hubo mortalidad relacionada al procedimiento. No hubo paraplejia. Un paciente de 60 años fallece al 5to día por lesiones asociadas graves. En el seguimiento alejado a 30,8 meses (1-80) no ha habido complicaciones ni reintervenciones. Conclusión: La cirugía endovascular es una alternativa eficaz y con baja morbimortalidad para el tratamiento de transecciones de la aorta torácica.

Endovascular elective treatment of the abdominal aortic aneurysm versus conventional open repair: a comparative study

O tratamento eletivo do aneurisma de aorta abdominal é recomendado pela alta morbiletalidade decorrente da eventual ruptura. O objetivo deste trabalho foi comparar o reparo endovascular eletivo com a cirurgia aberta e avaliar as mortalidades hospitalar e perioperatória, em 1 ano, por todas as causas e relacionadas ao aneurisma, a permanência hospitalar, as complicações, as taxas de sobrevida, conversão e reintervenção, a durabilidade do enxerto, o custo-benefício e a relação desses dados com o treinamento da equipe médica responsável pelo tratamento. Realizou-se uma revisão da literatura sobre reparo endovascular versus cirurgia convencional. Foram observados vantagem na sobrevivência perioperatória e menor estresse pós-cirúrgico; no entanto, os benefícios iniciais são perdidos por complicações e reintervenções tardias. Trabalhos baseados nas primeiras gerações de endopróteses superestimam as taxas de mortalidade em curto prazo, complicações e reintervenções. A durabilidade do enxerto, a real vantagem na sobrevida e o custo-benefício são incertos, e outros estudos são necessários para o seguimento em longo prazo.

The elective treatment of the abdominal aortic aneurysm is recommended due to the high morbidity and mortality of a possible rupture. The objective of this study was to compare the elective endovascular aneurysm repair with open repair and to analyze the in-hospital and perioperative mortality rate during 1 year related to all causes and to the aneurysm, as well as the postoperative length of hospital stay, complications, survival rates, conversion and reintervention, graft durability, cost-benefit ratio, and relation with the medical team's experience. A review of the scientific literature about endovascular versus open repair was carried out. We found a higher rate of perioperative survival and less postoperative stress; nevertheless, the initial benefits were lost due to late complications and reinterventions. First-generation endografts overestimated the early results of mortality rates, complications, and reinterventions. Endograft durability, real advantage of survival rates, and cost-benefits are uncertain and further long-term follow-up studies are necessary.

Implante de endoprótese aórtica através de acesso totalmente percutâneo / Total percutaneous access for aortic endograft placement

O acesso totalmente percutâneo para o implante de endopróteses aórticas, através da preclose technique, é possível mesmo quando utilizadas bainhas introdutoras de elevado perfil. Relatamos sete casos de tratamento endovascular de doenças da aorta, todos realizados de modo percutâneo, e discutimos os principais aspectos desta técnica.

Total percutaneous access for aortic endograft delivery, using the preclose technique, is feasible even with the use of large-diameter introducer sheaths. We report seven cases of percutaneous approach in endovascular treatment of aortic diseases and discuss the main technical aspects.

Uninfected Para-Anastomotic Aneurysms after Infrarenal Aortic Grafting

PURPOSE: This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. MATERIALS AND METHODS: From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. RESULTS: The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. CONCLUSION: Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.

Aneurisma de la aorta abdominal: Tratamiento endovascular con una endoprótesis fenestrada / Abdominal aortic aneurysm: Endovascular treatment with fenestrated endoprothesis

El tratamiento endovascular de los aneurismas de aorta abdominal es una alternativa a la cirugía abierta para pacientes de alto riesgo. Consiste en la exclusión del saco aneurismático mediante la interposición de una endoprótesis colocada por vía femoral. El tratamiento endovascular no puede ser utilizado en todos los pacientes. Una limitación frecuente la constituye el nacimiento de una arteria visceral desde el saco aneurismático. Para contrarrestar esta limitación recientemente se han desarrollado endoprótesis fenestradas que presentan orificios que se corresponden con el nacimiento de las arterias involucradas en el aneurisma evitando su oclusión, permitiendo de esta manera el tratamiento endovascular. En esta comunicación se presenta un caso de tratamiento endovascular de un aneurisma de aorta abdominal mediante la colocación de una endoprótesis fenestrada en un paciente cuya arteria renal izquierda nacía directamente del saco aneurismático.

Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.