Partial Endograft Removal Preserves the Aortic Walls During Delayed Open Conversions of Endovascular Aortic Repair.

BACKGROUND: Open conversion of endovascular aortic repair (EVAR) is the first-choice treatment in case of endograft failure or high-flow endoleak. However, the traditional technique based on the total removal of the endograft can produce injuries of the aortic walls, with severe consequences on the anastomoses quality. Our aim is to show the advantages of the partial endograft removal on the aortic integrity by reporting a case series including 25 delayed open conversion performed with this technique. METHODS: A retrospective study was conducted over the cases of delayed open conversions performed in the last 30 months. Demographics, past medical history, endograft type, causes for conversions, and early and mid-term outcomes were recorded and analyzed in relation with the technique employed (partial vs total endograft removal). RESULTS: Between September 2016 and March 2019, 25 consecutive cases of EVAR failure were converted to open treatment. In all cases, the endografts were resected leaving in place part of the iliac branches, and, whenever possible, also the proximal stent of the main body. Primary technical success was achieved in 100% of cases. Disease-free survival over 18-month median follow-up was 100%. All patients underwent abdominal aortic duplex scan controls as scheduled, with no early or late postoperative complication. No anastomotic aneurysms or any surgery-related complications were observed. CONCLUSIONS: Partial endograft removal is a safe and effective technique that could be used to protect the aortic integrity in delayed open conversions of EVAR.

The Bolton Treo Endograft: A Single-Center Preliminary Experience.

BACKGROUND: Endovascular repair is currently the most frequently used treatment of abdominal aortic aneurysms, but its feasibility and success highly depend on the characteristics and the correct choice of the endograft to be used. Bolton Treo is one of the most popular endografts of newer generation which have been launched in the past few years, and this study aims to analyze the preliminary outcomes (8 months in average) of a single-center experience with this device. METHODS: Thirty-seven consecutive abdominal aortic aneurysms, treated with Treo between June 2016 and December 2017, were followed up every 3, 6, and 12 months, and any kind of endograft-related complications was recorded. RESULTS: Technical success was 100%, and no perioperative death (within 30 days) was recorded. Over a mean follow-up period of 8 months, the overall reintervention rate was 5.4% (2 cases, for a type Ia endoleak and an iliac branch thrombosis), for those performed by endovascular techniques. Two type II endoleaks, not worthy of treatment, were also observed. No procedure-related mortality, endograft thrombosis, or rupture was observed. CONCLUSIONS: Over the short term, Treo demonstrated high effectiveness in treating abdominal aortic aneurysms both in elective and urgent settings, within and outside the indications for use. Outcomes over long term are still needed to validate these results.

Deferment of objective assessment of deep vein thrombosis and pulmonary embolism without increased risk of thrombosis: a practical approach based on the pretest clinical model, D-dimer testing, and the use of low-molecular-weight heparins.

BACKGROUND: Treatment of patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) is problematic if diagnostic imaging is not immediately available. Pretest clinical probability (PCP) and D-dimer assessment can be used to identify patients for whom empirical protective anticoagulation is indicated. To evaluate whether PCP and D-dimer assessment, together with the use of low-molecular-weight heparins (LMWHs), allow objective appraisal of DVT and PE to be deferred for up to 72 hours, patients with suspected DVT and PE were prospectively examined. METHODS: Patients identified with a high PCP or a moderate PCP with positive D-dimer test results received a protective full-dose treatment of LMWH; the remaining patients were discharged without anticoagulant administration. However, all patients were scheduled to undergo objective tests for DVT or PE within 72 hours. Standard antithrombotic therapy was administered when deferred diagnostic tests confirmed venous thromboembolism. RESULTS: In total, 409 consecutive patients with suspected DVT and 124 with suspected PE were included in this study. A total of 23.8% (95% confidence interval [CI], 20.3%-27.3%) of patients had confirmed venous thromboembolism. At the short-term follow-up (72 hours), only a single thromboembolic event (0.2%; upper 95% CI, 0.6%) had occurred, whereas at the 3-month follow-up, 5 events (1.2%; 95% CI, 0.2%-2.1%) had occurred in patients in whom diagnosis of DVT or PE had previously been ruled out. None of the patients had major bleeding events. Ninety percent of patients were treated as outpatients. CONCLUSION: Our study demonstrates that this approach allows the safe deferral of diagnostic procedures for DVT and PE for up to 72 hours.