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1. Editor's choice – Influence of proximal aortic neck diameter on durability of aneurysm sealing and overall survival in patients undergoing endovascular aneurysm repair. Real world data from the Gore Global Registry for Endovascular Aortic Treatment (GREAT)

Author

Howard, DPJ, Marron, CD, Sideso, E, Puckridge, PJ, Verhoeven, ELG, Spark, JI, and Investigators, Global Registry for Endovascular Aortic Treatment (GREAT)

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Prosthesis Design, Endovascular aneurysm repair, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Aneurysm, Blood vessel prosthesis, Risk Factors, parasitic diseases, Aneurysm neck, medicine, Overall survival, Humans, In patient, Aged, Aged, 80 and over, business.industry, Endovascular Procedures, Stent, Middle Aged, medicine.disease, Abdominal aortic aneurysm, Surgery, Blood Vessel Prosthesis, Treatment Outcome, Outcome analysis, Female, Stents, Cardiology and Cardiovascular Medicine, Aortic neck, business, Aortic Aneurysm, Abdominal
Abstract

OBJECTIVES: Aortic neck diameter is an independent anatomical feature that is poorly understood, yet potentially linked to proximal seal failure and adverse outcome following standard EVAR. The aim of this study was to assess whether large proximal aortic neck (LAN) diameter is associated with adverse outcome using prospectively collected individual patient data from The Global Registry for Endovascular Aortic Treatment (GREAT). METHODS: A total of 3166 consecutive patients, from 78 global centres, receiving Gore Excluder stent grafts for infrarenal abdominal aortic aneurysm repair between 2011 and 2017 were included. Patient demographics, biometrics, operative details, and clinical outcome were analysed. Patients were divided into two groups: normal baseline proximal aortic neck (NAN) diameter (99.9%) of cases. Freedom from Type IA endoleak was achieved in 99.3% at 1 year and 97.3% at 5 years (lower in LAN vs. NAN: 96.8% [CI 93.7-98.4] vs. 98.6% [CI 94.5-99.6], p = .007). Freedom from aortic re-intervention was 93.7% at 1 year and 83.2% at 5 years (78.6% [CI 66.0-87.0] LAN vs. 86.0% [CI 81.8-89.3] NAN, p = .11). Freedom from primary composite endpoint was 95.9% at 1 year and 84.9% at 5 years (81.3% [CI 69.2-89.0] LAN vs. 87.0% [CI 81.6-91.0] NAN, p = .066). Five year survival was lower in the LAN group; 64.6% (CI 50.1-75.7) vs. 76.5% (CI 70.7-81.3), p = .03). CONCLUSION: LAN is associated with delayed Type IA endoleak occurrence and lower overall survival. ispartof: Eur J Vasc Endovasc Surg vol:56 issue:2 pages:189-199 ispartof: location:England status: published

Published
2021

2. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

Author

Powell, JT, Sweeting, MJ, Ulug, P, Blankensteijn, JD, Lederle, FA, Becquemin, J-P, Greenhalgh, RM, Beard, JD, Buxton, MJ, Brown, LC, Harris, PL, Rose, JDG, Russell, IT, Sculpher, MJ, Thompson, SG, Lilford, RJ, Bell, PRF, Whitaker, SC, Poole-Wilson, PA, Ruckley, CV, Campbell, WB, Dean, MRE, Ruttley, MST, Coles, EC, Halliday, A, Gibbs, SJ, Epstein, D, Hannon, RJ, Johnston, L, Bradbury, AW, Henderson, MJ, Parvin, SD, Shepherd, DFC, Mitchell, AW, Edwards, PR, Abbott, GT, Higman, DJ, Vohra, A, Ashley, S, Robottom, C, Wyatt, MG, Byrne, D, Edwards, R, Leiberman, DP, McCarter, DH, Taylor, PR, Reidy, JF, Wilkinson, AR, Ettles, DF, Clason, AE, Leen, GLS, Wilson, NV, Downes, M, Walker, SR, Lavelle, JM, Gough, MJ, McPherson, S, Scott, DJA, Kessell, DO, Naylor, R, Sayers, R, Fishwick, NG, Gould, DA, Walker, MG, Chalmers, NC, Garnham, A, Collins, MA, Gaines, PA, Ashour, MY, Uberoi, R, Braithwaite, B, Davies, JN, Travis, S, Hamilton, G, Platts, A, Shandall, A, Sullivan, BA, Sobeh, M, Matson, M, Fox, AD, Orme, R, Yusef, W, Doyle, T, Horrocks, M, Hardman, J, Blair, PHB, Ellis, PK, Morris, G, Odurny, A, Vohra, R, Duddy, M, Thompson, M, Loosemore, TML, Belli, AM, Morgan, R, Adiseshiah, M, Brookes, JAS, McCollum, CN, Ashleigh, R, Aukett, M, Baker, S, Barbe, E, Batson, N, Bell, J, Blundell, J, Boardley, D, Boyes, S, Brown, O, Bryce, J, Carmichael, M, Chance, T, Coleman, J, Cosgrove, C, Curran, G, Dennison, T, Devine, C, Dewhirst, N, Errington, B, Farrell, H, Fisher, C, Fulford, P, Gough, M, Graham, C, Hooper, R, Horne, G, Horrocks, L, Hughes, B, Hutchings, T, Ireland, M, Judge, C, Kelly, L, Kemp, J, Kite, A, Kivela, M, Lapworth, M, Lee, C, Linekar, L, Mahmood, A, March, L, Martin, J, Matharu, N, McGuigen, K, Morris-Vincent, P, Murray, S, Murtagh, A, Owen, G, Ramoutar, V, Rippin, C, Rowley, J, Sinclair, J, Spencer, S, Taylor, V, Tomlinson, C, Ward, S, Wealleans, V, West, J, White, K, Williams, J, Wilson, L, Grobbee, DE, Bak, AAA, Buth, J, Pattynama, PM, Verhoeven, ELG, van Voorthuisen, AE, Balm, R, Cuypers, PWM, Prinssen, M, van Sambeek, MRHM, Baas, AF, Hunink, MG, van Engelshoven, JM, Jacobs, MJHM, de Mol, BAJM, van Bockel, JH, Reekers, J, Tielbeek, X, Wisselink, W, Boekema, N, Heuveling, LM, Sikking, I, de Bruin, JL, Buskens, E, Tielbeek, AV, Reekers, JA, Pattynama, P, Prins, T, van der Ham, AC, van der Velden, JJIM, van Sterkenburg, SMM, ten Haken, GB, Bruijninckx, CMA, van Overhagen, H, Tutein Nolthenius, RP, Hendriksz, TR, Teijink, JAW, Odink, HF, de Smet, AAEA, Vroegindeweij, D, van Loenhout, RMM, Rutten, MJ, Hamming, JF, Lampmann, LEH, Bender, MHM, Pasmans, H, Vahl, AC, de Vries, C, Mackaay, AJC, van Dortmont, LMC, van der Vliet, AJ, Schultze Kool, LJ, Boomsma, JHB, van Dop, HR, de Mol van Otterloo, JCA, de Rooij, TPW, Smits, TM, Yilmaz, EN, van den Berg, FG, Visser, MJT, van der Linden, E, Schurink, GWH, de Haan, M, Smeets, HJ, Stabel, P, van Elst, F, Poniewierski, J, Vermassen, FEG, Freischlag, JA, Kohler, TR, Latts, E, Matsumura, J, Padberg, FT, Kyriakides, TC, Swanson, KM, Guarino, P, Peduzzi, P, Antonelli, M, Cushing, C, Davis, E, Durant, L, Joyner, S, Kossack, A, LeGwin, M, McBride, V, O'Connor, T, Poulton, J, Stratton, S, Zellner, S, Snodgrass, AJ, Thornton, J, Haakenson, CM, Stroupe, KT, Jonk, Y, Hallett, JW, Hertzer, N, Towne, J, Katz, DA, Karrison, T, Matts, JP, Marottoli, R, Kasl, S, Mehta, R, Feldman, R, Farrell, W, Allore, H, Perry, E, Niederman, J, Randall, F, Zeman, M, Beckwith, D, O'Leary, TJ, Huang, GD, Bader, M, Ketteler, ER, Kingsley, DD, Marek, JM, Massen, RJ, Matteson, BD, Pitcher, JD, Langsfeld, M, Corson, JD, Goff, JM, Kasirajan, K, Paap, C, Robertson, DC, Salam, A, Veeraswamy, R, Milner, R, Guidot, J, Lal, BK, Busuttil, SJ, Lilly, MP, Braganza, M, Ellis, K, Patterson, MA, Jordan, WD, Whitley, D, Taylor, S, Passman, M, Kerns, D, Inman, C, Poirier, J, Ebaugh, J, Raffetto, J, Chew, D, Lathi, S, Owens, C, Hickson, K, Dosluoglu, HH, Eschberger, K, Kibbe, MR, Baraniewski, HM, Endo, M, Busman, A, Meadows, W, Evans, M, Giglia, JS, El Sayed, H, Reed, AB, Ruf, M, Ross, S, Jean-Claude, JM, Pinault, G, Kang, P, White, N, Eiseman, M, Jones, R, Timaran, CH, Modrall, JG, Welborn, MB, Lopez, J, Nguyen, T, Chacko, JKY, Granke, K, Vouyouka, AG, Olgren, E, Chand, P, Allende, B, Ranella, M, Yales, C, Whitehill, TA, Krupski, WC, Nehler, MR, Johnson, SP, Jones, DN, Strecker, P, Bhola, MA, Shortell, CK, Gray, JL, Lawson, JH, McCann, R, Sebastian, MW, Kistler Tetterton, J, Blackwell, C, Prinzo, PA, Lee, N, Cerveira, JJ, Zickler, RW, Hauck, KA, Berceli, SA, Lee, WA, Ozaki, CK, Nelson, PR, Irwin, AS, Baum, R, Aulivola, B, Rodriguez, H, Littooy, FN, Greisler, H, O'Sullivan, MT, Kougias, P, Lin, PH, Bush, RL, Guinn, G, Bechara, C, Cagiannos, C, Pisimisis, G, Barshes, N, Pillack, S, Guillory, B, Cikrit, D, Lalka, SG, Lemmon, G, Nachreiner, R, Rusomaroff, M, O'Brien, E, Cullen, JJ, Hoballah, J, Sharp, WJ, McCandless, JL, Beach, V, Minion, D, Schwarcz, TH, Kimbrough, J, Ashe, L, Rockich, A, Warner-Carpenter, J, Moursi, M, Eidt, JF, Brock, S, Bianchi, C, Bishop, V, Gordon, IL, Fujitani, R, Kubaska, SM, Behdad, M, Azadegan, R, Ma Agas, C, Zalecki, K, Hoch, JR, Carr, SC, Acher, C, Schwarze, M, Tefera, G, Mell, M, Dunlap, B, Rieder, J, Stuart, JM, Weiman, DS, Abul-Khoudoud, O, Garrett, HE, Walsh, SM, Wilson, KL, Seabrook, GR, Cambria, RA, Brown, KR, Lewis, BD, Framberg, S, Kallio, C, Barke, RA, Santilli, SM, d'Audiffret, AC, Oberle, N, Proebstle, C, Johnson, LL, Jacobowitz, GR, Cayne, N, Rockman, C, Adelman, M, Gagne, P, Nalbandian, M, Caropolo, LJ, Pipinos, II, Johanning, J, Lynch, T, DeSpiegelaere, H, Purviance, G, Zhou, W, Dalman, R, Lee, JT, Safadi, B, Coogan, SM, Wren, SM, Bahmani, DD, Maples, D, Thunen, S, Golden, MA, Mitchell, ME, Fairman, R, Reinhardt, S, Wilson, MA, Tzeng, E, Muluk, S, Peterson, NM, Foster, M, Edwards, J, Moneta, GL, Landry, G, Taylor, L, Yeager, R, Cannady, E, Treiman, G, Hatton-Ward, S, Salabsky, B, Kansal, N, Owens, E, Estes, M, Forbes, BA, Sobotta, C, Rapp, JH, Reilly, LM, Perez, SL, Yan, K, Sarkar, R, Dwyer, SS, Perez, S, Chong, K, Hatsukami, TS, Glickerman, DG, Sobel, M, Burdick, TS, Pedersen, K, Cleary, P, Back, M, Bandyk, D, Johnson, B, Shames, M, Reinhard, RL, Thomas, SC, Hunter, GC, Leon, LR, Westerband, A, Guerra, RJ, Riveros, M, Mills, JL, Hughes, JD, Escalante, AM, Psalms, SB, Day, NN, Macsata, R, Sidawy, A, Weiswasser, J, Arora, S, Jasper, BJ, Dardik, A, Gahtan, V, Muhs, BE, Sumpio, BE, Gusberg, RJ, Spector, M, Pollak, J, Aruny, J, Kelly, EL, Wong, J, Vasilas, P, Joncas, C, Gelabert, HA, DeVirgillio, C, Rigberg, DA, Cole, L, Marzelle, J, Sapoval, M, Favre, J-P, Watelet, J, Lermusiaux, P, Lepage, E, Hemery, F, Dolbeau, G, Hawajry, N, Cunin, P, Harris, P, Stockx, L, Chatellier, G, Mialhe, C, Fiessinger, J-N, Pagny, L, Kobeiter, H, Boissier, C, Lacroix, P, Ledru, F, Pinot, J-J, Deux, J-F, Tzvetkov, B, Duvaldestin, P, Jourdain, C, David, V, Enouf, D, Ady, N, Krimi, A, Boudjema, N, Jousset, Y, Enon, B, Blin, V, Picquet, J, L'Hoste, P, Thouveny, F, Borie, H, Kowarski, S, Pernes, J-M, Auguste, M, Desgranges, P, Allaire, E, Meaulle, P-Y, Chaix, D, Juliae, P, Fabiani, JN, Chevalier, P, Combes, M, Seguin, A, Belhomme, D, Baque, J, Pellerin, O, Favre, JP, Barral, X, Veyret, C, Peillon, C, Plissonier, D, Thomas, P, Clavier, E, Martinez, R, Bleuet, F, C, D, Verhoye, JP, Langanay, T, Heautot, JF, Koussa, M, Haulon, S, Halna, P, Destrieux, L, Lions, C, Wiloteaux, S, Beregi, JP, Bergeron, P, Patra, P, Costargent, A, Chaillou, P, D'Alicourt, A, Goueffic, Y, Cheysson, E, Parrot, A, Garance, P, Demon, A, Tyazi, A, Pillet, J-C, Lescalie, F, Tilly, G, Steinmetz, E, Favier, C, Brenot, R, Krause, D, Cercueil, JP, Vahdat, O, Sauer, M, Soula, P, Querian, A, Garcia, O, Levade, M, Colombier, D, Cardon, J-M, Joyeux, A, Borrelly, P, Dogas, G, Magnan, P-É, Branchereau, A, Bartoli, J-M, Hassen-Khodja, R, Batt, M, Planchard, P-F, Bouillanne, P-J, Haudebourg, P, Bayne, J, Gouny, P, Badra, A, Braesco, J, Nonent, M, Lucas, A, Cardon, A, Kerdiles, Y, Rolland, Y, Kassab, M, Brillu, C, Goubault, F, Tailboux, L, Darrieux, H, Briand, O, Maillard, J-C, Varty, K, Cousins, C, EVAR-1, DREAM, OVER and ACE Trialists, Surgery, ICaR - Ischemia and repair, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, Halliday, A, Sweeting, Michael [0000-0003-0980-8965], Apollo - University of Cambridge Repository, and National Institute for Health Research

Subjects
Male, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], 030204 cardiovascular system & hematology, Endovascular aneurysm repair, Medical and Health Sciences, law.invention, Aortic aneurysm, 0302 clinical medicine, Randomized controlled trial, DESIGN, law, Models, 80 and over, Multicenter Studies as Topic, 030212 general & internal medicine, Randomized Controlled Trials as Topic, RISK, Aged, 80 and over, Hazard ratio, Endovascular Procedures, DREAM, 11 Medical And Health Sciences, Statistical, Middle Aged, Corrigenda, Abdominal aortic aneurysm, Aortic Aneurysm, Treatment Outcome, CARDIOVASCULAR-DISEASE, Elective Surgical Procedures, Female, Reoperation, medicine.medical_specialty, and over, 03 medical and health sciences, Aneurysm, medicine, Journal Article, MANAGEMENT, Humans, Comparative Study, Abdominal, OVER and ACE Trialists, Aged, Models, Statistical, business.industry, MORTALITY, Odds ratio, medicine.disease, Surgery, Vascular Grafting, business, Abdominal surgery, Meta-Analysis, EVAR-1, Aortic Aneurysm, Abdominal
Abstract

Background The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods An individual-patient data meta-analysis of four multicentre randomized trials of EVARversus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention. Results The analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0–6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization. Conclusion The early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.

Published
2017

3. First experience with the new repositionable C3 excluder stent-graft

Author

Verhoeven, ELG, Oikonomou, K, Mohner, B, Renner, H, Ritter, W, and Research & Education

Abstract

Aim. The Gore Excluder device is a modern third generation device that performs well. Nevertheless, the proximal deployment was not as accurate and controlled as with some other modern devices. Therefore a new deployment system was developed. This system allows to reconstrain the graft after initial deployment, with the purpose to reposition the graft for both level or orientation. Methods. The new system was used in 25 patients with an infrarenal abdominal aortic aneurysm. In 72% of cases the system was used to achieve a better proximal position or to facilitate catheterization of the contralateral limb. Surprisingly, the option to orientate the graft was used most. Results. The new deployment system worked well, and all grafts were easily repositioned to the intended final position. Additional cuffs were not required in any of the patients. Surgical mortality was nil. All patients left the hospital in good condition. There were no type I endoleaks at completion angiography neither at first computed tomography scanning. Conclusion. With the new deployment system it is possible to reposition the Excluder to achieve optimal fixation and sealing. A global registry has been set into place to report real life results including longer term performance of the graft.

Published
2011

5. Fenestrated and branched endovascular techniques for thoraco-abdominal aneurysm repair

Author

Verhoeven, ELG, Zeebregts, CJ, Kapma, MR, Tielliu, IFJ, Prins, TR, Van Den Dungen, JJAM, Man, Biomaterials and Microbes (MBM), and Vascular Ageing Programme (VAP)

Subjects
ABDOMINAL AORTIC-ANEURYSM, aortic aneurysm, surgery, JUXTARENAL ANEURYSMS, ARCH RECONSTRUCTION, DESCENDING THORACIC AORTA, surgical procedures, operative, stents, EXPERIENCE, CELIAC AXIS, EVAR, cardiovascular diseases, blood vessel, prosthesis implantation, LOCAL-ANESTHESIA, STENT-GRAFT, INTERVENTIONS
Abstract

Since 1991, endovascular aortic aneurysm repair (EVAR) has been established as an alternative for open surgical repair of aortic aneurysms. one of the main limitations for EVAR is the need for a sufficient scaling zone below or above vital aortic side branches. Recently, efforts have been made to overcome these limitations by incorporating fenestrations or branches in customized stent-grafts. This paper reviews the technical and clinical possibilities, as well as the results with fenestrated and branched stent-grafts. All these techniques can be classified into 6 groups, including abdominal fenestrated, abdominal branched, thoraco-abdominal fenestrated, thoraco-abdominal branched, thoracic fenestrated, and thoracic branched stent-grafting. The only well-elaborated technique at this moment is abdominal fenestrated stent-grafting. Currently, branched stent-grafting must be regarded as experimental, but advancements are taking place rapidly. It is anticipated that wider adoption will take place in the near future. New developments include the further use of reinforced fenestrations, indwelling catheters and flexor sheaths, as well as the use of new type branches.

Published
2005

6. Thoracic stent grafts with a distal fenestration for the celiac axis

Author

Tielliu, IFJ, Verhoeven, ELG, Zeebregts, CJ, Prins, TR, van den Dungen, JJAM, Man, Biomaterials and Microbes (MBM), and Vascular Ageing Programme (VAP)

Subjects
fenestration, surgical procedures, operative, cardiovascular system, endovascular, thoracic aneurysm, EXPERIENCE, cardiovascular diseases, AORTIC-ANEURYSM REPAIR, stent graft, THORACOABDOMINAL ANEURYSM, SYSTEM, celiac axis, ARCH
Abstract

Descending thoracic aneurysms can be treated with a stent graft provided that there is sufficient proximal and distal aortic neck length above the celiac axis. One of the options for the treatment of thoracic aneurysms with a too short distal neck is described in this report. For this purpose, a stent graft was constructed with a scallop for the celiac axis. Three cases are presented, and the technical details are described.

Published
2005

7. Treatment of popliteal artery aneurysms with the Hemobahn stent-graft

Author

Tielliu, IFJ, Verhoeven, ELG, Prins, TR, Post, WJ, Hulsebos, RG, van den Dungen, JJAM, and Faculteit Medische Wetenschappen/UMCG

Subjects
REPAIR, surgical procedures, operative, stent-graft kinking, PERCUTANEOUS ENDOVASCULAR TREATMENT, WALLGRAFT ENDOPROSTHESIS, limb salvage, cardiovascular diseases, popliteal artery aneurysm, Hemobahn endoprosthesis, stent-graft occlusion
Abstract

Purpose: To report a prospective study to ascertain the results of popliteal aneurysm treatment with a self-expanding stent-graft. Methods: In a recent 3-year period, 21 patients (18 men; median age 67 years, range 5282) with 23 popliteal aneurysms were treated with Hemobahn stent-grafts. Follow-up evaluation included duplex scanning, ankle-brachial index (ABI) measurements, and radiographic examination of the knee. Outcome measures were occlusion of the stent-graft and limb loss. Results: Technical success in placing the stent-graft and excluding the aneurysm was 100%. An additional vascular intervention was performed in the same session in 5 (24%) cases. In the other 16 patients, local anesthesia was used in 10 (63%). During a median follow-up of 15 months (range 2-37), 5 (22%) of 23 stent-grafts occluded, resulting in a cumulative patency of 74%. All occlusions occurred within 6 months after the intervention; 2 were successfully recanalized, and none of the 3 patients with persisting occlusion required an amputation. Conclusions: The results of this study suggest that endovascular stent-graft repair of popliteal artery aneurysms is feasible. Midterm patency rates are lower compared to traditional surgical repair.

Published
2003

8. Endovascular repair of acute AAAs under local anesthesia with bifurcated endografts: A feasibility study

Author

Verhoeven, ELG, Prins, TR, van den Dungen, JJAM, Tielliu, IFJ, Hulsebos, RG, and van Schilfgaarde, R

Subjects
stent-graft, COMPLICATIONS, surgical procedures, operative, ABDOMINAL AORTIC-ANEURYSMS, cardiovascular system, symptomatic aneurysm, rupture, cardiovascular diseases, Zenith Tri-Fab endograft, mortality
Abstract

Purpose: To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting. Methods: Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms. Complications and outcome of endovascular repair were evaluated; mortality was compared to a contemporaneous surgical cohort. Results: Seven (23%) of 31 patients having a standard surgical procedure died in the study period compared to 1 (6%) of 16 patients undergoing endovascular repair (following conversion to surgery because of calcified access vessels). Twelve (75%) of the endovascular repairs were performed under local anesthesia; no complications with this mode of anesthesia were encountered. The median duration of the endovascular procedures was 110 minutes (range 75-240); median blood loss was 250 mL (range 100-2800 mL). Only 4 patients required blood transfusion, and only 8 patients required admission to the intensive care unit. There were 3 postoperative complications (1 ischemic colitis, 1 renal failure, 1 groin hematoma). During follow-up, 3 endograft patients received stent-graft extensions in uneventful procedures. Two patients died at 9 and 16 months from cardiac causes. Conclusions: This study demonstrates the feasibility and possible advantages of endovascular repair under local anesthesia in selected acute AAA patients. Further studies are needed to prove the advantages over open repair.

Published
2002

12. Renewed endovascular repair for recurrent acute abdominal aortic aneurysm

Author

Umberto Bracale, Eric L.G. Verhoeven, Ben R. Saleem, Ted R. Prins, Clark J. Zeebregts, BRACALE UM, ZEEBREGTS CJ, SALEEM BR, PRINS TR, and VERHOEVEN ELG

Subjects
Male, medicine.medical_specialty, Endoleak type III, Recurrent acute, Settore MED/22 - Chirurgia Vascolare, Blood Vessel Prosthesis Implantation, Postoperative Complications, Recurrence, Endovascular repair, Back pain, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Acute abdominal aortic aneurysm, Aged, 80 and over, Endoleak type II, business.industry, medicine.disease, Abdominal aortic aneurysm, Surgery, surgical procedures, operative, Treatment Outcome, cardiovascular system, Emergency Medicine, Radiology, medicine.symptom, business, Tomography, X-Ray Computed, Aortic Aneurysm, Abdominal
Abstract

The aim of the study was to describe the successful endovascular management of a patient who was admitted urgently with a second episode of acute abdominal aortic aneurysm (AAA) 30 months after emergency endovascular abdominal aortic aneurysm repair (eEVAR) for a ruptured AAA. The patient, an 84 year-old male physician, presented with severe acute abdominal and back pain. Contrast-enhanced computer tomography scanning showed type III endoleak owing to complete disconnection of both graft limbs and the prosthetic main body. Treatment consisted of acute stent-grafting with two bridging stent-grafts to seal the endoleak and reline the graft. The patient is alive and well 6 months postoperatively. This case indicates the need for follow-up after eEVAR, but also that complications can be managed endovascularly.

Published
2009

13. An international, expert-based, Delphi consensus document on controversial issues in the management of abdominal aortic aneurysms.

Author

Paraskevas KI, Schermerhorn ML, Haulon S, Beck AW, Verhagen HJM, Lee JT, Verhoeven ELG, Blankensteijn JD, Kölbel T, Lyden SP, Clair DG, Faggioli G, Bisdas T, D'Oria M, Mani K, Sörelius K, Gallitto E, Fernandes E Fernandes J, Katsargyris A, Lepidi S, Vacirca A, Myrcha P, Koelemay MJW, Mansilha A, Zeebregts CJ, Pini R, Dias NV, Karelis A, Bosiers MJ, Stone DH, Venermo M, Farber MA, Blecha M, Melissano G, Riambau V, Eagleton MJ, Gargiulo M, Scali ST, Torsello GB, Eskandari MK, Perler BA, Gloviczki P, Malas M, and Dalman RL

Abstract

Objective: As a result of conflicting, inadequate or controversial data in the literature, several issues concerning the management of patients with abdominal aortic aneurysms (AAAs) remain unanswered. The aim of this international, expert-based Delphi consensus document was to provide some guidance for clinicians on these controversial topics., Methods: A three-round Delphi consensus document was produced with 44 experts on 6 prespecified topics regarding the management of AAAs. All answers were provided anonymously. The response rate for each round was 100%., Results: Most participants (42 of 44 [95.4%]) agreed that a minimum case volume per year is essential (or probably essential) for a center to offer open or endovascular AAA repair (EVAR). Furthermore, 33 of 44 (75.0%) believed that AAA screening programs are (probably) still clinically effective and cost effective. Additionally, most panelists (36 of 44 [81.9%]) voted that surveillance after EVAR should be (or should probably be) lifelong. Finally, 35 of 44 participants (79.7%) thought that women smokers should (or should probably/possibly) be considered for screening at 65 years of age, similar to men. No consensus was achieved regarding lowering the threshold for AAA repair and the need for deep venous thrombosis prophylaxis in patients undergoing EVAR., Conclusions: This expert-based Delphi consensus document provides guidance for clinicians regarding specific unresolved issues. Consensus could not be achieved on some topics, highlighting the need for further research in those areas., Competing Interests: Disclosures A.K. has received speaker fees from Cook Inc., & W.L. Gore & Associates, and is a consultant for Bentley Innomed. M.A.F. has received clinical trial support and is a Consultant for Cook, W. L. Gore & Associates, Getinge, and ViTAA. He has received research support from Cook and has stock options in Centerline Biomedical. M.E. is a paid consultant for W. L. Gore & Associates and Silk Road Medical. M.G. is a consultant for Cook Medical, W. L. Gore & Associates and Medtronic and a proctor for Cook Medical., (Copyright © 2024 Society for Vascular Surgery. All rights reserved.)

Published
2024
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14. Editor's Choice - Long Term Outcomes of the Advanta V12 Covered Bridging Stent for Fenestrated and Branched Endovascular Aneurysm Repair in 1 675 Target Vessels.

Author

Katsargyris A, Hasemaki N, Marques de Marino P, Abu Jiries M, Gafur N, and Verhoeven ELG

Abstract

Objective: To report outcomes of the Advanta V12 as a covered bridging stent in fenestrated and branched endovascular aneurysm repair (F/BEVAR)., Methods: Patients treated with F/BEVAR and followed in a single centre receiving the Advanta V12 as a covered bridging stent between January 2010 and May 2020 were included., Results: A total of 636 patients (543 men) were analysed. A total of 1 675 target vessels (TVs) were bridged with the Advanta V12. Estimated TV patency at one, five, and eight years was 99.1% ± 0.2%, 96.9% ± 0.5% and 96.2% ± 0.7%, respectively. Estimated patency at eight years was 98.1% ± 0.5% for fenestrations and 87.3% ± 2.9% for branches (p < .001). Estimated patency of renal arteries was statistically significantly lower for those targeted with branches compared with fenestrations (p = .001). Multivariable analysis showed that targeting a TV with a branch compared with a fenestration was the only independent risk factor for occlusion during follow up (hazard ratio 6.41, 95% CI 3.4 - 11.9; p < .001). Estimated freedom from endoleak at one, five, and eight years was 99.4% ± 0.2%, 96.4% ± 0.6%, and 95.4% ± 0.8%, respectively. Estimated freedom from target vessel instability (TVI) at one, five, and eight years was 98.5% ± 0.3%, 93.0% ± 0.8%, and 91.3% ± 1%, respectively. Estimated freedom from TVI at eight years was 93.2% ± 0.9% for fenestrations and 82.7% ± 3.5% for branches (p < .001). Estimated freedom from TVI was statistically significantly lower for renal arteries targeted with branches compared with those targeted with fenestrations (p < .001) CONCLUSION: The Advanta V12 shows excellent technical success rates as a covered bridging stent in F/ΒEVAR. Late outcomes remain good with low rates of TV occlusion, endoleak, and re-intervention. Renal arteries targeted with branches demonstrated a higher risk of occlusion and instability compared with those targeted with fenestrations., (Copyright © 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2023
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15. Editor's Choice - Single Centre Midterm Experience with Primary Fenestrated Endovascular Aortic Aneurysm Repair for Short Neck, Juxtarenal, and Suprarenal Aneurysms.

Author

Katsargyris A, Marques de Marino P, Hasemaki N, Nagel S, Botos B, Wilhelm M, and Verhoeven ELG

Abstract

Objective: The use of fenestrated stent grafts to treat short neck, juxta- and suprarenal aortic aneurysms is increasing worldwide, but midterm outcome reports are scarce. This study aimed to report peri-operative results and midterm outcomes after five years from a single centre., Methods: Patients treated with primary fenestrated endovascular aortic aneurysm repair (FEVAR) for short neck, juxta- or suprarenal aortic aneurysms within the period January 2010 to May 2020 with follow up in the centre were included. Early (technical success, operative mortality, spinal cord ischaemia) and five year outcomes (cumulative survival, freedom from aortic related death, target vessel patency, target vessel instability [TVI], re-interventions) were analysed., Results: A total of 349 patients (313 male, mean age 72.3 ± 7.7 years) were included in the study. Technical success was 98% (342/349). The thirty day mortality rate was 0.9% (3/349). Estimated survival at five years was 69.3 ± 3.1%. Freedom from aneurysm related death at five years was 98.8% ± 0.7%. Estimated target vessel patency at five years was 98.7 ± 0.4%. Estimated freedom from TVI at five years was 97.2 ± 0.6%. Estimated freedom from re-intervention at five years was 86.5 ± 2.3%. Survival did not differ significantly between patients with and without re-interventions (p = .088)., Conclusion: Midterm results of FEVAR remain good as indicated by sustained target vessel patency and low aortic related mortality rates. An important proportion of patients require re-interventions, which do not have a negative impact on midterm survival., (Copyright © 2023. Published by Elsevier B.V.)

Published
2023
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16. Invited Commentary to: Minimally Invasive Segmental Artery Coil Embolization (MISACE) Prior to Endovascular Thoracoabdominal Aortic Aneurysm Repair.

Author

Verhoeven ELG

Subjects
Arteries surgery, Blood Vessel Prosthesis, Humans, Treatment Outcome, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation, Embolization, Therapeutic, Endovascular Procedures
Published
2022
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17. Three-Dimensional Geometric Analysis of Balloon-Expandable Covered Stents Improves Classification of Complications after Fenestrated Endovascular Aneurysm Repair.

Author

van der Riet C, Schuurmann RCL, Verhoeven ELG, Katsargyris A, Tielliu IFJ, Resch T, Bokkers RPH, and de Vries JPM

Abstract

In balloon-expandable covered stent (BECS) associated complications after fenestrated endovascular aneurysm repair (FEVAR), geometric analysis may determine the cause of failure and influence reintervention strategies. This study retrospectively classifies BECS-associated complications based on computed tomographic angiography (CTA) applied geometric analysis. BECS-associated complications of FEVAR-patients treated in two large vascular centers between 2012 and 2021 were included. The post-FEVAR CTA scans of complicated Advanta V12 BECSs were analyzed geometrically and complications were classified according to its location in the BECS. BECS fractures were classified according to an existing classification system. In 279 FEVAR-patients, 34 out of the 683 included Advanta V12 BECS (5%) presented with a complication. Two Advanta V12 complications occurred during the FEVAR procedure and 32 occurred during follow-up of which five post-FEVAR CTA scans were missing or not suitable for analysis. In the remaining 27 BECSs complications were classified as (endoleaks (n = 8), stenoses (n = 4), occlusions (n = 6), fractures (n = 3), and a combination of complications (n = 6)). All BECSs associated complications after FEVAR with available follow up CTA scans could be classified. Geometric analysis of BECS failure post-FEVAR can help to plan the reintervention strategy.

Published
2022
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18. Position Paper on Young Vascular Surgeons Training of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS): State of the Art and Perspectives.

Author

Bracale UM, Ammollo RP, Hussein EA, Hoballah JJ, Taurino M, Saleem BR, Setacci C, Pecoraro F, Serra R, Bracale G, Panagrosso M, Peluso A, Petrone A, Maisto M, Del Guercio L, Dinoto E, Bajardi G, Bouayed MN, Zeebregts CJ, Pulli R, Pane B, Pratesi G, Castelli P, Setacci F, Gargiulo M, Stella A, Illario M, De Luca V, Verhoeven ELG, Riambau V, Saratzis N, Cvjetko I, Resch T, Fernandes E Fernandes J, Chiche L, and Goeau-Brissonniere O

Subjects
Clinical Competence, Curriculum, Diabetic Angiopathies diagnosis, Diabetic Angiopathies epidemiology, Humans, Learning Curve, Mediterranean Region epidemiology, Peripheral Arterial Disease diagnosis, Peripheral Arterial Disease epidemiology, Program Evaluation, Specialization, Diabetic Angiopathies surgery, Education, Medical, Graduate, Internship and Residency, Peripheral Arterial Disease surgery, Surgeons education, Vascular Surgical Procedures education
Abstract

The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Published
2021
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19. Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair.

Author

van der Riet C, Schuurmann RCL, Verhoeven ELG, Zeebregts CJ, Tielliu IFJ, Bokkers RPH, Katsargyris A, and de Vries JPM

Subjects
Aged, Aged, 80 and over, Blood Vessel Prosthesis, Humans, Middle Aged, Prosthesis Design, Retrospective Studies, Stents, Time Factors, Treatment Outcome, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects
Abstract

Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent., Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up., Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years., Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.

Published
2021
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20. Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'.

Author

Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Corte AD, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D'Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D'Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, and Weigang E

Published
2021
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21. Single Center Experience with Endovascular Repair of Acute Thoracoabdominal Aortic Aneurysms.

Author

Katsargyris A, de Marino PM, Botos B, Nagel S, Ibraheem A, and Verhoeven ELG

Subjects
Acute Disease, Aged, Blood Vessel Prosthesis, Feasibility Studies, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Retrospective Studies, Risk Factors, Stents, Survival Analysis, Time Factors, Treatment Outcome, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic surgery, Endovascular Procedures methods
Abstract

Purpose: To investigate feasibility and outcomes of endovascular repair for acute thoracoabdominal aortic aneurysms (TAAA)., Materials and Methods: Data from a single center were retrospectively analyzed. Patients who underwent endovascular repair for acute TAAA between January 2010 and April 2020 were included. Perioperative and mid-term follow-up outcomes were analyzed. Survival, freedom from reintervention, and target vessel patency were calculated by Kaplan-Meier analysis., Results: A total of 30 patients (18 men, 67.5 ± 6.9 years) underwent endovascular repair for acute symptomatic (n = 15) or contained ruptured (n = 15) TAAA. An off-the-shelf four-branched stent-graft (T-Branch) was used in 19 (63.3%) patients, a custom-made device (CMD) with expedite order in 5 (16.7%) patients, a CMD with short anticipated delivery time in 3 (10.0%) patients, and a CMD available in the hospital in 3 (10.0%) patients. Technical success was 90.0% (n = 27). Thirty-day mortality was 10% (n = 3). There was no complete persistent paraplegia, but one (3.3%) patient suffered permanent limb weakness. Estimated survival at 1 and 2 years was 86.3% ± 6.4%, and 82.3% ± 7.2%, respectively. Estimated freedom from reintervention at 1 and 2 years was 81.4% ± 7.6% and 73% ± 8.8%. Estimated target vessel patency at 1 and 2 years was 96.6% ± 2% and 92.6% ± 2.9%., Conclusion: Endovascular treatment of acute TAAA in this selected group of patients was associated with low early mortality and excellent mid-term survival. The off-the-shelf stent-graft option (T-Branch) was used in the majority of patients. Endovascular repair should be considered the first option for suitable acute TAAA.

Published
2021
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22. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions.

Author

Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Della Corte A, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, and Weigang E

Subjects
Asia, Elective Surgical Procedures, Europe, Humans, Italy, SARS-CoV-2, Switzerland, COVID-19, Pandemics
Abstract

Objectives: To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures., Methods: Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared., Results: No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89-1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76-0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (-40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02)., Conclusions: There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Published
2021
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23. Increasing Role of Fenestrated and Branched Endoluminal Techniques in the Thoracoabdominal Segment Including Supra- and Pararenal AAA.

Author

Verhoeven ELG, Marques de Marino P, and Katsargyris A

Subjects
Aorta surgery, Aortic Aneurysm, Abdominal mortality, Aortic Aneurysm, Thoracic mortality, Endovascular Procedures methods, Female, Humans, Male, Postoperative Complications epidemiology, Prosthesis Design, Vascular Patency, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation mortality, Stents
Abstract

Fenestrated and branched stent-grafts are being increasingly used to address complex pararenal and thoracoabdominal aortic aneurysms by endovascular means. The present paper describes the current indications, anatomical suitability and techniques of fenestrated and branched stent-grafts in the treatment for pararenal and thoracoabdominal aortic pathologies. Published outcomes with regard to perioperative mortality and morbidity, survival, reinterventions and target vessel patency during follow-up are also presented. Finally, advantages and disadvantages of endovascular repair as compared to open repair are discussed.

Published
2020
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24. The Relationship Between Operative Volume and Peri-operative Mortality After Non-elective Aortic Aneurysm Repair in Australia.

Author

Sawang M, Paravastu SCV, Liu Z, Thomas SD, Beiles CB, Mwipatayi BP, Verhagen HJM, Verhoeven ELG, and Varcoe RL

Subjects
Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal mortality, Aortic Rupture diagnostic imaging, Aortic Rupture mortality, Australia epidemiology, Clinical Competence, Databases, Factual, Emergencies, Female, Hospital Mortality, Humans, Male, Medical Audit, Middle Aged, Postoperative Complications mortality, Postoperative Complications therapy, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Aortic Aneurysm, Abdominal surgery, Aortic Rupture surgery, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Hospitals, High-Volume, Hospitals, Low-Volume, Outcome and Process Assessment, Health Care, Surgeons, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures mortality, Workload
Abstract

Objective: Hospital and surgeon operative caseload is thought to be associated with peri-operative mortality following the non-elective repair of aortic aneurysms; however, whether such an association exists within the Australian healthcare setting is unknown., Methods: The Australasian Vascular Audit was interrogated to identify patients undergoing non-elective (emergency [EMG] or semi-urgent [URG]) aortic aneurysm repair between 2010 and 2016, as well as their treating surgeon and hospital. Hierarchal logistic regression modelling was used to assess the impact of caseload on outcomes after both endovascular (EVAR) and open surgical repair (OSR)., Results: Volume counts were determined from 14 262 patients (4 121 OSR and 10 141 EVAR). After exclusion of elective procedures and duplicates, 1 153 EVAR (570 EMG and 583 URG) and 1 245 OSR (946 EMG and 299 URG) non-elective cases remained for the analysis. Crude mortality was 24.0% following OSR (EMG 29.2%; URG 7.7%) and 7.5% following EVAR (EMG 12.6%; URG 2.4%). Univariable analysis demonstrated an association between OSR mortality and hospital volume (quintile [Q] 1: 25.3%, Q2: 27.8%, Q3: 23.9%, Q4: 27.0%, Q5: 16.2%; p = .030), but not surgeon (Q1: 25.2%, Q2: 27.4%, Q3: 26.0%, Q4: 21.4%, Q5: 19.5%, p = .32). Multivariable analysis confirmed this association (odds ratio (OR) [95% CI]; Q1 vs 5: 1.91 [1.13-3.21], Q2 vs. 5: 2.01[1.24-3.25], Q3 vs. 5: 1.41 [0.86-2.29], Q4 vs. 5: 1.92 [1.17-3.15]; p = .020). The difference was most pronounced in the EMG OSR group [Q1 - 3 vs. 4-5] (OR 1.63 [1.07-2.48]; p = .020). Mortality after EVAR was not associated with either hospital (Q1: 6.3%, Q2: 10%, Q3: 6.8%, Q4: 4.5%, Q5: 10%; p = .14) or surgeon volume (Q1: 9.3%, Q2: 5.7%, Q3: 8.1%, Q4: 7.0%, Q5: 7.3%; p = .67)., Conclusion: There is an inverse correlation between hospital volume and peri-operative mortality following EMG open repair of aortic aneurysm. These data support restructuring Australian pathways of care to direct suspected ruptured aneurysm to institutions that reach a minimum volume threshold., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2020
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26. Vascular access animal models used in research.

Author

Kokozidou M, Katsargyris A, Verhoeven ELG, and Schulze-Tanzil G

Subjects
Animals, Dogs, Hyperplasia, Mice, Neointima pathology, Rabbits, Rats, Renal Dialysis, Renal Insufficiency, Chronic therapy, Sheep, Swine, Vascular Diseases therapy, Arteriovenous Fistula, Arteriovenous Shunt, Surgical, Models, Animal, Vascular Access Devices standards
Abstract

Purpose: To provide a systematic literature review on effectiveness of arteriovenous fistula (AVF) and Shunt (AVS) research animal models., Background: Due to advancing human population age, there is increased incidence of patients suffering from vascular and renal diseases leading to dialysis access using AVF and/or AVS. During those interventions native venous or synthetic grafts are arterialized. Despite temporary good patency, complications are a consequence of neointimal hyperplasia (NIH) development that contributes to patients' morbidity and mortality. Basic research attempts to elucidate the pathomechanisms, therefore the small and large animal models are becoming attractive., Methods: Medline search (within 1966-2018) was performed on AVF/AVS animal models. Studies fulfilled following criteria: (1) reported complete material-methods-results section, (2) included statistically significant number of animals, (3) provided statistically significant results. 55 articles were identified encompassing six animal species used., Results: Large animal models include creation of AVF and AVS in pig, sheep and dog. Porcine animal models use pelvic or femoral vessels, ovine use the common carotid artery (CCA) and jugular vein (JV). Canine animal models use the femoral vessels. Small animal models use rabbit (CCA/JV), rat (JV/CCA, abdominal aorta /Vena cava inferior and femoral artery/femoral vein) and mouse (aortocaval and supraortic AVF models)., Conclusions: Large animal models are best for haemodynamic shear stress studies and in vivo evaluation of new synthetic vascular grafts. Small animal models, especially the genetically manipulated ones, are ideal for analysis of molecular and cellular pathomechanisms. The selection of animal species to be used depends on the addressed research question., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Published
2019
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28. Looking for the Holy Grail in Acute/Subacute Type B Dissection.

Author

Verhoeven ELG, de Marino PM, and Katsargyris A

Subjects
Humans, Long Term Adverse Effects diagnosis, Patient Selection, Prognosis, Risk Adjustment, Treatment Outcome, Aortic Dissection complications, Aortic Dissection diagnosis, Aortic Dissection therapy, Aortic Aneurysm diagnosis, Aortic Aneurysm etiology, Conservative Treatment adverse effects, Conservative Treatment methods, Endovascular Procedures adverse effects, Endovascular Procedures methods
Published
2019
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29. The Relationship Between Aortic Aneurysm Surgery Volume and Peri-Operative Mortality in Australia.

Author

Sawang M, Paravastu SCV, Liu Z, Thomas SD, Beiles CB, Mwipatayi BP, Verhagen HJM, Verhoeven ELG, and Varcoe RL

Subjects
Adult, Aged, Aged, 80 and over, Aortic Aneurysm mortality, Australia epidemiology, Blood Vessel Prosthesis Implantation statistics & numerical data, Databases, Factual statistics & numerical data, Female, Hospitals, High-Volume statistics & numerical data, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Perioperative Period statistics & numerical data, Risk Assessment, Surgeons statistics & numerical data, Treatment Outcome, Workload statistics & numerical data, Aortic Aneurysm surgery, Blood Vessel Prosthesis Implantation adverse effects, Hospital Mortality, Medical Audit statistics & numerical data, Outcome and Process Assessment, Health Care statistics & numerical data
Abstract

Objectives: Operative caseload is thought to be associated with peri-operative mortality following intact aortic aneurysm repair. The aim was to study that association in the Australian setting, which has a unique healthcare provision system and geographical population distribution., Methods: The Australasian Vascular Audit database was used to capture volume measurements for both individual surgeon and hospital and to separate it into quintiles (1, lowest, to 5, highest) for endovascular (EVAR), open surgical repair (OSR), and subgroups of repair types between 2010 and 2016. Multivariable logistic regression modelling was used to assess the impact of caseload volumes on in hospital mortality after adjustment for confounders., Results: Volume counts were determined from 14,262 aneurysm repair procedures (4121 OSR, 10,106 EVAR). After exclusions, 2181 OSR (161 complex, 2020 standard) and 7547 EVAR (6198 standard, 1135 complex, 214 thoracic (TEVAR)) elective cases were available for volume analysis. Unadjusted mortality after EVAR was unaffected by either surgeon (Quintile 1, 1.0%; Quintile 5, 0.9%; p = .28) or hospital volume (Quintile 1, 0.8%; Quintile 5, 1.3%; p = .47). However, univariable analysis of the TEVAR subgroup revealed a significant correlation with hospital volume (Quintiles 1-2 vs. Quintiles 3-5; p = .02). Univariable analysis for OSR demonstrated a marginal, non-significant value for surgeon (Quintile 1, 4.0%; Quintile 5, 3.6%; p = .06), but not hospital volume (Quintile 1, 4.7%; Quintile 5, 4.0%; p = .67). After adjustment for confounders hospital volume remained a significant predictor of peri-operative TEVAR mortality (Quintile 1-2 vs. 3-5; OR 5.62, 95% CI 1.27-24.83; p = .02) and surgeon volume a predictor following standard OSR (Quintile 1-2 vs. Quintile 3-5; OR 2.15, 95% CI 1.21-3.83; p = .01)., Conclusions: There is an inverse correlation between both surgeon volume of open aortic aneurysm repair, hospital volume of thoracic endovascular aneurysm repair and in hospital mortality. These findings suggest that in Australia TEVAR should be performed by high volume hospitals and OSR by high volume surgeons., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2019
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31. Use of Bilateral Cook Zenith Iliac Branch Devices to Preserve Internal Iliac Artery Flow During Endovascular Aneurysm Repair.

Author

Marques de Marino P, Botos B, Kouvelos G, Verhoeven ELG, and Katsargyris A

Subjects
Aged, Anastomotic Leak surgery, Endovascular Procedures adverse effects, Female, Follow-Up Studies, Humans, Length of Stay, Male, Middle Aged, Operative Time, Regional Blood Flow, Reoperation, Retrospective Studies, Stents, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic surgery, Endovascular Procedures instrumentation, Iliac Artery physiology
Abstract

Objectives: Iliac branch devices (IBD) have become a widespread option to preserve antegrade internal iliac artery (IIA) flow during endovascular aneurysm repair (EVAR). Reported experience with bilateral implantation of IBDs is limited. This study aimed to describe the indications, technical options, and outcomes with the use of bilateral IBDs., Methods: All patients undergoing elective implantation of bilateral Cook Zenith IBD between January 2010 and September 2017 in a single centre were included. Bilateral IBD was indicated in physically active, anatomically suitable patients and those with previous or concomitant surgery for a thoraco-abdominal aortic aneurysm or impaired collateral circulation to the IIA. Data were collected prospectively., Results: Twenty-nine patients (29 male, mean age 64.1 ± 10 years) were included. Of the 58 IBDs, 48 (83%) were implanted in one procedure and 10 (17%) in two procedures (mean time between procedures 30.4 ± 9 months). Nineteen patients (65%) had a previous or simultaneous EVAR and the remaining 10 (35%) a previous or simultaneous complex aortic repair. Mean CIA diameter was 35.2 ± 8 mm. Technical success was achieved in 55 of the 58 IBDs (95%) with no mortality. Axillary artery access was used in 13 (38%) procedures. During follow up, four (7%) IIA branches occluded (1 bilateral occlusion and 2 unilateral). Estimated IIA branch patency at one and three years was 97.8% ± 2% and 88.5% ± 7%, respectively. All patients with late IIA occlusion remained asymptomatic. Re-intervention was needed in four patients (14%): two bridging stent graft extensions for type Ib endoleak, one relining of the external iliac artery because of mural in-stent thrombus and one femoro-femoral crossover bypass to treat an external iliac limb occlusion., Conclusions: Bilateral implantation of IBDs is a safe and effective technique to preserve IIA flow in selected patients with suitable anatomy, showing similar technical success and mid-term outcomes to the unilateral use of the device., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2019
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32. Mid-Term Results of Fenestrated/Branched Stent Grafting to Treat Post-dissection Thoraco-abdominal Aneurysms.

Author

Oikonomou K, Kasprzak P, Katsargyris A, Marques De Marino P, Pfister K, and Verhoeven ELG

Subjects
Aged, Aortic Aneurysm, Thoracic etiology, Endoleak surgery, Female, Follow-Up Studies, Hospital Mortality, Humans, Male, Middle Aged, Postoperative Complications surgery, Reoperation, Retrospective Studies, Risk Factors, Survival Analysis, Vascular Patency, Aortic Dissection complications, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Stents
Abstract

Objectives: Patients surviving acute aortic dissection are at risk of developing a post-dissection thoraco-abdominal aortic aneurysm (PD-TAAA) during follow up, regardless of the type of treatment in the acute setting. Fenestrated and branched stent grafting (F/B-TEVAR) has been used with success to treat PD-TAAA, albeit reported only with short-term results. The aim of this study was to report mid-term results in a cohort of 71 patients., Methods: This was a retrospective analysis of a prospectively maintained database including all patients with PD-TAAAs who underwent F/B-TEVAR within the period January 2010 - April 2017 at two vascular institutions experienced in endovascular techniques., Results: A total of 71 consecutive patients (56 male, mean age 63.8 ± 10.6 years) were treated. Technical success was achieved in 68/71 (95.8%) patients. In hospital mortality was four (5.6%) patients. Peri-operative morbidity was 19.6%. Three (4.2%) patients developed severe spinal cord ischaemia, one of these patients 12 months post-operatively. Mean follow up was 25.3 months (1-77 months). Cumulative survival rates at 12, 24, and 36 months were 84.7 ± 4.5%, 80.7 ± 5.1%, and 70.0 ± 6.7%, respectively. Estimated freedom from re-intervention at 12, 24, and 36 months was 80.7 ± 5.3%, 63.0 ± 6.9%, and 52.6 ± 8.0%, respectively. The main reasons for re-intervention were endoleak from visceral/renal arteries and iliac endoleak requiring extension. Target vessel occlusion occurred in 8/261 (3.1%) vessels (renal artery n = 4; superior mesenteric artery n = 2; coeliac artery n = 2). Mean aneurysm sac regression during follow up was 9.2 ± 8.8 mm, with a false lumen thrombosis rate of 85.4% for patients with a follow up longer than 12 months. No ruptures occurred during follow up., Conclusion: F/B-TEVAR for post-dissection TAAA is feasible and associated with low peri-operative mortality and peri-operative morbidity. Mid-term results demonstrate a high rate of aneurysm sac regression. Rigorous follow up is required because of the significant re-intervention rate. Longer bridging covered stents for target vessels are advised., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2019
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34. Editor's Choice - Influence of Proximal Aortic Neck Diameter on Durability of Aneurysm Sealing and Overall Survival in Patients Undergoing Endovascular Aneurysm Repair. Real World Data from the Gore Global Registry for Endovascular Aortic Treatment (GREAT).

Author

Howard DPJ, Marron CD, Sideso E, Puckridge PJ, Verhoeven ELG, and Spark JI

Subjects
Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal mortality, Female, Humans, Male, Middle Aged, Prosthesis Design, Risk Factors, Stents, Treatment Outcome, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation methods, Endovascular Procedures methods
Abstract

Objectives: Aortic neck diameter is an independent anatomical feature that is poorly understood, yet potentially linked to proximal seal failure and adverse outcome following standard EVAR. The aim of this study was to assess whether large proximal aortic neck (LAN) diameter is associated with adverse outcome using prospectively collected individual patient data from The Global Registry for Endovascular Aortic Treatment (GREAT)., Methods: A total of 3166 consecutive patients, from 78 global centres, receiving Gore Excluder stent grafts for infrarenal abdominal aortic aneurysm repair between 2011 and 2017 were included. Patient demographics, biometrics, operative details, and clinical outcome were analysed. Patients were divided into two groups: normal baseline proximal aortic neck (NAN) diameter (<25 mm on computed tomography aortography), and LAN (≥25 mm). Clinical follow up (including imaging) was available for 76.5% of patients 5 years post-intervention. Primary endpoints analysed were Type IA endoleak and any aortic re-intervention up to 5 years post-procedure. A composite endpoint of Type IA endoleak, re-intervention, aortic rupture, or aortic related mortality was also assessed., Results: A total of 1977 (62.4%) patients were classified NAN and 1189 (37.6%) were LAN. Immediate technical success was achieved in 3164 out of 3166 (>99.9%) of cases. Freedom from Type IA endoleak was achieved in 99.3% at 1 year and 97.3% at 5 years (lower in LAN vs. NAN: 96.8% [CI 93.7-98.4] vs. 98.6% [CI 94.5-99.6], p = .007). Freedom from aortic re-intervention was 93.7% at 1 year and 83.2% at 5 years (78.6% [CI 66.0-87.0] LAN vs. 86.0% [CI 81.8-89.3] NAN, p = .11). Freedom from primary composite endpoint was 95.9% at 1 year and 84.9% at 5 years (81.3% [CI 69.2-89.0] LAN vs. 87.0% [CI 81.6-91.0] NAN, p = .066). Five year survival was lower in the LAN group; 64.6% (CI 50.1-75.7) vs. 76.5% (CI 70.7-81.3), p = .03)., Conclusion: LAN is associated with delayed Type IA endoleak occurrence and lower overall survival., (Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.)

Published
2018
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35. Early Experience with the Use of Inner Branches in Endovascular Repair of Complex Abdominal and Thoraco-abdominal Aortic Aneurysms.

Author

Katsargyris A, Marques de Marino P, Mufty H, Pedro LM, Fernandes R, and Verhoeven ELG

Subjects
Aged, Aortic Aneurysm, Abdominal mortality, Aortic Aneurysm, Thoracic mortality, Blood Vessel Prosthesis, Celiac Artery surgery, Female, Follow-Up Studies, Humans, Length of Stay, Male, Mesenteric Artery, Superior surgery, Postoperative Complications, Renal Artery surgery, Retrospective Studies, Vascular Grafting adverse effects, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic surgery, Stents, Vascular Grafting methods
Abstract

Objectives: Visceral arteries in fenestrated and branched endovascular repair (F/BEVAR) have been addressed by fenestrations or directional side branches. Inner branches, as used in the arch branched device, could provide an extra option for visceral arteries "unsuitable" for fenestrations or directional side branches. Early experience with the use of inner branches for visceral arteries in F/BEVAR is described., Methods: All consecutive patients treated by F/BEVAR for complex abdominal aortic aneurysm (AAA) or thoraco-abdominal aneurysm (TAAA) using stent grafts with inner branches were included. Data were collected prospectively., Results: Thirty-two patients (28 male, mean age 71.6 ± 8.3 years) were included. Seven (21.9%) patients had a complex AAA and 25 (78.1%) had a TAAA. A stent graft with inner branches only was used in four (12.5%) patients. The remaining 28 (87.5%) patients received a stent graft with fenestrations and inner branches. In total 52 vessels were targeted with inner branches. Technical success was achieved in all 32 (100%) patients. All 38 inner branch target vessels in grafts including fenestrations and inner branches were instantly catheterised (<1 minute), whereas catheterisation of target vessels in "inner branch only" grafts proved more difficult (<1 minute, n = 3; 1-3 min, n = 4; and >3 min, n = 7). The 30 day operative mortality was 3.1% (1/32). Estimated survival at 1 year was 80.0% ± 8.3%. During follow-up, four renal inner branches occluded in three patients. The estimated inner branch target vessel stent patency at 1 year was 91.9 ± 4.5%. The estimated freedom from re-intervention at 1 year was 78.4% ± 8.9%., Conclusions: Early data suggest that visceral inner branches might represent a feasible third option to address selected target vessels in F/BEVAR. Stent grafts with inner branch(es) in combination with fenestrations seem to be a better configuration than stent grafts with inner branches alone. Durability of the inner branch design needs further investigation., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2018
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37. "Snare-Ride": A Bailout Technique to Catheterize Target Vessels With Unfriendly Anatomy in Branched Endovascular Aortic Repair.

Author

Ferreira M, Katsargyris A, Rodrigues E, Ferreira D, Cunha R, Bicalho G, Oderich G, and Verhoeven ELG

Subjects
Aorta, Thoracic diagnostic imaging, Aorta, Thoracic physiopathology, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic physiopathology, Aortography, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Catheterization, Peripheral adverse effects, Catheterization, Peripheral instrumentation, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Humans, Prosthesis Design, Stents, Time Factors, Treatment Outcome, Vascular Access Devices, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation methods, Catheterization, Peripheral methods, Endovascular Procedures methods
Abstract

Purpose: To describe a novel endovascular bailout technique for successful completion of target vessel stenting during branched stent-graft repair of thoracoabdominal aortic aneurysms (TAAA) after encountering difficulties with standard catheterization techniques., Technique: Technical difficulties when using fenestrated and branched grafts should be expected, especially in difficult anatomy or when an off-the-shelf device (eg, standard 4-branch device) is used that does not perfectly "match" the anatomy. The "snare-ride technique" facilitates antegrade transaxillary side branch catheterization and stent placement during TAAA branched grafting using a snare via a transfemoral approach. The branch of the graft is catheterized from an axillary access. The respective target vessel is then catheterized via a femoral access. An Indy snare is advanced over the transfemoral wire and positioned near the entrance of the target vessel. The transaxillary wire inside the branch of the graft is then advanced, snared, and pushed inside the target vessel with the snare. The procedure is thereafter continued with antegrade bridging of the target vessel in routine fashion., Conclusion: The snare-ride technique can be a useful maneuver to catheterize target vessels with difficult anatomy in TAAA branched stent-graft repair. Early experience shows safety and feasibility.

Published
2017
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38. Comparison of outcomes for double fenestrated endovascular aneurysm repair versus triple or quadruple fenestrated endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysms.

Author

Katsargyris A, Oikonomou K, Kouvelos G, Mufty H, Ritter W, and Verhoeven ELG

Subjects
Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal mortality, Aortic Aneurysm, Abdominal physiopathology, Aortography methods, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis Implantation mortality, Celiac Artery diagnostic imaging, Computed Tomography Angiography, Disease-Free Survival, Endovascular Procedures adverse effects, Endovascular Procedures instrumentation, Endovascular Procedures mortality, Female, Humans, Kaplan-Meier Estimate, Male, Mesenteric Artery, Superior diagnostic imaging, Middle Aged, Operative Time, Postoperative Complications mortality, Postoperative Complications therapy, Prosthesis Design, Radiation Dosage, Radiography, Interventional, Renal Artery diagnostic imaging, Retreatment, Risk Factors, Stents, Time Factors, Treatment Outcome, Vascular Patency, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation methods, Celiac Artery surgery, Endovascular Procedures methods, Mesenteric Artery, Superior surgery, Renal Artery surgery
Abstract

Objective: This study compared outcomes of standard fenestrated endovascular aneurysm repair (St-FEVAR) with renal artery fenestrations only with more complex FEVAR (Co-FEVAR) with additional fenestrations for the superior mesenteric artery or the celiac trunk, or both., Methods: All consecutive patients treated with FEVAR for short-necked, juxtarenal, or suprarenal aortic aneurysms between January 2010 and July 2016 were included. Patients with stent grafts with a combination of fenestrations and branches were excluded. Data were collected prospectively. All stent grafts used were customized based on the Zenith system (William A. Cook Australia, Ltd, Brisbane, Queensland, Australia)., Results: A total of 384 patients (345 men; mean age, 72.7 ± 7.8 years) were treated. St-FEVAR was used in 199 patients (51.8%) and Co-FEVAR in 185 (48.2%), including 30 patients with a quadruple FEVAR. Overall technical success was 373 of 384 (97.1%), and the difference between the St-FEVAR group (195 of 199 [98%]) and the Co-FEVAR group (178 of 185 [96.2%]) was not statistically significant (P = .37). Mean operative time was 135 ± 46 minutes for St-FEVAR and 176 ± 53 minutes for Co-FEVAR (P < .001). Mean fluoroscopy time was 45 ± 17 minutes for St-FEVAR and 57 ± 21 minutes for Co-FEVAR (P < .001). Overall 30-day mortality was two of 384 (0.5%), and the difference between the two groups was not statistically significant (St-FEVAR: 1 of 199 [0.5%] vs Co-FEVAR: 1 of 185 [0.5%]; P = 1.0). Major perioperative complications between St-FEVAR group (22 of 199 [11.1%]) and Co-FEVAR group (24 of 185 [13%]) were similar (P = .64). Mean follow-up was 20 ± 17.1 months. Estimated survival at 1 and 3 years was 95% ± 1.7% and 83.4% ± 3.6% for St-FEVAR vs 94% ± 2.4% and 89.4% ± 3.5%, respectively, for Co-FEVAR (P = .96). Estimated freedom from reintervention at 1 and 3 years was 97.9% ± 1.2% and 90.5% ± 3.1% for St-FEVAR vs 95.4% ± 2.0% and 89.1% ± 4.2%, respectively, for Co-FEVAR (P = .5). Estimated target vessel patency at 1 and 3 years was 99.2% ± 0.4% and 98.6.0% ± 0.6% for St-FEVAR vs 98.6% ± 0.6% and 97.9% ± 0.9%, respectively, for Co-FEVAR (P = .48)., Conclusions: Co-FEVAR is not associated with an increase in perioperative mortality and morbidity compared with St-FEVAR. Co-FEVAR requires longer procedure and fluoroscopy duration, but technical success rates are as high as in St-FEVAR. A liberal use of Co-FEVAR is therefore justified whenever a longer and higher proximal sealing zone is needed., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Published
2017
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39. Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results.

Author

Patel RP, Katsargyris A, Verhoeven ELG, Adam DJ, and Hardman JA

Subjects
Humans, Prosthesis Design, Treatment Outcome, Aortic Aneurysm therapy, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation methods, Endovascular Procedures methods, Stents
Abstract

The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

Published
2013
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