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[PMID]: 29522871
[Au] Autor:Mascoli C; Faggioli GL; Gallitto E; Vento V; Pini R; Vacirca A; Indelicato G; Gargiulo M; Stella A
[Ad] Address:Vascular Surgery, DIMES, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
[Ti] Title:Standardization of a carbon dioxide automated system for endovascular aortic aneurysm repair.
[So] Source:Ann Vasc Surg;, 2018 Mar 06.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Endovascular Aortic Repair (EVAR) is presently the preferred treatment for abdominal aortic aneurysm; however, it requires the injection of contrast medium, which can hamper the renal function. Other non-toxic agents, such as carbon dioxide (CO ) have been sporadically tested in this setting with uncertain results. Aim of the study is to investigate the efficacy of a new standardized CO injection method in standard EVAR procedures. METHODS: Between August and October 2016, 31 consecutive patients (median age 76.1 (IQR:7.4) years) were submitted to standard EVAR. Proximal and distal endograft landing zone were identified by the injection of 100 mL of CO at 300 mmHg, through a 11 cm 10-Fr femoral sheath by a specifically manufactured automated injection device (Angiodroid SRL, San Lazzaro, Bologna, Italy). Before EVAR deployment a confirmative injection with conventional contrast medium was accomplished. The possibility of precisely visualize the proximal and distal landing zones by CO -DSA (digital subtraction angiography) was evaluated considering the contrast medium injection obtained in the same procedure as a gold standard. Similarly, the possible presence of endoleak was assessed at the end of the procedure with the two techniques. RESULTS: CO -DSA allowed to identify the juxta-renal landing zone of the endograft in 19/31 cases (61%) and the distal one in 31/31 (100%). In 12 (39%) cases CO injection failed to visualize at least the lowest renal artery. This occurred in large aneurysms with scarce thrombotic apposition and a luminal volume greater than 95.9 (IQR:25.2) mm . Completion CO -DSA detected type II endoleaks in 10 cases compared with 2 of conventional contrast media. CONCLUSION: The injection of non-toxic CO through an automated device allowed to perform EVAR procedure effectively, in the majority of cases. In some cases, a single injection of a minimum amount of conventional contrast medium can be used to overcome the lack of renal artery visualization by CO . Type II endoleaks are more frequently visualized with CO compared with standard contrast medium. Although the CO injection technique needs further amelioration particularly in the renal arteries detection, this technique appears promising and possibly substitutive of the standard contrast medium, with significant benefit for the renal function.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  2 / 3430 MEDLINE  
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[PMID]: 29425771
[Au] Autor:Rajasinghe HA; Miller LE; Krajcer Z
[Ad] Address:The Vascular Group of Naples, Naples, FL. Electronic address: HRajasinghe@tvgnaples.com.
[Ti] Title:Early Outcomes with Fast-Track EVAR in Teaching and Nonteaching Hospitals.
[So] Source:Ann Vasc Surg;, 2018 Feb 07.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: The influence of hospital teaching status on fast-track endovascular aneurysm repair (EVAR) outcomes is unknown. This study explored the feasibility, safety, and effectiveness of a fast-track EVAR protocol at teaching and nonteaching hospitals. METHODS: Patients underwent a fast-track EVAR protocol composed of bilateral percutaneous access using a 14F stent graft, avoidance of general anesthesia and intensive care admission, and next-day discharge. Patients were followed up for 1 month post-treatment. Participating hospitals were categorized by teaching status (teaching versus nonteaching) and compared for perioperative and 30-day outcomes. RESULTS: Between October 2014 and May 2016, 250 patients were enrolled at 31 centers in the United States. The study included 186 patients treated among 21 teaching hospitals and 64 patients treated among 10 nonteaching hospitals. Fast-track EVAR protocol completion was higher at teaching hospitals (91% vs. 73%, P = 0.01). Intensive care admission was avoided in 99% of patients at teaching hospitals versus 84% at nonteaching hospitals (P < 0.001). The ability to complete all other fast-track EVAR elements was proportionally higher at teaching hospitals, but differences were not statistically different. In-hospital outcomes by teaching status were comparable overall. Median time to discharge was 25 and 26 hr, respectively. There were no reports of type III endoleak, abdominal aortic aneurysm rupture, or secondary intervention. Comparing teaching versus nonteaching hospitals, there were no differences in major adverse events (1% vs. 0%), type I endoleak (0% vs. 2%), limb occlusion (1% vs. 0%), all-cause mortality (1% vs. 0%), and 30-day readmissions (1% vs. 3%). CONCLUSIONS: A fast-track EVAR protocol can be implemented with high success in well-selected patients at teaching and nonteaching hospitals. Health care resource utilization, perioperative data, and 30-day outcomes were excellent overall, with higher frequency of intensive care admission at nonteaching hospitals.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  3 / 3430 MEDLINE  
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[PMID]: 29518520
[Au] Autor:Reddy NP; Ham SW; Weaver FA; Rowe VL; Ziegler KR; Han SM
[Ad] Address:Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of University of Southern California, Los Angeles, CA. Electronic address: Neil.Reddy@med.usc.edu.
[Ti] Title:Repair of delayed type 1a endoleak using fenestrated and parallel endografts.
[So] Source:Ann Vasc Surg;, 2018 Mar 05.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Endovascular aneurysm repair has become the first-line treatment modality for infrarenal aortic aneurysms. However, obtaining successful long-term results frequently require re-interventions. Particularly, delayed type 1a endoleaks pose a challenging problem, as they are often associated with proximal extension of the aneurysmal process to juxta or para-renal aortic segments. We describe two remedial techniques to repair delayed type 1a endoleak by extending the seal zone to the suprarenal aorta, while incorporating the renal arteries. In the first case, a commercially available fenestrated stent-graft was utilized. Parallel grafting technique was used in the other. Both cases were technically successful. Follow up imaging revealed endoleak resolution with patent renal arteries for both patients. In addition, we describe the difference between the two techniques, as well as relevant anatomic and device specific considerations.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher

  4 / 3430 MEDLINE  
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[PMID]: 29505865
[Au] Autor:Deery SE; Shean KE; Pothof AB; O'Donnell TFX; Dalebout BA; Darling JD; Bodewes TCF; Schermerhorn ML
[Ad] Address:Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215.
[Ti] Title:Three-Year Results of the Endurant Stent Graft System Post-Approval Study (ENGAGE PAS).
[So] Source:Ann Vasc Surg;, 2018 Mar 02.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Long-term data following endovascular aortic aneurysm repair (EVAR) exist, but are limited to endografts that are no longer in use. The aim of the ENGAGE Post-Approval Study is to describe the long-term safety and effectiveness data following EVAR using the Endurant stent graft system. METHODS: From August 2011 to June 2012, 178 patients were enrolled and treated with the Endurant stent graft system. Clinical and radiologic data were prospectively collected and analyzed. The primary endpoint was AAA-related mortality, and secondary endpoints were overall mortality, endoleak, secondary interventions, and device-related complications. Kaplan-Meier estimates were used for late outcomes. RESULTS: A total of 178 patients underwent EVAR with the Endurant stent graft across 24 centers (82% men; median age 71, interquartile range [IQR] 66-79). Median aortic diameter was 55 mm (IQR 51-58 mm). There was a 98.9% technical success rate. Three-year clinical and radiographic follow-up data were available for 87% and 74% of patients, respectively. Median follow-up was 37 months (IQR 30-38 months). Three-year aneurysm-related mortality rate was 1.1%, with two deceased patients in the perioperative period. All-cause mortality rate at three years was 13%. No patients suffered from aneurysm rupture or underwent conversion to open repair through three years of follow-up. Only 11 patients (6.2%) had undergone reintervention at three years. Younger age was associated with reintervention (HR 3.3 per younger decade, 95% Confidence Interval 1.3 - 7.6, P < .01), but neck diameter, length, angulation were not significantly associated with reintervention. CONCLUSIONS: The Endurant stent graft system provides a safe, durable approach to treating infrarenal AAA. No patients experienced late rupture or aneurysm-related mortality, and only one in 16 patients underwent reintervention by three years. The rate of reintervention with the Endurant graft appears to be lower than other contemporary grafts despite more liberal "Instructions For Use" parameters, but further research including direct graft comparisons will be necessary to guide appropriate graft selection.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher

  5 / 3430 MEDLINE  
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[PMID]: 29279976
[Au] Autor:Jeon YS; Cho YK; Song MG; Seo TS; Kim JH; Song SY; Lee SY
[Ad] Address:Department of Radiology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
[Ti] Title:Clinical Outcomes of Endovascular Aneurysm Repair with the Kilt Technique for Abdominal Aortic Aneurysms with Hostile Aneurysm Neck Anatomy: A Korean Multicenter Retrospective Study.
[So] Source:Cardiovasc Intervent Radiol;41(4):554-563, 2018 Apr.
[Is] ISSN:1432-086X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: We aimed to evaluate the clinical efficacy and short-term clinical outcomes of Kilt technique-based endovascular aneurysm repair (EVAR) with Seal stent-grafts for abdominal aortic aneurysms (AAAs) with hostile neck anatomy (angle > 60°). MATERIALS AND METHODS: We retrospectively evaluated the pre-EVAR and follow-up computed tomography angiography findings of 24 patients (mean age 71 ± 11 years; age range 32-87 years; mean follow-up 50 ± 12 months) with hostile neck AAAs treated between 2010 and 2015. Serial change in aneurysmal neck angle was calculated using a standardized protocol. Relationships between clinical variables and outcomes were evaluated using univariate and multivariate Cox analyses and mixed-model regression. In addition, the Kaplan-Meier method was used to assess the cumulative rates of survival, endoleak, and reintervention. RESULTS: The primary technical success rate (success within 24 h after EVAR) was 100% (24/24). The survival rate was 96 ± 8% at 1 month, 6 months, 1 year, and 3 years, and 87 ± 18% at 5 years. Endoleaks occurred in three patients. Four reinterventions were performed in three patients; no surgical revisions were required. Causes of post-EVAR mortality included intracerebral hemorrhage at 14 days and rhabdomyolysis at 32 months. The most remarkable change after Kilt-based EVAR was an acute decrease in the neck angle, which was observed between the pre-EVAR and first follow-up visits (at 1 month) (P = 0.001). CONCLUSION: Kilt-based EVAR with Seal stent-grafts for AAAs with a severely angulated neck (angle > 60°) provided high technical success, low mortality, and low complication rates during short-term follow-up.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:In-Process
[do] DOI:10.1007/s00270-017-1867-y

  6 / 3430 MEDLINE  
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[PMID]: 29238868
[Au] Autor:Tan GWL; Quek L; Tan BP; Pua U
[Ad] Address:Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. glenn_tan@ttsh.com.sg.
[Ti] Title:Early Experience and Lessons Learnt with Customized Fenestrated Thoracic Endovascular Aortic Reconstruction for Aortic Arch Pathology in an Asian Population.
[So] Source:Cardiovasc Intervent Radiol;41(4):544-553, 2018 Apr.
[Is] ISSN:1432-086X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment of descending thoracic aorta pathology. However, TEVAR in the aortic arch remains challenging. Customized fenestrated TEVAR (fTEVAR) allows extension of the proximal seal zone, while preserving the involved supra-aortic vessels. There is a paucity of information on fTEVAR; hence, we aim to evaluate our early experience and lessons learnt with fTEVAR in the aortic arch. METHODS: This is a retrospective single-centre review of fTEVAR endografts for aortic arch pathology over 24 months. Seven patients with mean age of 72.8 years (range 63-84 years) were included. A total of 15 supra-aortic branches were treated [left subclavian artery (n = 7), left carotid artery (n = 5), innominate artery (n = 1), bovine origins (n = 2)], involving a total of nine fenestrations and six scallops. No supra-aortic debranching was required. RESULTS: Median follow-up was 15 months. Technical success was 86%, and one patient had malalignment of the fTEVAR endograft requiring salvage with double chimney technique. There were no early endoleaks with one type 2 endoleak detected in the follow-up period. Two access site pseudoaneurysms required intervention. There was a learning curve involved reflected by higher than average mean operative time of 224 min with average radiation dose of 3029.86 mGy and mean contrast volume of 283 mls. CONCLUSION: fTEVAR in the aortic arch is feasible in Asian patients, although there was a learning curve involved, and careful patient selection is advised. Longer term data in a larger population are required to assess its durability.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:In-Process
[do] DOI:10.1007/s00270-017-1858-z

  7 / 3430 MEDLINE  
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[PMID]: 29503083
[Au] Autor:Powell JT; Sweeting MJ; Ulug P; Thompson MM; Hinchliffe RJ; IMPROVE Trial Investigators
[Ad] Address:Vascular Surgery Research Group, Imperial College, London, UK. Electronic address: j.powell@imperial.ac.uk.
[Ti] Title:Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial.
[So] Source:Eur J Vasc Endovasc Surg;, 2018 Mar 01.
[Is] ISSN:1532-2165
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE/BACKGROUND: The aim was to describe the re-interventions after endovascular and open repair of rupture, and investigate whether these were associated with aortic morphology. METHODS: In total, 502 patients from the IMPROVE randomised trial (ISRCTN48334791) with repair of rupture were followed-up for re-interventions for at least 3 years. Pre-operative aortic morphology was assessed in a core laboratory. Re-interventions were described by time (0-90 days, 3 months-3 years) as arterial or laparotomy related, respectively, and ranked for severity by surgeons and patients separately. Rare re-interventions to 1 year, were summarised across three ruptured abdominal aortic aneurysm trials (IMPROVE, AJAX, and ECAR) and odds ratios (OR) describing differences were pooled via meta-analysis. RESULTS: Re-interventions were most common in the first 90 days. Overall rates were 186 and 226 per 100 person years for the endovascular strategy and open repair groups, respectively (p = .20) but between 3 months and 3 years (mid-term) the rates had slowed to 9.5 and 6.0 re-interventions per 100 person years, respectively (p = .090) and about one third of these were for a life threatening condition. In this latter, mid-term period, 42 of 313 remaining patients (13%) required at least one re-intervention, most commonly for endoleak or other endograft complication after treatment by endovascular aneurysm repair (EVAR) (21 of 38 re-interventions), whereas distal aneurysms were the commonest reason (four of 23) for re-interventions after treatment by open repair. Arterial re-interventions within 3 years were associated with increasing common iliac artery diameter (OR 1.48, 95% confidence interval [CI] 0.13-0.93; p = .004). Amputation, rare but ranked as the worst re-intervention by patients, was less common in the first year after treatment with EVAR (OR 0.2, 95% CI 0.05-0.88) from meta-analysis of three trials. CONCLUSION: The rate of mid-term re-interventions after rupture is high, more than double that after elective EVAR and open repair, suggesting the need for bespoke surveillance protocols. Amputations are much less common in patients treated by EVAR than in those treated by open repair.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher

  8 / 3430 MEDLINE  
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[PMID]: 29501907
[Au] Autor:Martinelli O; Fresilli M; Irace L; Venosi S; Jabbour J; Picone V; Maruca D; Di Girolamo A; Gossetti B
[Ad] Address:Department of Vascular and Endovascolar Surgery, Policlinico "Umberto I" Hospital, Rome, Italy.
[Ti] Title:An alternative approach for treating a type Ia endoleak after conventional EVAR using the Nellix Endovascular Aneurysm Sealing.
[So] Source:Ann Vasc Surg;, 2018 Mar 01.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:PURPOSE: To report the use of a Nellix endovascular aneurysm sealing (EVAS) device, to successfully treat a type Ia endoleak after an endovascular aortic repair (EVAR). CASE REPORT: A 70-years old man was diagnosed with a 90-mm aortic aneurysm, suspicious for being inflammatory. It was initially treated successfully, with a Medtronic Endurant (Medtronic, Minneapolis, MN). Five years after the index endovascular repair, an asymptomatic type Ia endoleak was detected on duplex ultrasound and computed tomographic angiogram. Other endovascular solutions in the form of proximal cuff, chimney was considered difficult to execute due to challenges in planning, manipulation, and renal cannulation caused by the short proximal sealing zone above the existing stent-graft and the constraints of the previous endograft Thus, a relining of the previous endoprothesis was performed using the Nellix system (Endologix, Inc., Irvine, CA). One-year follow-up imaging demonstrated successful resolution of the endoleak and persistent sealing of the Nellix device. CONCLUSION: Nellix Endovascular Aneurysm Sealing system can be an alternative and safe option for relining a stent-graft with a type Ia endoleak. Nellix platform may can be added to the clinician's armamentarium for treating type Ia endoleak after conventional EVAR of infrarenal AAA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180304
[Lr] Last revision date:180304
[St] Status:Publisher

  9 / 3430 MEDLINE  
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[PMID]: 29501905
[Au] Autor:Karkos CD; Mitka M; Pliatsios I; Xanthopoulou E; Giagtzidis IT; Papadimitriou CT; Papazoglou KO
[Ad] Address:Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, Thessaloniki, Greece. Electronic address: ckarkos@hotmail.com.
[Ti] Title:Rupture after previous endovascular aneurysm repair due to type IA endoleak: complete endograft preservation is feasible with proximal suturing, aortic neck banding and sac plication.
[So] Source:Ann Vasc Surg;, 2018 Mar 01.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Rupture of an abdominal aortic aneurysm (AAA) after previous endovascular repair (EVAR) may require endograft explantation and replacement with a prosthetic surgical graft. Recent reports have suggested that total endograft removal during late surgical conversion in the non-ruptured setting may not be necessary and that preserving functional parts of the endograft may improve results. Similar techniques may be used for ruptured cases diminishing the magnitude of an already difficult and complex procedure. We describe the successful treatment of a ruptured AAA after previous EVAR with complete endograft preservation by combining transmural endograft fixation with sutures, proximal aortic neck banding and sac plication.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180304
[Lr] Last revision date:180304
[St] Status:Publisher

  10 / 3430 MEDLINE  
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[PMID]: 29501597
[Au] Autor:Seike Y; Matsuda H; Fukuda T; Inoue Y; Omura A; Uehara K; Sasaki H; Kobayashi J
[Ad] Address:Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
[Ti] Title:The influence of four or more patent lumbar arteries on persistent type II endoleak and sac expansion after EVAR.
[So] Source:Ann Vasc Surg;, 2018 Feb 28.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: This study aimed to review our clinical results and determine how preoperative patent lumbar arteries (LAs) influence the occurrence of type II endoleaks or aneurysm sac enlargement after endovascular aneurysm repair (EVAR), and to identify the preoperative computed tomography findings of persistent type II endoleaks from patent LAs that indicate the need for preventive procedures during EVAR. METHODS: A total of 293 patients who underwent EVAR for infrarenal abdominal aortic aneurysm between August 2007 and July 2013 were reviewed. Follow-up data were available for 194 patients (76% male, mean age 78 ± 6.8 years), and the mean follow-up time was 57 ± 23 months. RESULTS: The number of patent LAs was identified as a significant positive predictor of persistent type II endoleaks [hazard ratio (HR), 1.4; 95% confidence interval (CI): 1.2-1.7; P < .001] and sac enlargement (≥5 mm) at the 2-year follow-up period (HR, 1.3; 95% CI: 1.1-1.8; P = .009) after EVAR using Cox regression analysis. The receiver operating characteristics curve (AUC: 0.72) showed that a cut-off of four patent LAs resulted in a sensitivity of 87% and specificity of 48%. The rates of freedom from sac enlargement (≥5 mm) at 3 and 5 years after EVAR were significantly lower in patients with four or more patent LAs than in those with fewer (90% and 76% vs. 96% and 89%; P =.0008) . CONCLUSIONS: The number of patent LAs is associated as a significant risk factor with the development of persistent type II endoleaks and sac enlargement after EVAR. Four or more patent LAs should be recognized as the group having an elevated risk of developing late sac enlargement after EVAR.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180304
[Lr] Last revision date:180304
[St] Status:Publisher


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