A New Management for Limb Graft Occlusion after Endovascular Aneurysm Repair Adding a Vollmar Ring Stripper: The Unclogging Technique

Ronsivalle, Salvatore; Faresin, Francesca; Franz, Francesca; Pedon, Luigi; Rettore, Carlo; Zonta, L; Olivieri, Armando

doi:10.1016/j.avsg.2013.02.018

Cited by 15 publications

(10 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ronsivalle et al described re-occlusion after intervention in five patients (29%), major amputation in one (12%) patient, and occlusion related mortality in two (6%). 2 Maleux et al described two cases of re-occlusion and one occlusion related mortality in the group of patients submitted to thrombolysis and BMS deployment (n ¼ 9). One case of femorofemoral bypass infection was also described (from a total of 19 patients).…”

Section: Resultsmentioning

confidence: 99%

Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management

Coelho

Nogueira

Lobo

et al. 2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

The aim of this study was to review preventive and treatment management of one of the most common complications of endovascular aneurysm repair, which surprisingly, is little described in the literature. This study aimed to objectively identify high risk patients for kinking and make recommendations for intra-operative diagnosis and management, as well as management of limb occlusion.Objective/background: Endograft limb occlusion is a potential complication of endovascular aneurysm repair (EVAR), being one of the major causes of secondary interventions and rehospitalisation. The aim of this review is to report on the impact of endograft kinking in endograft limb occlusion, as well as on risk factors, prevention, early diagnosis, and management. Methods: A systematic review and meta-analysis was conducted according to the recommendations of the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. Results: After a MEDLINE and Scopus search, 55 articles (27,509 patients) were included in the qualitative analysis and eight in the quantitative analysis. In this meta-analysis, 179 at risk limbs were treated by preemptive stenting, which significantly reduced the risk of limb occlusion: not pre-emptively stenting limbs at risk had a negative impact on graft limb patency (odds ratio 4.30, 95% confidence interval 1.45e12.78). Postoperatively, a kink was identified in 422 patients (1.5%), contributing to 42.8% of all limb occlusions. Relevant data support that completion angiography is an inadequate means of diagnosing high risk limbs, proposing cone beam computed tomography and intravascular ultrasound as adjuncts. The post-operative limb occlusion rate ranged from 0% to 10.6%, affecting 984 patients. Several risk factors for limb occlusion have been identified. Regarding treatment, most patients were submitted to femorofemoral bypass (52.3%) or to deployment of a bare metal stent, either alone or associated with catheter directed thrombolysis or mechanical thrombectomy (26.4%). Complications and outcome after re-intervention for limb occlusion are described infrequently in the literature, but single studies have reported on re-occlusion, major amputation, and limb occlusion related mortality rates. Conclusion: Pre-EVAR planning should focus on identification of risk factors for kinking. Adjunctive stenting is an effective prophylaxis for selected high risk limbs, yet intra-operative identification remains problematic. Also, it is noteworthy that most limb occlusions occur in the first year after EVAR, emphasising the importance of careful early follow up of high risk patients.

show abstract

Section: Resultsmentioning

confidence: 99%

Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management

Coelho

Nogueira

Lobo

et al. 2019

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

show abstract

“…More specifically, bilateral occlusion is a rare complication with a reported incidence ranging from 0% to .6%. 4,5 Limb occlusion manifests with acute ischemia (present in a third of patients in published series 3 ), rest pain, paresthesia, functional impairment, non-healing lesions or intermittent claudication. Some patients can remain asymptomatic, with a decreased femoral pulse as the sole finding.…”

Section: Discussionmentioning

confidence: 99%

“…1 Its incidence rates range from 0% to 7%. 2,3 Compared with unilateral limb occlusion, bilateral limb occlusion is relatively uncommon, with a reported incidence ranging from 0% to .6%. 4,5 Many endograft limb occlusions can be attributed to mechanical complications, especially endograft kinking, which is thought to be the predominant underlying cause of occluded limbs.…”

Section: Introductionmentioning

confidence: 99%

Aneurysm Sac Shrinkage After EVAR Can Lead to Complications: A Case Report of Complete Endograft Thrombosis Due to Kinking

Canga

Pastor

Al-Sibbai

et al. 2023

Vasc Endovascular Surg

View full text Add to dashboard Cite

Background Bilateral limb occlusion after endovascular repair of abdominal aortic aneurysms (EVAR) is an uncommon entity. The relationship between graft kinking and unilateral limb occlusion is widely described in the literature. Our aim is to report a case of complete endograft thrombosis due to bilateral limb kinking secondary to aneurysm sac shrinkage, treated by endovascular means. Case report A 67 year-old male with history of EVAR with an Incraft® endograft (Cordis, Bridgewater, NJ, USA) four years before, presented at the emergency department with disabling claudication of the right lower extremity and a better tolerated 10-month left extremity claudication. Complete endograft thrombosis with bilateral limb kinking and a remarkable reduction of the aneurysm sac was observed in the computed tomography angiography. An endovascular repair was performed, through bilateral open femoral access and with angiographic control through percutaneous left brachial access. Bilateral recanalization was achieved and the endograft was re-lined with two 10x150 mm Viabahn (WL Gore & Ass., Flagstaff, AZ, USA). Both sides were extended with a 11 × 50 mm Viabahn (WL Gore & Ass., Flagstaff, AZ, USA). The final angiographic control showed bilateral patency with no residual stenosis and the patient recovered distal pulses. Follow-up showed complete patency and no complications at 17 months. Conclusions Bilateral limb occlusion is a rare complication with technically challenging treatment options. Aneurysm sac shrinkage can affect the endograft configuration, leading to limb distortion and occasionally to bilateral limb occlusion after EVAR. Special attention should be put on imaging follow-up to detect these complications before occlusion occurs.

show abstract

“…We experienced an extremely rare case of extensive ischemic ulcers due to limb occlusion after EVAR. Limb occlusion is a well-known complication occurring in 2.6–7.4 % of patients during follow-up after EVAR (Sampram et al 2003 , Fairman et al 2002 , Ronsivalle et al 2013 ), whereas the development of ischemic ulcers is very rare. Cochennec et al reported that 27 % of patients present with acute ischemia, 24 % with rest pain, 30 % with claudication, and 12 % with no symptoms (Cochennec et al 2007 ).…”

Section: Discussionmentioning

confidence: 99%

Extensive ischemic ulcers due to limb occlusion after endovascular aneurysm repair: a case report

Kadoya¹,

Kenzaka

Naito

2016

SpringerPlus

View full text Add to dashboard Cite

IntroductionLimb occlusion after endovascular aneurysm repair (EVAR) is a well-known complication. However, extensive ischemic ulcers due to limb occlusion are extremely rare.Case descriptionWe report a rare case of extensive ischemic ulcers that developed seven months after EVAR in an 85-year-old Japanese man. He had been taking appropriate anticoagulant therapy because of paroxysmal atrial fibrillation. Angiography showed a left limb occlusion and superficial femoral artery (SFA) chronic total occlusion (CTO), and intravascular ultrasound showed limb kinking. Endovascular therapy (EVT) was performed, and stent placement was used to cover a large amount of thrombi and correct the limb kinking, leading to complete recovery of left limb blood flow. After additional EVT was performed for the SFA CTO, outflow improved and the ulcers healed completely.Discussion and evaluationIt seemed that the combination of poor inflow and poor outflow led to limb thrombosis.ConclusionsHere, we describe an extremely rare case of extensive ischemic ulcers due to limb occlusion after EVAR. Patients should undergo careful follow-up after EVAR to monitor blood flow to the lower extremities. Additionally, the early detection and correction of limb kinking and poor outflow are essential to prevent the development of ischemic ulcers.

show abstract

A New Management for Limb Graft Occlusion after Endovascular Aneurysm Repair Adding a Vollmar Ring Stripper: The Unclogging Technique

Cited by 15 publications

References 6 publications

Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management

Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management

Aneurysm Sac Shrinkage After EVAR Can Lead to Complications: A Case Report of Complete Endograft Thrombosis Due to Kinking

Extensive ischemic ulcers due to limb occlusion after endovascular aneurysm repair: a case report

Contact Info

Product

Resources

About