Amplatzer Vascular Plug to occlude the internal iliac arteries in patients undergoing aortoiliac aneurysm repair

Ha, Chi; Calcagno, David

doi:10.1016/j.jvs.2005.08.017

Cited by 91 publications

(74 citation statements)

References 21 publications

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“…It is based on statewide data collection by individual data organizations across the USA and includes the largest collection of longitudinal hospital care data in the USA, encompassing all-payer, discharge-level information. The other AE and complication-related treatment cost data were obtained using the published literature [16][17][18][19]. These cost estimates were then inflated to 2016 (October) US dollars using the Medical Care Component of the Consumer Price Index [20].…”

Section: Cost End Pointsmentioning

confidence: 99%

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

et al. 2018

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Aim:The incremental cost of peripheral orbital atherectomy system (OAS) plus balloon angioplasty (BA) versus BA-only for critical limb ischemia was estimated. Materials & methods: A deterministic simulation model used clinical and healthcare utilization data from the CALCIUM 360• trial and current cost data. Incremental cost of OAS + BA versus BA-only included differential utilization during the procedure and adverse-event costs at 3, 6 and 12-months. Results: For every 100 procedures, incremental annual costs to the hospital were US$350,930 lower with OAS + BA compared with BA-only. Despite higher upfront costs, savings were realized due to reduced need for revascularization, amputation and end-of-life care over 6-12-month postoperative period. Conclusion: Atherectomy with OAS prior to BA was associated with cost savings to the hospital. Critical limb ischemia (CLI) is the most serious manifestation of peripheral artery disease (PAD). Considered as the 'end stage' of PAD, it involves a chronic lack of blood supply leading to persistent ischemic rest pain in the feet or toes, nonhealing wounds and ulcers, and gangrene [1]. CLI often results in amputation of the affected limb(s) with roughly 25% of CLI patients receiving at least one lower extremity amputation [2]. The economic burden of CLI-diagnosed Medicare patients exceeds US$3.1 billion annually, with most of this cost reflecting the high incidence of hospitalizations related to limb loss and the need for major amputation [3].Treating CLI patients has remained quite challenging, since the associated calcification requires a unique mechanism of action to treat the lesion without damaging the vessel [4]. Balloon angioplasty (BA) continues to be the first-line of revascularization strategy in patients where procedural success via less invasive, nonsurgical approach is favored despite consistently poor intermediate and long-term patency outcomes [5,6]. The latter has been attributed to the presence of calcified plaque in femoropopliteal lesions, with arterial wall calcium associated with higher rates of procedural complications, and flow-limiting dissections that frequently require stent deployment in order to maintain vessel patency [4][5][6]. Furthermore, restenosis rates as high as 40-60% within 1 year of postprocedure and poor correlation between primary patency and limb preservation have been reported. But the American College of Cardiology/American Heart Association guidelines currently recommend against primary stenting of femoropopliteal lesions with atherectomy and stent devices indicated for 'bailout' purposes following suboptimal BA results [5]. Stenting in calcified segments after a prior failed BA often results in stent under expansion and malapposition [6,7]. These are recognized predictors of long-term stent patency and indicate an increased risk of

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Section: Cost End Pointsmentioning

confidence: 99%

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

et al. 2018

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“…This device allows a more precise proximal embolization (ProxEmbX) in comparison with embolization with several coils. 1 Recent studies demonstrated that the AVP is a suitable alternative to coil embolization to achieve successful occlusion of the IIA before EVAR. [9][10][11][12] Isolated AVP embolization seems to be reasonable in case of an unaffected IIA.…”

Section: Endovascular Aneurysm Repair (Evar) Is An Established Alternmentioning

confidence: 99%

Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Dierks

Sauer

Wolfschmidt

et al. 2017

BJR

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“…The successful use of vascular plugs has been reported in similar scenarios. 8) However this is dependent on favourable aneurysm morphology and access. In addition factors such as experience of the interventional team and case volume load of acute presentations have been identified from trials on ruptured aortic aneurysm as a major determinant of a successful outcome.…”

Section: Case Presentationmentioning

confidence: 99%

Common Iliac Aneurysm Rupture after Previous Aortic Aneurysm Resection

Mylankal¹,

Baxter²,

Perry³

2010

Annals of Vascular Diseases

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Introduction Iliac artery aneurysms pose diagnostic difficulties as they are relatively asymptomatic and hence difficult to detect and treat.1) In addition, rupture of common iliac artery aneurysm is associated with a higher mortality rate despite modern surgical and anaesthetic care.2) They are commonly seen in patients with abdominal aortic aneurysms although there is no association between the diameter of the iliac aneurysm and abdominal aortic aneurysm.3) There are reports of common iliac aneurysm developing in patients operated for infra-renal aortic aneurysms with non-bifurcating grafts. 4) In addition, there is recent evidence to suggest that in patients with abdominal aortic aneurysms, common iliac arteries measuring over 1.6 cm are prone to aneurysmal degeneration in later life and this is of relevance particularly when considering endovascular interventions. 5)The development and subsequent rupture of a common iliac artery aneurysm, which has been excluded from high-pressure direct flow from the aorta has not been previously reported. We report such a case of rupture of the common iliac artery aneurysm eight years after an aorto-bifemoral bypass graft repair for ruptured infra-renal abdominal aortic aneurysm and discuss relevant management issues. Case PresentationAn 84-year-old man with significant past medical history of cardio-respiratory co-morbidities presented with acute onset left iliac fossa pain. He had undergone an aorto-bifemoral bypass graft eight years ago for a ruptured infra-renal abdominal aortic aneurysm. A prosthetic aorto-bifemoral bypass graft was performed as the iliac arteries were severely calcified and unsuitable for anastamosis. The origins of the common iliac arteries were ligated to allow for retrograde perfusion of the internal iliac vessels via the graft. The iliac arteries were noted to be of normal calibre with no aneurysmal changes at the initial repair of the aortic aneurysm. On the current admission, an urgent contrast enhanced CT scan demon- Common Iliac Aneurysm Rupture after Previous Aortic

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Amplatzer Vascular Plug to occlude the internal iliac arteries in patients undergoing aortoiliac aneurysm repair

Cited by 91 publications

References 21 publications

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

Hospital cost impact of orbital atherectomy with angioplasty for critical limb ischemia treatment: a modeling approach

Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Common Iliac Aneurysm Rupture after Previous Aortic Aneurysm Resection

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