Aneurysm-related death: Primary endpoint analysis for comparison of open and endovascular repair

Arko, Frank R.; Lee, W.Anthony; Hill, Bruce C.; Olcott, Cornelius; Dalman, Ronald L.; Harris, E. John; Cipriano, Paul R.; Fogarty, Thomas J.; Zarins, Christopher K.

doi:10.1067/mva.2002.126314

Cited by 86 publications

(68 citation statements)

References 20 publications

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“…Many patients with an AAA remain asymptomatic until rupture occurs: rupture of an AAA (rAAA) is associated with significant mortality and morbidity [3][4][5]. The overall mortality rate for rAAA is 80-90 %, the mortality rate before hospital admission is 66 %, and the survival rate is 30-65 % for those patients admitted to the hospital alive [4,5]. Rupture is proportionally related to the rapid enlargement of the aneurism and its diameter [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…They occur in 1 % of women and 6 % of men older than age 64 years [1] and the incidence of rupture ranges between 5.6 and 17.5 per 100,000 person-years [2]. Many patients with an AAA remain asymptomatic until rupture occurs: rupture of an AAA (rAAA) is associated with significant mortality and morbidity [3][4][5]. The overall mortality rate for rAAA is 80-90 %, the mortality rate before hospital admission is 66 %, and the survival rate is 30-65 % for those patients admitted to the hospital alive [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Fossaceca

Guzzardi

Cerini

et al. 2013

Cardiovasc Intervent Radiol

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Objective This study was designed to evaluate the effectiveness of endovascular treatment (EVAR) for ruptured abdominal aortic aneurysms (rAAAs). Methods Between September 2005 and December 2012, 44 patients with rAAA suitable for endovascular repair underwent emergency EVAR. We did not consider hemodynamic instability to be a contraindication for EVAR. Results Successful stent-graft deployment was achieved in 42 patients, whereas 2 required open surgical conversion. The overall 30-day mortality was 10 of 44 patients (5/34 in stable patients, 5/10 in unstable patients). Postoperative complications were observed in 7 of 44 patients (16 %): 5 patients developed abdominal compartment syndrome requiring decompressive laparotomy; 1 patient developed bowel ischemia; 1 patient had limb ischemia, and 1 had hemodynamic shock. Mean length of intensive care unit stay was 2.9 (range 2-8) days, and mean length of hospital stay was 8.6 (range 0-18) days. At a mean follow-up of 22.2 (range 1-84) months, the overall incidence of endoleak was 23.5 %: 1 type I and 7 type II endoleaks. Conclusions Our study demonstrates that EVAR of rAAA is associated with acceptable mortality and morbidity rates in dedicated centers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Fossaceca

Guzzardi

Cerini

et al. 2013

Cardiovasc Intervent Radiol

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“…[1][2][3] However, the migration of endoluminal devices has been noted following successful endovascular repair, raising concerns about long-term durability of endovascular repair. [4][5][6] Continuous downward displacement forces are exerted on all aortic devices by the pulsatile nature of blood flow, with cumulative effects over time.…”

Section: Introductionmentioning

confidence: 99%

Endograft Migration: Incidence, Causes, and Clinical Significance

Lee

Zarins

2004

Perspectives in Vascular Surgery and Endovascular Therapy

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Endovascular device migration is approximately 2% at 1 year using each of the Food and Drug Administration-approved devices (Medtronic AneuRx, Gore Excluder, Cook Zenith). In this report, we review the incidence, causes, and clinical importance of endograft migration over a 5-year period after endovascular aneurysm repair with the AneuRx stent graft. In a multicenter United States clinical trial of the AneuRx device, migration was identified in 8% (94/1119) of patients over a mean follow up time of 30 ± 11 months. A Kaplan-Meier analysis determined migration rates were 1.4% at 1 year, 6.6% at 2 years, and 18.8% at 3 years. The significant factors in device migration appeared to be proximal fixation length (P = .005), renal artery to stent-graft distance (P = .001), and the clinical site (P < .001). Preimplantation aortic neck length, neck diameter, degree of device oversizing, device type (stiff vs flexible), placement of proximal extender cuffs at the original procedure, and postprocedure endoleak were not significant predictors of migration. These results highlight the importance of technical precision in stent-graft deployment as critical in preventing late AneuRx stent graft migration.

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“…It is therefore of paramount importance to pay attention to the interfaces between the different foreign materials and the living tissues, despite an improvement in the clinical results [30][31][32]. Indications for endovascular surgery were also refined and they complement rather than compete with open surgery [33].…”

Section: Introductionmentioning

confidence: 99%

Polymethylmethacrylate (PMMA) as an Embedding Medium Preserving Tissues and Foreign Materials Encroaching in Endovascular Devices

Guidoin¹,

Zhang²,

Douville³

et al. 2006

Artificial Cells, Blood Substitutes, and Biotechnology

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Problems of displacement, poor healing, degradation of the polymers and corrosion of the metallic frame in endovascular devices still require in-depth investigations. As the tissues and the foreign materials are in close contact, it is of paramount importance to efficiently investigate the interfaces between them. 349 Inclusion in polymethymethacrylate (PMMA) permits us to obtain thin slides and preserve the capacity to perform the appropriate stainings.An AneuRx prosthesis was harvested in bloc with the surrounding tissues at the autopsy of a patient 25 months post deployment in a 5.7 cm diameter AAA and sectioned in the direction of the blood flow in two halves. A cross-section of the encapsulated distal segment together with the surrounding aneuryshmal sac was embedded in polymethylmethacrylate (PMMA). Further to complete polymerization, slices of the specimen were cut on a precision banding saw under coolant. They were affixed onto methacrylate slides with a UV cured adhesive. Binding and polishing were done on a numeric grinder and slices 25 to 30 mm in thickness were stained with toluidine blue prior to observation in light microscopy. Additional slices were prepared for scanning electron microscopy and X-ray energy dispersive spectrometry for determination of the elemental composition of the Nitinol stent.The aortic wall did not demonstrate complete integrity along with its circumference. Some areas of rupture were noted. The content of the sac was heavily shrunk and was mostly acellular. The walls of the device were very well encapsulated. The PMMA embedding permitted the polyester wall, the Nitinol wire and the collagen to keep in close contact. Scanning electron microscopy involved backscattered electrons and confirmed the corrosion the Nitinol wire at the boundary with living tissues.Based upon the results obtained, we believe that PMMA embedding is the most appropriate method to process endovascular devices for histological and material investigation. Needless to say, that paraffin embedding would have not been feasible for such a big size specimen involving different materials.

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Aneurysm-related death: Primary endpoint analysis for comparison of open and endovascular repair

Cited by 86 publications

References 20 publications

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

Endograft Migration: Incidence, Causes, and Clinical Significance

Polymethylmethacrylate (PMMA) as an Embedding Medium Preserving Tissues and Foreign Materials Encroaching in Endovascular Devices

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