<b>Suitability of Ruptured AAA for Endovascular Repair</b>

Wilson, W.R.W.; Fishwick, Guy; Bell, Sir Peter; Thompson, Matthew M.

doi:10.1583/04-1275r.1

Cited by 26 publications

(11 citation statements)

References 31 publications

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“…Jego wykonalność zależy od licznych czynników, w tym anatomii aorty, indywidualnej oceny klinicznej pacjenta i wytycznych producenta. Odsetek AAA nadających się do wykonania EVAR różni się między różnymi badaniami, utrzymując się w zakresie 15-68% [384]. W niedawnym badaniu z udziałem 241 pacjentów i wykorzystaniem trzech różnych urządzeń opisano całkowity odsetek przypadków nadających się do wykonania EVAR na poziomie 49,4%.…”

Section: Wewnątrznaczyniowe Zabiegi Naprawcze Tętniaków Aortyunclassified

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Erbel

Aboyans²,

Boileau³

et al. 2014

Kardiol Pol

266

236

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Section: Wewnątrznaczyniowe Zabiegi Naprawcze Tętniaków Aortyunclassified

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Erbel

Aboyans²,

Boileau³

et al. 2014

Kardiol Pol

266

236

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show abstract

“…Due to strict criteria, only 40-60% of patients qualify for endovascular treatment. Disregarding the criteria dramatically increases the risk of complications [14–16]. The main postulated advantage of the endovascular technique is the reduction of mortality and peri- and postoperative complication rate.…”

Section: Discussionmentioning

confidence: 99%

Hybrid procedure in a patient with symptomatic thoraco-abdominal aneurysm and prior abdominal aortic reconstruction - case report.

Synowiec¹,

Chęciński²,

Samolewski³

et al. 2012

Videosurgery and Other Miniinvasive Techniques

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Open repair of thoracoabdominal aortic aneurysm is connected with high mortality and morbidity. On the other hand, endovascular treatment of thoraco-abdominal aneurysms, which started 10 years ago, reduced perioperative mortality and morbidity. However, it results in a high level of late complications. It seems that an interesting solution to the problem is a hybrid procedure, which allows late complications to be reduced with acceptable levels of operative mortality and morbidity. This case report presents the use of a hybrid procedure in treatment of symptomatic thoraco-abdominal aneurysm in a patient with prior abdominal aortic reconstruction. In the first stage the patient underwent open revascularization of visceral vessels of the aorta. One week later a thoraco-abdominal stent-graft was implanted. The perioperative and postoperative period was uncomplicated. Two months after the second intervention the patient returned to work. Control imaging conducted 30 and 90 days after the procedure confirmed patency of all revascularized vessels and did not reveal any graft-related complications. The hybrid procedure seems to be an interesting alternative for open and endovascular repair of thoraco-abdominal aneurysms because it combines the advantages of open and endovascular repair. It also gives an opportunity to perform the procedure within a reasonable period of time from diagnosis of symptomatic thoraco-abdominal aneurysm.

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“…Lee and colleagues noted that ruptured AAAs had a larger diameter than asymptomatic AAAs and were less likely to be candidates for endovascular repair (46% vs. 74%) due primarily to unfavorable neck anatomy 40 . This was confirmed by others 41,42 . It is unclear if the relationship between rupture and candidacy for endovascular repair is simply confounded by larger diameter of ruptured AAAs, or if there is a true association between anatomic suitability for endovascular repair and rupture at a given diameter.…”

Section: Candidacy For Endovascular Repair: Small Vs Largementioning

confidence: 98%

“…40 This was confirmed by others. 41,42 It is unclear if the relationship between rupture and candidacy for endovascular repair is simply confounded by larger diameter of ruptured AAAs, or if there is a true association between anatomic suitability for endovascular repair and rupture at a given diameter.…”

Section: Candidacy For Endovascular Repair: Small Vs Largementioning

confidence: 99%

Should Usual Criteria for Intervention in Abdominal Aortic Aneurysms Be “Downsized,” Considering Reported Risk Reduction with Endovascular Repair?

Schermerhorn

2006

Annals of the New York Academy of Sciences

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Two randomized trials have demonstrated the safety of waiting until abdominal aortic aneurysm (AAA) diameter reaches 5.5 cm for repair in most patients. Other recent randomized trials have demonstrated lower perioperative mortality and morbidity with endovascular aneurysm repair (EVAR) compared to open surgery. Therefore, it is logical to assume that endovascular repair may change the appropriate threshold for intervention. However, endovascular repair is not as durable as open surgery and is associated with ongoing risks of rupture and reintervention. Decision analysis based on data available in 1998 showed that endovascular repair should not change the threshold for intervention. Since that time retrospective data have emerged to suggest that outcomes with endovascular repair are improved in smaller AAAs, although this may simply represent selection bias and the natural history of small AAAs. Randomized trials are appropriate to determine whether improved endovascular outcomes in small AAAs reduce late rupture and reintervention enough to justify early intervention in patients with appropriate anatomy. In the absence of data from these trials, the threshold for intervention should not be changed.

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Suitability of Ruptured AAA for Endovascular Repair

Abstract: Ruptured AAAs are less suitable for EVR due to differing neck morphology. An EVR program for ruptured AAA requires an inventory of endografts with appropriate aortic and iliac components.

Cited by 26 publications

References 31 publications

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Hybrid procedure in a patient with symptomatic thoraco-abdominal aneurysm and prior abdominal aortic reconstruction - case report.

Should Usual Criteria for Intervention in Abdominal Aortic Aneurysms Be “Downsized,” Considering Reported Risk Reduction with Endovascular Repair?

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