Clinical outcome and morphologic analysis after endovascular aneurysm repair using the Excluder endograft

Gonçalves, Frederico Bastos; Jairam, An P.; Voûte, Michiel T.; Moelker, Adriaan; Rouwet, Ellen V.; Raa, Sander Ten; Hendriks, Johanna M.; Verhagen, Hence J.M.

doi:10.1016/j.jvs.2012.03.263

Cited by 39 publications

(28 citation statements)

References 37 publications

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“…On one hand, device-specific studies of other currently commercially available stent grafts are scarce but show comparable primary clinical success rate after 3 years. 19,20 On the other hand, Pratesi et al 21 and Baptiste et al 22 reported a freedom of reintervention rate of 94.6% and 92% after 3 years. However, only approximately one-third of patients were available for analysis at this point.…”

Section: Discussionmentioning

confidence: 99%

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Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft

Zandvoort

Gonçalves

Verhagen

et al. 2014

Journal of Vascular Surgery

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The 4-year follow-up data of the Endurant stent graft for AAA treatment shows its use results in a low AAA-related mortality with adequate prevention of rupture or aneurysm growth. Although patients with very challenging anatomy were treated in our series, primary clinical success rates were comparable for patients treated within and outside the IFU. However, both patients outside the iliac IFU needed a secondary iliac intervention. The knowledge of the present results may aid in improving outcomes in the future.

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Section: Discussionmentioning

confidence: 99%

“…This occlusion rate of 4% is comparable with other studies with this particular stent graft 3,4,23 but is still substantial and seems higher compared with other simultaneously available grafts. [20][21][22] However, comparing the results is difficult because of the heterogeneity in patient population and follow-up duration.…”

Section: Discussionmentioning

confidence: 99%

Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft

Zandvoort

Gonçalves

Verhagen

et al. 2014

Journal of Vascular Surgery

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“…The associations between proximal neck complications and mural neck thrombus and neck calcification are less clear in the literature, which may be caused by the diversity in onset of the complications throughout these studies. 1,2,7,9,14 When comparing our previous study 10 with this one, the results suggest that neck calcification is associated with early complications, while mural neck thrombus is rather associated with late (>1 year) sequelae. Acute complications may be associated with factors that increase the procedure difficulty (tortuous aorta) or immediately impede sufficient fixation and sealing (neck calcification); later failure may be associated with factors that do not provide a stable environment and are prone to change over time (high curvature, mural neck thrombus, and large aneurysm diameter).…”

Section: Discussionmentioning

confidence: 56%

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

et al. 2017

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Purpose: To evaluate the association between aortic curvature and other preoperative anatomical characteristics and late (>1 year) type Ia endoleak and endograft migration in endovascular aneurysm repair (EVAR) patients. Methods: Eight high-volume EVAR centers contributed 116 EVAR patients (mean age 81±7 years; 103 men) to the study: 36 patients (mean age 82±7 years; 31 men) with endograft migration and/or type Ia endoleak diagnosed >1 year after the initial EVAR and 80 controls without early or late complications. Aortic curvature was calculated from the preoperative computed tomography scan as the maximum and average curvature over 5 predefined aortic segments: the entire infrarenal aortic neck, aneurysm sac, and the suprarenal, juxtarenal, and infrarenal aorta. Other morphological characteristics included neck length, neck diameter, mural neck calcification and thrombus, suprarenal and infrarenal angulation, and largest aneurysm sac diameter. Independent risk factors were identified using backward stepwise logistic regression. Relevant cutoff values for each of the variables in the final regression model were determined with the receiver operator characteristic curve. Results: Logistic regression identified maximum curvature over the length of the aneurysm sac (>47 m −1 ; p=0.023), largest aneurysm sac diameter (>56 mm; p=0.028), and mural neck thrombus (>11° circumference; p<0.001) as independent predictors of late migration and type Ia endoleak. Conclusion: Aortic curvature is a predictor for late type Ia endoleak and endograft migration after EVAR. These findings suggest that aortic curvature is a better parameter than angulation to predict post-EVAR failure and should be included as a hostile neck parameter.

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“…3,7) Notably, Gore Excluder endoprosthesis (W.L. Gore & Associates, Flagstaff, Arizona), one of the currently available third-generation endografts, has been reported to more suitable for complex iliac anatomy, with a limb occlusion incidence of 0%-1.4%, 4,9) which is lower than that of Zenith stent graft (4.8%-5.5%) 4,6,8) or Endurant endograft (Medtronic Inc, Minneapolis, Minnesota) (3.4%). 7) Treatment modalities for endograft limb occlusion are determined by the area and length of thrombosis, pattern of disease progression, clinical presentation, and severity of leg ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Endograft occlusion, a serious late complication following EVAR, has been reported to have an incidence ranging from 1.1% to 7.1%. [1][2][3][4][5][6][7][8][9] Typically, endograft limb occlusion occurs unilaterally. If endograft occlusion occurs acutely in the bilateral limb or the main body of the endograft, its pathological condition may be similar to that of acute occlusion of the abdominal aorta, a emergency treatment.…”

Section: Introductionmentioning

confidence: 99%

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.Keywords: abdominal aortic endograft, total occlusion, axillobifemoral bypass life-threatening disease associated with high morbidity and mortality. Here we report a case of abdominal aortic endograft total occlusion that was successfully managed with axillobifemoral bypass; in addition, we discuss the treatment strategies for this critical situation. Case ReportA 72-year-old man was admitted to an emergency department of a district hospital, complaining of sudden bilateral lower extremity numbness and severe rest pain. At the age of 62, he had undergone mechanical valve replacement for aortic valve stenosis and permanent pacemaker insertion for sick sinus syndrome at the same hospital. Sixteen months ago, he had undergone abdominal aortic endograft implantation for infrarenal abdominal aortic aneurysm at a different hospital. Preoperative computed tomography (CT) showed the maximum aneurysm diameter of 62 mm, the neck angulation 10) of 77°, and the terminal aorta diameter of 21 mm (Fig. 1). A Zenith endovascular graft (Cook Inc., Bloomington, Indiana) was implanted through the right femoral approach. The procedure was performed successfully and the postoperative course was uneventful. A postoperative CT showed the neck angulation of 56° and the terminal aorta diameter of 21 mm (Fig. 1). The patient was discharged from the hospital with no endoleak. Subsequently, he had been regularly followed-up for anticoagulation therapy at a local hospital. He had not experienced intermittent claudication previously.On further examination at the district hospital, a CT showed an abdominal endograft implanted from below the orifice of the renal arteries to the bilateral common iliac arteries with complete occlusion at the mid-portion of the main body (Fig. 2). The neck angulation was 54°, and the terminal aorta diameter of 21 mm (Fig. 2). Preoperative echocardiography showed that there was no obvious thrombus in the left atrium and the left ventricle, and around the mechanical aortic valve. A diagnosis of acute endograft occlusion was made. The patient was transferred to our hospital 4 h after the onset of symptoms for

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Clinical outcome and morphologic analysis after endovascular aneurysm repair using the Excluder endograft

Cited by 39 publications

References 37 publications

Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft

Results of endovascular repair of infrarenal aortic aneurysms using the Endurant stent graft

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

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