Early Elective Conversion for Failing Evar

Aho, Pekka; Roth, Wolf-Dieter; Keto, Pekka; Lepäntalo, Mauri

doi:10.1177/145749690509400309

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…In our material, only 54% of the patients had needed no secondary procedurewithin two years and by the end of the followup at least one additional procedurewas required in 81% of patients. Our mid-term results show ahigher rate of secondary interventions than reported in previous Finnish studies (25,26). At the end of the follow-up therewas only one patient alive without any complications related to endoprosthesis.…”

Section: Discussioncontrasting

confidence: 47%

Ten-Year Outcomes after Endovascular Aneurysm Repair (Evar) and Magnitude of Additional Procedures

et al. 2007

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The impact of long-term follow-up of patients treated with the new technology was emphasized in this patient population. A careful surveillance protocol and active endovascular treatment of complications can yield acceptable results and low AAA rupture and aneurysm mortality rates, also with the first-generation endovascular graft. A new technology, however, may involve unpredictable problems which can magnify the workload and incur high costs over several years after the initial procedure.

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Section: Discussioncontrasting

confidence: 47%

Ten-Year Outcomes after Endovascular Aneurysm Repair (Evar) and Magnitude of Additional Procedures

et al. 2007

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“…In three cases with solid stent graft proximal fixation with hooks, we used the previously described inclusion technique with incorporation of the suprarenal stent graft part in the anastomotic suture line, avoiding the hazardous suprarenal clamping. [27][28][29][30] Following this technique, renal failure occurred in six of our patients. The suprarenal aortic dissection and clamping offers better surgical field and safer removal of the stent graft but is related to high mortality rates, and we avoid using it.…”

Section: Secondary Procedures For Failing Evarmentioning

confidence: 95%

Secondary Endovascular and Conversion Procedures for Failed Endovascular Abdominal Aortic Aneurysm Repair: Can We Still Be Optimistic?

et al. 2009

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The purpose of this study was to evaluate the incidence, etiology, and outcome of secondary endovascular and "open" conversion procedures after failed endovascular abdominal aortic aneurysm repair (EVAR). From January 1997 until December 2005, 625 patients with an infrarenal abdominal aortic aneurysm were treated by elective EVAR, with 98.7% (n = 617) primary EVAR success. The mean follow-up of the 617 patients was 46.7 +/- 11.2 months. One hundred of these patients (16.2%) required secondary endovascular or peripheral procedures, and 39 (6.3%) patients underwent a secondary abdominal conversion. There were 5 acute conversions (0.8%) and 34 elective conversions (5.5%). The pre-EVAR anatomic suitability data, the main cause of the secondary procedure, and stent graft type were compared between patients with primary EVAR success, patients in need of a secondary endovascular or peripheral procedure, and patients with abdominal conversion. The overall main causes for reinterventions were proximal migration (n = 60; 9.7%), progressive kinking of the stent graft (n = 59; 9.6%), and late type III endoleak (n = 12; 1.9%). Multivariate logistic regression analysis showed that factors significantly correlated with secondary procedures were the abdominal aortic aneurysm's maximum diameter, the proximal neck's width and length, and particularly the commercial withdrawal of the stent graft (p < .001). The morbidity and mortality rates of secondary endovascular or peripheral interventions were 0%. The mortality rate of acute secondary conversions was 20% (n = 1) and of elective secondary conversions was 8.8% (n = 3). The morbidity rates for acute and elective conversions were 0% and 65%, respectively. The aneurysm-related mortality rate in our series was below 1%. Abdominal conversion surgery still carries a high mortality rate, but the overall EVAR-related mortality rate remains low. Early pitfall detection and proper reintervention are crucial to long-term EVAR success.

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“…Another risk factor associated with IEs is immunodeficiency (primary or secondary), especially that due to corticosteroid therapy or chemotherapy in neoplastic patients [22].…”

Section: Etiologiesmentioning

confidence: 99%

How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

Setacci

Chisci

Setacci

et al. 2014

aorta

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The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.

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Early Elective Conversion for Failing Evar

Cited by 11 publications

References 29 publications

Ten-Year Outcomes after Endovascular Aneurysm Repair (Evar) and Magnitude of Additional Procedures

Ten-Year Outcomes after Endovascular Aneurysm Repair (Evar) and Magnitude of Additional Procedures

Secondary Endovascular and Conversion Procedures for Failed Endovascular Abdominal Aortic Aneurysm Repair: Can We Still Be Optimistic?

How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

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