Endovascular abdominal aortic aneurysm repair

Norwood, M. G. A.; Lloyd, Geraint; Bown, Matthew J.; Fishwick, Guy; London, N.J.M.; Sayers, Robert D.

doi:10.1136/pgmj.2006.051177

Cited by 19 publications

(20 citation statements)

References 103 publications

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“…short proximal neck and tortuous, heavily calcified, or stenotic iliac arteries) [13]. Of those that receive EVAR, there is a 14% secondary intervention rate within 4 years [14], mostly due to device migration and persistent or de novo endoleak. Drug treatments that halt AAA growth are currently under investigation [15–18].…”

Section: Introductionmentioning

confidence: 99%

Polymeric endoaortic paving: Mechanical, thermoforming, and degradation properties of polycaprolactone/polyurethane blends for cardiovascular applications

et al. 2011

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Polymeric endoaortic paving (PEAP) is a process by which a polymer is endovascularly delivered and thermoformed to coat or “pave” the lumen of the aorta. This method may offer an improvement to conventional endoaortic therapy in allowing conformal graft application with reduced risk of endoleak and customization to complex patient geometries. Polycaprolactone (PCL)/polyurethane (PU) blends of various blend ratios were assessed as a potential material for PEAP by characterizing their mechanical, thermoforming, and degradation properties. Biaxial tension testing revealed that the blends' stiffness is similar to that of aortic tissue, is higher for blends with more PCL content, and may be affected by thermoforming and degradation. Tubes of blends were able to maintain a higher diameter increase after thermoforming at higher PCL content and higher heating temperatures; 50/50 blend tubes heated to 55°C were able to maintain 90% of the diameter increase applied. Delamination forces of the blends ranged from 41 to 235 N/m2. In a Pseudomonas lipase solution, the 50/50 blend had a 94% lower degradation rate than pure PCL, and the 10/90 blend exhibited no degradation. These results indicate that PEAP, consisting of a PCL/PU blend, may be useful in developing the next generation of endoaortic therapy.

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Section: Introductionmentioning

confidence: 99%

Polymeric endoaortic paving: Mechanical, thermoforming, and degradation properties of polycaprolactone/polyurethane blends for cardiovascular applications

et al. 2011

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“…1,10,12,63 In atherosclerotic aortic aneurysm, EVAR is associated with lower operative mortality than open surgery. 1,10,12,63 In a controlled trial, 5-year survival was similar for EVAR compared to open surgery, but with less morbidity despite the need for late reinterventions. 11 Early mortality rate with open surgery in inflammatory aneurysm is slightly higher than in atherosclerotic aneurysm and ranges from 6.8% to 11%.…”

Section: Discussionmentioning

confidence: 99%

Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature

et al. 2008

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Data on the outcome of aneurysmal chronic peri-aortitis ('inflammatory aneurysm') after open surgical aneurysm repair are few and contradictory. To what extent this inflammatory process is reversed after endovascular aneurysm repair (EVAR) is even more unclear. The objective of this review was to study the outcome of peri-aortic fibrosis (PAF) and ureteral obstruction in patients with aneurysmal chronic peri-aortitis treated with open surgery or EVAR. Medical literature was searched for pertinent articles on the outcome of PAF and ureteral obstruction after open surgery or EVAR from 1970 through October 2007. Studies were included if specific follow-up data were available on outcomes of interest. A total of 19 studies were included comprising 478 patients (open surgical, n = 426; EVAR, n = 52). Age, sex and percentage of patients with ureteral obstruction (31% vs 37%) did not differ between groups. Regression of PAF occurred more frequently after open surgery compared to EVAR (86% vs 60%; p < 0.0001). Complete regression of PAF was more frequent after open surgery compared to EVAR (52% vs 14%; p < 0.0001). After excluding patients in whom concurrent ureterolysis was performed, the frequency of persistent ureteral obstruction remained lower in patients treated surgically compared to patients treated with EVAR, albeit not statistically significant (32% vs 56%; p = 0.09). In conclusion, although open surgery is superior to EVAR in achieving regression of chronic periaortitis, the frequency of persistent PAF and/or ureteral obstruction is not negligible. Additional medical and/or urological treatment should be considered in selected cases of aneurysmal chronic peri-aortitis.

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“…32 Although it is fairly successful and is continually improving with new devices and updated techniques, there are several challenges remaining in EVAR of AAA. 8 About a third of patients are declined EVAR due to anatomic limitations, 9 and of those that receive EVAR, there is a 14% secondary intervention rate within 4 years, 28 mostly due to device migration and endoleak.…”

Section: Introductionmentioning

confidence: 99%

Wall Stress Reduction in Abdominal Aortic Aneurysms as a Result of Polymeric Endoaortic Paving

et al. 2011

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Polymeric endoaortic paving (PEAP) may improve endovascular repair of abdominal aortic aneurysms (AAA) since it has the potential to treat patients with complex AAA geometries while reducing the incidence of migration and endoleak. Polycaprolactone (PCL)/polyurethane (PU) blends are proposed as PEAP materials due to their range of mechanical properties, thermoformability, and resistance to biodegradation. In this study, the reduction in AAA wall stress that can be achieved using PEAP was estimated and compared to that resulting from stent-grafts. This was accomplished by mechanically modeling the anisotropic response of PCL/PU blends and implementing these results into finite element model (FEM) simulations. We found that at the maximum diameter of the AAA, the 50/50 and 10/90 PCL/PU blends reduced wall stress by 99 and 98%, respectively, while a stent-graft reduced wall stress by 99%. Our results also show that wall stress reduction increases with increasing PEAP thickness and PCL content in the blend ratio. These results indicate that PEAP can reduce AAA wall stress as effectively as a stent-graft. As such, we propose that PEAP may provide an improved treatment alternative for AAA, since many of the limitations of stent-grafts have the potential to be solved using this approach.

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Endovascular abdominal aortic aneurysm repair

Cited by 19 publications

References 103 publications

Polymeric endoaortic paving: Mechanical, thermoforming, and degradation properties of polycaprolactone/polyurethane blends for cardiovascular applications

Polymeric endoaortic paving: Mechanical, thermoforming, and degradation properties of polycaprolactone/polyurethane blends for cardiovascular applications

Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature

Wall Stress Reduction in Abdominal Aortic Aneurysms as a Result of Polymeric Endoaortic Paving

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