Endovascular Repair of Acute AAAs under Local Anesthesia with Bifurcated Endografts: A Feasibility Study

Verhoeven, Eric L.G.; Prins, Ted R.; Dungen, J.J.A.M. van den; Tielliu, Ignace F.J.; Hulsebos, R.G.; Schilfgaarde, R. van

doi:10.1177/152660280200900603

Cited by 56 publications

(50 citation statements)

References 23 publications

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“…The above mentioned advantageous consequences of the minimally invasive endovascular approach of acute AAA might reflect on perioperative mortality. Approximately 26 studies comparing EVAR with conventional open surgery in patients with a ruptured AAA can be identified (Ohki & Veith 2000;van Sambeek et al, 2002;Verhoeven et al, 2002;Yilmaz et al, 2002;Reichart et al, 2003;Resch et al, 2003;Lee et al, 2004;Alsac et al, 2005;Brandt et al, 2005;Kapma et al, 2005;Larzon et al, 2005;Vaddineni et al, 2005;Arya et al, 2006;Coppi et al, 2006;Dalainas et al, 2006;Dillavou et al, 2006;Franks et al, 2006;Greco et al, 2006;Hinchliffe et al, 2006;Peppelenbosch et al, 2006;Visser et al, 2006;Acosta et al, 2007;Anain et al, 2007;Moore et al, 2007;Ockert et al, 2007;Egorova et al, 2008). Twenty-four of these studies compared early mortality of EVAR compared to open surgery (Ohki & Veith 2000;van Sambeek et al, 2002;Verhoeven et al, 2002;Yilmaz et al, 2002;Reichart et al, 2003;Resch et al, 2003;Lee et al, 2004;Alsac et al, 2005;Brandt et al, 2005;Kapma et al, 2005;Larzon et al, 2005;Vaddineni et al, 2005;…”

Section: Evar Versus Open Surgerymentioning

confidence: 99%

Treatment of Ruptured Abdominal Aortic Aneurysms

Bosch¹,

Willigendael²,

Cuypers³

et al. 2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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Section: Evar Versus Open Surgerymentioning

confidence: 99%

Treatment of Ruptured Abdominal Aortic Aneurysms

Bosch¹,

Willigendael²,

Cuypers³

et al. 2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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“…In Groningen, we adopted a protocol of selective use of EVAR for RAAA in 2002 after encouraging initial results with EVAR (1998-2001). 16) Since then, we have offered both modalities of treatment to the patients. 17) Although our EVAR results show excellent results, in accordance with the literature, we were not able to scientifically prove superiority of EVAR above open repair in view of the same confounding factors as mentioned above.…”

Section: Evar For Ruptured Aneurysmsmentioning

confidence: 99%

“…19) With regard to graft selection, we have always opted for a bifurcated stent-graft and not an aorto-uni-iliac (AUI) stent-graft. 16,17) In our opinion, the advantages are clear: the bifurcated stent-graft represents the most physiological solution, and is also used in elective EVAR. Disadvantages of the AUI system include the higher risk of infection of the femoro-femoral cross-over bypass, prolonged ischemia of one limb intra-operatively, ischemic problems in the longer term in case of occlusion, and the risk of anastomotic aneurysms at the level of the femoral arteries.…”

Section: Evar For Ruptured Aneurysmsmentioning

confidence: 99%

Open Treatment Versus Endovascular Repair for Aortic Abdominal Aneurysm-Keeping the Balance

Bos¹,

Cohen²,

Vourliotakis³

et al. 2009

Annals of Vascular Diseases

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E ndovascular repair of abdominal aortic aneurysms (EVAR) has enjoyed a quick and widespread growth over the last 15 years. Both clinicians and patients have embraced the minimal invasive alternative to open surgery. Although early benefits of EVAR have been confirmed in two randomized trials, the number of late complications and re-interventions remains an issue for debate.1, 2) However, the trials failed to demonstrate a late overall survival gain. This opened the way for some epidemiologists and other financial decision makers to question the technique or even worse, to qualify the technique as a failed experiment.3) Despite this, this important surgical innovation has continued to evolve with expansion into the treatment of acute aneurysms and the development of fenestrated and branched grafts. This paper discusses the ongoing evolution of EVAR with respect to the available literature and our personal experience. Elective EvarAs mentioned, the short-term benefits have undoubtedly been demonstrated by two randomized trials. In summary, EVAR presents with a threefold lower mortality than open repair (P = 0.009, EVAR trial) and almost a twofold lower aneurysm related mortality at four years (4% versus 7%, P = 0.04 EVAR trial). In addition, the health related quality of life, often regarded as non-different due to similar results after one year, demonstrated a better outcome from 3 to 12 months.2) Costs were higher in the trial setting, but the difference was marginal, and there are no post-trial comparisons available. The flip side was that the two randomized trials demonstrated a higher late complication rate which resulted in a higher reintervention rate of EVAR compared to open repair.Since the trials, the technique has matured and devices have undergone further development. This has widely resulted in better results especially with regard to durability and reintervention rate. Many reports were published on these changes in outcome with maturation of the technique with the lifeline Registry and Eurostar Registry reporting a decrease in secondary interventions over time. 4,5) With increased experience it is also became clear that Type II endoleaks were not presenting with increased risk of rupture as initially thought. Silverberg et al. reported an incidence of Type II endoleaks of 16% (154/ 946), but 35% of these Type II endoleaks resolved spontaneously during a mean follow-up of 14.5 months.6) A Kaplan Meier analysis suggested spontaneous seal of Type II endoleak of 75% within 5 years. Franks et al. reported in a systematic review a decreasing trend over time in operative mortality, endoleak rate and post-operative rupture. 7)Our personal results show a mortality below 1% which includes all patients, both low-and high risk, and difficult anatomy. The overall reintervention rate dropped from 15% to below 10% with 75% of all reinterventions performed by endovascular means. Furthermore reinterventions were not associated with mortality.

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“…Avoidance of laparotomy, aortic clamping and the use of local anaesthesia (in selected cases) confer significant physiological advantages over conventional surgery in this already precarious situation. 10 Since the priority is to save life rather than to achieve maximum long-term aneurysm exclusion, the criteria used in the assessment of rAAA should lead to the inclusion of a number of cases that would be unsuitable for elective EVR. Currently, 'acute' (ruptured and symptomatic) AAA morphology is amenable to EVR in 34-69% of cases, 3,10,12,13 depending on exclusion criteria and use of adjunctive procedures.…”

Section: Ruptured Abdominal Aortic Aneurysm -The Case For Endovasculamentioning

confidence: 99%

“…10 Any intervention for rAAA should be exclusively concerned with preservation of life and comparison to the current pooled operative mortality of 40% 13 supports a central role for EVR in AAA rupture. Potential late device failures are of minimal immediate concern and can usually be managed on an elective basis, by endovascular means or by open surgery.…”

Section: Evidencementioning

confidence: 99%