Endovascular Treatment of Failed Prior Abdominal Aortic Aneurysm Repair

Faries, Peter L.; Won, Jamie; Morrissey, Nicholas J.; Briggs, Vania L.; Cadot, Hadley; Carroccio, Antonio; Teodorescu, Victoria; Chae, Kristina; Hollier, Larry H.; Marin, Michael L.

doi:10.1007/s10016-001-0335-x

Cited by 37 publications

(22 citation statements)

References 26 publications

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“…Atualmente, um procedimento menos invasivo, através da colocação de endopróteses, encontra-se cada vez mais presente na literatura, apresentando bons resultados para um determinado grupo de pacientes [14][15][16][17][18][19] .…”

Section: Introductionunclassified

Fatores de morbimortalidade na cirurgia eletiva do aneurisma da aorta abdominal infra-renal: experiência de 134 casos

Carvalho¹,

Santos

Filho³

et al. 2008

J. vasc. bras.

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CONTEXTO: O tratamento cirúrgico convencional do aneurisma da aorta abdominal (AAA) infra-renal pode resultar em complicações graves. A fim de otimizar os resultados na evolução do tratamento, é importante que sejam identificados os pacientes predispostos a determinadas complicações e instituídas condutas preventivas. OBJETIVOS: Avaliar a taxa de mortalidade operatória precoce, analisar as complicações pós-operatórias e identificar os fatores de risco relacionados com a morbimortalidade. MÉTODO: Foram analisados 134 pacientes com AAA infra-renal submetidos a correção cirúrgica eletiva no período de fevereiro de 2001 a dezembro de 2005. RESULTADOS: A taxa de mortalidade foi de 5,2%, sendo secundária principalmente a infarto agudo de miocárdio (IAM) e isquemia mesentérica. As complicações cardíacas foram as mais freqüentes, seguidas das pulmonares e renais. A presença de diabetes melito (DM), insuficiência cardíaca congestiva (ICC), insuficiência coronariana (ICO) e cintilografia miocárdica positiva para isquemia estiveram associadas às complicações cardíacas. A idade avançada, a doença pulmonar obstrutiva crônica (DPOC) e a capacidade vital forçada reduzida aumentaram os riscos de atelectasia e pneumonia. História de nefropatia, tempo de pinçamento aórtico prolongado e níveis de uréia elevados aumentaram os riscos de insuficiência respiratória aguda (IRA). A isquemia dos membros inferiores esteve associada ao tabagismo e à idade avançada, e a maior taxa de mortalidade, à presença de coronariopatia, tempos prolongados de pinçamento aórtico e de cirurgia. CONCLUSÃO: A taxa de morbimortalidade esteve compatível com a literatura nacional e internacional, sendo secundária às complicações cardíacas, respiratórias e renais. Os fatores de risco identificados no pré e transoperatório estiveram relacionados com essas complicações.

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Section: Introductionunclassified

Fatores de morbimortalidade na cirurgia eletiva do aneurisma da aorta abdominal infra-renal: experiência de 134 casos

Carvalho¹,

Santos

Filho³

et al. 2008

J. vasc. bras.

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“…Endovascular treatment of uninfected PAAA is based on the larger experience reported with infrarenal aortic aneurysms and has advantages that contribute significantly to reducing peri-operative morbidity and mortality 12,42-45. Our database includes information on only 3 patients who underwent endovascular treatment, but it is clear that this less invasive approach reduces complications and shortens time spent in the hospital by eliminating the above described technical/surgical risks.…”

Section: Discussionmentioning

confidence: 99%

“…There were no peri-operative deaths in our subgroup of patients who were managed with an endovascular procedure and the complications described were minor events with a weak relationship with the procedure. The endovascular option for uninfected PAAA, however, has some limitations: the absence of an infrarenal neck long enough for an endoanastomosis (if considering a pararenal PAAA);12,42,43 the high risk of a type II endoleak from the patent caudal aorta or iliac arteries after proximal end-to-side reconstruction;42 the management of residual hypogastric vasculature;12 tortuosity and poor flexibility of iliac arteries/grafts due to periprosthetic fibrosis; persistent pressure of the PAAA on adjacent organs after effective exclusion of the aneurysm;12 graft infection;12,42,43 the absence of long-term results completely validating AAA endovascular treatment;42-45 and the failure of endograft/Dacron fixation 46. In particular, failed fixation of tube stent-grafts inside old Dacron, causing endotension and sac rupture has been documented, therefore, bifurcated endografts appear to be a more durable solution for exclusion of a PAAA 46.…”

Section: Discussionmentioning

confidence: 99%

Uninfected Para-Anastomotic Aneurysms after Infrarenal Aortic Grafting

et al. 2009

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Purpose This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. Materials and Methods From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. Results The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively ( p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases ( p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. Conclusion Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery.

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“…Failure of standard repair of abdominal aortic aneurysm (AAA) occurs most commonly as a result of paraanastomotic aneurysm formation. 1 The occurrence rate is 1 -3% during the initial months and years following the operation, increasing to 13.3% in series with longer follow-up. 2 Causative factors include: anastomosis far below the renal arteries with an aneurysm formation in the infrarenal aortic wall; extensive thromboendarterectomy in the area of the anastomosis; infection leading to rupture of the anastomotic suture line.…”

Section: Introductionmentioning

confidence: 94%