Evolving Concepts, Management, and Treatment of Type 1 Endoleaks after Endovascular Aneurysm Repair

Gaffey, Ann C.; Damrauer, Scott M.

doi:10.1055/s-0040-1715883

Cited by 8 publications

(2 citation statements)

References 64 publications

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Section: Discussionmentioning

confidence: 99%

“…44 Endovascular management of endoleaks such as aortic balloon angioplasty, cuff or stent extension, endoanchors or lumbar/inferior mesenteric artery embolisation are reported to have high success rates (90–100%) and low complication rates; however, they may be unsuitable in cases of stent migration, patients with insufficient landing zones for stent graft extensions or cases in which access would not facilitate delivery of devices. 44–47 Thus, open-graft explantation should be considered in such cases. Conversely, in cases of graft infection, guidelines suggest elective open explantation of infected materials to reduce the risk of rupture (in setting of aortic wall necrosis) and sepsis, with endovascular managements such as stent relining considered in cases of acute bleeding as a bridge to definitive explantation.…”

Section: Discussionmentioning

confidence: 99%

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The failing endograft-A systematic review of aortic graft explants and associated outcomes

et al. 2022

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Objective The prominent use of endovascular stent grafts in the management of abdominal aortic aneurysms is associated with increased descriptions of late complications such as graft infection and endoleaks, which can confer significant morbidity and mortality. Failed endovascular management of late complications often requires open conversion and graft explantation. This systematic review sought to highlight the peri- and post-operative course of patients undergoing aortic graft explants to inform readers of the associated morbidity and mortality of patients undergoing this procedure. Methods The review was conducted in accordance with PRISMA guidelines. A search of the PubMed, Google Scholar and Ovid MEDLINE databases from January 1995 to April 2021 was performed with a combination of MeSH terms pertaining to endovascular aneurysm repair and open conversion. Articles were screened and included based on pre-determined selection criteria. Results A total of 818 studies were identified, with 41 meeting inclusion criteria. These studies examined a total of 1324 patients, 84.3% of whom were male with a mean age of 74 years at explantation. Mean time to graft explantation was 36 months, with a mean aneurysm size of 66 mm. The majority of aortic explants were performed for persistent endoleaks (68%), and 10% for infection. There was high morbidity with the procedure, with high rates of post-operative complications (mean, 37%) and 30-day mortality (11%). The most common complications included renal (15%), respiratory (12%) and cardiac (9%). Most explanted grafts were first-generation endografts. Morbidity and mortality rates were reduced in patients undergoing elective explants compared to emergent procedures (3.3% compared to 43.4%). Conclusion Aortic graft explant remains a highly co-morbid procedure, with high rates of peri- and post-operative complications and mortality. The number of explant procedures reported over the past 25 years has increased, reflecting the prominent use of EVAR in the management of AAAs. Whilst remaining a highly co-morbid procedure, patients undergoing elective explants had markedly reduced rates of mortality and morbidity compared to emergent explants. Thus, clinical focus should be on identifying patients who require graft explantation early to perform these procedures in an elective setting.

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