Immediate and Two-year Outcomes after EVAR in “On-label” and “Off-label” Neck Anatomies Using Different Commercially Available Devices. Analysis of the Experience of Two Italian Vascular Centers

Speziale, Francesco; Sirignano, Pasqualino; Setacci, Francesco; Menna, Danilo; Capoccia, Laura; Mansour, Wassim; Galzerano, G; Setacci, Carlo

doi:10.1016/j.avsg.2014.06.057

Cited by 44 publications

(43 citation statements)

References 30 publications

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“…Patients with more than two Boff-label^aortic neck features-defined as non-cylindrical, angulated, short, or enlarged-underwent more intraoperative adjunctive procedures and had higher rates of intraoperative endoleaks and all-cause mortality. However, at 2-year follow-up, both groups had similar rates of AAA-related death and rupture [7]. A review of over 10,000 patients revealed that only 42 % had anatomy that was compliant with anatomic IFU guidelines.…”

Section: Has the Pendulum Swung Too Far Towards Evar?mentioning

confidence: 85%

Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

2015

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Since its advent in 1991, endovascular aortic aneurysm repair (EVAR) has become a mainstay of treatment for abdominal aortic aneurysms (AAA). Studies such as the comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR 1) trial, have demonstrated the effectiveness of EVAR in reducing perioperative mortality. Technological improvements in graft design and delivery account for an increasing utilization of endovascular repair. Newer branch and fenestrated graft designs have allowed for treatment of patients with complex aortic anatomy that previously could not be treated with EVAR. Endovascular repair, while dominant, is unlikely to eliminate the need for open repair or to relegate open surgery for AAA to historical interest only. The unprecedented adoption of EVAR has led to complications and modes of failure that were not seen with open repair. The rate of failure is markedly increased when endografts are used outside of the instructions for use (IFU). The long-term durability of fenestrated and investigational branch devices remains to be established. The demand for an endovascular approach by patients and the willingness of physicians to place endografts outside the anatomic IFU criteria may have resulted in the pendulum swinging too far away from open surgical management. The consequence of reduced open aortic surgeries is a concern for both patient care as well as training for vascular surgery fellows. Vascular surgery training programs will require innovative changes in training to assure that vascular surgery trainees will have the requisite skill and experience required to competently perform open surgical repair on what will undoubtedly be some of the most complex aortic pathology.

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Section: Has the Pendulum Swung Too Far Towards Evar?mentioning

confidence: 85%

Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

2015

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“…In particular, EVAR is also becoming the method of choice for aneurysmal sac exclusion in vascular patients with difficult vascular anatomies due to its favourable outcomes, customised approach and easy technical execution[23-25]. Despite these advantages some articles debate the risk of long-term lifelong EVAR CT follow-up, with a remarkable amount of radiation exposure carrying the risk of developing cancers; moreover they report the need of dose optimisations using new targeted CT protocols, considering that the absorbed dose by the patient differs on the basis different scanners, patient body size and age[26-28].…”

Section: Discussionmentioning

confidence: 99%

Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

Mazzei

Guerrini

Gentili

et al. 2017

WJR

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AIMTo validate the feasibility of high resolution computed tomography (HRCT) of the lung prior to computed tomography angiography (CTA) in assessing incidental thoracic findings during endovascular aortic aneurysm repair (EVAR) planning or follow-up.METHODSWe conducted a retrospective study among 181 patients (143 men, mean age 71 years, range 50-94) referred to our centre for CTA EVAR planning or follow-up. HRCT and CTA were performed before or after 1 or 12 mo respectively to EVAR in all patients. All HRCT examinations were reviewed by two radiologists with 15 and 8 years’ experience in thoracic imaging. The results were compared with histology, bronchoscopy or follow-up HRCT in 12, 8 and 82 nodules respectively.RESULTSThere were a total of 102 suspected nodules in 92 HRCT examinations, with a mean of 1.79 nodules per patient and an average diameter of 9.2 mm (range 4-56 mm). Eighty-nine out of 181 HRCTs resulted negative for the presence of suspected nodules with a mean smoking history of 10 pack-years (p-y, range 5-18 p-y). Eighty-two out of 102 (76.4%) of the nodules met criteria for computed tomography follow-up, to exclude the malignant evolution. Of the remaining 20 nodules, 10 out of 20 (50%) nodules, suspected for malignancy, underwent biopsy and then surgical intervention that confirmed the neoplastic nature: 4 (20%) adenocarcinomas, 4 (20%) squamous cell carcinomas, 1 (5%) small cell lung cancer and 1 (5%) breast cancer metastasis); 8 out of 20 (40%) underwent bronchoscopy (8 pneumonia) and 2 out of 20 (10%) underwent biopsy with the diagnosis of sarcoidosis.CONCLUSIONHRCT in EVAR planning and follow-up allows to correctly identify patients requiring additional treatments, especially in case of lung cancer.

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“…Our results confirm the possibility of using DTA combined with CEUS as a cost-effective diagnostic protocol alternative to CTA in EVAR followup. This diagnostic protocol has the potential to limit the use of CTA in doubtful cases and cases requiring reintervention or with an unfavorable anatomy, significantly reducing costs and risk of CIN as well as overall radiation dose received by patients [25][26][27][28][29][30][31] .…”

Section: Discussionmentioning

confidence: 99%

Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

Mazzei¹,

Guerrini²,

Mazzei³

et al. 2016

WJR

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REVIEW 434Radiological features of uncommon aneurysms of the cardiovascular system COPYRIGHT © 2016 Baishideng Publishing Group Inc. Articles published by this Open-Access journal are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. SPECIAL STATEMENTAll articles published in journals owned by the Baishideng Publishing Group (BPG) represent the views and opinions of their authors, and not the views, opinions or policies of the BPG, except where otherwise explicitly indicated. WJR covers topics concerning diagnostic radiology, radiation oncology, radiologic physics, neuroradiology, nuclear radiology, pediatric radiology, vascular/interventional radiology, medical imaging achieved by various modalities and related methods analysis. The current columns of WJR include editorial, frontier, diagnostic advances, therapeutics advances, field of vision, mini-reviews, review, topic highlight, medical ethics, original articles, case report, clinical case conference (clinicopathological conference), and autobiography. INSTRUCTIONS TO AUTHORSWe encourage authors to submit their manuscripts to WJR. We will give priority to manuscripts that are supported by major national and international foundations and those that are of great basic and clinical significance.World Journal of Radiology is now indexed in PubMed, PubMed Central. I-IIIEditorial Board Author contributions: Mazzei MA, Guerrini S, Mazzei FG, Cioffi Squitieri N, Notaro D, de Donato G, Galzerano G, Sacco P and Setacci F made substantial contributions to conception and design of the study, and acquisition, analysis and interpretation of the data; Mazzei MA, Guerrini S and Setacci C contributed to drafting the article and revising it critically for important intellectual content; Mazzei MA, Volterrani L and Setacci C approved the final version to be published. AIM AND SCOPEInstitutional review board statement: The study was reviewed and approved by the University of Siena Institutional Review Board.Clinical trial registration statement: None.Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.Conflict-of-interest statement: None. RESULTS:Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33 (96.96%) patients and for the absence of complications in 127/130 (97.69%) patients; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33 (57.57%) patients and for the absence of complications in 129/130 (99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivit...

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Immediate and Two-year Outcomes after EVAR in “On-label” and “Off-label” Neck Anatomies Using Different Commercially Available Devices. Analysis of the Experience of Two Italian Vascular Centers

Cited by 44 publications

References 30 publications

Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

Management of Aortic Aneurysms: Is Surgery of Historic Interest Only?

Incidental extravascular findings in computed tomographic angiography for planning or monitoring endovascular aortic aneurysm repair: Smoker patients, increased lung cancer prevalence?

Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

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