Intraoperative Proximal Endoleaks during AAA Stent-Graft Repair: Evaluation of Risk Factors and Treatment with Palmaz Stents

Dias, Nuno; Resch, Timothy; Malina, Martin; Lindblad, Bengt; Ivancev, Krassi

doi:10.1177/152660280100800306

Cited by 50 publications

(60 citation statements)

References 40 publications

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“…4,5 The angulation of the proximal aneurysm neck is considered one of the most important morphologic characteristics with major negative effects on the results of EVAR, including type I endoleaks, stent graft migration, secondary interventions, and conversion. 2,3,[6][7][8][9] For this reason, the instructions for use for all commercially available endografts have clear guidelines on maximal angulation of the aortic neck. The reporting standards for EVAR also contain recommendations regarding the investigation of the aneurysm neck morphology.…”

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confidence: 99%

Validation of a new standardized method to measure proximal aneurysm neck angulation

Keulen

Moll

Tolenaar

et al. 2010

Journal of Vascular Surgery

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confidence: 99%

Validation of a new standardized method to measure proximal aneurysm neck angulation

Keulen

Moll

Tolenaar

et al. 2010

Journal of Vascular Surgery

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“…There is little debate that type-I endoleaks originating from attachment sites in the aneurysm neck or iliac arteries indicate incomplete repair with continued risk of aneurysm rupture. [5][6][7][8][9][10][11][12][13][14] These endoleaks should be repaired either with endovascular or standard open repair with little delay. However, there is no consensus as to the relevance of type-II endoleaks, 5,6,14 which are related to retrograde flow into the aneurysm sac through the lumbar arteries or inferior mesenteric artery (IMA).…”

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Type-II Endoleaks following Endovascular AAA Repair: Preoperative Predictors and Long-term Effects

et al. 2001

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ࡗ ࡗPurpose: To determine the significance of persistent type-II endoleaks and whether they can be predicted preoperatively in patients with abdominal aortic aneurysms (AAA). Methods:The charts of all AAA patients treated with the AneuRx stent-graft at a single center from 1996 to 1998 were reviewed. Patients with Ͻ12-month follow-up or type-I endoleaks were excluded. The presence or absence of type-II endoleaks was determined from duplex imaging and computed tomographic angiography. Three groups were identified and compared: 16 patients with persistent type-II endoleaks (PE), 14 patients with transient type-II endoleaks (TE), and 16 patients with no endoleak (NE). Results:The groups did not differ with regard to age, preoperative comorbidities, followup time, and AAA neck diameter and length. AAA diameters were 57.1 Ϯ 9.0 mm for NE, 63.4 Ϯ 11.4 mm for TE, and 55.6 Ϯ 4.2 mm for PE. The inferior mesenteric artery (IMA) was patent in 5 (31%) NE patients, 6 (43%) TE patients, and 13 (81%) PE patients (p Ͻ 0.01). The number of patent lumbar arteries visualized preoperatively was 0.5 Ϯ 1.0 in NE, 1.3 Ϯ 0.8 in TE, and 2.4 Ϯ 0.6 in PE (p Ͻ 0.0001). Patent IMAs (RR 0.82, pϽ0.01) and Ͼ2 lumbar arteries (RR 0.40, p Ͻ 0.0001) were identified as independent preoperative risk factors for persistent endoleaks. There were no changes in mean diameter or volume in aneurysms with persistent endoleaks. Conclusions:No adverse clinical events were related to the presence of type-II endoleaks, but there was no decrease in aneurysm size in patients with persistent type-II leaks. Patients with a large, patent IMA, or Ͼ2 lumbar arteries on preoperative CT angiography are at higher risk for persistent type-II endoleaks.

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“…Large balloon-expandable stents have been used in selected cases to increase the force needed to separate the components and improve the seal between them. 18,19 Ancillary devices that deploy staples to secure endovascular grafts to the aortic wall may be useful to secure endovascular graft components together.…”

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A comparative analysis of the outcomes of aortic cuffs and converters for endovascular graft migration

Thomas

Sánchez

Geraghty

et al. 2010

Journal of Vascular Surgery

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Proximal attachment failure and graft migration are potentially lethal complications of EVAR. Proximal graft extension using an aortic cuff is the easiest technique for salvaging an endovascular graft. Unfortunately, it has a predictable failure mode (development of a type III endoleak due to component separation) and is associated with a significantly higher failure rate than with the use of a converter. EVAR salvage with a converter and a femorofemoral bypass is a more complex but superior option for endovascular graft salvage.

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Intraoperative Proximal Endoleaks during AAA Stent-Graft Repair: Evaluation of Risk Factors and Treatment with Palmaz Stents

Abstract: Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.

Cited by 50 publications

References 40 publications

Validation of a new standardized method to measure proximal aneurysm neck angulation

Validation of a new standardized method to measure proximal aneurysm neck angulation

Type-II Endoleaks following Endovascular AAA Repair: Preoperative Predictors and Long-term Effects

A comparative analysis of the outcomes of aortic cuffs and converters for endovascular graft migration

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