Lack of Iliac Engagement Correlates With Iliac Limb Complications Following Standard EVAR

Coulston, James; Baigent, Amy; Selvachandran, Haran; Jones, Steven M.; Torella, Francesco; Fisher, Robert K.

doi:10.1177/1538574415614403

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…Longer distal seal zones (>15 mm), coverage of at least 70% of the iliac seal zone, and deployment of the endograft limb within 10 mm of the internal iliac artery protect against proximal migration of the endograft limb and type Ib endoleak. 4,6,8,12,21 In this study, however, no significant changes were observed between the endoleak and control groups for seal zone length, CIA coverage, or deployment accuracy on the first postoperative CT scan. This suggests that the 1-month CT scan is good for identifying acute failures (which were not included in this study) and for defining a postoperative baseline for endograft dimensions.…”

Section: Discussioncontrasting

confidence: 63%

“…Seal may be compromised by dilatation of the CIA or by limb retraction. 4,[6][7][8]12,[15][16][17][18] Expansion of the endograft limb within the CIA, displacement of the endograft limb, as well as the resulting loss of apposition, can be precisely quantified and visualized with the VIA prototype software.…”

Section: Discussionmentioning

confidence: 99%

“…However, less attention has been paid to distal endograft fixation, even though a type Ib endoleak may also repressurize the aneurysm and increase the risk of rupture. [4][5][6][7][8] Accurately quantifying and visualizing the endograft position and apposition during follow-up is essential to prevent late seal failures. Identifying small changes in the position of the endograft, such as tilting, migration, and dilatation of the common iliac artery (CIA) and thereby full expansion of the endograft limb, is challenging with standard CT imaging.…”

Section: Introductionmentioning

confidence: 99%

“…However, less attention has been paid to distal endograft fixation, even though a type Ib endoleak may also repressurize the aneurysm and increase the risk of rupture. 4–8…”

Section: Introductionmentioning

confidence: 99%

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Changes in Apposition of Endograft Limbs in the Iliac Arteries After Endovascular Aneurysm Repair: Determination With New Computed Tomography–Applied Software

et al. 2019

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Purpose: To validate new computed tomography (CT)–applied software used to determine endograft limb position and apposition after endovascular aneurysm repair (EVAR). Materials and Methods: Twelve EVAR patients (mean age 81±6 years; 10 men) with distal stent-graft extensions for 15 (3 bilateral) type Ib endoleaks during follow-up were selected based on the availability of the following CT studies: pre-EVAR, 1 month, and the penultimate scan prior to the scan disclosing the type Ib endoleak. Twelve patients (mean age 82±7 years; 11 men) without endoleak and a similar interval between the primary EVAR procedure and the penultimate CT scan of the endoleak group were selected as controls using measurements from both endograft limbs (n=21, 3 excluded). Prototype Vascular Imaging Analysis software was adapted to calculate 6 parameters for the distal apposition zone: fabric distance, shortest apposition length, endograft diameter, iliac seal surface (ISS), iliac endograft apposition surface (IEAS), and percentage of iliac surface coverage (IEAS/ISS × 100). Measurements were performed on the preoperative, first postoperative, and penultimate/matched follow-up CT scans. Interobserver variability was assessed with the intraclass correlation coefficient (ICC). Continuous data are presented as the median [interquartile range (IQR) Q1, Q3]. Results: CTA follow-up was not significantly different between the endoleak and control groups [30 months (IQR 18, 58) vs 36 months (IQR 21, 59), p=0.843]. Interobserver agreement was good to excellent for all parameters (ICC 0.879–0.985). Preoperative anatomy and endograft dimensions on the first follow-up CTA scan did not differ significantly between the groups. When the penultimate CTA scan was compared with the first postoperative CT scan, endograft dimensions had significantly changed in the endoleak group; importantly, apposition was significantly decreased, and fabric distance was significantly increased, indicating limb retraction. Differences in changes in endograft dimensions were significant between the groups. Conclusion: New CT-applied software was introduced to visualize apposition and position changes of endograft limbs during follow-up. The software demonstrated good-to-excellent interobserver agreement and enabled accurate analysis of post-EVAR endograft dimensions. Significant changes in apposition and position were observed with the software on the penultimate CT scan prior to diagnosis of type Ib endoleak.

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Section: Discussioncontrasting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…However, less attention has been paid to distal endograft fixation, even though a type Ib endoleak may also repressurize the aneurysm and increase the risk of rupture. 4–8…”

Section: Introductionmentioning

confidence: 99%

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Changes in Apposition of Endograft Limbs in the Iliac Arteries After Endovascular Aneurysm Repair: Determination With New Computed Tomography–Applied Software

et al. 2019

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“…Kinking is a poorly understood phenomenon that has been defined as a doubling of peak systolic velocity (PSV) throughout the artery and confirmed with subsequent pressure measurement on angiography. 13 Stent graft kinking and infolding can result in flow restricting stenosis, graft thrombosis, and occlusion. Depending on their location and degree of angulation they can also result in type I endoleaks.…”

Section: Discussionmentioning

confidence: 99%

Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management

Coelho

Nogueira

Lobo

et al. 2019

European Journal of Vascular and Endovascular Surgery

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The aim of this study was to review preventive and treatment management of one of the most common complications of endovascular aneurysm repair, which surprisingly, is little described in the literature. This study aimed to objectively identify high risk patients for kinking and make recommendations for intra-operative diagnosis and management, as well as management of limb occlusion.Objective/background: Endograft limb occlusion is a potential complication of endovascular aneurysm repair (EVAR), being one of the major causes of secondary interventions and rehospitalisation. The aim of this review is to report on the impact of endograft kinking in endograft limb occlusion, as well as on risk factors, prevention, early diagnosis, and management. Methods: A systematic review and meta-analysis was conducted according to the recommendations of the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. Results: After a MEDLINE and Scopus search, 55 articles (27,509 patients) were included in the qualitative analysis and eight in the quantitative analysis. In this meta-analysis, 179 at risk limbs were treated by preemptive stenting, which significantly reduced the risk of limb occlusion: not pre-emptively stenting limbs at risk had a negative impact on graft limb patency (odds ratio 4.30, 95% confidence interval 1.45e12.78). Postoperatively, a kink was identified in 422 patients (1.5%), contributing to 42.8% of all limb occlusions. Relevant data support that completion angiography is an inadequate means of diagnosing high risk limbs, proposing cone beam computed tomography and intravascular ultrasound as adjuncts. The post-operative limb occlusion rate ranged from 0% to 10.6%, affecting 984 patients. Several risk factors for limb occlusion have been identified. Regarding treatment, most patients were submitted to femorofemoral bypass (52.3%) or to deployment of a bare metal stent, either alone or associated with catheter directed thrombolysis or mechanical thrombectomy (26.4%). Complications and outcome after re-intervention for limb occlusion are described infrequently in the literature, but single studies have reported on re-occlusion, major amputation, and limb occlusion related mortality rates. Conclusion: Pre-EVAR planning should focus on identification of risk factors for kinking. Adjunctive stenting is an effective prophylaxis for selected high risk limbs, yet intra-operative identification remains problematic. Also, it is noteworthy that most limb occlusions occur in the first year after EVAR, emphasising the importance of careful early follow up of high risk patients.

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Endograft Occlusion

Mariani,

D’Alessio,

Belloni

et al. 2024

Mastering Endovascular Techniques

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Lack of Iliac Engagement Correlates With Iliac Limb Complications Following Standard EVAR

Cited by 6 publications

References 23 publications

Changes in Apposition of Endograft Limbs in the Iliac Arteries After Endovascular Aneurysm Repair: Determination With New Computed Tomography–Applied Software

Changes in Apposition of Endograft Limbs in the Iliac Arteries After Endovascular Aneurysm Repair: Determination With New Computed Tomography–Applied Software

Impact of Post-EVAR Graft Limb Kinking in EVAR Limb Occlusion: Aetiology, Early Diagnosis, and Management

Endograft Occlusion

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