Limb Occlusion Rate after EVAR With Individualized Graft Limb Selection and a Liberal Protocol of Primary Relining

Marino, Pablo Marqués de; Ibraheem, Anas; Gafur, Nargis; Mufty, Hozan; Schubert, Niklas; Verhoeven, Eric; Katsargyris, Αthanasios

doi:10.1016/j.avsg.2021.02.046

Cited by 11 publications

(2 citation statements)

References 20 publications

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“…The TEs and the performed treatments, listed in appendix A, reveal that realigning the limbs with Gore Excluder limbs avoids re-TE in 9 of the 10 limbs that underwent this TE-treatment. This is in line with the recent publication of Marino et al 26 Although relining may aid in future durability of the device, note should be made of the additional costs that come with relining. Relining had limited to no influence on the postoperative changes calculated in this study.…”

Section: Discussionsupporting

confidence: 87%

Geometrical Changes of the Aorta as Predictors for Thromboembolic Events After EVAR With the Anaconda Stent-Graft

et al. 2022

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Purpose: Thromboembolic events (TE), including limb graft occlusion (LGO) and distal limb embolization (DLE), are common complications after endovascular aneurysm repair (EVAR). The aim of this study was to find predictors for TE in patients treated with the Anaconda stent-graft for infrarenal aneurysms. Materials and Methods: Geometrical and anatomical variables were retrospectively analyzed in a consecutive Anaconda cohort. Pre- and postoperative CT scans were used to derive geometrical parameters length, curvature, torsion, and tortuosity index (TI) from the center lumen lines (CLLs). Limb characteristics, pre-to-post EVAR and mid-term-follow-up changes in the parameters were evaluated for their predictive value for TE. Results: Eighty-four patients (mean age 74±8.3 years, 74 men) were enrolled. The risk of TE was lowered with pre-to-post implant decreasing TI (steps of 0.05: OR: 1.30, 95% CI: 1.01-1.66, p=0.04), pre-to-post implant decreasing mean curvature (OR: 1.08, 95% CI: 1.01-1.16, p=0.03), and a larger degree of circumferential common iliac artery (CIA) calcification (OR: 0.98, 95% CI: 0.97-1.00, p=0.03). The only LGO predictor was the caudal relocation of maximal curvature after EVAR (OR: 1.01, 95% CI: 1.00-1.01, p=0.04). Preventors of DLE were CIA diameter (OR: 0.87, 95% CI: 0.76-0.99, p=0.04), circumferential CIA calcification (OR: 0.97, 95% CI: 0.95-1.00, p=0.03), mean and maximal curvature of the preoperative aortoiliac trajectory (OR: 0.86, 95% CI: 0.79-0.94, p<0.01 and OR: 0.97, 95% CI: 0.95-1.00, p=0.03, respectively) and pre-to-postoperative decrease in mean curvature (OR: 1.11, 95% CI: 1.02-1.21, p=0.02). Midterm TE predictors were length (OR: 0.95, 95% CI: 0.89-1.01, p=0.08) and torsion maximum location (OR: 1.01, 95% CI: 0.99-1.01, p=0.10). Conclusion: The present study confirms that treatment of infrarenal AAA with an Anaconda stent-graft is related to a relatively high TE rate which decreases with a pre-to-postoperative reduction in curvature and TI, and a larger degree of circumferential CIA calcification. In other words, more aortoiliac straightening and more circumferential CIA calcification may prevent TE development after EVAR with this stent-graft.

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Section: Discussionsupporting

confidence: 87%

Geometrical Changes of the Aorta as Predictors for Thromboembolic Events After EVAR With the Anaconda Stent-Graft

et al. 2022

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“… 15 However, limb relining with a sufficient proximal and distal seal around the fenestration is likely to be as, or more, effective than relining for other kinds of type III endoleaks, such as modular endograft component separation, which has been well-described with excellent long-term outcomes. 16 , 17 Furthermore, in bench-top studies, ballooning unreinforced fenestrations to 8 mm in diameter has been shown to induce minimal fabric tearing. 18 …”

Section: Discussionmentioning

confidence: 99%