Lower Extremity Ischemia after Abdominal Aortic Aneurysm Repair

Behrendt, Christian‐Alexander; Dayama, Anand; Debus, Eike Sebastian; Heidemann, Franziska; Matolo, Nathaniel M.; Kölbel, Tilo; Tsilimparis, N.

doi:10.1016/j.ejvs.2019.06.688

Cited by 5 publications

(8 citation statements)

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“…The EVAR-I trial reported a 3 e 4 times higher rate of graft related complications after endovascular aneurysm repair compared with open aortic surgery 260. Newer generations of stent grafts may be more flexible and have more kink resistant limbs261 which may reduce the incidence of EVAR graft limb occlusion. For more details regarding aortic or iliac occlusions after aortic surgery, and recommendations on how to prevent this complication, please consult the ESVS 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms, in particular section 6.3.2.…”

mentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

336

222

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mentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

336

222

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“…Occlusions and limb ischaemia after AAA repair are, fortunately, a rare complication with reported frequencies of <2%, but are associated with worse overall outcome. 16 The increased use of EVAR has led to a decrease in post-operative morbidity and shorter hospital stay. Nevertheless, EVAR is burdened with lower limb ischaemic complications, also seen after open aortic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…complications related to EVAR have decreased significantly over time as the issue of limb occlusions was acknowledged, and new generation stent grafts are typically manufactured with flexible and more kink resistant limbs. 16 In the UK IMPROVE trial, which randomised patients with ruptured AAA between open repair and EVAR, occlusion of the reconstructions were more common after EVAR. 28 Another contributing factor to the observed increase in graft/stent/stent graft occlusions might be the overall increase in the frequency aortic interventions, leaving more patients with aortic reconstructions that can possibly occlude.…”

Section: Discussionmentioning

confidence: 99%

“…There was no difference in the need for re-intervention between the aetiological groups (p ¼ . 16 Long term survival also differed between the aetiological groups ( Table 3). Fig.…”

Section: Long Term Outcomementioning

confidence: 99%

“…Increasingly, abdominal aortic aneurysms (AAA) are being treated by endovascular aneurysm repair (EVAR). 11e 14 Although EVAR rarely leads to acute ischaemic complications, 15,16 with the increasing volume of this surgery a substantial number of patients presenting with acute limb ischaemia secondary to endograft occlusion/collapse and subsequent aortic occlusion is expected.…”

Section: Introductionmentioning

confidence: 99%

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Temporal Trends and Management of Acute Aortic Occlusion: A 21 Year Experience

Grip

Wanhainen

Björck

2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Acute aortic occlusion is a rare, serious, and yet poorly investigated event. It can be caused by different aetiologies and be treated in many different ways. This investigation includes far more patients than all previous reports and can therefore report on time trends including long term survival with reporting of similar results for patient subgroups. Objectives: The aim was to study patients with acute aortic occlusion (AAO), a rare and life threatening event, in a population based cohort and the outcome of surgical treatment. Methods: The Swedish nationwide vascular database (Swedvasc) was used to identify cases, and the population registry to study long term survival. Variables associated with outcome were tested with the chi-square test and analysis of variance. Results: During the 21 year study period (1994e2014), 693 cases of surgical treatment for AAO were included, with a yearly incidence of 3.6 per million inhabitants. Mean AE SD age was 69.9 AE 11.2 years, 352 patients (50.8%) were women, and mean AE SD length of follow up was 5.2 AE 5.5 years. Most patients presented with bilateral acute limb ischaemia (596 patients, 86.0%). The aetiology of AAO was native artery thrombosis in 458 patients (66.1%), saddle embolus in 152 (21.9%), and occluded graft/stent/stent grafts in 83 (12.0%). The proportion of occluded grafts/stent/stent grafts increased during the study period (n ¼ 14 [6.7%] in 1994e 2000 vs. n ¼ 45 [17.4%] in 2008e2014; p < .001) with a simultaneous reduction of arterial thrombosis (n ¼ 149 [71.6%] in 1994e2000 vs. n ¼ 158 [61.2%] in 2008e2014; p <. 001). Major amputation above the ankle was performed in 39 patients (8.5%), and 140 patients died within 30 days of surgery (20.2%). Thirty day mortality rate was lower after occluded grafts/stents/stent grafts (eight patients [9.6%]) and higher after saddle embolus (47 patients [30.9%]); p < .001). There was a reduction in overall 30 day mortality over time (n ¼ 53 [25.5%] in 1994e2000 vs. n ¼ 40 [15.5%] in 2008e2014; p ¼ .007). Long term survival revealed significant differences between the subgroups, although the difference occurred early after the event (p < .001). Conclusions: Mortality after surgical treatment of AAO is improving over time, yet a significant mortality rate was observed throughout the study period. The proportion of AAO secondary to occluded grafts/stents/stent grafts increased over time.

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