Multicenter Registry about the Use of EndoAnchors in the Endovascular Repair of Abdominal Aortic Aneurysms with Hostile Neck Showed Successful but Delayed Endograft Sealing within Intraoperative Type Ia Endoleak Cases

Valdivia, Andrés Reyes; Beropoulis, Efthymios; Pitoulias, Georgios A.; Pratesi, Giovanni; Marcos, Francisco; Barbante, Matteo; Gandarias, Claudio; Torsello, Giovanni; Bisdas, Theodosios; Donas, Konstantinos P.

doi:10.1016/j.avsg.2019.01.017

Cited by 18 publications

(18 citation statements)

References 17 publications

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“… 11 If these options also fail to seal the endoleak, coil and/or glue embolization or endostaples can be used at a second stage. 1 12 Chimney grafts and fenestrated cuffs have also been used to treat Type 1a endoleaks.…”

Section: Discussionmentioning

confidence: 99%

Aortic Rupture during Endovascular Aneurysm Repair. Report of Our Experience and Review of the Literature

et al. 2020

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Background Aortic neck wall rupture during endovascular repair of abdominal aortic aneurysms (EVAR) is an underreported potentially fatal complication. Only a few cases have been reported. The main cause of this complication is repeated attempts at balloon inflation or overdilation to treat an intraoperative Type 1a endoleak. We report three cases complicated by procedure-related aortic neck wall rupture during EVAR. We also review the literature regarding the causes and outcomes of this complication. Methods Medical records of all patients undergoing EVAR between January 2009 and March 2019 were retrospectively reviewed. Results Overall, 824 EVAR procedures were performed, and rupture of the aortic neck wall was observed in three patients. In all cases, a Type 1a endoleak was observed and, in all cases, repeated ballooning attempts had been performed to resolve the endoleaks. In all cases, conversion to open repair was performed and all patients survived. Conclusion In cases of Type 1a endoleak, a maximum of two ballooning attempts should be performed even if a Type 1a endoleak persists. In case of intraoperative aortic neck wall rupture, control of the hemorrhage should be achieved immediately by advancing the balloon above the site of rupture. Emergency surgical conversion in case of hemodynamic stability is the first choice. According to the literature, emergency surgical conversion, especially in cases of endograft with suprarenal fixation, is associated with significant morbidity and mortality rates, mainly due to hemorrhage and to the length of the procedure required to repair the aortic neck wall injury.

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Section: Discussionmentioning

confidence: 99%

Aortic Rupture during Endovascular Aneurysm Repair. Report of Our Experience and Review of the Literature

et al. 2020

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“…Data on regression or expansion of the aneurysm sac were extracted from six studies. 5,9,[11][12][13]15 Regression of the aneurysmal sac was estimated at 68.82% (95%CI: 51.02-84.21), while 1.93% (95%CI: 0.91-3.24) of the patients developed expansion of the sac (Figures 5 and 6).…”

Section: Meta-analysismentioning

confidence: 99%

“…Data on the freedom of aneurysm-related reintervention at a mean 10 months follow-up period were extracted from four studies. 5,9,14,15 The pooled rate was 97.68% (95%CI: 95.17-99.44) ( Supplementary Figure 1). No aneurysm rupture was recorded among four eligible studies 5,9,10,15 (Supplementary Figure 2).…”

Section: Meta-analysismentioning

confidence: 99%

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Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants

et al. 2020

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Objective Endovascular aneurysm repair has gained field over open surgery for the treatment of abdominal aortic aneurysm. However, type Ia endoleak represents a common complication especially in hostile neck anatomy that is recently faced using endoanchors. We conducted a systematic review and meta-analysis to collect and analyse all the available comparative evidence on the outcomes of the endosuture aneurysm repair in patients with or without hostile neck in standard endovascular aneurysm repair. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the prospective and retrospective studies reporting primary use of the Heli-FX EndoAnchor implants were considered eligible for inclusion in this study. The main study outcomes (technical success of endoanchor implantation, incidence of type Ia endoleak, aortic stent graft migration and the percentage of patients who presented regression or expansion of aneurysm sac throughout the follow-up) were subsequently expressed as proportions and 95% confidence intervals. Results Eight studies with a total of 968 patients were included in a pooled analysis. The technical success of the primary endoanchor fixation was 97.12% (95%CI: 92.98–99.67). During a mean six months follow-up period, a pooled rate of 6.23% (95%CI: 0.83–15.25) of the patients developed a persistent type Ia endoleak despite the primary implantation. Migration of the main graft was reported in five studies, in which a 0.26% (95%CI = 0.00–1.54) of the patients required an additional proximal aortic cuff. Regression of the aneurysm sac was observed at 68.82% (95%CI: 51.02–84.21). An expansion of the aneurysm sac was found in 1.93% (95%CI: 0.91–3.24) of the participants. The overall survival rate was 93.43% (95%CI: 89.97–96.29) at a mean six months follow-up period. Conclusions Endosuture aneurysm repair with the Heli-FX EndoAnchor implants seems to be technically feasible and safe either for prevention or for repair of intraoperative type Ia endoleak. Despite the primary implants of endoanchors, few cases of persistent type Ia endoleak and migration are still conspicuous. Long-term follow up is needed to determinate the role of this therapeutic option in the treatment of aortic aneurysms.

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“…Вместе с тем важным фактором успешного эндоваскулярного лечения (ЭЛАБА), позволяющим снизить частоту осложнений (миграция стент-графта, неполное выключение аневризматического мешка -эндолик IA типа) и повторных вмешательств, является благоприятная анатомия проксимальной шейки [8,9]. К параметрам, определяющим анатомию проксимальной шейки как благоприятную, принято относить следующие показатели: достаточную длину проксимальной зоны приземления -более 15 мм, ангуляцию проксимальной шейки (угол, образованный между центральной линией аорты на уровне почечных артерий и центральной линией аорты ниже почечных артерий) менее 60°, форму шейки (цилиндрическая или коническая с сужением книзу), диаметр аорты на уровне шейки менее 28 мм, распространенность пристеночного тромбоза менее 180° по окружности, отсутствие выраженного кальциноза [4,10].…”

Section: Introductionunclassified

Proximal fixation devices in endovascular repair of abdominal aortic aneyrysm with unfavourable proximal neck anatomy

Абугов¹,

Puretskiy²,

Polyakov³

et al. 2019

Khir. Z. im. N.I. Pirogova

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Аневризма брюшного отдела аорты-распространенное сосудистое заболевание, которое требует хирургического лечения. В настоящее время эндоваскулярное протезирование является полноценной альтернативой открытому вмешательству. Однако высокая частота встречаемости вариантов неблагоприятной анатомии проксимальной зоны фиксации ограничивает применение эндоваскулярного лечения аневризм брюшного отдела аорты у таких пациентов. Использование дополнительных техник может увеличить применимость эндоваскулярной методики с сохранением оптимальных результатов. Приводим 2 клинических случая эндоваскулярного лечения аневризм брюшного отдела аорты у пациентов с неблагоприятной анатомией проксимальной шейки и использованием устройств проксимальной фиксации якорного типа.

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Multicenter Registry about the Use of EndoAnchors in the Endovascular Repair of Abdominal Aortic Aneurysms with Hostile Neck Showed Successful but Delayed Endograft Sealing within Intraoperative Type Ia Endoleak Cases

Cited by 18 publications

References 17 publications

Aortic Rupture during Endovascular Aneurysm Repair. Report of Our Experience and Review of the Literature

Aortic Rupture during Endovascular Aneurysm Repair. Report of Our Experience and Review of the Literature

Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants

Proximal fixation devices in endovascular repair of abdominal aortic aneyrysm with unfavourable proximal neck anatomy

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