Outcomes after Open Surgery and Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm in Patients with Massive Neck Atheroma

Hoshina, Katsuyuki; Hosaka, Akihiro; Takayama, Tadatoshi; Kato, Masaaki; Ohkubo, Nobukazu; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

doi:10.1016/j.ejvs.2011.11.023

Cited by 26 publications

(44 citation statements)

References 16 publications

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“…[3][4][5] Massive neck atheroma was also shown to affect EVAR outcome when compared to the outcome of open surgery. 6) In our study, device oversizing did not occur. There was less difficulty in creating an access route by extending the iliac limbs along with hypogastric artery embolization or in creating an access route via a retroperitoneal approach for cases of hostile iliac anatomy.…”

Section: Methodsmentioning

confidence: 61%

“…The definitions of neck factors were as follows: (1) length of aneurysmal neck <15 mm, (2) angulation of infrarenal neck ≥60 degrees (measured using the method described previously), 9) and (3) massive neck atheroma with a thickness and length ≥5 mm and circumference ≥75%. 6) Patients who had at least one of three factors were classified as Outside of the IFU (O-IFU) group, and the others were classified as Within the IFU (W-IFU) group. There were 82 patients in the O-IFU group: 25 had short length; 50, severe angulation; and 16, massive atheroma necks (in 9 patients, two factors overlapped).…”

Section: Methodsmentioning

confidence: 99%

“…In some studies on the results of EVAR outside of IFU, aneurysmal neck factors (short length, severe angulation, and presence of massive atheroma) are commonly reported to cause EVAR-related adverse events. [3][4][5][6] Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure neck atheroma, even in the presence of a type 1a endoleak.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure

Hoshina

Hashimoto

Kato

et al. 2014

Annals of Vascular Diseases

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Introduction:We retrospectively analyzed outcomes of patients who had undergone endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) more than 3 years previously in a single institution. We compared outcomes between patients who underwent EVAR within and outside of the devices' instructions for use (IFU) and examined mid-term morphological changes in AAA. Methods: A total of 275 patients who underwent EVAR for AAA were selected. IFU parameters included aneurysmal neck length, angulation and presence of massive atheroma. Patients were divided into 2 groups: the Within IFU group (W-IFU: n = 193) and the Outside of IFU group (O-IFU: n = 82). Results: Patients in the O-IFU group were older and had a larger AAA diameter. Other comorbid factors were similar between the 2 groups. There was no difference in overall survival rates and reintervention rates between the 2 groups. The most common cause for reintervention was AAA enlargement 3 years after EVAR. Irrespective of the IFU, mid-term morphological changes, including neck angulation, neck diameter, sac re-expansion, and Palmaz stent displacement, were found. Conclusion: Outcomes of EVAR were considered acceptable in the O-IFU group. Careful follow-up is necessary considering the morphological changes in AAAs after EVAR.

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Section: Methodsmentioning

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure

Hoshina

Hashimoto

Kato

et al. 2014

Annals of Vascular Diseases

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“…However, it is evident from a study comparing EVAR and open surgical repair in patients with a massive aortic atheromatous thrombus that EVAR was associated with a significantly higher rate of late-phase embolic complications [3]. The repair of AAA has a higher risk of embolization than other vascular procedures, because of the thrombus and debris in the aneurysmal sac or atherosclerotic aorta that can be released into the circulation during the manipulation of various guidewires, sheaths, and stents.…”

Section: Discussionmentioning

confidence: 99%

Successful Endovascular Aortic Repair (EVAR) for an Abdominal Aortic Aneurysm with a Shaggy Aorta Using a Temporary Filtered Aorto-Venous Shunt for Protection against Shower Embolism

Takebayashi

Shuto

Wada

et al. 2017

Interventional Radiology

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Endovascular aortic repair (EVAR) is generally considered to be contraindicated in the presence of a shaggy aorta, because of the high risk of shower embolization. However, many patients who have abdominal aortic aneurysms (AAAs) with diffuse aortic atherosclerosis need EVAR because of high surgical risk. We report a case of AAA with massive aortic plaques that was treated with EVAR, using an extracorporeal shunt with a blood filter constructed from the femoral artery and vein during the procedure. The patient had an uneventful postoperative course. This method of sieving emboli in a filter in an external shunt is highly effective for EVAR of a shaggy aorta.

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“…12) Hoshina et al investigated the incidence of perioperative microembolisms of the intestine or kidney in patients and identified circumferential thrombi surrounding the aneurysmal neck, during the early period following OS and at 6 months after EVAR. 13) Regarding the association between the accessory renal artery and renal function, occlusion of an accessory renal artery to less than 3 mm in diameter reportedly has no effect on postoperative renal function. Greenberg et al evaluated postoperative eGFR values in EVAR-treated patients with an accessory renal artery, and compared patients in whom the accessory renal artery was occluded and patients in whom the accessory renal artery was preserved, with no significant difference observed between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Is Endovascular Aneurysm Repair a Relative Contraindication for Patients with Preoperative Renal Dysfunction?

Furuyama

Onohara

Mikasa

et al. 2015

Annals of Vascular Diseases

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Whether endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is a relative contraindication in patients with preoperative renal dysfunction (Pre-RD), remains controversial because the contrast medium may induce nephrotoxicity. In this study 1658 patients were treated at ten Japanese medical centers between January 2005 and March 2011 (Open surgery (OS) vs. EVAR: n = 1270 vs. n = 388). They were retrospectively analyzed. Multiple logistic regression analysis (MLRA) with pre-and intra-operative variables was applied to all patients. The endpoints induced onset of new dialysis and postoperative renal dysfunction (Post-RD), were defined as a 50% decrease or more from the preoperative estimated glomerular filtration rate (eGFR) level. Results: Early mortality, Post-RD, incidence of new dialysis in all patients were 1.6% (OS: EVAR = 1.9%:0.8%), 6% (OS: EVAR = 8%:2.3%) and 1.4% (OS: EVAR = 1.5%:1.0%) respectively. MLRA identified operation time, clamp of renal artery as risk factors for Post-RD, and operation time and Pre-eGFR level as risk factors for new dialysis. Conclusion: Although Post-RD was more frequently observed in the OS group, MLRA showed that the choice of OS or EVAR was not a risk factor for Post-RD and new dialysis. It was strongly suggested that using contrast medium during EVAR is not a contraindication to AAA repair in patients with Pre-RD. (This article is a translation of J Jpn Coll Angiol 2014; 54: 13-18.)

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Outcomes after Open Surgery and Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm in Patients with Massive Neck Atheroma

Cited by 26 publications

References 16 publications

Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure

Feasibility of Endovascular Abdominal Aortic Aneurysm Repair Outside of the Instructions for Use and Morphological Changes at 3 Years after the Procedure

Successful Endovascular Aortic Repair (EVAR) for an Abdominal Aortic Aneurysm with a Shaggy Aorta Using a Temporary Filtered Aorto-Venous Shunt for Protection against Shower Embolism

Is Endovascular Aneurysm Repair a Relative Contraindication for Patients with Preoperative Renal Dysfunction?

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