Pararenal Aortic Ulcer Repair

Taher, Fadi; Assadian, Afshin; Strassegger, J.; Duschek, Nikolaus; Koulas, Spyridon; Senekowitsch, C.; Falkensammer, Juergen

doi:10.1016/j.ejvs.2015.12.005

Cited by 8 publications

(9 citation statements)

References 22 publications

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“…The total reintervention rate in patients receiving endovascular repair was 9% (43/482). 8,9,12,15,17,18,21,22,[24][25][26][27][28][29][30][31][32][33][34][35] The need for reintervention in most patients were due to post-operative complications such as endoleaks (n ¼ 22), thrombosis (n ¼ 1), access site hematoma (n ¼ 1) and humeral pseudoaneurysm following puncture (n ¼ 1). However, some were required due to complications secondary to aortic disease progression (n ¼ 18).…”

Section: Discussionmentioning

confidence: 99%

“…For studies addressing resolution of symptoms post endovascular stent graft repair; all patients had complete resolution of symptoms. 12,25,29,32,33,35 In the study reported by Absi et al 11…”

Section: Resolution Of Symptomsmentioning

confidence: 97%

“…Eighteen studies 9,12,15,17,18,21,22,[24][25][26][27][28][29][31][32][33][34][35] addressed 30-day mortality for all PAUs treated with endovascular stent-grafting (23/463, 5%), 6 addressed surgical management 7,15,19,20,26,30 (16/106, 15%) and 6 medical management 7,19,20,26,31,30 (12/130, 9%) (Table 2). The studies comparing open surgery versus medical management reported a 30-day mortality of 14% (10/69) vs 10% (12/120), respectively.…”

Section: Management Modalitymentioning

confidence: 99%

“…Ten studies addressed resolution of symptoms (Table 2). 7,11,12,20,25,26,30,32,33,35 Out of 159 symptomatic patients assessed, 125 showed resolution of symptoms during follow-up (79%). For studies addressing resolution of symptoms post endovascular stent graft repair; all patients had complete resolution of symptoms.…”

Section: Resolution Of Symptomsmentioning

confidence: 99%

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The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

Pandey

Sharma

2021

Vasc Endovascular Surg

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Background: Penetrating aortic ulcers (PAUs) are an entity within acute aortic syndrome. They often remain undiagnosed and are found incidentally or when they become symptomatic. Management is currently guided by clinical judgment. This review aims to identify indications for treatment and inform management. Methods: We searched PubMed for studies on the management of PAUs. The outcome measures were mortality, progression and resolution of symptoms. Results: This review incorporates 27 studies involving 1356 patients with PAU. Data was available regarding symptoms for 1213 patients (494 symptomatic, 719 asymptomatic). Overall late mortality for PAUs was found to be higher than 30-day mortality. Early mortality was higher for symptomatic patients as compared to those with asymptomatic PAUs. Early mortality was lowest for PAUs treated with endovascular interventions (5%), followed by PAUs managed medically and highest following open surgical management. Indications for treatment included symptoms, progression/instability, aortic diameter >5 cm, concomitant aortic pathology or pleural effusion. 13% of patients managed conservatively at initial presentation demonstrated progression and were considered for intervention subsequently. 9% of patients required reintervention after initial endovascular surgery. Conclusion: Endovascular treatment, if anatomically suitable, should be considered as first line treatment for symptomatic PAUs. Patients with asymptomatic PAUs, if associated with high-risk features such as PAU diameter >20 mm, PAU depth >10 mm, aortic diameter >42 mm, concomitant pathology, morphological change or an infective etiology, should also be considered for intervention. Small asymptomatic PAUs with no high-risk features may be managed conservatively but must undergo regular surveillance.

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Section: Discussionmentioning

confidence: 99%

Section: Resolution Of Symptomsmentioning

confidence: 97%

Section: Management Modalitymentioning

confidence: 99%

Section: Resolution Of Symptomsmentioning

confidence: 99%

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The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review

Pandey

Sharma

2021

Vasc Endovascular Surg

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“…The fenestrated Anaconda Stent Graft System (Vascutek, Inchinnan, Scotland, UK) has undergone rapid popularization since its introduction less than a decade ago. 1,4,5 Inability to connect visceral or renal arteries through their intended fenestrations due to graft misalignment may require bailout strategies or result in an unconnected fenestration with potentially debilitating adverse events and serious sequelae for the patient. Bailout strategies may for instance include the use of a parallel graft to connect a target vessel.…”

Section: Introductionmentioning

confidence: 99%

Assessing the institutional learning curve for pararenal aortic repair using the fenestrated Anaconda endograft

et al. 2018

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Objective Custom-made fenestrated aortic endografts allow exclusion of pararenal aortic aneurysms while maintaining blood flow to aortic branches. Meticulous device planning and precise deployment of the main body are essential to allow successful cannulation of the fenestrations. This study investigates whether a learning curve can be observed with more reliable cannulation and connection of fenestrations over time at a single department of vascular and endovascular surgery with multiple surgeons trained to use the device. Methods A retrospective analysis of data from all patients undergoing primary fenestrated endovascular aneurysm repair during the study period was performed. Outcome measures included case volume and average number of fenestrations over time, average fluoroscopy dose area product per calendar year and primary unconnected fenestration and 30-day mortality rates. Results Between 1 January 2013 and 31 December 2016, 89 patients with no history of endovascular aneurysm repair underwent fenestrated endovascular aneurysm repair at our institution. The number of fenestrations per case increased over time, averaging 2.6 in 2013 and 3.3 in 2016. Primary unconnected fenestration and 30-day mortality rates were 5.6%. Primary-assisted technical success was 93.3%, secondary-assisted technical success was 94.4%. Fluoroscopy dose area product declined over the study period. Thirty-day mortality and primary unconnected fenestration rates did not significantly change over the study period. Conclusion Albeit the reduction in lethal complications and primary technical success rates were not statistically significant, a lower percentage of unconnected fenestrations and 30-day mortality per calendar year were observed over time. At the same time, an increasing complexity of performed cases, as reflected by an increasing number of fenestrations per case, was observed. Complications associated with this complex endovascular procedure are potentially lethal and remain an unfortunate reality and may not be entirely dependent on overcoming a learning curve. A higher volume of cases performed over the study period and a reduction in fluoroscopy use can be considered a representation of the institutional development and learning curve for the Anaconda fenestrated endograft at a department with prior complex endovascular aortic repair experience, but due to limitations of the current retrospective observation, deserve further consideration in future trials, ideally designed in a prospective fashion.

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