Perigraft air and endoleak post endovascular repair of abdominal aortic aneurysm: is it always catastrophic?

Deshpande, Amit Ajit; Malhi, Amarinder Singh; Nandi, Debanjan; Kumar, Sanjeev

doi:10.1136/bcr-2021-242254

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…To investigate the parameters associated with the rate of air embolism, endovascular aortic repair (EVAR) is increasingly utilized as a clinical model for several reasons: (1) the delivery systems of EVAR devices are almost identical to that of TEVAR implants; (2) air bubbles at the outer surface of the prosthesis can be trapped within the abdominal aortic aneurysm sac at the luminal surface of the ventral mural thrombus, which is a usual and easily quantifiable finding on the first follow-up CT (20,21); and (3) EVAR is more frequently performed than TEVAR (9,13). Similar to TEVAR, hepatic failure, renal failure, or adverse cardiovascular events can occur due to perigraft air after EVAR, and trapped air also should be monitored to rule out the possibility of graft infection (20,21). Trapped air detected in the aneurysm sac after EVAR has an identical etiology to what may result in stroke during a TEVAR procedure, thus making EVAR an appropriate model to evaluate the effectiveness of delivery system deairing.…”

Section: Discussionmentioning

confidence: 99%

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses—a randomized controlled trial

Szentiványi,

Borzsák,

Vecsey-Nagy

et al. 2024

Front. Cardiovasc. Med.

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BackgroundAir embolism is a known risk during thoracic endovascular aortic repair (TEVAR) and is associated with an incomplete deairing of the delivery system despite the saline lavage recommended by the instructions for use (IFU). As the delivery systems are identical and residual air remains frequently in the abdominal aortic aneurysm sac, endovascular aortic repair (EVAR) can be used to examine the effectiveness of deairing maneuvers. We aimed to evaluate whether increasing the flush volume can result in a more complete deairing.MethodsPatients undergoing EVAR were randomly assigned according to flushing volume (Group A, 1× IFU; Group B, 4× IFU). The Terumo Aortic Anaconda and Treo and Cook Zenith Alpha Abdominal stent grafts were randomly implanted in equal distribution (10-10-10). The quantity of air trapped in the aneurysm sac was measured using a pre-discharge computed tomography angiography (CTA). Thirty patients were enrolled and equally distributed between the two groups, with no differences observed in any demographic or anatomical factors.ResultsThe presence of air was less frequent in Group A compared to that in Group B [7 (47%) vs. 13 (87%), p = .02], and the air volume was less in Group A compared to that in Group B (103.5 ± 210.4 vs. 175.5 ± 175.0 mm3, p = .04). Additionally, the volume of trapped air was higher with the Anaconda graft type (p = .025).DiscussionThese findings suggest that increased flushing volume is associated with a higher amount of trapped air; thus, following the IFU might be associated with a reduced risk of air embolization. Furthermore, significant differences were identified between devices in terms of the amount of trapped air. Clinical trial registration[NCT04909190], [ClinicalTrials.gov].

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Section: Discussionmentioning

confidence: 99%

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses—a randomized controlled trial

Szentiványi,

Borzsák,

Vecsey-Nagy

et al. 2024

Front. Cardiovasc. Med.

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show abstract

“…This amount of saline is approximately four times the prescribed in the instruction for use (IFU) which is also concordant with previous results. 9,10 To investigate the parameters associated with the rate of air embolism endovascular aortic repair (EVAR) is increasingly being used as a clinical model as (1) the delivery systems of EVAR devices are almost identical to that of TEVAR implants, (2) air bubbles remained at the outer surface of the prosthesis can be trapped within the abdominal aortic aneurysm sac at the luminal surface of the ventral mural thrombus which is a usual and easily quanti able nding on the rst follow-up CTA 11,12 and (3) EVAR being more frequently performed than TEVAR. 8,13 Similar to TEVAR, hepatic failure, renal failure or adverse cardiovascular events can occur due to perigraft air after EVAR and trapped air also should be monitored to rule out the possibility of graft infection.…”

Section: Introductionmentioning

confidence: 99%

“…8,13 Similar to TEVAR, hepatic failure, renal failure or adverse cardiovascular events can occur due to perigraft air after EVAR and trapped air also should be monitored to rule out the possibility of graft infection. 11,12 Trapped air detected in the aneurysm sac after EVAR has an identical etiology to what may result in stroke during a TEVAR procedure, thus making EVAR an appropriate model to evaluate the effectiveness of DS deairing.…”

Section: Introductionmentioning

confidence: 99%

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses – a randomized controlled trial

Szentiványi

Borzsák

Vecsey-Nagy

et al. 2023

Preprint

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Air embolism during thoracic endovascular aortic repair (TEVAR) is associated to an incomplete deairing of the delivery system (DS) despite the saline lavage recommended by the instructions for use (IFU). As the DSs are identical, endovascular aortic repair (EVAR) can be used to examine the effectiveness of deairing maneuvers. We aimed to evaluate if a more complete deairing can be achieved with increasing the flush volume. EVAR patients were randomised according to flushing volume (Group A:1xIFU & Group B: 4xIFU). Air trapped in the aneurysm sac was quantified on pre-discharge CTA. 30 patients were enrolled and equally distributed between the two groups. There were no differences in any demographic or anatomical factors. Presence of air was less frequent in Group A than in Group B (7 (47%) vs. 13 (87%), p = .02), volume of air was less in Group A compared to Group B (103.5 ± 210.4 vs. 175.5 ± 175.0 mm3, p = .04). Volume of trapped air was higher with Anaconda graft type (p = .025). Increased flushing volume is associated with more trapped air, thus following the IFU might be associated with smaller risk of air embolization. Significant differences were identified between devices regarding the amount of trapped air.

show abstract

Perigraft air and endoleak post endovascular repair of abdominal aortic aneurysm: is it always catastrophic?

Cited by 2 publications

References 11 publications

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses—a randomized controlled trial

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses—a randomized controlled trial

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses – a randomized controlled trial

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