Systematic Review and Meta-Analysis of the Outcome of Different Treatments for Type 1a Endoleak After EVAR

Perini, Paolo; Massoni, Claudio Bianchini; Mariani, Erica; Ucci, Alessandro; Fanelli, Mara; Azzarone, Matteo; Freyrie, Antonio

doi:10.1016/j.avsg.2019.03.032

Cited by 41 publications

(15 citation statements)

References 53 publications

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“…Fenestrated EVAR demonstrated to be safe and feasible to treat type Ia endoleaks after standard EVAR, even though with greater radiation exposure and operating time, and an endovascular approach to repair a proximal endoleak represents the first choice treatment in the literature. 4,19 Fenestrated cuffs to repair type Ia endoleaks were available in the centres, and were adopted commonly. However, in selected cases such as patients fit for open surgery with an unfavourable anatomy for advanced EVAR, primary LOC can be considered.…”

Section: Discussionmentioning

confidence: 99%

Twenty-two Year Multicentre Experience of Late Open Conversions after Endovascular Abdominal Aneurysm Repair

Perini

Gargiulo

Silingardi

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSLate open conversions for endovascular aneurysm repair complications have increased in number over the last 20 years. They are technically challenging operations, with high post-operative mortality and morbidity rates, especially for infection and urgent operations. Morbidity rates are lower when the endograft is clamped infrarenally.Objective: The aim was to report indications, technical aspects, and outcomes of a multicentre experience of late open conversions (LOCs) after endovascular abdominal aneurysm repair (EVAR), in order to identify risk factors which may influence early morbidity and mortality rates, and long term survival. Methods: Ten vascular centres retrospectively reviewed all patients requiring LOC (!30 days from initial EVAR, undergoing total or partial endograft explantation) from 1996 to 2017. Baseline characteristics, endograft data, indications, procedural details, post-operative outcomes, and follow up data were reviewed and analysed. Results: Included patients totalled 232 (90.1% males, mean age 74.3 AE 7.9 years). The number of LOC per year significantly increased during the study period, reaching 22 in 2017 (correlation r ¼ 0.867, p < .0001). Reasons for LOC were 80.2% endoleak (186/232), 15.5% endograft infection (36/232), and 9.9% endograft thrombosis (23/232). Sixty-nine patients (29.7%) were operated on urgently; rupture was present in 18.5% (43/232). Eighty-nine patients (38.4%) underwent endovascular re-interventions prior to LOC. The proximal aortic cross clamp site was infrarenal in 40.5% (94/232), suprarenal in 25.4% (59/232), supracoeliac in 32.8% (76/232), and thoracic in 1.3% (3/232). Endograft explantation was total in 164/232 patients (70.7%), and partial in the remaining 68/232 (29.3%). The overall 30 day mortality was 11.2% (26/232). Early mortality was significantly higher for patients operated on urgently (26.1% vs. 4.9%, p < .001). Suprarenal clamping (odds ratio (OR) 2.34, 95% CI 1.12e4.88) and pre-existing renal insufficiency (OR 2.11, 95% CI 1.03e4.31) were independent risk factors for post-operative renal failure on multivariable analysis. Median follow up was 24.1 months (IQR 4.4e60.6). The estimated overall one and five year survival rates were 79.7% and 58.6%, respectively. Survival estimates were significantly lower for patients with endograft infection (83.8% vs. 59% at one year, 65.2% vs. 28.9% at five years; log rank p ¼ .005), as well as for urgent patients (87.2% vs. 62.1% at one year, 65.1% vs. 43.7% at five years; log rank p < .0001). Conclusion:The annual number of LOC increased over time. LOCs performed urgently or for endograft infection are associated with poor survival. Infrarenal aortic clamping has lower post-operative complication rates.

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Section: Discussionmentioning

confidence: 99%

Twenty-two Year Multicentre Experience of Late Open Conversions after Endovascular Abdominal Aneurysm Repair

Perini

Gargiulo

Silingardi

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…Endovascular management of EL1a is mandatory, because of the documented risk of rupture. Technical success rates are high when managing intra-procedural or early EL1a, in the order of 90–100% [ 12 – 14 ]. Multiple options for reintervention are available, depending on the primary aortic repair technique that was used and the appearance on imaging.…”

Section: Management Of Secondary Endoleaks—evarmentioning

confidence: 99%

Secondary Endoleak Management Following TEVAR and EVAR

Ameli-Renani

Pavlidis

Morgan

2020

Cardiovasc Intervent Radiol

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Endovascular abdominal and thoracic aortic aneurysm repair and are widely used to treat increasingly complex aneurysms. Secondary endoleaks, defined as those detected more than 30 days after the procedure and after previous negative imaging, remain a challenge for aortic specialists, conferring a need for long-term surveillance and reintervention. Endoleaks are classified on the basis of their anatomic site and aetiology. Type 1 and type 2 endoleaks (EL1 and EL2) are the most common endoleaks necessitating intervention. The management of these requires an understanding of their mechanics, and the risk of sac enlargement and rupture due to increased sac pressure. Endovascular techniques are the main treatment approach to manage secondary endoleaks. However, surgery should be considered where endovascular treatments fail to arrest aneurysm growth. This chapter reviews the aetiology, significance, management strategy and techniques for different endoleak types.

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“…Alternative strategies such as proximal endograft extension may have better outcomes for treating established TIaE. 34 On the other hand, endoanchors in this review prevented and treated all graft migrations in the secondary cohort. However, the small sample size and lack of long term follow up negates definitive conclusions for endoanchor treatment of established complications.…”

Section: Proportion Of Graft Migration After Primary Evar -%mentioning

confidence: 88%

Editor's Choice – Systematic Review of the Use of Endoanchors in Endovascular Aortic Aneurysm Repair

Qamhawi

Barge

Makris

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis systematic review and meta-analysis summarises the evidence for endoanchor use in EVAR and TEVAR to treat type Ia endoleak (TIaE) and graft migration. Endoanchor fixation in EVAR is technically feasible with at least comparable early outcomes to the latest generation of stent grafts in treating TIaE and graft migration. Evidence for endostapling in TEVAR is sparse, and results show lower technical success, higher peri-operative mortality, and potential serious adverse events. The current evidence is limited by short term data and a lack of case controlled trials. Further robust studies are required before endoanchor use can be recommended in routine clinical practice.Objective: Endoanchor fixation might be a potential adjunct for the prevention and treatment of type Ia endoleak (TIaE) and graft migration in thoracic or abdominal endovascular aortic aneurysm repairs (TEVAR or EVAR). This review aimed to explore the safety and effectiveness of endoanchor fixation in TEVAR and EVAR. Methods: A systematic review and random effects meta-analysis was conducted. Data sources were PubMed/ MEDLINE, Embase, and the Cochrane Library. Results: Seven EVAR and three TEVAR studies using the Heli-FXÔ EndoAnchorÔ system were included in the meta-analysis. A total of 455 EVAR patients underwent primary endoanchor fixation. Technical success was 98.4% (95% CI 95.7e99.8%). The rate of TIaE and graft migration was 3.5% (95% CI 1.7e5.9%) and 2.0% (95% CI 0.12e6.0%), respectively, after 15.4 months (95% CI 1.76e29.0) follow up. A total of 107 EVAR patients underwent secondary fixation with a technical success of 91.8% (95% CI 86.1e96.2%). Rates of TIaE and graft migration were 22.6% (95% CI 9.1e40.0%) and 0% after a mean 10.7 month (95% CI 7.8e13.6) follow up. Adverse events included three endoanchor fractures, three dislocated endoanchors, one entrapped endoanchor, and one common iliac artery dissection. All cause 30 day EVAR mortality was 0.82% (95% CI 0.20e1.85%). Sixty-six TEVAR patients underwent endoanchor fixation with a mean 9.8 month (95% CI 8.1e 11.5) follow up. Technical success was 90.3% (95% CI 72.1e99.4%). The rates of TIaE and migration were 8.7% (95% CI 1.0e18.9%) and 0%, respectively. Adverse events included two misdeployed endoanchors with one fatal aortic dissection. All cause 30 day TEVAR mortality was 11.9% (95% CI 5.4e20.6%). Conclusion:Endoanchor fixation in EVAR is technically feasible and safe, with at least comparable early outcomes to the latest generation of stent grafts. Endostapling in TEVAR is associated with lower technical success, higher peri-operative mortality, and potential serious adverse events. Current evidence lacks long term follow up and case controlled trials to recommend endoanchor use in routine practice.

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Systematic Review and Meta-Analysis of the Outcome of Different Treatments for Type 1a Endoleak After EVAR

Cited by 41 publications

References 53 publications

Twenty-two Year Multicentre Experience of Late Open Conversions after Endovascular Abdominal Aneurysm Repair

Twenty-two Year Multicentre Experience of Late Open Conversions after Endovascular Abdominal Aneurysm Repair

Secondary Endoleak Management Following TEVAR and EVAR

Editor's Choice – Systematic Review of the Use of Endoanchors in Endovascular Aortic Aneurysm Repair

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