Technical Tips for Endovascular Treatment of Abdominal Aortic Aneurysms With Challenging Infrarenal Neck Anatomy Using the Excluder Endoprosthesis

Ghouri, Maaz; Dougherty, Kathryn G.; Krajcer, Zvonimir

doi:10.1583/10-3170.1

Cited by 13 publications

(13 citation statements)

References 19 publications

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“…On the other side, a large aneurysm, co-morbidity or previous abdominal surgery would significantly increase the risks of open repair; this situation warrants the use of EVAR. Furthermore, surgeons' learning curve and advances in device technology are considerations in interpreting these results, [12][13][14] even though we did not compare these factors.…”

Section: Discussionmentioning

confidence: 98%

Long-Term Outcomes of Endovascular Repair versus Open Repair of Abdominal Aortic Aneurysm

Ren

Fan

et al. 2012

ATCS

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An alternative to open repair was initially reported by Parodi in 1991.2) A covered stent was inserted within the aneurysm by an endoluminal route via the femoral artery. About 90 per cent of AAAs can be excluded from the circulation with low risk of subsequent aneurysm rupture, thereby reducing significantly postoperative pain, critical care requirement and hospital stay. 3,4) There are numerous reports on the long-term effects of patients after EVAR, including the DREAM, EVAR1 and EVAR2 studies. [5][6][7][8] These trials showed that EVAR is more likely to be more cost-effective than open repair in terms of operative mortality with no differences in mortality or aneurysm-related mortality existing between both groups in long-term. [5][6][7][8] However, patients undergoing the EVAR procedure have a higher rate of graft-related complications and more costly reinterventions. 8,9)

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Section: Discussionmentioning

confidence: 98%

Long-Term Outcomes of Endovascular Repair versus Open Repair of Abdominal Aortic Aneurysm

Ren

Fan

et al. 2012

ATCS

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“…Others have suggested bending the stiff wire. [12][13][14] Furthermore, to facilitate a good fit between the rigid body of the endoprosthesis and a torturous neck, we implant the device with the body in a lower position and add an aortic extender. If large endoleak and hemodynamic instability develop, however, conversion to open surgery becomes unavoidable.…”

Section: Discussionmentioning

confidence: 99%

Protocol-Based Strategy for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

Ogino

Watanabe

Ikegaya

et al. 2013

Annals of Vascular Diseases

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“…Some intraoperative maneuvers help achieve effective and durable fixation and sealing of stent-grafts in patients with hostile proximal neck anatomy: use of high-pressure balloons to reinforce the seal, deployment of a proximal cuff, controlled slow deployment of the main body of the stent-graft, use of the bending-the-wire technique to realign the axis of the aneurysm with the neck, and use of appropriate C-arm angulation to adequately visualize the landing zone [44]. As endovascular technology continues to evolve, it is likely that additional maneuvers will evolve, enhancing the surgeon's skill in dealing with hostile anatomy.…”

Section: Perspective On Development Of New Technologymentioning

confidence: 99%

Treatment of Hostile Proximal Necks During Endovascular Aneurysm Repair

Navarro

Bernardes

Procópio

et al. 2014

aorta

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Endovascular aneurysm repair (EVAR) is a therapy that continues to evolve rapidly as advances in technology are incorporated into new generations of devices and surgical practice. Although EVAR has emerged as a safe and effective treatment for patients with favorable anatomy, treatment of patients with unfavorable anatomy remains controversial and is still an off-label indication for endovascular treatment with some current stent-grafts. The proximal neck of the aneurysm remains the most hostile anatomic barrier to successful endovascular repair with long-term durability. Open surgery for unfavorable necks is still considered the gold standard treatment in contemporary practice, despite the increased mortality and morbidity attributed to suprarenal cross-clamping, particularly in high-risk patients. Evolving technology may overcome the obstacles preventing endovascular treatment of unfavorable proximal neck anatomy; current approaches include purely endovascular as well as hybrid approaches, and generally include strategies that either extend the length of the short neck, move the proximal neck more proximally, or keep the short neck intact. These approaches include the use of debranching techniques, banding, chimneys, fenestrated and branched devices, filling the sac with endobags, endoanchors, and other novel devices. These newer-generation devices appear to have promising short-and midterm results. However, lack of good evidence of efficacy with long-term results for these newer approaches still precludes wide dissemination of endovascular solutions for the hostile proximal neck.

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Technical Tips for Endovascular Treatment of Abdominal Aortic Aneurysms With Challenging Infrarenal Neck Anatomy Using the Excluder Endoprosthesis

Cited by 13 publications

References 19 publications

Long-Term Outcomes of Endovascular Repair versus Open Repair of Abdominal Aortic Aneurysm

Long-Term Outcomes of Endovascular Repair versus Open Repair of Abdominal Aortic Aneurysm

Protocol-Based Strategy for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

Treatment of Hostile Proximal Necks During Endovascular Aneurysm Repair

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