Use of endostaples to secure migrated endografts and proximal cuffs after failed endovascular abdominal aortic aneurysm repair

Vries, Jean-Paul de; Schrijver, A. Marjolein; Heuvel, D.A.F. van den; Vos, Jan Albert

doi:10.1016/j.jvs.2011.05.099

Cited by 14 publications

(14 citation statements)

References 7 publications

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“…However, due to improved graft technology, development of endoluminal salvage techniques, such as balloon-expandable stent implantation 19 , embolization 11, 20 , cuff extensions 21 , endostaples (HeliFX, Aptus Endosystems Inc., Sunnyvale, CA) 22 , and “chimney” 23 and fenestrated 24 techniques, along with increased operator experience, modern series consistently report lower conversion rates between 0–3% 25–27 . These techniques have significant merit particularly in older patients with extensive comorbidities, however the mid-term results are not well established 21, 28 .…”

Section: Discussionmentioning

confidence: 99%

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

Scali

McNally

Feezor

et al. 2014

Journal of Vascular Surgery

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Objectives Type 1a endoleak after endovascular aortic repair (EVAR) can be a challenging complication to manage, and due to concerns regarding morbidity and mortality of open surgical conversion (OSC), reports of complex endoluminal salvage techniques are increasing. Despite development of these endovascular remedial strategies, many patients ultimately require OSC. The purpose of this analysis was to determine outcomes of elective open conversion for type 1a endoleak and compare them to elective primary open juxtarenal aortic repair (OJAR) to determine if these concerns are warranted. Methods From 2000–12, 54 patients underwent EVAR conversion at median time of 27 months [interquartile range (IQR): 9, 55]. Indications included: endograft thrombosis (N=2, 4%), intraoperative EVAR failure (N=3, 6%), rupture (N=5, 9%), graft infection (N=6, 11%), and endoleak (All: N=38, 70%; type 1a: N=25). Because many open conversions are performed for emergent indications without endovascular options, we chose elective type 1a endoleak patients as our study group. These 25 patients were compared to an elective open juxtarenal aneurysm repair cohort matched by anatomy and comorbidities. Primary end-points were 30-day and 1-year mortality. Secondary end-points included early complications, cross-clamp time, procedure time, blood loss, and length of stay (LOS). Results Demographic and comorbidity data in the OSC and OJAR groups did not differ with the exception that OJAR patients presented with smaller aneurysm diameter and a higher rate of chronic obstructive pulmonary disease (P = .03). OSC patients more frequently underwent a non-tube graft repair [OSC, N=6 (24%) vs. OJAR, N=20 (80%); P=.0002], required longer procedure times (P=.03), and received more plasma transfusion (P=.03). The 30-day mortality was 4% in both groups (observed difference in rates = 0%, 95% CI for difference in mortality rates = [−14.0%, 14.0%], P=1). A similar rate of major complications occurred [OSC (N = 9) 36% vs. OJAR (N = 8) 32%; P = 1]. One-year survival was 83% in OSC and 91% in OJAR (observed difference = 7%, 95% CI [−15%, 29%], P=.65). Conclusions Despite many advances in EVAR technology, the need for OSC persists, and will likely become more common as older generation devices fail or providers attempt EVAR in more anatomically complex patients. Elective OSC for type 1a endoleak can be technically challenging, but is not associated with increased morbidity or mortality when compared to OJAR in appropriately selected patients. These results should be considered before pursuing complex endovascular remediation of EVAR failures.

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Section: Discussionmentioning

confidence: 99%

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

Scali

McNally

Feezor

et al. 2014

Journal of Vascular Surgery

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“…2); none was misplaced or misfired. In operations that lasted a median 110 minutes (95-130), the stapling time was 12 minutes (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In all, a median 110 mL (80-140) of contrast was used.…”

Section: Resultsmentioning

confidence: 99%

“…Gore & Associates, Flagstaff, AZ, USA), and Zenith (Cook Inc., Bloomington, IN, USA) devices as (1) an adjunctive measure during the primary procedure to enhance proximal fixation and sealing and prevent migration or endoleak (de novo use) or (2) during reintervention to repair endografts that have migrated or developed a type I endoleak. 15 Aptus EndoAnchors have already been described and analytically tested in a cadaveric protocol 13 ; only a brief description is given herein.…”

Section: Device Specificationsmentioning

confidence: 99%

Primary EndoAnchoring in the Endovascular Repair of Abdominal Aortic Aneurysms With an Unfavorable Neck

Perdikides

Melas

Lagios

et al. 2012

Journal of Endovascular Therapy

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“…The use of aortic endostaples after failed endovascular abdominal aortic aneurysm repair was initially described by de Vries in 2011 [15]. …”

Section: Discussionmentioning

confidence: 99%

Predeployed aortic extension cuff (kilt) in EVAR with hostile neck anatomy using Endurant II system: preliminary results

Szaniewski¹,

Biernacka²,

Walas

et al. 2016

kitp

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IntroductionVarious modifications of standard endovascular aortic aneurysm repair (EVAR) have been developed to solve the problem of difficult neck anatomy.AimThe authors propose the implantation of a predeployed extension cuff (kilt) using on-shelf Endurant II elements. In a vast majority of cases, the proposed method provides a solution for the hostile neck problem using standard Endurant II elements available in all centers performing subrenal EVAR procedures.Material and methodsThe early outcomes of kilt implantation were evaluated in 11 patients (three with ruptured abdominal aortic aneurysms, one symptomatic) in 2 vascular centers in Silesia (Poland). All patients presented with hostile neck anatomy defined as neck length < 10 mm, diameter > 28 mm, angulation > 60°, mural thrombus or calcium > 2 mm in thickness or > 180° circumference.ResultsNo intraoperative type I endoleak or device migration was observed. Two perioperative deaths occurred in patients in a severe condition with ruptured aneurysms. One case of type III endoleak was managed by the implantation of an additional iliac extension with complete endoleak sealing.ConclusionsThe proposed method seems to be effective in early endoleak prevention in patients with hostile neck anatomy undergoing EVAR procedures; however, studies with long-term follow-up are needed.

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Use of endostaples to secure migrated endografts and proximal cuffs after failed endovascular abdominal aortic aneurysm repair

Cited by 14 publications

References 7 publications

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

Primary EndoAnchoring in the Endovascular Repair of Abdominal Aortic Aneurysms With an Unfavorable Neck

Predeployed aortic extension cuff (kilt) in EVAR with hostile neck anatomy using Endurant II system: preliminary results

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